Biomedical subjects

V Guerra

Publications and source records attributed to V Guerra.

At least 55 records · Page 3Linked to original sources

PubMed1995

[Ulcerative rectocolitis: review of clinical characteristics in patients with distal colitis and extended colitis].

Ulcerative colitis is an inflammatory disease which, starting from the rectum, affects more or less extended tracts of the colon. Given that distal and extended forms are generally described as a single nosological entity, the authors aimed to verify whether there are any clinical differences between the two groups of patients with varying extents of disease. A retrospective review was made of data relating to 189 patients suffering from ulcerative colitis observed over a 90-months period. Only 111 cases were included in the study: all patients had undergone an endoscopic and histological diagnosis with a follow-up of over one year. Seventy-eight patients (41.26%) were excluded from the study because they had been lost during follow-up, or follow-up had lasted less than one year, or it had not been possible to perform pancolonoscopy. The 111 patients examined were subdivided into 2 groups: one (39 patients) with distal colitis, namely involving the rectum or recto-sigmoid, and the other (72 patients) with more extended disease. The extension of disease was evaluated on the basis of histological findings. The mean follow-up was 5 years and 11 months. The two groups were comparable for age, sex, number of annual attacks, maximum duration of disease-free periods, clinical evolution, predominant symptoms, extraintestinal symptoms and surgical treatment. Results were processed using Student's t test and the chi-square test.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

[Comparative study of clonidine and lidocaine on the attenuation of the intraocular pressure increase associated with laryngoscopy and endotracheal intubation].

OBJECTIVE: To verify and compare the efficacy of clonidine and lidocaine for attenuating the ocular hypertensive response generated by manipulation of the laryngoscope and endotracheal intubation (EIT). PATIENTS AND METHODS: In this prospective double blind study 45 patients undergoing non-ocular surgery were divided into 3 groups according to pretreatment protocol: A, approximately 3 micrograms/kg clonidine orally 90-120 min before surgery; B, 1.5 mg/kg intravenous lidocaine 1 min before EIT and C, control group. On all patients we recorded intraocular pressure (IOP), mean arterial pressure and heart rate at the following times: basal, just before EIT, immediately after EIT, 5 minutes later and 10 minutes later. RESULTS: The patients pretreated with clonidine had significantly lower IOP levels than did the control group at all measurements times; patients pretreated with lidocaine had lower IOP after induction and after intubation. IOP was significantly lower in patients who received lidocaine than in control group patients after EIT, although IOP levels with lidocaine were higher than with clonidine. CONCLUSIONS: Pretreatment with oral clonidine is an effective method for preventing increases in IOP after EIT, is more effective than pretreatment with lidocaine, and should therefore be used for that end. Intravenous lidocaine represents a valid alternative in emergency cases when the approximate wait time of 2 hours is contraindicated.

Adult↗

PubMed1994

Prognostic value of cytosolic estrogen receptors in human colorectal carcinoma and surrounding mucosa. Preliminary results.

Estrogen receptors have been found in normal and neoplastic gastrointestinal mucosa. The aim of our study was to verify whether the content of cytosolic estrogen receptor in normal and neoplastic tissue has a prognostic value in patients with colorectal adenocarcinoma. Eighty consecutive patients entered the study, and their follow-up was complete because none were lost to follow-up. Estrogen receptors were evaluated by an enzymatic immunoassay. Fifty-four percent of neoplastic samples and 84% of samples from surrounding mucosa showed an estrogen receptor content higher than 1.0 fmol/mg of cytosolic proteins (cut point for positive/negative hormone receptor status). Estrogen receptor levels were lower in neoplastic tissue than surrounding mucosa (1.2 +/- 1.05 fmol/mg protein vs 2.07 +/- 1.36 fmol/mg protein, respectively, t test P = 0.001). The survival of patients with estrogen receptor expression in uninvolved surrounding mucosa was longer than that of patients without estrogen receptor in the same type of mucosa (log rank test, P < 0.01). In the neoplastic tissue, receptor status had no prognostic value (log rank, P = 0.8). After taking into account the most important potential confounders by using the Cox proportional hazard model, the estrogen receptor status in normal mucosa samples maintained an independent prognostic value. These results support an association between the estrogen receptor status in normal mucosa and survival of patients with colorectal adenocarcinoma.

Adenocarcinoma↗

PubMed1994

Dietary habits and colorectal cancer in a low-risk area. Results from a population-based case-control study in southern Italy.

Many epidemiological studies have focused on the relationships between diet and colorectal cancer, but only a few have been conducted in the Mediterranean area. A population-based case-control study was carried out from July 1987 to June 1989 in a low-risk area in Southern Italy. By means of an "ad hoc" tumor registry, 132 diagnosed colorectal cancers were detected during the two years of study. One hundred nineteen of these 132 colorectal cancer cases were interviewed about their personal dietary habits with use of a questionnaire concerning the frequency of consumption of 70 foods or beverages. An equal number of controls was randomly selected from the lists of general practitioners of the area during the same period and interviewed with the same food frequency questionnaire. In a multivariate analysis, the relative risks (RRs) of developing colorectal cancer were estimated according to the different levels of consumption of food groups and selected food items. All RRs were adjusted for age, sex, education, smoking status, and modifications in diet in the previous 10 years. The risk of colorectal cancer increased nearly threefold for the highest level of consumption of foods with a high content of refined sugar [RR = 2.75, 95% confidence interval (CI) 1.26-5.97] and for the consumption of wine (> 1 l/day) (RR = 3.22, 95% CI 1.05-9.88). An inverse relationship was revealed for the highest consumption of raw and cooked vegetables (RR = 0.51, 95% CI 0.25-1.04) and diary products (RR = 0.46, 95% CI 0.22-0.98) and for the consumption of more than two cups of coffee per day (RR = 0.38, 95% CI 0.16-0.89). In this Mediterranean area, the main source of calories, cereals, did not show a significant relationship with colorectal cancer. These findings support the hypothesis that the local Mediterranean dietary pattern could explain the low risk of colorectal cancer.

Adult↗

PubMed1994

Duodenogastric reflux and gastric mucosal cell proliferation after cholecystectomy or Billroth II gastric resection.

OBJECTIVES AND METHODS: Twelve patients to be undergone cholecystectomy and 4 patients to be undergone Billroth II gastric resection were examined before and after surgery in order to evaluate the association between duodenogastric reflux and gastric mucosal cell proliferation. Duodenogastric reflux was assessed by measuring the concentration of bile acids in gastric juice and expressed as fasting bile reflux in mumol/h. Gastric mucosal cell proliferation was assessed by measuring the concentration of polyamines (putrescine, spermidine and spermine) in biopsy specimens and expressed in mumol/g of tissue. RESULTS: The median increase in fasting bile reflux was 34 mumol/h after cholecystectomy and 238 mumol/h after Billroth II gastric resection (P = 0.008). After cholecystectomy the median value of putrescine levels in antrum was 39 mumol/g, whereas after Billroth II gastric resection putrescine levels in pre-anastomotic area was 79.5 mumol/g (P = 0.008). There was a positive correlation between fasting bile reflux and putrescine levels either in antrum (r = 0.37, P = 0.04) or body (r = 0.48, P = 0.006). CONCLUSIONS: The increase in cell proliferation activity of gastric mucosa after Billroth II gastric resection might explain the increased risk for cancer of gastric remnant.

Adult↗

PubMed1994

[The effect of ursodeoxycholic acid in patients with liver cirrhosis and chronic hypertransaminasemia].

The aim of the study was to evaluate the effect of ursodeoxycholic acid (UDCA) oral administration on alanine aminotransferases (ALT) levels in cirrhotic patients with chronic hypertransaminasemia. Ninety consecutive patients with histologically proven liver cirrhosis and ALT levels higher than twice the upper limit of normal for at least six months, were admitted to the study. All the patients were treated with UDCA 10 mg/kg/day for one year. At the end of this period they were randomized to placebo or to continue UDCA therapy for three further months. ALT levels were evaluated before the beginning of UDCA therapy, at twelve and fifteen months by standard methods. After 12 months of UDCA, ALT decreased significantly (-39 UI, 95% confidence intervals -27 to -52 UI). At the 15 th month ALT did not vary with respect to its values at the 12th month in 36 patients randomized to continue UDCA, while it increased significantly in patients taking the placebo (+11 UI 95% confidence intervals +2 to +19). The results of this study suggest that UDCA is effective in controlling the biochemical activity of the liver disease in cirrhotic patients.

Adult↗

PubMed1993

Familial risk of colo-rectal cancer in a low incidence area in southern Italy.

The risk of colo-rectal cancer (CRC) in subjects with a positive family history (FH+) for malignancy has been assessed by means of a case-control study carried out between 1987-89 in an area of about 215,000 inhabitants in Southern Italy. One hundred and nineteen CRC cases were compared with 119 sex- and age-frequency matched population controls. Detailed pedigrees were collected at the family homes of both cases and controls. The odds ratio (OR) of CRC, adjusted by means of logistic regression for age, sex and number of first-degree relatives, increased with the number of any kinds of cancers in first-degree relatives with a significant linear trend (p = 0.042), while there was no risk with a FH+ for digestive cancer excluding CRC or for other cancers excluding large bowel and digestive organs. The OR (and 95% confidence interval) for CRC was 5.9 (1.64-21.23) for at least one first-degree relative with CRC. After a mutual adjustment between CRC and the other cancers in the families of cases and controls, the risk of CRC with a FH+ for other cancers did not change, revealing a strong association (p = 0.002) for CRC alone. From the analysis of the family history of cancer in the case group, the relative frequency of families that satisfied the criteria for so-called hereditary non-polyposic colo-rectal cancer (HNPCC) was 2.6%. The increased relative risk of CRC observed only in families with FH+ for CRC is a supportive finding for organizing and planning prevention and genetic counselling for these families, whose members should be referred for further assessment.

Aged↗

PubMed1993

Influence of the method of digestive tract reconstruction on gallstone development after total gastrectomy for gastric cancer.

The aim of this study was to evaluate whether total gastrectomy performed for gastric cancer leads to an increased risk of cholelithiasis and whether the method of reconstruction of the digestive tract influences that risk. A total of 102 patients who had undergone total gastrectomy for gastric cancer between 1980 and 1990 were studied. The preoperative prevalence of cholelithiasis was 4% in men and 12% in women. Eighty-seven patients (85%) without gallstones before surgery were reexamined after gastrectomy. The postoperative prevalence of cholelithiasis in this group was 36% in men and 19% in women. Before surgery, the difference between the expected frequency of cholelithiasis (calculated on the basis of the data of a community survey) and the observed frequency was not statistically significant (p > 0.05) either in men or women. After surgery, the observed frequency of gallstones was significantly higher than the expected frequency in men (p < 0.0001) but not in women (p = 0.06). The risk of cholelithiasis was significantly higher in patients with Roux-en-Y reconstruction (n = 55) than in those with jejunal interposition (n = 32) (log-rank test, p = 0.03), and that risk was independent of age, sex, and body mass index.

Adult↗

PubMed1993

[Serum lipids and biliary sludge during pregnancy].

We have examined serum lipids and apoprotein levels and the formation of biliary sludge in 56 pregnant women. During pregnancy, 8 women showed biliary sludge which disappeared after delivery. Pregnant women with sludge had serum levels of total cholesterol, triglycerides, LDL-cholesterol and apo-B higher than women without sludge, although it was not statistically significant. Moreover, these women had serum levels of HDL-cholesterol and apoA1 significantly lower and LDL/HDL and apoB/apoA1 ratio significantly higher than the women without sludge. Thus, biliary sludge seems to be associated with serum lipid and apoprotein variations. Further investigations are required to clarify if these variations are also expressed in the bile.

Adult↗

PubMed1993

[Morbidity and mortality after elective Billroth II gastric resection in duodenal ulcer. Authors' experience].

A retrospective study was carried out those patients who underwent elective Billroth II gastric resection for pyloric or duodenal ulcer at the Surgical Division of the Scientific Institute of Gastroenterology of Castellana Grotte between 1974 and 1989. The aim of the study was to asses the incidence of postoperative morbidity and mortality. A total of 526 patients were included in the study (mean age 49 years +/- 12 years; 451 males (86%) and 75 females (14%). Morbidity was 20.7% and mortality 1.5%. These findings are in line with those reported in the literature and confirm that gastric resection for duodenal ulcer, even when performed electively, has a far from negligible morbidity and mortality rate. It is well known that, in comparison to more conservative operations such as vagotomy, gastric resection for peptic ulcer presents a high rate of postoperative morbidity and mortality, but a lower incidence of ulcerous recidivation. Unless there are valid preoperative criteria on which to base the choice of one or other techniques, the surgeon will usually choose the method with which the is most familiar. until studies have been carried out to identify the risk factors leading to postoperative morbidity and mortality, the authors suggest that gastric resection is reserved for those patients presenting a low operative risk.

Adult↗

PubMed1993

Endogenous sex hormones and cholesterol gallstones: a case-control study in an echographic survey of gallstones.

In a population survey of gallstones, the serum levels of hormones of the pituitary-gonadal axis and the sex hormone-binding globulin (SHBG) were compared in subjects with cholesterol gallstones and in a control group. In 84 subjects who entered the survey, echographic gallstones that had been identified at the survey, turned out to be radiolucent or mixed (predominantly of cholesterol) at subsequent x-ray. The controls were without gallstones at echography, matched to the cases for potential confounders of the association sex hormones-cholelithiasis. Testosterone (T) 17-beta-estradiol (E2), 17-OH progesterone (P), and SHBG were dosed by radioimmunoassay; follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (Prl) by dissociation-enhanced lanthanide fluoro immunoassay (DELFIA). Men with gallstones had lower LH than controls (n = 34, median difference = -0.62 mU/ml, 95% confidence interval (CI) -1.20 to -0.26 mU/ml, paired sign test, p = 0.003). Premenopausal women in the luteal phase of the menstrual cycle with gallstones had higher E2 than controls (n = 7, median difference: +117, pg/ml, 95% CI: +10 to +218 pg/ml, p = 0.008). Postmenopausal women had lower LH than controls (n = 35, median difference = -4.57 mU/ml, 95% CI -9.5 to -1.0 mU/ml, p = 0.04). No other hormones showed statistically significant differences between cases and controls, in either males or females. The findings of this exploratory study in subjects with radiolucent and mixed gallstones suggest that men and postmenopausal women have lower LH, and premenopausal women in the luteal phase of the cycle have higher E2, than controls.

Adult↗

PubMed1993

[Calculi and sludge in the gallbladder during pregnancy].

Ultrasound examination surveys carried out during puerperium or pregnancy have demonstrated the presence of biliary sludge and gallstone with a percentage of the examined women varying from 30% to 40%. Our aim was to evaluate the incidence of biliary sludge and gallstones during pregnancy and the natural history of this pathology after delivery in our rural population. Fifty six pregnant women entered the study. The pregnant women were subjected to ultrasonography during the 12th-14th and the 34th-36th week of amenorrhea, and two weeks after delivery. Women with biliary sludge or gallstones were subjected to a further ultrasound examination 12 months after delivery. At the first ultrasonography, women were questioned about menarche, menstruation (rhythm, intensity and period), previous pregnancies, number of deliveries, use of oral contraceptives and possible abdominal symptoms connected with the pathology of gallbladder. Besides, in order to form the body mass index (BMI) [weight (kg)/height (m)2], weight and height were obtained from each subject. Before the second ultrasonography, women were questioned about abdominal symptoms connected with the pathology of gallbladder. It was assessed the weight in order to calculate the ponderal increase during pregnancy. Biliary sludge or gallstones were found at ultrasound examination in: 5 out of 56 women in the first trimester (one woman with gallstones, 4 with sludge); 9 out of 49 women examined in the third trimester (2 women with gallstones, 7 with sludge); 2 out of 46 women examined were still affected by gallstones two weeks after delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

[Postoperative morbidity and mortality in patients undergoing additional cholecystectomy during digestive surgery].

A retrospective case-control study was carried out to assess whether additional cholecystectomy in patients undergoing digestive surgery caused increased postoperative morbidity and mortality. During the period 1983-90, 70 patients underwent cholecystectomy at the same time as other surgery (25 gastric resections, 23 colon resections, 17 total gastrectomies, 2 fundoplicatio using Nissen's technique, 2 cases of Heller's operation, 1 truncular vagotomy and pyloroplasty). These cases were matched for sex, age (+/- 5 years) and type of primary operation with 70 controls (patients without additional cholecystectomy). Complications were significantly more frequent among the former group compared to controls (28.6% vs 11.4%, p = 0.02), in particular in the group of patients undergoing colon resection (34.8% vs 8.7%, p = 0.04). The frequencies of reoperation and mortality were also higher in patients undergoing additional cholecystectomy than in controls (10% vs 1.4%), but the difference was not statistically significant (p = 0.06). In conclusion, additional cholecystectomy during digestive surgery increases the risk of postoperative complications, in particular in colorectal surgery.

Adult↗

PubMed1992

[Cholecystectomy and duodenogastric reflux].

With the aim of evaluating whether cholecystectomy causes an increase in duodenogastric reflux (DGR) 34 patient (12 males and 22 females, mean age 50 years) were examined before and 6 months after cholecystectomy. DGR was evaluated by assaying total and individual biliary acids in gastric juice and was expressed as fasting bile reflux (FBR) in mumol/h. The histology of gastric mucosa in endoscopic biopsies taken from the antrum and body was also analysed. FBR of total biliary acids rose from 2.4 mumol/h before surgery to 41.33 mumol/h after cholecystectomy (p = 0.000). A significant increase was observed for all the individual biliary acids. Histological tests of gastric mucosa revealed an increased percentage of chronic atrophic gastritis of the antrum following cholecystectomy. Histological conditions in the body were unaltered. The results of this study show that there is a significant increase in DGR (months after cholecystectomy together with increased histological damage to the mucosa of the antrum. Further studies are necessary in order to evaluate whether the two phenomena are related.

Adult↗

PubMed1992

[Development of an integrated system of family medicine--pathologic anatomy service to start epidemiologic studies on tumors occurring in an area of southern Italy. First results].

In Italy there are eight tumor Population-Based Registries (PBRs) that publish incidence data, and only one of them (Ragusa) provides data for Southern Italy. Usually, PBRs are based on data collection from Pathologists and medical records. Our integrated system differentiates from traditional PBRs because the information comes from the General Practitioners (GPs) and is completed with the diagnosis provided by the Pathologists (Ps). During two years we have registered 1,057 new cancers on a middle period population of 212,644. GPs and Ps signed 395 and 879 incident cases, respectively. GPs alone provided 16.8%, Ps alone 62.6%, and either source 20.6% of total cases. After excluding non melanotic skin cancers and bladder carcinoma, the GPs-Ps integrated system counted 828 new cases in two years. These incidence data are the first in our region (Puglia). The 178 cases signed by GPs alone should have been lost if the informations of our PBR had been based only on local Ps' records. Moreover, 94 of GPs cases (11% of total cancers registered) were subjects who moved outside the area for diagnosis and treatment. Even if this article evaluates the effect of under-registration attributable to Ps or GPs, the cancer incidence data and the active involvement of GPs indicate that they could be usefully involved in the registration of cancer data.

Epidemiologic Methods↗

PubMed1992

A prospective study on duodenogastric reflux and on histological changes in gastric mucosa after cholecystectomy.

The authors carried out a prospective study to evaluate variations with time in postcholecystectomy duodenogastric reflux (expressed as "fasting bile reflux" in mumol/h) and in gastric mucosal damage. Ten patients underwent (before cholecystectomy, 6 months after surgery and after a median period of 4 years from surgery) a gastric drainage to assess total (enzymatic method) and single (high performance liquid chromatography) intragastric bile acids, and a gastroscopy with biopsies of the antrum and gastric body to assess histological damage to the mucosa. The results showed that there was a progressive increase in the fasting bile reflux of total bile acids with time (precholecystectomy median value 0.295 mumol/h; 6 months control median value 12.045 mumol/h; late control medial value 19.9 mumol/h; Friedman test, P = 0.0022). Examination of the gastric mucosa at the three moments of the study showed that histological damage worsened progressively. In fact chronic atrophic gastritis of the antrum was present in 10 percent of cases before surgery and in 50 percent 4 years after, and the prevalence of chronic superficial gastritis of the body progressed from 0 to 40 percent. Studies on larger groups of patients are necessary to evaluate whether these two phenomena are correlated.

Adult↗

PubMed1992

[Factors influencing the effect of ursodeoxycholic acid therapy in chronic hypertransaminasemia].

The aim of this work was to detect, in patients with chronic hypertransaminasemia (CH), the factors associated with the changes of ALT serum levels after one year of 10 mg/Kg/die ursodeoxycholic acid (UDCA). One hundred and twenty two consecutive patients with ALT values more than twice the normal upper limit for at least six months were admitted to the study. At the liver biopsy 82 patients were affected by liver cirrhosis (LC), 7 by chronic persistent hepatitis (CPH), and 14 by chronic active hepatitis (CAH). Nineteen patients were classified as unspecified chronic liver disease (UCLD) due to biopsy refusal. Five patients (4 LC and 1 UCLD) did not finish the study. Before and after the beginning of the treatment ALT and the other routine tests of liver function were determined in serum by routine laboratory methods. In all the diagnosis a decrease of ALT was observed after one year UDCA therapy. Particularly, in cirrhotic patients a reduction of 40% in the ALT serum levels was detected (baseline m +/- ds 98 +/- 55 UI, one year transaminase decrease -39 UI with 95% C.I. -27 UI to -52 UI). Furthermore in liver cirrhosis there was an increase of serum albumin (baseline m +/- ds 3.5 +/- 0.6, one year albumin increase +0.2 gr with 95% I.C. +0.1 gr to +0.3 gr). The decrease of ALT showed an inverse association (p < 0.05) with the presence of antibodies to hepatitis C virus and with diagnosis of CAH, and a direct one with the basal values of ALT.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

Polyamines and estrogen-receptor concentrations in human colorectal carcinomas.

We assayed the estrogen receptors and polyamine levels (putrescine, spermidine and spermine) in the neoplastic and "normal" surrounding tissue of patients with colorectal cancer. Polyamine levels and the spermidine/spermine ratio were significantly higher in the neoplastic tissue than in the "normal" surrounding colonic mucosa of the same patients. Estrogen receptors were fewer in neoplastic mucosa than in the surrounding tissue, and polyamine levels were higher in estrogen-receptor negative tumours than in estrogen-receptor positive ones, although this was statistically significant only in the case of spermidine. Polyamine levels and estrogen receptor concentrations did not correlate with the tumour site, histological differentiation, or the age and sex of patients.

Adenocarcinoma↗