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Biomedical subjects

V Guerra

Publications and source records attributed to V Guerra.

At least 73 records · Page 4Linked to original sources
PubMed1991

[Reconstruction of the digestive tract after total gastrectomy. A comparison of Roux anastomosis with Nakayama's beta-anastomosis].

Digestive tract reconstruction following total gastrectomy can be classified into two types according to whether the duodenal tract is excluded or preserved. Two groups of patients who underwent digestive tract reconstruction excluding the duodenal tract following total gastrectomy due to cancer were compared retrospectively: Nakayama's anastomosis was used in 20 patients (57%), and a Roux-en-Y anastomosis was performed in 15 (43%). The main technical difference between the two groups consists in the distance between esophagojejunostomy and jejunojejuno anastomosis: 20 cm in the case of Nakayama's technique and 50 cm in the case of the Roux-en-Y reconstruction. Results showed that 40% of patients with Roux-en-Y anastomoses were asymptomatic compared to 60% of patients with Nakayama's beta-anastomosis (chi-square test, p = 0.36). The most frequent symptom in patients with Roux-en-Y reconstructions was a feeling of postprandial fullness (33%), whereas pyrosis (25%) was the most common compliant in patients with Nakayama's reconstruction. Endoscopy revealed the presence of esophagitis in 35% of patients with Nakayam's beta-anastomosis compared to 6.5% in patients with Roux-en-Y anastomosis (chi-square test, p = 0.012). Results confirm that a minimum distance of at least 50 cm between the esophagojejunal and jejunojejunal anastomoses is decisive in reducing the frequency of reflux esophagitis after total gastrectomy.

Adult↗
PubMed1991

Prevalence of pigment gallstones in sheep.

In a survey of 666 sheep at a slaughterhouse, gallstones (concretions with a diameter greater than or equal to 1 mm) were found in the gallbladder of 50 sheep (7.5%), sludge (concretions with a diameter less than 1 mm) was found in 9 sheep (1.4%), and sludge plus gallstones were found in 7 sheep (1.1%). Gallstones and sludge were associated, and were more frequent in lambs and females, compared with adults and males. Qualitative analysis of the stones revealed all to be pigment (bilirubin) stones. There was a statistically significant increase of biliary bilirubin (total and indirect quota) only in sheep with gallstones plus sludge, compared with control sheep without sludge or gallstones. Concentrations of bilirubin, cholesterol, phospholipids, total and single bile aids, and total and ionized calcium were similar in the bile of sheep with gallstones, sludge, or both and control sheep. Bacteriologic analysis of the bile in 10 sheep with gallstones and 10 controls revealed bacteria in 50% of the first group and in 75% of the second group (Escherichia coli in all sheep and Salmonella spp also in 1 sheep with gallstones). These findings confirm our earlier findings of a high prevalence of black pigment gallstones in sheep. On that basis, we suggest that gallstones are associated with high total bilirubin concentration in the bile, and deconjugating bacteria are common in the biliary tract of these animals.

Animals↗
PubMed1990

Duodenogastric reflux and gastric histology after cholecystectomy with or without sphincteroplasty.

Sixteen patients who had undergone cholecystectomy plus sphincteroplasty, 14 cholecystectomized patients and ten control patients were studied to evaluate whether differences existed in duodenogastric reflux and whether these were related to morphological damage of the gastric mucosa. Duodenogastric bile reflux during fasting was evaluated by measuring the concentration of total bile acids (by an enzymatic method) and single bile acids in the gastric juice by high performance liquid chromatography. The damage was evaluated histologically by systematic endoscopic biopsy of the antrum and body of the stomach. There was a statistically significant difference in fasting bile reflux between the three groups (Kruskal-Wallis test, P less than 0.001), and the group that underwent cholecystectomy plus sphincteroplasty had a significantly higher median value than the cholecystectomized group (P less than 0.05) and the control group (P less than 0.01). The distribution of chronic antral atrophic and superficial gastritis was different in the three groups (chi 2 test, P less than 0.005). Chronic atrophic gastritis was associated with cholecystectomy plus sphincteroplasty (P less than 0.01), while chronic superficial gastritis was more frequent in cholecystectomized patients. These results suggest that there may be more duodenogastric reflux after cholecystectomy plus sphincteroplasty than after cholecystectomy alone, and that there may be a correlation between the amount of duodenogastric reflux and the severity of mucosal damage.

Adult↗
PubMed1990

Cholelithiasis in inflammatory bowel disease. A case-control study.

Cholelithiasis is considered an extraintestinal manifestation of Crohn's ileitis but has not been associated with ulcerative colitis. To evaluate if an increased risk of cholelithiasis exists in patients with ulcerative colitis, biliary ultrasonography was performed on 159 patients with inflammatory bowel disease, 114 patients with ulcerative colitis, and 45 patients with Crohn's disease. A control population of 2453 residents of the town near the authors' institute was also studied. An echographic survey of gallstones was performed on the control subjects, who participated in the Multicentrica Italiana Colelitiasi (MICOL). Seventeen patients with inflammatory bowel disease had gallstones (10.7 percent), 11 patients with ulcerative colitis had gallstones (9.6 percent), and 6 patients with Crohn's disease had gallstones (13.3 percent). In the control population, diagnosis of cholelithiasis was made in 239 subjects (9.7 percent). An estimate of the relative risk (odds ratio) of gallstones in ulcerative colitis and Crohn's disease and also in 4 subgroups formed on the basis of the extent of disease (total ulcerative colitis, partial ulcerative colitis, Crohn's disease with ileitis, Crohn's disease without ileitis) with respect to the general population was calculated using logistic regression with gallstones, sex, age, and body mass index as independent variables and inflammatory bowel disease as a dependent variable. The author's findings show an increased risk of gallstones in both patients with Crohn's disease (odds ratio = 3.6; 95 percent confidence limits = 1.2 - 10.4; P = 0.02) and patients with ulcerative colitis (odds ratio = 2.5; 95 percent confidence limits = 1.2 - 5.2; P = 0.01). The risk was highest in patients with Crohn's disease involving the distal ileum (odds ratio = 4.5; 95 percent confidence limits = 1.5 - 14.1; P = 0.009) and in patients with total ulcerative colitis extending to the cecum (odds ratio = 3.3; 95 percent confidence limits = 1.3 - 8.6; P = 0.01). These results confirm that there is an increased risk of gallstones in Crohn's ileitis but they show that there also exists an increased risk in patients with total ulcerative colitis.

Adult↗
PubMed1990

Duodenogastric reflux of bile acids, gastrin and parietal cells, and gastric acid secretion before and 6 months after cholecystectomy.

In order to evaluate the effect of cholecystectomy on the gastric mucosa, the duodenogastric reflux of total and single bile acids, the number of parietal and gastrin cells, and the volume of gastric acid secretion were examined in 15 patients with gallstones and functioning gallbladders before and 6 months after cholecystectomy. The duodenogastric reflux of the total bile acids increased from a mean preoperative value of 1.9 mumol/hour to a mean postoperative value of 21 mumol/hour (p = 0.008). The duodenogastric reflux of all single bile acids increased after cholecystectomy, with a higher increase in glycoconjugated compared with tauroconjugated bile acids. The parietal cells decreased from a mean preoperative value of 82.8 to a mean postoperative value of 68.7 (p = 0.05), whereas there was only a mild increase in the number of gastrin cells; the output of gastric acid remained unchanged. The variation of the gastrin cells before and after cholecystectomy was negatively correlated only with the variation of taurocholic acid (r = -0.50, p = 0.05), while the variation of the parietal cells was mildly correlated with all single bile acids (r = 0.35-0.50, 0.05 less than p less than 0.02). These findings show an increased duodenogastric reflux of bile acids 6 months after cholecystectomy with a mild morphologic alteration of the gastric mucosa.

Adult↗
PubMed1989

[Non-tuberculous spondylodiscitis. Multicenter study of 19 cases].

19 patients diagnosed as non-tuberculous infectious spondylodiscitis (NTIS) have been studied retrospectively over the last 10 years in three general hospitals. The etiology of 13 cases was confirmed (there were nine cases of Staphylococcus aureus, two of Brucella, one of Pseudomonas aeruginosa and another of Salmonella typhi), and the diagnosis of the remaining cases was based on clinical and radiological data as well as on the evolution with antibiotic treatment. The age of the majority of these patients ranged between 40 and 60 years (p less than 0.05), showing a clear predominance of males (p less than 0.05). The most frequently appearing symptom at the beginning of the disease was local pain which was observed in nine patients; the rest presented mixed symptoms which led to misdiagnosis at admission; an exploratory laparotomy was carried out in one patient. The interval from the symptoms' onset to diagnosis ranged between two and sixteen weeks, with an average of 6.8 weeks. The VSG had values between 22 and 148 mm during the first hour, with an average of 83.3 mm. Seven patients underwent surgery, six of them presenting paraparesis-paraplegia, while another presented cervical spondylodiscitis. One patient passed away, two persisted with paraparesis-paraplegia as an irreversible sequela and one with persistent local pain.

Adolescent↗
PubMed1989

Cigarette smoking and ulcerative colitis. A case control study.

In order to examine the relationship between cigarette smoking and ulcerative colitis (UC), we carried out a case-control study of smoking habits in 84 patients with UC and in two different types of controls: 84 taken from a hospital population and 84 from the general population, matched to the cases for age, sex, school education and social class. Non-smokers were found to have a greater UC risk than smokers in both internal controls (Odds ratio = 4.6, 95% CL = 1.8-11.7) and external controls (OR = 10, 95% CL = 3.6-26.9). There was a larger number of ex-smokers among patients with UC than among the controls. Evaluations at the time of disease onset also demonstrated that ex-smokers had a greater relative risk. Furthermore, 84% of the ex-smoker patients had stopped smoking before the onset of symptoms. Conditional multiple logistic regression with the introduction of alcohol (wine) and coffee as additional variable factors to age, sex, education and social class confirmed the independent protective effect of smoking on UC (OR for internal controls = 4.2, 95% CL = 1.7-10.2, OR for external controls = 5.7, 95% CL = 2.3-14.1). These results indicate that non-smokers and especially ex-smokers of cigarettes have a greater risk of UC, and thus confirm the results of other studies.

Adolescent↗
PubMedDate not supplied

Are 90K/MAC-2BP serum levels correlated with poor prognosis in HCC patients? Preliminary results.

In this study we assessed the prognostic significance of 90K/MAC-2BP serum levels in a group of 40 hepatocellular carcinoma patients. This glycoprotein is a new, interesting serum marker that reflects the immune reaction of the host against certain viral infections and tumors such as breast, ovarian and pancreatic cancer. Hepatocellular carcinoma (HCC) is one of the most widespread tumors in the world. AFP is currently the most useful marker for HCC, in spite of its poor diagnostic sensitivity. In this study 40 cirrhotic HCC patients were enrolled. The prevalence of viral hepatic infections in this group was 73% for HCV, 8% for HBV, and 8% for both viruses. Thirteen percent of the patients showed non-virus-related liver damage. 90K serum levels were assayed by an ELISA kit and AFP levels by a chemiluminescent enzyme immunometric system. The overall survival curves were estimated by the Kaplan-Meier method, taking into account age, sex, 90K and AFP serum levels. Statistical analysis showed a highly significant influence on overall survival of age below 70 years and 90K serum levels below the cutoff of 14 ng/mL. Serum AFP (< or = 20 ng/mL) had positive prognostic value only when it was associated with 90K levels (p < 0.02, log-rank).

Aged↗
PubMedDate not supplied

Erythrocyte polyamines and prognosis in colorectal cancer patients.

BACKGROUND: Polyamines play a role in cell proliferation and in cancer development: they are mainly carried by red blood cells (RBCs). Abnormally high polyamine levels in RBCs have been demonstrated in patients with various types of cancer and the prognostic value of RBC polyamine levels has also been underlined. Our aims were to compare polyamine levels in RBCs from colorectal adenocarcinoma (CRA) patients with those from non neoplastic patients and to evaluate the prognostic value of pre-treatment polyamine erythrocyte levels. PATIENTS AND METHODS: Sixty-one patients with colorectal cancer and 28 surgical patients affected by non neoplastic diseases were included in this study. RBCs polyamine levels were evaluated by HPLC. RESULTS: Significantly higher spermidine, spermine and total polyamine levels were found in RBCs from CRA patients compared to those from control patients. However, there was no significant difference in the survival of patients with different polyamine levels. CONCLUSION: Our findings show that RBC polyamine levels are not a biologic parameter that may help to discriminate between good and poor prognosis in colorectal cancer patients.

Adenocarcinoma↗
PubMedDate not supplied

Duodenogastric reflux and gastric mucosal polyamines in the non-operated stomach and in the gastric remnant after Billroth II gastric resection. A role in gastric carcinogenesis?

BACKGROUND: The relationship between bile reflux and gastric cancer is not defined. In order to verify whether a relationship exists, we evaluated the duodenogastric reflux and the mucosal polyamines concentration, polycation compounds actively involved in cell proliferation, in the non-operated stomach and in gastric remnant after Billroth II gastric resection, a precancerous condition. MATERIALS AND METHODS: The study was performed on three groups of subjects: A) 43 subjects with slight dispeptic symptoms, never operated on; B) 54 cholecystectomized subjects; C) 38 subjects operated on Billroth II gastric resection for duodenal ulcer. Duodenogastric reflux was assessed by measuring the concentration of bile acids in gastric juice and expressed as Fasting Bile Reflux in micromol/hour. Gastric mucosal polyamine concentration was assessed by High Performance Liquid Chromatography and expressed in nmol/mg of proteins. RESULTS: The lowest levels of Fasting Bile Reflux (7.95 micromol/hour) and polyamines (7.09 nmol/mg proteins) were observed in subjects never operated on. The middle values were present after cholecystectomy (Fasting Bile Reflux = 18 micromol/hour; polyamines = 8.14 nmol/mg proteins). The highest values were observed after Billroth II gastric resection (Fasting Bile Reflux = 830 micromol/hour; polyamines 11.74 nmol/mg proteins) (Kruskal-Wallis test, p = 0.0001). There was a positive correlation between Fasting Bile Reflux and polyamines (Spearman's rank = 0.33; p = 0.0008). CONCLUSIONS: High levels of duodenogastric reflux observed after Billroth II gastric resection are associated with high polyamine concentration in the gastric mucosa. Bile reflux can be considered an important causal factor of the increased risk of gastric stump cancer after Billroth II gastric resection.

Adult↗
PubMedDate not supplied

[Cholelithiasis after total gastrectomy for gastric cancer].

After gastric resection for peptic ulcer and total gastrectomy for Zollinger-Ellison syndrome, there is an increased prevalence of cholelithiasis. In order to assess whether this increased prevalence also exists after total gastrectomy for cancer, we evaluated the rate of cholelithiasis (echographic diagnosis) both before and after this operation. Between 1980 and 1990, 89 patients underwent total gastrectomy for cancer in the Surgical Department of our Institute. The pre-operative prevalence of gallstones was 5% in the males and 13.8% in the females. Seventy-four of the eighty-nine patients (83%) were examined post-operatively (7 patients with pre-operative cholelithiasis, 3 who died during the post-operative stay and 5 lost to follow-up were excluded from the study). The median post-operative follow-up was 24 months (range 3-115 months). The post-operative prevalence of cholelithiasis in the 74 patients was 39.6% in the males and 19% in the females. We also calculated the expected frequency of gallstones in both the pre- and post-operative groups from prevalence data in the population of the city where our Institute is based (taken from an echographic survey). We then compared the observed frequency of cholelithiasis with the expected frequency and we found that the difference in pre-operative frequencies, both in the males and females, was not statistically significant (p > 0.05). The same was true of the post-operative frequencies in the females (p = 0.48), but in the males there was a statistically significant difference between the observed frequency of cholelithiasis and that expected after total gastrectomy (p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Antibodies to hepatitis C virus and chronic hypertransaminasemia in southern Italy.

In an ecographic survey for gallstones, executed on a systematic sample from the municipal electoral roll of a town in Southern Italy, 164 subjects were found with ALT more than twice the upper normal limit (unl). Five years later 138 of these were re-examined; 76 still had ALT greater than 2 unl (group A), 41 still abnormal (group B) and 21 normal (group C). Anti-HCV antibodies were found in 52 subjects of group A (68%). 18 of group B (44%) and 2 of group C (9.5%). The odds ratio of ALT greater than 2 unl (A vs C) in anti-HCV+ was 20.6 and of a still elevated ALT (A + B vs C) was 14.1. Logistic regression was used to eliminate the effect of possible confounding factors (sex, age, alcohol, drugs, HBV markers) on the relationship chronic ALT increase and anti-HCV positivity but the odds ratio was still 18.9 (A vs C) and 11 (A + B vs C). These findings suggest that anti-HCV antibodies are strongly associated with chronic hypertransaminasemia at the population level in Southern Italy.

Adult↗
PubMedDate not supplied

[Genetic epidemiology of cholelithiasis. A case-control study of a population].

Aim of this study is to evaluate the familial risk of cholelithiasis in non hospitalized subjects with and without gallstones. A population sample of 2.472 subjects was examined by echography for gallstones; 220 subjects (92 males and 128 females) had gallstones or had already been cholecystectomized for gallstones. These cases and an equal number of controls were interrogated about the diagnosis of gallstones in their family using a standardized questionnaire. The comparison of the frequency of symptomatic gallstones and cholecystectomies for gallstones in the relatives of cases and controls showed an increase of the relative risk of gallstones in sons of parents with cholelithiasis (OR 2.9, CI 95% 1.2-8.0) and in siblings of subjects with cholelithiasis (if sister with gallstones: OR 2.4, CI 95% 1.05-5.6; if brother with gallstones: OR 2.9, CI 95% 0.6-14.6). The stratification for sex of cases and controls, however, pointed out that the risk increased only in daughters and sisters of subjects with gallstones. There was no statistically significant difference of frequency of gallstones between spouses of cases and controls (chi square, p greater than 0.05). The results of this study confirm that there is a familial risk of gallstones, even if it is evident only in the female relatives of subjects with gallstones, and suggest that probably the main cause of this risk is genetic and not environmental.

Adult↗
PubMedDate not supplied

[Prevention of duodenal ulcer recurrence by the use of anti H2. Comparison of continuous long-term and seasonal therapy].

The Authors have assessed the incidence of ulcer recidivation in patients with cicatrized bulbar ulcers following anti H2 treatment using two maintenance therapy protocols: 1) 400 mg/day of cimetidine in a single evening dose for 1 year (continuous therapy); 2) the same dose of cimetidine administered at the same time but only for 4 months a year (February-March and September-October) (seasonal therapy). Ninety patients with cicatrized ulcers which had been diagnosed using endoscopy were randomly assigned to the two treatment protocols. Protocols were followed for a least one year with endoscopic controls every 6 months. There were no significant differences between continuous and seasonal therapy in relation to the recurrence of duodenal ulcers (Log Rank test p less than 0.05). Cox's proportional hazard model was used to assess the effect of the two treatment protocols on ulcer recurrence eliminating the influence of sex, age and smoking; it was seen that only smoking influenced the incidence of recidivation (p less than 0.05). These results suggest that seasonal maintenance therapy with anti H2 is as efficacious as continuous therapy in preventing the recurrence of ulcers.

Adult↗
PubMedDate not supplied

Duodenogastric reflux, histology and cell proliferation of the gastric mucosa before and six months after cholecystectomy.

In order to evaluate the effects that an increase in duodenogastric reflux (DGR) has on the mucosal cell proliferation of the non-operated stomach, we made a prospective study on 13 patients (9 female and 4 male, mean age 52 years) both before and 6 months after cholecystectomy, an operation which determines a significant increase in DGR with an intact pyloric sphincter. DGR was evaluated by measuring total intragastric bile acids (dosed by an enzymatic method), and single intragastric bile acids (dosed by High Performance Liquid Chromatography) and it was expressed as Fasting Bile Reflux (FBR) in mumol/h. Gastric cell proliferation was evaluated by measuring (by High Performance Liquid Chromatography) polyamine (putrescine, spermidine and spermine) levels in biopsy specimens taken from the antrum and gastric body. The histology of the antrum and gastric body was also evaluated. After cholecystectomy, there was a significant increase in DGR (delta = 39.23 mumol/h, 95% C.L. 11.69-136.22, sign-test for matched pairs p = 0.0003). The tissue concentration of putrescine in the antrum increased significantly (delta = 8.36 mumol/g of tissue, 95% C.L. 0.34-18.01, sign-test for matched pairs p = 0.013) and there was a worsening of histological findings in the antrum (preoperative chronic atrophic gastritis rate 38.5%, postoperative 69%). In the body there were no significant variations either in polyamine levels or in histology. The increase in DGR and in putrescine concentrations in the antrum were associated negatively (Spearman's rank -0.64, 95% C.L. -0.88 to -0.14).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Asymptomatic gallstones. What to do in patients undergoing colonic surgery for cancer?

Twenty-three patients who underwent elective surgery for colorectal cancer in our hospital between 1983 and 1989, underwent concomitant cholecystectomy for asymptomatic gallstones. In order to assess whether additional cholecystectomy increases postoperative morbidity and mortality, a comparison was made between these cases and 23 controlled patients (without gallstones) matched for sex, age (+/- 3 years), Dukes stage and type of primary colonic surgery. The duration of postoperative stay was similar in the two groups (14.1 +/- 4.5 days vs 12.4 +/- 2.3 days). Postoperative complications were more frequent among the case patients than among the controls (34.8% vs 8.7%, p = 0.04), and the same was true for the mortality (8.7% vs 0%). During the same period, another 11 patients with asymptomatic cholelithiasis were operated on for colorectal cancer but in these patients gallstones were left in place. Two of the patients died postoperatively and only one of the remaining 9 (11.2%) had an episode of biliary pain. The results of our study would suggest that in patients undergoing surgery for colorectal cancer the risk entailed in carrying out an additional cholecystectomy for asymptomatic gallstones is greater than the risk of future morbidity caused by gallstones left in place.

Aged↗
PubMedDate not supplied

Demonstration of low density lipoprotein receptor in human colonic carcinoma and surrounding mucosa by immunoenzymatic assay.

In order to verify the presence of Low Density Lipoprotein Receptor (LDLR) in cellular membranes isolated from human colonic tissue, samples from the neoplastic colorectum and the normal surrounding mucosa were studied by an enzyme-linked-immunosorbent assay. A monoclonal antibody against the human LDLR was used. The LDLR content revealed a considerable inter-individual variation. In 36 out of 53 cases (68%) there was no LDLR presence in either normal or neoplastic tissue samples. In 5 out of 53 cases (9.4%), LDLRs were detected in both types of tissue samples, in 9 cases out of 53 (17%) LDLRs were present in neoplastic tissue, while in 3 out of 53 cases (5.6%) only in normal mucosa. The anti-LDLR mono-clonal antibody (mAb) binding was significantly higher in neoplastic tissue samples than normal surrounding colonic mucosa ones. Sex, age, body mass index (BMI), serum cholesterol, tumour site, histologic grading and Dukes' stage did not seem to be associated with LDLR presence.

Adenocarcinoma↗