[Changes in the pattern of serum biliary acids and lipoprotein picture during therapy with biliary acids in cholesterol lithiasis]. / Modificazioni del "pattern" degli acidi biliari sierici e del quadro lipoproteico in corso di terapia con acidi biliari nella litiasi colesterolica.

Several studies are present in the literature about the efficacy of medical treatment with biliary acid, orally administered, on the symptomatic gallstone patients. Both this drugs act, with different mechanisms, on the same pathophysiological pathway, represented by the supersaturated bile in cholesterol. Aim of the present investigation was to study the possible modifications of serum bile acids pattern and of lipoproteins in a large sample of gallstone patients under long-term treatment with biliary acids. One hundred and twelve patients with radiolucent gallstones entered the study; 54 received chenodeoxycholic acid (CDCA) and 58 ursodeoxycholic (UDCA) at dosage of 15 mg/kg/daily. Blood samples for determination of serum cholesterol, triglycerides, phospholipids, lipoproteins, total and fractionated biliary acids were collected from each subjects every three months for a mean "follow-up" of 24 months. The levels of serum cholesterol, triglycerides and phospholipids showed a mild decrease only in the patients under therapy with CDCA, while no modifications were detected using UDCA. The same was found for two other parameters, HDL-cholesterol and lipoproteins, with both treatments during the overall period of follow-up. The biliary acids levels showed a significant increase only in the patients treated with CDCA, but no differences were found between "responders" and "non responders" to the therapy.

[X-ray diffraction study of biliary calculi. Morphological and composition correlations of calculi]. / Studio diffrattometrico a raggi X della litiasi biliare. Correlazione morfologica e composizione dei calcoli.

In this study, we examined the composition of crystallographic structure of biliary stones in 106 patients (27 male, 79 female). The material has been obtained following cholecystectomy. In 70 cases (66%), the monohydrate cholesterol was the main constituent, alone (33%) or in combination with calcium salts (32%). In 52% of the cases, we found presence of vaterite, aragonite and calcite. The anhydrous cholesterol was determined in 28 subjects (26%), alone (9.4%) or associated with calcium salts (16%). Cholesterol was completely absent in 8 cases: of them, 4 presented an aspecific diffrattografic picture and 4 revealed presence of calcium carbonate. Finally, no correlation was found between epidemiological data (sex or age) and macroscopic feature of biliary stones (chemical and morphological structure).

Psychosomatic factors and peptic ulcer disease.

The authors present a review of the role of psychological factors in peptic ulcer disease (PU). Three lines of research have been identified: personality, psychological factors and PU; stressful life events and their relationship to PU; possible interactions between biological parameters, the CNS and psychosocial aspects. The analysis of the studies presented shows that there is a certain level of agreement with regard to personality and psychological aspects; PU patients present a personality with dependence/independence problems and high level of anxiety. Data concerning the role of stress appear to be far from uniform and often even contradictory. Much remains to be done with respect to the possible links between psychological and biological parameters; there have been only few studies in man--which have not been duplicated and were performed on a limited number of patients--but a fair number in animals. However, the results concerning the relationship between psyche and secretory patterns are very interesting, and represent one of the most important lines of future research.

Gastric emptying and anxiety in chronic duodenal ulcer.

The authors have evaluated in a group of patients afflicted with duodenal ulcer whether anxiety might be in some way linked to gastric emptying. The 23 patients studied were subdivided into two groups: "fast" emptiers (n = 12; t 1/2 less than 90 min) and "normal" emptiers (n = 11; t 1/2 greater than 90 min). There were no significant differences between the two groups for the following parameters: sex, age, marital status, educational level, social class, number of cigarettes smoked per day, type of treatment undergone for the duodenal ulcer and maximal acid output. Anxiety levels measured with the Q4 and QII factors of the Cattell's PF 16 were found to be the same in the two groups. The authors conclude that anxiety does not seem to be linked to gastric emptying in chronic duodenal ulcer.

Personality and psychological factors in chronic duodenal ulcer. Their interaction with biological parameters.

Forty patients with chronic duodenal ulcer were studied to determine whether some particular personality and psychological factors are associated with this disease. To this purpose the Cattell's PF 16 personality Test was utilized. Duodenal ulcer population presented a typical personality profile characterized by: high anxiety, dependence and introversion. Some biological parameters, suggested as predictors of slow healing and/or relapse of ulcer, were studied: patients with maximal acid output greater than 60 mEq/h and /or total serum pepsinogen greater than 109 micrograms tyr/ml/24 hrs and/or serum pepsinogen group I greater than 99 ng/ml showed an anxiety level significantly higher than that of patients with values less than the reported thresholds. These results suggest a contributory role by psychological factors in duodenal ulcer disease. The association of anxiolitic drugs to the traditional antiulcer therapy may be proposed, particularly in hypersecretors.