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1.
Cogn Process ; 24(1): 59-70, 2023 Feb.
Article in English | MEDLINE | ID: mdl-36376612

ABSTRACT

Debate surrounds processes of visual recognition, with no consensus as to whether recognition of distinct object categories (faces, bodies, cars, and words) is domain specific or subserved by domain-general visual recognition mechanisms. Here, we investigated correlations between the performance of 74 participants on recognition tasks for words, faces and other object categories. Participants completed a counter-balanced test battery of the Cambridge Face, Car and Body Parts Memory tests, as well as a standard four category lexical decision task, with response time and recognition accuracy as dependent variables. Results revealed significant correlations across domains for both recognition accuracy and response time, providing some support for domain-general pattern recognition. Further exploration of the data using principal component analysis (PCA) revealed a two-component model for both the response time and accuracy data. However, how the various word and object recognition tasks fitted these components varied considerably but did hint at familiarity/expertise as a common factor. In sum, we argue a complex relationship exists between domain-specific processing and domain-general processing, but that this is shaped by expertise. To further our understanding of pattern recognition, research investigating the recognition of words, faces and other objects in dyslexic individuals is recommended, as is research exploiting neuroimaging methodologies, with excellent temporal resolution, to chart the temporal specifics of different forms of visual pattern recognition.


Subject(s)
Pattern Recognition, Visual , Recognition, Psychology , Humans , Recognition, Psychology/physiology , Pattern Recognition, Visual/physiology , Visual Perception/physiology , Reaction Time , Face
3.
Eur Rev Med Pharmacol Sci ; 23(5): 2253-2256, 2019 Mar.
Article in English | MEDLINE | ID: mdl-30915773

ABSTRACT

OBJECTIVE: Blood loss following joint replacement surgery represents a relevant issue for orthopedic surgeons. The use of tranexamic acid (TXA) to reduce transfusion requirements has become mainstream. However, consensus about the starting time, methods, or volume of usage of TXA in joint replacement surgery has yet to be found. A retrospective study was conducted comparing pre- and post-operative infusion of TXA 15 mg/kg to a single pre-operative infusion. PATIENTS AND METHODS: 291 patients undergoing TKA were retrospectively reviewed. 109 received a single pre-operative dose of 15 mg/ kg TXA (single dose, SD group), 182 received a single pre- operative dose of 15 mg/ kg TXA followed by a second post-operative dose of 15 mg/kg TXA (double dose, DD group). The primary outcome was blood loss calculated from haematological values and perioperative transfusions. Secondary outcomes included the occurrence of major complications within the first postoperative year. RESULTS: None of the patients reported adverse events. Blood transfusions were administered to 63 patients (13.5%) in the SD and 36 in the DD group (5.7%). Significant difference between the groups was observed (p < 0.005). No significant difference between the two groups was found concerning mean blood loss in drainage after the 24th hour and postoperative hemoglobin values (p = n.s.). CONCLUSIONS: The study demonstrated that TXA possesses a good safety profile. In addition, pre- and post-operative infusion of TXA 15 mg/kg is more effective compared to single pre-operative infusion in reducing need for transfusion requirements.


Subject(s)
Antifibrinolytic Agents/administration & dosage , Arthroplasty, Replacement, Knee/adverse effects , Blood Transfusion/statistics & numerical data , Tranexamic Acid/administration & dosage , Administration, Intravenous , Antifibrinolytic Agents/therapeutic use , Arthroplasty, Replacement, Knee/methods , Blood Loss, Surgical/prevention & control , Humans , Postoperative Period , Preoperative Period , Retrospective Studies , Tranexamic Acid/therapeutic use
4.
J Breath Res ; 12(2): 026007, 2018 02 06.
Article in English | MEDLINE | ID: mdl-29408802

ABSTRACT

BACKGROUND: Analysis of exhaled volatile organic compounds (VOCs) may be applied for diagnostic purposes in some chronic diseases, but there are no data on their role for discriminating people with congestive heart failure (CHF), particularly in older patients where natriuretic peptides have lower accuracy. We evaluated whether VOCs analysis can discriminate patients with or without CHF, stratify CHF severity and predict the response to therapy of decompensated CHF. METHODS AND RESULTS: We recruited 89 subjects admitted to an acute care ward with acutely decompensated CHF, 117 healthy controls and 103 chronic obstructive pulmonary disease (COPD) controls. CHF patients performed echocardiography. VOCs were collected using the Pneumopipe® and analyzed with the BIONOTE electronic nose. Partial least square analysis was used to evaluate the discriminative capacity of VOCs. Accuracy in discrimination of CHF versus healthy and COPD controls was 81% and 69%, respectively; accuracy did not decrease in a sensitivity analysis excluding subjects younger than 65 and older than 80 years. In CHF patients VOCs pattern could predict with fair precision ejection fraction and systolic pulmonary arterial pressure, but not changes in weight due to therapy. CONCLUSIONS: VOCs pattern is able to discriminate older CHF patients from healthy people and COPD patients and correlates with cardiac function markers.


Subject(s)
Heart Failure/diagnosis , Volatile Organic Compounds/analysis , Aged , Aged, 80 and over , Blood Pressure , Breath Tests , Case-Control Studies , Discriminant Analysis , Exhalation , Female , Humans , Least-Squares Analysis , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/physiopathology , Respiratory Function Tests , Stroke Volume
5.
Clin Hemorheol Microcirc ; 58(4): 489-95, 2014.
Article in English | MEDLINE | ID: mdl-23603321

ABSTRACT

Systemic lupus erythematosus (SLE) is an autoimmune, chronic inflammatory, non-organ specific disease with an important morbimortality affecting several organs and systems. Oxidative stress is a well documented mechanism of red blood cells (RBC) mechanical impairment. Free radicals could produced, through lipid peroxidation, physical and chemical alterations in the cellular membrane properties modifying its composition, packing and lipid distribution on the membrane erythrocyte. The aim of the present work is to study the lipid peroxidation in the RBC membrane in SLE patients (n = 42) affecting so far the lipid membrane fluidity and erythrocyte deformability in comparison with healthy controls (n = 52). Malonildialdehyde (MDA) is a subrogate assessing lipidic peroxidation, rigidity index estimating erythrocyte deformability and the anisotropy coefficient estimating lipid membrane fluidity were used. Our results show that MDA values are increased, while erythrocyte deformability and membrane fluidity are significantly decreased in erythrocyte membrane from SLE patients in comparison with normal controls. The association of thiobarbituric acid reactive substances (TBARS) with membrane lipid fluidity and erythrocyte deformability confirms that the damage of membrane properties is produced by lipid peroxidation.


Subject(s)
Erythrocyte Membrane/metabolism , Lipid Peroxidation/physiology , Lupus Erythematosus, Systemic/blood , Adult , Erythrocytes/metabolism , Female , Humans , Membrane Fluidity/physiology , Middle Aged , Oxidative Stress/physiology
6.
Int J Colorectal Dis ; 29(1): 57-64, 2014 Jan.
Article in English | MEDLINE | ID: mdl-23975054

ABSTRACT

BACKGROUND AND AIMS: Subsite-specific incidence rates of colorectal cancer (CRC) and adenomas may vary considerably by race, sex and age as well as due to different screening strategies. We assessed variations in the anatomical distribution of adenomas according to age and sex in an average-risk screening cohort testing positive at immunological faecal occult blood test (i-FOBT) in northern Italy. METHODS: Data from 2,281 consecutive asymptomatic i-FOBT-positive subjects ageing 50-70 years undergone colonoscopy were reviewed. Size, number, macroscopic and histological features of all adenomas found as well as their proximal or distal location in relation to the splenic flexure were examined. Odds ratios (OR) of proximal neoplasms, according to the presence of distal neoplasms and other selected covariates were assessed by multiple logistic regression analysis. RESULTS: A total of 2,599 neoplasms were found in 1,396 patients. Of these, 116 (5 %) were colorectal cancers, diagnosed in 106 patients. Out of 2,483 adenomas found, 1,564 (63 %) were sessile, 795 (32 %) were peduncolated and 124 (5 %) were flat-type; 54 % of all adenomas were tubular, 36 % were tubulovillous or villous, and 10 % were serrated adenomas. The majority of neoplasms (66 %) were located in the distal colon. Tumour subsite distribution was consistent in both sexes, whereas significant proximal migration of neoplasms occurred in the older age cohort. Indeed, the rate of proximal neoplasms in patients aged ≥60 years was 37 % as compared with 29 % in those ageing 50-59 years. Male gender (OR 1.84), age of 60 years or older (OR 1.44), having a family history of colorectal neoplasms (OR 1.47) and presence of at least 1 distal advanced adenoma (OR 1.63) were all significant predictors of advanced proximal neoplasms. CONCLUSIONS: A left to right shift of colorectal adenomas with increasing age is evident in northern Italian asymptomatic i-FOBT-positive population. Advanced proximal neoplasms are not uncommon in subjects with or without distal adenomas, especially after 60 years of age. This should be carefully considered when implementing public screening strategies for CRC since the use of flexible sigmoidoscopy as a screening tool, particularly in older age groups, appears to be less effective.


Subject(s)
Adenoma/pathology , Colorectal Neoplasms/pathology , Early Detection of Cancer/methods , Hematologic Tests/methods , Occult Blood , Sex Characteristics , Adenoma/blood , Adenoma/diagnosis , Adenoma/epidemiology , Age Factors , Aged , Cohort Studies , Colonoscopy , Colorectal Neoplasms/blood , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/epidemiology , Female , Humans , Italy/epidemiology , Male , Middle Aged , Risk Factors
7.
Int J Colorectal Dis ; 28(10): 1423-31, 2013 Oct.
Article in English | MEDLINE | ID: mdl-23754545

ABSTRACT

BACKGROUND AND AIM: Recurrence of diverticulitis is frequent within 5 years from the uncomplicated first attack, and its prophylaxis is still unclear. We have undertaken a multicentre, randomised, double-blind, placebo-controlled pilot study in order to evaluate the role of mesalazine in preventing diverticulitis recurrence as well as its effects on symptoms associated to diverticular disease. METHODS: Ninety-six patients with the recent first episode of uncomplicated diverticulitis were randomised to receive mesalazine 800 mg twice daily for 10 days every month or placebo for 24 months. The primary efficacy end point was the diverticulitis recurrence at intention to treat analysis. Clinical evaluations were performed using the Therapy Impact Questionnaire (TIQ) for physical condition and quality of life at admission and at 3-month intervals. Treatment tolerability and routine biochemistry parameters as well as the use of additional drugs were also evaluated. RESULTS: Ninety-two patients (mean age, 61.5) completed the study, 45 of whom received mesalazine, and 47, placebo. Diverticulitis relapse incidence in mesalazine-treated group was 5/45 (11%) at the 12th month and 6/45 (13%) at the 24th month; in the placebo-treated group, the correspondent rates were 13% (6/47) and 28% (13/47), respectively. Mean values of TIQ at 24 months were significantly better in mesalazine-treated group than in placebo-treated group (p = 0.02); in addition, average additional drug consumption was significantly lower (-20.4%, p < 0.03) in mesalazine than in placebo. CONCLUSIONS: Diverticulitis recurrence occurred in as many as 28% of patients under placebo within 24 months from the initial episode. Intermittent prophylaxis with mesalazine did not significantly reduce the risk of relapse but induced a significant improvement of patients' physical conditions and significantly lowered the additional consumption of other gastrointestinal drugs.


Subject(s)
Diverticulitis/drug therapy , Diverticulitis/prevention & control , Mesalamine/therapeutic use , Adult , Aged , Aged, 80 and over , Confidence Intervals , Demography , Double-Blind Method , Female , Humans , Kaplan-Meier Estimate , Male , Mesalamine/adverse effects , Middle Aged , Pilot Projects , Placebos , Recurrence , Risk Factors , Surveys and Questionnaires , Time Factors , Treatment Outcome
8.
Endoscopy ; 45(1): 27-34, 2013.
Article in English | MEDLINE | ID: mdl-23254404

ABSTRACT

BACKGROUND AND STUDY AIMS: Colorectal cancer (CRC) screening aims to reduce mortality by detecting cancers at an early stage and removing adenomatous polyps at an acceptable cost. The aim of the current study were to assess the outcomes and costs of the first two biennial rounds of a population-based CRC screening program using the immunochemical fecal occult blood test (i-FOBT) in a northern Italian province. METHODS: All residents aged 50 - 69 years were invited to take part in a biennial screening program using a 1-day i-FOBT, followed by colonoscopy in positive individuals. The i-FOBT uptake, compliance to colonoscopy, detection rate for cancer or advanced adenomas according to age and sex, and direct cost analysis were carried out separately for the 1st and 2nd rounds of screening. RESULTS: In 78 083 (1st round) and 81 619 (2nd round) individuals who were invited to screening, the participation rates were 49.7 % and 54.4 % and i-FOBT positivity rates were 6.2 % and 5.8 %, respectively. Detection rates for cancer and advanced adenomas were lower in the 2nd screening compared with the 1st one (1.6‰ vs. 2.5‰ for cancers and 15.8‰ vs. 17.9‰ for advanced adenomas, respectively), whereas positive predictive values for cancer and advanced adenoma were similar in both rounds. In 165 adenocarcinomas detected, 52 % were Dukes' stage A and 21 % were stage B. All cost indicators were slightly higher in the 1st round of screening compared with the 2nd. The direct cost per cancer or advanced adenoma detection was similar in the two rounds (€â€Š1252 and €â€Š1260, respectively). CONCLUSIONS: Compliance and diagnostic yield of i-FOBT screening were satisfactory. Most detected cancers were at a very early stage. Program costs were reasonable and did not increase with repeat screening. Screening could contribute to decreasing the cost of CRC care by improving the stage at diagnosis.


Subject(s)
Colorectal Neoplasms/diagnosis , Mass Screening/economics , Occult Blood , Outcome and Process Assessment, Health Care , Aged , Colorectal Neoplasms/economics , Colorectal Neoplasms/epidemiology , Costs and Cost Analysis , Early Detection of Cancer , Female , Humans , Italy/epidemiology , Male , Middle Aged
9.
Aliment Pharmacol Ther ; 35(2): 222-37, 2012 Jan.
Article in English | MEDLINE | ID: mdl-22112043

ABSTRACT

BACKGROUND: Previous reviews of bowel preparation for colonoscopy have given contradictory answers. AIM: To provide a definitive insight, using PRISMA-compliant methodology. METHODS: A comprehensive literature review identified randomised controlled trials comparing bowel preparation regimens. Data for quality of bowel preparation were pooled in multiple meta-analyses exploring a range of inclusion criteria. RESULTS: A total of 104 qualifying studies were identified, the majority of which involved comparisons of sodium phosphate (NaP) or polyethylene glycol (PEG). There was no significant difference demonstrated between NaP and PEG overall (OR = 0.82; 95% CI = 0.56-1.21; P = 0.36). Cumulative meta-analysis demonstrated that this conclusion has been qualitatively similar since the mid 1990s, with little quantitative change for the past 10 years. Amongst studies with previous day dosing in both study arms there was a significant advantage in favour of PEG (OR = 1.78; 95% CI = 1.13-2.81; P = 0.006). Studies focussing on results in the proximal colon also favoured PEG (OR = 2.36; 95% CI = 1.16-4.77; P = 0.012). PEG was also significantly more effective than non-NaP bowel preparation regimens (OR = 2.02; 95% CI = 1.08-3.78; P = 0.03). Other comparisons showed no significant difference between regimens. CONCLUSIONS: Although there is no compelling evidence favouring either of the two most commonly used bowel preparation regimens, this may reflect shortcomings in study design. Where studies have ensured comparable dosage, or the clinically relevant outcome of proximal bowel clearance is considered, PEG-based regimens offer the most effective option.


Subject(s)
Cathartics/therapeutic use , Colonoscopy/methods , Phosphates/administration & dosage , Polyethylene Glycols/administration & dosage , Surface-Active Agents/administration & dosage , Humans , Preoperative Care/methods , Randomized Controlled Trials as Topic , Therapeutic Irrigation
10.
Clin Hemorheol Microcirc ; 47(4): 279-85, 2011.
Article in English | MEDLINE | ID: mdl-21654057

ABSTRACT

Systemic Lupus Erythematosus (SLE) is an autoimmune, chronic inflammatory, non-organ specific disease. SLE patients present a high prevalence of thrombotic and arteriosclerotic disease. The aim of the present work was to study the erythrocyte aggregation kinetics, and the effect of plasma factors, namely, immunoglobulin and fibrinogen concentration, as well as cell factors such as deformability and erythrocyte membrane lipid fluidity on the erythrocyte aggregation, in SLE patients and healthy controls. The results show that SLE patients red blood cells aggregate at higher rate and the aggregates size are also greater than controls due to an increase of immunoglobulin and plasma fibrinogen. The negative correlation between aggregation parameters and rigidity index could point out that the altered deformability diminishes the erythrocyte aggregation. Correlation between rigidity index and anisotropy suggests that the decrease of membrane lipid fluidity might be a cause of deformability decrease. The erythrocyte aggregation increase in these patients could induce a decreased flow that might contribute to the thromboembolic process present in SLE patients.


Subject(s)
Erythrocyte Aggregation/physiology , Erythrocytes/pathology , Lupus Erythematosus, Systemic/blood , Adult , Cross-Sectional Studies , Erythrocyte Deformability , Erythrocyte Membrane/metabolism , Erythrocyte Membrane/pathology , Erythrocytes/metabolism , Female , Fibrinogen/metabolism , Humans , Immunoglobulins/metabolism , Lupus Erythematosus, Systemic/immunology , Male , Membrane Fluidity , Middle Aged
11.
Dig Dis ; 27(3): 285-90, 2009.
Article in English | MEDLINE | ID: mdl-19786753

ABSTRACT

BACKGROUND AND AIM: Mucosal healing (MH) after short-term medical treatment is being considered as an important step in the therapeutic work-up of inflammatory bowel disorder (IBD) patients due to the potential prognostic role of MH in predicting disease outcome. However, IBD patients are reluctant to be re-endoscoped during follow-up; therefore, there is a need for non-invasive alternative index of MH which can replace endoscopy in clinical practice. We evaluated bowel ultrasound (US) as a surrogate of colonoscopy in a series of consecutive patients with active ulcerative colitis (UC). PATIENTS AND METHODS: 83 patients with moderate to severe UC requiring high-dose steroids were initially recruited; endoscopic severity of UC was graded 0-3 according to Baron score, and US severity was also graded 0-3 according to the colonic wall thickening and the presence of vascular signal at power Doppler. 74 patients responsive to steroids and then maintained on 5-ASA compounds were followed up with repeated colonoscopy and bowel US at 3, 9 and 15 months from entry. Concordance between clinical, endoscopic and US scores at various visits was determined by kappa statistics. Multiple unconditional logistic regression models were used to assess the predictivity of Truelove, Baron and US scores measured at 3 and 9 months on the development of a UC relapse (Baron score 2-3) at 15 months. RESULTS: An inconsistent concordance was found over time between 0 and I Baron scores and Truelove score (weighted kappa between 0.38 and 0.94), with high and consistent concordance between 0 and I Baron scores and US scores (weighted kappa between 0.76 and 0.90). On logistic regression analysis, a moderate/severe Baron score, regardless of their Truelove score, at 3 months was associated with a high risk of endoscopic activity at 15 months (OR 5.2; 95% CI: 1.6-17.6); similarly, patients with severe US scores (2-3) at 3 months had a high risk of severe endoscopic activity at 15 months (OR 9.1; 95% CI: 2.5-33.5). DISCUSSION: In expert hands bowel US may be used as a surrogate of colonoscopy in evaluating the response to high-dose steroids in severe forms of UC. US score after 3 months of steroid therapy accurately predicts clinical outcome of disease at 15 months.


Subject(s)
Colitis, Ulcerative/diagnostic imaging , Colitis, Ulcerative/pathology , Intestinal Mucosa/diagnostic imaging , Intestinal Mucosa/pathology , Wound Healing , Adult , Colitis, Ulcerative/therapy , Female , Humans , Male , Middle Aged , Time Factors , Treatment Outcome , Ultrasonography , Young Adult
12.
Br J Surg ; 96(5): 533-40, 2009 May.
Article in English | MEDLINE | ID: mdl-19358181

ABSTRACT

BACKGROUND: The results of a pilot colorectal cancer screening programme by biennial immunochemical faecal occult blood test (FOBT) are reported. METHODS: All residents aged between 50 and 69 years in the Italian province of Lecco were invited to have a FOBT. Those with a positive result were offered colonoscopy. FOBT uptake and compliance with colonoscopy were assessed. Detection rate and positive predictive value (PPV) for cancer and adenoma were calculated. Tumour stages were compared between screen-detected cancers and other colorectal cancers diagnosed within the target age group. RESULTS: Some 38,693 (49.6 per cent) of 78,083 individuals had a FOBT and 2392 (6.2 per cent) had a positive result. Colorectal cancer was diagnosed in 4.6 per cent and advanced adenoma in 32.7 per cent. PPVs were 4.0 per cent for cancer, 28.1 per cent for advanced adenoma and 36.6 per cent for any adenoma. There was a significant difference in incidence of stage III/IV disease between screened and non-screened cohorts. Compliance for colonoscopy was 92.0 per cent. Major determinants of compliance were age less than 59 years, female sex, high education level and non-manual work. CONCLUSION: These results justify extension of colorectal cancer screening to other regions of Italy.


Subject(s)
Colorectal Neoplasms/diagnosis , Early Detection of Cancer , Mass Screening/methods , Occult Blood , Aged , Aged, 80 and over , Colonoscopy/statistics & numerical data , Educational Status , Female , Humans , Italy , Male , Middle Aged , Patient Compliance/statistics & numerical data , Pilot Projects , Sex Distribution
13.
Dig Liver Dis ; 41(2): 87-95, 2009 Feb.
Article in English | MEDLINE | ID: mdl-18676211

ABSTRACT

Colonoscopy constitutes the principal investigation for colo-rectal neoplasms due to its ability to detect and remove most of precancerous lesions; due to the ongoing or planned colon cancer screening programs in many European countries we should expect an enormous increase in colonoscopic demand over the next few years. Diagnostic accuracy and therapeutic safety of colonoscopy strictly depends upon the quality of bowel cleansing which is often perceived as the most unpleasant part of the procedure in individuals undergoing this examination. The ideal preparation for colonoscopy should reliably empty the colon from all faecal material allowing the optimal visualization of the entire colonic mucosa without causing great patient's discomfort nor significant shifts in fluids or electrolytes. Standard PEG solutions and sodium phosphate (NaP) compounds are the most frequently used preparations; both are accepted and relatively well tolerated by the majority of patients undergoing colonoscopy; however, NaP compounds should be avoided in elderly subjects as well as in those with congestive heart failure, renal and hepatic insufficiency or taking diuretics, ACE inhibitors or angiotensin receptor blockers, since they can induce severe electrolyte and/or fluid disturbances. Standard PEG solutions are often taken incompletely due to the low palatability and the high volume of liquids required which induce nausea and vomiting with negative consequences in terms of colon cleansing. Reduced volume and better palatability of PEG solutions, such as those obtained with the newest PEG formulations, as well as improved patient education concerning the importance of bowel cleansing could undoubtedly increase compliance with oral bowel preparations and promote adherence to colo-rectal cancer screening programs.


Subject(s)
Colon , Colonoscopy/methods , Preoperative Care/methods , Therapeutic Irrigation/methods , Cathartics/administration & dosage , Colonoscopy/history , Colorectal Neoplasms/prevention & control , Drug Therapy, Combination , Early Detection of Cancer , History, 20th Century , Humans , Intestinal Mucosa/drug effects , Laxatives/administration & dosage , Mass Screening/methods , Phosphates/administration & dosage , Polyethylene Glycols/administration & dosage , Preoperative Care/history , Randomized Controlled Trials as Topic , Surface-Active Agents/administration & dosage , Treatment Outcome
16.
Dig Liver Dis ; 39(8): 782-9, 2007 Aug.
Article in English | MEDLINE | ID: mdl-17606419

ABSTRACT

Proper management of Helicobacter pylori infection in clinical practice--when supported by evidence-based data--is expected to produce substantial cost-efficacy advantages. This consideration has prompted the Cervia Working Group to organise a meeting of experts to update the National Guidelines on the diagnosis and treatment of H. pylori infection in Italy. Recommendations in the new European Guidelines were considered in the National setting, here in the light of factors such as the incidence of gastric cancer and gastric lymphoma, the accessibility to different diagnostic tools, the prevalence of bacterial resistance against antibiotics, and the availability of different drugs. The main revisions in respect to the previous guidelines include H. pylori eradication in non-ulcer dyspepsia patients and in non-steroidal, anti-inflammatory drug users, as well as in patients with idiopathic thrombocytopenic purpura and iron deficiency anaemia. The stool antigen test is now accepted as a valid test for confirmation of H. pylori eradication following therapy. New therapeutic approaches have been recommended for both first- (sequential therapy) and second-line (levofloxacin-based) treatment in our country.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Consensus Development Conferences as Topic , Endoscopy, Gastrointestinal/methods , Enzyme Inhibitors/therapeutic use , Helicobacter Infections , Helicobacter pylori/isolation & purification , Practice Guidelines as Topic , Diagnosis, Differential , Helicobacter Infections/diagnosis , Helicobacter Infections/drug therapy , Helicobacter Infections/epidemiology , Humans , Italy/epidemiology , Prevalence , Proton Pump Inhibitors
17.
Clin Hemorheol Microcirc ; 36(2): 105-10, 2007.
Article in English | MEDLINE | ID: mdl-17325434

ABSTRACT

Systemic scleroderma is an autoimmune disease, due to a connective tissue alteration characterized by extracellular matrix increase in the skin and internal organs. It is already known that the Raynaud's phenomenon and the microcapillary obliteration lead to ischemia and peripheral tissue injury. The ischemia-reperfusion phenomenon releases free radicals, that react with red blood cells (RBCs) membrane components originating lipid peroxidation and impairment of the ATP-Ca(++) pump, two possible mechanisms responsible of disease pathogenesis. Nifedipine is a Ca(++)-channel antagonist that has been used for a long time in Raynaud's phenomenon treatment. In the present study we were able to demonstrate that erythrocyte deformability and two other related variables such as membrane fluidity and osmotic fragility improve significantly with nifedipine therapy. It is likely that nifedipine inhibiting cytoplasmic calcium accumulation could restore some red blood cell membrane properties.


Subject(s)
Blood Viscosity/drug effects , Calcium Channel Blockers/pharmacology , Erythrocyte Deformability/drug effects , Nifedipine/pharmacology , Osmotic Fragility/drug effects , Scleroderma, Systemic/drug therapy , Adult , Female , Hemorheology/drug effects , Humans
18.
Aliment Pharmacol Ther ; 22(3): 209-15, 2005 Aug 01.
Article in English | MEDLINE | ID: mdl-16091058

ABSTRACT

BACKGROUND: Hepatitis C virus infection is more common in patients with inflammatory bowel disease than in general population. Limited data are available as to the safety and efficacy of alpha-interferon therapy for chronic active hepatitis C in patients with concomitant inflammatory bowel disease. AIM: To evaluate the efficacy and safety of alpha-interferon monotherapy in patients with chronic active hepatitis C and inactive or mildly active inflammatory bowel disease. METHODS: A total of 513 consecutive inflammatory bowel disease patients at a single centre were tested for antibodies to hepatitis C virus (anti-hepatitis C virus) between 1995 and 2000. Twenty-one patients had detectable anti-hepatitis C virus Ab and were hepatitis C virus-RNA positive with histologically proved chronic active hepatitis. Each of these patients, whose inflammatory bowel disease was in clinical remission or mildly active, was sex- and age-matched to three controls with similar histological grade and stage of chronic hepatitis C virus but without inflammatory bowel disease; and all were treated with human leucocyte alpha-interferon 6 million units given thrice weekly for 12 months. Responses to treatment were classified as follows: complete response--persistently normal alanine aminotransferase and viral clearance (hepatitis C virus-RNA-ve) at the end-of-treatment, incomplete response--alanine aminotransferase normalization without viral clearance (hepatitis C virus-RNA+ve), and sustained response--alanine aminotransferase normalization and hepatitis C virus clearance 12 months after the end-of-treatment. RESULTS: Twenty-one patients with chronic active hepatitis C and inflammatory bowel disease (10 with Crohn's disease and 11 with ulcerative colitis) and 63 sex- and age-matched controls with chronic hepatitis C virus alone received alpha-interferon monotherapy. Response rates to interferon were similar for inflammatory bowel disease patients compared with controls [CR 42% vs. 35% and SR 24% vs. 18% (P, not significant), respectively]. None of the 21 inflammatory bowel disease patients had severe adverse effects and the mild ones observed were comparable with those seen in the control group. No patients developed an inflammatory bowel disease relapse during the interferon treatment period or in the 12 months thereafter. CONCLUSIONS: The biochemical and virological response to a 12-month human leucocyte alpha-interferon treatment in patients with chronic active hepatitis C are similar to that observed in matched controls with chronic hepatitis C virus without inflammatory bowel disease. Adverse effects are similar in both groups of patients and unrelated to the underlying inflammatory bowel condition. This provides hepatologists with evidence that alpha-interferon can be safely administered to patients with chronic hepatitis C virus and inflammatory bowel disease provided that the inflammatory bowel condition is in clinical remission.


Subject(s)
Hepatitis C, Chronic/drug therapy , Inflammatory Bowel Diseases/complications , Interferon-alpha/adverse effects , Adult , Aged , Alanine Transaminase/blood , Case-Control Studies , Female , Hepacivirus/isolation & purification , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/virology , Humans , Interferon-alpha/therapeutic use , Male , Middle Aged , Prospective Studies , Severity of Illness Index , Treatment Outcome , Viral Load
19.
Dig Liver Dis ; 36(11): 763-5, 2004 Nov.
Article in English | MEDLINE | ID: mdl-15571008

ABSTRACT

Hepato-biliary ascariasis is a rare condition in non-endemic areas; however, it should always be taken into account in patients with recurrent biliary colics and/or cholangitis, since these are among the most frequent modes of clinical presentation. We report a case of a young woman suffering from recurrent biliary colics in whom a diagnosis of biliary ascariasis was made. Endoscopic retrograde cholangiopancreatography with sphincterotomy and endoscopic extraction of the worm, using a Dormia basket, proved to be a safe and effective procedure for removing the living Ascaris from the biliary tree and relieving symptoms. In the era of worldwide travels, physicians in Western countries should be more aware of this infection especially in patients with biliary symptoms who have travelled to endemic areas or immigrant from endemic countries.


Subject(s)
Ascariasis/complications , Ascaris lumbricoides , Colic/etiology , Common Bile Duct Diseases/complications , Common Bile Duct Diseases/parasitology , Liver Diseases, Parasitic/complications , Adult , Animals , Female , Humans , Recurrence
20.
Aliment Pharmacol Ther ; 20(9): 959-68, 2004 Nov 01.
Article in English | MEDLINE | ID: mdl-15521843

ABSTRACT

BACKGROUND: Recurrences after surgery for Crohn's disease are frequent and unpredictable. To date, there is little agreement as to which factors increase a patient risk of early recurrence. AIM: To assess whether the post-operative behaviour of diseased bowel walls, as determined by ultrasound, may be a useful predictor of relapse. METHODS: A total of 127 Crohn's disease patients were monitored after surgery by means of bowel ultrasound as well as by clinical and laboratory evaluations for a median follow-up of 41.0 months. Bowel wall thickness of diseased loops measured at ultrasound during follow-up was compared with the presurgery values. Multivariable survival analysis was performed to elucidate predictors of early post-operative recurrence. Receiver operating characteristic curves were also constructed taking into account bowel wall thickness for selecting Crohn's disease patients with high risk of clinical/surgical recurrence. RESULTS: The estimated 5 years survival probability of symptomatic Crohn's disease recurrence were 90% and 33%, respectively for unchanged/worsened bowel wall thickness vs. improved bowel wall thickness at 12 months from surgery. The hazard ratio for unchanged/worsened bowel wall thickness at 12 months was 8.9 (95% CI: 3.4-23.2). Receiver operating characteristic curve identified a bowel wall thickness > 6.0 mm at 12 months from surgery as directly associated with the risk of having a Crohn's disease recurrence (hazard ratio was 6.5, 95% CI: 2.8-15.4). CONCLUSIONS: Systematic ultrasound follow-up of diseased bowel walls after conservative surgery allows the early identification of patients at high risk of clinical/surgical recurrence.


Subject(s)
Colonic Diseases/etiology , Crohn Disease/surgery , Postoperative Complications/etiology , Adolescent , Adult , Colonic Diseases/diagnostic imaging , Colonic Diseases/pathology , Crohn Disease/diagnostic imaging , Crohn Disease/pathology , Disease-Free Survival , Female , Humans , Male , Middle Aged , Multivariate Analysis , Postoperative Complications/diagnostic imaging , Postoperative Complications/pathology , Prospective Studies , ROC Curve , Recurrence , Risk Factors , Treatment Outcome , Ultrasonography
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