Segmental colitis associated with diverticula: a 7-year follow-up study.

BACKGROUND AND STUDY AIMS: We performed a long-term follow-up study of patients with segmental colitis associated with diverticula, in order to clarify the natural history of this disease. PATIENTS AND METHODS: We identified 15 patients who were diagnosed as having segmental colitis associated with diverticula during 1997. We assessed these patients by means of periodic follow-up visits from 1997 to 2004. RESULTS: Eight of the 15 patients had no clinical recurrence during follow-up. Five patients had sporadic recurrences that were clinically mild (on average, one in 5 years), which responded to topical therapy and often to self-medication. Only two patients were diagnosed during the follow-up period as having Crohn's disease; notably, these were the only patients who did not have hematochezia as the main symptom at onset. CONCLUSION: The course of this disease appears to be substantially benign.

Gastrectomy, lack of gastric first pass metabolism of ethanol and alcoholic liver disease. Results of a multicentre study.

BACKGROUND: Some conditions characterized by a loss (anatomical or functional) of parietal cells of the gastric antrum, containing an alcohol-dehydrogenase, may reduce the first pass metabolism of ethanol at that level and, simultaneously, raise its bioavailability. The observation that the first pass metabolism was drastically suppressed after gastrectomy would appear to suggest that the latter condition represents a risk for the development of liver damage in patients who continue to consume alcohol even in a non relevant amount. METHODS: Consecutively enrolled in the study were 304 individuals of both sexes aged between 45 and 70 years of whom 114 gastrectomized and 190 pair-matched control subjects all submitted to an Upper Gastrointestinal Endoscopy for whatever disturbance. All the patients were diagnosed as having liver disease with routine clinical and instrumental means. Information was collected concerning the mean daily alcohol intake, both before and after the operation. RESULTS: The overall prevalence of hepatic lesions was shown to be higher in the gastrectomized than in the control group (42.1% vs 25.8%, p = 0.005). Moreover, referring only to alcohol-related hepatic lesions (steatosis, steato-fibrosis and cirrhosis), the prevalence was higher in the gastrectomized patients than in the controls (29.8% vs 17.9%, p = 0.02). As far as concerns alcohol consumption, the gastrectomized group had consumed 71 g/day and the control group 39 g/day alcohol per person (p < 0.05) in a similar period of time (35 and 33 years, respectively). Also the non alcohol-related liver damage (especially the viral type) was slightly higher in the gastrectomized patients (gastrectomized 12.3% vs control 7.9%, p = ns). Accordingly, the percentage of serum markers of viral infection was higher in this group (HBs Ag: gastrectomized 3.9% vs control 2.2%, p = ns; anti-HCV: gastrectomized 13.5% vs control 5.0%, p = 0.03). Finally, to test the eventual damaging effects of gastrectomy alone (excluding ethanol and/or viral infection), two groups of patients with a medium to low alcoholic negative assumption (30-60 g ethanol/day) and no signs of viral infection (HBsAg and anti-HCV negative) were extrapolated. In these two selected groups, the prevalence of alcoholic-related hepatic lesions were not statistically different (28 gastrectomized 20.3% vs 44 control 18.4%). CONCLUSIONS: In conclusion, data emerging from investigations on the population under study indicate that the alcohol and viral infection appear to play a more important role in determining hepatic lesions than gastroresection.

Multiple primary malignant tumors in patients with hepatocellular carcinoma. A review of 29 patients.

BACKGROUND: The study of patients with hepatocellular carcinoma (HCC) and multiple primary malignant tumors (MPMTs) is interesting from an etiopathogenetic as well as from a clinical point of view. There are few studies dealing with this topic. METHODS: Smoking habits, alcohol intake, HBsAg status, alpha-feto-protein serum concentration, presence of liver cirrhosis, type of associated cancers, treatment, and survival were evaluated in 29 patients (25 men and 4 women; median age 73 years) with histologically confirmed HCC and MPMTs. All patients were examined between January 1980 and February 1995 at the General Hospital of Monfalcone, in northeastern Italy. In the same period there were 143 patients with HCC. RESULTS: Tumors associated with HCC were located in: prostate (9 cases), colon-rectum (5), bladder (3), lung (3), stomach (2), gallbladder (2), and brain, breast, oesophagus, pancreas, thyroid, larynx, pleura, small intestine, kidney (1 each). In 25 patients there was a single, and in 4 patients two associated malignancies. A diagnosis in vita of the associated malignancy was made in 15 cases. Cirrhosis was present in 90% of patients and HBsAg was positive in 15%. Mean survival time from diagnosis was 5.5 weeks (0-150) in patients with MPMTs and 6.8 weeks (0-221) in patients with HCC only. The cause of death was HCC in 18 patients, the associated tumor in 8, and non-neoplastic diseases in 2. Treatment of the associated tumors was performed in 8 cases. CONCLUSIONS: In this study the prevalence of MPMTs in patients with HCC is high (20.3%) in accordance with other autopsy series. Mean survival time in patients with MPMTs was similar to that in patients with HCC only. From a clinical point of view, attention must be paid to the diagnosis of hepatic lesions in patients affected with cirrhosis and extrahepatic cancer.

[S-adenosyl-L-methionine (SAMe) and its use in hepatology]. / L'S-adenosil-L-metionina (SAMe) e il suo uso in epatologia.

S-adenosyl-L-methionine (SAMe), a molecule naturally present in several body tissues and fluids, is produced, by SAMe synthetase, from ATP and methionine. SAMe has a fundamental role, as methyl group donor, in transmethylation reactions in which the synthesis of membrane phospholipids (especially phosphatidylcholine) is mandatory for the maintenance of membrane fluidity. Another metabolic pathway involving SAMe, transsulphuration, is initiated with the release of -CH3 from the molecule and the formation of S-Adenosyl-homocysteine and then homocysteine and cysteine, a precursor of glutathione the main cellular antioxidant, responsible of detoxification of various compounds and xenobiotics. At last SAMe is implicated in aminopropylation process for the polyamine synthesis. The development of stable double salt of p-toluene sulphonic acid and sulphuric acid of SAMe enables the clinical use of the drug, as a therapeutical agent, for the treatment of a number of liver dysfunctions. In various animal and human models, including controlled trials, it has been demonstrated that SAMe can ameliorate some biochemical parameters and pruritus in cholestasis induced by a range of compounds (i.e. oestrogens, lithocolate, etc) and in intrahepatic cholestasis superimposed to chronic liver disease. Concerning alcohol toxicity, SAMe prevents, in ethanol fed baboons, depletion of glutathione levels, normalizes the mitochondrial enzymes and improves the histological hepatic lesions. In human healthy volunteers it has been recently demonstrated that SAMe, after ethanol ingestion, significantly lowers plasma concentration of ethanol and acetaldehyde as well. Finally, SAMe has been proposed, instead of N-acetylcysteine, as precursor of glutathione, in patients who present late after ingestion of an overdose of paracetamol.