Luigi Benini
Università di Verona, Medicine, Faculty Member
The development of fistulae is a common complication of Crohn's disease (CD). The lifetime risk of fistula development in patients with CD has typically been reported to range from 20 to 40%. The reported incidence of fistulizing CD... more
The development of fistulae is a common complication of Crohn's disease (CD). The lifetime risk of fistula development in patients with CD has typically been reported to range from 20 to 40%. The reported incidence of fistulizing CD from referral-based case series ranged from 17% to as much as 85% Over time, many fistulae tend to heal. As for example, in a cohort of 87 patients In a longitudinal study of fistulizing CD in patients from Olmestead County, at least one fistula occurred in 35% of the patients, and at least one perianal fistula occurred in 20% The clinical consequences of the fistulous tract depend on the nature of the adjacent tissues, the origin and the terminus of the fistula and the infectious process resulting from transit of enteric microorganisms through the fistula. In perianal fistulae, identification of specific routes created by fistula tracts informs prognostic and therapeutic options. Patients with painful perianal fistula and associated abscess formati...
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Esophageal symptoms are common in anorexia nervosa, but it is not known whether they are associated with motility disorders, with different forms of the disease, and whether they respond to nutritional rehabilitation. To clarify these... more
Esophageal symptoms are common in anorexia nervosa, but it is not known whether they are associated with motility disorders, with different forms of the disease, and whether they respond to nutritional rehabilitation. To clarify these points, 23 patients with anorexia nervosa (12 binge-eating/purging, "purgers"; 11 restricting type, "restricters") were studied by esophageal manometry before and after 22 weeks rehabilitation. Manometric parameters of 35 age and sex-matched patients were used as controls. Patients with anorexia also filled questionnaires on eating disorder psychopathology, psychopathological distress and esophageal, gastric and colonic symptoms before and after 4 and 22 weeks of a rehabilitation program. Symptoms were more severe in patients than in controls. Gastric and colonic, but not esophageal symptoms improved with treatment. LES basal pressure was higher in restricters (restricters 32.1±4.6; purgers 14.9±2.2; controls 17.1±1.1 mmHg, p<0.005), but still within normal range; this difference disappeared after treatment. Postdeglutitive body waves were normally propagated. Their amplitude was significantly higher in anorexia than in controls. No correlation was found between results of psychopathological tests (improved after treatment), esophageal symptoms and manometry. In anorexia, esophageal symptoms are frequent and severe. They are not adequately explained by psychological or manometric derangements.
Research Interests: Gastroenterology, Group Psychotherapy, Medicine, Anorexia Nervosa, Humans, and 15 moreInternal Medicine, Female, Cognitive Therapy, Diet Therapy, Lower Esophageal Sphincter, Body Mass Index, Clinical Sciences, Adult, Anorexia, Caloric Restriction, Binge eating, Bulimia, Achalasia, Esophageal motility, and Nutritional Support
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Research Interests: Immunology, Pathogenesis, Molecular Genetics, Medicine, Clinical immunology, and 15 moreHumans, Mutation, Female, Clinical, Male, Pedigree, Adult, Chronic obstructive pulmonary disease, B Lymphocytes, Amino Acid Substitution Rates, X-linked Agammaglobulinemia, Autoimmune Pancreatitis, Agammaglobulinemia, Protein tyrosine kinases, and B cell
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Colorectal cancer (CRC) is among the leading causes of cancer-related mortality in Western countries. As for most other cancers, it is likely that CRC repre- sents an interaction between genetic and environmental factors. Since genetic... more
Colorectal cancer (CRC) is among the leading causes of cancer-related mortality in Western countries. As for most other cancers, it is likely that CRC repre- sents an interaction between genetic and environmental factors. Since genetic factors are a cause in only a minority of cases, environmental factors, particularly diet, are probably prevalent. Many studies have shown that an increase in meat consumption produces a clear increase in CRC. However, the difference is mostly in the extreme classes of meat intake (i.e. between people who eat a large amount of meat every day and those who hardly ever eat red meat). Moreover, the difference in risk is only 12-17% for an increase of 100 g/day in meat intake, probably not enough in itself to warrant large-scale campaigns to reduce meat intake. Similar conclusions can be drawn from the relationship between an increase in fruit, fiber, or milk intake and a decrease in CRC. However, all the suggested changes move towards a healthier diet, w...
Objective The objective of this study was to compare the preoperative diagnosis by International Consensus Diagnostic Criteria (ICDC) with histological diagnosis in patients with focal autoimmune pancreatitis (AIP) who underwent surgery.... more
Objective The objective of this study was to compare the preoperative diagnosis by International Consensus Diagnostic Criteria (ICDC) with histological diagnosis in patients with focal autoimmune pancreatitis (AIP) who underwent surgery. Methods Thirty patients (type 1 AIP in 23 and type 2 AIP in 7) with a diagnosis of AIP based on histology of surgical specimens were classified according to ICDC based on their preoperative data. Results Pancreatic core biopsies and diagnostic steroid trial were not preoperatively performed in any of the patients. Based on preoperative data, ICDC diagnosed 6 patients (20%) as having type 1 AIP and 24 (80%) as probable AIP. Assuming all patients had responded to a steroid trial preoperatively, ICDC would have diagnosed 8 patients (27%) as having type 1 AIP, 4 (13%) as type 2 AIP, 10 as AIP–not otherwise specified (33%), and 8 (27%) as probable AIP. In the hypothetical situation, 7 of 8 type 1 AIP patients and 3 of 3 type 2 AIP patients would have bee...
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This case report describes the clinical presentation, diagnosis, and management of a 26-year-old patient with anorexia nervosa (AN) diagnosed with Solitary Rectal Ulcer Syndrome (SRUS). To our knowledge, this is the first case report to... more
This case report describes the clinical presentation, diagnosis, and management of a 26-year-old patient with anorexia nervosa (AN) diagnosed with Solitary Rectal Ulcer Syndrome (SRUS). To our knowledge, this is the first case report to document SRUS in AN, whose pathogenesis in this case seems to have been determined by the patient's malnourished and underweight state. Furthermore, SRUS symptoms appear to have interacted with the eating disorder psychopathology, increasing the need to exert control over eating. Cognitive behavioral strategies and procedures were accordingly used to address the eating disorder psychopathology and to promote complete weight restoration, which brought about a significant reduction in the size of the ulcer and the complete resolution of SRUS symptoms. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:731-735).
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To investigate the influence of sodium acetate and acetic acid from vinegar on blood glucose and acetate response to a mixed meal in healthy subjects. Five healthy subjects consumed in random order six test meals consisting of 100 g of... more
To investigate the influence of sodium acetate and acetic acid from vinegar on blood glucose and acetate response to a mixed meal in healthy subjects. Five healthy subjects consumed in random order six test meals consisting of 100 g of sliced lettuce dressed with olive oil (Blank), olive oil plus 1 g acetic acid in the form of vinegar (AcOH), or olive oil plus sodium acetate in the form of vinegar neutralized to pH 6.0 with sodium bicarbonate (AcNa). On three occasions test meals were followed by a challenge consisting of 50 g carbohydrate portions of white bread (Bread). Glucose and acetate concentrations were measured in arterialized capillary blood before and until 95 min after the meals. Ultrasonography was performed in four other subjects to measure gastric emptying times after AcOH + Bread and AcNa + Bread. Blood acetate response over 95 min was markedly reduced after AcOH and AcOH+Bread meals compared to AcNa and AcNa + Bread. Similarly, the glucose response was depressed by 31.4% (P = 0.0228) after AcOH+Bread with respect to AcNa + Bread and Blank + Bread. No difference was observed between gastric emptying times after AcOH + Bread and AcNa + Bread. The results suggest that oral acetic acid and acetate might have a different effect on acetataemia and that a limited dose of vinegar, in the form of salad dressing, is sufficient to influence significantly the glycaemic response to a mixed meal in normal subjects by a mechanism related to acidity but not to gastric emptying.
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Background and Aims: International Consensus Diagnostic Criteria (ICDC) for autoimmune pancreatitis (AIP) have been proposed to identify type 1 AIP, type 2 AIP, and AIP-not otherwise specified (AIP-NOS). To date, no study on incidence,... more
Background and Aims: International Consensus Diagnostic Criteria (ICDC) for autoimmune pancreatitis (AIP) have been proposed to identify type 1 AIP, type 2 AIP, and AIP-not otherwise specified (AIP-NOS). To date, no study on incidence, clinical profiles and outcome in the groups classified according to ICDC has been reported. The aim of this study was to apply these criteria to an Italian series of patients to evaluate the incidence, clinical profiles, and outcome among these subtypes of AIP. Patients and Methods: We re-evaluated and classified 92 patients (16 operated patients and 76 non-operated patients) diagnosed as having AIP by Verona criteria, according to ICDC. Results: Out of 92 patients, 59 patients (64%) were diagnosed as type 1 AIP, 17 (18%) as type 2 AIP, and 15 (16%) as AIP-NOS according to ICDC. A patient showing a spontaneous remission was diagnosed as probable AIP (that fulfilled Verona criteria but not ICDC). Five type 1 AIP patients with ulcerative colitis fulfilled the diagnostic criteria of probable type 2 AIP as well. However, these patients were finally classified into type 1 AIP according to algorithm of ICDC. Type 1 AIP patients compared to type 2 AIP were older (54.5 ± 14.5 vs 34.4 ± 13.9; p ,0.0001) and different in the frequency of male sex (76% vs 47%; p=0.007), jaundice (66% vs 18%; p=0.002) and acute pancreatitis (9% vs 47%; p,0.0001) as initial symptom, elevated serum IgG4 levels (85% vs 7%; p,0.0001), inflammatory bowel disease (8% vs 82%; ,0.0001), and relapse of the disease (34% vs 0%; p=0.002). The clinical and epidemiological parameters in AIPNOS, such as mean age (45.7 ± 14.9), frequency of jaundice (47%) and acute pancreatitis (40%) as initial symptom, and relapse rate (20%), were intermediate between those of type 1 and type 2 AIP. Imaging and response to steroids in AIP-NOS were similar to those in two subtypes of AIP. CONCLUSIONS: Patients diagnosed as type 1 AIP by ICDC have different clinical profiles and outcome from those as type 2 AIP. Although AIP-NOS group seem to be composed of type 1 and type 2 AIP cases without typical clinical and serological features, we cannot exclude an overlap syndrome as a separate entity or as a possible evolution from type 2 AIP to type 1 AIP. ICDC may be unable to diagnose patients with spontaneous remission as having AIP.
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ABSTRACT
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During recent years, there has been considerable debate as to the nutritional supply that needs to be established for a patient with acute pancreatitis. The main problem is still infection of the pancreatic necrosis, which has a decisive... more
During recent years, there has been considerable debate as to the nutritional supply that needs to be established for a patient with acute pancreatitis. The main problem is still infection of the pancreatic necrosis, which has a decisive bearing on the indication for surgery and is the main cause of mortality. Infection stems from bacterial translocation from the patient's gut. Enteral nutrition with its known potential for reducing this type of infection constitutes an attempt to prevent it by preserving the enteric mucosal barrier. Today, the concept of pancreatic rest is no longer considered mandatory in the guidelines of many Surgical and Nutritional Societies, whilst enteral nutrition is the gold standard for acute pancreatitis. Assuring an integrated parenteral and enteral supply before reaching the full regimen of enteral nutrition is the most reliable policy during the early days of the disease. Moreover, outcomes being equal, enteral nutrition is cheaper than parenteral...
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To clarify 1) whether gastric emptying of a mixed meal is delayed in patients with gastroesophageal reflux and 2) the relationship between dyspeptic symptoms and delayed gastric emptying in refluxers. Gastric emptying of a solid meal was... more
To clarify 1) whether gastric emptying of a mixed meal is delayed in patients with gastroesophageal reflux and 2) the relationship between dyspeptic symptoms and delayed gastric emptying in refluxers. Gastric emptying of a solid meal was studied by ultrasound in 25 patients with pathological esophageal acid exposure. Gastric emptying was then assessed in relation to upper digestive endoscopy, esophageal manometry, 24-h pH monitoring and quantification of symptoms of reflux- and dysmotility-like dyspepsia. Fifteen of 25 refluxers had esophagitis, and 15 were "dyspeptic". Refluxers exhibited a significant delay in gastric emptying compared with controls [307.6 (21.0) vs. 209 (10.4) min, p < 0.001). Patients with delayed emptying had low LES pressure [11.9 (2.1) vs. 18.6 (2.1) mm Hg, p < 0.05]. There was no correlation between delayed emptying and either pH monitoring or presence of esophagitis. There were no differences in any of the pH monitoring parameters between re...
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A group of 191 patients with chronic relapsing pancreatitis was followed for about 10 years. Ninety-three of them were selected for surgery because of incapacitating painful relapses or persistent pain and were submitted to side-to-side... more
A group of 191 patients with chronic relapsing pancreatitis was followed for about 10 years. Ninety-three of them were selected for surgery because of incapacitating painful relapses or persistent pain and were submitted to side-to-side pancreaticojejunostomy. Ninety-eight were selected for medical management. Seventeen patients died during the follow-up. The cumulative probability of pain relief, 10 years after clinical onset of the disease was 62.9% in the patients who had been submitted to surgery and 42.8% in the nonoperated patients. In the operated group, no case of further relapse was observed after a 3-year pain-free interval, but in the nonoperated group some patients complained of further painful relapses. Complete and lasting alcohol withdrawal and/or steatorrhea were significantly associated with a more favorable result in the patients who had been submitted to surgery. However, the relationship between alcohol consumption, exocrine pancreatic insufficiency, and pain beh...
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The behaviour of serum gastrin fasting levels was studied in 39 randomized patients with proven duodenal ulcer, 21 receiving cimetidine (1 g/day) and 18 placebo for 28 days. No significant variations of gastrin fasting values were found,... more
The behaviour of serum gastrin fasting levels was studied in 39 randomized patients with proven duodenal ulcer, 21 receiving cimetidine (1 g/day) and 18 placebo for 28 days. No significant variations of gastrin fasting values were found, but in four patients given cimetidine a relevant increase was observed at the end of the treatment. One out of 6 patients, previously treated with placebo, showed a marked increase of fasting gastrin levels after a second trial of cimetidine. No increase of G-17 was observed in the patients showing fasting hypergastrinemia after cimetidine. The present study seems to confirm some previous observations and it seems to suggest the possibility that in some patients cimetidine could induce hypergastrinemia.
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The aim of this paper is to describe a patient with severe postpolio problems who developed achalasia. A 66-year-old patient came to our observation for severe dysphagia. He had suffered from paralytic poliomyelitis at the age of 7 months... more
The aim of this paper is to describe a patient with severe postpolio problems who developed achalasia. A 66-year-old patient came to our observation for severe dysphagia. He had suffered from paralytic poliomyelitis at the age of 7 months and had severe residual deficits. At the age of 62 he presented with sudden pain localized in the distribution of the C4 and C5 dermatomes and an inability to abduct the left arm. At the time, he experienced only occasional and mild dysphagia; his esophagus was not dilated and emptied normally. Over the following months his muscular function improved, but dysphagia worsened. We found a megaesophagus with a sigmoid appearance and the manometric features of achalasia. Pneumatic dilatation produced good resolution of dysphagia. A year later manometry showed the reappearance of peristalsis after all wet swallows. In patients with postpolio dysphagia, the possible presence of achalasia must be considered.
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In vitro behaviour of the enteric-coating of a new pancreatic enzyme containing preparation in enteric-coated microtablets was evaluated, by incubating at 37 degrees C, under gentle agitation, the preparation under study in buffered... more
In vitro behaviour of the enteric-coating of a new pancreatic enzyme containing preparation in enteric-coated microtablets was evaluated, by incubating at 37 degrees C, under gentle agitation, the preparation under study in buffered gastric (pH 2, 3, 4, 5, 6) and in buffered duodenal juice (pH 3, 4, 5, 6, 7, 8) for 30, 60, 90, 120 minutes. Lipase and chymotripsin activities were measured at each time and pH in the solution and in the undissolved microtablets. The drug under study showed a good enteric-coating, preserving about 100% of the enzyme content, when incubated in buffered gastric juice, up to pH 6, and releasing in the solution, during incubation in buffered duodenal juice, 75% of its enzyme content at pH 7 and 8. Therefore, the pancreatic enzymes contained in this new enteric-coated microtablet preparation are well protected against inactivation from acid and are bioavailable for digestion of alimentary substrates at optimal or near optimal pH in duodenal juice.
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Controversial data have been reported on gastric acid secretion in patients with chronic pancreatitis. Moreover, studies on gastroduodenal morphological changes in patients with this disease and with other alcohol-related conditions have... more
Controversial data have been reported on gastric acid secretion in patients with chronic pancreatitis. Moreover, studies on gastroduodenal morphological changes in patients with this disease and with other alcohol-related conditions have given different results. Basal and penta-gastrin-stimulated gastric secretion, histological changes of gastric and duodenal mucosa, and basal and meal-stimulated gastrin were measured in 21 patients with chronic alcoholic pancreatitis and in the following pair-matched groups: 21 chronic alcoholics and 21 control subjects (nonulcer dyspepsia), and in 19 patients with proven liver cirrhosis of alcoholic origin. No patient suffered from peptic ulcers. Moreover, gastric secretion was also measured in 51 patients with proven duodenal ulcers and in 34 healthy subjects. Basal acid output in patients with chronic pancreatitis was significantly higher (p less than 0.05) than in the other groups, except for the patients with duodenal ulcers. Peak acid output ...
Research Interests: Pancreatitis, Humans, Alcoholism, Chronic Disease, Female, and 6 moreMale, Clinical Sciences, Middle Aged, Adult, Stomach, and Duodenum
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Research Interests: Humans, Blood Glucose, Insulin, Female, Male, and 5 moreFollow-up studies, Middle Aged, Adult, Time Factors, and Duodenal Ulcer
Using an immunoenzymatic method, we studied lipase in the serum and urine of 23 controls, 22 chronic pancreatitis patients in symptomatic remission, and in 9 patients with proven pancreatic cancer. Serum and urine lipase and its... more
Using an immunoenzymatic method, we studied lipase in the serum and urine of 23 controls, 22 chronic pancreatitis patients in symptomatic remission, and in 9 patients with proven pancreatic cancer. Serum and urine lipase and its fractional urinary clearance were compared with those of amylase and immunoreactive trypsin. Lipase immunoreactivity was detectable in the urine of 81.5% of the studied subjects (controls: 82%, chronic pancreatitis: 86%, pancreatic cancer: 66%); its output was higher than the upper limit of controls in 31.8% of chronic pancreatitis and in only 1 of pancreatic cancer, and it was significantly correlated with the urinary output of trypsin (r = 0.487, P less than 0.001), but not with that of amylase. A significant correlation was found between urinary output and serum levels for lipase, but not for trypsin or amylase. Fractional clearance of lipase was of the same magnitude as that of trypsin but only 0.1% that of amylase. 19% of chronic pancreatitis and pancre...
Research Interests: Humans, Chronic Disease, Female, Male, Middle Aged, and 4 moreAdult, Reference Values, Lipase, and Pancreatic neoplasms
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In order to investigate the role of circulating free trypsinogen and renal tubular dysfunction in affecting trypsin plasma-urine transfer, serum immunoreactive trypsin (IRT), its urinary output, IRT molecular size distribution, filtrable... more
In order to investigate the role of circulating free trypsinogen and renal tubular dysfunction in affecting trypsin plasma-urine transfer, serum immunoreactive trypsin (IRT), its urinary output, IRT molecular size distribution, filtrable immunoreactive trypsin, gamma-glutamyltransferase and alpha-glucosidase outputs were studied in 6 control subjects, 9 patients with pancreatic cancer and 15 with chronic pancreatitis. The majority of immunoreactivity was always eluted at a molecular weight of about 24,000 and might therefore be considered as free trypsinogen. Variable amounts of IRT at higher molecular weights, possibly represented by trypsin-inhibitor complexes, were also detected. Increasing IRT levels were generally accounted for by free trypsinogen, regardless of the nature of the disease. Unlike serum free trypsinogen levels, renal tubular damage, evaluated by means of the excretion of two high-molecular weight urinary enzymes, seems to play a prominent role in explaining tryps...
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Serum and urine elastase 1, its renal output and clearance and urinary gamma-glutamyltransferase and ribonuclease excretions were measured in 16 patients with pancreatic cancer, 23 with chronic pancreatitis and in 22 healthy controls in... more
Serum and urine elastase 1, its renal output and clearance and urinary gamma-glutamyltransferase and ribonuclease excretions were measured in 16 patients with pancreatic cancer, 23 with chronic pancreatitis and in 22 healthy controls in order to evaluate elastase 1 plasma-urine transfer in chronic pancreatic disease and to investigate any factors that might influence the clearance of this enzyme. In an additional group of 17 patients with different pancreatic diseases the serum molecular size distribution of elastase 1 after chromatography was ascertained. An increased urinary elastase 1 output was found in 4/16 patients with pancreatic cancer and in 6/23 with chronic pancreatitis. No correlation was found between circulating elastase 1 and its urinary output; a negative correlation was detected between the serum levels of this enzyme and its clearance. The excretion of ribonuclease and gamma-glutamyltransferase was correlated with elastase 1 output and clearance. While the majority...
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This study was undertaken in order to ascertain the behaviour of amylase and trypsin fractional clearances in chronic pancreatic disease and to speculate on the factors involved. Renal tubular function was also assessed in these patients.... more
This study was undertaken in order to ascertain the behaviour of amylase and trypsin fractional clearances in chronic pancreatic disease and to speculate on the factors involved. Renal tubular function was also assessed in these patients. An increase of both clearances was found in a number of patients with pancreatic cancer and chronic pancreatitis. Amylase urinary output seems to be mainly related to the circulating enzyme levels; urinary IRT is principally accounted for by a functional tubular impairment. Tubular damage was observed in a number of patients with chronic pancreatic disease. This was related to pancreatic inflammation in chronic pancreatitis and to several factors, among which jaundice and pancreatic damage, in pancreatic cancer.
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Serum levels of elastase-1 were measured in 174 patients with pancreatic diseases and in 131 controls and were compared with the circulating levels of trypsin, lipase and amylase and with clinical data. In 48 patients with chronic... more
Serum levels of elastase-1 were measured in 174 patients with pancreatic diseases and in 131 controls and were compared with the circulating levels of trypsin, lipase and amylase and with clinical data. In 48 patients with chronic pancreatitis serum enzyme levels were also compared with the pancreatic exocrine capacity. About 50% of the patients with chronic pancreatic disease showed increased levels of serum elastase, sometimes even in the face of long lasting pain-free periods, and/or of severe pancreatic impairment. On the contrary, serum trypsin and lipase were almost always either normal or below the normal range in the absence of painful relapses and/or in the presence of an impairment of the exocrine pancreatic function. A strict correlation was found between elastase-1 and trypsin (r = 0.778) and lipase (r = 0.834). However, controls and patients with chronic pancreatic diseases behaved differently, an increase in trypsin and in lipase levels being associated in the patients...
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Pancreatic calcifications are particularly frequent in patients with severe pancreatic insufficiency and long-lasting chronic pancreatitis. To clarify whether calcifications point to a more severe form of the disease, irrespective of its... more
Pancreatic calcifications are particularly frequent in patients with severe pancreatic insufficiency and long-lasting chronic pancreatitis. To clarify whether calcifications point to a more severe form of the disease, irrespective of its duration, we have retrospectively analyzed patients with chronic pancreatitis submitted to the secretin-cerulein test in our center over a six-year period. Out of 120 patients, calcifications were found in 55. Higher alcohol intake and longer duration of the disease were found in patients with calcifications, compared with patients without calcifications (p less than 0.001). In both groups, lipase and chymotrypsin were more severely impaired than bicarbonate; a greater reduction of pancreatic exocrine function was found in patients with calcifications, compared to those without (p less than 0.001, Mann-Whitney U-test). When the patients were classified according to the duration of the disease or the severity of exocrine function impairment, higher p...
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Isoamylase analysis by isoelectric focusing was performed in the serum of 30 healthy volunteers, 65 patients with acute or chronic pancreatic diseases, nine with acute abdomen, four with macroamylasemia, and four with duodenal... more
Isoamylase analysis by isoelectric focusing was performed in the serum of 30 healthy volunteers, 65 patients with acute or chronic pancreatic diseases, nine with acute abdomen, four with macroamylasemia, and four with duodenal duplication. In controls, up to four fractions (2 salivary, 2 pancreatic) were found; the pancreatic fractions were as a mean 44.7% (SD 8.6) of total. In chronic pancreatitis, only patients with steatorrhea showed a significant reduction of pancreatic isoamylase (p less than 0.001). In all patients with acute pancreatitis or pseudocysts, an additional fraction (similar to the so-called P3 fraction) was resolved. Moreover, additional isoenzymes were found in all patients with severe acute pancreatitis or pseudocysts, and not in controls or patients with mild forms, acute abdomen or duodenal duplication. A similar pattern was shown in a stored control serum after 10 mo at -20 degrees C. These fractions disappeared after successful surgical drainage. No specific ...
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Human fibrin sealant (Tissucol) has been used in surgery for its haemostatic and sealing actions and stimulating effect on tissue regeneration. Recently it has been used in endoscopy, but controlled trials are not yet available. The aim... more
Human fibrin sealant (Tissucol) has been used in surgery for its haemostatic and sealing actions and stimulating effect on tissue regeneration. Recently it has been used in endoscopy, but controlled trials are not yet available. The aim of this study was to evaluate the efficacy of Tissucol on the healing rate of duodenal ulcers (DU). Thirty nine previously untreated DU patients received ranitidine 150 bid plus endoscopically applied either placebo (19 patients) or Tissucol (20 patients). Sixty-five percent of the patients in the Tissucol group and 21% in the control group healed after two weeks (p less than 0.02), 75 and 52.6% respectively after 4 weeks (NS). The endoscopic application of Tissucol seems to influence the healing of duodenal ulcer and its use could be suggested in selected patients with DU.
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Thirty-four patients with chronic calcified pancreatitis were evaluated clinically and biochemically (at a time when painful relapses were not present) every 9 mo for 3 yr; 25 of them were also studied at 4 and 9 yr. Serum elastase-1,... more
Thirty-four patients with chronic calcified pancreatitis were evaluated clinically and biochemically (at a time when painful relapses were not present) every 9 mo for 3 yr; 25 of them were also studied at 4 and 9 yr. Serum elastase-1, trypsin, lipase, and amylase in the same sera were measured at each visit; levels on entry and variations during the study were compared with the clinical and functional data of the patients. On entry, low levels of elastase-1 were found in 11.7% of the patients, high levels in 41.1%; in contrast, high levels of trypsin and lipase were found in only a small number of patients (5.8 and 11.7%, respectively), whereas low levels were present in a substantial number (47.8 and 32.3% for trypsin and lipase, respectively). Over time, we found a significant (p = 0.000002) reduction in elastase-1 levels. Such reduction was not found for trypsin, lipase, or amylase. The reduction of serum elastase-1 was significantly (p less than 0.003) more frequent in patients ...
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The diagnostic capacity of a semiquantitative latex test for lipase measurement was compared with the measurement of other pancreatic enzymes in 100 consecutive patients admitted to a general hospital for recent onset of severe abdominal... more
The diagnostic capacity of a semiquantitative latex test for lipase measurement was compared with the measurement of other pancreatic enzymes in 100 consecutive patients admitted to a general hospital for recent onset of severe abdominal pain. Positive results of the test were found in two patients with acute pancreatitis, and in one out of three chronic pancreatitis relapses. The test yielded false-positive results only in two patients who had no apparent pancreatic involvement. A marginal increase in other pancreatic enzymes was found in a few patients with acute biliary or appendicular problems. In conclusion, the lipase latex test can be suggested in an emergency setting as a quick and reliable alternative to serum amylase to rule out a diagnosis of acute pancreatitis.
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An increase in fasting cholecystokinin (CCK) levels has been reported in patients with pancreatic insufficiency, but the relationship of these findings to the clinical conditions has not been established. We, therefore, measured fasting... more
An increase in fasting cholecystokinin (CCK) levels has been reported in patients with pancreatic insufficiency, but the relationship of these findings to the clinical conditions has not been established. We, therefore, measured fasting serum CCK-like immunoreactivity in 70 patients with chronic relapsing pancreatitis (CRP) (38 non-surgically treated and 32 previously surgically treated) and in 44 healthy subjects. The radioimmunoassay detected three circulating forms of CCK. The mean value of the CCK levels in CRP (260.3 +/- 300.8 pg/ml) was significantly higher than that of the controls (56.6 +/- 61.7 pg/ml) (p less than 0.001), but in 39 (56.7%) of the 70 CRP cases the CCK was in the normal range. A smaller overlap with the controls was observed in the non-surgically than in the surgically treated patients (45 vs. 71.8%). In the 38 non-surgically treated CRP cases no relationship was observed between the CCK levels and each of the following parameters: age, length of history, pre...