290 results on '"Uomo G"'
Search Results
152. Prophylaxis with meropenem of septic complications in acute pancreatitis: a randomized, controlled trial versus imipenem.
- Author
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Manes G, Rabitti PG, Menchise A, Riccio E, Balzano A, and Uomo G
- Subjects
- Adult, Aged, Aged, 80 and over, Bacteria drug effects, Bacteria isolation & purification, Female, Humans, Male, Meropenem, Middle Aged, Prospective Studies, Sepsis complications, Sepsis microbiology, Time Factors, Treatment Outcome, Anti-Bacterial Agents therapeutic use, Imipenem therapeutic use, Pancreatitis, Acute Necrotizing complications, Sepsis prevention & control, Thienamycins therapeutic use
- Abstract
Objectives: Prophylactic antibiotics are helpful in decreasing the incidence of septic complications in acute pancreatitis. The aim of this study was to compare the efficacy of meropenem, a new carbapenem antibiotic, with that of imipenem, which is the standard prophylactic treatment in patients with severe acute pancreatitis., Methods: One hundred seventy-six patients with necrotizing pancreatitis were prospectively randomized to prophylactic treatment with 0.5 g meropenem t.i.d. intravenously or 0.5 g imipenem q.i.d. intravenously. The occurrence of infection of pancreatic necrosis, rate of extrapancreatic infections, systemic and local complications, need for surgery, mortality rate, and length of hospitalization were recorded for each group. When a septic complication of pancreatic necrosis was suspected, fine needle aspiration with cultures of the sample was performed. Surgery was performed in cases of verified infected necrosis., Conclusion: No difference was observed between patients treated with meropenem and those treated with imipenem in terms of incidence of pancreatic infection (11.4% versus 13.6%) and extrapancreatic infections (21.6% versus 23.9%) and clinical outcome. Meropenem is as effective as imipenem in preventing septic complications of patients with severe acute pancreatitis.
- Published
- 2003
- Full Text
- View/download PDF
153. Relationship of sliding hiatus hernia to gastroesophageal reflux disease: a possible role for Helicobacter pylori infection?
- Author
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Manes G, Pieramico O, Uomo G, Mosca S, de Nucci C, and Balzano A
- Subjects
- Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Cohort Studies, Comorbidity, Confidence Intervals, Esophagoscopy, Female, Follow-Up Studies, Gastritis diagnosis, Gastroesophageal Reflux diagnosis, Helicobacter Infections diagnosis, Hernia, Hiatal diagnosis, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Prevalence, Probability, Risk Assessment, Sex Distribution, Gastritis epidemiology, Gastroesophageal Reflux epidemiology, Helicobacter Infections epidemiology, Helicobacter pylori isolation & purification, Hernia, Hiatal epidemiology
- Abstract
Sliding hiatal hernia is a common endoscopic finding with a prevalence that increases with the age of patients. Although nearly all patients with GERD have HH, only a minority of patients with hernia reports reflux symptoms. Our hypothesis is that H. pylori infection may be responsible for the high number of asymptomatic hernias. After exclusion of patients with peptic ulcer, 507 patients with an endoscopic diagnosis of hernia were considered. Patients were divided into three groups: A, < or = 45 years, 141 patients; B, 46-60 years, 144 patients; and C, > or = 61 years, 222 patients. Presence of reflux symptoms (questionnaire) and esophagitis, H. pylori status, and gastric histology were recorded. The prevalence of hernia in the total series was 11% in group A, 23% in B, and 38% in C. Aging was associated with a significant increase in H. pylori prevalence and corpus gastritis scores, and a parallel decrease of GERD symptom prevalence, which was 66.6% in group A, 52.1% in B, and 46.8% in C (P < 0.01). Taking the three groups together, prevalence of H. pylori infection was higher in patients without GERD than with GERD (66.4 vs 57.3%, P < 0.05), and higher in patients with nonerosive GERD than erosive GERD (62.8 vs 48.6%, P = 0.02); corpus gastritis scores were significantly higher in patients without GERD than those with GERD and in those with nonerosive than erosive GERD. In conclusion, H. pylori infection protects against development of GERD in subjects with hiatus hernia. This effect is significantly more evident in the elderly where, in spite of the high prevalence of hernia, only a small number of individuals develop GERD. The development of a corpus-predominant gastritis is probably responsible for this effect.
- Published
- 2003
- Full Text
- View/download PDF
154. [Primary septic arthritis of the sterno-clavicular joint].
- Author
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Russo R, Manzo E, Russo L, and Uomo G
- Subjects
- Humans, Male, Middle Aged, Arthritis, Infectious diagnosis, Arthritis, Infectious microbiology, Staphylococcal Infections diagnosis, Sternoclavicular Joint
- Abstract
Septic arthritis of the sternoclavicular joint (SCJ) is an uncommon form of arthritis generally occurring in immuno-compromised patients with contiguous or distant foci of infection and central venous catheters. Septic SCJ arthritis in previously healthy subjects is a very rare occurrence requiring a high index of suspicion for the diagnostic assessment. We report here one patient without predisposing factors presenting Staphylococcus aureus SCJ infection.
- Published
- 2002
155. How far are we from the most accurate classification system for chronic pancreatitis ?
- Author
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Uomo G
- Subjects
- Alcohol Drinking trends, Chronic Disease, Humans, Pancreatitis diagnosis, Pancreatitis etiology, Pancreatitis physiopathology, Pancreatitis, Alcoholic diagnosis, Pancreatitis, Alcoholic physiopathology, Pancreatitis classification
- Published
- 2002
156. Gemcitabine alone or with cisplatin for the treatment of patients with locally advanced and/or metastatic pancreatic carcinoma: a prospective, randomized phase III study of the Gruppo Oncologia dell'Italia Meridionale.
- Author
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Colucci G, Giuliani F, Gebbia V, Biglietto M, Rabitti P, Uomo G, Cigolari S, Testa A, Maiello E, and Lopez M
- Subjects
- Adenocarcinoma pathology, Adult, Aged, Antimetabolites, Antineoplastic administration & dosage, Antimetabolites, Antineoplastic adverse effects, Cisplatin administration & dosage, Cisplatin adverse effects, Deoxycytidine administration & dosage, Deoxycytidine adverse effects, Disease Progression, Disease-Free Survival, Female, Humans, Infusions, Intravenous, Male, Middle Aged, Pancreatic Neoplasms pathology, Treatment Outcome, Gemcitabine, Adenocarcinoma drug therapy, Antimetabolites, Antineoplastic pharmacology, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Cisplatin pharmacology, Deoxycytidine analogs & derivatives, Deoxycytidine pharmacology, Pancreatic Neoplasms drug therapy
- Abstract
Background: A prospective, randomized Phase III trial was performed to determine whether, compared with gemcitabine (GEM) alone, the addition of cisplatin (CDDP) to GEM was able to improve the time to disease progression and the clinical benefit rate in patients with advanced pancreatic adenocarcinoma. The objective response rate, overall survival rate, and toxicity patterns of patients in the two treatment arms were evaluated as secondary end points., Methods: Patients with measurable, locally advanced and/or metastatic pancreatic adenocarcinoma were randomized to receive GEM (Arm A) or a combination of GEM and CDDP (Arm B). In Arm A, a dose of 1000 mg/m(2) GEM per week was administered for 7 consecutive weeks, and, after a 2-week rest, treatment was resumed on Days 1, 8, and 15 of a 28-day cycle for 2 cycles. In Arm B, CDDP was given at a dose of 25 mg/m(2) per week 1 hour before GEM at the same dose that was used in Arm A. On Day 22, only GEM was administered. Patients were restaged after the first 7 weeks of therapy and then again after the other 2 cycles., Results: A total of 107 patients entered the trial: Fifty-four patients were randomized to Arm A, and 53 patients were randomized to Arm B. The median time to disease progression was 8 weeks in Arm A and 20 weeks in Arm B; this difference was statistically significant (P = 0.048). In Arm A, one complete response and four partial responses were recorded on the basis of an intent-to-treat analysis, with an overall response rate of 9.2% (95% confidence interval [95%CI], 3-20%). In Arm B, there were no complete responses, whereas 14 partial responses were achieved, with an overall response rate of 26.4% (95%CI, 15-40%). This difference in the overall response rates was statistically significant (P = 0.02). The tumor growth control rate (i.e., total number of patients who achieved complete responses, partial responses, and stable disease) was 42.6% (95%CI, 29-57%) in Arm A and 56.6% (95%CI, 42-70%) in Arm B. A clinical benefit was observed in 21 of 43 patients (49%) in Arm A and in 20 of 38 patients (52.6%) in Arm B without any significant difference. The median overall survival was 20 weeks for patients in Arm A and 30 weeks for patients in Arm B (P = 0.43). Toxicity was mild in both treatment arms, with no significant differences between the two groups except for the statistically higher incidence of Grade 1-2 asthenia in Arm B (P = 0.046)., Conclusions: The addition of CDDP to GEM significantly improved the median time to disease progression and the overall response rate compared with GEM alone. The clinical benefit rate was similar in both arms, whereas the median overall survival rate was more favorable for Arm B, although the difference did not attain statistical significance. The authors conclude that the combination of CDDP and GEM currently may be considered as an optimal treatment for patients with locally advanced and/or metastatic adenocarcinoma of the pancreas., (Copyright 2002 American Cancer Society. DOI 10.1002/cncr.10323)
- Published
- 2002
157. [Somatostatin analogues for the treatment of gastro-entero-pancreatic neuroendocrine tumours].
- Author
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Uomo G, Germano D, and Rabitti PG
- Subjects
- Humans, Antineoplastic Agents, Hormonal therapeutic use, Gastrointestinal Neoplasms drug therapy, Neuroendocrine Tumors drug therapy, Pancreatic Neoplasms drug therapy, Somatostatin analogs & derivatives, Somatostatin therapeutic use
- Abstract
Somatostatin has represented a significant breakthrough in the treatment of patients with hormone-acting, neuroendocrine gastro-intestinal-pancreatic (NEGEP) neoplasms, even if its short half-life made it impractical in the clinical practice. Over the last recent years new long-acting formulations have been developed from the native peptide. Octreotide, lanreotide and vapeotide are octapeptides with similar biological activity, remarkable stability and longer half-life; an extended-release formulation of octreotide (Octreotide-LAR) and lanreotide (Lanreotide-SR) have been more recently developed by incorporating the peptide in microspheres of a biodegradable polymer. This formulation was conceived to provide patients with the convenience of a once-a-month or twice-a-month injection and to ensure a stable serum concentration between injections and good clinical control of NEGEP tumours symptoms. Nowadays, somatostatin long-acting analogues represent the first treatment option in those patients who doesn't underwent radical surgery; in addition, these substances present no important side effects, ameliorate the prognosis and can exert some degree of tumour growth control.
- Published
- 2001
158. Role of hereditary pancreatitis and CFTR gene mutations in the aetiology of acute relapsing pancreatitis of unknown origin. How are they important?
- Author
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Uomo G, Manes G, and Rabitti PG
- Subjects
- Acute Disease, Chronic Disease, Cystic Fibrosis Transmembrane Conductance Regulator physiology, Genetic Predisposition to Disease genetics, Humans, Mutation genetics, Pancreatitis genetics, Recurrence, Cystic Fibrosis Transmembrane Conductance Regulator genetics, Mutation physiology, Pancreatitis etiology, Pancreatitis pathology
- Published
- 2001
159. Pancreatic head mass: how can we treat it? Acute pancreatitis: conservative treatment.
- Author
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Uomo G
- Subjects
- Acute Disease, Humans, Pancreatitis complications, Pancreatitis diet therapy, Pancreatitis drug therapy
- Published
- 2000
160. Images of interest. Hepatobiliary and pancreatic: a woman who underwent cholecystectomy.
- Author
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Mosca S, Galasso G, Ragozzino A, and Uomo G
- Subjects
- Aged, Cholangiopancreatography, Endoscopic Retrograde, Cholelithiasis surgery, Fatal Outcome, Female, Humans, Laparotomy, Pancreatic Ducts surgery, Pancreatitis etiology, Pancreatitis surgery, Reoperation, Sphincterotomy, Endoscopic, Tomography, X-Ray Computed, Cholecystectomy adverse effects, Pancreatic Ducts diagnostic imaging, Pancreatitis diagnostic imaging
- Published
- 2000
- Full Text
- View/download PDF
161. Chronic pancreatitis: relation to acute pancreatitis and pancreatic cancer.
- Author
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Uomo G and Rabitti PG
- Subjects
- Acute Disease, Chronic Disease, Disease Susceptibility, Humans, Risk Factors, Pancreatic Neoplasms etiology, Pancreatitis complications, Pancreatitis etiology
- Abstract
The relationship between chronic pancreatitis (CP) and other pancreatic diseases, such as acute pancreatitis (AP) and pancreatic cancer (PK), remains a fairly debated question. The progression from alcoholic AP to CP is controversial, and some long-term epidemiological studies suggest that alcoholic CP might be the result of recurrent alcoholic AP (necrosis-fibrosis sequence) and a subgroup of alcoholics may present recurrent AP without progression to CP. Other predisposing factors (genetic, nutritional, environmental) seems to be important in inducing different outcomes of pancreatic damage due to alcohol. However, recurrent episodes of AP are clearly involved in pathophysiology of CP in patients with hereditary pancreatitis. A relationship between CP and subsequent PK development has long been suspected, but we actually don't know whether this association is direct or is the result of confounding factors, such as alcohol intake or cigarette smoking. Many issues should be considered as indicators of a causal association, and several of them are not fulfilled. Nonetheless, epidemiological studies (case-control or cohort studies) showed that the risk of PK is increased in patients with CP; the risk is significantly higher in tropical calcifying CP and hereditary pancreatitis. Studies on growth factors, oncogenes, tumor-suppressor genes, and angiogenesis suggest that the sequence PC-KP is plausible from the biological standpoint.
- Published
- 2000
162. Management of acute pancreatitis in clinical practice. ProInf - A.I.S.P. Study Group. Progetto Informatizzato Pancreatite Acuta--Associazione Italiana Studio Pancreas.
- Author
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Uomo G, Pezzilli R, and Cavallini G
- Subjects
- Acute Disease, Controlled Clinical Trials as Topic, Female, Health Care Costs, Humans, Italy, Male, Pancreatitis economics, Pancreatitis physiopathology, Patient Care economics, Patient Care methods, Prognosis, Severity of Illness Index, Treatment Outcome, Pancreatitis diagnosis, Pancreatitis therapy
- Abstract
Over the last few years, remarkable progress has been made in diagnosis, severity assessment and treatment as well as in our understanding of the pathophysiology of acute pancreatitis. New treatment modalities and new specific drugs have been introduced and this has led to practical changes in the daily bedside management of patients with acute pancreatitis. Treatment is essentially medical, both for mild and severe disease, and is aimed at reducing abdominal pain, restoring electrolyte and fluid losses, removing the aetiological factor(s), attenuating inflammation and autodigestive processes, as well as preventing local and systemic complications. Diagnostic and interventional percutaneous or endoscopic procedures are indicated mainly for patients with severe forms of the disease. Surgery is generally indicated for patients with necrosis infection or other local complications not manageable by percutaneous or endoscopic means.
- Published
- 1999
163. Neopterin serum levels in pancreatic adenocarcinoma.
- Author
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Manes G, Spada OA, Rabitti PG, Feola B, Misso S, Minerva A, and Uomo G
- Subjects
- Adenocarcinoma diagnosis, Adult, Aged, CA-19-9 Antigen blood, Chronic Disease, Diagnosis, Differential, Female, Humans, Interleukin-6 blood, Male, Middle Aged, Pancreatic Neoplasms diagnosis, Pancreatitis blood, Pancreatitis diagnosis, Predictive Value of Tests, ROC Curve, Receptors, Interleukin-2 blood, Reference Values, Sensitivity and Specificity, Tumor Necrosis Factor-alpha metabolism, Adenocarcinoma blood, Neopterin blood, Pancreatic Neoplasms blood
- Abstract
Conclusions: Activation of the immune system in pancreatic cancer is demonstrated by increased serum levels of neopterin, soluble Interleukin 2 receptor (sIL-2R), and Interleukin 6 (IL-6). Determination of these parameters does not provide benefit in the diagnosis of pancreatic cancer., Background: The aim of the study was to define the diagnostic value of serum neopterin, an in vivo marker of macrophage activity, in pancreatic cancer., Methods: Thirty-four patients with pancreatic cancer were studied. According to the UICC TNM classification 6 were in stage I, 9 in stage II, 6 in stage III, and 13 in stage IV. Twenty-four patients with chronic pancreatitis, 72 healthy blood donors, and 20 patients with jaundice resulting from gallstones were used as control groups. Neopterin, tumor necrosis factor (TNF), sIL-2R, and IL-6 were measured in serum in the different groups; Ca 19-9 was also measured in cancer and pancreatitis., Results: Serum levels of neopterin, sIL-2R, and IL-6 were higher in cancer than in pancreatitis and healthy donors, and in pancreatitis higher than in donors. Serum TNF was similar in the three groups. Serum levels of neopterin, TNF, sIL-2R, and IL-6 were not related to the tumor stage or to Ca 19-9 levels. A positive correlation was found between sIL-2R and neopterin levels. Neopterin levels in obstructive jaundice were similar to those of pancreatitis. Ca 19-9 at the recommended cutoff of 37 U/mL showed the best sensitivity and specificity (88.2 and 87.5%, respectively). At the selected cutoff neopterin, TNF, sIL-2R, and IL-6 showed low sensitivity and specificity in differentiating cancer from pancreatitis.
- Published
- 1999
- Full Text
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164. Controlled clinical trial of pefloxacin versus imipenem in severe acute pancreatitis.
- Author
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Bassi C, Falconi M, Talamini G, Uomo G, Papaccio G, Dervenis C, Salvia R, Minelli EB, and Pederzoli P
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, Severity of Illness Index, Anti-Infective Agents therapeutic use, Imipenem therapeutic use, Pancreatitis, Acute Necrotizing prevention & control, Pefloxacin therapeutic use, Thienamycins therapeutic use
- Abstract
Background & Aims: Antibiotic prophylaxis in severe pancreatitis has recently yielded promising clinical results, with imipenem significantly reducing the incidence of infected necrosis compared with an untreated control group. On the bases of pefloxacin's spectrum of action and pancreatic penetration, we investigated whether such drugs represent a valid alternative to imipenem., Methods: In a multicenter study, 60 patients with severe acute pancreatitis with necrosis affecting at least 50% of the pancreas were randomly allocated to receive intravenous treatment for 2 weeks with pefloxacin, 400 mg twice daily (30 patients), or imipenem, 500 mg three times daily (30 patients), within 120 hours of onset of symptoms. Age, sex, body weight, Ranson and Apache II scores, C-reactive protein, etiology, and time from onset of symptoms to treatment were well matched in the two groups., Results: The incidences of infected necrosis and extrapancreatic infections were 34% and 44%, respectively, in the pefloxacin group and 10% and 20% in the imipenem group. Imipenem proved significantly more effective in prevention of pancreatic infections (P = 0.05). Mortality was not significantly different in the two groups., Conclusions: Despite its theoretical potential, pefloxacin is inferior to imipenem in the prevention of infections associated with severe pancreatitis.
- Published
- 1998
- Full Text
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165. Influence of advanced age and related comorbidity on the course and outcome of acute pancreatitis.
- Author
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Uomo G, Talamini G, Rabitti PG, Cataldi F, Cavallera A, and Rengo F
- Subjects
- Acute Disease, Aged, Aged, 80 and over, Chi-Square Distribution, Comorbidity, Female, Humans, Male, Pancreatitis diagnosis, Pancreatitis etiology, Prognosis, Retrospective Studies, Severity of Illness Index, Statistics, Nonparametric, Aging, Pancreatitis mortality
- Abstract
Background and Aims: Aging process and comorbidity have been held to influence the course and outcome of acute pancreatitis in elderly patients. The aim of the present study was to investigate this issue in a large series of patients > or = 70 years of age suffering from acute pancreatitis., Patients and Methods: A retrospectively study was carried out on 439 patients with a first episode of AP. The patients were divided into two age groups: < or = 69 years (n = 340) and > or = 70 years (n = 99). Differences in general characteristics, aetiological factors, blood tests and laboratory data, severity of the disease and outcome were evaluated. The presence of intercurrent diseases was also investigated in the two age groups., Results: No significant difference was observed in the distribution of the various aetiological factors in the two age groups considered. The percentage of patients with necrotizing forms of AP, Ranson prognostic score for severity, local and systemic complications, the number of patients requiring surgical intervention or endoscopic sphincterotomy, as well as length of hospital stay were similar in the two groups. Considering the patients suffering from necrotizing acute pancreatitis, a significant increase (p = 0.01) in mortality was observed in > or = 70-year-old patients (25.8 vs 7.8%). Associated diseases were significantly more frequent in advanced age (63.6 vs 41.4%; p = 0.0004), but comorbidity did not correlate with the presence of pancreatic necrosis, the need for surgery or endoscopic sphincterotomy, and with mortality., Conclusions: The results of this study suggest that advanced age and related comorbidity have only a limited influence on the course and outcome of acute pancreatitis.
- Published
- 1998
166. Endoscopic sphincterotomy for acute pancreatitis: arguments in favour.
- Author
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Uomo G and Slavin J
- Subjects
- Acute Disease, Clinical Trials as Topic, Female, Follow-Up Studies, Humans, Male, Treatment Outcome, Pancreatitis surgery, Sphincterotomy, Endoscopic adverse effects, Sphincterotomy, Endoscopic methods
- Abstract
Pathogenetic factors of acute biliary pancreatitis include persistent or transient, absolute or relative, obstruction of Vater's ampulla or the main pancreatic duct and reflux of bile into the pancreatic ducts or of pancreatic juice into the bile ducts. There is an increasing incidence of persisting common bile duct stones in the more severe forms of acute biliary pancreatitis, in patients who die, and in patients with pancreatic necrosis. All these findings provide a rational basis for the use of early biliary decompression in patients with acute biliary pancreatitis. Endoscopic sphincterotomy offers a cost-effective and safe alternative to surgical biliary decompression with an overall morbidity rate of 8% and mortality rate of 2.4%. Randomized clinical trials showed that endoscopic sphincterotomy is useful in patients with predicted severe attack of acute biliary pancreatitis and is clearly indicated in all patients who are jaundiced or who have associated cholangitis. In addition, the procedure is valid in preventing recurrent attack of acute biliary pancreatitis in high risk elderly patients with gallstones, unfit for any kind of cholecystectomy.
- Published
- 1998
167. [Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy].
- Author
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Mosca S, Uomo G, Ceglia T, Galasso G, Ragozzino A, De Ritis R, and Ascione A
- Abstract
Background: Diagnostic and therapeutic endoscopic cholangiopancreatography (ERCP) is more difficult in patients with Billroth II gastrectomy., Methods: Personal experience in the last 28 months with 38 ERCP regarding 33 Billroth II patients representing the 5.4% of total number of ERCP performed in the same period is reported., Results: Choledochal lithiasis could be treated in all cases observed also if two observed patients necessitated of two ERCP procedure. Only one patient with biliary stenosis could not be treated because of failed sphincterotomy and deep incannulation. The most difficult step in the procedure was duodenal intubation. A final ERCP success rate was 79%. EST could be performed in most cases (16 out of 17 patients=94%). No complications are reported. The use of the lateral viewing duodenoscope is emphasized., Conclusions: Today, ERCP and endoscopic sphincterotomy (EST) give similar results and no higher risk in patients with regular anatomy or in patients with Billroth II gastrectomy.
- Published
- 1998
168. Increased risk for Helicobacter pylori recurrence by continuous acid suppression: a randomized controlled study.
- Author
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Manes G, Domínguez-Muñoz JE, Uomo G, Labenz J, Hackelsberger A, and Malfertheiner P
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- Adult, Aged, Aged, 80 and over, Biopsy, Colony Count, Microbial, Duodenal Ulcer drug therapy, Duodenal Ulcer metabolism, Endoscopy, Digestive System, Female, Follow-Up Studies, Gastric Mucosa metabolism, Gastric Mucosa microbiology, Helicobacter Infections drug therapy, Helicobacter Infections metabolism, Histamine H2 Antagonists therapeutic use, Humans, Male, Middle Aged, Prospective Studies, Ranitidine therapeutic use, Recurrence, Risk Factors, Duodenal Ulcer microbiology, Gastric Acid metabolism, Gastric Mucosa drug effects, Helicobacter Infections microbiology, Helicobacter pylori pathogenicity
- Abstract
Background and Aims: Acid hyposecretion may enhance Helicobacter pylori colonization. We tested the hypothesis that maintenance therapy with ranitidine after cure of Helicobacter pylori infection increases the risk of recurrence of infection., Patients and Methods: Sixty-six patients with duodenal ulcer and cured Helicobacter pylori infection were randomly assigned to 12 months maintenance treatment with ranitidine 150 mg daily (group A) or no treatment (group B). Follow-up consisted of clinical and endoscopic controls with biopsies for histology and rapid urease test every 4 months., Results: Six patients, 3 in each group, were lost to follow up. Helicobacter pylori recurrence occurred in 9 patients in group A and in 2 patients in group B (30% versus 7%; p < 0.05). Duodenal ulcer recurred in one patient in group A and in 2 in group B, all three patients were reinfected with Helicobacter pylori. A corpus-predominant gastritis was observed in all reinfected patients in group A but in none in group B., Conclusions: Long-term inhibition of gastric acid secretion after eradication of Helicobacter pylori increases the risk of recurrence of infection. Our data imply that gastric acid not only influences the pattern of Helicobacter pylori localization in gastric mucosa, but also plays a key role in preventing recurrence of infection with Helicobacter pylori.
- Published
- 1998
169. Serum interleukin-6 in acute pancreatitis due to common bile duct stones. A reliable marker of necrosis.
- Author
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Manes G, Spada OA, Rabitti PG, Pacelli L, Iannaccone L, and Uomo G
- Subjects
- Acute Disease, Adult, Aged, Biomarkers, C-Reactive Protein analysis, Cholangiopancreatography, Endoscopic Retrograde, Female, Humans, Male, Middle Aged, Necrosis, Pancreas pathology, Pancreatitis blood, Pancreatitis etiology, Prognosis, ROC Curve, Time Factors, Tomography, X-Ray Computed, Gallstones complications, Interleukin-6 blood, Pancreatitis diagnosis
- Abstract
In a prospective clinical study we have assessed the value of serum interleukin-6 in comparison with C-reactive protein in discriminating necrotizing from oedematous acute pancreatitis due to common bile duct stones in the first hours of disease. The study comprised 36 patients with acute biliary pancreatitis; inclusion criteria were admission in hospital within 48 hours from the onset of symptoms, availability of contrast enhanced CT scan within 72 hours from admission and presence of common bile duct stones at early ERCP. A sample of serum was taken at hospitalization and interleukin-6 and C-reactive protein were measured. Interleukin-6 levels were significantly higher in necrotizing pancreatitis, being closely related to the extension of necrosis. C-reactive protein showed low efficacy in detecting necrotizing forms, although its levels were higher than in oedematous. We conclude that serum interleukin-6 is a very reliable marker of necrosis in the first 48 hours of acute biliary pancreatitis.
- Published
- 1997
170. Endoscopic sphincterotomy and recurrence of acute pancreatitis in gallstone patients considered unfit for surgery.
- Author
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Uomo G, Manes G, Laccetti M, Cavallera A, and Rabitti PG
- Subjects
- Acute Disease, Aged, Aged, 80 and over, Female, Humans, Male, Prospective Studies, Recurrence, Cholelithiasis surgery, Pancreatitis prevention & control, Sphincterotomy, Endoscopic
- Abstract
The aim of the present prospective study was to investigate whether endoscopic sphincterotomy may be useful in preventing recurrence of acute pancreatitis in patients with gallstones and a high anesthesiological risk of cholecystectomy. Twenty-six elderly patients with severe cardiopulmonary, hepatic, and renal diseases were considered. Endoscopic sphincterotomy was successful in 19 cases (group A: mean age, 78.4 years; range, 71-87) and failed in 7 patients (group B: mean age, 79.8 years; range 73-85). In the follow-up period biliary pain without an increase in pancreatic serum enzymes occurred in six patients in group A and in all patients in group B (p = 0.002); recurrence of acute biliary pancreatitis with a need for hospitalization occurred in one patient in group A and in four patients in group B (p = 0.01). These results suggest that endoscopic sphincterotomy may be considered a very useful option in reducing the recurrence of acute biliary pancreatitis in elderly patients with gallstones and a high anesthesiological risk of cholecystectomy.
- Published
- 1997
- Full Text
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171. Periampullary extraluminal duodenal diverticula and acute pancreatitis: an underestimated etiological association.
- Author
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Uomo G, Manes G, Ragozzino A, Cavallera A, and Rabitti PG
- Subjects
- Acute Disease, Adult, Aged, Cholangiopancreatography, Endoscopic Retrograde, Diagnosis, Differential, Diverticulum diagnosis, Duodenal Diseases diagnosis, Female, Humans, Male, Middle Aged, Pancreatitis diagnosis, Ampulla of Vater, Diverticulum complications, Duodenal Diseases complications, Pancreatitis etiology
- Abstract
Objectives: The aim of this study was to investigate the etiological role of periampullary extraluminal duodenal diverticula (PEDD) in acute pancreatitis (AP)., Methods: The study included 433 consecutive patients who underwent successful ERCP during the period 1992-1994; PEDD were discovered in 58 cases (13.4%); patients without PEDD (n = 375) were considered the control group. Indication for ERCP and final diagnosis were recorded in each case., Results: The age of patients with PEDD was significantly higher (p < 0.0001) than that of controls. The incidence of biliary lithiasis was 65.5% in PEDD and 40.8% in controls (p = 0.0001). A recent episode or acute phase of AP constituted the indication for ERCP in 62% of PEDD and 24.8% of controls (p < 0.0001); idiopathic AP was found more often (p = 0.04) in PEDD patients (13.7%) than in controls (1.8%)., Conclusions: PEDD should be included in the list of possible etiological factors of AP. The presence of PEDD should be verified, mainly in elderly patients, before defining an AP episode as idiopathic.
- Published
- 1996
172. Nonsurgical treatment of acute necrotizing pancreatitis.
- Author
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Uomo G, Visconti M, Manes G, Calise F, Laccetti M, and Rabitti PG
- Subjects
- Acute Disease, Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Necrosis, Pancreatitis pathology, Pancreatitis therapy
- Abstract
Our objective was to analyze conservative management in a large series of acute necrotizing pancreatitis (ANP) patients in a specialized center for pancreatic disease in the Internal Medicine and Emergency Department of a 1,500-bed hospital. One hundred ninety-nine patients with ANP were considered (mean age, 55.4 +/- 18.2 years; biliary etiology, 60.3%). Identification of necrotizing forms of acute pancreatitis was obtained by ultrasonography, computed tomography scan, and surgery (53 cases). Exclusion of infection of the necrosis was based on clinical findings and percutaneous aspiration with bacteriological sampling. Medical treatment was started in all cases; 37 patients required ICU treatment; 87 patients underwent early endoscopic cholangiopancreatography (ERCP), and endoscopic sphincterotomy was performed in 61 cases; and percutaneous guided aspiration of necrosis and fluid collections was performed in 78 cases and in 9 patients with acute pseudocysts. Fifty-three patients (26.6%) underwent surgery; all patients (n = 30) with infected necrosis were in this group. One hundred forty-six patients were unoperated (73.3%): clinical resolution of ANP and biochemical normalization was achieved in 132 cases (66.3%) at discharge. Ultrasonographic follow-up documented morphological resolution of necrosis and fluid collections in 84 cases (57.5%) at different periods from the onset of ANP (range, 2.2-63.5 weeks); 16 patients dropped out and seven patients are still being followed. Spontaneous regression of acute pseudocysts was observed in 59.2%; percutaneous/endoscopic aspiration was successful in 33.3%. Mortality was 9.5%, significantly lower than the mortality observed in operated patients (28.3%; p = 0.002). Conservative treatment of ANP with sterile necrosis may allow healing in most cases, independent of the extent of necrosis or its association with major complications.
- Published
- 1996
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173. Early prediction of aetiology and severity of acute pancreatitis by serum amylase and lipase assays.
- Author
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Manes G, Rabitti PG, Laccetti M, Pacelli L, Carraturo I, and Uomo G
- Subjects
- Acute Disease, Adolescent, Adult, Aged, Aged, 80 and over, Clinical Enzyme Tests, Female, Humans, Male, Middle Aged, Pancreatitis enzymology, Predictive Value of Tests, Sensitivity and Specificity, Severity of Illness Index, Amylases blood, Lipase blood, Pancreatitis etiology
- Abstract
Objective: To evaluate whether simple pancreatic enzyme assays are useful in the early assessment of aetiology and prognosis of acute pancreatitis., Design: A retrospective clinical study., Setting: Department of Internal Medicine with a Pancreatic Disease Centre., Patients: The study included 246 patients with acute pancreatitis admitted to our Unit within the first 24 hours from the onset of disease. Amylase and lipase serum levels and lipase/amylase ratio were evaluated., Results: Serum amylase was higher in patients with necrotizing pancreatitis than oedematous and biliary pancreatitis than alcoholic (p < 0.009 and p < 0.05 respectively), but a high degree of overlap between values was found. No differences were noted in lipase serum levels. Lipase/amylase ratio was not different between patients with alcoholic and nonalcoholic pancreatitis., Conclusions: Evaluation of serum amylase and lipase is not useful for assessing aetiology and severity of acute pancreatitis, although amylase may be higher in severe and biliary forms.
- Published
- 1995
174. Rare presentation of endocrine pancreatic tumour: a case of glucagonoma without necrolytic migratory erythema?
- Author
-
Manes G, Pellegrini A, Riccardi F, and Uomo G
- Subjects
- Female, Follow-Up Studies, Glucagonoma complications, Humans, Middle Aged, Pancreatic Neoplasms complications, Glucagonoma diagnosis, Pancreatic Neoplasms diagnosis
- Abstract
The case of a 61-year-old woman with a probable pancreatic glucagonoma in reported. The clinical peculiarity of this case is the lack of the characteristic necrolytic migratory erythema (NME); the patient presented asthenia, weight loss and hyperglycemia. Ultrasonography, CT-scan and arterography showed a irregular pancreatic mass and secondary diffuse hepatic lesions. Fine needle aspiration cytology with immunohistochemistry and glucagon serum levels yielded to the diagnosis. Surgical treatment was not proposed because of the advanced stage of the disease; therefore, chemotherapy (streptozotocin, 5-fluorouracil) was performed. During a 16-month follow-up period the patient did not develop NME.
- Published
- 1995
175. Gabexate mesilate in the treatment of acute pancreatitis.
- Author
-
Pederzoli P, Bassi C, Falconi M, De Santis L, Uomo G, Rabitti PG, Talamini G, and Cavallini G
- Subjects
- Acute Disease, Adult, Aged, Aged, 80 and over, Aprotinin administration & dosage, Aprotinin therapeutic use, Double-Blind Method, Female, Gabexate administration & dosage, Humans, Male, Middle Aged, Necrosis, Pancreatic Pseudocyst prevention & control, Pancreatitis complications, Pancreatitis mortality, Prognosis, Prospective Studies, Sepsis prevention & control, Time Factors, Gabexate therapeutic use, Pancreatitis drug therapy
- Abstract
Despite controversial experimental and clinical findings, the use of Aprotinin (A) in the treatment of acute pancreatitis (AP) is still widespread in our country. Compared to A, Gabexate Mesilate (FOY) should have the following advantages: lack of antigenicity, low molecular weight with better cellular penetrance, wide inhibitory spectrum (against phospholipase A2 too) and good tolerability. In order to verify the efficacy of FOY versus, we decided to carry out a prospective multicenter (34 centers) randomized double blind trial in moderate-severe AP with FOY 3g/day versus A 1,500,000 U.I.K./day infused for 7 days with central venous line. Based on standard clinical, biochemical and radiological data, 199 patients suffering from AP were enrolled to the study from January 1989 to December 1990. The main admission criteria were: onset of the disease from no more than 72 hours, at least 2 Ranson positive criteria and C.T. evidence of acute pancreatic damage. Seventeen no protocol patients were excluded. The Etiology in the 182 analyzed patients (106 male, 76 female; mean age 57.6 years, range 21-91) were: biliary 102 (56%), alcohol 47 (25.8%), post-operative 13 (7.1%), unknown causes 13 (7.1%) and others 7 (3.8%). Median Ranson's Score was 3. CT examination showed 66 AP with edema, while 116 cases (63.7%) were recognized as severe forms with pancreatic necrotic involvement of 30% of the gland in 71 (61.2%), 50% in 31 (26.7%), and more than 50% in 14 (12.1%). Out of 182 patients, 91 were treated with A and 91 with FOY. The two groups were comparable regarding the main prognostic factors.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1995
176. [Predictive evaluation of acute necrotizing pancreatitis: results of a prospective study].
- Author
-
Uomo G, Rabitti PG, Laccetti M, Manes G, Carraturo I, Esposito P, and Visconti M
- Subjects
- Acute Disease, Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Necrosis, Pancreatitis blood, Pancreatitis diagnostic imaging, Predictive Value of Tests, Prognosis, Prospective Studies, Risk Factors, Tomography, X-Ray Computed, Pancreatitis physiopathology, Severity of Illness Index
- Abstract
Objectives: The aim of this study has been to evaluate the prognostic efficiency of some indexes based on biochemical and clinical criteria and computed tomography (CT) findings in the early phase of necrotizing acute pancreatitis., Methods: Prospective evaluation of 53 patients selected in two groups: a) 21 cases with severe prognosis (11 deaths and 10 patients with a complicated clinical outcome of more than 3 months) and b) 32 cases with lighter prognosis (clinical recovery within 3 months and no deaths). The prognostic indexes we considered were: CT-scan score, simplified prognostic criteria, modified Glasgow criteria, Hong-Kong criteria and C-reactive Protein serum value., Results: The best values of sensitivity were obtained by C-reactive protein (100%) and CT findings (90.4%), the best values of specificity by Hong-Kong criteria (87.5%) and of efficiency by CT (85.1%). As concerns sensitivity, the statistical comparison (McNemar test) showed a significantly lower Hong-Kong level versus all the other indexes and a significantly greater level C-reactive protein versus simplified prognostic criteria and modified Glasgow score. The comparison of the specificity results showed a significantly greater level of CT, Hong-Kong and simplified prognostic criteria versus C-reactive protein and versus modified Glasgow score. Associating CT-score with Hong-Kong improved the value of specificity (90.3%) and efficiency (90.3%)., Conclusions: Contrast enhancement CT-scan score showed the most valuable prognostic efficiency early during a severe form of necrotizing acute pancreatitis: the association with a simple biochemical index like Hong-Kong criteria (based on blood urea and glucose) yields an even greater accuracy in prognostic evaluation.
- Published
- 1995
177. Fusion and duplication variants of pancreatic duct system. Clinical and pancreatographic evaluation.
- Author
-
Uomo G, Manes G, D'Anna L, Laccetti M, Di Gaeta S, and Rabitti PG
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Cholangiopancreatography, Endoscopic Retrograde, Female, Humans, Male, Middle Aged, Pancreatic Ducts diagnostic imaging, Retrospective Studies, Pancreatic Ducts anatomy & histology
- Abstract
The aim of this study was to assess the incidence of fusion and duplication variants of the pancreatic duct system and their clinical significance. A total of 650 endoscopic retrograde cholangiopancreatography were reviewed; 485 cases with satisfactory imaging of the pancreatic ducts were included in the study. Anatomic variants were observed in 48 patients (9.9%), fusion variants were 54.1% of the cases (22 pancreas divisum and 4 functional divisum), and duplication variants were 45.8% (13 bifurcations of the main pancreatic duct, 4 loop, 2N-shape, 3 ring). Clinical indications to endoscopic cholangiopancreatography were idiopathic acute pancreatitis (33.3%), suspected chronic pancreatitis (18.7%), unexplained abdominal pain (14.5%), suspected pancreatic mass (10.4%), chronic hyperamylasemia (6.2%), and acute biliary pancreatitis (16.6%). Except for acute biliary pancreatitis (significantly more frequent in duplication variants), no statistical difference was observed between the groups with anatomical variants concerning clinical features.
- Published
- 1995
- Full Text
- View/download PDF
178. [The multiple-organ failure syndrome in acute pancreatitis. Its pathogenesis and treatment].
- Author
-
Visconti M, Rabitti PG, Uomo G, Giannattasio F, Varriale M, and Russo C
- Subjects
- Acute Disease, Combined Modality Therapy, Humans, Multiple Organ Failure mortality, Multiple Organ Failure physiopathology, Multiple Organ Failure therapy, Pancreatitis mortality, Pancreatitis physiopathology, Pancreatitis therapy, Syndrome, Multiple Organ Failure etiology, Pancreatitis complications
- Abstract
Multiple organ system failure (MOSF) is a severe clinical process that causes progressive renal and liver failure. Acute pancreatitis (AP) can cause MOSF. Several series document high mortality rate from necrotizing forms is associated with MOSF. The authors observed 199 cases of acute necrotizing pancreatitis in 10 years, with a mortality rate of 14.1%. MOSF occurred in 14 cases, resulting in death in 100% of affected patients. In AP, MOSF follows hemodynamic abnormalities suspected to be secondary to activation of kinins system and other vasoactive peptides that are responsible for pathogenetic mechanism of disease. Similar hemodynamic abnormalities can be observed in septic shock. Then many authors suppose causes of MOSF in AP are local (abscess, infection of pancreatic necrosis) and systemic septic complications or translocation of enteric bacteria or their endotoxins from the gut lumen. So it is important to provide prophylactic use of antibiotics that are effective against expected bacteria and also achieve a therapeutic concentration in pancreatic tissue and juice. Fluid replacement, nutritional support and other therapeutic strategies must be employed to prevent MOSF. When the MOSF is clearly developed, medical and surgical measures are unuseful and the mortality rate is very high also in an intensive care unit.
- Published
- 1995
179. Early prognostic assessment of acute pancreatitis with sterile necrosis. A perspective clinical study.
- Author
-
Manes G, Rabitti PG, Laccetti M, Perrotti F, Cavallera A, and Uomo G
- Subjects
- Acute Disease, Adult, Aged, Alcoholism complications, Female, Humans, Male, Middle Aged, Necrosis, Pancreatitis complications, Pancreatitis pathology, Prognosis, Prospective Studies, Sensitivity and Specificity, Survivors, Time Factors, Pancreas pathology, Pancreatitis mortality
- Abstract
In an attempt to early assess the prognosis of acute pancreatitis with sterile necrosis, we have perspectively studied 40 patients with necrotizing acute pancreatitis and sterile necrosis in the first 48 hours of disease. As prognostic parameters, we have considered the computed tomography score according to Balthazar, simplified prognostic criteria according to Agarwal, Glasgow criteria and C reactive protein. Patients were divided in A group, 5 patients who died, and B group, 35 patients who survived. Computed tomography score, simplified prognostic criteria and Glasgow criteria were significantly higher in A group than B (9.5 +/- 1 vs 6.3 +/- 1.9, 3.6 +/- 0.5 vs 1.2 +/- 1.2 and 5.4 +/- 1.7 vs 2.7 +/- 1.9 respectively); conversely, C reactive protein serum levels did not show significantly difference in the two groups. We conclude that the extension of pancreatic and extrapancreatic necrosis, as measured by computed tomography, as well as the failure of extrapancreatic organs and the development of systemic and metabolic complications, as assessed by simplified prognostic score and Glasgow criteria, are the most important determinant of prognosis in necrotizing acute pancreatitis with sterile necrosis.
- Published
- 1994
180. Soluble interleukin-2 receptor: a new marker in pancreatic adenocarcinoma?
- Author
-
Rabitti PG, Pacelli L, Uomo G, Laccetti M, Spada OA, Esposito G, and Visconti M
- Subjects
- Adenocarcinoma blood, Adult, Aged, Alcoholism complications, Chronic Disease, Diagnosis, Differential, Enzyme-Linked Immunosorbent Assay, Female, Humans, Male, Middle Aged, Pancreatic Neoplasms blood, Pancreatitis blood, Pancreatitis diagnosis, Pancreatitis etiology, Adenocarcinoma diagnosis, Biomarkers, Tumor analysis, Pancreatic Neoplasms diagnosis, Receptors, Interleukin-2 analysis
- Abstract
An increase in soluble Interleukin-2 receptor has been observed in several lymphoproliferative diseases and in certain solid neoplasms. Little is known, however, of the serum levels of this marker in pancreatic cancer. We studied the behaviour of the soluble Interleukin-2 receptor in 32 patients with pancreatic cancer versus 17 patients with alcoholic chronic pancreatitis and 24 healthy controls. The results obtained showed a significant statistical difference (Student's "t"-test and Mann Whitney U test) between pancreatic cancer on one hand and chronic pancreatitis plus healthy controls on the other (p < 0.0001).
- Published
- 1994
181. [Serum pancreatic enzymes in patients with chronic renal failure on hemodialysis and in transplant patients].
- Author
-
Manes G, Ricci E, Rabitti PG, Caruso S, Carraturo I, Laccetti M, and Uomo G
- Subjects
- Adolescent, Adult, Aged, Amylases blood, Child, Female, Humans, Isoamylase blood, Kidney Transplantation, Lipase blood, Male, Middle Aged, Pancreatic Elastase blood, Renal Dialysis, Kidney Failure, Chronic enzymology, Kidney Failure, Chronic therapy, Pancreas enzymology
- Abstract
Objective: The aim of this study was to evaluate which of serum pancreatic enzymes was less influenced by chronic renal failure (CRF)., Materials and Methods: 40 patients with CRF undergoing hemodialysis (A group) and 24 renal transplant patients (B group) were considered. None of these patients showed clinical and instrumental findings of exocrine pancreas disease. Total amylase (T Amy), pancreatic isoamylase (P Amy), lipase (L) and Elastase-1 (E-1) were measured (in A group immediately before hemodialysis)., Results: In A group T Amy and P Amy showed a significant correlation with serum creatinine level. In A group T Amy serum levels were increased in 65% of cases, P Amy in 72.5%, L in 47.5%, E-1 in 10%; in B group T Amy serum levels were increased in 41.6%, P Amy in 20.1%, L in 8.3% and E-1 in 4.1%. Statistical comparison showed a significantly lower percentages in B group considering P Amy (p < 0.001) and L (p = 0.003)., Conclusions: Our data suggest that E-1 is the only pancreatic enzyme whose specificity is not limited by CRF and thereby may be of value in the diagnosis of the exocrine pancreatic disease in patients with CRF on hemodialysis.
- Published
- 1994
182. Necrotizing acute pancreatitis due to a common bile duct foreign body.
- Author
-
Uomo G, Manes G, Laccetti M, and Rabitti PG
- Subjects
- Acute Disease, Adult, Female, Humans, Necrosis, Common Bile Duct, Foreign Bodies complications, Pancreatitis etiology
- Published
- 1994
183. [Cystic dilatation of the choledochus associated with biliopancreatic anatomic variants and complicated by gallbladder carcinoma].
- Author
-
Di Gaeta A, Uomo G, D'Anna L, and Manes G
- Subjects
- Adenocarcinoma complications, Cholangiopancreatography, Endoscopic Retrograde, Female, Gallbladder Neoplasms complications, Humans, Middle Aged, Pancreatic Ducts diagnostic imaging, Adenocarcinoma diagnostic imaging, Bile Ducts abnormalities, Choledochal Cyst complications, Choledochal Cyst diagnostic imaging, Gallbladder Neoplasms diagnostic imaging, Pancreatic Ducts abnormalities
- Published
- 1994
184. Pancreatico-choledochal junction and pancreatic duct system morphology in acute biliary pancreatitis. A prospective study with early ERCP.
- Author
-
Uomo G, Rabitti PG, Laccetti M, and Visconti M
- Subjects
- Acute Disease, Adolescent, Adult, Aged, Aged, 80 and over, Biliary Tract Diseases diagnostic imaging, Cholangiopancreatography, Endoscopic Retrograde, Common Bile Duct diagnostic imaging, Humans, Middle Aged, Pancreas diagnostic imaging, Pancreatic Ducts diagnostic imaging, Pancreatitis diagnostic imaging, Prospective Studies, Biliary Tract Diseases pathology, Common Bile Duct pathology, Pancreas pathology, Pancreatic Ducts pathology, Pancreatitis pathology
- Abstract
Sixty-two patients with acute biliary pancreatitis (ABP) were prospectively studied by early ERCP in order to evaluate the morphology of the pancreatico-choledochal junction and the pancreatic duct system (PDS) and compared with 62 control patients. Abnormalities of the ampulla of Vater were observed in 66.1% (33.5% in controls; p = 0.001). A common channel for the common bile duct and the main pancreatic duct (MPD) were found in 70.9% of ABP cases; the length of common channel was < or = 5 mm in 79.5% and > 5 mm in 20.4%; the angle between CBD and MPD was < or = 30 degrees in 88.6% and > 30 degrees in 11.4% (no difference compared to the control group). A patent Santorini's duct were found in 37% of ABP cases vs 38.7% in controls (NS); there was no significant difference in patency of the duct of Santorini between edematous and necrotizing cases of ABP. Morphological changes of the PDS were found in all patients with necrotizing (22 cases) and in 15 out of 40 patients with edematous ABP (p < 0.0001).
- Published
- 1993
- Full Text
- View/download PDF
185. [Pain in chronic pancreatitis: recent pathogenetic findings].
- Author
-
Manes G, Pieramico O, and Uomo G
- Subjects
- Chronic Disease, Humans, Pancreas innervation, Pancreatitis physiopathology, Pressure, Pain etiology, Pancreatitis complications
- Abstract
Pain is the major symptom in chronic pancreatitis. Its intensity frequently necessitates partial or complete pancreatectomy. The mechanisms of pain are not yet fully understood and, thereby, the therapeutic management is still controversial. Possible causes of pain include outflow obstruction with increased ductal and parenchymal pressure within the pancreas, and inflammatory involvement of intrapancreatic nerve fibres. Possible extrapancreatic causes are common bile duct and duodenal stenosis. The first theory has recently been substantiated by the demonstration of a definite relationship between intrapancreatic pressure, as measured intraoperatively, and intensity of pain. Infiltration of inflammatory cells around the nerves together with an increase in the number of nerve fibres in the fibrotic pancreatic tissue has been proposed as a possible cause of pain in chronic pancreatitis. Moreover, immunohistological studies have shown that the amount of neurotransmitters, such as substance P, is increased in afferent pancreatic nerves. Stenosis of the common bile duct and duodenum has been reported to be associated with severe abdominal pain. Common bile duct and duodenal stenosis in chronic pancreatitis may be caused by extension of fibrosis and active inflammation of the pancreas within the wall of duodenum and bile duct. This article updates the different pathogenetic mechanisms in pancreatic pain and the current therapeutic possibilities with their advantages and shortcomings.
- Published
- 1992
186. [The role of clinical, biochemical and echographic data in identifying the biliary pathogenesis of acute pancreatitis].
- Author
-
Uomo G, Rabitti PG, Laccetti M, Marcopido B, Picciotto FP, Visconti M, and Galloro V
- Subjects
- Abdomen diagnostic imaging, Acute Disease, Biliary Tract Diseases complications, Biliary Tract Diseases epidemiology, Chi-Square Distribution, Cholangiopancreatography, Endoscopic Retrograde, Cholelithiasis complications, Cholelithiasis diagnosis, Clinical Enzyme Tests, Humans, Pancreatitis epidemiology, Pancreatitis etiology, Prognosis, Prospective Studies, Sensitivity and Specificity, Ultrasonography, Biliary Tract Diseases diagnosis, Pancreatitis diagnosis
- Abstract
The role of clinical (biliary pain and/or jaundice), laboratory (discriminant function (DF) calculated using AST, ALT, AlkPh and GGT serum values) and ultrasonographic (US)(dilation and/or stone of common bile duct (CBD)) findings in identification of the biliary etiology of acute pancreatitis (AP) was studied in 60 patients. AP biliary etiology was defined by ERCP executed in the early phase of the disease (lithiasis and/or stenosis of CBD; endoscopic features of forced papilla in patients with gallstone). US showed the best values of sensitivity (84.6%) and diagnostic efficacy (76.7%); DF showed the best results of specificity (62.5%) and of test positive predictive value (92.8%). The statistical evaluation (McNemar test) showed a significant increase of sensitivity for US vs clinical findings and of specificity for DS vs clinical findings (p less than 0.05). The sensitivity, specificity, accuracy, test negative and positive predictive value were improved to 96.1, 87.5, 96.6, 77.1 and 92% by the combination of US and DF. Therefore the association of US and DF can provide the best non invasive method in rapidly detecting CBD pathology as an etiological factor in AP and then the enough accurate indication to early operative ERCP.
- Published
- 1992
187. Early endoscopic cholangiopancreatography and sphincterotomy in acute biliary pancreatitis: report of 50 cases.
- Author
-
Uomo G, Galloro V, Rabitti PG, Marcopido B, Laccetti M, and Visconti M
- Subjects
- Acute Disease, Common Bile Duct Diseases complications, Constriction, Pathologic complications, Female, Gallstones epidemiology, Gallstones surgery, Humans, Male, Middle Aged, Prospective Studies, Time Factors, Cholangiopancreatography, Endoscopic Retrograde, Gallstones complications, Pancreatitis etiology, Sphincterotomy, Endoscopic
- Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) was successfully performed in 49/50 consecutive patients with acute pancreatitis and suspected biliary aetiology in the early phases of the disease (24-72 hours from admission). ERCP showed common bile duct lithiasis and/or stenosis (25 cholecystectomized patients) in 41/49 cases (83.7%). In 38 patients endoscopic sphincterotomy (ES) was performed: stone removal was possible in lithiasic patients (36 cases, 13 previously cholecystectomized); 3 further patients showed a main pancreatic duct stenosis (2 of these underwent pancreatic ES). The patients treated with ES showed a quick improvement in symptomatology and clinical outcome; no adverse effect of ERCP was found; no mortality was registered. Comparison with a previous series of 130 cases of acute biliary pancreatitis (ABP) showed a reduction in mortality, complications and length of hospitalization. These findings suggest that, from a diagnostic and therapeutic point of view, early ERCP is safe and useful in ABP.
- Published
- 1991
188. Hereditary pancreatitis: report of the second kindred in Italy.
- Author
-
Cucchiara S, Staiano A, Minella R, Uomo G, and Cipolletta L
- Subjects
- Adult, Child, Preschool, Humans, Italy, Male, Pancreatic Ducts diagnostic imaging, Pancreatitis diagnosis, Pancreatitis therapy, Pedigree, Radiography, Pancreatitis genetics
- Published
- 1990
189. [The clinical, histological and ultrastructural findings in a case of acute steatosis of pregnancy with a severe cholestatic syndrome].
- Author
-
Visconti M, Rabitti PG, Uomo G, Laccetti M, Picciotto FP, Borgia G, Cicciarello S, Lambiase A, Nappa S, and Galloro V
- Subjects
- Acute Disease, Adult, Biopsy, Needle, Cholestasis blood, Cholestasis pathology, Fatty Liver blood, Fatty Liver pathology, Female, Humans, Liver ultrastructure, Pregnancy, Pregnancy Complications blood, Pregnancy Complications pathology, Cholestasis diagnosis, Fatty Liver diagnosis, Pregnancy Complications diagnosis
- Abstract
A case of acute steatosis in pregnancy featuring unusually severe cholestasis is discussed with details of the successful outcome for mother and foetus. The correspondence between clinical picture, histological and ultrasound findings is reported together with a detailed review of the latest reports in the literature and what they reveal about the true incidence of the disease, the variability of the clinical picture, whether and when it is better for both mother and child to interrupt.
- Published
- 1990
190. [Pathogenic mechanisms and therapy of coagulation disorders in liver cirrhosis].
- Author
-
Galloro V, Capezzuto C, Di Cesare D, Niola O, Pezzella G, Rabitti PG, Saffiotti O, Schimizzi S, Uomo G, and Visconti M
- Subjects
- Blood Coagulation Disorders drug therapy, Blood Coagulation Factors metabolism, Fibrinolysis, Humans, Liver Cirrhosis metabolism, Blood Coagulation Disorders etiology, Liver Cirrhosis complications
- Published
- 1983
191. [Hemorrhage in the Wirsung's duct caused by aneurysm of the splenic artery in chronic pancreatitis].
- Author
-
Uomo G, Visconti M, Ziviello M, Galloro G, Rabitti PG, and Galloro V
- Subjects
- Aortic Dissection diagnostic imaging, Chronic Disease, Female, Hemorrhage diagnosis, Humans, Male, Middle Aged, Pancreatic Diseases diagnosis, Pancreatic Diseases etiology, Pancreatitis diagnosis, Tomography, X-Ray Computed, Ultrasonography, Aortic Dissection complications, Hemorrhage etiology, Pancreatic Ducts, Pancreatitis complications, Splenic Artery
- Abstract
Two cases of haemorrhage from rupture of a splenic artery aneurysm into the pancreatic duct are reported. Both patients suffered from chronic pancreatitis; when haemorrhage appeared both patients experienced abdominal pain. In one patient the melaena was repetitive, in the other one--with a single episode of melaena - the endoscopy showed fresh blood near the papilla. In both patients ultrasonography and computerized tomography (CT) revealed a cystic mass in the pancreatic tail; CT scan also showed a clear contrast enhancement of these lesions after iodinated medium intravenous bolus. Coeliac arteriography confirmed the presence of two large saccular aneurysmal dilatation of the splenic artery. Both patients underwent a laparotomy: distal pancreatectomy with aneurysm resection and splenectomy were successfully performed.
- Published
- 1989
192. [Treatment of pyogenic hepatic abscess. Systemic and local antibiotic therapy during ultrasonically guided percutaneous drainage].
- Author
-
Uomo G, Russo S, Carnovale A, Nuzzi L, and Verde F
- Subjects
- Aged, Female, Humans, Liver Abscess diagnosis, Liver Abscess surgery, Tomography, X-Ray Computed, Anti-Bacterial Agents administration & dosage, Drainage, Liver Abscess therapy, Ultrasonography
- Published
- 1985
193. [Basal and stimulated blood gastrin in subjects with partial gastrectomy and gastrojejunal anastomosis].
- Author
-
Uomo G, Capece G, Esposito G, Ricolo M, Salvatore M, Visconti M, and Galloro V
- Subjects
- Adult, Aged, Dietary Proteins pharmacology, Female, Humans, Male, Middle Aged, Pyloric Antrum surgery, Duodenal Ulcer surgery, Gastrectomy, Gastrins blood, Jejunum surgery, Peptic Ulcer surgery
- Published
- 1982
194. [The disseminated intravascular coagulation syndrome].
- Author
-
Uomo G, Ricolo M, Capece G, Galloro P, and Esposito S
- Subjects
- Blood Coagulation Tests, Capillary Fragility, Disseminated Intravascular Coagulation diagnosis, Disseminated Intravascular Coagulation drug therapy, Fibrinogen metabolism, Fibrinogen therapeutic use, Heparin therapeutic use, Humans, Monitoring, Physiologic, Syndrome, Disseminated Intravascular Coagulation blood
- Published
- 1979
195. Evaluation of pancreatic amylase immunoassay in acute pancreatitis.
- Author
-
Sacchetti L, Cavalcanti E, Cerasuolo D, Oriani G, Uomo G, Rabitti PG, Laccetti M, Visconti M, and Salvatore F
- Subjects
- Acute Disease enzymology, Adult, Aged, Aged, 80 and over, Electrophoresis, Cellulose Acetate, Female, Humans, Immunoenzyme Techniques, Lipase blood, Male, Middle Aged, Regression Analysis, Amylases blood, Pancreas enzymology, Pancreatitis enzymology
- Published
- 1989
- Full Text
- View/download PDF
196. [Diet and cholesterol cholelithiasis].
- Author
-
Galloro V, Rabitti PG, Uomo G, and Visconti M
- Subjects
- Ascorbic Acid Deficiency complications, Cholesterol, Dietary metabolism, Dietary Fiber administration & dosage, Energy Intake, Humans, Hyperlipidemias diet therapy, Vitamin A Deficiency complications, Cholelithiasis etiology, Diet, Reducing adverse effects, Obesity diet therapy
- Published
- 1983
197. [Hepatic sarcoidosis. Considerations apropos of a clinical case].
- Author
-
Uomo G, Carnovale A, De Nucci C, Ferbo U, Rabitti PG, Visconti M, and Galloro V
- Subjects
- Humans, Liver pathology, Liver Diseases drug therapy, Liver Diseases pathology, Male, Middle Aged, Prognosis, Sarcoidosis drug therapy, Sarcoidosis pathology, Liver Diseases diagnosis, Sarcoidosis diagnosis
- Published
- 1985
198. [A rare cause of hematuria: Behçet disease located in the bladder].
- Author
-
Carnovale A, Nuzzi L, and Uomo G
- Subjects
- Adult, Behcet Syndrome pathology, Humans, Male, Urinary Bladder pathology, Behcet Syndrome complications, Hematuria etiology
- Published
- 1985
199. [Gastro-entero-pancreatic hormone and chronic pancreatitis].
- Author
-
Uomo G, Rabitti PG, and Visconti M
- Subjects
- Animals, Cholecystokinin metabolism, Chronic Disease, Gastric Inhibitory Polypeptide metabolism, Gastrins metabolism, Glucagon metabolism, Humans, Insulin metabolism, Insulin Secretion, Pancreatic Polypeptide metabolism, Gastrointestinal Hormones metabolism, Pancreatic Hormones metabolism, Pancreatitis physiopathology
- Published
- 1982
200. [Changes in serum levels of antibiotics in experimental CCL4 poisoning. I. Gentamycin].
- Author
-
Uomo G, Roperto F, Andini A, Capasso D, Esposito S, Galloro P, Guarino G, Niola O, and Ricci E
- Subjects
- Animals, Carbon Tetrachloride Poisoning blood, Carbon Tetrachloride Poisoning pathology, Gentamicins metabolism, Kidney pathology, Rats, Carbon Tetrachloride Poisoning metabolism, Gentamicins blood
- Abstract
The AA. studied gentamycin serum levels (1mg/Kg b.w.) in rats. The 50% of the animals studied where treated with CCl4 (1 ml/Kg b;w.) 24h previously, the remaining 50% recieved a placebo. The maximum serum levels where similar in both groups; but the antibiotic was removed more slowly (120-240min) in the groups which recieved CCl4. The slower rimotion rate causes more serious histological changes in the kidney.
- Published
- 1979
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