The Italian journal of gastroenterology最新文献

A case is presented of Whipple's disease with mild gastrointestinal symptoms. Abdominal ultrasonography and breath test after lactose load were of great help in the diagnostic phase and follow-up. Ultrasonography showed dilated and thickened ansae and abdominal lymph nodes which were considerably increased in volume and markedly hyperechoic; this latter aspect would seem to be typical of lymph adenomegalia secondary to Whipple's disease and is linked to the accumulation of fats. The breath test showed two H2 peaks, the first being early (30 min after lactose intake) suggesting high seated bacterial colonization. Intestinal biopsy confirmed the diagnosis of Whipple's disease. After 40 days of antibiotic treatment the clinical and laboratory pictures were almost normal and the breath test showed complete disappearance of H2 production, thus confirming the effectiveness of the treatment in eradicating the intestinal bacteria.

Unexpectedly high early reinfection rates are reported in duodenal ulcer patients in whom Helicobacter pylori infection had been considered eradicated two months (T2) after appropriate therapy. Since some of these re-conversions to Helicobacter pylori positivity were probably recrudescences of a latent infection rather than reinfections, studies were performed to evaluate whether the type of antral gastritis could predict the infection outcome. In 142 eradicated patients at T2, endoscopies were repeated 6 (T6), 12 (T12) and 24 (T24) months after therapy to assess Hp status and to score antral gastritis. Re-conversion to Hp positivity occurred in 14.79% between T2/T6, in 5.40% between T6/T12 and 11.11% between T12/T24. The absence of active antral gastritis at T2 with its 87.31% negative predictive value was a fairly good marker of subsequently confirmed eradication (p = 0.017). It is suggested that, evaluation of antral gastritis soon after an eradicating course, could be a reliable parameter in assessing "true" Hp eradication.

Overexpression of p53 protein was studied in neoplastic specimens of 150 patients registered for colorectal adenocarcinoma in the Health Care District 16 of Modena, Italy, from 1984 to 1986. We selected Dukes' stage B (92) and C (58) patients whose survival and recurrence rates are not easily predictable, with the purpose of defining subgroups of patients at high risk of recurrence. Monoclonal antibody PAb 1801 was used on formalin-fixed, paraffin embedded specimens. Nuclear staining was assessed to divide tumours into three groups: a) negative, b) low expressors, c) high expressors. Histomorphological variables of tumours, major clinical features of the patients and 5-year specific survival, were evaluated and related to p53 status. p53 was found in 71 out of 150 cases (47.3%); 50 tumours were high and 21 low expressors. No correlation was found between p53 overexpression and clinico-pathological variables. No difference in survival was found between patients with p53 positive and negative tumours in the entire series or within Dukes' stage B and C patients. However, the subgroup of patients with stage C rectal cancer seemed to have a better prognosis if the tumour was p53 negative (of borderline significance, p = 0.15). The same results were obtained by grouping low expressor tumours alternatively with negative or high expressors. We conclude that p53 nuclear overexpression does not seem to influence the prognosis of Dukes' stage B or C colorectal cancer patients.

The incidence of relapses of inflammatory bowel disease in pregnancy ranges from 20 to 35%. The effect of pregnancy on Crohn's disease and ulcerative colitis after pregnancy has been investigated here. During the survey period, 29 pregnancies occurred in 18 Crohn's patients, and 25 in 19 ulcerative colitis patients. Incidence of relapses during pregnancy and post-partum was 14 and 17% in Crohn's, and 36 and 12% in ulcerative colitis. Fourteen Crohn's patients (17 pregnancies) and 17 ulcerative colitis patients (19 pregnancies) were followed for 3 years before pregnancy and for 4 years after delivery. During the 3 years after pregnancy, the number of relapses/year was significantly lower compared to the 3 years before pregnancy and to the incidence in controls, both in Crohn's (p < 0.05) and ulcerative colitis (p < 0.005). Changes in nutritional status were recorded in 41% of Crohn's, but in none of the ulcerative colitis patients. The reduced incidence of relapses following delivery in Crohn's patients was more marked in the 10 with normal nutritional status at the time of conception (70% reduction in number of relapses, p < 0.05), while in the 7 significantly underweight patients, the reduction was slight (27% reduction in number of relapses, p = NS). In conclusion, the incidence of relapses in the first 3 years after pregnancy is lower than in the pre-pregnancy period. In Crohn's disease, the effect is more evident in patients with normal nutritional status at the time of conception than in malnourished patients.

A 60-year-old female with a history of chronic pancreatitis and previous pancreaticojejunostomy has been submitted to distal gastric resection for recurrent perforating ulcers. A carcinoid tumour was identified in the surgical specimen. Hypergastrinaemia was subsequently diagnosed and tumour localization was carried out by a new scintigraphic technique with 111In-Pentetreotide. The tumour was found to be a metastasis confined to a peripancreatic lymph node. Surgery was successful, and 6 months later the patient is still eugastrinaemic. The different imaging methods for the identification of gastrinomas are discussed together with the current therapeutic options.

Two complete colonoscopic examinations, up to the ileocecal valve, were performed in 51 patients with idiopathic ulcerative proctocolitis. The extent of the disease was assessed as prevalent in the endoscopic and histological observations on biopsy tissue. The mean interval between the two endoscopies was 36 months (minimum interval 3 months). In 58.8% of cases, a variation of extent was observed: in 33.3% with an upward diffusion, in 25.5% with a reduction. In a larger group (51 vs 31) of patients observed for a longer period of time (36 vs 17 months), the findings of Niv et al. were confirmed. No correlation between epidemiological and clinical data and changes in the anatomical extent of colitis was shown. Disease extent does not, therefore, appear to contribute to the prognosis, in particular to the more severe attacks and cancer.

It has been hypothesized that a state of microchimerism in recipients of organ transplants may result in donor-specific tolerance to the graft. Numerous studies show that infusion of donor-derived bone marrow cells can, indeed, achieve systemic chimerism in the recipient and effectively prolong allograft survival. We have compared organ and patient survival in recipients of liver allografts alone (controls) or in combination with single or multiple infusions of donor bone marrow cells; recipients were infused either at day 0 (perioperatively) or at day 0 and 11 post-transplant. The incidence of rejection episodes and survival of the liver allograft were significantly reduced in recipients of two bone marrow infusions compared to controls; recipients of one infusion, conversely, experienced a higher number of rejection episodes when compared to controls, pointing to a possible sensitizing role of a single bone marrow infusion if administered perioperatively. Variables such as timing, number and composition of the bone marrow inocula still remain to be elucidated but may be of critical importance for the attainment of a state of donor-specific tolerance without the need for immunosuppressive therapy in recipients of organ allografts.

The purpose of this review is to analyze the role of genetic factors in the pathogenesis of human cancer, with particular attention to tumours of the digestive organs. Human neoplasms are defined as "sporadic" when there is no evidence of cancer among relatives besides the index case; "Familial" tumours are characterized by cancer aggregation in a given family, but without verticality or other features of mendelian (autosomal) transmission. In "Hereditary" tumours there is sufficient clinical and biologic evidence to suspect that genetic factors are the main event responsible for their development. Hereditary tumours have been associated with germ-line mutations of oncogenes or, more often, of tumour suppressor genes. More recently, a new category of cancer-related genes has been defined-the mutator genes-which are involved in the mechanisms of DNA repair. Among the various hereditary cancer syndromes, Hereditary non polyposis Colorectal Cancer (HNPCC or Lynch syndrome), Familial Adenomatous Polyposis (FAP) and related syndromes, Hereditary Breast tumours, Li-Fraumeni syndrome and Von Hippel-Lindau disease have been discussed in more detail. Besides purely scientific problems, many ethical and social aspects remain to be solved in hereditary cancer syndromes, and it is likely that their solution will require-in the years to come-a close collaboration between oncologists, geneticists and basic research workers.

A double-blind randomized placebo controlled trial of ursodeoxycholic acid was performed in 31 patients undergoing T-cell depleted allogeneic or autologous bone marrow transplantation to determine the effectiveness of this hydrophilic bile acid in improving the increase in serum liver enzymes that generally accompanies this procedure. Neither group showed any significant difference in magnitude of the increases in serum transaminases and gamma-glutamyltranspeptidase following the conditioning regimen that included chemotherapy and total body irradiation. In the 6 months after transplantation, serum enzymes decreased in both groups, but were consistently higher in the placebo treated patients, indicating that ursodeoxycholic enhances normalization of liver. Faecal bile acid showed that following chemotherapy and irradiation in which intestinal bacteria are ablated, secondary bile acid formation was practically abolished and faeces contained mainly cholic and chenodeoxycholic acids. During bile acid treatment, ursodeoxycholic acid accounted for 31.3 +/- 10.9% of faecal bile acids compared with 4.0 +/- 2.1% in the basal period. Serum and urinary ursodeoxycholic acid concentrations (mean +/- SD, 13.3 +/- 6.9 mumol/L and 2.65 +/- 0.84 mumol/L, respectively) were significantly higher in patients receiving bile acid than in thos on placebo (mean +/- SD, 0.15 +/- 0.12 mumol/L and 0.29 +/- 0.35 mumol/L, respectively) thus confirming compliance.