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ABSTRACT: Non-alcoholic fatty liver disease (NAFLD) has recently been recognized as the leading cause of the abnormalities in the liver function tests in the Western countries. Celiac disease (CD) is a permanent immunological intolerance to gluten proteins in genetically predisposed individuals. CD has been reported in 4-13 % of the cases with steatohepatitis, although the pathogenesis of the liver steatosis in CD patients is unclear. Based on the literature data, it can be concluded that the inclusion of serological markers of CD should be a part of the general workup in the patients with steatosis when other causes of the liver disease are excluded and in the patients with NAFLD when metabolic risk factors are not evident.
Endocrine 06/2012; · 1.42 Impact Factor
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ABSTRACT: To investigate risk factors for low bone mineral density (BMD) in celiac disease (CD) patients, focusing on circulating autoantibodies against osteoprotegerin (OPG).
Seventy asymptomatic CD adult patients on gluten-free diet (GFD) and harbouring persistent negative CD-related serology were recruited. Conventional risk factors for osteoporosis (e.g., age, sex, menopausal status, history of fractures, smoke, and body mass index) were checked and BMD was assessed by dual energy X ray absorptiometry. Serum calcium and parathyroid hormone (PTH) levels were evaluated. Thirty-eight patients underwent repeat duodenal biopsy. Serum samples from a selected sub-group of 30 patients, who were also typed for human leukocyte antigen (HLA) DQ2 and DQ8 haplotype, were incubated with homodimeric recombinant human OPG and tested by western blotting with an anti-OPG antibody after immunoprecipitation.
Despite persistent negative CD-related serology and strict adherence to GFD, 49 out of the 70 (74%) patients displayed low BMD. Among these patients, 13 (24%) showed osteoporosis and 36 (76%) osteopenia. With the exception of age, conventional risk factors for osteoporosis did not differ between patients with normal and low BMD. Circulating serum calcium and PTH levels were normal in all patients. Duodenal mucosa healing was found in 31 (82%) out of 38 patients who underwent repeat duodenal biopsy with 20 (64%) still displaying low BMD. The remaining 7 patients had an incomplete normalization of duodenal mucosa with 6 (84%) showing low BMD. No evidence of circulating antibodies against OPG was found in the serum of 30 celiac patients who were tested for, independent of BMD, duodenal histology, and HLA status.
If any, the role of circulating autoantibodies against OPG in the pathogenesis of bone derangement in patients with CD is not a major one.
World Journal of Gastroenterology 04/2012; 18(14):1622-7. · 2.47 Impact Factor
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ABSTRACT: Gene polymorphism of thiopurine methyltransferase (TPMT) correlates with decreased enzyme activity which determines a significant risk of adverse effect reactions (ADR) in patients treated with thiopurines. The aim of this study was to investigate TPMT genotype and phenotype status in patients with inflammatory bowel diseases (IBD).
Fifty-one consecutive out-patients with IBD were genotyped for the following allelic variants: rs1800462 (referred as TPMT 2 allele), rs1800460 (referred as TPMT 3B allele), and 1142345 (referred as TPMT 3C allele). Red blood cell TPMT activity was measured using a competitive micro-well immunoassay for the semi-quantitative determination of TPMT activity in red blood cells (RBC) by means of a 6-MP substrate.
Polymorphism of TPMT was found in 5 out of 51 patients (10%; 95% CI 2%-18%), three heterozygous and two homozygous carriers. Six patients (11.8%; 95% CI 2.4%-19.5%) displayed very low, 12 (23.5%; 95% CI 11.4%-34.5%) intermediate, and 33 (64.7%; 95% CI 52%-78%) normal/high TPMT activity. There were no differences between TPMT genotype and phenotype groups according to age, type of disease, smoking, and chronic medications. A 71% (95% CI 61%-81%; κ=0.45) concordance rate was found between genotype and phenotype status. Six out of 27 (22%) current or past users of azathioprine developed ADR, with three (50%) displaying TPMT genotype and/or phenotype alterations.
Compared to the general population, IBD patients may have significantly higher prevalence of TPMT polymorphism and, even more, low activity. Phenotypic more than genotypic TPMT analysis could be useful to better manage IBD therapy with thiopurines.
European Journal of Internal Medicine 04/2012; 23(3):273-7. · 2.00 Impact Factor
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ABSTRACT: Drug-induced liver injury represents the principal cause of acute liver failure and orthotopic liver transplantation in western country. A very large number of different drugs and medicinal herbs has been associated with liver injury but just for few of them we know the process that causes liver disease. All the people which ingest a large number of drugs present a risk of developing liver injury. Diagnosis is very difficult because a specific biomarker of damage is absent and the clinical picture is common to other liver diseases. A therapeutic approach is efficacy only in few cases. When a drug-induced liver injury is suspected, cessation of the drug is the first step in their management.
Recenti progressi in medicina 02/2012; 103(2):79-84.
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ABSTRACT: Evidence indicates a well-established relationship between low bone mineral density (BMD) and celiac disease (CD), but data on the pathogenesis of bone derangement in this setting are still inconclusive. In patients with symptomatic CD, low BMD appears to be directly related to the intestinal malabsorption. Adherence to a strict gluten-free diet (GFD) will reverse the histological changes in the intestine and also the biochemical evidence of calcium malabsorption, resulting in rapid increase of BMD. Nevertheless, GFD improves BMD but does not normalize it in all patients, even after the recovery of intestinal mucosa. Other mechanisms of bone injury than calcium and vitamin D malabsorption are thought to be involved, such as proinflammatory cytokines, parathyroid function abnormalities, and misbalanced bone remodeling factors, most of all represented by the receptor activator of nuclear factor B/receptor activator of nuclear factor B-ligand/osteoprotegerin system. By means of dual-energy X-ray absorptiometry (DXA), it is now rapid and easy to obtain semiquantitative values of BMD. However, the question is still open about who and when submit to DXA evaluation in CD, in order to estimate risk of fractures. Furthermore, additional information on the role of nutritional supplements and alternative therapies is needed.
Gastroenterology Research and Practice 01/2012; 2012:198025. · 0.98 Impact Factor
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Vincenzo De Francesco,
Floriana Giorgio,
Enzo Ierardi,
Mariangela Zotti,
Matteo Neri,
Angelo Milano,
Vincenzo Varasano, Francesco Luzza,
Evelina Suraci,
Riccardo Marmo, [......],
Stefano Pallotta,
Paolo Usai,
Mauro Liggi,
Giovanni Gatto,
Vittorio Peri,
Rodolfo Sacco,
Giampaolo Bresci,
Fabio Monica,
Cesare Hassan,
Angelo Zullo
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ABSTRACT: Primary clarithromycin resistance markedly reduces Helicobacter pylori eradication rate following standard therapies. Prevalence of primary clarithromycin resistance in H. pylori is increasing, and three point mutations are mainly involved. AIM. To assess both the prevalence of primary clarithromycin resistance in Italy, and the distribution of the involved point mutations.
Primary clarithromycin resistance was assessed by TaqMan real-time polymerase chain reaction on antral biopsies of 253 consecutive, H. pylori infected patients enrolled in 13 Italian centres between January and September 2010.
Primary clarithromycin resistance was detected in 25 (9.9%) patients, with prevalence values widely ranging from 0 to 25%. Clarithromycin resistance rate was higher in female as compared to male patients (13.4% vs. 5.3%, p=0.03), and it tended to be higher in non-ulcer dyspepsia than in peptic ulcer patients (10.6% vs. 6.9%, p=0.5), female patients with non-ulcer dyspepsia showing the highest value (15.4%). The A2143G point mutation was detected in 13 (52.0%) patients, the A2142G in 9 (34.6%), whilst a double point mutation (A2143G plus A2142G) in 3 (11.6%) cases.
Primary clarithromycin resistance is highly variable in different Italian geographic areas. High resistance rates were observed in female and in dyspeptic patients. Among the three point mutations of clarithromycin resistance, the A2143G remains the most frequently observed.
Journal of gastrointestinal and liver diseases: JGLD 09/2011; 20(3):235-9. · 1.81 Impact Factor
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ABSTRACT: Selective cyclooxygenase-2 (COX-2) inhibitors and proton pump inhibitors may exert immune-mediated effects in human gastric mucosa. T-cell immune response plays a role in Helicobacter pylori-induced pathogenesis. This study evaluated effects of celecoxib and lansoprazole on T-helper (Th) 1 and Th2 immune response in human gastric mucosa.
Dyspeptic patients with or without osteoarticular pain were given one of the following 4-week therapies: celecoxib 200 mg, celecoxib 200 mg plus lansoprazole 30 mg, and lansoprazole 30 mg daily. Expression of COX-2, T-bet, and pSTAT6 and production of prostaglandin E₂ (PGE₂), interferon (IFN)-γ, and interleukin (IL)-4 were determined in gastric biopsies before and after therapy. Histology was evaluated.
Cyclooxygenase-2 expression and PGE₂ production was higher, and Th1 signaling pathway was predominant in H. pylori-infected vs. uninfected patients. T-bet expression and IFN-γ production increased, while STAT6 activation and IL-4 production decreased following therapy with celecoxib and celecoxib plus lansoprazole, respectively. Th1 and Th2 signaling pathways down-regulated after therapy with lansoprazole, and this was associated with an improvement of gastritis. Effect of therapy was not affected by H. pylori status.
Celecoxib and lansoprazole modulate Th1/Th2 immune response in human gastric mucosa. The use of these drugs may interfere with long-term course of gastritis.
Helicobacter 10/2010; 15(5):449-59. · 3.15 Impact Factor
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Antonio Tursi,
Giovanni Brandimarte,
Alfredo Papa,
Andrea Giglio,
Walter Elisei,
Gian Marco Giorgetti,
Giacomo Forti,
Sergio Morini,
Cesare Hassan,
Maria Antonietta Pistoia, [......],
Ladislava Sebkova,
Natale Sacca,
Emilio Di Giulio, Francesco Luzza,
Maria Imeneo,
Tiziana Larussa,
Salvatore Di Rosa,
Vito Annese,
Silvio Danese,
Antonio Gasbarrini
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ABSTRACT: VSL#3 is a high-potency probiotic mixture that has been used successfully in the treatment of pouchitis. The primary end point of the study was to assess the effects of supplementation with VSL#3 in patients affected by relapsing ulcerative colitis (UC) who are already under treatment with 5-aminosalicylic acid (ASA) and/or immunosuppressants at stable doses.
A total of 144 consecutive patients were randomly treated for 8 weeks with VSL#3 at a dose of 3,600 billion CFU/day (71 patients) or with placebo (73 patients).
In all, 65 patients in the VSL#3 group and 66 patients in the placebo group completed the study. The decrease in ulcerative colitis disease activity index (UCDAI) scores of 50% or more was higher in the VSL#3 group than in the placebo group (63.1 vs. 40.8; per protocol (PP) P=0.010, confidence interval (CI)₉₅(%) 0.51-0.74; intention to treat (ITT) P=0.031, CI₉₅(%) 0.47-0.69). Significant results with VSL#3 were recorded in an improvement of three points or more in the UCDAI score (60.5% vs. 41.4%; PP P=0.017, CI₉₅(%) 0.51-0.74; ITT P=0.046, CI₉₅(%) 0.47-0.69) and in rectal bleeding (PP P=0.014, CI₉₅(%) 0.46-0.70; ITT P=0.036, CI₉₅(%) 0.41-0.65), whereas stool frequency (PP P=0.202, CI₉₅(%) 0.39-0.63; ITT P=0.229, CI₉₅(%) 0.35-0.57), physician's rate of disease activity (PP P=0.088, CI₉₅(%) 0.34-0.58; ITT P=0.168, CI₉₅(%) 0.31-0.53), and endoscopic scores (PP P=0.086, CI₉₅(%) 0.74-0.92; ITT P=0.366, CI₉₅(%) 0.66-0.86) did not show statistical differences. Remission was higher in the VSL#3 group than in the placebo group (47.7% vs. 32.4%; PP P=0.069, CI₉₅(%) 0.36-0.60; ITT P=0.132, CI₉₅(%) 0.33-0.56). Eight patients on VSL#3 (11.2%) and nine patients on placebo (12.3%) reported mild side effects.
VSL#3 supplementation is safe and able to reduce UCDAI scores in patients affected by relapsing mild-to-moderate UC who are under treatment with 5-ASA and/or immunosuppressants. Moreover, VSL#3 improves rectal bleeding and seems to reinduce remission in relapsing UC patients after 8 weeks of treatment, although these parameters do not reach statistical significance.
The American Journal of Gastroenterology 10/2010; 105(10):2218-27. · 7.28 Impact Factor
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ABSTRACT: The correct diagnosis of wide QRS complex tachycardia is an old problem, but it is still a new problem since no simple approach aimed at solving it is up to now available, despite the amount of research devoted to this topic. A wide QRS tachycardia can be: 1) ventricular tachycardia; 2) supraventricular tachycardia with bundle branch block that may be either preexisting or due to aberrant conduction, namely tachycardia-dependent; a further possibility is the effect of antiarrhythmic drugs, which slow down intraventricular conduction, resulting in marked QRS complex widening; 3) supraventricular tachycardia with conduction of impulses to the ventricles over an accessory pathway (preexcited tachycardia). The origin of a wide QRS complex tachycardia can be reliably identified using a "holistic" approach, namely taking into account all of the available items: no single criterion, thus, is able to provide a simple and quick solution to the problem in all cases. The electrocardiographic signs are, without any exception, suggestive of ectopy, namely ventricular origin of the impulses; supraventricular tachycardia with aberrant conduction may be diagnosed only by excluding all of the items favoring ectopy. The classic diagnostic criteria include: 1) atrio-ventricular dissociation, characterized by absence of any relationship between QRS complexes and P waves; this phenomenon is at times immediately recognizable but more often can be discovered only by means of a detailed analysis of the tracing; 2) second degree ventriculo-atrial block, characterized by a relationship between QRS complexes and P waves, but with more ventricular complexes than P waves; 3) fusion and/or capture beats; 4) concordant precordial pattern, a sign that can be also expressed as absence of RS (or even rs, Rs, rS) complexes in the precordial leads; 5) an interval > 100 ms from the beginning of the QRS complex to the nadir of S wave in any precordial lead. Vagal maneuvers and analysis of previous ECGs recorded during sinus rhythm, if available, can provide further keys to the diagnosis. Some criteria proposed in the past, such as QRS axis or ventricular complex duration, are nowadays no longer considered; in addition, it has been demonstrated that items such as age, hemodynamic status, heart rate and regularity of R-R intervals may be misleading and should not be taken into account. Analysis of QRS configuration in leads V1 and V6 is a keystone in distinguishing the origin of wide QRS tachycardia: diagnostic criteria rely upon the assumption that aberration is due to a functional bundle branch block, whereas ectopy derives from a totally abnormal activation of the ventricles. Aberration, thus, results in a "typical" bundle branch block morphology, whereas ectopy is expressed by an "atypical" bundle branch block. Specific criteria, based on analysis of leads V1 and V6, have been developed to distinguish the two conditions from each other. The criteria based on QRS configuration, however, suffer from limitations since unexpected complicating factors, such as a previous myocardial infarction, can result in an "atypical" form of bundle branch block even in the presence of supraventricular tachycardia. A new algorithm has recently been introduced, based on analysis of lead aVR only. Any of the following features, observed in this lead, pinpoints a diagnosis of ventricular tachycardia: 1) a dominant R wave (R or Rs complexes); 2) an initial q or r wave with duration > 40 ms (qR or rS complexes); 3) a notch in the descending Q wave limb in a negative (Qr or QS) complex. In the absence of these signs, the ratio between the voltages recorded during the first and the last 40 ms of the QRS complex helps distinction between ectopy and aberration: a ratio < or = 1 suggests ventricular tachycardia whereas a ratio > 1 indicates supraventricular tachycardia. A hard diagnostic problem is associated with preexcited tachycardia, the condition resulting whenever supraventricular tachycardia impulses are conducted to the ventricles over an accessory pathway. This situation is far more rare than ectopy and aberration, and can be ruled out in the presence of negative precordial concordance (QS complexes in all the chest leads) or deep q waves in a precordial lead other than V1. A QRS morphology not consistent with any of the typical patterns observed in the various locations of the accessory pathways rules out a preexcited tachycardia, too.
Giornale italiano di cardiologia (2006) 09/2009; 10(9):580-95.
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ABSTRACT: Rhythm disturbances have been described in immunological and connective diseases. Scleroderma is a fibrotic condition characterized by immunological abnormalities, vascular injury and increased accumulation of extracellular matrix proteins. The heart is one of the major organs involved in scleroderma, the involvement of which can be manifested by myocardial disease, conduction system abnormalities, arrhythmias, or pericardial disease. Additionally, scleroderma renal crisis and pulmonary hypertension lead to significant cardiac dysfunction secondary to damage in the kidney and lung. Changing axis deviation has been reported also during atrial fibrillation or atrial flutter. Changing axis deviation has been also reported during acute myocardial infarction associated with atrial fibrillation too or at the end of atrial fibrillation during acute myocardial infarction. We present a case of atrial flutter, ventricular tachycardia and changing axis deviation in a 61-year-old Italian woman with scleroderma. This case focuses attention on changing axis deviation and on the presentation of arrhythmias in scleroderma. The underlying arrhythmogenic mechanisms are probably multiple and intriguing, even though the myocardial fibrosis and immunological autoantibody-mediated mechanisms seem to play a pivotal role.
International journal of cardiology 05/2009; 153(2):e25-8. · 7.08 Impact Factor
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ABSTRACT: In a patient with atrial tachycardia with a rate of 200 per minute, the A-V conduction ratio was at times 2:1, but often it was 4:3 or 3:2 with progressive P-R interval prolongation (Wenckebach mechanism, an expression of presumable A-V nodal block). In each episode of 4:3 conduction, the first QRS complex was narrow, and the 2 ensuing beats were wide due to aberrant conduction. Aberration did not occur with a constant configuration, but in consecutive episodes of 4:3 conduction ratio there was a regular alternation of left bundle branch block and right bundle branch block. The pattern was explained by concealed retrograde conduction into the anterogradely blocked bundle branch. This caused 2 distinct effects: (1) shifting "to the right" of the refractory period of the affected bundle branch, resulting in maintenance of aberration with the same configuration, if consecutive atrial impulses were conducted to the ventricles, and (2) shortening of the effective cycle of the affected bundle branch, resulting in aberration due to block of the controlateral bundle branch, whenever a pause occasioned by a nonconducted atrial impulse was followed by restoration of 1:1 conduction for 2 or more consecutive beats.
Journal of electrocardiology 05/2009; 42(6):633-5. · 1.08 Impact Factor
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ABSTRACT: Gastric biopsies obtained through endoscopy from patients uninfected by Helicobacter pylori were co-cultured with an H. pylori strain. According to tissue and H. pylori viability, interleukin 8 was increased in biopsy homogenate and supernatant after 12-36h culture. This simple method is suitable to investigate early phases of bacteria-host interaction.
Journal of Microbiological Methods 07/2008; 75(2):346-9. · 2.09 Impact Factor
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ABSTRACT: Supraventricular tachycardias (SVTs) are observed in 0,1-0,4% of the paediatric population and represent an important clinical problem with related significant health and social issues. Most tachycardias are paroxysmal, being associated with sudden onset and termination, and only a relatively small number of them is permanent, namely chronic. Paroxysmal tachycardias, in addition, can be either sustained (lasting > 30 seconds) or non-sustained whenever their duration is less. Most SVTs are due to re-entry, and only atrial tachycardia and and junctional ectopic tachycardia are caused by enhanced automaticity. Atrial tachycardia, however, can also be due, although rarely, to re-entry or to triggered activity. A prompt recognition of these arrthmias in children by pediatric cardiologist is essential for a correct clinical managemet of the patients. In this review, the epidemiologic data regarding the SVTs in pediatric age are reported along with the description of the pathophysiological mechanisms and the analysis of electrocardiographic findings to be considered for a correct clinical diagnosis and a rational therapeutic approach to these arrhythmias.
Current pharmaceutical design 01/2008; 14(8):723-8. · 4.41 Impact Factor
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ABSTRACT: Evidence suggests that an impaired T-cell response against Helicobacter pylori plays a role in the pathogenesis of H. pylori-related diseases. Cyclooxygenase (COX) 2 has been shown to inhibit the production of T-helper (Th) 1 cytokines. This study aimed to ascertain whether COX-2 downregulates Th1 signaling pathway in human gastric mucosa colonized by H. pylori.
COX-2 expression and prostaglandin E(2) (PGE(2)) production were determined in total proteins extracted from freshly obtained gastric biopsies of H. pylori-infected and uninfected patients by Western blotting and enzyme-linked immunosorbent assay (ELISA). Phosphorylated (p)STAT4, pSTAT1, T-bet, and pSTAT6 expression and interleukin (IL)-12, interferon (IFN)-gamma, and IL-4 production were also determined by Western blotting and ELISA, respectively, in total protein extracts from gastric biopsy cultures of H. pylori-infected patients treated without and with COX-2 inhibitor NS-398.
Enhanced expression of COX-2 and production of PGE(2) was found in H. pylori-infected compared to uninfected patients. COX-2 inhibition significantly increased expression of Th1 transcription factors along with production of IL-12 and IFN-gamma. By contrast, no changes in the expression of STAT6 and production of IL-4 were found.
This study provides a mechanism by which H. pylori may actually interfere with normal T-cell activation in human gastric mucosa, possibly enhancing its pathogenicity. The use of COX-2 selective inhibitors as immunomodulators in the course of H. pylori infection deserves investigations.
Helicobacter 07/2007; 12(3):193-9. · 3.15 Impact Factor
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ABSTRACT: In this study we examined mechanisms that regulate T-helper lymphocyte 1 (Th1) commitment in Helicobacter pylori-infected human gastric mucosa. The levels of gamma interferon (IFN-gamma), interleukin-4 (IL-4), and IL-12 in total extracts of gastric biopsies taken from H. pylori-infected and uninfected patients were determined by an enzyme-linked immunosorbent assay. The levels of signal transducer and activator of transcription 4 (STAT4), STAT6, and T-box expressed in T cells (T-bet) in total proteins extracted from gastric biopsies were determined by Western blotting. Finally, the effect of a neutralizing IL-12 antibody on expression of Th1 transcription factors and the levels of IFN-gamma in organ cultures of H. pylori-infected biopsies was examined. Increased levels of IFN-gamma and IL-12 were found in gastric biopsy samples of H. pylori-infected patients compared to the levels in uninfected patients. In addition, H. pylori-infected biopsies exhibited high levels of expression of phosphorylated STAT4 and T-bet. Higher levels of IFN-gamma and expression of Th1 transcription factors were associated with greater infiltration of mononuclear cells in the gastric mucosa. By contrast, production of IL-4 and expression of phosphorylated STAT6 were not associated with the intensity of mononuclear cell infiltration. In ex vivo organ cultures of H. pylori-infected biopsies, neutralization of endogenous IL-12 down-regulated the expression of phosphorylated STAT4 and T-bet and reduced IFN-gamma production. Our data indicated that IL-12 contributes to the Th1 cell commitment in H. pylori-infected human gastric mucosa.
Infection and Immunity 05/2007; 75(4):1738-44. · 4.16 Impact Factor
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ABSTRACT: It is commonly agreed that the electrocardiographic recognition of left ventricular hypertrophy (LVH) is difficult, or even impossible, in patients with bundle branch or fascicular block; the opposite, however, has been demonstrated by several studies. In the presence of intraventricular conduction disturbances, many criteria can reveal LVH, with sensitivity and specificity not inferior than that of electrocardiographic signs used in subjects with normal intraventricular conduction. The following criteria can be helpful in left bundle branch block: QRS voltage increase, left atrial enlargement, QRS duration > 155 ms. LVH is suggested by one or more of the following: Sokolow index > or = 35 mm, R wave in lead aVL > or = 11 mm, left axis deviation at -40 degrees or more, SV2 > 30 mm + SV3 >25 mm. In left anterior hemiblock, LVH is diagnosed whenever the sum of S wave in lead III plus the maximal R+S in a precordial lead is > or = 30 mm. Further criteria are SV1 + (R+S) in V5 or V6 > or = 25 mm, and the presence of secondary ST-T changes. In right bundle branch block, LVH is suggested by a left atrial enlargement pattern, secondary repolarization changes, and a sum of S wave in lead III plus the maximal R+S in a precordial lead > or = 35 mm.
Giornale italiano di cardiologia (2006) 03/2007; 8(3):161-7.
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ABSTRACT: Differences may occur in the mode of transmission of Helicobacter pylori between developed and developing countries: direct human-to-human contacts have been suggested as the primary route in the former while the fecal-oral route, also, through contaminated water, in the latter. Data on intrafamilial transmission of H. pylori among children continue to be produced. The importance of low socioeconomic conditions on the acquisition of H. pylori infection has been confirmed in a number of population-based studies. Due to the improvement of living standards, the prevalence of the infection has fallen dramatically in many countries. It varies from 8.9 to 72.8% among children from developed and developing countries, respectively, the re-infection rate being also significantly higher in the latter. Conflicting data have been reported on the effect of breastfeeding against H. pylori colonization in infancy as well as on the occupational risk for acquiring H. pylori. This review summarizes recent results from the literature on these topics.
Helicobacter 11/2006; 11 Suppl 1:1-5. · 3.15 Impact Factor
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ABSTRACT: To evaluate the prevalence of Giardia lamblia (G. lamblia) infection in patients with irritable bowel syndrome (IBS) and dyspepsia and to establish which is the most accurate test to diagnose the infection in this setting.
One hundred and thirty-seven patients who consecutively attended the Outpatient Gastroenterology Clinic for the first time between January 2002 and December 2003 due to symptoms of IBS and/or dyspepsia were recruited. All patients underwent clinical evaluation, first-step haematology and chemistry tests, serologic assays for celiac disease, lactose-H(2) breath test, abdominal ultrasonography, and esophagogastroduodenoscopy. Helicobacter pylori status was evaluated. In patients with symptoms of IBS older than 45 years, colonoscopy was also performed. In all patients, duodenal biopsies and stool samples were examined for trophozoites and cysts of G. lamblia by several methods.
G. lamblia was identified in 9 patients. The following diagnoses were also made: IBS (100/137, 73%), functional dyspepsia (62/137, 45%), organic dyspepsia (33/137, 24%), and lactose intolerance (75/137, 55%). A significant association was found between giardiasis and H pylori infection (c2=6.632, OR=12.4, CI=1.5-68.1). There were no symptoms that reliably allowed the recognition of giardiasis. Direct search of the parasite in duodenal biopsy and stool sample examinations gave concordant results in all cases while histological examination of duodenal biopsies displayed a low sensitivity (e.g., 22.2%).
In this consecutive series, diagnosis of G. lamblia infection accounted for 6.5% of patients with IBS and dyspepsia. Duodenal biopsies for diagnosis of giardiasis may be unnecessary if stool sample examination is performed.
World Journal of Gastroenterology 04/2006; 12(12):1941-4. · 2.47 Impact Factor
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ABSTRACT: This presentation deals with a case of atrial flutter. During 2:1 A/V conduction, the QRS complexes showed a regular alternation of narrow beats and wide beats with a typical configuration of left bundle branch block. In contrast, pauses resulting from 4:1 A/V conduction ratio always resulted in narrow beats. Disappearance of left bundle branch block with long R-R intervals demonstrated that the block was tachycardia-dependent or phase 3. Analysis of the tracing suggested that narrowing of QRS complexes in alternate beats was due to supernormal left bundle branch conduction associated with retrograde concealed conduction into the anterogradely blocked bundle branch.
Journal of Electrocardiology 02/2006; 39(1):38-41. · 1.14 Impact Factor
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ABSTRACT: Atrial septal aneurysm (ASA) is a well-recognized cardiac abnormality of uncertain clinical significance. It has early been reported as an unexpected finding during autopsy, but it may also be diagnosed in living patients by echocardiographic techniques. An association between ASA and focal cerebral ischemic events has been suggested. Nevertheless, the role of ASA as a risk factor for cerebral ischemia is poorly defined. Several studies have demonstrated a significantly higher proportion of ASA in the patients referred for transesophageal echocardiography after a cerebral ischemic event of unknown cause. However, ASA is often associated with other cardiac abnormalities such as patent foramen ovale, atrial septal defects, as well as mitral valve prolapse or atrial arrhythmias. Due to the fact that these abnormalities are also possible sources of cardiac emboli it is even more difficult to assess the embolic potential of an ASA, independently. In this review, we have examined most of the papers on this topic to try to define the prevalence of ASA in the stroke patients and how this abnormality could be a risk factor for recurrences of cerebrovascular events.
Italian heart journal. Supplement: official journal of the Italian Federation of Cardiology 04/2005; 6(3):135-44.
