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Gonuguntla K, Chobufo MD, Shaik A, Patel N, Penmetsa M, Sattar Y, Thyagaturu H, Sama C, Alharbi A, Chan PS, Balla S. Impact of Social Vulnerability on Cardiac Arrest Mortality in the United States, 2016 to 2020. J Am Heart Assoc 2024:e033411. [PMID: 38686873 DOI: 10.1161/jaha.123.033411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/16/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Cardiac arrest is 1 of the leading causes of morbidity and mortality, with an estimated 340 000 out-of-hospital and 292 000 in-hospital cardiac arrest events per year in the United States. Survival rates are lower in certain racial and socioeconomic groups. METHODS AND RESULTS We performed a county-level cross-sectional longitudinal study using the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research multiple causes of death data set between 2016 and 2020 among individuals of all ages whose death was attributed to cardiac arrest. The Social Vulnerability Index is a composite measure that includes socioeconomic vulnerability, household composition, disability, individuals from racial and ethnic minority groups status and language, and housing and transportation domains. We examined the impact of social determinants on cardiac arrest mortality stratified by age, race, ethnicity, and sex in the United States. All age-adjusted mortality rate (cardiac arrest AAMRs) are reported as per 100 000. Overall cardiac arrest AAMR during the study period was 95.6. The cardiac arrest AAMR was higher for men compared with women (119.6 versus 89.9) and for the Black population compared with the White population (150.4 versus 92.3). The cardiac arrest AAMR increased from 64.8 in counties in quintile 1 of Social Vulnerability Index to 141 in quintile 5, with an average increase of 13% (95% CI, 9.8%-16.9%) in AAMR per quintile increase. CONCLUSIONS Mortality from cardiac arrest varies widely, with a >2-fold difference between the counties with the highest and lowest social vulnerability, highlighting the differential burden of cardiac arrest deaths throughout the United States based on social determinants of health.
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Affiliation(s)
- Karthik Gonuguntla
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
| | - Muchi Ditah Chobufo
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
| | - Ayesha Shaik
- Department of Cardiology Hartford Hospital Hartford CT
| | - Neel Patel
- Department of Medicine New York Medical College/Landmark Medical Center Woonsocket RI
| | - Mouna Penmetsa
- Department of Medicine University of Connecticut Farmington CT
| | - Yasar Sattar
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
| | - Harshith Thyagaturu
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
| | - Carlson Sama
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
| | - Anas Alharbi
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
| | - Paul S Chan
- Department of Cardiology Saint Luke's Mid-America Heart Institute Kansas City MO
| | - Sudarshan Balla
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
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Sama C, Fongwen NT, Chobufo MD, Ajibade A, Roberts M, Greathouse M, Ngonge AL, Adekolu A, Hamirani YS. Frequency of Cardiac Valvulopathies in Patients With Marfan Syndrome: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e54141. [PMID: 38487153 PMCID: PMC10940034 DOI: 10.7759/cureus.54141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 03/17/2024] Open
Abstract
Marfan syndrome (MFS) is a progressive connective tissue disease with a broad range of clinical manifestations. We sought to establish the spectrum of structural valvular abnormalities as cardiovascular involvement has been identified as the most life-threatening aspect of the syndrome. This was a systematic review with a meta-analysis of studies indexed in Medline from the inception of the database to November 7, 2022. Using the random-effects model, separate Forest and Galbraith plots were generated for each valvular abnormality assessed. Heterogeneity was assessed using the I2 statistics whilst funnel plots and Egger's test were used to assess for publication bias. From a total of 35 studies, a random-effects meta-analysis approximated the pooled summary estimates for the prevalence of cardiac valve abnormalities as mitral valve prolapse 65% (95% CI: 57%-73%); mitral valve regurgitation 40% (95% CI: 29%-51%); aortic valve regurgitation 40% (95% CI: 28%-53%); tricuspid valve prolapse 35% (95% CI: 15%-55%); and tricuspid valve regurgitation 43% (95% CI: 8%-78%). Only one study reported on the involvement of the pulmonary valve (pulmonary valve prolapse was estimated at 5.3% (95% CI: 1.9%-11.1%) in a cohort of 114 patients with MFS). We believe this study provides a description of the structural valvular disease spectrum and may help inform providers and patients in understanding the clinical history of MFS in the current treatment era with its increased life expectancy.
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Affiliation(s)
- Carlson Sama
- Internal Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Noah T Fongwen
- Public Health Sciences, Africa Centre for Disease Control and Prevention (Africa CDC), Addis Ababa, ETH
| | | | - Ademola Ajibade
- Internal Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Melissa Roberts
- Cardiology, West Virginia University School of Medicine, Morgantown, USA
| | - Mark Greathouse
- Cardiology, West Virginia University School of Medicine, Morgantown, USA
| | | | - Ayowumi Adekolu
- Internal Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Yasmin S Hamirani
- Cardiology, West Virginia University School of Medicine, Morgantown, USA
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Sama C, Abdelhaleem A, Velu D, Ditah Chobufo M, Fongwen NT, Budoff MJ, Roberts M, Balla S, Mills JD, Njim TN, Greathouse M, Zeb I, Hamirani YS. Non-calcified plaque in asymptomatic patients with zero coronary artery calcium score: A systematic review and meta-analysis. J Cardiovasc Comput Tomogr 2024; 18:43-49. [PMID: 37821352 DOI: 10.1016/j.jcct.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/12/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND There is growing interest in understanding the coronary atherosclerotic burden in asymptomatic patients with zero coronary artery calcium score (CACS). In this population, we aimed to investigate the prevalence and severity of non-calcified coronary plaques (NCP) as detected by coronary CT angiography (CCTA), and to analyze the associated clinical predictors. METHODS This was a systematic review with meta-analysis of studies indexed in PubMed/Medline and Web of Science from inception of the database to March 31st, 2023. Using the random-effects model, separate Forest and Galbraith plots were generated for each effect size assessed. Heterogeneity was assessed using the I2 statistics whilst Funnel plots and Egger's test were used to assess for publication bias. RESULTS From a total of 14 studies comprising 37808 patients, we approximated the pooled summary estimates for the overall prevalence of NCP to be 10% (95%CI: 6%-13%). Similarly, the pooled prevalence of obstructive NCP was estimated at 1.1% (95%CI: 0.7%-1.5%) from a total of 10 studies involving 21531 patients. Hypertension [OR: 1.46 (95%CI:1.31-1.62)] and diabetes mellitus [OR: 1.69 (95%CI: 1.41-1.97)] were significantly associated with developing any NCP, with male gender being the strongest predictor [OR: 3.22 (95%CI: 2.17-4.27)]. CONCLUSION There is a low burden of NCP among asymptomatic subjects with zero CACS. In a subset of this population who have clinical predictors of NCP, the addition of CCTA has a potential to provide a better insight about occult coronary atherosclerosis, however, a risk-benefit approach must be factored in prior to CCTA use given the low prevalence of NCP.
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Affiliation(s)
- Carlson Sama
- Department of Medicine, Section of Internal Medicine, West Virginia University School of Medicine, WV, USA
| | - Ahmed Abdelhaleem
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Dhivya Velu
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Muchi Ditah Chobufo
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Noah T Fongwen
- London School of Hygiene and Tropical Medicine & Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
| | - Matthew J Budoff
- Division of Cardiology, Harbor-UCLA Medical Center and the Lundquist Institute for Biomedical Innovation, Torrance, CA, USA
| | - Melissa Roberts
- Department of Medicine, Section of Internal Medicine, West Virginia University School of Medicine, WV, USA
| | - Sudarshan Balla
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - James D Mills
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Tsi N Njim
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mark Greathouse
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Irfan Zeb
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Yasmin S Hamirani
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA.
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Sama C, Fongwen NT, Chobufo MD, Hamirani YS, Mills JD, Roberts M, Greathouse M, Zeb I, Kazienko B, Balla S. A systematic review and meta-analysis of the prevalence, incidence, and predictors of atrial fibrillation in cardiac sarcoidosis. Int J Cardiol 2023; 391:131285. [PMID: 37619882 DOI: 10.1016/j.ijcard.2023.131285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/06/2023] [Accepted: 08/20/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND The occurrence of atrial arrhythmias, in particular, atrial fibrillation (AF) in patients with cardiac sarcoidosis (CS) are of growing interest in the field of infiltrative cardiomyopathies. Via a systematic review with meta-analysis, we sought to synthesize data on the prevalence, incidence, and predictors of atrial arrhythmias as well as outcomes in patients with CS. METHODS PubMed/Medline, Web of Science, and Scopus were systematically queried from inception until April 26th, 2023. Using the random-effects model, separate plots were generated for each effect size assessed. RESULTS From a total of 8 studies comprising 978 patients with CS, the pooled summary estimates for the prevalence of AF was 23% (95% CI: 13%-34%). Paroxysmal AF was the most common subtype of AF (83%; 95% CI: 77%-90%), followed by persistent AF (17%; 95% CI: 10%-23%). In 9 studies involving 545 patients with CS, the pooled incidence of AF was estimated at 5%, 13.1%, and 8.9% at <2 years, 2-4 years, and > 4 years of follow-up respectively, with an overall cumulative incidence of 10.6% (95% CI: 4.9%-17.8%) over a 6-year follow-up period. Increased left atrial size and atrial 18F-fluorodeoxyglucose uptake were identified as strong independent predictors for the development of atrial arrhythmias on qualitative synthesis. CONCLUSION The burden of AF and related arrhythmias in CS patients is considerable. This necessitates close follow-up and predictive risk-stratification tools to guide the initiation of appropriate strategies, including therapeutic interventions for prevention of AF-related embolic phenomenon, especially in those with known clinical predictors.
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Affiliation(s)
- Carlson Sama
- Department of Medicine, Section of Internal Medicine, West Virginia University School of Medicine, WV, USA.
| | - Noah T Fongwen
- London School of Hygiene and Tropical Medicine, London, United Kingdom; Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
| | - Muchi Ditah Chobufo
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Yasmin S Hamirani
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - James D Mills
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Melissa Roberts
- Department of Medicine, Section of Internal Medicine, West Virginia University School of Medicine, WV, USA
| | - Mark Greathouse
- Department of Cardiology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Irfan Zeb
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Brian Kazienko
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Sudarshan Balla
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
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Sama C, Crespo-Cebada E, Díaz-Caro C, Mesías F. Análisis de las preferencias de los consumidores españoles hacia la miel de producción social y ambientalmente responsable frente a la de Comercio Justo. ARCH ZOOTEC 2019. [DOI: 10.21071/az.v68i264.4988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
En las últimas décadas se ha producido un notable aumento en la concienciación del consumidor por alimentos de calidad, y producidos de una forma social y ambientalmente responsable. El ámbito agroalimentario presenta uno de los mayores mercados en lo que se refiere a este tipo de producción ética-sostenible, como el Comercio Justo, y abre nuevas oportunidades para los productores a través de otros sistemas como la producción social y ambientalmente responsable. El objetivo de este trabajo consiste en determinar los condicionantes en el consumo de alimentos de Comercio Justo, además de la disposición a comprar alimentos social y ambientalmente responsable para la población de Extremadura (España). Para ello se ha aplicado un cuestionario a una muestra representativa (n=461) de la población extremeña en términos de edad y sexo. El análisis empírico consta de un análisis conjunto para determinar las preferencias hacia ambos tipos de producto y un modelo probit para determinar qué factores inciden sobre la probabilidad de consumo/disposición a consumir. Los resultados muestran que los consumidores prefieren los dos tipos de producción responsable a la convencional. Asimismo, el perfil de individuo que tiene una mayor probabilidad de consumir alimentos de comercio justo es mujer, con conocimiento previo acerca del Comercio Justo y con sensibilidad hacia los problemas laborales y ambientales. Finalmente, las mujeres, las rentas más altas, y los consumidores sensibilizados y que eran consumidores de Comercio Justo, son las principales características que influyen positivamente sobre la disposición a consumir alimentos social y ambientalmente responsables.
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Munaretto G, Bonadonna A, Piccoli A, Sama C. A New Hemodialysis Monitoring Device Using Filtrate Concentrations: A Comparison with Standard Serum Techniques. Int J Artif Organs 2018. [DOI: 10.1177/039139888500800305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- G. Munaretto
- Nephrology and Hemodialysis Unit, U.S.S.L. N. 20, Camposampiero (Padova), Italy
| | - A. Bonadonna
- Nephrology and Hemodialysis Unit, U.S.S.L. N. 20, Camposampiero (Padova), Italy
| | - A. Piccoli
- Institute of Internal Medicine, University of Padova, Italy
| | - C. Sama
- Inphardial S.p.A., Viadana (Mantova), Italy
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Golfieri R, Marini E, Bazzocchi A, Fusco F, Trevisani F, Sama C, Mazzella G, Cavuto S, Piscaglia F, Bolondi L. Small ( Radiol Med 2009;114:1239-66. [PMID: 19697104 DOI: 10.1007/s11547-009-0439-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 02/10/2009] [Indexed: 12/11/2022]
Abstract
PURPOSE We prospectively compared gadoliniumenhanced magnetic resonance imaging (dynamic MRI), superparamagnetic iron oxide (SPIO) (ferucarbotran) MRI and multidetector-row computed tomography (MDCT) and the combination of dynamic MRI plus MDCT vs. dynamic MRI plus SPIO-MRI (double-contrast MRI: DC-MRI) for the detection of small ( MATERIALS AND METHODS Sixty-three patients with liver cirrhosis and suspicious nodules detected during ultrasound (US) surveillance underwent DC-MRI in the same imaging session and MDCT within 15 days. The final diagnosis was established at pathology on the explanted liver (n=10), resection (n=6) and biopsy (n=38) specimens or at 2-years' follow-up (n=9). RESULTS One hundred and twenty-three nodules were detected: 87 were confirmed HCCs in 54 patients. The accuracy of SPIO-MRI and dynamic MRI were similar, both being superior to MDCT. Dynamic MRI demonstrated the highest sensitivity (83.9%; p<0.001). especially for lesions <1 cm (90.6%) - coupled with a lower specificity (36.1%) than SPIO-MRI, particularly in subcentimeter lesions (28.6%). SPIO-MRI demonstrated the highest sensitivity for nodules >1 cm and the highest specificity (83.3%) superior to dynamic MRI (p<0.0001). In the per-lesion analysis, SPIO-MRI demonstrated a positive predictive value higher than dynamic MRI (p=0.0059) and than both the combinations dynamic MRI/MDCT and DC-MRI (p=0.0021 and p=0.0087, respectively). DC-MRI showed the highest sensitivity (97.7%) and accuracy (78.9%), detecting hypovascular and atypical HCCs >1 cm. Furthermore its per-patient negative predictive value was the highest (100%), and significantly higher than all the other methods. CONCLUSIONS DC-MRI is the most sensitive and accurate method and can be confidently used as a single-step procedure for the detection of small HCCs, with the exception of lesions <1 cm.
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Affiliation(s)
- R Golfieri
- Radiologia Malpighi, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Università di Bologna, Via Albertoni 15, 40138, Bologna, Italy.
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Lodato F, Berardi S, Gramenzi A, Mazzella G, Lenzi M, Morelli MC, Tame MR, Piscaglia F, Andreone P, Ballardini G, Bernardi M, Bianchi FB, Biselli M, Bolondi L, Cescon M, Colecchia A, D'Errico A, Del Gaudio M, Ercolani G, Grazi GL, Grigioni W, Lorenzini S, Pinna AD, Ravaioli M, Roda E, Sama C, Vivarelli M. Clinical trial: peg-interferon alfa-2b and ribavirin for the treatment of genotype-1 hepatitis C recurrence after liver transplantation. Aliment Pharmacol Ther 2008; 28:450-7. [PMID: 18549463 DOI: 10.1111/j.1365-2036.2008.03761.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Treatment of hepatitis C virus (HCV) recurrence after liver transplantation (LT) is difficult with low response rates. AIM To assess the safety and efficacy of pegylated-interferon (PEG-IFN) alfa-2b + ribavirin (RBV) in patients with post-LT recurrent genotype-1 HCV and to establish stopping rules according to response. METHODS Fifty-three patients with post-LT HCV recurrence were enrolled. Patients received PEG-IFN alfa-2b 1.0 micro/kg/week plus RBV 8-10 mg/kg/day for 24 weeks. Those with 'early virological response at week 24' (EVR24) continued treatment for 24 weeks (group A). Patients without EVR24 were randomized to continue (group B) or to discontinue (group C). RESULTS Overall sustained virological response (SVR) was 26% (14/53). Alanine aminotransferase, rapid virological response, EVR12, EVR24, undetectable serum HCV-RNA at weeks 12 (cEVR12) and 24 (cEVR24) were related to SVR. cEVR12 and cEVR24 (OR: 14.7; 95% CI: 2.02-106.4) were independent predictors of SVR. All patients with SVR, had cEVR12. No patient in groups B and C achieved end-of-treatment response. One patient in group B had SVR. CONCLUSIONS Pegylated-interferon alfa-2b was effective in one of four of patients with HCV genotype 1 after LT. Treatment should be discontinued in patients with no virological response at week 12. Further studies are needed to evaluate whether a longer treatment period may be beneficial in patients with > or =2 log10 drop in HCV-RNA at week 24.
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Affiliation(s)
- F Lodato
- Department of Digestive Diseases and Internal Medicine, Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
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Gatta L, Vaira D, Sorrenti G, Zucchini S, Sama C, Vakil N. Meta-analysis: the efficacy of proton pump inhibitors for laryngeal symptoms attributed to gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2007; 25:385-92. [PMID: 17269993 DOI: 10.1111/j.1365-2036.2006.03213.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Many investigators have proposed an association between gastro-oesophageal reflux disease and laryngo-pharyngeal symptoms, suggesting that medical or surgical therapy for reflux may be useful. AIM To perform a meta-analysis assessing the effectiveness of medical or surgical therapy for reflux disease in adult patients with laryngeal or pharyngeal symptoms presumed to be due to gastro-oesophageal reflux disease. METHODS Randomized controlled trials comparing medical or surgical treatments for gastro-oesophageal reflux disease against placebo were identified by searching MEDLINE (1966-September 2005), EMBASE (1974-September 2005), the CCRCT (until September 2005) and abstracts from gastroenterology and ENT meetings. The relative risks of reporting symptomatic improvement or resolution of symptoms was evaluated using a random-effects model. RESULTS Five studies using high-dose proton pump inhibitor as intervention met the inclusion criteria and were included in the meta-analysis. No surgical studies met inclusion criteria. The pooled relative risk was 1.18 (95% confidence interval: 0.81-1.74). There was no heterogeneity between studies but evidence of significant publication bias. Sub-group analysis performed evaluating Jadad scores and symptom type, did not change the relative risk. CONCLUSIONS Therapy with a high-dose proton pump inhibitor is no more effective than placebo in producing symptomatic improvement or resolution of laryngo-pharyngeal symptoms. Further studies are necessary to identify the characteristics of patients that may respond to proton pump inhibitor therapy.
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Affiliation(s)
- L Gatta
- Department of Internal Medicine and Gastroenterology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Berardi S, Lodato F, Gramenzi A, D'Errico A, Lenzi M, Bontadini A, Morelli MC, Tamè MR, Piscaglia F, Biselli M, Sama C, Mazzella G, Pinna AD, Grazi G, Bernardi M, Andreone P. High incidence of allograft dysfunction in liver transplanted patients treated with pegylated-interferon alpha-2b and ribavirin for hepatitis C recurrence: possible de novo autoimmune hepatitis? Gut 2007; 56:237-42. [PMID: 16798778 PMCID: PMC1856781 DOI: 10.1136/gut.2006.092064] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Interferon may trigger autoimmune disorders, including autoimmune hepatitis, in immunocompetent patients. To date, no such disorders have been described in liver transplanted patients. METHODS 9 of 44 liver transplanted patients who had been receiving pegylated-interferon alpha-2b and ribavirin for at least 6 months for hepatitis C virus (HCV) recurrence, developed graft dysfunction despite on-treatment HCV-RNA clearance in all but one case. Laboratory, microbiological, imaging and histological evaluations were performed to identify the origin of graft dysfunction. The International Autoimmune Hepatitis scoring system was also applied. RESULTS In all cases infections, anastomoses complications and rejection were excluded, whereas the autoimmune hepatitis score suggested a "probable autoimmune hepatitis" (score from 10 to 14). Three patients developed other definite autoimmune disorders (overlap anti-mitochondrial antibodies (AMA)-positive cholangitis, autoimmune thyroiditis and systemic lupus erythematosus, respectively). In all cases, pre-existing autoimmune hepatitis was excluded. Anti-lymphocyte antibodies in immunosuppressive induction treatment correlated with the development of the disorder, whereas the use of granulocyte colony-stimulating factor to treat interferon-induced neutropenia showed a protective role. Withdrawal of antiviral treatment and treatment with prednisone resulted in different outcomes (five remissions and four graft failures with two deaths). CONCLUSIONS De novo autoimmune hepatitis should be considered in differential diagnosis along with rejection in liver transplanted patients developing graft dysfunction while on treatment with interferon.
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Affiliation(s)
- S Berardi
- Dipartimento di Medicina Interna et Gastroenterologia, Università di Bologna, Italy
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Golfieri R, Giampalma E, Morselli Labate AM, d'Arienzo P, Jovine E, Grazi GL, Mazziotti A, Maffei M, Muzzi C, Tancioni S, Sama C, Cavallari A, Gavelli G. Pulmonary complications of liver transplantation: radiological appearance and statistical evaluation of risk factors in 300 cases. Eur Radiol 2000; 10:1169-83. [PMID: 11003416 PMCID: PMC7102073 DOI: 10.1007/s003309900268] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The aim of this study was to evaluate the incidence, radiographic appearance, time of onset, outcome and risk factors of non-infectious and infectious pulmonary complications following liver transplantation. Chest X-ray features of 300 consecutive patients who had undergone 333 liver transplants over an 11-year period were analysed: the type of pulmonary complication, the infecting pathogens and the mean time of their occurrence are described. The main risk factors for lung infections were quantified through univariate and multivariate statistical analysis. Non-infectious pulmonary abnormalities (atelectasis and/or pleural effusion: 86.7%) and pulmonary oedema (44.7%) appeared during the first postoperative week. Infectious pneumonia was observed in 13.7%, with a mortality of 36.6%. Bacterial and viral pneumonia made up the bulk of infections (63.4 and 29.3%, respectively) followed by fungal infiltrates (24.4 %). A fairly good correlation between radiological chest X-ray pattern, time of onset and the cultured microorganisms has been observed in all cases. In multivariate analysis, persistent non-infectious abnormalities and pulmonary oedema were identified as the major independent predictors of posttransplant pneumonia, followed by prolonged assisted mechanical ventilation and traditional caval anastomosis. A "pneumonia-risk score" was calculated: low-risk score ( < 2.25) predicts 2.7% of probability of the onset of infections compared with 28.7% of high-risk (> 3.30) population. The "pneumonia-risk score" identifies a specific group of patients in whom closer radiographic monitoring is recommended. In addition, a highly significant correlation (p < 0.001) was observed between pneumonia-risk score and the expected survival, thus confirming pulmonary infections as a major cause of death in OLT recipients.
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Affiliation(s)
- R Golfieri
- Dipartimento Clinico di Scienze Radiologiche ed Istocitopatologiche, Policlinico S. Orsola, Università di Bologna, Italy
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Danesi G, Pianta P, Mastroianni A, Cicognani C, Cristoni L, Sama C. [Hepatic and pancreatic disease in patients with acquired immunodeficiency syndrome (AIDS)]. Minerva Med 1999; 90:123-31. [PMID: 10518957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
AIDS is frequently expressed through gastrointestinal o abdominal symptoms. In addition, patients with AIDS or ARC frequently have hepatic and biliary symptoms, while pancreatic alterations are found in 4-30% of patients hospitalised for AIDS. Since AIDS patients are immunodepressed, they are subject to opportunistic infection often multifocal and the pathological processes can be present simultaneously. About 2/3 of patients have enlarged liver, steatosis, splenomegaly, lymphoadenopathy, cholecystic and biliary tract abnormalities, alterations of liver function tests, and abdominal discomfort in the upper right quadrant. Jaundice is rare and hepatic failure is not common. Hepatic biopsy is often necessary to establish the diagnosis. The hepatic localisation of an opportunistic pathogenic agent is generally a sign of systemic dissemination which is expressed as granulomatous hepatitis (atypical mycobacteria, frequently mycobacterium avium, or M. tuberculosis representing the reactivation of latent diseases), peliosis hepatis, infection from CMV, HSV, EBV, Pneumocystis carinii, and mycotic infections. Coinfections with the hepatic virus (HBV, HDV, HCV) are also often present. Pharmacological damage may also be present (mainly caused by antibiotic therapies). Neoplasia are rare (hepatic Kaposi's sarcoma associated with cutaneous and gastrointestinal manifestations, or generally metastatic lymphoma). Damage of the biliary tract usually develops after other manifestations of the illness; the most frequent pictures are cholestatic syndromes and cholangitis, while cholecystitis and jaundice are rare. Pancreatic lesions are generally asymptomatic. They are diagnosed during autopsy and are caused principally by opportunistic agents.
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Affiliation(s)
- G Danesi
- Dipartimento di Medicina Interna e Gastroenterologia, Università degli Studi, Bologna
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13
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Pezzilli R, Andreone P, Morselli-Labate AM, Sama C, Billi P, Cursaro C, Barakat B, Gramenzi A, Fiocchi M, Miglio F, Bernardi M. Serum pancreatic enzyme concentrations in chronic viral liver diseases. Dig Dis Sci 1999; 44:350-5. [PMID: 10063922 DOI: 10.1023/a:1026662719514] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Serum amylase and lipase concentrations were determined in 78 patients with chronic liver diseases [26 chronic active hepatitis (CAH) and 52 liver cirrhosis] and in 15 healthy subjects. Pancreatic isoamylase concentrations and macroamylase complexes were assayed in hyperamylasemic sera. Serum amylase levels were abnormally elevated in 27 patients (35%; 22 liver cirrhosis, 5 CAH), whereas serum lipase levels were elevated in 16 patients (21%; 15 liver cirrhosis, 1 CAH). In 9 of the 27 hyperamylasemic patients, the hyperamylasemia was of pancreatic type. Macroamylasemic complexes were not detected in hyperamylasemic sera. Patients with liver cirrhosis had serum levels of amylase and lipase significantly higher than both the healthy subjects and the patients with CAH, while no significant differences were found in serum levels of these enzymes in patients with CAH as compared to the healthy subjects. A decreased liver metabolism of serum amylase and lipase in patients with chronic infective liver disease, especially in those having liver cirrhosis, may lead to an accumulation of these enzymes in the blood.
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Affiliation(s)
- R Pezzilli
- Emergency Department, Sant' Orsola Hospital, University of Bologna, Italy
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14
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Attili AF, Capocaccia R, Carulli N, Festi D, Roda E, Barbara L, Capocaccia L, Menotti A, Okolicsanyi L, Ricci G, Lalloni L, Mariotti S, Sama C, Scafato E. Factors associated with gallstone disease in the MICOL experience. Multicenter Italian Study on Epidemiology of Cholelithiasis. Hepatology 1997; 26:809-18. [PMID: 9328297 DOI: 10.1002/hep.510260401] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The epidemiological associations of gallstone disease were evaluated in a general population sample of 29,584 individuals (15,910 men and 13,674 women; age range, 30-39 years) belonging to 14 cohorts examined between December 1984 and April 1987. Subjects were screened for the presence of gallstones by gallbladder ultrasonography, completed a questionnaire, and underwent a physical examination and blood chemistry tests. Participants were considered to have gallstone disease if they had already had cholecystectomy or gallstones. Statistical associations were established by univariate analysis of the age-standardized data and by stepwise multiple logistic regression. Increasing age and body mass index and a maternal family history of gallstone disease were the most consistent associations (both at univariate and multivariate analysis and in both sexes) found in this study. Personal history of dieting was associated with gallstone disease in men, and at univariate analysis, in women. Decreasing serum total cholesterol levels and increasing serum triglycerides were associated with gallstone disease in both sexes in the multivariate analysis. In women, associations were also found with a number of pregnancies and paternal family history of gallstone disease. A slight but negative association with contraceptive pill use was identified only at multivariate analysis. Associations (investigated at univariate analysis) were also found with diabetes, cirrhosis, angina or myocardial infarction, and peptic ulcer. There was no association with smoking habits and use of aspirin or antirheumatic drugs.
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Affiliation(s)
- A F Attili
- MICOL (Multicenter Italian Study on Epidemiology of Cholelithiasis) Research Group, Rome, Italy
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15
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Cicognani C, Malavolti M, Morselli-Labate AM, Zamboni L, Sama C, Barbara L. Serum lipid and lipoprotein patterns in patients with liver cirrhosis and chronic active hepatitis. ACTA ACUST UNITED AC 1997. [PMID: 9125012 DOI: 10.1001/archinte.1997.00440280120012] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND An impaired lipid metabolism is often found in patients with chronic liver diseases. Unfortunately, few studies are available concerning serum lipid and lipoprotein levels in patients with liver cirrhosis and chronic active hepatitis (CAH). OBJECTIVES To evaluate low-density lipoprotein (LDL), high-density lipoprotein (HDL), very low-density lipoprotein (VLDL), and total cholesterol serum levels in patients with cirrhosis and CAH and control patients and to relate the findings to the severity of the cirrhosis (Child classification). METHODS We measured the serum lipid pattern in 34 consecutive patients with liver cirrhosis (15 men and 19 women; mean [+/-SD] age, 55 +/- 14 years; Child classes: 14 in A, 9 in B, 11 in C; patients with biliary cirrhosis were excluded), 34 patients with CAH, and 34 control patients. The 3 groups were matched for sex and age. Total serum, HDL cholesterol, and triglyceride levels were measured by enzymatic methods; serum LDL and VLDL levels were calculated. RESULTS In patients with cirrhosis, there was a significant decrease in LDL, HDL, and total cholesterol serum levels compared with both the patients with CAH and the control patients, while the VLDL cholesterol level in patients with cirrhosis was significantly lower compared with the control patients alone. A significant decrease in total cholesterol levels was also observed in the CAH group when compared with the control patients. In patients with cirrhosis, levels of LDL, HDL, and total serum cholesterol were progressively lower when comparing patients in Child class A with patients in class C. CONCLUSIONS In this study, the striking decrease in the level of serum LDL cholesterol in patients with liver disease was related to the increasing severity of the disease. Accordingly, the assessment of the serum LDL cholesterol level is important for an effective treatment and prognostic evaluation of patients with chronic liver disease.
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Affiliation(s)
- C Cicognani
- Istituto di Clinica Medica e Gastroenterologia, Università degli Studi di Bologna, Italy
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16
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Grazi GL, Mazziotti A, Sama C, Jovine E, Stefanini F, Paladini R, Rossi R, Cavallari A. Liver transplantation in HBsAg-positive HBV-DNA--negative cirrhotics: immunoprophylaxis and long-term outcome. Liver Transpl Surg 1996; 2:418-25. [PMID: 9346687 DOI: 10.1002/lt.500020603] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The presence of a positive hepatitis B surface antigen (HBsAg) has been considered a highly questionable indication for orthotopic liver transplantation. We report our experience in the treatment of HBsAg-positive HBV-DNA-negative cirrhotics with liver transplantation, whether or not followed by passive prophylaxis with specific immunoglobulins. Of the 123 cirrhotics who received transplants at our institution since May 1986, 39 (31.7%) were HBsAg positive; of these, 1 was HBV-DNA positive, and 4 were hepatitis Be antigen (HBeAg) positive. Since April 1991, 25 HBsAg-positive HBV-DNA-negative cirrhotics have undergone an original protocol with the periodical intramuscular administration of 5,000 IU of specific immunoglobulins starting in the anhepatic phase and lasting for at least 1 year. There were no differences among cirrhotics in terms of operative mortality and long-term survival with respect to the presence of the HBsAg. Of the 35 HBsAg-positive HBV-DNA-negative patients having a follow-up of 1 month or longer, 12 (34.3%) developed HBsAg recurrence; of them, 4 (33.3%) had received a complete prophylaxis, whereas 8 (66.7%) had not. The recurrence rate was 80% (8 out of 10) in the group of patients who had not received the prophylaxis and 16% (4 out of 25) in the group who had received the prophylaxis (P = .0003). The actuarial recurrence rate in the treated patients was 20.2% and 20.2% after 1 and 3 years, respectively, whereas in the untreated group it was 60.0% and 70.0% (P < .01). The hazard of recurrence of treated patients was reduced to 24.9% compared with untreated patients. Liver transplantation can be performed in HBsAg-positive HBV DNA negative patients without an increase in the operative risk or a worsening of long-term results. Immunoglobulin prophylaxis seems to be effective in preventing hepatitis recurrence after transplantation.
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Affiliation(s)
- G L Grazi
- Second Department of Surgery, University of Bologna, S. Orsola Hospital, Italy
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17
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Cicognani C, Malavolti M, Morselli-Labate AM, Sama C, Barbara L. Flutamide-induced toxic hepatitis. Potential utility of ursodeoxycholic acid administration in toxic hepatitis. Dig Dis Sci 1996; 41:2219-21. [PMID: 8943975 DOI: 10.1007/bf02071403] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Flutamide is a nonsteroidal antiandrogen commonly used in the treatment of prostate cancer. Hepatic toxicity associated with flutamide has been reported with an incidence from less than 1% to about 5%. Ursodeoxycholic acid (UDCA), a hydrophilic bile acid, has been widely used in the treatment of cholesterol gallstones and of several liver diseases, but few data are now available concerning its use in the management of drug-induced hepatitis. The case of a patient who presented severe hepatitis with jaundice following use of flutamide is reported. UDCA treatment was started on admission and, contemporaneously, flutamide was withdrawn. Clinical and biochemical improvement was progressively observed, and the patient was discharged six weeks after the admission. Since fatal flutamide-related hepatitis has been reported, monitoring of serum liver tests is advocated during flutamide administration, and the effectiveness of UDCA in the treatment of drug-induced hepatotoxicity requires further study.
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Affiliation(s)
- C Cicognani
- Department of Internal Medicine and Gastroenterology, Policlinico S. Orsola, University of Bologna, Italy
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18
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Golfieri R, Giampalma E, Sama C, Labate AM, Mazziotti A, Berardi R, Gozzetti G, Gavelli G. Pulmonary complications following orthotopic liver transplant: radiologic patterns and epidemiologic considerations in 100 cases. Rays 1994; 19:319-38. [PMID: 7800841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- R Golfieri
- Istituto di Radiologia II Cattedra, Policlinico S. Orsola, Università di Bologna
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19
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Barbara L, Roda E, Malavolti M, Sama C, Morselli Labate AM, Zamboni L, Cicognani C. [Consensus conference: therapy and prevention of biliary lithiasis]. Minerva Med 1994; 85:343-8. [PMID: 8084439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- L Barbara
- Istituto di Clinica Medica e Gastroenterologia, Università degli Studi di Bologna
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20
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Golfieri R, Giampalma E, Lalli A, Sama C, Venturoli N, Mazziotti A, Gozzetti G, Gavelli G. [Pulmonary complications from monoclonal antibody (OKT3) immunosuppression in patients who have undergone an orthotopic liver transplant]. Radiol Med 1994; 87:58-64. [PMID: 8128034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The authors investigated the incidence of pulmonary complications following immunosuppression with monoclonal antibodies (OKT3) in a series of 100 consecutive cases of orthotopic liver transplantation (OLT). Of 17 patients treated with OKT3 (16 for acute rejection and 1 for cyclosporine toxicity), 11 pulmonary infections were observed (65%), 9 of which (53%) with onset within a mean of 9 days after OKT3 administration. The infections were severe in all cases and lethal in 8 cases: the most common pathogens were Candida (4 cases) and Pseudomonas aeruginosa (3 cases). On the contrary, of 39 cases of rejection treated with steroids, infections were observed in 3 cases only (8%). The 53% incidence of pulmonary infections in OKT3 patients, significantly higher than in the extant patients (19%), confirms OKT3 treatment as a strong risk factor for severe pulmonary infections. Furthermore, the occurrence of pulmonary edema was directly related to OKT3 administration in 7 OKT3 patients (41%), whereas only 20 cases (24%) occurred in the extant OLT patients (p < 0.001). OKT3-related pulmonary edema was always observed in hyperhydrated patients at the time of drug administration and it seemed to be related to the vasoactive myocardiotoxic agents released by damaged T-cells.
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Affiliation(s)
- R Golfieri
- Istituto di Radiologia, II Cattedra, Policlinico S. Orsalo, Bologna
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21
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Legnani C, Palareti G, Rodorigo G, Gozzetti G, Mazziotti A, Martinelli G, Zanello M, Sama C, Coccheri S. Protease activities, as well as plasminogen activators, contribute to the "lytic" state during orthotopic liver transplantation. Transplantation 1993; 56:568-72. [PMID: 7692627 DOI: 10.1097/00007890-199309000-00014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
High levels of tissue plasminogen activator (t-PA) have been reported to be the main component of the high fibrinolytic activity measured in patients during orthotopic liver transplantation. However, a previous study of our group suggested that specific t-PA may not completely account for the massive fibrinolytic activities recorded. In the present study we investigated the fibrinolytic patterns in 10 consecutive liver cirrhosis patients undergoing OLT. Euglobulin fibrinolytic activity, measured either on physiologic (fibrin plates) or amidolytic substrates, increased as expected during anhepatic and reperfusion phases, but largely exceeded the specific activity of t-PA, as proved by quenching procedures using anti-t-PA antibodies. The presence of plasmin- and trypsin-like amidolytic activities was detected in native plasmas at the end of anhepatic and reperfusion phases, together with decreased levels of protease inhibitors, especially alpha 1 Antitrypsin. In conclusion, the hyperfibrinolytic pattern recorded in the central OLT phases is not only attributable to an increased t-PA concentration, and is better described as a complex "lytic" state also including the presence of free proteases (plasmin- and trypsin-like), with limited participation of u-PA. Although t-PA increase is probably the main mechanism of stimulation of the fibrinolytic system during OLT, actual and not just potential proteolytic activities can be found in this condition independent of the occurrence of major hemorrhagic complications.
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Affiliation(s)
- C Legnani
- Department of Angiology and Blood Coagulation, University Hospital S. Orsola, Bologna, Italy
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22
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Palareti G, Legnani C, Mazziotti A, Zanello M, Sama C, Coccheri S. The "lytic state" during orthotopic liver transplantation: plasminogen activators and other protease activities. Semin Thromb Hemost 1993; 19:290-1. [PMID: 8362258 DOI: 10.1055/s-2007-994043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- G Palareti
- Department of Angiology and Blood Coagulation, University Hospital S. Orsola, Bologna, Italy
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23
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Sama C, Morselli Labate A, Barbara L. The role of liver transplantation in the treatment of hepatocellular carcinoma. Ital J Gastroenterol 1992; 24:139-43. [PMID: 1314114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The role of liver transplantation in the treatment of hepatocellular carcinoma (HCC) is still debated. Overall survival is poor because of the high recurrence rate. Negative prognostic factors are the presence of large, multiple lesions, lymph node involvement, gross vascular invasion and extrahepatic metastases. On the other hand a long term survival (5 yrs), can be achieved in about 30 to 48% of transplanted patients. In the case of incidental tumours, the survival rate can be as high as 90%. Fibrolamellar HCC have a better prognosis than non fibrolamellar HCC. Due to the short supply of donor livers, OLT should be offered to those patients who have the highest probability of surviving.
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Affiliation(s)
- C Sama
- Istituto di Clinica Medica e Gastroenterologia, Università di Bologna, Italy
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24
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Grazi GL, Mazziotti A, Sama C, Stefanini GF, Gozzetti G. Reversal of primary liver graft non-function using prostaglandins. Hepatogastroenterology 1991; 38:254-6. [PMID: 1937366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Primary graft non-function remains one of the most life-threatening problems after liver transplantation. Its etiology is still unclear. Liver retransplantation is the only therapeutic alternative to this problem. The PGE1 series of prostaglandins have recently been successfully used in the treatment of transplanted organ dysfunction. In this paper we describe a case of primary graft non-function successfully treated with continuous infusion of prostaglandin PGE1, and we briefly discuss the pathogenetic and therapeutic hypotheses.
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Affiliation(s)
- G L Grazi
- 2nd Department of Surgery, University of Bologna, Ospedale S. Orsola, Italy
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25
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Palareti G, Legnani C, Maccaferri M, Gozzetti G, Mazziotti A, Martinelli G, Zanello M, Sama C, Coccheri S. Coagulation and fibrinolysis in orthotopic liver transplantation: role of the recipient's disease and use of antithrombin III concentrates. S. Orsola Working Group on Liver Transplantation. Haemostasis 1991; 21:68-76. [PMID: 1959800 DOI: 10.1159/000216206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In this study we report the data obtained from extensive haemostatic testing of 25 patients undergoing orthotopic liver transplantation and the results of an open randomized pilot trial of antithrombin III concentrate administration during surgery. Marked differences in transfusional needs and in pre- and intraoperative blood coagulation and fibrinolytic changes were observed between recipients with liver cirrhosis and those with primary biliary cirrhosis. In the former, the increases in tissue-type plasminogen activator activity, total euglobulin fibrinolytic activity, and fibrin-derived degradation products occurred earlier and were more marked, as were the signs of increased thrombin formation. Supplementation of antithrombin III concentrate during surgery failed to induce significant changes in the main parameters studied and in the transfusional needs.
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Affiliation(s)
- G Palareti
- Department of Angiology and Blood Coagulation, University Hospital S. Orsola, Bologna, Italy
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26
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Stefanini GF, Perini A, Pasi E, Gasbarrini G, Sama C, Barbara L, Grazi G, Mazziotti A, Bellusci R, Cavallari A. A promising rescue activity of prostaglandin E1 infusion in primary liver graft non function. Ital J Gastroenterol 1990; 22:368-9. [PMID: 2131959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Affiliation(s)
- C Sama
- Istituto di Clinica Medica e Gastroenterologia, Università di Bologna, Italy
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28
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Bolondi L, Benzi G, Santi V, Gaiani S, Li Bassi SL, Zironi G, Mazziotti A, Sama C, Grigioni W, Gozzetti G. Relationship between alpha-fetoprotein serum levels, tumour volume and growth rate of hepatocellular carcinoma in a western population. Ital J Gastroenterol 1990; 22:190-4. [PMID: 1720058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In order to detect a possible relationship between alpha-fetoprotein (AFP) levels, total tumour volume at the moment of the discovery and the tumour volume doubling time, we studied a population of 138 patients, affected by Hepatocellular Carcinoma (HCC) discovered at abdominal ultrasound (US) examination and confirmed by liver biopsy in all cases. In each patient the serum AFP level was determined within a week before or after the US examination. A small therapy-free subgroup of 23 patients, was also serially observed for a mean period of 4 months, so making possible the evaluation of the tumour volume doubling time and its relationship with the initial value of AFP. In 81 patients (58.7%) the serum AFP resulted less than 20 ngr/ml in 21 (15.2%), between 20 and 200 and in 36 (26.1%) greater than 200ngr/ml. No statistical correlation was found between the tumour volume calculated on the basis of the US image at the moment of the discovery and the AFP level, even though very high levels (greater than 3000) were found only in large tumours. Furthermore the tumour doubling time was not correlated with the initial value of AFP.
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Affiliation(s)
- L Bolondi
- Istituto di Clinica Medica e Gastroenterologia, University of Bologna, Italy
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29
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Rusticali AG, Sama C, Morselli Labate AM, Frabboni R, Nacchiero MC, Tassinari G, Barbara L. [The Boario project. A study of the prevalence of lithiasis in a spa population]. Minerva Med 1990; 81:301-6. [PMID: 2188169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In order to better evaluate some epidemiological findings observed during previous studies on large samples of free living populations we carried out a case-control study on a randomly selected group of subjects in a health spa, Boario Terme. Seven-hundred and thirty subjects, aged 40-69 years, participated in the study. The study protocol included an ultrasonographic examination of the upper abdomen, a physical examination, a questionnaire, and a blood sample. Prevalence of gallstone disease was two times higher in females (37.2%) than in males (19.7%) (RRMH = 1.88). Fifty out of the 80 gallstone subjects were not aware of the disease prior the study (62.5%), and 60 did not experience any specific biliary symptom (colic) in the 5 years prior the study. The so-called "nonspecific symptoms" were not found related to gallstone disease. Gallstone disease was positively related to number of pregnancies, obesity, and economical status. In conclusion the present study confirmed some results observed during previous epidemiological studies. In regards to symptoms present data suggest that biliary colic is the only specific symptom for gallstone disease. In addition, the high number of asymptomatic gallstones observed in this study suggests the need of more investigations on high-risk populations in order to make earlier diagnosis and eventually to prevent the disease.
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30
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Barbara L, Sama C, Morselli Labate AM, Taroni F, Rusticali AG, Festi D, Sapio C, Roda E, Banterle C, Puci A. A population study on the prevalence of gallstone disease: the Sirmione Study. Hepatology 1987; 7:913-7. [PMID: 3653855 DOI: 10.1002/hep.1840070520] [Citation(s) in RCA: 315] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The prevalence of gallstone disease (cholelithiasis and previous cholecystectomy for gallstones) in the population of the town of Sirmione, Italy, examined by ultrasonography, was 6.7% in men and 14.6% in women, ranging from 18 to 65 yr of age (overall prevalence = 11%). The prevalence of cholelithiasis in the same age span was 6.9% (4.5% in men and 8.9% in women). Prevalence of cholelithiasis increased with age in both sexes. Twenty-two percent of gallstone subjects suffered from biliary pain vs. 2% of subjects without gallstones. No difference was observed in the frequency of nonspecific symptoms between subjects with and without gallstones. Of the 132 gallstone subjects, 108 (82%) were not aware of having gallstones prior to the study. Prevalence of gallstone disease was found to be higher in obese and hypertriglyceridemic subjects and to increase with the number of pregnancies.
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Affiliation(s)
- L Barbara
- Clinica Medica I, Universitá di Bologna, Italy
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31
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Munaretto G, Bonadonna A, Bisetto F, Grando R, Sama C. Clinical evaluation of a new water removal measuring device in standard dialysis. Artif Organs 1987; 11:183-7. [PMID: 3593046 DOI: 10.1111/j.1525-1594.1987.tb02654.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A new device measuring water removal during standard dialysis is evaluated. The filtrate, collected from a small hemofilter inserted into a normal Cuprophan hollow-fiber dialyzer, was used to evaluate the total water removed from the patient. The device was tested in 46 patients undergoing regular dialysis treatment; the body weight loss ranged from 300 to 5,600 ml for a total of 71 dialysis sessions. Results confirmed the reliability of the device, as the mean prediction error was 5.4%. No influence of the dialyzer blood rest volume on the prediction error was observed. The authors propose this system as an alternative to bed or armchair scales and emphasize its usefulness for experimental purposes.
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Munaretto G, Bonadonna A, Piccoli A, Sama C. A new hemodialysis monitoring device using filtrate concentrations: a comparison with standard serum techniques. Int J Artif Organs 1985; 8:129-34. [PMID: 4030131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A new device allowing sampling to be performed at any time, and using the filtrate obtained during hemodialysis is described. The device was used in 27 patients undergoing regular dialysis. Urea, creatinine and potassium were measured in samples taken both from arterial blood and from the device at 10, 40, 120 and 230 minutes after the beginning of the dialysis. The results were compared. A constant bias of about 10% was noted between the two sets of results but statistical analysis showed this was correctable.
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Sama C, Petronelli A, Malavolti M, Mastroroberto G, Roda E. A double-blind comparative trial of dihydroxydibutylether in patients with cholesterol gallstones. Int J Clin Pharmacol Ther Toxicol 1983; 21:95-7. [PMID: 6341262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In a double-blind crossover design we compared dihydroxydibutylether (DHBE) with placebo in ten patients with cholesterol gallstones. The results showed that DHBE reduced (p less than 0.01) the bile saturation index (SI). The bile lipid composition demonstrated that the reduced SI was due to a decrease (p less than 0.01) in the molar percentage of cholesterol. There was no significant modification in biliary acid and phospholipid molar percentage.
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Roda E, Bazzoli F, Labate AM, Mazzella G, Roda A, Sama C, Festi D, Aldini R, Taroni F, Barbara L. Ursodeoxycholic acid vs. chenodeoxycholic acid as cholesterol gallstone-dissolving agents: a comparative randomized study. Hepatology 1982; 2:804-10. [PMID: 7141392 DOI: 10.1002/hep.1840020611] [Citation(s) in RCA: 111] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Cholesterol gallstones are dissolved in man by chenodeoxycholic acid (CDCA) and ursodeoxycholic acid (UDCA). To test the comparative efficacy of these two cholelitholytic bile acids, 223 gallstones patients were randomly treated with either UDCA or CDCA at two different doses: 7 to 8 mg per kg per day and 14 to 15 mg per kg per day. Efficacy and factors influencing dissolution (dose, size of the stones, and time) were evaluated after 3, 6, and 12 months of treatment. UDCA was significantly more efficacious than was CDCA after 3 and 6 months of treatment, whereas after 12 months, no significant differences were observed. UDCA was equally effective at high and low doses, both on small and large stones. CDCA was significantly more effective at high doses and on small stones. Seventy-four per cent of the total dissolutions with UDCA and 42% with CDCA occurred within the first 6 months of treatment. Diarrhea and hypertransaminasemia occurred only in the CDCA-treated patients. We conclude that UDCA seems to be the bile acid of choice in dissolving cholesterol gallstones.
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Aldini R, Roda A, Festi D, Mazzella G, Morselli AM, Sama C, Roda E, Scopinaro N, Barbara L. Diagnostic value of serum primary bile acids in detecting bile acid malabsorption. Gut 1982; 23:829-34. [PMID: 7117902 PMCID: PMC1419835 DOI: 10.1136/gut.23.10.829] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Serum cholic and chenodeoxycholic acid conjugates were measured in fasting conditions and after meals in 14 patients with bile acid malabsorption due to ileal resection. Mean serum fasting levels of both primary bile acids did not differ from the controls. After meals, serum cholic acid peaks were lower in patients with ileal resection than in control subjects (p less than 0.001), while chenodeoxycholic acid peaks were reduced in colectomised patients (p less than 0.01). In the sera from patients with ileal resection, the glycine/glycine + taurine ratio for cholic and chenodeoxycholic acid increased (p less than 0.001) from morning to evening, and glycine/glycine + taurine ratio for chenodeoxycholic acid was significantly (p less than 0.01) different from the controls in the sera collected in the evening. The results are consistent with the concept of a better intestinal conservation of chenyl, mainly of the glycine conjugated from, than of cholylconjugates, in patients with ileal resection; this is probably because of passive absorption in the intestine. The postprandial peaks of serum cholic acid conjugates may therefore be regarded as a test of ileal dysfunction, while peaks of chenodeoxycholic acid conjugates suggest colonic impairment.
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Aldini R, Roda A, Festi D, Sama C, Mazzella G, Bazzoli F, Morselli AM, Roda E, Barbara L. Bile acid malabsorption and bile acid diarrhea in intestinal resection. Dig Dis Sci 1982; 27:495-502. [PMID: 6806052 DOI: 10.1007/bf01296727] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Bile acid fecal excretion and dihydroxy bile acid concentration in the fecal water of patients with large (N = 6) and small (N = 8) ileal resection, colectomy (N = 5), and healthy controls (N = 10) have been studied in order to evaluate the degree of bile acid malabsorption and the occurrence of bile acid diarrhea in intestinal resections of different extent. Bile acid malabsorption was severe in large ileal resections, mild in small ones, and slight in colectomy. The fecal pH seems to be a limiting factor in the occurrence of a bile acid diarrhea, playing a critical role in determining the dihydroxy bile acid solubility in the fecal water. These results seem to suggest that the bile acids may induce water secretion in the colon not only in small but also in large ileal resections.
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Sama C, LaRusso NF, Lopez del Pino V, Thistle JL. Effects of acute bile acid administration on biliary lipid secretion in healthy volunteers. Gastroenterology 1982; 82:515-25. [PMID: 7054046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Roda A, Roda E, Sama C, Festi D, Aldini R, Morselli AM, Mazzella G, Barbara L. Serum primary bile acids in Gilbert's syndrome. Gastroenterology 1982; 82:77-83. [PMID: 7053338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
We studied some aspects of bile acid metabolism in 25 patients affected by Gilbert's syndrome, 5 patients with hemolytic anemia, and 25 control subjects in order to assess whether bile acids as well as bilirubin are affected in unconjugated hyperbilirubinemic conditions. We measured serum cholic and chenodeoxycholic acid conjugates fasting and postprandially, the plasma disappearance of intravenously injected cholyl[1-14C]glycine, 14CO2 in breath, and 14C in stools after oral administration of the same isotope. Mean serum fasting level of conjugated cholic acid was significantly reduced in hyperbilirubinemic patients (p less than 0.01) in comparison with the controls, while the postprandial elevation was similar. The cholyl[1-14C]glycine hepatic uptake was faster in the patients with Gilbert's syndrome, but no significant difference was found as far as 14CO2 in breath and 14C in stools were concerned. Additional in vitro studies showed that increasing bilirubin concentrations displace glycocholic acid and, to a lesser extent, glycochenodeoxycholic acid from their binding to albumin, the affinity constant of the latter bile acid being 30 times greater than that of the former one. This competition between bilirubin and bile acids explains the faster hepatic uptake of cholic acid conjugates and hence their lower serum levels in unconjugated hyperbilirubinemic conditions. In addition, low levels of cholic acid conjugates, together with normal serum chenodeoxycholic acid conjugate levels, discriminate Gilbert's syndrome from other causes of hyperbilirubinemia.
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Sama C, LaRusso NF. Effect of deoxycholic, chenodeoxycholic, and cholic acids on intestinal absorption of cholesterol in humans. Mayo Clin Proc 1982; 57:44-50. [PMID: 7033682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The effect of administration of primary and secondary bile acids on absorption of cholesterol was investigated in 15 volunteers. Eight Caucasians with radiolucent gallstones were studied before and after administration of chenodeoxycholic acid (all eight) and cholic acid (eight before, six after treatment) for 3 months, and seven healthy subjects were studied before and five were studied after administration of deoxycholic acid for 6 weeks. The hourly absorption of [3H]cholesterol was measured for 24 hours in a 20-cm duodenal segment by use of an intestinal perfusion technique. Fasting serum cholesterol and triglyceride levels were also measured before and after administration of bile acid. In patients with gallstones, absorption of cholesterol in the duodenum, expressed as the mean (+/- SEM) percentage of [3H]cholesterol absorbed hourly for 24 hours, was not significantly different after administration of chenodeoxycholic (22.5 +/- 4.4%) or cholic (25.6 +/- 5.9%) acid when compared with the pretreatment value (21.1 +/- 4.3%). Moreover, administration of chenodeoxycholic and cholic acid did not affect serum lipid levels. In contrast, administration of deoxycholic acid to healthy volunteers suppressed [3H]cholesterol absorption (13.2 +/- 3.2%) compared with that of the pretreatment period (26.5 +/- 3.8%) and decreased serum cholesterol levels by 15%. Our results suggest that chenodeoxycholic acid decreases the concentration of cholesterol in bile and dissolves gallstones by a mechanism other than inhibition of absorption of cholesterol. The data also indicate that the hypocholesterolemic effect of deoxycholic acid is due to the inhibition of intestinal absorption of cholesterol.
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Casanova S, Roda A, Festi D, Mazzella G, Aldini R, Bazzoli F, Sama C, Morselli AM, Barbara L, Roda E. Effect of chenodiol on the small intestine. Unimpaired structure and function during therapy for gallstone dissolution. JAMA 1981; 246:2597-601. [PMID: 7299987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
To test whether long-term oral dosage with chenodiol (chenodeoxycholic acid) used for dissolution of cholesterol gallstones would cause impairment of small-intestinal structuree or function, ten patients were studied before and after three months of oral chenodiol administration, 15 mg/kg of body weight per day. Small-intestinal structure was assessed by roentgenogram and intestinal biopsy, using both light and electron microscopy. Small-intestinal function was assessed by xylose, fat and vitamin B12, lactose, and bile-acid absorption. Bile acid metabolism was also characterized by the breath test for deconjugation using carbon dioxide labeled with radioactive carbon 14. No significant abnormalities were found. The results suggest that oral chenodiol administration does not impair intestinal structur or function in doses used for gallstone dissolution.
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Roda A, Roda E, Aldini R, Capelli M, Festi D, Sama C, Mazzella G, Morselli AM, Barbara L. Results with six "kit" radioimmunoassays for primary bile acids in human serum intercompared. Clin Chem 1980; 26:1677-82. [PMID: 7428151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We examined six radioimmunoassay procedures for measuring primary bile acids in human serum (two 3H-labeled and four 125I-labeled). A significant (p < 0.01) correlation was observed between measurements in the assay both for cholic acid and chenodeoxycholic acid, at low and high concentrations of serum bile acids. All kits were acceptable with respect to accuracy, precision, stability, and analytical recovery. All six procedures gave similar results for chenodeoxycholic and cholic acid in sera of 80 healthy subjects; the agreement was also close when the two primary bile acids were compared with their sum in serum. Normal values ranged from 0.4 to 2.5 mumol/L for conjugated chenodeoxycholic acid and from 0.3 to 1.5 mumol/L for conjugated cholic acid. The 125I assays do not require liquid-scintillation equipment but 125I induces a decrease in the affinity constant of antibody. The sensitivity of the assays was still adequate for measuring bile acids in the serum of healthy fasting persons and liver-disease patients.
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Barbara L, Lazzari R, Roda A, Aldini R, Festi D, Sama C, Morselli AM, Collina A, Bazzoli F, Mazzella G, Roda E. Serum bile acids in newborns and children. Pediatr Res 1980; 14:1222-5. [PMID: 7454436 DOI: 10.1203/00006450-198011000-00014] [Citation(s) in RCA: 40] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A specific and sensitive radioimmunoassay for cholic, chenodeoxycholic, and lithocholic acid conjugates and for sulfolithocholylglycine was used to measure serum bile acids (BA) in infants and children. Elevated cholic and chenodeoxycholic acid values were observed in the first year of life in fasting infants. Newborn babies presented high levels of primary BA not correlated with those of the mothers. In premature newborn babies who had not yet been fed, meal induced a considerable reduction in the primary BA levels in serum. In normally fed babies, meal induced a significant increase in the primary BA levels in serum. These data suggest a progressive maturity throughout the first year of life of the serum BA determinants, i.e., gallbladder emptying, intestinal motility and absorption, and hepatic uptake.
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Roda A, Roda E, Aldini R, Capelli M, Festi D, Sama C, Mazzella G, Morselli AM, Barbara L. Results with six "kit" radioimmunoassays for primary bile acids in human serum intercompared. Clin Chem 1980. [DOI: 10.1093/clinchem/26.12.1677] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
We examined six radioimmunoassay procedures for measuring primary bile acids in human serum (two 3H-labeled and four 125I-labeled). A significant (p < 0.01) correlation was observed between measurements in the assay both for cholic acid and chenodeoxycholic acid, at low and high concentrations of serum bile acids. All kits were acceptable with respect to accuracy, precision, stability, and analytical recovery. All six procedures gave similar results for chenodeoxycholic and cholic acid in sera of 80 healthy subjects; the agreement was also close when the two primary bile acids were compared with their sum in serum. Normal values ranged from 0.4 to 2.5 mumol/L for conjugated chenodeoxycholic acid and from 0.3 to 1.5 mumol/L for conjugated cholic acid. The 125I assays do not require liquid-scintillation equipment but 125I induces a decrease in the affinity constant of antibody. The sensitivity of the assays was still adequate for measuring bile acids in the serum of healthy fasting persons and liver-disease patients.
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Barbara L, Roda E, Sama C, Festi D, Mazzella G, Aldini R, Roda A. [Problems of physiopathology of the enterohepatic circulation of bile acids. The "colonopathies"]. Minerva Med 1980; 71:33-6. [PMID: 7354923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Roda E, Roda A, Mazzella G, Aldini R, Sama C, Festi D, Barbara L. [Determinants of serum levels of biliary acids]. Minerva Med 1979; 70:3907-10. [PMID: 530443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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46
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Morselli AM, Roda E, Roda A, Sama C, Aldini R, Mazzella G, Festi D, Bazzoli F, Sarti E, Barbara L. [Kinetics of 14C-cholic acid in the baboon under normal conditions and in cholestasis. Description and validity of a multicompartmental model]. Boll Soc Ital Biol Sper 1979; 55:1527-33. [PMID: 261824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A multicompartmental model was applied to the study of the plasmatic and biliary kinetics of the 14C-Cholic acid intravenously injected into a baboon in normal and cholestatic condition. For the evaluation of transfer rates FORTAN IV procedures were used, utilizing Powell method. The degree of fitting was: in normal condition in serum 7% for free and 35% for conjugated Cholic acid, while in bile 5% and 4% respectively; in serum in cholestatic condition 7% for free and 12% for conjugates. The high degree of fitting and reliable estimation of transfer rates suggest that the multicompartmental model applied represents most likely the physio-pathological conditions studied.
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Roda E, Sama C, Festi D. [Controlled clinical evaluation of the therapeutic effectiveness of AICA orotate in chronic hepatitis]. Clin Ter 1979; 89:489-93. [PMID: 535326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Roda E, Sama C, Festi D, Aldini R, Mazzella G, Roda A, Barbara L. Caroli's disease. description of a rare clinical case with monolobar localization. Am J Gastroenterol 1979; 71:621-6. [PMID: 453163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A case of monolobar localization of Caroli's disease with intrahepatic cholesterol gallstones is described. The patient was successfully treated with left hepatic resection. Residual intrahepatic cholesterol gallstones causing frequent cholangitis dissolved with chenodeoxycholic acid treatment.
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Roda E, Roda A, Sama C, Festi D, Mazzella G, Aldini R, Barbara L. Effect of ursodeoxycholic acid administration on biliary lipid composition and bile acid kinetics in cholesterol gallstone patients. Dig Dis Sci 1979; 24:123-8. [PMID: 428300 DOI: 10.1007/bf01324739] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The effect of ursodeoxycholic acid (UDCA) on bile lipid composition and bile acid kinetics was evaluated in seven cholesterol gallstone patients following one month of UDCA administration (12 mg/kg/day). UDCA administration induces a significant reduction in the cholesterol saturation index (SI). After UDCA treatment, UDCA becomes the predominant biliary bile acid while chenodeoxycholic, cholic, and deoxycholic acid are significantly reduced. UDCA pool significantly increases, and chenodeoxycholic, cholic, and total bile acid pools significantly decrease. The reduction in bile lithogenicity during UDCA administration suggests that UDCA may be useful for cholesterol gallstone treatment in man.
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Roda A, Roda E, Festi D, Sama C, Mazzella G, Aldini R, Barbara L. [Radioimmunoassay for biliary acids: its value in diagnosis and prognosis (author's transl)]. Acta Gastroenterol Belg 1978; 41:653-8. [PMID: 751373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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