Search

This study was performed in order to investigate the dopaminergic mechanism involved in the control of arginine-vasopressin (AVP) secretion in normal men. Plasma AVP concentrations were measured before and after the administration of an i.v. bolus of 10 mg metoclopramide or domperidone to twelve healthy males. Metoclopramide, a cerebral and peripheral antagonist of dopaminergic receptors, significantly stimulated AVP secretion, whereas domperidone, a dopamine antagonist which does not cross the blood-brain barrier, was without effect. These data suggest that metoclopramide stimulates the release of AVP by blocking dopaminergic receptors in structures located inside the blood- brain barrier. Alternatively, it is possible that the stimulation of AVP release induced by metoclopramide does not occur through inhibition of dopamine receptors but rather through interaction with other neuroendocrine pathways. [ABSTRACT FROM AUTHOR]

In order to determine whether nicotine exerts its stimulant effect on serum concentrations of growth hormone (GH) by interacting with an adrenergic pathway, we evaluated the effect of cigarette smoking on the response of GH to the administration of clonidine, a specific alpha- adrenoceptor agonist. In six normal volunteers, clonidine significantly increased serum levels of GH. When subjects smoked two non-filter cigarettes, GH response to the alpha-adrenoceptor agonist was greatly enhanced. These findings suggest that in man nicotinic cholinergic and adrenergic mechanisms might interact in the stimulation of GH secretion. [ABSTRACT FROM AUTHOR]

Background/Aim: Helicobacter pylori (Hp) has been assigned as a class I carcinogen because of its relation to gastric carcinoma (GC). Infection with different genotypes of virulent Hp strain, CagA and/or VacA positive, play a role in the development of atrophic gastritis, duodenal ulcer (DU), and GC. Methods: This study was undertaken to investigate if patients with GC with Hp negative (Hp[sup -]) histological staining had a past infection by virulent strains of Hp CagA and/or VacA positive. 20 GC, 15 males and 5 females (mean age ± SD) 68.14 ± 9.8 y old Hp[sup -] to histological staining in antrum, corpus and in the lesion take part to the study. Two control group were included: 19 Hp infected patients with DU eradicated 10 years before, 14 males and 5 females, (mean age ± SD) 58 ± 18.2 y old. Hp[sup -] status was determined every year with histology Giemsa staining and follow-up after therapy was (average ± SD) 120 ± 32 months; range 96-44 months. 20 asymptomatic children, 10 males and 10 females, (mean age ± SD) 7 ± 4.47 years old, with Hp[sup -] faecal test (HPSA-Meridian). The immunoblot assay (Mikrogen-Germany) was used to detect serum antibodies against CagA and VacA of all patients. Results: The prevalence of CagA and VacA seropositivity was 90% and 95% in GC, 84% and 84% in DU Hp[sup -], 25% and 5% in children Hp[sup -] respectively. Serum CagA and VacA antibody positivity was not significantly different between GC and patients with DU eradicated 10 years before. In contrast a true significant positivity was found against children (t-student test; P<0.0001). Statistical difference was found in age between groups P<0.03. Conclusions: patients with GC, although Hp[sup -] at present, could be infected by Hp before the appearance of the disease as confirmed by CagA and VacA seropositivity. [ABSTRACT FROM AUTHOR]

Background/Aim: To evaluate the utility of 2 biopsies of antrum and gastric body on routinary endoscopy for the assessment of type III intestinal metaplasia (IM-3) and Helicobacter pylori (Hp) status, 1750 patients (pts) (895 males and 855 females, mean age 60.2) were considered from June'98 to June'00. Methods: Specimens were graded 0 to 3 for atrophy, IM-3 and Hp status. 620 pts treated previously with antibiotics or not eligible for biopsy were excluded from initial 2360 pts. Results: IM-3 (score >0), was found in 118 pts (6.7%), 86 pts (4.9%) only in the Antrum. 10 of 355 pts (2.8%) with normal endoscopy findings and 47 of 702 (6.6%) with non erosive endoscopic gastritis resulted IM-3 positive in the antrum. 709 pts (40.5%) were found positive for Hp in antrum or/and corpus. The presence of Hp and IM-3 in the antrum was not correlated (p=0.99; spearman test). A positive correlation (p=0.000) between duodenal ulcer and Hp was found when antral Hp posttivity was taken in account. Gastric carcinoma risk index (GCRI) (Meining et al, Virchows Arch 1998; 432: 311-314) was found in 358 pts (20.4%); in this group 131 pts (36.6%) were Hp positive, 82 pts (23%) have IM-3, 184 pts (51.4%) have atrophy. Conclusions: The incidence of IM-3 is low (6.7%) in routinary endoscopy. Normal endoscopy doesn't exclude the presence of IM-3. The biopsy is necessary to discover IM-3 in the antrum in 5.3% of pts with normal or aspecific endoscopic gastritis. Application of the GCRI might be useful to identifying a group of patients carrying a higher risk for gastric carcinoma. [ABSTRACT FROM AUTHOR]

The implementation of FIT programs reduces incidence and mortality from CRC in the screened subjects. The ultimate efficacy for CRC morbidity and mortality prevention in a FIT program depends on the colonoscopy in FIT+ subjects that has the task of detecting and removing these advanced lesions. Recently, there has been growing evidence on factors that influence the quality of colonoscopy specifically withing organized FIT programs, prompting to dedicated interventions in order to maximize the benefit/harm ratio of post-FIT colonoscopy. This document focuses on the diagnostic phase of colonoscopy, providing indications on how to standardise colonoscopy in FIT+ subjects, regarding timing of examination, management of antithrombotic therapy, bowel preparation, competence and sedation., Competing Interests: Conflict of Interest None., (Copyright © 2023 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Background and Aim: Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for the treatment of gastric outlet obstruction (GOO) has been actually performed only with one type of electrocautery lumen-apposing metal stents (EC-LAMS). We aimed to evaluate the safety, technical and clinical effectiveness of EUS-GE using a newly available EC-LAMS in patients with malignant and benign GOO., Materials and Methods: Consecutive patients who underwent EUS-GE for GOO using the new EC-LAMS at five endoscopic referral centers were retrospectively evaluated. Clinical efficacy was determined utilizing the Gastric Outlet Obstruction Scoring System (GOOSS)., Results: Twenty-five patients (64% male, mean age 68.7 ± 9.3 years) met the inclusion criteria; 21 (84%) had malignant etiology. Technically, EUS-GE was successful in all patients, with a mean procedural time of 35 ± 5 min. Clinical success was 68% at 7 days and 100% at 30 days. The mean time to resume oral diet was 11.4 ± 5.8 h, with an improvement of at least one point of GOOSS score observed in all patients. The median hospital stay was 4 days. No procedure-related adverse events occurred. After a mean follow-up of 7.6 months (95% CI 4.6-9.2), no stent dysfunctions were observed., Conclusion: This study suggests EUS-GE can be performed safely and successfully using the new EC-LAMS. Future large multicenter prospective studies are needed to confirm our preliminary data., Competing Interests: Conflict of interest Author B.M. is has received research grants from Taewoong Dott. Mangiavillano and Prof Moon are consultant for Taewoong medical., (Copyright © 2023. Published by Elsevier Ltd.)

Background: Ampullary adenomas are rare and potentially malignant. Surgery was the standard treatment but endoscopic papillectomy (EP) is a possible alternative., Aim: We retrospectively evaluated the principal clinical outcomes of EP in all patients referred to our unit also dividing sporadic ampullary adenoma (SAA) from familial adenomatous polyposis (FAP)-associated adenomas., Methods: All consecutive patients who underwent endoscopic papillectomy because of ampullary adenoma were considered. The primary outcome was the technical success of EP. Secondary outcomes included the number of procedures, the adverse event rate, the recurrence rate, the concordance of histology pre- and post-EP, and the evaluation of factors related to technical success., Results: Between January 2001 and December 2015, sixty-two patients were included (21 FAP and 41 SAA). Technical success was achieved in 75.8% and was different in the two groups (FAP 95.2%, SAA 65.8%, p 0.025). Intraductal invasion was negatively associated with technical success (41.7% vs. 84.0%; p 0.005). The intestinal subtype was predictive of success (79.7% vs. 0%; p 0.012) as well as en bloc resection (90.3% vs. 61.3%; p 0.016). Adverse events were reported in 14 patients (22.6%)., Conclusions: EP is an effective and safe procedure and is a viable alternative to surgery., Trial Registration: ClinicalTrials.gov Identifier: NCT03494543.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) with the placement of a biliary stent is the treatment of choice for palliation of malignant obstructive jaundice. In 5-10% of cases ERCP fails. In these cases an effective alternative is endoscopic ultrasonography-guided biliary drainage (EUS-BD)., Aim: Evaluation of the principal clinical outcomes of direct transluminal EUS-BD., Patients and Methods: This study is a retrospective analysis. All consecutive patients with malignant obstructive jaundice, in whom ERCP had failed, were enrolled. The primary outcome was the technical success of EUS-BD defined as the correct placement of the metal or plastic stent across the stomach or duodenum to the biliary tree. The most important secondary outcomes were early and late clinical success, both linked to the decrease of bilirubin haematic level., Results: Between January 2011 and November 2017 thirty-six patients were included. Technical success was obtained in 91.6%. A clinical success, early or late was obtained in 75.8%. The ECOG performance status of less than 3 was correlated with clinical success. Adverse events occurred in 30.3% of patients., Conclusions: EUS-BD is an effective and safe procedure., (Copyright © 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Background: After two strong earthquakes in the Emilia region in Italy, many HCWs had to deal with the psychological consequences of the aftershocks., Objective: The aims of this case study were a) to describe the psychosocial condition of the HCWs affected by the earthquake; b) to present an intervention immediately after the earthquake on HCWs in a post-disaster situation using a mixed-method approach., Methods: A mixed-method study was conducted collecting qualitative data (during Group Counselling sessions) and quantitative data (through questionnaires)., Results: The results suggested that the impact of the earthquake was very strong, as more than 80% perceived at least a severe impact event capable of altering their ability to function; most of the thoughts and feelings were related to death and fear., Conclusions: This study adds knowledge about how to plan interventions aiming to help those workers at both individual and organisational level.

Purpose: To estimate the treated prevalence of eating disorders (ED) in Emilia-Romagna, Italy, and to compare health services utilization among age groups and geographical areas., Methods: The study cohort consists of patients aged 12-64 years with a primary or secondary ED diagnosis, treated in regional healthcare facilities in 2012. Patients were followed up for 1 year from the first contact. Data were extracted from regional administrative databases., Results: The study cohort included 1550 cases, 36.8 % with anorexia nervosa, 21.9 % with bulimia nervosa and 41.3 % with ED not otherwise specified. Adolescents (12-17 years) were 18.6 %, young adults (18-30) 32.7 % and older adults (31-64) 48.7 %. The annual treated prevalence rate was 5.2/10,000 (13.3 for adolescents, 9.3 for young adults and 3.4 for older adults) and was highest among adolescent (24.6/10,000) and young adult females (17.1/10,000). Cases without a record for ED in the previous year were 46.8 %. Older adults displayed higher comorbidity and used more services including hospital-based care. Outpatient care greatly exceeded inpatient care across age groups. Variations in care patterns across regional areas were found., Conclusions: Our results indicate that the care pathway for ED varies among age groups and geographical areas, but is consistent with the regional care model that favors the use of outpatient services. Future perspectives include evaluating the integration among mental health services, specialty outpatient units and primary care.

The Ki-67 labeling index has been found to bear prognostic significance in gastrointestinal neuroendocrine tumors (NETs), and it was recently incorporated in NET histological grading. Nevertheless, a reliable preoperative determination of NET grading could be useful in clinical practice. The aim of this study is to compare the results of Ki-67 labeling index, as measured on cytological samples and on surgical specimens of patients with pancreatic NETs (P-NETs). We also investigated whether concordance might be improved, using a 5 % (instead of 2 %) cutoff value for defining G2 tumors. We retrospectively identified 48 consecutive patients with 53 P-NETs, from our five institutions, and we measured Ki-67 labeling index on their cytological samples and surgical specimens. The traditional 2 % and the alternative 5 % cutoff values were used to classify G2 tumors. The concordance rate between cytological and histological grading was 46/53 (86.8 %; weighted κ statistic 0.77; 95 % confidence interval (95 % CI) 0.60-0.94). No cases of cytological G1-G2 NETs were upgraded to G3 neuroendocrine carcinoma (NEC) at histological grading. Cytology was found to be highly specific in the diagnosis of both G2 (94.1 %; 95 % CI 80.3-99.3) and G3 tumors (100.0 %; 95 % CI 92.8-100), but the sensitivity was poor for G2 NETs (66.7 %; 95 % CI 38.4-88.2) and high for the prediction of G3 NECs (100 %; 95 % CI 39.8-100.0). When the 5 % cutoff value was adopted, concordance rate was 49/53 (92.4 %; weighted κ 0.82; 95 % CI 0.64-1.00). In conclusion, Ki-67 cytological expression can distinguish well-differentiated (both G1 and G2) from poorly differentiated P-NETs, and it may be useful for their preoperative classification.

Aim: To determine the efficacy of our therapeutic strategy for Helicobacter pylori (H. pylori) eradication and to identify predictive factors for successful eradication., Methods: From April 2006 to June 2010, we retrospectively assessed 2428 consecutive patients (1025 men, 1403 women; mean age 55 years, age range 18-92 years) with gastric histology positive for H. pylori infection referred to our unit for 13-C urea breath test (UBT), after first-line therapy with proton pump inhibitor (PPI) b.i.d. + amoxicillin 1 g b.i.d. + clarithromycin 500 mg b.i.d. for 7 d. Patients who were still positive to UBT were recommended a second-line therapy (PPI b.i.d. + amoxicillin 1 g b.i.d. + tinidazole 500 mg b.i.d. for 14 d). Third choice treatment was empirical with PPI b.i.d. + amoxicillin 1 g b.i.d. + levofloxacin 250 mg b.i.d. for 14 d., Results: Out of 614 patients, still H. pylori-positive after first-line therapy, only 326 and 19 patients respectively rechecked their H. pylori status by UBT after the suggested second and third-line regimens. "Per protocol" eradication rates for first, second and third-line therapy were 74.7% (95% CI: 72.7%-76.4%), 85.3% (95% CI: 81.1%-89.1%) and 89.5% (95% CI: 74.9%-103%) respectively. The overall percentage of patients with H. pylori eradicated after two treatments was 97.8% (95% CI: 97.1%-98.4%), vs 99.9% (95% CI: 99.8%-100%) after three treatments. The study found that eradication therapy was most effective in patients with ulcer disease (P < 0.05, P = 0.028), especially in those with duodenal ulcer. Smoking habits did not significantly affect the eradication rate., Conclusion: First-line therapy with amoxicillin and clarithromycin produces an H. pylori eradication rate comparable or superior to other studies and second-line treatment can still be triple therapy with amoxicillin and tinidazole.

Colorectal cancer screening programs result in an early diagnosis of the disease. In 2007, 250 malignant polyps were identified in Lombardy, out of 1,329 screen-detected colorectal carcinomas. The Italian Group for Colorectal Cancer (GISCoR) promoted the multicentric study "Endoscopic Follow-up versus Surgical Radicalization of Malignant Polyps after Complete Endoscopic Polypectomy" (SEC-GISCoR). The protocol was a multicentric, prospective, observational, non-randomized study. It included patients diagnosed a colorectal malignant adenoma, after complete endoscopic removal. From November 2005 to September 2009, three participating centers enrolled 120 patients with malignant polyps after "complete" endoscopic polypectomy; malignant polyps were classified as "low risk" or "high risk". The study had two arms: "Intensive follow-up" (42 patients: 32 with low-risk and 10 with high-risk polyps) and "Surgical radicalization" (78 patients: 5 with low-risk and 73 with high-risk polyps). Data were collected using an online CRF. Overall, 37/120 polyps (30.8%) were low risk and 83/120 (69.2%) were high risk. 42 out of 120 patients (35%) were enrolled in the "clinical follow-up" arm, while 78/120 (65%) entered the surgery arm. In 15 cases, patients were not enrolled in the correct arm, according to the criteria agreed upon before starting the study. There still is a high incidence (11.5%) of pathological mismatches. No clinical event was reported in 2.9 years of follow-up. In conclusion, some differences emerged in the management of patients with malignant polyps among participating centers (p < 0.001), mismatches can be explained by high surgical risk or patient's choice. Only in 5 cases (4.2%), did data analysis not allow to exactly determine the reason for a choice different from protocol criteria. The availability of new risk factors and the evidence of pathological mismatches confirmed the need for future studies on this issue.