RESUMO
BACKGROUND/AIMS: The surveillance of subjects at high risk for developing gastric cancer (GC) may represent an effective strategy for reducing specific morbidity and mortality. The aim of this study was to identify GC at its initial phase and to identify precancerous lesions in a group of GC high-risk subjects. METHODS: We enrolled first-degree relatives of patients affected by GC who resided in a GC high-risk area (Tuscany, Central Italy). The study's protocol included the collection of several individual measurements, including a blood sample for the determination of specific biomarkers, an upper digestive tract endoscopy with detailed gastric biopsies and Helicobacter pylori (Hp) treatment followed by a specific check. RESULTS: We enrolled 167 subjects who were members of 128 different familial groups with GC history. We identified 1 case of initial-phase GC, 1 gastric dysplasia type II, 32 intestinal metaplasia, 10 gastric atrophy, and 21 atrophic chronic gastritis. 81 subjects were Hp-positive and underwent eradication therapy. CONCLUSION: This study of a GC high-risk Italian population reveals positive results in terms of population compliance, the identification of specific gastric lesions requiring close follow-up and successful therapy for Hp infection. To define future surveillance strategies, a longer follow-up of these patients is necessary.
Assuntos
Helicobacter pylori , Vigilância da População , Lesões Pré-Cancerosas/diagnóstico , Neoplasias Gástricas/diagnóstico , Adulto , Idoso , Biomarcadores/sangue , Biópsia , Endoscopia Gastrointestinal , Feminino , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/tratamento farmacológico , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pepsinogênios/sangue , Fatores de Risco , Neoplasias Gástricas/microbiologiaRESUMO
The purpose of this report is to describe a simple, reproducible technique for pleural drainage. This technique that requires scant resources should be used only in life-threatening situations calling for pleural drainage. It is not intended to replace conventional techniques.
Assuntos
Drenagem/métodos , Derrame Pleural/terapia , Drenagem/instrumentação , Tratamento de Emergência , HumanosRESUMO
Recent evidence suggests that interleukin-4 (IL-4) is related to mucosal tolerance by which an injurious immune response is prevented, suppressed or shifted to a non-injurious response. We investigated the expression of IL-4 and its splice variant isoform IL-4delta2 in gastric epithelial cells of healthy subjects and gastritis patients infected with Helicobacter pylori (H. pylori) with or without the cag pathogenicity island (cag-PAI). IL-4 and IL-4delta2 mRNAs were evaluated in microdissected gastric epithelium and in AGS cell lines co-cultured with H. pylori B128 or SS1 strains. IL-4 mRNA was consistently detected in microdissected gastric epithelial cells from healthy subjects. The IL-4 mRNA expression was low in H. pylori?infected patients, and markedly reduced in cag-PAI-positive ones. IL-4delta2 mRNA was expressed on gastric epithelium of H. pylori-infected patients, but not in healthy subjects. The IL-4delta2 expression was lower in cag-PAI-positive than in cag-PAI-negative H. pylori infected patients. AGS cells also produced IL-4 mRNA upon SS1 strain stimulation, whereas IL-4delta2 mRNA expression was detected in AGS co-cultured with either SS1 or B128 strains. An inverse correlation was documented between IL-4 and IL-4delta2 mRNA expression by microdissected gastric epithelial cells and the score of gastritis. IL-4, but not IL-4delta2, is expressed by gastric epithelium of healthy subjects, whereas IL-4delta2 and lesser IL-4 mRNA are detectable in the gastric epithelium of H. pylori-infected patients. Data suggest that gastric epithelial cells might regulate the balance between tolerance and immune response by the fine tuning of IL-4 and IL-4delta2 expression.
Assuntos
Mucosa Gástrica/metabolismo , Infecções por Helicobacter/metabolismo , Helicobacter pylori , Interleucina-4/biossíntese , Adenocarcinoma/genética , Adenocarcinoma/metabolismo , Adulto , Linhagem Celular Tumoral , Separação Celular , Epitélio/metabolismo , Feminino , Mucosa Gástrica/citologia , Ilhas Genômicas/genética , Humanos , Interleucina-4/genética , Masculino , Microdissecção , Antro Pilórico , RNA/biossíntese , RNA/genética , RNA Mensageiro/biossíntese , RNA Mensageiro/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Neoplasias Gástricas/genética , Neoplasias Gástricas/metabolismoRESUMO
Excessive consumption of alcoholic beverages may be associated with gastrointestinal symptoms, including dyspepsia and diarrhoea. It is not clear whether or not chronic alcohol ingestion damages the mucosa of the small intestine. We investigated the effect of chronic alcohol abuse on the duodenal mucosa, and particularly on its extracellular matrix (ECM) network. Duodenal biopsy specimens were obtained during upper gastrointestinal endoscopy from 50 chronic alcoholics without cirrhosis and 10 healthy subjects. Morphological studies were performed by routine histology, immunohistochemistry and electron microscopy. Morphometry of duodenal tissues was performed with a computerized image analyser. No significant duodenal epithelial changes were found in alcoholics, despite an evident reduction in the enterocyte turnover. Myofibroblast-like cells were significantly increased in the villus stroma of alcoholics in comparison to controls. These cells stained positively for desmin, alpha-smooth muscle actin and for several ECM components. In alcohol abusers the thickness of the mucosal basement membrane was greater and the staining for collagen I and III was enhanced both in the basement membrane and in the villus stroma. A higher expression of tenascin was also seen at the base of villi of alcoholics. Chronic alcohol abuse may induce fibrosis of duodenal villi which is associated with a transformation of villus juxta-parenchymal cells into active subepithelial myofibroblast-like cells able to produce different ECM components.
Assuntos
Alcoolismo/patologia , Duodeno/patologia , Proteínas da Matriz Extracelular/análise , Matriz Extracelular/efeitos dos fármacos , Mucosa Intestinal/patologia , Adulto , Idoso , Alcoolismo/metabolismo , Membrana Basal/patologia , Membrana Basal/ultraestrutura , Duodeno/efeitos dos fármacos , Duodeno/ultraestrutura , Feminino , Humanos , Mucosa Intestinal/efeitos dos fármacos , Mucosa Intestinal/ultraestrutura , Masculino , Pessoa de Meia-IdadeRESUMO
A sensitive radioimmunoassay was developed for human epidermal growth factor (hEGF) in saliva and gastric juice. This method was sufficiently sensitive for an accurate measurement of hEGF in these biological fluids. The minimal detectable concentration of EGF was 30 ng/L. The imprecision profile of EGF standard curve had a CV less than 10% in the range of 0.1-3.0 micrograms/L. Serial dilution curves of saliva and gastric juice paralleled that of standard EGF. The antibody to hEGF showed no cross-reactivity with a large excess of growth factors, such as human transforming growth factor alpha, human insulin-like growth factor I, and platelet-derived growth factor (c-sis). No detectable cross-reactivity was observed with some biological gut peptides: somatostatin, gastrin, secretin or pancreatic polypeptide. The intra-assay CV for saliva and gastric juice was less than 10%, and the recoveries were 93.9 +/- 8.7% and 93.7 +/- 11.3%, respectively for saliva and gastric juice. Gel exclusion chromatography revealed hEGF-like substances, heterogeneous in size in saliva and gastric juice, the origins and physiological functions of which are unknown.
Assuntos
Fator de Crescimento Epidérmico/análise , Suco Gástrico/química , Radioimunoensaio/métodos , Saliva/química , Adulto , Idoso , Anticorpos , Ligação Competitiva , Cromatografia em Gel , Reações Cruzadas , Fator de Crescimento Epidérmico/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A second antibody solid-phase enzyme immunoassay for the determination of prostaglandin E2 in human gastric juice was developed using acetylcholine esterase as label, covalently coupled to the eicosanoid. The assay was performed on 96-well microtiter plates coated with the second antibody (swine antirabbit IgG antibody). The enzyme-labeled and unlabeled prostaglandin E2 were allowed to react in a competitive manner with the immobilized specific antibody (rabbit anti-prostaglandin E2 serum). After addition of the enzyme substrate, the specifically bound acetylcholine esterase was determined at 414 nm by means of a colorimetric assay and the enzyme activity was correlated with the amount of unlabeled prostaglandin E2. According to the calibration curve, prostaglandin E2 was determined in the range of 0.5-250 pg/ml. The minimal detectable concentration of prostaglandin E2 was 1.9 +/- 0.2 pg/ml. The intraassay coefficient of variation was less than 10%. Most prostaglandins and their metabolites tested showed a cross-reactivity of less than 1%.
Assuntos
Suco Gástrico/análise , Prostaglandinas E/análise , Cromatografia Líquida de Alta Pressão , Humanos , Técnicas ImunoenzimáticasRESUMO
BACKGROUND: In vitro studies showed that Helicobacter pylori strains carrying the cag pathogenicity island are able to induce epithelial secretion of Interleukin-8. AIMS: To evaluate the assessment of cag pathogenicity island and the expression of Interleukin-8 in the gastric mucosa of Helicobacter pylori-infected patients and correlate these data with the activity of gastritis and Helicobacter pylori density. METHODS: cag status was determined by polymerase chain reaction directly on gastric biopsies from 13 Helicobacter pylori+ patients with non-ulcer dyspepsia and 13 Helicobacter pylori+ with duodenal ulcer. Interleukin-8 gene transcription and protein expression were analysed by in situ hybridization and immunofluorescence, respectively. Gastritis activity and Helicobacter pylori density were also investigated. RESULTS: cag was present in 20/26 of Helicobacter pylori+ patients: in 7/13 non-ulcer dyspepsia (53.8%] and in 13/13 duodenal ulcer patients (100%), (p<0.05). Interleukin-8 mRNA and protein expression in epithelial and inflammatory cells was higher in cag+ than in cag- patients (p<0.005). Gastritis activity significantly correlated with cag (p<0.05) and Interleukin-8 expression (p<0.005]. Helicobacter pylori density was enhanced in cag+ [p<0.005] and correlated with Interleukin-8 expression (p<0.0051. CONCLUSIONS: The present study demonstrates that in Helicobacter pylori-infected human gastric mucosa, cag+ infection is associated with enhanced Interleukin-8 expression, higher levels of active gastritis and bacterial density, and presence of duodenal ulcer.
Assuntos
Antígenos de Bactérias , Proteínas de Bactérias/genética , Úlcera Duodenal/microbiologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/genética , Helicobacter pylori/patogenicidade , Interleucina-8/biossíntese , Proteínas de Bactérias/biossíntese , Mucosa Gástrica/microbiologia , Gastrite/microbiologia , Regulação da Expressão Gênica , Humanos , Hibridização In Situ , Reação em Cadeia da PolimeraseRESUMO
BACKGROUND: It is unclear whether the extent of duodenal gastric metaplasia is due to Helicobacter pylori and/or acid. AIMS: To investigate the role of Helicobacter pylori eradication in the regression of duodenal gastric metaplasia in patients with duodenal ulcer maintained in acid suppression conditions. METHODS: . Duodenal (anterior, superior inferior walls of first part of duodenum) and gastric antrum biopsies were obtained from 44 Helicobacter pylori positive duodenal ulcer patients. Helicobacter pylori infection was diagnosed by rapid urease test, histology and 13C-Urea Breath Test. Patients were treated with 20 mg omeprazole tid associated with 250 mg clarithromycin and 500 mg amoxycillin four times daily for 10 days and maintained with 20 mg omeprazole daily for 18 weeks. Control endoscopies were performed at 6 and 18 weeks after beginning treatment. RESULTS: Duodenal gastric metaplasia regression was observed in all (32/32) patients in whom Helicobacter pylori was eradicated, but in only 3 out of 6 patients in whom eradication was not achieved (p<0. 001). CONCLUSIONS: . The present results suggest that Helicobacter pylori eradication associated with prolonged acid suppression may represent a good therapeutic strategy to achieve duodenal gastric metaplasia regression and highlight the combined role of acid and Helicobacter pylori in the pathogenesis of duodenal gastric metaplasia.
Assuntos
Antiulcerosos/uso terapêutico , Úlcera Duodenal/microbiologia , Mucosa Gástrica/patologia , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/isolamento & purificação , Omeprazol/uso terapêutico , Adulto , Idoso , Úlcera Duodenal/tratamento farmacológico , Úlcera Duodenal/patologia , Endoscopia Gastrointestinal , Feminino , Humanos , Masculino , Metaplasia/tratamento farmacológico , Pessoa de Meia-IdadeRESUMO
Major lung resection using minimally invasive techniques - video-assisted thoracoscopic surgery (VATS) - was first described 20 years ago. However, its development has been slow in many countries because the value of this approach has been questioned. Different techniques and definitions of VATS are used and this can be confusing for physicians and surgeons. The benefit of minimally invasive thoracic surgery was not always apparent, while many surgeons pointed to suboptimal operative outcomes. Recently, technological advances (radiology, full HD monitor and new stapler devices) have improved VATS outcomes. The objectives of this review are to emphasize the accepted definition of VATS resection, outline the different techniques developed and their results including morbidity and mortality compared to conventional approaches. Minimally invasive thoracic surgery has not been proven to give superior survival (level one evidence) compared to thoracotomy. A slight advantage has been demonstrated for short-term outcomes. VATS is not a surgical revolution but rather an evolution of surgery. It should be considered together with the new medical environment including stereotactic radiotherapy and radiofrequency. VATS seems to be more accurate in the treatment of small lung lesions diagnosed with screening CT scan. In the academic field, VATS allows easier teaching and diffusion of techniques.
Assuntos
Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Previsões , Humanos , Complicações Intraoperatórias/epidemiologia , Pneumopatias/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Excisão de Linfonodo/métodos , Metástase Linfática , Metanálise como Assunto , Estudos Multicêntricos como Assunto , Dor Pós-Operatória/prevenção & controle , Pneumonectomia/efeitos adversos , Pneumonectomia/economia , Complicações Pós-Operatórias/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/economia , Cirurgia Torácica Vídeoassistida/educação , Cirurgia Torácica Vídeoassistida/tendências , Toracotomia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Pulmonary parasitosis is scarcely encountered in France, and its diagnosis is quite difficult. If numerous parasites can be responsible for respiratory symptoms, only few of them can develop in the lung parenchyma and lead to complications necessitating a surgical treatment. The most common example is the hydatic disease of the lung. The authors review the biological cycles, clinical forms, diagnostic and treatment principles of those main lung parasites, which deserve surgical consideration.
Assuntos
Pneumopatias Parasitárias/cirurgia , Procedimentos Cirúrgicos Pulmonares/estatística & dados numéricos , Amebíase/diagnóstico , Amebíase/cirurgia , Diagnóstico Diferencial , Equinococose Pulmonar/diagnóstico , Equinococose Pulmonar/cirurgia , Humanos , Pneumopatias Parasitárias/diagnóstico , Paragonimíase/diagnóstico , Paragonimíase/cirurgia , Procedimentos Cirúrgicos Pulmonares/métodosRESUMO
Non-tumoral vascular disorders of the lung are multiple, even if cases diagnosed in the adulthood are rare. They include congenital or acquired conditions, which related symptoms, if present, are non specific. This explains why their diagnosis is challenging and usually delayed. Surgery is the cornerstone of their treatment, although interventional radiology represents currently a less invasive alternative option for some of them.
Assuntos
Pneumopatias/terapia , Doenças Vasculares/terapia , Adulto , Fístula Artério-Arterial/diagnóstico , Fístula Artério-Arterial/terapia , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/terapia , Sequestro Broncopulmonar/diagnóstico , Sequestro Broncopulmonar/terapia , Humanos , Pulmão/anormalidades , Pulmão/irrigação sanguínea , Pneumopatias/diagnóstico , Pneumopatias/etiologia , Artéria Pulmonar/anormalidades , Artéria Pulmonar/embriologia , Anormalidades do Sistema Respiratório/diagnóstico , Anormalidades do Sistema Respiratório/terapia , Doenças Vasculares/diagnóstico , Doenças Vasculares/etiologiaRESUMO
Mobile ECMO support for remote cardiac or respiratory assistance (MESRCA and MESRRA) allows mobilization of the medical and paramedical team 24/7 in a very large geographical area. Mobility and autonomy require adapted devices. During many years, teams had to deal with non useful equipment. Recently, thanks to interest of medical world and laboratories, many materials especially suitable for this activity are developed. We describe our local experience and solutions we tented to fi nd to deal with material difficulties.
Assuntos
Serviços Médicos de Emergência/tendências , Oxigenação por Membrana Extracorpórea/instrumentação , Reanimação Cardiopulmonar/instrumentação , Equipamentos e Provisões/estatística & dados numéricos , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , França , Cardiopatias/terapia , Humanos , Transferência de Pacientes , Insuficiência Respiratória/terapiaAssuntos
Anticorpos Antibacterianos/análise , Fezes/microbiologia , Infecções por Helicobacter/diagnóstico , Helicobacter pylori/imunologia , Adulto , Idoso , Feminino , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/microbiologia , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Pentagastrin-stimulated gastric luminal prostaglandin E2 (PGE2), 6-keto-PGF1 alpha, PGF2 alpha and thromboxane B2 (TxB2) were measured using a second antibody solid-phase enzyme immunoassay before, during and after cigarette smoking in healthy smokers. Smoking significantly increased PGF2 alpha and TxB2 concentration and output; in contrast no significant changes were found for PGE2 and 6-keto-PGF1 alpha levels. In addition, cigarette smoking caused a significant reduction in gastric juice volume and acid output but did not alter intragastric acidity. These findings may suggest a possible role of prostanoids in the response of the stomach to cigarette smoking.
Assuntos
Dinoprosta/metabolismo , Mucosa Gástrica/metabolismo , Fumar/metabolismo , Tromboxano B2/metabolismo , 6-Cetoprostaglandina F1 alfa/metabolismo , Adulto , Cromatografia Líquida de Alta Pressão , Dinoprostona/metabolismo , Suco Gástrico/metabolismo , Humanos , Técnicas Imunoenzimáticas , MasculinoRESUMO
The effect of sulglycotide, a polysulphated glycopeptide isolated from pig duodenum, on PGE2, 6-ketoPGF1 alpha and TxB2 production from isolated biopsy specimens of human antral mucosa was investigated in vitro, in comparison with carbenoxolone. In addition to a tendency toward increased PGE2 production just short of statistical significance, both sulglycotide and carbenoxolone significantly increased 6-ketoPGF1 alpha accumulation in the incubation medium. TxB2 levels were not significantly modified by the two drugs. Therefore, changes in the prostanoid production by human antral mucosa could, at least partially account for the cytoprotective effects of sulglycotide in man.
Assuntos
Antiulcerosos/farmacologia , Mucosa Gástrica/metabolismo , Prostaglandinas/biossíntese , Sialoglicoproteínas/farmacologia , 6-Cetoprostaglandina F1 alfa/biossíntese , Adulto , Animais , Carbenoxolona/farmacologia , Dinoprostona/biossíntese , Duodeno/efeitos dos fármacos , Duodeno/metabolismo , Feminino , Suco Gástrico/efeitos dos fármacos , Suco Gástrico/metabolismo , Mucosa Gástrica/efeitos dos fármacos , Humanos , Técnicas Imunoenzimáticas , Técnicas In Vitro , Masculino , Antro Pilórico/efeitos dos fármacos , Antro Pilórico/metabolismo , Suínos , Tromboxano B2/biossínteseRESUMO
Current evidence indicates that epidermal growth factor (EGF) and transforming growth factor-alpha (TGF-alpha) play a pivotal role in the maintenance of gastric mucosal integrity, via binding to a common cell-surface receptor (EGF/TGF-alpha receptor). We examined the distribution and cellular sites of synthesis of EGF/TGF-alpha receptor in normal human gastric mucosa by immunohistochemical and in situ hybridization techniques. Intense EGF/TGF-alpha receptor immunoreactivity was observed in the basal cytoplasm and along basolateral membranes of mucus neck cells, foveolar columnar cells, and surface epithelial cells facing the gastric lumen. Parietal cells and mucus-secreting pyloric gland cells displayed a distinct basolateral immunostaining, whereas the luminal membrane was unstained. Immunoreactivity was also noted in spindle-shaped cells of the lamina propria and in smooth muscle cells of the muscularis mucosae and muscularis propria. In situ hybridization revealed EGF/TGF-alpha receptor RNA transcripts in all cell types displaying positive immunoreaction. These results suggest a physiological role for EGF/TGF-alpha in the regulation of multiple gastric functions. The receptor distribution at the luminal aspect of the gastric mucosa provides the anatomical basis for a possible interaction of gastric juice EGF (or TGF-alpha) with cells of the mucosal surface, whereas the expression of EGF/TGF-alpha receptor in cells which are not in direct contact with the gastric lumen is consistent with blood-mediated or paracrine/autocrine mechanisms of EGF/TGF-alpha action on these cells.
Assuntos
Receptores ErbB/análise , Mucosa Intestinal/química , Adulto , Idoso , Anticorpos Monoclonais , Receptores ErbB/genética , Feminino , Expressão Gênica , Humanos , Técnicas Imunoenzimáticas , Hibridização In Situ , Masculino , Pessoa de Meia-Idade , Sondas RNA , RNA Mensageiro/análiseRESUMO
Immunoreactive epidermal growth factor (IR-EGF) was measured by a highly sensitive and specific radioimmunoassay in gastric juice samples obtained during endoscopy from 26 control subjects, 44 patients with duodenal ulcers, and 18 with benign gastric ulcers. In the active stage, the concentrations of the peptide were consistently reduced, compared with those found in control subjects (592.7 +/- 55.8 pg/ml), in both duodenal (262.6 +/- 21.4 pg/ml) and gastric ulcer patients (320.2 +/- 34.1 pg/ml) (p less than 0.001 and 0.01, respectively). Mean IR-EGF values distinctly lower than in the controls were still present in the gastric juice of patients with inactive duodenal ulcers (349.7 +/- 35.9 pg/ml; p less than 0.001), whereas no difference was observed in patients with healed gastric ulcers (502.2 +/- 132.3 pg/ml). Although these findings suggest a possible role for EGF deficiency in the pathogenesis of peptic ulcer disease, the pathophysiological significance of our results (if any) remains to be elucidated.
Assuntos
Úlcera Duodenal/metabolismo , Fator de Crescimento Epidérmico/metabolismo , Suco Gástrico/metabolismo , Úlcera Gástrica/metabolismo , Adulto , Feminino , Humanos , Masculino , RadioimunoensaioRESUMO
A highly sensitive enzyme immunoassay was used to determine gastric juice prostaglandin E2 (PGE2) levels in control subjects with or without gastritis and in both active or inactive duodenal ulcer patients. Mean pentagastrin-stimulated PGE2 concentration was significantly lower in patients with duodenal ulcer than in control subjects considered as a whole group (with or without gastritis). However, no such difference was found between duodenal ulcer patients and controls showing histologically normal gastric mucosa. On the other hand, controls with chronic superficial gastritis had PGE2 levels significantly higher than those of histologically normal subjects and duodenal ulcer patients. Therefore, it seems unlikely that an absolute gastric PGE2 deficiency is involved in the pathogenesis of duodenal ulcer disease. However, the possibility that PGE2 synthesis could be deficient in relation to the prevailing level of mucosal inflammation cannot be excluded.
Assuntos
Dinoprostona/análise , Úlcera Duodenal/metabolismo , Suco Gástrico/análise , Gastrite/metabolismo , Adulto , Dinoprostona/biossíntese , Feminino , Gastroscopia , Humanos , Técnicas Imunoenzimáticas , Masculino , Pessoa de Meia-Idade , PentagastrinaRESUMO
In four wards of a large specialized orthopedic hospital in Bologna a self-administered questionnaire has been distributed to 34 nurses and 70 patients to investigate on one side, the representation which nurses have of patients' needs and the difficulties met in their work, on the other side the representation which patients have of the care they receive and of the difficulties they have in their relationship with nurses. Nurses give principal importance to those activities which contribute to the development of a good relationship with the patients. There is however a clear gap between the degree of awareness of the principles and their implementation, possibly as a consequence of the work organization. Some model situations are examined and discussed (e.g. the time allowed for dialogue, which is confined to ten minutes).
Assuntos
Relações Enfermeiro-Paciente , Comportamento Social , Comunicação , Humanos , Itália , Recursos Humanos de Enfermagem Hospitalar/psicologia , Enfermagem Ortopédica , Pacientes/psicologia , Qualidade da Assistência à SaúdeRESUMO
BACKGROUND & AIMS: Although epidermal growth factor (EGF) inhibits gastric acid secretion, the effects it exerts on gastric chief cells are unknown. The aim of this study was to investigate whether EGF modulates pepsinogen release and intracellular Ca2+ concentrations ([Ca2+]i) and whether the effect involves mitogen-activated protein (MAP) kinase, eicosanoid generation, and nitric oxide. METHODS: Chief cells were obtained by sequential digestion with collagenase and Ca2+ chelation. [Ca2+]i was measured in cells loaded with Fura-2 and NO generation by the NO coproduct citrulline. RESULTS: In situ hybridization, immunohistochemistry, and immunoblotting showed that EGF receptor and MAP kinases were constitutively expressed in chief cells. EGF caused a concentration-dependent stimulation of pepsinogen secretion and MAP kinase activity and determined a 2.5-7.0-fold increase in [Ca2+]i, inositol 1,4,5-tryphosphate, prostaglandin E2, and leukotriene B4. Tyrosine kinase inhibitors and cyclooxygenase and lipoxygenase inhibitors reduced pepsinogen secretion and eicosanoid generation induced by EGF. EGF increased citrulline generation and guanosine 3',5'-cyclic monophosphate accumulation sixfold; the effect was blocked by NG monomethyl-L-arginine, which is an NO synthase inhibitor. CONCLUSIONS: EGF stimulates pepsinogen secretion by activating eicosanoid generation, tyrosine kinases, MAP kinases, Ca2+, NO, and guanosine 3',5'-cyclic monophosphate.