[Our experience with ischemic colitis]. / Nostra esperienza sulle coliti ischemiche.

Personal experience in seven cases of ischaemic colitis that required surgery is reported. The aetiological, pathological and clinical features of the disease are then considered.

Effect of cessation of alcohol use on the course of pancreatic dysfunction in alcoholic pancreatitis.

Exocrine pancreatic function was studied sequentially by means of the secretin-cerulein test in 32 patients with alcoholic chronic pancreatitis to elucidate the long-term course of pancreatic dysfunction, and to determine whether the cessation of alcohol use had any influence on the natural history of pancreatic functional changes caused by this disease. At initial studies, 5 patients had normal pancreatic function, and the remaining 27 had pancreatic insufficiency, which was mild to moderate in most subjects. The final studies, carried out at an average of 7.3 yr (range, 4-11 yr) after the first, showed a significant deterioration in pancreatic function, both in patients who stopped alcohol after the initial study (n = 18) and in those who did not (n = 14). The deterioration, however, was significantly less marked in patients who stopped drinking alcohol than in those who continued. These data indicate that pancreatic functional changes caused by alcoholic pancreatitis progress even after cessation of alcohol use; however, the progression is slower and less severe when alcohol intake is stopped.

Regional distribution of immunoreactive dynorphin A in the human gastrointestinal tract.

Immunoreactive dynorphin A (ir-Dyn A) was detected throughout the human gastrointestinal tract by a validated radioimmunoassay. Moreover, the stability of 125I-Dyn A during extraction procedures was confirmed by high performance liquid chromatography. Levels of ir-Dyn A were higher in the stomach and in the small bowel. In tissue samples separated into the main layers composing the gut wall (muscularis externa, submucosa and mucosa) ir-Dyn A was uniformly distributed. An exception was the colon, where concentrations were higher in the muscular portion. Gel permeation chromatography on samples of mucosa and muscularis externa extracts of ileum and gastric fundus, showed immunoreactive material eluting in several forms of apparently higher molecular weight than Dyn A, while only a minor peak was found to coelute with authentic Dyn A.

Does ephedrine promote weight loss in low-energy-adapted obese women?

A double-blind cross-over randomized study was performed in 10 selected adult overweight and obese (body mass index greater than 27) women who had been adapted to low-energy intake for a long period of time and who had shown difficulty in losing weight with conventional hypocaloric treatment. Combined with diet therapy (1000-1400 kcal/day), l(-)ephedrine hydrochloride (50 mg three times a day per os) or placebo were administered daily before each meal, after a period of stabilization with diet only for 1 month. Each pharmacological treatment lasted for 2 months. Weight loss was significantly (P less than 0.05) greater during the ephedrine period (2.41 +/- 0.61 kg) than during the placebo period (0.64 +/- 0.50 kg). None of the patients presented clinically important side-effects. These preliminary results seem to suggest a possible role for a thermogenic compound such as ephedrine in promoting weight loss in low-energy-adapted obese women.

Influence of gastric acid secretion on interdigestive gastric motor activity and serum motilin in the elderly.

The purpose of this study is to investigate the influence of gastric secretion on the interdigestive gastric motor activity and related serum motilin variations in elderly subjects. The study was carried out on two groups of elderly subjects: one with achlorhydria or marked hypochlorhydria due to chronic atrophic gastritis and the other with normal acid secretion. A group of nonelderly subjects with normal acid secretion was also examined as control. Gastric motility was studied manometrically and serum motilin was measured by radioimmunoassay on blood samples taken every 15 min during the entire motor recording period of 200-300 min. Both groups of elderly subjects showed (1) alterations in interdigestive gastric motility and (2) serum motilin which was steadily high without the normal cyclic fluctuations. These studies suggest that the alterations in gastric motor activity and serum motilin in aged subjects are not related to the acid secretory capacity of the stomach. Other factors, such as alterations in the neurohormonal control system of gut motility, should be considered in the genesis of these age-related disorders.

Relationship between morphological changes detected by ultrasonography and pancreatic exocrine function in chronic pancreatitis.

We have studied the degree of pancreatic secretory alterations assessed by secretin-cerulein test (S-C) in relation to various morphological changes detected by real-time ultrasonography (US) in 42 patients affected by chronic pancreatitis. Exocrine insufficiency was found in 41 patients (97.6%), while morphological alterations were detected in 32 (76.1%). In the 10 patients with normal US, a mild or moderate exocrine insufficiency was present. Significant negative linear correlations of decreasing volumes of duodenal aspirate (r = 0.528, p less than 0.001) and output of bicarbonate (r = 0.635, p less than 0.001), lipase (r = 0.583, p less than 0.001), and chymotrypsin (r = 0.592, p less than 0.001) were found with increasing ultrasonographic alterations. However, a wide overlap was found in the secretory behavior in the various categories of change as determined by ultrasound. Hence, the attempt to predict exocrine function on the basis of morphological alterations proved unsuccessful.

The sonographic appearance of the normal gastric wall: an in vitro study.

In order to evaluate the real number and anatomical correspondence of the ultrasonographically recognizable layers within the gastric wall, we used a high frequency (7.5 MHz) rotating transducer to examine five surgical specimens of the stomach suspended in a water bath. Five layers were always clearly distinguishable within the gastric wall, whose thickness was 3-6 mm. Fine needles and lancets were localized at the level of the 3rd hyperechoic layer when inserted in the submucosa and in the 4th hypoechoic layer when inserted in the muscolaris propria. Thin echogenic bands were always displayed on both sides of other homogeneous tissues (spleen, myometrium) suspended in water. On the basis of these findings and also taking in account the physical laws of ultrasound interactions with tissues, we conclude that the 1st and the 5th hyperechoic layers are partially generated by ultrasound reflection at the interface liquid/wall. The 2nd hypoechoic layer corresponds to the deepest part of the mucosa; the 3rd hyperechoic to the submucosa and the submucosa/muscularis propria interface and the 4th hypoechoic layer to the muscularis propria.

Effect of somatostatin and thyrotropin-releasing hormone on cholecystokinin-induced gallbladder emptying.

The effect of somatostatin (0.05 and 1.5 micrograms/kg/hr) and of thyrotropin-releasing hormone (0.1 and 1.0 microgram/kg/hr) on cholecystokinin-induced gallbladder emptying was studied in healthy volunteers by means of real-time ultrasonography. In addition, the action of increasing doses (0.05, 0.15, 0.45, and 1.35 micrograms/kg/hr) of somatostatin on resting gallbladder volume was also evaluated. Somatostatin, at the dose of 0.05 microgram/kg/hr (shown to produce blood levels similar to those measured after a meal) significantly inhibited the gallbladder contraction in response to cholecystokinin. Kinetic analysis showed that the interaction of somatostatin and cholecystokinin is of the noncompetitive type. The higher dose of the peptide (1.5 microgram/kg/hr) completely suppressed cholecystokinin-induced gallbladder contraction. In experiments carried out using somatostatin alone, a progressive increase in gallbladder volume in response to increasing doses of peptide was observed. The administration of either dose of thyrotropin-releasing hormone did not affect gallbladder emptying in any of the subjects studied. It is concluded that somatostatin is a potent inhibitor of cholecystokinin action on the gallbladder. The clear effectiveness of a very low, presumably physiological, dose indicates that somatostatin may play a physiological role in the regulation of gallbladder motor activity and provides further evidence that the peptide may act as a true hormone in man. Thyrotropin-releasing hormone does not seem to affect gallbladder motility, at least under the experimental conditions of the present study.

Interdigestive plasma motilin concentrations in aged adults.

The interdigestive plasma motilin concentrations were evaluated in 13 over-65 healthy adults with no evidence of significant disease and in 19 younger individuals. Plasma motilin levels were determined every 15 min during a 3-hr fasting period, using a radioimmunological method. The individual median values of plasma motilin concentrations during the entire study period were significantly higher in aged than younger adults. The individual median coefficients of variation of motilin concentrations and the percentage increases of plasma motilin above baseline at each peak were significantly lower in the aged than in the young group. The results of this study indicate that during the interdigestive period aged individuals have markedly elevated circulating motilin levels, with less pronounced fluctuations than younger persons. This particular hormone pattern could be involved in motor disturbances of the stomach in elderly adults.

Intraoperative ultrasonography in surgery for liver tumors.

Intraoperative ultrasonography was used in 37 patients during surgery for suspected liver tumors. The size, number, and site of the lesions were determined together with the relationship of the tumor to the intrahepatic vessel, as well as possible small daughter lesions within the liver. Final diagnosis in these patients was hepatocellular carcinoma in 19 cases, metastases from colorectal cancers in 15 cases, and benign lesions in three cases. Previously undetected small tumors were revealed in one patient with sigmoid cancer and in five patients with liver cell carcinoma who had cirrhosis. Vascular tumoral infiltrations were easily displayed and the surgical approach modified accordingly: a more extended resection was performed in two cases of huge central hepatic metastases. Intraoperative ultrasonography revealed seven cases of small (2 to 3 cm) hepatocellular carcinomas in cirrhotic livers that were not visible or palpable, thus allowing a subsegmentary resection. Finally, in three cases of atypical tumors, an intraoperative echo-guided biopsy specimen was required to establish the benign nature of lesions and resection was avoided. Intraoperative ultrasonography facilitates the diagnosis of small liver tumors and can also aid the surgeon in his choice of technique, especially in cases of cirrhosis of the liver. A resection can be avoided altogether when multiple lesions are involved, or echo-guided subsegmentary resections can be performed in cirrhotic livers when a less extended resection is required. This technique makes it possible to establish the relationship between the tumor and intrahepatic vessels, thus preventing vascular injury and making radical hepatic resection safer.

Gastric carcinoid: a clinical and endoscopic assessment of four cases.

We have established a pre-operative diagnosis in four cases of non-secretory gastric carcinoid of the body and fundus presenting as multiple polyps in three patients, and a single polyp mass in the fourth patient. Clinical and endoscopic findings are not specific, and the pre-operative diagnosis was established by means of biopsy or polypectomy. We observed biochemical and histological differences between multiple and single carcinoids, which might indicate different mechanisms of carcinoid pathogenesis.

Technique of endoscopic ultrasonography investigation: esophagus, stomach and duodenum.

Endoscopic ultrasonography (EUT) allows a better sonographic image of the internal organs. Moreover, it is possible for the first time to explore the upper GI tract wall. To achieve this, three methods are available: 1) direct apposition of the transducer on the mucosa; 2) contact of a small balloon filled with water over the tip of the ultrasonic probe; 3) direct instillation of water. The esophageal wall is explored with the first and second method; the gastric wall is best explored with the third method; the duodenal wall is explored with the second or the third method. Exploration of esophagus and stomach has been achieved in 100% of cases, duodenal exploration in 72% of cases. No complications occurred in this study.

Problems and variations in the interpretation of the ultrasound feature of the normal upper and lower GI tract wall.

The aim of this study was to define the various ultrasound appearances of the normal upper and lower GI tract wall and to discuss current interpretations of the relationship between each echographic layer with the real anatomical structures. We studied a total of 70 patients by means of endoscopic ultrasonography and examined in vitro some surgical specimens of the normal stomach, colon and rectum. We found a 'five layer' structure at the level of the esophageal and gastric wall. This pattern was not recognized in the duodenum during the in vivo study. Our experimental results support the hypothesis that the first and fifth hyperechoic layers of the gastric wall are partially generated by ultrasound reflection at the interface liquid/wall and that the second hypoechoic layer corresponds to the deepest part of the mucosa. Important variations in the thickness of each layer were found in different conditions during in vivo studies. The fourth hypoechoic layer becomes very thin after water distension of the stomach. The in vitro investigation of the specimen of normal colon and rectum showed some different features. At this level it is sometimes possible to distinguish a separate very thin hypoechoic layer in the deepest part of the second layer, probably corresponding to the muscularis mucosae. The muscular layer is sharply divided into two distinct layers related to the circular and longitudinal muscular coats.

Detection of portal hypertension and esophageal varices by means of endoscopic ultrasonography.

Endoscopic ultrasonography (EUT) enables not only the visualization of the portal system and of the esophageal varices, as obtained by transabdominal ultrasonography and fiberoptic endoscopy, but also the visualization of intramural and periesophageal collateral veins. Fifteen cirrhotic patients were examined by EUT without complications. When present, esophageal or gastric varices were always detected. In all cases enlarged extrinsic periesophageal veins were visualized, and in 14 of 15 their caliber was correlated with the size of esophageal varices. In three patients examined after sclerotherapy the submucosal veins had disappeared, but extrinsic collateral vessels were patent. EUT will probably become a fundamental technique in the study of portal hypertension and esophageal varices, before and after therapy.

Effect and tolerability of omeprazole in the treatment of duodenal ulcer disease.

In an open clinical trial, 16 hospital outpatients with endoscopically proven duodenal ulcer were given 30 mg omeprazole once daily for four weeks. After two weeks' treatment 14 of the 16 patients had healed and after four weeks all patients were healed. Reduction of pain was rapid and occurred during the first part of the trial. No serious adverse events or clinically significant deviations from normal laboratory values were reported. Serum gastrin levels significantly increased during treatment but returned to normal levels after the treatment was discontinued.