The proposal of a clinical protocol to assess central and peripheral fatigue in myotonic dystrophy type 1.

DM1 is an autosomal-dominant disorder characterized by muscle weakness, myotonia, and multisystemic involvement. According to current literature fatigue and daytime sleepiness are among the main symptoms of DM1. Oxidative stress has been proposed to be one of the pathogenic factors of fatigue consequent to DM1. In this study, we investigated the dimensions of experienced fatigue and  physiological fatigue in a sample of 26 DM1 patients (17 males, 9 females, mean age 41.6 years, SD±12.7); experienced fatigue has been studied through Fatigue Severity Scale (FSS), and physiological fatigue was measured through an intermittent incremental exercise of the forearm muscles using a myometer; oxidative stress balance markers trend during aerobic exercise test have been collected. The occurrence of central fatigue in the sample means that central activation worsens during the motor contraction; interestingly FSS score was significantly correlated to MVC (before and after the effort, r-before=-0.583, p<0.01, r-after= -0.534, p<0.05), and to motor disability measured by MRC (r=-0.496, p<0.05); moreover we found a strong tendency towards significance in the association to lactate baseline (r=0.378, p=0.057).Results are discussed to define whether or not, based on clinical and laboratory grounds, such exercise training protocol may be suitable for proper management of DM1 patients; proper assessment of fatigue should be included in algorithms for data collection in DM1 patient registries.

Gastric infection by Helicobacter pylori and antral gastritis in hyperglycemic obese and in diabetic subjects.

The aim of this work was to ascertain if diabetes and obesity can affect gastric colonization by Helicobacter pylori. 59 hospitalized subjects with dyspepsia and endoscopic antral gastritis were selected. They were divided into three groups: I) 13 patients with normal body weight and without disease other than gastritis (control group); II) 15 patients with essential obesity of whom 10 had impaired glucose tolerance (IGT); III) 31 patients with type II diabetes mellitus, of whom 14 were obese. Three gastric biopsies were obtained from each patient for histologic examination and H. pylori detection by means of rapid urea test, culture and histological evidence of Helicobacter-Like Organisms (HLO). Age, sex, blood glucose, cholesterol, triglycerides, HDL-cholesterol, basal gastrine, duration of illness, body weight were statistically analysed. Differences between the three groups were not statistically significant. There was a higher prevalence of H. pylori infection both in obese and in diabetic patients with respect to control subjects. Prevalence became still higher in obese patients with impaired glucose tolerance. Among the three tests used for the detection of H. pylori, culture and rapid urea were reliable and specific, while the histologic test was highly sensitive but barely specific. Our data suggest that both obesity and type II diabetes may be associated with an increased incidence of H. pylori-colonization. This could be related to the reduced gastric motility observed in both pathologies and chemical changes in gastric mucosa following non-enzymatic glycosylation processes.

[Morphological variations of the human gastric mucosa after omeprazole treatment: a scanning electron microscopic study]. / Variazioni morfologiche della mucosa gastrica umana dopo trattamento con omeprazolo: studio al microscopio elettronico a scansione.

Numerous studies have been performed on the effects of omeprazole, a powerful inhibitor of gastric acid secretion, on the various morphotypes of oxyntic mucosa, whilst scant attention has been paid to modifications induced by this drug on surface epithelial mucosa. The authors carried out a SEM study on bioptic fragments removed at gastric level from 15 patients receiving omeprazole treatment for duodenal ulcer and/or reflux esophagitis, but apparently free from lesions to the mucosa of the body of the stomach. Biopsies were performed before the start, after two months and after seven-ten months of treatment. The results of basal biopsies showed an hypersecretive trend in surface epithelial cells, with frequent dissolution of the apical plasmalemma and emptying of cell bodies. After two months of treatment the hypersecretive phenomena regressed, whereas the mucosa appeared hypertrophic and presented typical cell polymorphism in some areas. After seventeen months of treatment the mucosa showed normal characteristics, except in one case in which there was a trend towards atrophy. In conclusion, the authors attribute the hypertrophic-dysplastic modifications observed after medium-term treatment to hypergastrinemia, secondary to treatment, and suggest careful morphological control follow-up during the course of treatment so as to obtain an early diagnosis of a possible deviation towards intestinal metaplasia.

Hypnosis, behavioral theory, and smoking cessation.

Although nicotine replacement and other pharmacological treatments head the list of popular interventions for smoking cessation, approaches based on psychology can also assist smokers. Hypnosis, suggestion, and behavior therapies have been offered to patients and studied experimentally for several decades. Although no single psychological approach has been found to be superior to others, psychological interventions contribute significantly to successful treatment outcome in smoking cessation. This article describes common hypnotic and behavioral approaches to smoking cessation and critically reviews some of the findings from clinical and experimental research studies. The authors also offer suggestions regarding treatment and future research.

[The role of esophageal sphincter tonus and of gastric motility in the extent of reflux esophagitis]. / Ruolo del tono sfinteriale esofageo e della motilità gastrica sull'entità dell'esofagite da reflusso.

Thirty-two patients with symptomatic gastroesophageal reflux disease were investigated by esophagogastroduodenoscopy, 24 h pH monitoring, esophageal manometry and measurement of gastric emptying of solids, in order to elucidate the relative importance of lower esophageal sphincter tone, amount of acid reflux and gastric emptying on the degree of esophagitis. The mechanical competency of lower esophageal sphincter was significantly deranged in patients with moderate/severe esophagitis than in patients with mild esophagitis. The gastric emptying time was significantly delayed in patients with moderate/severe esophagitis than in patients with mild esophagitis. No relationship was observed between amount of acid reflux, lower esophageal sphincter function and gastric emptying time. Our results suggest that resting pressure of lower esophageal sphincter and the gastric motor function play a major role in severity of reflux esophagitis.

[Apropos of 1 case of anisakiasis contracted in Sicily]. / A propos d'un cas d'anisakiase contractée en sicile.

The authors describe a case of anisakiasis in Sicily. The diagnosis was based on the knowledge that a contaminated fish, Lepidopus caudatus, had probably been absorbed, as well as on clinical intestinal symptoms, intestinal lesions observed by endoscopy and O.G.D.S, duodenal infiltration by eosinophilic polymorphonuclear, positive ELISA anisakis serology and successful treatment by albendazole.

[Vascular compression syndrome of the duodenum. Diagnostic and therapeutic update]. / La sindrome da compressione vascolare del duodeno. Attualità diagnostiche e terapeutiche.

Superior mesenteric artery syndrome is an uncommon clinical condition. A case of duodenal vascular compression and a review of the literature are reported in order to clarify the pathophysiology of the disease. Diagnostic values of hypotonic duodenography and angiography are emphasized. Although, the significance of long-term pH monitoring and gastric emptying for preoperative study and its importance in follow-up after the surgical treatment are evaluated.

[Stenosing esophagitis caused by Trichosporon beigelii: presentation of a rare case]. / Esofagite stenosante da Trichosporon beigelii: presentazione di un raro caso clinico.

The Authors describe a rare case of esophageal stenosis complicated by gastroesophageal reflux due to Trichosporon beigelii in the absence of a pathologic predisposition or immunodeficiency. The diagnosis was drawn by embedding membrane fragments obtained endoscopically in Sabouraud and blood-Agar cultures. The patient was treated with antimicotics, immunostimulants, inhibitors of the gastric protonic pump, prokinetics and later underwent endoscopic dilatation combined with Savary-Guillard and pneumatic dilatators of growing diameter, until complete "restitutio ad integrum" of the esophageal lumen.

Carboplatin and gemcitabine combination in metastatic triple-negative anthracycline- and taxane-pretreated breast cancer patients: a phase II study.

Triple-negative breast cancer (TNBC) is characterized by lack of hormone receptors and HER-2 and shares many features with BRCA1-associated cancer. Preclinical data indicate cisplatin sensitivity, suggesting that these tumors may have defects in the BRCA1 pathway. The carboplatin and gemcitabine (CG) combination is active in unselected anthracycline/taxane pretreated metastatic breast cancer patients, so we carried out a phase II study to evaluate the activity of the CG combination in pretreated metastatic TNBC patients. From 10/2004 to 3/2009 we enrolled 31 patients. Median age was 57 years and 29 patients out of 31 had visceral involvement. The overall response rate (ORR) was 32% (1 complete response /9 partial responses), in addition 5 patients obtained stable disease for >12 weeks. After a median follow-up of 34 months, all patients progressed with a median time to progression of 5.5 months and median overall survival of 11 months. Dose reductions, delays and omissions occurred in 75 (60%), 36 (29%) and 22 (18%) cycles. Grade 3/4 neutropenia occurred in 17 and febrile neutropenia in 4 patients. Ten patients had Grade 3/4 thrombocytopenia. Non hematological toxicities were manageable. The CG combination is a reasonable option for the treatment of metastatic pretreated TNBC patients.

Protective effect of leuprolide on ovarian function in young women treated with adjuvant chemotherapy for early breast cancer: a multicenter phase II study.

The aim of this study was to evaluate the protective effect of concomitant leuprolide treatment on ovarian function in young women undergoing adjuvant chemotherapy for early breast cancer. 19 women, median age 36.5 years (range 26-40 years), with operable breast cancer and negative hormonal receptors, received six cycles of FEC 100 regimen as adjuvant chemotherapy and co-treatment with leuprolide. Menstrual resumption was gained in all patients in a median time of 5 months (range 3-8). Follicle-stimulating hormone and estradiol assessment was performed in all patients. The return to pre-menopausal values was achieved within 6 months of the last leuprolide administration. At a median follow-up of 3 years (range 1-5 years), no patient relapsed and four full-term pregnancies were recorded in four women, each of whom delivered a healthy infant. Our data are in agreement with similar experiences and confirm the activity of GnRH therapy in preventing ovarian failure.

[Clinical evaluation of doxofylline sachets in a pediatric population]. / Valutazione clinica della doxofillina bustine per os in una popolazione in età pediatrica.

Therapeutic efficacy and tolerability of doxofylline 200 mg sachets, were evaluated, in a pediatric population in comparison with placebo. After double blind randomization, 11 patients aged from 6 to 12 years, were treated for 14 consecutive days. Doxofylline was administered at the daily dose of 12 mg/kg in two times. In the doxofylline group the authors observed a significative improvement of the evaluated spirometric paramethers (FEV1, FCV, FEF, FMF, PEF, MVV); in the placebo group there were only casual modifications. None of the patients treated complained of any side effect.

A computerized program of skin test evaluation and its predictive value in immunotherapy.

The present study describes a computerized methodology for the assessment of specific skin testing which is both sensitive and reproducible. We evaluated the predictive value of this technique in identifying patients at great risk for developing undesirable reactions during hyposensitization. In 11 of 93 patients we were able to detect an unusual dermal response in the patients who developed either generalized or local generalized adverse reactions.

Giant fibrovascular polyp of the esophagus: CT and MR findings.

We present a case of giant fibrovascular polyp of the esophagus with predominant fat contents. Both computed tomography (CT) and magnetic resonance imaging (MRI) findings of this rare tumor are reported. The employment of CT and MRI in the presurgical evaluation of fibrovascular esophageal polyp is suggested.

Upper gastrointestinal endoscopy can be a reliable screening tool for celiac sprue in adults.

In our study, we evaluated whether the combination of two endoscopic abnormalities in the duodenum (the "mosaic" appearance and loss of duodenal folds) is significantly associated with duodenal villous atrophy secondary to celiac sprue in adults. Fourteen patients referred for esophagogastroduodenoscopy for suspected celiac sprue and 146 for suspected peptic disease were enrolled in the study. At least one of the two endoscopic duodenal abnormalities was observed in all 10 untreated celiac patients but in only one of the dyspeptic patients. The sensitivity and specificity were 100 and 99.3%, with positive and negative predictive value of 90.9 and 100%, respectively. Such good results suggest that duodenal endoscopy can be a screening procedure for celiac sprue in patients who are undergoing endoscopy for other reasons.

Tumors of the ampulla diagnosed by CT hypotonic duodenography.

Adenocarcinoma is an uncommon gastrointestinal malignancy. Fiberoptic duodenoscopy is the diagnostic procedure of choice, allowing direct visualization as well as biopsy of the neoplasm. Conversely, in the vast majority of cases, CT is unable to demonstrate the duodenal tumor. We describe a technical procedure that has permitted CT visualization of a small ampullary tumor in two cases.

Comparison between ranitidine 150 mg b.d. and ranitidine 300 mg nocte in the treatment of duodenal ulcer.

A multicenter trial was undertaken to assess the clinical usefulness of a single night-time dose of ranitidine in the short-term healing of duodenal ulcer. 384 patients with endoscopically diagnosed duodenal ulcer were randomly allocated to treatment with ranitidine either 150 mg b.d. or 300 mg as a single night-time dose for four weeks. The patients not healed after four weeks were again treated for four weeks. Of the 356 patients who completed the study, according to the protocol, 148 of 176 (84.1%) recovered on ranitidine 150 mg b.d. and 147 of 180 (81.7%) recovered on 300 mg nocte after four weeks. The healing rates increased to 95.8% and 94.8% respectively after four more weeks. Ulcer symptoms were rapidly reduced with no significant differences between the two treatment groups. There were no unwanted effects in either group and no significant abnormal biochemical or hematological changes. The results of this study support the hypothesis that ranitidine 300 mg given as one night-time dose and ranitidine 150 mg b.d. are equally effective. Ranitidine 300 mg once daily in a clinical practice may be advantageous to the patient.

Gastric mucosal mast cells in atopic subjects.

Intragastral allergen provocation under endoscopic control (IPEC) allows direct observation of gastric mucosa reactions after contact with inhalant allergens that reach the stomach. We selected patients with proved atopy to Parietaria but without clinical and endoscopic signs of gastric disease, and we tested them with the specific inhalant allergen during IPEC, recording gastric macroscopic reaction and mucosal mast-cell changes in biopsy specimens. All atopic patients showed visible changes in gastric mucosa quantified as IPEC score. Mast-cell numbers detected in atopic patients (135.4 +/- 102.6/mm2 of stromal area) were significantly higher than in nonatopic subjects (59.8 +/- 25.4/mm2; P < 0.03) and were positively correlated to atopic IPEC score (P < 0.01). In addition, 6/12 atopics who had both higher mast-cell counts and IPEC score showed an intraepithelial distribution of gastric mast cells which displayed ultrastructural features of partial degranulation. It is likely that changes observed in our patients with allergy to Parietaria reflect a subclinical activation of mast cells in the gastric mucosa.