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La colite ischemica
No full textVengono riportati:
Cenni di Anatomia; Eziopatogenesi; Anatomia Patologica; Quadrio Clinico; Diagnosi e Terapia della Colite Ischemica
Effetti avversi delle terapie nelle malattie infiammatorie intestinali croniche
No full textL'efficacia e la tossicità dei farmaci usati nelle MICI dipende dall'ampia variabilità dei pazienti. Tra i fattori che possono influenzare l'insorgenza di effetti avversi vi sono la severità della malattia, i fattori ambientalie genetici. L'utilizzo di più famraci contemporaneamente e le complicanze legate alla malattia stessa possono essere elementi importantinell'influenzare la relazione tra evento avversoe farmaco sospetto
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Can metabolic and hepatic abnormalities be improved by intragastric balloon treatment for obesity?
No full textPurpose: In obesity, a cluster of metabolic alterations (Metabolic Syndrome, MS) is often associated with Fatty Liver (FL). The bright liver at abdominal ultrasonography (US) and, in most cases, increased levels of hepatic enzymes, alanine aminotransferase (ALT) and gamma-glutamyltranspeptidase (GGT), are considered the hallmarks of Nonalcoholic Fatty Liver Disease (NAFLD) in obese patients. Insulin resistance (IR) is the main link among obesity, FL and MS. Bioenterics Intragastric Balloon (BIB, Inamed Health, Santa Barbara, Ca., USA) is considered a safe procedure to prepare patients to the bariatric surgery. The aim was to evaluate if the weight loss induced by BIB can improve both IR and liver enzymes.
Methods: From March 2003 through April 2007 in our digestive endoscopy service, 100 patients (F 65; age 20-63 yrs) with obesity and severe obesity (BMI 32-62) underwent BIB insertion. The BIB was placed under endoscopic control and removed 6 months later. US, clinical and routine laboratory investigations were performed before and after BIB. IR was calculated by the Homeostasis Model Assessment (HOMA-IR), as fasting serum insulin ( U/ml) x fasting plasma glucose (mmol/l)/22.5; values >2.5 indicate a state of IR. Exclusion criteria: HBV(+), HCV(+), alcohol consumption >20g/day, known drugs in the history.
Results: BMI decreased significantly after BIB (42.7 5.6 vs. 38.4 5.3; p10%) was observed in 50 patients (pts.). US showed FL in the majority (70%). In FL pts. ALT U/L (48.8 46.5 vs. 31.1 26.9) and GGT U/L (41.5 38.9 vs. 29.5 20.9) significantly decreased after treatment (p2.5 were recorded in 86% FL and in 74% noFL pts. Values significantly decreased after treatment both in FL (6.03 4.47 vs. 4.21 3.35; p<0.05), and in noFL pts. (4.71 2.62 vs 2.89 1.39; p<.001). FL and noFL pts. with BMI<10%, HOMA-IR, ALT, GGT values did not significantly change after BIB. Before BIB in FL pts. a weak correlation (r=0.37) was found between GGT and HOMA-IR values. Hypertriglyceridemia in 42.3%, HDL cholesterol levels <40mg/dL in 32.4% did not significantly change after BIB.
Conclusion: Weight loss induced by intragrastric balloon reduces IR. The ALT and GGT decrease suggests an improvement of hepatic lobular inflammation. The benefit depends on a decrease of BMI higher than 10%. We confirm the pivotal role of IR in FL
Non-cirrhotic extrahepatic portal vein thrombosis: A 6-year long case history
No full textWe reviewed a case of a 47 years-old man with splenoportal vein thrombosis (SVT), not associated with liver cirrhosis. Additional risk factors as neoplasia, abdominal inflammatory disease, inherited and acquired thrombophilia were considered in the differential diagnosis. PCR assay identified the V617F mutation of JAK2 gene, a molecular marker of chronic myeloproliferative disorders (CMPD). JAK2 mutation and CMPD were diagnosed six years later than the onset of SVT. We discuss which clinical and laboratory features might be considered in advance, avoiding a delay of correct diagnosis. We confirm the importance to search JAK2 mutation whenever splanchnic vein thrombosis takes place, without underlying liver cirrhosi
Bariatric Therapy with Intragastric Balloon Improves Liver Dysfunction and Insulin Resistance in Obese Patients
No full textBACKGROUND: Obesity is often associated with fatty liver (FL). In most cases, bright liver at ultrasound (US) and increased alanine aminotransferase (ALT) and gamma-glutamyltranspeptidase (GGT) levels are considered the hallmarks of nonalcoholic fatty liver disease (NAFLD). Insulin resistance (IR) is the main link between obesity and NAFLD. The use of the Bioenterics intragastric balloon (BIB) is a safe procedure either for inducing a sustained weight loss with diet support or for preparing those patients who are candidates for bariatric surgery. The aim of the study was to investigate whether the weight loss induced by intragastric balloon might improve IR and liver enzymes. The presence or absence of FL at US and the influence of a body mass index (BMI) decrease > or = 10% after BIB (DeltaBMI > or = 10%) were also considered. METHODS: One hundred and three consecutive obese (BMI > 30 kg/m(2)) patients (38 males/65 females; mean age 41.3, range 20-63 years) underwent BIB insertion under endoscopic control. The BIB was removed 6 months later. US, clinical, and routine laboratory investigations were performed before and after BIB. IR was calculated by the homeostasis model assessment (HOMA-IR > 2.5). Exclusion criteria were hepatitis B virus positive, hepatitis C virus positive, alcohol consumption >30 g/day, history of hepato-steatogenic drugs, and type 1 diabetes. RESULTS: Ninety-three patients were eligible for the study. The BMI significantly decreased in all investigated patients, and it was > or = 10% in 59% of the patients. FL was seen at US in 70%, impaired fasting blood glucose was present in 13%, ALT exceeded the normal limit in 30.1%, GGT exceeded the normal limit in 15%, and HOMA-IR was >2.5 in 85%. Median HOMA-IR decreased significantly in FL (4.71 vs 3.10; p or = 10%, the median values of HOMA-IR (4.95 vs 2.69; p or = 10%; ALT and GGT did not significantly decrease. CONCLUSIONS: Weight loss induced by intragrastric balloon reduces IR. The ALT and GGT decrease suggests an improvement in hepatic damage. The benefit depends on the decrease of BMI higher than 10%
NONALCOHOLIC FATTY LIVER DISEASE AND INTRAGASTRIC BALLOON TRATMENT FOR OBESITY
No full textINTRODUCTION: Hepatic lipid accumulation (Fatty Liver, FL) is often associated with obesity especially when a cluster of metabolic disturbances (Metabolic Syndrome, MS) occurs. A "bright liver" at abdominal ultrasonography (US) and, in most cases, increased levels of hepatic enzymes, alanine aminotransferases (ALT) and gamma-glutamyltranspeptidases (GGT), are considered the hallmarks of Nonalcoholic Fatty Liver Disease (NAFLD) in obese and severely obese patients. Insulin resistance (IR) is reported to be the main link among obesity, NAFLD and MS. Bioenterics Intragastric Balloon (BIB; Bioenterics, Santa Barbara, Ca., USA) is considered a safe procedure for preparing the patients to the bariatric surgery.
AIMS & METHODS:20g/day, or known drugs in the history were excluded.
RESULTS: The investigated patients showed at US a "bright liver", consistent with NAFLD. BMI significantly decreased (42.8±5.9 vs. 38.8±5.1; p126 mg/dL in 18% pts.) did not change after BIB (113±37 vs. 103±36). After BIB, ALT values decreased (43.5±34.5 vs. 28.5±16.4; p<.01), as well as GGT (42.3±35.2 vs. 28.9±20.7; p<.05). Before BIB, HOMA-IR was <2.5 in 9% pts. and it showed a significant decrease (7.14±6.14 vs. 3.54±2.08; p<.02); after BIB, HOMA-IR was <2.5 in 43% pts. Hypertrigliceridemia in 33.3% pts., HDL cholesterol levels <40mg/dL in 32% pts., arterial hypertension in 22.2 % pts did not significantly improve after BIB.
CONCLUSION: The significant weight loss induced by BIB treatment improves insuline resistance and liver enzymes in obese patients. Our findings confirm the pivotal role of insuline resistance in NAFLD
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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