Francesco Paolo Tinozzi

Oral butyrate for mildly to moderately active Crohn's disease

Background : Butyrate exerts anti‐inflammatory effects in experimental colitis and on Crohns disease lamina propria mononuclear cells in vitro.

Doppler enhancement after intravenous levovist injection in Crohn's disease

Although transabdominal bowel sonography (TABS) has been proposed as a reliable tool to assess increased bowel wall thickness (BWT), the most common sonographic pattern in patients with Crohns disease (CD), its accuracy is limited in the diagnosis of CD. We therefore tried to assess whether color Doppler enhancement with Levovist, a galactose-based intravenous sonographic contrast agent able to enhance the arterial Doppler signal, increases TABS accuracy. Thirty-one patients with ileal CD, diagnosed by endoscopy and enteroclysis, and 20 healthy volunteers were examined with conventional TABS. Color Doppler of the intramural enteric vessels was then performed before and after intravenous injection of Levovist. Twenty-two CD patients had a BWT >4 mm, and 16 of them presented with active disease. Two of the remaining nine CD patients, all with BWT <4 mm, presented with active disease. By means of color Doppler we identified six patients with inactive disease, normal BWT, and normal basal Doppler signal intensity, who showed an enhanced Doppler signal in intramural vessels after contrast agent bolus. Four of these patients, identified only by color Doppler after Levovist injection, relapsed within 6 months. In our experience, sensitivity and specificity of TABS, integrated with additional stimulated acoustic emission mode, were 96.7% and 100%, respectively. The use of Levovist in color Doppler increases the accuracy of TABS in CD diagnosis and follow-up.

Splenic function and IgM-memory B cells in Crohn's disease patients treated with infliximab

Background: Under experimental chronic inflammation, tumor necrosis factor (TNF)‐&agr; plays a role in damaging spleen marginal zone. This latter has a crucial function in mounting B cell‐dependent immune responses against infections by encapsulated bacteria. In Crohns disease (CD), a chronic inflammatory disorder where TNF‐&agr; is centrally involved, impaired splenic function may increase the susceptibility to bacterial infections. On this basis, we aimed to investigate the influence of anti‐TNF therapy on splenic function in CD patients. Methods: Peripheral blood samples were obtained from 15 CD patients before and after treatment with infliximab administered at weeks 0, 2, and 6 at a dose of 5 mg/kg. Counting of erythrocytes with membrane abnormalities (pitted red cells) was used as an indicator of splenic function. Multicolor flow cytometry was performed to analyze circulating B cells. Results: A substantial clinical improvement in 10 of the 15 CD patients was associated with a significant reduction of pitted red cells (from median 6.0% to 3.6%; P < 0.01) after 10 weeks of treatment. In responder patients the improvement of splenic function was accompanied by a parallel increase of circulating IgM‐memory B cells (from median 6.9% to 13.3%; P < 0.005). Splenic function was not ameliorated in nonresponder patients. Conclusions: Splenic function improved in CD patients who responded to infliximab and was accompanied by a concomitant restoration of the IgM‐memory B cell pool responsible for the protection against encapsulated bacteria. Restoration of splenic function after infliximab treatment is intriguing and requires further investigation.

Radioguided surgery for gastrinoma: a case report.

Aims and Background Gastrinomas are the most common neuroendocrine tumors of the duodenopancreatic region. Surgical resection is the primary type of radical treatment. Methods and Study Design At the Institute of General, Gastrointestinal and Breast Surgery we treated a patient with a duodenal gastrinoma that was diagnosed and localized by means of selective celiacmesenteric angiography and labeled octreotide scintigraphy. Surgery was performed using a radioguided technique; in this way we easily detected the small tumor and discovered another tracer-uptaking lesion that turned out to be a metastatic lymph node. Results Surgical resection is the ideal treatment for sporadic gastrinoma: it improves quality of life, prolongs survival, and reduces the incidence of metastases, with a modest percentage of complications and practically zero mortality. Meanwhile, medical treatment is being revaluated, particulary in the case of metastatic disease or polyendocrine MEN1 syndrome. A fundamental aspect in the management of gastrinomas is tumor localization. Endoscopic ultrasonography and labeled octreotide scintigraphy (Octreoscan) proved to be more effective than the usual imaging modalities. Intraoperative ultrasonography, gastroscopy for duodenal transillumination and repeated measurement of blood gastrin levels should be performed intraoperatively in the surgical treatment of gastrinomas. Conclusions The clinical application of radioguided surgery for tracer-uptaking endocrine tumors is still controversial. In our case the decision to use this method was influenced by the fear that the patients obesity and the effects of previous surgery could hamper the identification of the small tumor.

Efficacy of butyrate in the treatment of mild to moderate Crohn's disease

Abstract Background Butyrate exerts anti-inflammatory effects in experimental colitis and in lamina propria mononuclear cells of patients with Crohns disease. Aims To assess the safety and efficacy of butyrate in Crohns disease. Patients Thirteen patients with mild to moderate Crohns disease were treated with enteric-release sodium butyrate tablets at a dosage of 4 g/day for eight weeks. Methods Before and after treatment, patients underwent coloscopy with evaluation of the clinical activity of their disease, systemic inflammation index and mucosal expression of interleukin (IL)-1β, IL-6, IL-12, interferon (IFN)-γ, tumour necrosis factor (TNF)-α and nuclear factor (NF)-κB. Results Of the nine patients (69%) responding to treatment, 7 (53%) exhibited complete response and 2 exhibited partial response. Endoscopic and histological evaluation scores were significantly improved ( p p Conclusions Oral administration of butyrate may be effective in inducing clinical improvement or remission in patients with Crohns disease.

A case of bilateral breast cancer and Graves' disease.

We report a case of bilateral breast cancer associated with Graves’ disease characterized by a large goiter and complicated by a severe ophthalmopathy. The hyperthyroidism was treated initially with methimazole and then with thyroidectomy, the ophthalmopathy with intravenous steroids combined with orbital radiotherapy. The breast tumors underwent surgical resection followed by chemotherapy. We describe this case because of the well-known association between breast cancer and thyroid disease, particularly of the autoimmune type, the causes of this being still unclear. Recent literature on this topic is reviewed, discussing the possible role of the Na+-I− symporter and anti-TPO antibodies.