Gaetano Ideo

Beta-adrenergic-antagonist drugs in the prevention of gastrointestinal bleeding in patients with cirrhosis and esophageal varices : an analysis of data and prognostic factors in 589 patients from four randomized clinical trials

BACKGROUNDnThe value of beta-adrenergic-antagonist drug therapy for the prevention of initial episodes of gastrointestinal bleeding in patients with cirrhosis and esophageal varices is uncertain, both positive and negative study results having been reported.nnnMETHODSnIn this study, we analyzed data on individual patients from four randomized, controlled trials to assess the efficacy of this treatment. Of the 589 patients studied, 286 received a beta-adrenergic-antagonist drug (propranolol in 203 and nadolol in 83) and 303 received placebo.nnnRESULTSnAfter two years, the mean (+/- SE) percentage of patients who had had no upper gastrointestinal bleeding was 78 +/- 3 percent in the beta-adrenergic-antagonist treatment group and 65 +/- 3 percent in the control group (P = 0.002). The percentage of patients without fatal bleeding was 90 +/- 2 percent in the treatment group and 82 +/- 3 percent in the control group (P = 0.01). The percentage of patients surviving after two years was 71 +/- 3 percent in the treatment group and 68 +/- 3 percent in the control group (P = 0.34). After age and severity of cirrhosis were taken into account, the survival rate was better in the treatment group (P = 0.09). The percentage of surviving patients who had had no bleeding after two years was 62 +/- 3 percent in the treatment group and 53 +/- 3 percent in the control group (P = 0.04). Both propranolol and nadolol prevented a first episode of bleeding. Severe cirrhosis and especially the presence of ascites were associated with bleeding (P less than 0.001) and death (P less than 0.001) in both groups. The efficacy of beta-adrenergic-antagonist therapy in the prevention of bleeding (P less than 0.001) and of fatal bleeding (P = 0.004) and in the prevention of bleeding or death (P = 0.005) was the same after adjustment for cause and severity of cirrhosis, ascites, and size of varices.nnnCONCLUSIONSnPropranolol and nadolol are effective in preventing first bleeding and reducing the mortality rate associated with gastrointestinal bleeding in patients with cirrhosis, regardless of severity.

Beta-Adrenergic–Antagonist Drugs in the Prevention of Gastrointestinal Bleeding in Patients with Cirrhosis and Esophageal Varices

BACKGROUNDnThe value of beta-adrenergic-antagonist drug therapy for the prevention of initial episodes of gastrointestinal bleeding in patients with cirrhosis and esophageal varices is uncertain, both positive and negative study results having been reported.nnnMETHODSnIn this study, we analyzed data on individual patients from four randomized, controlled trials to assess the efficacy of this treatment. Of the 589 patients studied, 286 received a beta-adrenergic-antagonist drug (propranolol in 203 and nadolol in 83) and 303 received placebo.nnnRESULTSnAfter two years, the mean (+/- SE) percentage of patients who had had no upper gastrointestinal bleeding was 78 +/- 3 percent in the beta-adrenergic-antagonist treatment group and 65 +/- 3 percent in the control group (P = 0.002). The percentage of patients without fatal bleeding was 90 +/- 2 percent in the treatment group and 82 +/- 3 percent in the control group (P = 0.01). The percentage of patients surviving after two years was 71 +/- 3 percent in the treatment group and 68 +/- 3 percent in the control group (P = 0.34). After age and severity of cirrhosis were taken into account, the survival rate was better in the treatment group (P = 0.09). The percentage of surviving patients who had had no bleeding after two years was 62 +/- 3 percent in the treatment group and 53 +/- 3 percent in the control group (P = 0.04). Both propranolol and nadolol prevented a first episode of bleeding. Severe cirrhosis and especially the presence of ascites were associated with bleeding (P less than 0.001) and death (P less than 0.001) in both groups. The efficacy of beta-adrenergic-antagonist therapy in the prevention of bleeding (P less than 0.001) and of fatal bleeding (P = 0.004) and in the prevention of bleeding or death (P = 0.005) was the same after adjustment for cause and severity of cirrhosis, ascites, and size of varices.nnnCONCLUSIONSnPropranolol and nadolol are effective in preventing first bleeding and reducing the mortality rate associated with gastrointestinal bleeding in patients with cirrhosis, regardless of severity.

Protective role of S-adenosyl-L-methionine on liver injury induced by D-galactosamine in rats.

Abstract A decrease of S-Adenosyl- l -methionine(SAMe) levels and of the activity of its synthesizing enzyme is demonstrated in liver of rats treated with d -galactosamine. These effects appear to be reversed by the i.m. administration of SAMe. A protective role of SAMe on liver is also obtained by SAMe treatment of intoxicated animals, as demonstrated both by the histological analysis of the liver and GOT and GPT levels in serum. The activity of SAMe, in this respect, is comparable to that one of prednisolone when the drugs are given at the daily dose of 60 mg/kg and 100 mg/kg, respectively.

Serum Cytosolic/Mitochondrial Enzyme Ratio: A Tool for the Estimation of the Severity of Acute Hepatitis

The serum levels of the mitochondrial enzymes), aspartate transatninase II, malate dehydrogenase II and glutamate dehydrogenase were studied in 82 cases of acute hepatitis. The activity ratio alanine transaminase/glutamate dehydrogenase and the C/M-ratios of aspartate transaminase and malate dehydrogenase were also studied. The serum levels of the mitochondrial en2ymes glutamate dehydrogenase, aspartate transaminase Π and malate dehydrogenase II were per se useless in defining the severity of acute hepatitis. Conversely, the activity ratio alanine transaminase/glutamate dehydrogenase and the C/M-ratio) of aspartate transaminase proved to be very helpful for this purpose. These cytoplasmic/mitochondrial (C/M) ratios were very high in patients vho later made a good recovery, while they were surprisingly low in those cases which progressed toward acute liver atrophy.

Effect of carbon tetrachloride poisoning on the plasma levels of aspartate-aminotransferase isoenzymes in the rat

Mediante frazionamento cromatografico su colonna di resina a scambio anionico, abbiamo potuto documentare nel siero di ratti intossicati con dosi diverse di CCl4, incrementi assai significativi sia della componente mitocondriale che citoplasmatica della aspartato-aminotransferasi.

Mitochondrial Aspartate Aminotransferase is a normal Constituent of human Serum

There is no general agreement as to whether mitochondnal aspartate aminotransferase is a normal constituent of human serum, or not. This isoenzyme was studied in the serum of normal subjects by means of a new, quantitative method, involving anion-exchange column chromatography. The normal serum contains about 2.65 mU/m/ of mitochondrial isoenzyme. This datum is compared with those of other Authors.

Randomised trial of interferon α2b plus ribavirin for 48 weeks or for 24 weeks versus interferon α2b plus placebo for 48 weeks for treatment of chronic infection with hepatitis C virus

Background:Only 15–20% of patients with chronic hepatitis C achieve a sustained virological response with interferon therapy. The aim of this study was to compare the efficacy and safety of interferon α2b in combination with oral ribavirin with interferon alone, for treatment of chronic infection wi

Malignant ascites: role of the embryological origin of the tumour on ascitic humoral test concentrations

Objective: The aim of this study was to investigate the influence of the embryological origin of the tumour on the ascitic humoral test concenrations. Patients: One hundred and twenty-four patients with extra-hepatic malignancy-related ascites were divided into three groups according to the embryological origin of the tumour: group A (mesoderm) consisted of 52 patients, group B (endoderm) of 55 and group C (ectoderm) of 17. Design: Ascitic fluid (40 ml) was aseptically aspirated and examined routinely for culture by the bedside blood-culture-bottles method for white blood cells, polymorphonuclear ceil count per mm3, malignant cell test and chemistries. Cytological examination was performed within 2 h of ascitic fluid aspiration. Fibronectin, cholesterol, triglycerides, lactic dehydrogenase (LDH), total protein and carcino-embryonic antigen (CEA) ascitic concentrations were determined. Results: The ascitic concentrations of fibronectin, cholesterol, LDH and total protein were significantly higher in group A than in the other two groups, while CEA levels were significantly higher in groups B and C than in A. Triglyceride levels did not differ in the three groups. Factorial analysis of variance showed that malignant cells and embryological origin of the tumour independently influenced ascitic levels of cholesterol, total protein and fibronectin. There was a significant interaction between malignant cells and embryological origin of the tumour for fibronectin whereas CEA and LDH levels were influenced by the embryological origin of the tumour only. Conclusion: This study underlines the role of the oncological histotype on ascitic humoral test concentrations in malignant ascites. In clinical practice, a panel of tests such as cholesterol, LDH and CEA should be used for a suitable diagnostic outcome.