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Biomedical subjects

A Florio

Publications and source records attributed to A Florio.

At least 19 recordsLinked to original sources
PubMed2002

[Popliteal aneurysms. Personal experience].

BACKGROUND: The 70% of peripheral aneurysms are localized at the popliteal artery; approximately one third of patients are asymptomatic, but the occurrence of complications (acute ischemia, rupture) endangers the survival of the leg. The purpose of this paper is to demonstrate the validity of elective surgery for popliteal aneurysms, also for asymptomatic lesions. METHODS: Twenty-seven popliteal aneurysms were observed in 20 patients; only 7 of these were affected by a unilateral lesion, other 7 patients by a bilateral lesion and the remainder 6 patients by a polydistrict association; 3 patients refused the surgical therapy which was proposed. Prosthetic grafting with exclusion or resection of the aneurysm has been practiced in 16 cases; one time only a Dacron graft was employed, while the autologous saphenous vein was employed in 15 cases. A locoregional thrombolysis has been performed in 3 patients, in presence of an acute peripheral ischemia. In 5 cases a conservative approach has been chosen; these were asymptomatic aneurysms with a <2 cm diameter. RESULTS: In 87,5% of patients operated (14/16) a good immediate result was obtained. In a mean 2 years follow-up the 75% of these patients maintained the clinical result. The fibrinolytic therapy was resolutive in 2 cases of acute peripheral ischemia; a lumbar sympathectomy was necessary in one case. CONCLUSIONS: In consideration of the complications that the aneurysmatic disease can give, among which the acute peripheral ischemia is the most dreadful, a surgical approach is widely justified, also in the light of the good results described.

Aneurysm↗
PubMed2002

Prosthetic infections.

BACKGROUND: The authors report the up to date trends regarding the etiopathology, diagnosis and treatment of vascular-graft infections. This paper concerns the responsible micro-organisms; the reference to the formation of anastomotic pseudo-aneurysm for the infections involving the lines of suture and the reference to the aortoenteric fistula. METHODS: A case study which refers to the period between 1990 and 1999 presents 19 cases of prosthetic infections out of 520 operations of implants of prosthetic materials. RESULTS: 11 successful, 7 amputations, 1 decrease. CONCLUSIONS: In the past years the results of the treatment have improved thanks to a more refined and codified therapeutical conduct and to the employment of prosthetic materials which are more resistant to infection, or to a greater attention paid to asepsis, before, during and after surgery to antibiotic prophylaxis before, during and after the operation. But, nevertheless graft infection still remains a dreadful complication for vascular surgery operations. The therapeutical approach is substantially aggressive and the removal of the infected prosthesis is essential. Nevertheless we believe that we should not underestimate open local treatment, which in localized and superficial infections and infections not involving anastomosis allows us to preserve prosthesis and make it root.

Aged↗
PubMed2002

[Present-day role of vena cava filters].

BACKGROUND: The purpose of the present is to assess the effectiveness of pulmonary embolism prevention using temporary or permanent vena cava filters in deep venous thromboses of the lower extremities with a discussion of indications and complications. METHODS: In the period between 1989 and 1998 we observed 46 patients (33 m, 13 f) suffering from deep venous thrombosis of the lower extremities. RESULTS: The cases treated with cava filter showed an improvement in clinical conditions in 15-19 cases with 4/19 cases of complications: filter ascent, lipothymia, one case of pneumothorax and one case of filter ascent with thrombosis of the contralateral venous axis. All complications were solved without further sequelae. After catheterisation of the femoral vein, the thrombosis of the contralateral venous axis in patients with caval filter was a frequently observed event (in 75% of cases). In the cases without filter, an evident improvement was observed in 22/27 cases, a slight improvement in 2/27 cases, with 3/27 cases of complications: two cases of cardiocirculatory arrest and one case of severe dyspnea with suspected pulmonary embolism which survived the event. CONCLUSIONS: From our experience, the use of caval filters is unquestionably useful for the prevention of pulmonary embolism, but is not wholly free from complications.

Adolescent↗
PubMed2002

Possibilities at present for the application of lumbar sympathectomy in chronic occlusive arterial disease of the lower limbs.

BACKGROUND: Research on the limitations of the validity of lumbar sympathectomy in surgical treatment of lower limb occlusive arterial disease is still of great interest today. METHODS: Our study deals with 385 patients who underwent the surgical removal of a segment which includes the 2nd and the 3rd ganglion of the lumbar sympathetic chain in the period between the month of January 1989 and the month of December 1998. RESULTS: Results were good in 63.6% of patients and stationary in 10.53% of cases; in 26% of cases lumbar sympathectomy was not valid. CONCLUSIONS: Satisfactory results were recorded, as will be shown in this text, on patients experiencing a period of rest pain, patients with ischaemic dystrophic lesions and those with very advanced intermittent claudication equally favourable results were seen in diabetic patients.

Adult↗
PubMed2002

[Spinal cord electric stimulation. Treatment of serious chronic ischemic syndromes of the limbs].

BACKGROUND: Aim of this study is to estimate the effectiveness of epidural electric stimulation of spinal cord for the treatment of patients with severe peripheral chronic arteriopathy who can't be surgically treated or when surgical therapy failed. METHODS: A retrospective study was carried out on 18 patients with peripheral chronic arteriopathy at clinical stage I of Fontaine classification; average age was of 60.08 years an they had rest pain and dystrophic lesions. Five patients couldn't be surgically treated. Stimulator catheter was placed in the epidural space and its action was evaluated studying lesion demarcation and pain resolution. RESULTS: In 16 cases there was a good pain control and in 14 patients lesion demarcation, while in 4 cases there was cases no improvement and amputation was necessary. CONCLUSIONS: Epidural electric stimulation of spinal cord is a valid treatment in selected patients for ischemia pain control and limb savage.

Chronic Disease↗
PubMed1999

Management of chronic subdural hematoma in patients treated with anticoagulation.

BACKGROUND: The diffusion of the surgical technique of cardiac valve replacement with metallic prostheses, as well as bypass graft in the arterial occlusive disease of the lower extremities, both requiring permanent oral anticoagulation, has increased the number of patients affected by chronic subdural hematoma that can be diagnosed at an earlier stage of this disease with the advent of the CT. METHODS: The records of seven patients with mean GCS = 14.2 and mean clinical grade = 1.85 affected by chronic subdural hematoma and in treatment with anticoagulants were examined retrospectively. All the patients underwent subtemporal craniectomy plus closed drainage or burrhole(s) plus closed drainage after immediate correction of hypocoagulability by administration of vitamin K and fresh frozen plasma and normalization of PA by calcium heparin. RESULTS: Outcome was good for all the patients except one who died because of cerebral herniation due to massive solid subdural hematoma during extracorporeal dialysis. Complications included: intracerebral hemorrhage, solid subdural hematoma, slow brain reexpansion, subdural collection reaccumulation and cerebral embolism. Three patients required re-operation. Mean duration of hospital stay was 18 days with range from 7 to 24 days. CONCLUSIONS: Basing on this retrospective study and the proposed pathophysiology, the guidelines for optimal management of this subgroup of patients are proposed. Recommendations include the immediate correction of hypocoagulability, the appropriate surgical technique and the cautious conversion to oral anticoagulation as well as the appropriate timing of such conversion.

Aged↗
PubMed1998

[The Studer ileal bladder and the Paduan ileal bladder: comparison of 2 techniques].

Between January 1988 and December 1995 48 orthotopic detubularized and reconfigured ileal neobladder were carried out with two distinct surgical procedures in the same Hospital. 33 underwent lower urinary tract reconstruction using Studer's technique with an afferent ileal tubular isoperistaltic segment; in 15 patients the ileal substitution of the bladder was performed with Paduan ileal bladder (VIP). In any case an ileal low pressure reservoir was obtained with similar functional capacity (400 ml. at the urodynamic control), as using the same length of ileum (40 cm) for the reconstruction of the reservoir itself. In order to other functional aspects (e.g. diurnal and nocturnal continence) results were analogous if a correct rehabilitation program was observed. Significant post-voiding residual and late neobladder decompensation was prevented with adequate mictional training. Early and late complications (globally 19-24%) were evaluated: strictures of ureteroileal and ileo-urethral anastomoses were rare; an ileoureteral reflux was observed at a cystographic control in 50% of Studer group, but never clinically significant and only in 20% of VIPs. No clinically significant metabolic changes were found. Survival was satisfactory at a mean follow-up of 48 months.

Adult↗
PubMed1998

[Magnetic resonance angiography of the epiaortic vessels of the thorax].

INTRODUCTION: Magnetic Resonance angiography (MRA) is an accurate and non-invasive diagnostic method to evaluate vascular disease. On the basis of its technological advancements, this technique has gained an important role in the diagnostic protocol of cerebral and cervical vascular diseases. Nonetheless, MRA efficacy changes in different anatomic districts as a consequence of the specific anatomy and flow features. Cardiac and respiratory artifact and different coil sensitivity also affect MRA results. For these reasons, intrathoracic epiaortic vessels are a difficult applications for MRA. MATERIAL AND METHODS: We examined 20 patients affected with epiaortic atherosclerosis with MRA, carried out with an 0.5 T MR unit (Vectra, GE). Examinations consisted of Phase Contrast (PC) 3D sequences (TR/TE/FA/Venc = 30/13/45/30-50), with 3 axes of flow encode, matrix 128 x 256, 2 mm partition thickness, and axial and/or coronal acquisition volume. The MRA was repeated after Gd-DTPA intravenous perfusion and a qualitative and quantitative evaluation of pre- and post-contrast results was performed. Specific parameters of evaluation were: angiographic contrast, contrast to noise ratio, saturation effect of longitudinal magnetization, contrast between arteries and veins. All patients were examined with Doppler US and angiography. MRA data were compared to angiography in order to establish MRA sensitivity and specificity. RESULTS AND CONCLUSIONS: PC sequences showed high accuracy in the examination of the proximal tract of epiaortic vessels; Gd-DTPA administration substantially improved MRA results. The perspectives of technological improvement will probably candidate PC MRA to be a valid alternative to US-Doppler and, perhaps, to angiographic study.

Adult↗
PubMed1997

Transurethral incision of prostate (TUIP) and retrograde ejaculation.

OBJECTIVE: Men of any age with bladder outlet obstruction and without measurable enlargement of the prostate constitute ideal candidates for TUIP. Effectiveness of any technique with respect to flow rate improvement is firmly established, indifferently whether unilateral or bilateral. But there is a wide variation in the reported incidence of retrograde ejaculation with unilateral and bilateral incision. MATERIAL AND METHODS: The retrospective analysis of our 45/57 available patients treated with this technique, between January 1993 and March 1995, does not show a major incidence of this complication for the bilateral incision, with an overall incidence of 6.6% (3/45 patients). CONCLUSIONS: Although ejaculation may be preserved, it cannot be guaranteed.

Adult↗
PubMed1996

Unorthodox antibiotic combinations including ciprofloxacin against high-level gentamicin resistant enterococci.

Development of high-level gentamicin resistance among enterococci represents a serious therapeutic problem as it precludes synergy between aminoglycosides and cell-wall active agents. As part of a search for active antibiotic combinations against enterococci with high-level gentamicin resistance, we tested by the time kill curve method the efficacy of ciprofloxacin combined with ampicillin, trimethoprim-sulphamethoxazole, vancomycin or teicoplanin against ten isolates of Enterococcus faecium, three of Enterococcus casseliflavus and 13 of Enterococcus faecalis that exhibited a MIC of gentamicin > or = 2000 mg/L. Most of the E. faecium were also resistant to ampicillin and to ciprofloxacin. The combination of ciprofloxacin with ampicillin was bactericidal against five of seven E. faecium strains that exhibited a ciprofloxacin MIC < or = 4 mg/L, but was inactive against the three E. faecium that were highly resistant to ciprofloxacin. This combination was also bactericidal against the E. casseliflavus and all the E. faecalis strains. The combination of ciprofloxacin with trimethoprim-sulphamethoxazole was bactericidal against five of the seven E. faecium and seven of the nine E. faecalis strains with a ciprofloxacin MIC < or = 4 mg/L. No bactericidal activity of this combination was seen against the enterococci that were highly resistant to either ciprofloxacin or to trimethoprim-sulphamethoxazole. The combination of ciprofloxacin with glycopeptides was inactive against E. faecium and E. casseliflavus and against E. faecalis, it was either ineffective or antagonistic; in only one case it was bactericidal. Five strains of E. faecium were resistant to all antibiotic combinations tested.

Ampicillin↗
PubMed1996

[Enterococcal endocarditis: clinical and microbiological features of our series].

Of 81 cases of infectious endocarditis seen at our institution from 1988 to 1995, 61 had positive culture (75%) and, of these, 10 (16%) were caused by enterococcal strains (9 by Enterococcus faecalis, 1 by Enterococcus faecium). The 10 cases consisted of 5 native valve endocarditis and 5 late prosthetic valve endocarditis. Median age of patients was 50 years (range 21-58); 6, were males. Diagnostic or surgical procedures on the abdomen, genito-urinary tract, or chest preceded the onset of fever in almost all cases. Nine enterococcal strains showed low-level resistance to aminoglycosides and one was highly resistant. Seven patients were treated with ampicillin and gentamicin and 2 with teicoplanin and gentamicin. The patient, whose infection was caused by an high gentamicin-resistant E. faecalis, was treated with the combination of ciprofloxacin and cotrimoxazole chosen on the basis of the in vitro susceptibility tests. Congestive heart failure occurred in 4 patients and major embolic events in 3. All patients were cured; 4, with medical therapy alone and 6, with antimicrobials associated with surgical substitution of the valve. The data indicate that enterococcal endocarditis, when treated with appropriate antimicrobial regimens, associated with surgical treatment when necessary, has a very low mortality rate. The conventional treatment, -lactams plus gentamicin is usually effective. However, for high-level gentamicin-resistant strains alternative treatments must be selected on the basis of the in vitro susceptibility tests.

English Abstract↗
PubMed1996

Different susceptibility of coagulase-positive and coagulase-negative staphylococci to ciprofloxacin.

Ciprofloxacin susceptibility was evaluated in 573 clinical staphylococcal isolates (Staphylococcus aureus 230, methicillin-resistant (MR) 36%; coagulase-negative strains 343, MR 66%) collected from 1989 to 1995. Resistance to ciprofloxacin for MR Staphylococcus aureus was 25% until 1991 when ciprofloxacin was introduced into the hospital formulary, and rose progressively to 90% in 1994-1995. MR Staphylococcus haemolyticus showed a ciprofloxacin resistance of 46% until 1991 and of 73% from 1992 to 1995. In contrast MR Staphylococcus epidermidis and other coagulase-negative strains showed a constant susceptibility to this agent (80%). Ciprofloxacin has limited usefulness against MR Staphylococcus aureus but can be still used to treat Staphylococcus epidermidis infections.

Ciprofloxacin↗
PubMed1995

Bacillus Calmette-Guerin in the treatment of stage T1 grade 3 transitional cell carcinoma of the bladder: long-term results.

PURPOSE: We performed a retrospective long-term study to evaluate the results of immunotherapy in the treatment of high grade superficial bladder tumors. MATERIALS AND METHODS: Between 1981 and 1993, 593 patients with superficial transitional cell carcinoma of the bladder underwent transurethral resection. Of 64 patients with stage T1 grade 3 disease 50 received intravesical bacillus Calmette-Guerin after transurethral resection of all visible tumor. RESULTS: At a median followup of 42 months (range 12 to 112) 36 patients (72%) are disease-free and have not required further treatment. Superficial recurrence was noted in 8 patients (16%). Disease progressed in 6 patients (12%), including 5 with locally invasive and 1 with metastatic disease. Cystectomy was performed for progression in 4 patients and for recurrent stage T1 grade 3 disease in 1. There was 1 disease related death (2%). The overall survival rate is 94%. CONCLUSIONS: Intravesical bacillus Calmette-Guerin appears to be the most effective conservative treatment for patients with stage T1 grade 3 bladder cancer.

Adjuvants, Immunologic↗
PubMed1995

Resistance to aminoglycosides and other antibiotics among clinical isolates of Enterococcus spp.

We conducted a study on 81 clinical isolates of enterococci (65 Enterococcus faecalis and 16 Enterococcus faecium) collected consecutively over a one year period at our University Hospital. Of them, 10 (15%) Enterococcus faecalis and 6 (38%) Enterococcus faecium showed high level resistance to aminoglycosides, were all acquired in surgical units and in five cases they were responsible for invasive infections. Ampicillin and imipenem were active only against Enterococcus faecalis. Vancomycin and teicoplanin were bacteriostatic; however, teicoplanin MICs were lower and in 45% of cases its MBC values were within clinically achievable serum concentrations. Ciprofloxacin and cotrimoxazole were active in vitro.

Aminoglycosides↗
PubMed1995

Biologic characteristics of T1 papillary bladder cancer. Flow cytometric study of paraffin-embedded material.

DNA ploidy, proliferative activity (evaluated in terms of the proliferative index [PI]) and epidermal growth factor receptors (EGF-R) expression in primary bladder cancer in 52 patients were studied by means of flow cytometry and immunohistochemistry. Forty of the 52 tumors yielded evaluable DNA histograms: 22 were diploid (55%) and 18 aneuploid (45%) (median DNA index = 1.5). Ninety-five percent of the tumors were positive for EGF-R expression. The median PI value of the entire case series, estimated with a mathematical model, was 5.4%, or 6.7% in diploid tumors and 12.1% in aneuploid ones. EGF-R expression was higher in aneuploid than diploid tumors. Most of the well-differentiated tumors were diploid, while aneuploid populations and positivity for EGF-R expression were more frequent in poorly and moderately differentiated tumors. No differences in proliferative activity were observed in relation to grade. Overexpression of EGF-R in aneuploid tumors and a relationship between it, proliferative activity and grading were observed. The disease-free survival rates were 72% and 91% for patients with aneuploid and diploid tumors, respectively.

Aneuploidy↗
PubMed1994

Prevalence of antibiotic resistance among clinical isolates of methicillin-resistant staphylococci.

The prevalence of methicillin-resistant and multiply antibiotic-resistant staphylococci causing infections in hospitalized patients was studied over a two-year period. Among 122 clinically significant staphylococci, the prevalence of methicillin resistance was 66%, with a higher prevalence of Staphylococcus haemolyticus (85%) and Staphylococcus epidermidis (83%) observed than of Staphylococcus aureus (49%). Multiple antibiotic resistance was observed more frequently among coagulase-negative staphylococcus (52 to 70%) than among Staphylococcus aureus (17%). All strains of methicillin-resistant Staphylococcus aureus were susceptible to glycopeptide antibiotics and to trimethoprim-sulfamethoxazole, whereas approximately 50% of coagulase-negative staphylococci exhibited either moderate susceptibility or resistance to teicoplanin. For these latter strains, vancomycin remains the agent of choice, whereas teicoplanin cannot be recommended unless its efficacy is established by MIC determination.

Anti-Bacterial Agents↗