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Biomedical subjects

A Lapini

Publications and source records attributed to A Lapini.

18 recordsLinked to original sources
PubMed2004

A low incidence of positive surgical margins in prostate cancer at high risk of extracapsular extension after a modified anterograde radical prostatectomy.

OBJECTIVES: To evaluate the incidence of positive surgical margins (and associated risk factors) in patients with localized prostate cancer at high preoperative risk of extracapsular disease treated using a modified anterograde radical retropubic prostatectomy technique. Positive surgical margins are an important risk factor for disease recurrence after radical prostatectomy, particularly in patients with extracapsular disease. PATIENTS AND METHODS: In total, 84 patients with clinically localized prostate cancer and a preoperative prostate-specific antigen (PSA) level > 10 ng/mL and/or a biopsy Gleason score > or = 7 were evaluated. The surgical technique allows easy, wide resection of the posterolateral prostatic pedicles, and good mobilization and exposure of the apex before the urethra transection. Prostatectomy specimens were examined for extracapsular tumour spread and positive surgical margins. Differences in putative risk factors (Gleason score, preoperative PSA level, prostate weight) between the positive- and negative-margin groups were evaluated using the Mann-Whitney test. RESULTS: Overall, 11 of the 84 (13%) patients had positive surgical margins and of these a single site was involved in six. In total, 15 positive-margin sites were identified (five apical, four basal, three posterolateral, two anterior and one posterior). All patients with positive margins had histological extracapsular disease. The preoperative PSA level and Gleason score were significantly higher in the positive- than in the negative-margin group (P = 0.025 and 0.035, respectively). CONCLUSIONS: The anterograde radical prostatectomy minimizes the incidence of positive surgical margins in patients at high risk of extracapsular disease.

Aged↗
PubMed2001

Imperative indications for conservative surgery for renal cell carcinoma: 20 years' experience.

INTRODUCTION: Radical nephrectomy is the treatment of first choice for unilateral renal cell carcinoma (RCC) with a healthy contralateral kidney; however, the current standard for dealing with RCC in patients with a solitary kidney, bilateral tumor and renal or systemic disease inducing a progressive impairment of renal function is nephron-sparing surgery. MATERIALS AND METHODS: Between January 1974 and July 1996, 62 patients (39 men and 23 women, 33-77 years old, mean age 60.6 years) with RCC underwent nephron-sparing surgery. The patients were divided in to two groups according to treatment indication: 46 patients with bilateral tumor (n = 21) or solitary kidney (n = 25) and 16 patients with renal or systemic disease that could damage the contralateral kidney. Survival curves were calculated according to the Kaplan-Meyer method. RESULTS: In the first group 3 patients died postoperatively, and 3 were lost to follow-up; 12 patients (27.9%) had malignant recurrence and 5 (11.6%) died of local recurrence or systemic diffusion. The probability of local or systemic tumor recurrence was 9.9% at 2 years, 20.2% at 5 years and 24.7% at 10 years; the probability of survival was 100% at 2 years, 91.9% at 5 years and 81.9% at 10 years. In the second group 3 patients died of unrelated causes and 1 was lost to follow-up; 4 patients (25%) had a malignant recurrence and 2 (12.5%) died of systemic diffusion of RCC. The probability of tumor recurrence was 13.0% at 2 years, 19.7% at 5 years and 26.4% at 10 years, the probability of survival was 100% at 2 years, 93.3% at 5 years and 86.1% at 10 years. CONCLUSIONS: In our experience nephron-sparing surgery seems justified in patients with a solitary kidney, bilateral tumor or a disease that potentially damages renal function. Tumor diameter and stage, incidental or symptomatic tumor presentation and specific indication for conservative surgery determine the prognosis.

Adult↗
PubMed2001

[Technical solution for single kidney patients with multiple ureteral neoplasms].

When ureteral length is extensively compromised, preservation of the kidney without recurring to external urinary diversion may be attempted by various techniques. The choice depends on the extension and localization of the defect. We report a technique solution performed in a patient with multiple ureteral tumors and solitary kidney. A 70-years old underwent TURB for superficial bladder cancer and right nephroureterectomy for upper urinary tract tumor. He was admitted for hematuria and renal failure which need a percutaneous nephrostomy. Urography and pielo-RMN showed multiple and irregular defects of proximal left ureter. We performed a left ureterectomy with ureteral substitution by tailored and retroperitonealized ileal segment with simultaneous ileal bladder augmentation. The six months follow-up including serum creatinine, sonography, urodynamic evaluation, urinary cytology, excretory urogram and pielo-RMN shows good results. Ureteral replacement with ileum is indicated only for extensive ureteral diseases in which ureteroneocystostomy or vesical Psoas hitch and/or Boari bladder flap are not feasible. With particular attention to surgical aspects as tailoring ileum (to improve propulsion of urinary bolus, limit the absorbing surface area and decrease mucus formation) and the use of an ileal segment longer than 15 cm (to prevent reflux) and with an accurate patient selection, we think that this procedure can assure satisfactory results also in difficult cases.

Aged↗
PubMed1996

Local staging of prostate carcinoma with endorectal coil MRI: correlation with whole-mount radical prostatectomy specimens.

The purpose of this study was to investigate the accuracy of endorectal coil MRI in the local staging of prostate carcinoma. A total of 73 patients with biopsy-proven prostate carcinoma were examined at 0.5 T prior being submitted to radical prostatectomy. The gold standard was provided in all patients by findings at whole-mount sectioning of the surgical specimens. At pathology 28 patients had stage T2, 30 had stage T3a/b, and 15 had stage T3c lesions. Overall accuracy of endorectal coil MRI in defining local tumor stage was 82% (60 of 73 patients). Of 73 patients, 5 (7%) were underestimated and 8 (11%) overestimated. The sensitivity and the specificity of endorectal coil MRI in diagnosing capsular penetration were 95% and 82%, respectively. Seminal vesicle invasion was detected with 80% sensitivity and 93% specificity. Our data indicate that endorectal coil MRI is an accurate method for local staging of prostate cancer.

Humans↗
PubMed1996

Adaptive morphological changes of the intestinal mucosa in orthotopic ileal bladder. Short-term and long-term evaluation.

The morphology of the mucosa of orthotopic ileal bladders in place for 3 months to 4 years was studied in biopsies obtained at random from 12 patients. A mucosal flattening, a reorganization of the lining epithelium and a disappearance of the fenestrated areas of blood capillaries were found. Enterocytes progressively stratified and acquired poorly differentiated features, along with loss of microvilli, reduction of the apical fuzzy glycocalyx and enlargement of intercellular spaces. Goblet cells at short-term evaluation were actively involved in mucous synthesis and secretion. Metabolic acidosis was slight both in short-term postoperative periods-under alkaline therapy- and in long-term postoperative periods-when therapy was suspended. It can be concluded that, firstly, urine contact determines in such reservoirs a condition of acute irritation and, secondly, environmental changes induce the ileal mucosa to develop a new phenotype probably better suited to a protective rather than absorptive function.

Aged↗
PubMed1994

Second stage reconfiguration of Camey I ileal bladder improves its urodynamic and clinical characteristics.

Second stage reconfiguration of Camey I neobladder with intact ileal loop was performed in 3 patients due to poor functional results and associated complications requiring reintervention. Neoblasdder capacity increased from a mean volume of 240 to 593 mL, maximum endoluminal pressure decreased from a mean value of 86 to 29 mm water, and night-time incontinence uniformly disappeared. Loop detubularization and reconfiguration, therefore, results in marked improvement of the clinical and urodynamic characteristics of Camey I ileal neobladder.

Aged↗
PubMed1993

Modified urethro-ileal anastomosis in the Studer ileal bladder.

Studer ileal bladder substitute is a low pressure reservoir anastomosed to the membranous urethra. Suitable length of mesentery is necessary to allow the ileal loop to reach the urethral stump. However, reconfiguration by double folding of the detubularized ileal segment tends to move the inferior portion of the pouch away from the membranous urethra making more difficult, if not impossible, the ileo-urethral anastomosis. In order to avoid this technical limitation, we suggest a reconfiguration of the lowest portion of the pouch into the shape of a 5-cm-long funnel, which permits the loop to approach the urethral stump and therefore facilitates the ileo-urethral anastomosis. This technique has been successfully employed in 10 patients. Eight of them have clinical, radiological and urodynamic follow-up.

Adult↗
PubMed1992

Orthotopic ileal bladder: clinical, urodynamic and metabolic evaluation.

Since January 1985, orthotopic ileal bladder substitution after radical cystectomy was performed in 64 male patients. The Camey I procedure was performed in 35 patients (group 1) and the Studer procedure in 29 (group 2). Clinical, metabolic and urodynamic evaluation was performed at regular intervals with a mean follow-up of 27 months for group 1 and 13.6 months for group 2. Patients with a Camey I bladder reconstruction presented smaller capacity and higher intraluminal pressure resulting in shorter voiding intervals and a practically uniform presence of enuresis, as opposed to those reconstructed with the Studer procedure. The incidence of ureteral reflux was also higher in group 1. Metabolic studies in both groups revealed a slight metabolic acidosis which was treated with oral alkalinization. It is concluded that detubularization of the terminal ileum creates a more favorable low-pressure reservoir.

Adult↗
PubMed1992

MR imaging with STIR technique and air insufflation for local staging of bladder neoplasms.

Fifty-six patients with bladder carcinoma were studied with MR imaging for the assessment of the local stage, using the inversion recovery pulse sequence with fat suppression (STIR) with air in the bladder. With this technique images of the inner and the outer parts of the bladder wall were obtained, showing high contrast between the latter and the tumor (tumor/muscle contrast 89.9%). Four tumor stages were recognized: superficial neoplasms (Tis, Ta, and T1), partial wall infiltrating neoplasms (T2); total wall infiltrating neoplasms (T3a, T3b), and neoplasms involving other pelvic organs (T4). MR imaging was compared with histopathologic diagnosis obtained at transurethral resection or cystectomy. True-positive diagnosis was obtained in 80.4%; false-positive in 14.3% of cases; false-negative in 5.3%. Despite the relatively high incidence of overstaged neoplasms, STIR technique combined with air in the bladder allowed a good accuracy in local staging.

Adult↗
PubMed1989

Undiversion with ileocecal segment following high transureteroureterostomy.

A boy presenting with a small bladder and refluxing blind-ending ureteral stumps following multiple attempts at ureteral reimplantation and supravesical diversion with a high left-to-right transureteroureterostomy and right cutaneous ureterostomy underwent successful undiversion. Surgery consisted of bilateral ureterectomy and ileocecocystoplasty, with intussusception of the ileocecal valve and anastomosis of the ileal tail to the right renal pelvis.

Adolescent↗
PubMed1988

Relaxation of isolated corpus cavernosum induced by smooth-muscle relaxant drugs. A comparative study.

Intracavernous injection of vasoactive substances are used in the treatment and investigation of impotence. We studied the effects induced by some pharmacological agents on strips of human erectile tissue. Specimens of corpus cavernosum were obtained from 16 men undergoing cystectomy or penectomy for bladder or penile malignancy. Strip preparations were mounted in thermostically controlled baths containing Krebs solution. Pharmacologic effects were monitored by means of an isotonic transducer. Papaverine was shown to be the substance able to cause the biggest relaxation effect. The authors compared the action of other drugs having a relaxant effect, studied the antagonist effects of epinephrine and dopamine on the pharmacologically relaxed preparations, and stressed that the relaxation of the erectile tissue has a determinant role in the appearance and maintenance of erection.

Adult↗
PubMed1988

Conservative surgical treatment of renal cell carcinoma: clinical experience and reappraisal of indications.

During a 14-year period 36 patients who presented with renal cell carcinoma underwent conservative surgical treatment. The patients were divided into 3 groups according to treatment indications and condition of the contralateral kidney: group 1 included patients with a solitary kidney or bilateral tumors, group 2 patients had a damaged contralateral kidney and group 3 patients were without abnormalities of the contralateral kidney. Cumulative 6-year survival rates were 58 per cent for group 1, and 90 per cent for groups 2 and 3 combined. The over-all cumulative 6-year survival rate was 74 per cent. Based on these data extension of the indication for conservative surgical treatment seems to be justified in patients who present with low stage tumors and partial or potential damage to the contralateral organ.

Adult↗