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Biomedical subjects

A Loffredo

Publications and source records attributed to A Loffredo.

At least 19 recordsLinked to original sources
PubMed2006

Laparoscopic gastric bypass performed with the Da Vinci Intuitive Robotic System: preliminary experience.

BACKGROUND: This study aimed to analyze retrospectively the authors' preliminary experience using the Da Vinci Intuitive Robotic System for gastric bypass in managing morbid obesity, and to determine its efficacy and safety in relation to other standardized laparoscopic surgical techniques. METHODS: From October 2000 to March 2004 the authors performed 146 laparoscopic gastric bypasses, 17 of which were robot assisted using the Da Vinci Intuitive Robotic System. The last patients were 7 men and 10 women with a mean age of 44 years. The mean weight was 139 kg, and the mean body mass index (BMI) was 49.8 kg/m at first postoperative recovery. The mean excess body weight (EBW) was 131%. Follow-up assessment, performed at months 1, 3, 6, and 12, then yearly thereafter, included evaluation of the variations in BMI and the percentage of excess body weight loss (EBWL%). All the patients were informed of the risks inherent with each surgical procedure as well as the potential benefits. RESULTS: The mean operative time was 201 min (range, 90-300 min). No intraoperative complications and no conversion occurred in this series. The mean hospital stay was 9 days (range, 6-18 days). The patients in this series experienced a normal postoperative course without anastomotic complications. The mortality rate was zero. No robot-related complications were noted. The analysis of follow-up assessment at months 1, 3, 6, and 12 showed a progressive decrease in BMI and an increment of EBWL%. CONCLUSIONS: The authors' early experience with robotic surgery suggests that it is safe and could be an effective alternative to conventional laparoscopic surgery. The authors believe that robotic surgery, with its ability to restore the hand-eye coordination and three-dimensional view lost in laparoscopic surgery, could allow complex procedures to be performed with greater precision and better results.

Adult↗
PubMed2001

Three years experience with the new intragastric balloon, and a preoperative test for success with restrictive surgery.

BACKGROUND: The BioEnterics Intragastric Balloon (BIB) is a smooth, spherical, saline-filled, silicone elastomer with a black radiopaque filling valve, intended to induce weight loss by limiting food consumption. This can be considered a "restrictive" procedure, and by using this balloon, we can assess the patient's eligibility for a restrictive surgical procedure (the BIB-Test). METHODS: From May 1997 to May 2000, 87 BIB were inserted in 77 moderately to severely obese patients (4 BIB in 1 patient, 2 BIB in 7 patients). 64 patients completed the treatment. Out of these, 18 (16 female, 2 male) underwent laparoscopic gastric banding after BIB removal. RESULTS: After the treatment (3-6 months), weight loss results were as follows: WL 14.3 kg, %EWL 23.5 and loss in BMI 5.3. 12 patients after the preliminary BIB, have been followed > or = 6 months after gastric banding, and have significant further weight loss. CONCLUSIONS: BIB appears to have good results. A supervised nutritional and behavioral regimen is mandatory. The balloon may be indicated to: 1) induce weight loss in patients whose obesity is not severe enough to warrant surgery; 2) reduce the surgical risk in those who are massively obese; 3) select patients for gastric restrictive surgery if they lose weight with the balloon. The data showed that patients who had good results with the BIB (positive BIB-Test) are still losing weight after subsequent gastric banding.

Adult↗
PubMed2000

Solitary necrotic nodule of the liver misinterpreted as malignant lesion: considerations on two cases.

In our experience, we document 2 cases of a rare and non-tumoral lesion of the liver misinterpreted as necrotic tumor: necrotic solitary nodule. In the first clinical case, ultrasound (US) showed a polylobated lesion (35 x 35 x 38 mm) at segment 8. Color-doppler identified a compression of celiac axis (Dunbar syndrome). Arteriography revealed a subtotal stenosis of celiac tripod soon after the emergence of the left gastric artery. FNAB-CT showed a highly cellulated tissue with a necrotic core surrounded by a fibersclerotic tissue. The patient underwent surgery: cholecystectomy and correction of Dunbar syndrome. US follow-up showed a progressive reduction in diameter of the lesion (24 x 25 x 25 mm at 24 months), suggesting in this case the role of ischemic injury in the pathogenesis of the lesion. In the second clinical case, a hypoechoic lesion (32 x 32 x 30 mm) of segment 6 as occasional US finding during the staging for prostate cancer was shown. FNAC-CT showed a positive result for necrotic cells. Surgical treatment consisted in a wide excision of the lesion. Histologically the lesion was solitary necrotic nodule. The diagnosis of this rare lesion is accidental. In accordance with the literature (50% of cases), we founded an associated tumor. Radiology doesn't differentiate solitary necrotic nodule and other solid lesions. Diagnosis is histological (in our second case, FNAC-CT misinterpreted the tumor as a malignant lesion, while histology showed the real nature of it).

Adult↗
PubMed2000

Laparotomic vs laparoscopic lap-band: 4-year results with early and intermediate complications.

BACKGROUND: Adjustable banding is safe, low invasive, and effective for losing weight. METHODS: 69 patients underwent this procedure by laparotomy or laparoscopy. RESULTS: Patients operated by laparotomy lost more weight than those operated by laparoscopy, but in 4 patients we were forced to re-operate in order to remove the band (3 pouch dilatations and 1 stomach slippage), and in 9 patients a ventral hernia appeared (5 patients repaired). In the laparoscopic cases there were 4 intra-operative gastric perforations, but all were repaired and the band placed at the same time (3 conversions to open), causing an increased post-operative hospital stay. There was a lower limb deep venous thromboembolism, which was followed by fatal pulmonary embolism (although the patient had been given heparin and had been treated with elastocompression and mobilization 2 hours after surgery). The band eroded in one patient. Weight losses in these morbidly obese patients were satisfactory at 2 years and maintained beyond 3 years. CONCLUSION: Laparoscopic adjustable banding is an efficient, generally safe procedure.

Adult↗
PubMed1998

Bariatric analysis and reporting outcome system (BAROS) applied to laparoscopic gastric banding patients.

BACKGROUND: The definition of success and failure of a bariatric procedure should include weight loss as well as improvement in comorbidity and quality of life assessment. The Bariatric Analysis and Reporting Outcome System (BAROS), introduced by Oria and Moorhead in 1997, seems to provide a standard for comparison in the surgical treatment of morbid obesity. METHODS: 180 morbidly obese and super-obese patients, who underwent laparoscopic gastric banding (lap-band) at our institutions and had a follow-up >18 months (19-55 months) were evaluated with BAROS. RESULTS: The patients were divided into four outcome groups (failure, fair, good, and excellent) based on a scoring table that adds or subtracts points while evaluating three main areas: percentage of excess weight loss, changes in medical conditions, and assessment of quality of life. Points were deducted for complications and reoperative surgery. CONCLUSIONS: The BAROS outcome system has proved to be a useful instrument in evaluating midterm results in our series of lap-band patients.

Adolescent↗
PubMed1996

The synovial-like membrane at the bone interface in loose total hip replacements contains high levels of extracellular group II phospholipase A2.

Progressive lysis of bone in loose total hip replacement has been ascribed to the capacity of the synovial-like membrane present at the bone interface to produce prostaglandin E2 and cytokines such as tumor necrosis factor (TNF alpha). Phospholipase A2 (PLA2) produces rate limiting precursor i.e. arachidonic acid in the biosynthesis of various types of biologically active lipids including prostaglandins. It has been shown that extracellular human group II phospholipase A2 is present in large amount in synovial fluid of patients with synovitis and that the expression of this enzyme is under the control of cytokines such as TNF alpha. Furthermore, the human extracellular enzyme has been also shown to induce in an experimental animal model to cause disruption of a synovial like membrane without increasing prostaglandin production. Here we have evaluated PLA2 and TNF alpha levels in the supernatant of homogenate of the synovial-like membrane present at the bone interface retrieved from six patients with a loose non septic failed total hip replacement. In all the membranes examined were found high levels of both TNF alpha (856 +/- 211 units/ml) and extracellular phospholipase A2 (2616 +/- 862 ng/ml). These findings suggest that extracellular PLA2 may play a major role in the process that cause disruption of the membrane at the bone-prosthesis interface.

Bone and Bones↗
PubMed1988

Characterization of the atrial natriuretic peptide clearance receptor using a vaccinia virus expression vector.

A recombinant vaccinia virus has been used to direct the expression of the atrial natriuretic peptide clearance receptor (ANP C-receptor) in mammalian cell lines normally deficient in this protein. The recombinant receptor binds 125I-ANP-(102-126) in a specific and saturable manner and carboxyl-terminal truncated and internal-deleted ANP analogs bind to this site with high affinity. Following the covalent attachment of 125I-ANP-(102-126) to the recombinant ANP C-receptor, the protein exhibits an electrophoretic mobility identical to that of the native ANP C-receptor of cultured vascular cells. Expression of the ANP C-receptor in heterologous cells does not affect ANP-stimulated cyclic GMP accumulation, confirming previous reports that this novel ANP receptor subpopulation is not coupled to cyclic GMP metabolism. Furthermore, specific antisera, generated by inoculating rabbits with living recombinant virus, block 125I-ANP binding to the ANP C-receptor but do not inhibit ANP stimulation of cyclic GMP, supporting the existence of two receptor subpopulations that are functionally and immunologically distinct.

Animals↗
PubMed1983

Hepatolenticular degeneration: histological study of conjunctiva and observation of chalazii during D-penicillamine treatment.

Three patients with hepatolenticular degeneration (Wilson's disease) are described. Bilateral blepharoconjunctivitis and Kayser-Fleischer ring was observed in all 3 patients. In 2 patients, long-lasting, bilateral chalazii appeared during chronic treatment with D-penicillamine. Histochemical and ultrastructural studies of pre-treatment conjunctival biopsies showed no copper storage in the tissue thus supporting the hypothesis that copper storage in Descemet's membrane derives from the anterior chamber.

Adolescent↗
PubMed1981

Stevens-Johnson syndrome: a clinical and histological study.

A description is given of a case of Stevens-Johnson syndrome clinically and histologically ascertained in a middle-aged male with typical localization and later chronicity of the ocular involvement. Besides, an outline is drawn of its clinical picture and of the etiopathogenetical hypothesis, dwelling upon the allergic hypothesis though not excluding the iatrogenic one.

Adult↗