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Biomedical subjects

A Mingoli

Publications and source records attributed to A Mingoli.

At least 19 recordsLinked to original sources
PubMed2006

Laparoscopic treatment of blunt splenic injuries: initial experience with 11 patients.

BACKGROUND: Nonoperative treatment of splenic injuries is the current standard of care for hemodynamically stable patients. However, uncertainty exists about its efficacy for patients with major polytrauma, a high Injury Severity Score (ISS), a high grade of splenic injury, a low Glasgow Coma Score (GCS), and important hemoperitoneum. In these cases, the videolaparoscopic approach could allow full abdominal cavity investigation, hemoperitoneum evacuation with autotransfusion, and spleen removal or repair. METHODS: This study investigated 11 hemodynamically stable patients with severe polytrauma who underwent emergency laparoscopy. The mean ISS was 29.0 +/- 3.9, and the mean GCS was 12.1 +/- 1.6. A laparoscopic splenectomy was performed for six patients, whereas splenic hemostasis was achieved for five patients, involving one electrocoagulation, one polar resection, and three polyglycolic mesh wrappings. RESULTS: The average length of the operation was 121.4 +/- 41.6 min. There were two complications (18.2%), with one conversion to open surgery (9.1%), and no mortality. CONCLUSIONS: Laparoscopy is a safe, feasible, and effective procedure for evaluation and treatment of hemodynamically stable patients with splenic injuries for whom nonoperative treatment is controversial.

Adolescent↗
PubMed2005

Squamous and adenosquamous cell carcinomas of the gallbladder.

Squamous and adenosquamous cell carcinomas (ASC and SCC) are rare subtypes of gallbladder cancer, traditionally considered more aggressive and with a poorer prognosis than adenocarcinoma. We report about two patients affected by an advanced squamous cell carcinoma of the gallbladder. Both had a large tumour in the gallbladder fossa region with infiltration of the liver. Surgical resection was radical in one, but palliative in the other. pTNM was T3 N0 M0, G3, R0 in the former and T3 N0 M0, G2 R1 in the latter. Patients died for local recurrence after 12 and 5 months, respectively. Natural history, clinical findings, prognosis and outcome of this rare gallbladder tumour are discussed on the basis of a review of the English literature. In conclusion, an aggressive and radical surgical treatment of advanced squamous and adenosquamous cell gallbladder carcinomas seems to be indicated for their low proclivity to distant spreading.

Aged↗
PubMed2004

Basic fibroblast growth factor mediates carotid plaque instability through metalloproteinase-2 and -9 expression.

OBJECTIVE(S): We hypothesized that basic fibroblast growth factor (bFGF) may exert a role in carotid plaque instability by regulating the expression of matrix metalloproteinases (MMP). METHODS: Plaques obtained from 40 consecutive patients undergoing carotid endarterectomy were preoperatively classified as soft or hard. Serum bFGF was pre- and postoperatively measured. The release of MMP-2 and MMP-9 in the blood serum, and the activity, production and expression in the carotid specimens was analyzed. Specific anti-bFGF inhibition tests were performed in vitro on human umbilical artery smooth muscle cells (HUASMC) to evaluate the role of bFGF in the activity, production and expression of MMP-2 and -9. RESULTS: Twenty-one (53%) patients had a soft carotid plaque and 19 (48%) a hard plaque. Preoperative bFGF serum levels were higher in patients with soft plaques [soft=34 (28-39) pg/mL and hard=20 (17-22) pg/mL-p<0.001] and postoperatively returned to normal values (when compared to 10 healthy volunteers). The serum levels of MMP-2 in patients' with soft plaques were higher than those in patients' with hard plaques [soft=1222 (1190-1252) ng/mL and hard=748 (656-793)ng/mL-p<0.0001]. MMP-9 serum values were 26 (22-29) ng/mL for soft plaques and 18 (15-21) ng/mL for hard plaques (p<0.0001). We found increased activity, production and expression of MMP-2 and -9 in soft plaques compared to hard plaques (p<0.001). In vitro inhibition tests on HUASMC showed the direct influence of bFGF on the activity, production and expression of MMP-2 and -9 (p<0.001). CONCLUSIONS: bFGF seems to exert a key role in carotid plaque instability regulating the activity, production and expression of MMP thus altering the physiologic homeostasis of the carotid plaque.

Aged↗
PubMed2003

[Digestive hemorrhage from a duodenal neuroendocrine tumor. Diagnostic-therapeutic features and emergency surgical strategy].

The Authors report a rare case of duodenal neoplasia in a 17 year old boy. The patient was admitted in an emergency setting for hemorrhagic shock and duodenal perforation. Laparotomy was performed and a huge perforated neoplasia of the duodenum was found. Conservative approach was preferred, since the intraoperative histology was unuseful in choosing the better procedure: thus just a tumorectomy and closure of the duodenum were performed. Pathology examination demonstrated a neuroendocrine primitive duodenal tumors not well differentiated and with high grade of malignancy. The Authors discuss the role of the elements, clinical features and pathology, as well as emergency and postoperative management.

Abdomen, Acute↗
PubMed2001

Femorofemoral bypass grafts: Factors influencing long-term patency rate and outcome.

BACKGROUND: Crossover femorofemoral bypass graft (CFFBG) was proposed in the early days of modern vascular surgery to treat patients affected with unilateral iliac artery disease who were a high surgical risk. We investigated factors influencing short- and long-term outcomes of CFFBG: METHODS: The study was designed as a retrospective clinical study in a university hospital setting with a base of 228 patients. Of these patients, 154 (67.5%) presented a high surgical risk. The indication for operation was limb-threatening ischemia in 188 (82.5%) patients. All patients underwent CFFBG: The procedure was performed in 150 patients as the primary operation and in 78 patients after previous vascular graft failure or infection, or both. A preoperative percutaneous transluminal angioplasty was performed in 57 patients (25%) to correct donor iliac artery disease. In 127 patients (55.7%), an associated vascular procedure was performed to improve the outflow. Postoperative complications; 5- and 10-year primary, secondary, and limb salvage rates; and factors influencing short- and long-term results were assessed. RESULTS: Thirteen (5.7%) postoperative deaths occurred. Postoperative mortality and morbidity rates were significantly higher in patients aged more than 65 years (7.9% versus 3.5% and 18.6% versus 6.1%, respectively, P <.03). Primary and secondary patency rates at 5 and 10 years were 70.2% and 48.1%, 82.8% and 63.2%, respectively; 5- and 10-year limb salvage and survival rates were 85.5% and 80.1%, 63.3% and 31.0%, respectively. Ten-year primary and secondary patency and limb salvage rates were significantly lower when the procedure was performed after previous vascular graft failures (50.2% versus 26.5%, P <.007; 74.1% versus 44.1%, P <.01; and 84.3% versus 72.5%, P <.03, respectively). Five- and 8-year patency rates of autogenous vein CFFBG (34.3% and 22.8%, respectively, P <.03) were significantly lower than those of expanded polytetrafluoroethylene (71.1% and 59.8%, respectively) and polyester (77.3% and 50.3%, respectively) CFFBG: Moreover, 5- and 10-year primary and secondary patency rates were significantly better when externally supported grafts were used as compared with those without external support (80.1% and 69.9% versus 61.1% and 21.1%, P <.01; 88.8% and 75.9% versus 78.9% and 45.4%, P <.05, respectively). Multivariate analysis showed that the only variable associated with poor primary and secondary patency and limb salvage rates was the operation performed after previous vascular graft failures (P <.04, P <.03 and P<.05, respectively). CONCLUSIONS: CFFBG allows early and long-term results similar to those obtained with reconstructions originating from the aorta when it is performed as a primary operation when an adequate outflow is provided and externally supported prosthetic material is used.

Aged↗
PubMed2001

[Duodenal ulcer and Helicobacter pylori].

BACKGROUND: The purpose of this study was to evaluate the relationship between duodenal ulcer (DU), Helicobacter pylori (Hp) infection and genetic and enviromental factors, and its influence on treatment and long-term RESULTS. METHOD: In the course of an epidemiological study on the prevalence of esophagogastroduodenal diseases, 1,169 volunteers underwent an endoscopy of the upper part of the gastrointestinal tract. The relationship of incidence rate and size of duodenal ulcers and several risks factors was investigated. RESULTS: A DU was observed in 240 subjects (20.5%), mostly of male gender (64.4% - p<0.0001). The Histological presence of a gastric Hp infection was confirmed in 179 cases (74.6%); it did not influenced the mean size of the ulcers and the presence of gastric intestinal metaplasia, compared to subjects without Hp infection. However, a superficial chronic gastritis was observed in 95.9% of Hp+ subjects and in 83.3% of Hp- (p<0.003), whereas a familiar history of DU was noted in 33.3% of Hp+ subjects and in 50.8% of Hp- (p<0.02). The main risk factor for DU was represented by Hp infection in 119 cases (49.6%), by infective and genetic factors in 60 cases (25%) and only by the genetic factor in 31 cases (12.9%), and was not detected in 30 cases (12.5%). Ulcer recurrence rates, after medical therapy, were 0,5% and 6.5% (p<0.03) at a 2-month follow-up, and 2.2% and 49.1% (p<0.00001) at a 12-month follow-up, among Hp+ and Hp- patients, respectively. CONCLUSIONS: The most common risk factor for DU was a gastric Hp infection, alone or associated to the genetic factor. Since the high incidence of recurrences at a 12-month follow-up, patients affected with a DU but Hp- represented an important therapeutic concern.

Adolescent↗
PubMed2001

Comparison of femorofemoral and aortofemoral bypass for aortoiliac occlusive disease.

BACKGROUND: Role and results of femorofemoral bypass grafting, usually reserved to high-risk patients affected with unilateral iliac artery occlusion, are still debated. METHODS EXPERIMENTAL DESIGN: retrospective clinical study. SETTINGS: University Hospital. PATIENTS: seventy-six high-risk patients (group 1) who underwent a primary expanded polytetrafluoroethylene (ePTFE) externally supported femorofemoral bypass graft were retrospectively compared to two additional groups of patients selected from the entire series of patients who underwent an aortobifemoral bypass graft. Patients of group 2 (n=80) were randomly chosen to determine differences in risk factors, associated diseases, previous abdominal operations, operative indications, preoperative findings and outcome. Patients of group 3 (n=50) were matched for sex, risk factors, associated diseases, previous abdominal operations, operative indications and preoperative findings with those of group 1 to assess the importance of the type of operation in determining the outcome of the procedure. RESULTS: Postoperative mortality (6, 4 and 6%, respectively), 5-year primary and secondary patency (71, 80, 83% and 80, 87, 87%, respectively) and limb salvage rates (78, 87 and 87%, respectively) were similar among the groups (p=NS, p=NS, p=NS, respectively). Five-year survival rate of group 2 was significantly better than that of group 1 and 3 (p<0.04 and p<0.04, respectively). CONCLUSIONS: Primary ePTFE externally supported femorofemoral bypass graft in high-risk patients is safe and produces long-term results similar to aortofemoral reconstruction.

Aged↗
PubMed2000

[Reflux oesophagitis and risk factors. Results of a population study].

BACKGROUND: To evaluate the prevalence and endoscopic grade of reflux oesophagitis (RO) and to correlate them to symptoms and to a list of risk factors including age, sex, weight, smoking, alcohol, work, hiatus hernia. METHODS: This study was carried out in Roccacorga (LT), a little town of 3435 inhabitants in central Italy. The sample totalled 1084 volunteers, aged over 18 years old and enlisted in opened cohort. After filling in the questionnaire, all the patients were subjected to esophagogastroduodenoscopy without eating for at least six hours and diazepam pretreated (10 mg ev). Three biopsies were routine performed on the 3 biopsies on distal esophagous wall. The RO range was evaluated according to the Savary-Miller classification. RESULTS: The RO was found in 443 patients (188 M, 42%; 255 F, 58%) (p<0.0002), a large number of asymptomatic patients (39%). The prevalence of hiatus hernia was 7.2%, RO associated in 60.3% (p<0005). The prevalence of associated gastroduodenal injuries was pointed out (p<0.03). Patients affected only by RO were mostly female (p<0.02). Precancerous esophagous were 0,37%. CONCLUSIONS: According to this study the RO diagnosed through endoscopy is much more prevalent than supposed, especially among females and it affects a younger age than reported (31-50 years). Smoking and alcohol are among male risk factors, while, in female, agricultural works, weight and hormonal state could have a leading role (p=NS).

English Abstract↗
PubMed1999

Long-term results and outcomes of crossover axilloaxillary bypass grafting: A 24-year experience.

OBJECTIVE: The outcome of crossover axilloaxillary bypass grafting in patients with stenosis or occlusion of the innominate or subclavian arteries was investigated. METHODS: The study was designed as a retrospective clinical study in a university hospital setting with 61 patients as the basis of the study. Fifty-eight patients (95.1%) had at least two risk factors or associated medical illnesses for atherosclerosis, and 35 patients (57.4%) had concomitant carotid artery stenosis that necessitated a staged procedure in 12 patients (19.7%). The patients underwent a total of 63 crossover axilloaxillary bypass grafting procedures. Demographics, risk factors and associated medical illnesses, preoperative symptoms and angiographic data, blood flow inversion in the vertebral artery, concomitant carotid artery disease, graft shape, caliber and material, and intraoperative and postoperative complications were studied to assess the specific influence in determining the outcome. RESULTS: One postoperative death (1.6%), four early graft thromboses (6.2%), and six minor complications (9. 8%) occurred. The overall mortality and morbidity rates were 1.6% and 16.1%, respectively. During the follow-up period (mean, 97.3 +/- 7.9 months), we observed five graft thromboses (8.3%). Primary and secondary patency rates at 5 and 10 years were 86.5% and 82.8% and 88.1% and 84.3%, respectively. Overall, two patients (3.3%) had recurrence of upper limb symptoms and none had recurrence of symptoms in the carotid or vertebrobasilar territory. The 5-year and 10-year symptom-free interval rates were 97.7% and 93.5%, respectively. Nine patients (15%) died of unrelated causes. The 5-year and 10-year survival rates were 93.2% and 67.3%, respectively. Multivariate analysis showed that no specific variables exerted an influence in the short-term and long-term results and the outcome. CONCLUSION: The optimal outcome of axilloaxillary bypass grafting supports its use as the most valuable surgical alternative to transthoracic anatomic reconstructions for innominate lesion, long stenosis of the subclavian artery, and short subclavian artery stenosis associated with ispilateral carotid artery lesions.

Adult↗
PubMed1999

Iliorenal bypass for the treatment of type-3 Takayasu's disease. A case report with 10-year follow-up.

The case of a 16-year old female with severe renovascular hypertension resulting from type-3 Takayasu's arteritis is reported. The entire thoracic and abdominal aorta was affected by an active inflammatory process and all its branches were stenotic or occluded. After the early failure of a percutaneous balloon angioplasty of the left renal artery, an iliac to renal artery bypass graft using a reversed autologous saphenous vein was performed through a retroperitoneal tunnel The patient is asymptomatic and the graft is patent at 10-year follow-up.

Adolescent↗
PubMed1999

31Phosphorus magnetic resonance spectroscopy to evaluate medical therapy efficacy in peripheral arterial disease. A pilot study.

BACKGROUND: Human and animal studies have shown that propionyl-L-carnitine, increasing carnitine content, improves the energy metabolism of ischemic skeletal muscle. The aim of the study was to evaluate the accuracy of Doppler continuous wave, Treadmill test and 31Phosphorus magnetic resonance spectroscopy in determining the efficacy of propionyl-L-carnitine in patients with peripheral arterial disease. METHODS EXPERIMENTAL DESIGN: Prospective study. SETTING: University hospital. PATIENTS: Eighteen male patients with peripheral arterial disease (category 3) and 8 healthy volunteers form the basis of the study. Patients quit smoking, start physical training (2-3 Km walk per day) and were assigned to medical therapy consisting of propionyl-L-carnitine (8 patients) or placebo (10 patients). Patients were studied with Doppler continuous wave, Treadmill test and 31Phosphorus magnetic resonance spectroscopy at day 0 and at day 90. The following parameters were assessed by the principal component analysis: clinical (absolute claudication, ankle brachial index at rest and at 2, 5 and 10 minutes after completing Treadmill exercises) and biochemical (inorganic phosphorus/phosphocreatine ratio and pH profiles at 20% and 50% of the maximum load, the recovery half time of phosphocreatine, number of exercise steps and slope of linear relationship between muscle power and inorganic phosphorus/phosphocreatine ratio). RESULTS: Final evaluation showed a significant improvement of clinical and biochemical variables (p < 0.05 and p < 0.02 respectively). Breaking down the results on the basis of the two study arms, 31Phosphorus magnetic resonance spectroscopy showed a significant improvement of biochemical variables in the group of patients treated with propionyl-L-carnitine (p < 0.05) and was more sensitive in the evaluation of changes induced by 90-day treatment as compared with the other noninvasive examinations. CONCLUSIONS: 31P-MRS permits the evaluation of muscle metabolic effect induced by PLC after a 90-day-period in patients affected by category 3 of peripheral arterial disease and it is a more sensitive tool in the evaluation of the pharmacological effects of medical therapy.

Aged↗
PubMed1998

Release of PDGF-BB and bFGF by human endothelial cells seeded on expanded polytetrafluoroethylene vascular grafts.

BACKGROUND: The majority of endothelial cell (EC) seeded graft failures are due to anastomotic neointimal fibrous hyperplasia. We investigated the PDGF-BB and bFGF release in vitro by umbilical vein EC seeded on precoated expanded polytetrafluoroethylene (ePTFE) prostheses. MATERIALS: EC harvested from human umbilical veins were seeded into ePTFE (30 microns internodal distance, 1 cm2 in diameter) disks. ePTFE disks uncoated or precoated with collagen type I, fibronectin, and Matrigel were used, and EC seeded into plastic wells coated as ePTFE disks or uncoated plastic wells served as controls. Scanning electron microscopy study assessed EC coverage. The presence of bFGF and PDGF-BB in serum-free conditioned media from EC seeded into ePTFE grafts and EC seeded into wells was determined by the inhibition antibody-binding assay 72 h after seeding. RESULTS: EC coverage was similar in uncoated and coated ePTFE grafts. The release of PDGF-BB and bFGF by EC seeded into ePTFE grafts was significantly higher than that observed in EC seeded into plastic wells. The release of PDGF-BB and bFGF was independent from the various substrates used in the experiments in EC seeded into either ePTFE grafts or plastic wells. CONCLUSIONS: Our findings pointed out that in seeded ePTFE grafts, anastomotic smooth muscle cell proliferation and intimal thickening could take place underneath an intact endothelium because seeded EC may release several growth factors.

Becaplermin↗
PubMed1998

Iliac-to-isolated hepatic artery bypass in the treatment of intestinal angina: two cases.

Two cases in which a severe form of intestinal angina was cured by revascularization of an isolated hepatic artery were studied. The collateral pathways to the hepatic artery may serve, in a retrograde fashion, to assure an acceptable blood supply to the splanchnic organs, even when the disease of the 3 main vessels is so extensive that the commonly used techniques of revascularization cannot be applied.

Abdominal Pain↗