Biomedical subjects
Publications and source records attributed to A Renda.
The relation between young surgeons and transplantation has always been a "love and hate" one. Until a few years ago this branch of surgery was seen as pioneering, with extreme and and extensive training, and was reserved to few elected members. Nowadays things are different. In this article we try to understand the true reasons that young Italian surgeons avoid transplantation surgery.
INTRODUCTION: Impaired healing of the surgical incision represents a common complication after kidney transplantation. We led a retrospective study seeking to understand the factors linked to these complications and reasons for their reduction during the last year. PATIENTS AND METHODS: From January 2000 to April 2004, 170 consecutive kidney transplantations were performed in a homogenous patient population. We evaluated the influence of following factors to determine impaired healing of the incision: antirejection drugs, overweight/obesity, age, delayed graft function (DGF), diabetes, and abdominal wall reconstruction technique. RESULTS: Among 165 patients we observed 26 (15.76%) cases of impaired healing of the surgical incision: 17 (65,38%) with first-level and nine with second-level wound complications. CONCLUSIONS: Impaired healing of the surgical incision influences the outcome of kidney transplant patients. In our study we observed that cyclosporine and tacrolimus similary affected the incision's healing. It was not possible to evaluate the role of basiliximab. A univariate analysis of the factors related to complications revealed overweight and DGF. However, all patients developing second-level complications showed more risk factors. Patients who had not had reconstruction of the muscle layers showed a greater incidence of surgical complications, whereas patients who had skin sutured with an intradermic technique did not show an increased risk.
Anorectal atresia, which is classified as a low anorectal malformation, is characterised by the absence of the anal verge and by variable rectal atresia. In some cases, which have been classified as rectal agenesis, the atresia is associated with the absence of the internal sphincter. The therapeutic options are definitely surgical, aiming to relieve the bowel occlusion and to restore faecal continence by lowering the cul-de-sac to the perineum. We present the case of an adult patient with congenital rectal agenesis, double fistula (cul-de-sac-urethra and cul-de-sac-perineum) and caecostomy since birth. The patient was treated with a resection of sigmoid-rectum for the presence of a 20-cm faecaloma in the cul-de-sac, with a non-continent pull-through, and with implantation of an artificial bowel sphincter. Despite some difficulties in managing the device and a slight symptomatic mucosal prolapse, the results after 30 months have so far satisfied both the patient and the medical staff, especially in consideration of the limited number of alternative therapies.
OBJECTIVE: Two common factors, cigarette smoking and appendectomy, have been found to play a role in ulcerative colitis (UC). Data on their role in the development of extraintestinal manifestations (EIM) are scarce. METHODS: The relationship between cigarette smoking, appendectomy, and EIM was examined in a prospective study involving 535 (M/F = 319/216) consecutive UC patients followed up for 18 yr. We considered the major EIM: seronegative spondyloarthropathy, pyoderma gangrenosum/erythema nodosum, acute anterior uveitis, and primary sclerosing cholangitis. We excluded patients with a history of EIM or those colectomized before study entry, ex-smokers, and those who started to smoke during the course of UC. RESULTS: In UC patients, seronegative spondyloarthropathy and dermatologic complications were found increased in smokers (p < 0.0001; p = 0.001) or in subjects with appendectomy (p = 0.0003; p = 0.02), while acute anterior uveitis and primary sclerosing cholangitis did not differ. The Kaplan-Meier analysis showed 18-yr rates for EIM of 71% in smokers and 45% in nonsmokers (log-rank test, p = 0.0001), and of 85% in patients with appendectomy and 48% in those without (p = 0.0001). Cox proportional-hazard model showed that cigarette smoking and appendectomy are independent factors promoting EIM. In smokers with appendectomy the adjusted hazard ratio (3.197, 95% CI 1.529-6.684) was higher than in patients with appendectomy alone (2.617, 95% CI 1.542-4.442) or smoking alone (1.947, 95% CI 1.317-2.879). CONCLUSIONS: In UC patients, appendectomy and cigarette smoking are prognostic factors for the development of EIM. The unfavorable effect of cigarette smoking on EIM is additive to that of appendectomy.
Testicular tumours represent 2% of all male malignancies, mostly concerning young men (20-40 years old). The polyembryoma is one of the uncommonest lesions and just recently it has been identified as autonomous nosographic entity. The reported case is peculiar because the patient was older than the most ones described in the literature and the tumour arose after polychemotherapy for non Hodgkins' disease. The Authors analyse some aspects concerning etiology, pathology and clinical approach to such rare neoplasm.
Since the identification of the BRCA1 and BRCA2 genes (MIM#s 113705 and 600185), more than hundred different mutations throughout both genes have been reported. Recurrent mutations are rare and mainly due to founder effects. We analyzed 12 sporadic female patients with breast cancer before age 35, as well as 16 unrelated families, presenting with either (i) at least 3 first degree relatives with breast and/or ovarian cancer diagnosed at any age, or (ii) at least 2 first and/or second degree relatives with breast and/or ovarian cancer before age 45 years. We performed a protein truncation test for BRCA1 exon 11 and BRCA2 exons 10 and 11 and heteroduplex analysis for all the remaining exons of BRCA1 and 2. Presence of genomic deletions encompassing exons 13 or 22 of BRCA1, known to be Dutch founder mutations, was investigated by PCR. In 6/16 (37.5%) unrelated families the causal mutation in either the BRCA1 or BRCA2 gene was identified. Four different mutations were found in the BRCA1 gene: IVS5+3A>G (intron 5), 1191delC (exon 11), R1443X (exon 13), IVS22+5G>A (intron 22) and two in the BRCA2 gene: 6503delTT (exon 11), 6831delTG (exon 11). 1191delC (BRCA1) and 6831delTG (BRCA2) are novel mutations. IVS5+3A>G in exon 5 of BRCA1 published by Peelen et al. (1997) as a novel Belgian mutation, was identified in one additional family, not fulfilling our inclusion criteria. In the group of 12 sporadic female patients no mutations were found.
We describe three unrelated kindreds, affected by familial adenomatous polyposis (FAP), with 5q submicroscopic deletions that encompass the entire adenomatous polyposis coli (APC) gene and the adjacent DP1 gene. In one family the deletion encompasses also the MCC (mutated in colon cancer) gene. Affected members of these families had dysplastic adenomatous polyps and congenital hypertrophy of the retinal pigment epithelium (CHRPE); no individual was affected by mental retardation or facial dysmorphism. The deletions were detected by linkage analysis with several intragenic and closely flanking polymorphic markers and confirmed by a quantitative PCR analysis. This procedure could have an impact on the detection of the molecular defect in FAP patients in whom mutational analysis fails to identify the specific mutation.
This study examined the effect of volatile components of citrus fruit essential oils on P. digitatum and P. italicum growth. The hydrodistilled essential oils of orange (Citrus sinensis cvv. "Washington navel", "Sanguinello", "Tarocco", "Moro", "Valencia late", and "Ovale"), bitter (sour) orange (C. aurantium), mandarin (C. deliciosa cv. "Avana"), grapefruit (C. paradisi cvv. "Marsh seedless" and "Red Blush"), citrange (C. sinensis x Poncirus trifoliata cvv. "Carrizo" and "Troyer"), and lemon (C. limon cv. "Femminello", collected in three periods), were characterized by a combination of GC and GC/MS analyses. The antifungal efficacy of the oils was then examined at progressively reduced rates. Findings showed a positive correlation between monoterpenes other than limonene and sesquiterpene content of the oils and the pathogen fungi inhibition. The best results were shown by the citrange oils, whose chemical composition is reported for the first time, and lemon. Furthermore P. digitatum was found to be more sensitive to the inhibitory action of the oils.
Intraoperative radioimmunodetection is a new staging technique for epithelial neoplasms. After intravenous injection, a radioimmunoconjugate compound (monoclonal antibody and isotope) attaches itself to the antigens expressed on the surface of neoplastic cells, causing them to emit gamma rays. Radioactivity is detected at the presurgical stage by immunoscintigraphy and intraoperatively with a gamma-detecting probe (GDP). In our experience, intraoperative tumor-to-normal-tissue (T/NT) GDP ratio counts > or =3:1 were considered positive radioimmunoguided surgery (RIGS) findings. We studied 52 colorectal cancer patients, 48 with primary lesions and 7 with relapses. Positive RIGS findings were obtained in 33 patients whose lymph node assessments were characterised by eight false positive identifications. In 10 patients, RIGS data yielded a more accurate staging of the disease. Unreliable RIGS findings were recorded in 15 patients: four injected with monoclonal antibody (MAb) B72.3 labeled with Iodine-125; five with MAb anti-carcinoembryonic antigen (CEA) labeled with 99mTechnetium (Tc); two with MAb B72.3 labeled with Indium-111; and three with MAb B72.3 labeled with Iodine-131 plus interferon-beta. In analysis, our experience did not permit definitive evaluation of the method's diagnostic and staging accuracy.
Hereditary nonpolyposis colorectral cancer (HNPCC), an autosomal dominantly inherited predisposition for early onset colorectal cancer, accounts for at least 6% of all colorectal malignancies. HNPCC results from germ-line mutations in DNA mismatch repair (MMR) genes (hMSH2, hMLH1, hPMS1 and hPMS2) and is associated with a high rate of replication errors in tumor cells. Using PCR-SSCP, the protein truncation test and DNA sequencing we have analyzed the hMSH2 and hMLH1 genes in 10 Italian families that met the standard diagnostic criteria for HNPCC. We have identified three new mutations in the hMLH1 gene. One mutation consists in a deletion of one base pair at nucleotide 954 (954delC) in exon 11 that creates an early stop at codon 366 and is predicted to abolish normal protein function. The other two are missense mutations. Cys77Arg and Ser193Pro, that cause dramatic amino acid substitutions in two highly conserved MLH domains. The Cys77Arg mutation occurs within a domain (1-114 residues) that is very critical for MMR function. The Ser193Pro mutation occurs in a highly conserved central region of the MLH1 protein. No functional domains have yet been identified in this region. All mutant alleles cosegregate with the cancer phenotype.
Even if the first radical prostatectomy was performed more than ninety years ago by Hugh Hampton Young, it's only during the 20 last years that an anatomical approach to this technique has been developed, to reduce the number of complications routinely described. The evolution of the procedure allow us how to make the operation safer, to perform it in a bloodless field and increase the possibility to preserve continence and potency. We would like to show you how two simple technical variations for the control of dorsal vein complex and the vesico-uretral anastomosis can, at our opinion, decrease the number of operative and postoperative complications. A retrospective review was performed on 168 clinical localised prostate cancer patient (stages T1 to T2 N0 M0) treated in our hospital between December 1987 and March 1998. All these patients underwent retropubic radical prostatectomy with pelvic lymphadenectomy. The preoperative clinical stage was T1 for 48.2% and T2 for 51.8%. The mean age of the patients at operation was 64.4 years and the mean PSA level at diagnosis was 12.4 ng/ml. Our results revealed that 97% of the patients are now perfectly continent and that the continence was immediately recovered by 16% at the removal of the bladder catheter.
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A unique case of true inferior pancreaticoduodenal artery aneurysm (IPDA) associated with occlusion of common hepatic artery is reported. Radiological and MRI findings are described. Because of high risk of visceral ischemia that contraindicated a percutaneous transluminal embolization, a successful tangential resection of aneurysm was performed.
The use of supercritical fluid extraction (SFE) as an alternative to liquid extraction was examined for the isolation of vitamin A palmitate and vitamin E acetate from cream and lotion preparations. Investigation of the factors controlling the extraction efficiency in SFE indicated that vitamin recoveries were affected mainly by the extraction pressure and by the degree of sample dispersion. The vitamins were analysed by high-performance liquid chromatography after a 30-min extraction of the cosmetic product with supercritical carbon dioxide at 40 degrees C and at a pressure of 250 atm. Compared with conventional liquid extraction SFE produced slightly lower recoveries (> 91.6%) but afforded a more effective purification of the cosmetic matrices. Moreover, SFE minimized sample handling and the use of harmful solvents and provided mild extraction conditions for the analysis of the labile vitamins. Vitamin E acetate and vitamin A palmitate were assayed in commercial cream and lotion formulations using the proposed SFE technique.
Primary lymphoma of the parotid gland is uncommon: we report a case in an 82-year-old man, classified according to the Working Formulation as a low-grade lymphoma. After parotidectomy the patient was treated with radiation therapy and, subsequently, with polychemotherapy (endoxan, vincristine and prednisone) for six cycles. At follow-up examination one year after, the patient is in complete remission. The major problem encountered was the correct diagnosis that became possible only when the surgical specimen was available. The authors review the pathological features of this extranodal form of lymphoma and discuss the treatment.
Pro-inflammatory and vasoactive mediators released from human basophils and mast cells play a role in several inflammatory and immune disorders. It was recently demonstrated that cyclosporin A (CsA) exerts anti-inflammatory effects by inhibiting the release of preformed and de novo synthesized mediators from human basophils. This study compared the effects of pharmacological concentrations of deflazacort (DFZ) and prednisolone (PRED) on the anti-IgE-mediated release of preformed (histamine) and de novo synthesized (leukotriene C4: [LTC4]) mediators from basophils. Basophils were cultured for 18 hours in the presence of pharmacological concentrations of DFZ (10(-8) to 3 x 10(-6) M). DFZ inhibited the anti-IgE-mediated release of histamine and LTC4 from basophils in a concentration-dependent manner (6-40%), and had a similar efficacy and potency to PRED. The effect of DFZ (10(-8) to 10(-7) M) in combination with CsA on the immunological release of histamine and LTC4 from basophils was also evaluated. An 18-hour incubation of basophils with DFZ (10(-8) M) followed by a short (15-minute) incubation with CsA (30 ng/ml) resulted in an additive inhibition of the release of histamine and LTC4. The additive anti-inflammatory effect of these drugs makes them interesting candidates for future controlled clinical trials in inflammatory diseases in which basophil-derived mediators play a relevant role.
The authors report their experience in the management of desmoid tumors, rare benign neoplasias, locally aggressive and potentially recurrent after surgery. Etiopathogenetic, diagnostic, and therapeutic features of these tumors are analysed and the value of surgery as well as chemo- or radiotherapy is considered.
Thirty patients who had curative surgery for sigmoid and rectal carcinoma were studied by immunoscintigraphy using a new monoclonal antibody: B72.3 radiolabeled with Iodine-131 (I-131) or Indium-111 (In-111). Results were compared with other conventional diagnostic procedures such as computed tomography, ultrasound, endoscopy, and tumor markers. Seven patients had local recurrences and/or distant metastases. Immunoscintigraphy identified all local recurrences (five cases) that were confirmed by CT and was able to localize three of five liver metastases (two false-negatives). Furthermore, immunoscintigraphy also recorded a false-positive. Preliminary use of B72.3 shows good potential for the evaluation and detection of neoplastic sites.