PubMed Health⌕ Search

Biomedical subjects

C Giberti

Publications and source records attributed to C Giberti.

At least 19 recordsLinked to original sources
PubMed2001

Transvaginal sacrospinous colpopexy by palpation-a new minimally invasive procedure using an anchoring system.

OBJECTIVES: To evaluate the preliminary results and complications of a new, minimally invasive, transvaginal sacrospinous colpopexy for vault and uterovaginal prolapse. METHODS: Twelve women, 41 to 79 years old, underwent sacrospinous fixation by palpation using the Raz Anchoring System (RAS) between October 1998 and September 1999. The vaginal vault prolapse was grade II and III in 4 and 6 patients, respectively. Two patients had grade III uterovaginal prolapse. Two patients underwent RAS alone, and 10 underwent RAS in conjunction with simultaneous related vaginal surgery. Eleven patients underwent vaginal vault and one uterovaginal fixation. RAS features two components: first, a 15-mm-long cylindrical titanium anchor and second, a disposable inserter. A penetration limiter tube allows one to penetrate the sacrospinous ligament up to the desired depth. The anchor is released into the ligament and then the vaginal apex is fixed in place. RESULTS: The minimum and mean follow-up was 12 and 16 months, respectively. The operative time to complete the colpopexy ranged from 8 to 15 minutes. We recorded only one recurrent vaginal vault prolapse due to pull-through of the suspension sutures through the vagina. No significant perioperative complications occurred. No de novo or recurrent cystocele, rectocele, enterocele, stress urinary incontinence, urgency, or frequency was seen. Defecation was normal in all patients. Coital function was normal in 8 patients who were still sexually active. No patient experienced perineal or buttock pain. CONCLUSIONS: RAS seems to be quick, easy, safe, and effective in the suspension of vaginal apex to the sacrospinous ligament, but our preliminary results must be confirmed by controlled prospective studies with a larger number of patients and wider follow-up.

Adult↗
PubMed2001

Bone anchored sling for the treatment of post-prostatectomy incontinence.

PURPOSE: This ongoing study evaluates the safety and efficacy of a new minimally invasive sling procedure for treating post-prostatectomy incontinence. MATERIALS AND METHODS: A total of 16 men 56 to 74 years old (mean age 67) underwent the procedure using the Straight-In bone anchoring system. Time after prostatectomy was 1.5 to 5 years (mean 2.5). Of the 16 patients 14 had urodynamically confirmed stress urinary incontinence, while 2 had mixed incontinence with stress incontinence and detrusor instability. The procedure is performed with the patient in the lithotomy position using a perineal approach. Four miniature bone screws with pre-attached pairs of No. 1 polypropylene sutures are placed directly into the medial aspect of the inferior rami of the pubic bone. A pair of bone anchors is placed just below the symphysis on each side, and the second pair is inserted 3 to 4 cm. lower. To support the bulbar urethra a gelatin coated polyethylene terephthalate trapezoid shaped sling or cadaveric fascia lata is tied to the pubic bone using the 4 pairs of sutures attached to the bone anchors. Urethral resistance is increased to 30 to 50 cm. water above baseline pressure. RESULTS: Followup was 4 to 20 months (mean 12.2). Of the 14 men with the preoperative urodynamic diagnosis of genuine stress incontinence 12 were cured of incontinence, defined as subjectively dry with no or only 1 pad used daily for security without any episode of leakage, while 2 were improved subjectively with a decrease of 50% or more in pads daily. Two other patients with the preoperative diagnosis of mixed urinary incontinence were improved. Postoperatively urodynamic study in these patients revealed resolved stress incontinence but persistent urge urinary incontinence. They responded to anticholinergics and are completely dry. Intraoperative and postoperative complications were minimal with no erosion, infection or osseous complications. CONCLUSIONS: This new minimally invasive male sling procedure is safe and efficacious. Adjusting sling tension by measuring urethral resistance results in a low rate of over correction and failure. Further experience is needed to establish this procedure as treatment for post-prostatectomy incontinence.

Aged↗
PubMed2000

Transvaginal bone-anchored synthetic sling for the treatment of stress urinary incontinence: an outcomes analysis.

OBJECTIVES: To evaluate the results and complications of a new transvaginal minimally invasive procedure for the treatment of stress urinary incontinence. METHODS: Sixty-seven women aged 37 to 77 years underwent a pervaginal bone-anchoring synthetic sling procedure between April 1997 and February 1999. Sixty-three patients had a defect of the anatomic support, and 4 had iatrogenic intrinsic sphincteric deficiency (ISD). Patients were assessed at least 1 year postoperatively, underwent physical examination, and filled in the self-assessment questionnaire with the help of a nonpartisan health care provider. The questionnaire inquired about urine leakage, obstructive and irritative symptoms, quality of life, and satisfaction with the treatment received. The physician and questioner had no knowledge of each other. RESULTS: Mean follow-up was 17 months. Perfect dryness was seen in 82% of patients with improvement in 9% and failure in 9%. Patients reporting a failed outcome were significantly older than those reporting improvement or cure (P = 0.01). All patients with ISD failed. Moderate obstructive symptom scores have been noticed in 31% of patients. Irritative voiding symptoms have been recorded in 22% of cured patients and 83% and 80% of improved and failed patients, respectively (P <0.001). Three percent of patients experienced pain during intercourse. Mild pelvic pain was found in 8% of patients. The only main complication of the operation was the vaginal erosion and sling removal in 16% of patients. Seventy-two percent of patients were completely satisfied with the treatment received. CONCLUSIONS: This procedure allows a high cure rate in patients with urinary incontinence due to a defect of anatomic support, and it is unsuitable when incontinence is due to ISD. The only main complication came from the use of the gelatin-coated Dacron sling that resulted in vaginal erosion, often necessitating the sling removal. The use of different synthetic or nonsynthetic materials may be advisable.

Adult↗
PubMed2000

[Translabial ultrasonography in the diagnosis of stress urinary incontinence in women].

The target of this work is to evaluate the translabial ultrasonography (US) reliability as valid alternative to chain cystography in the pre and post operative assessment of patients with stress urinary incontinence (SUI). From June 1996 to May 1999, we studied 448 patients ranging in age from 35 to 90 years old with SUI from defect of anatomic support. Patients underwent translabial ultrasonography. The translabial US was performed with the patient in lithotomic position using a linear 7.5 MHz probe. The bladder was slightly filled, and the probe positioned longitudinally at the introitus to evaluate downwards and posterior rotation of bladder neck and urethra in basal conditions as well as during the abdominal strain. The evaluation of the anterior urethral angle of the 448 patients who underwent translabial US showed that, during the abdominal strain, all the patients with SUI had a very significative rotation of the urethral axis compared to continent women. Translabial US is a quick, simple, reliable non-invasive procedure. It may be used routinely for the pre and post-operative evaluation of anti-incontinence surgery.

Adult↗
PubMed1999

[Giuliani's method of anterio-lateral transabdominal muscle splitting and nerve preservation for kidney tumors].

OBJECTIVES: Anterolateral transabdominal incisions provide good exposure for supramesocolonic and inframescolonic surgery. However, these incisions section and denervate the rectus abdominis, oblique and transversus abdominis muscles with marked loss of active muscle control in a large number of patients. In 1974, Giuliani described an anterolateral transbdominal approach for renal tumours, which provides good visualization and good access to the renal pedicle, as well as good exposure caudally as far as the aortic bifurcation and cranially as far as the diaphragm. The authors report a new anatomical technique using this incision, which splits the muscles and preserves the nerves thereby avoiding the abdominal muscle hypotonia. MATERIAL AND METHODS: From March 1996 to March 1998, Giuliani's surgical incision was performed in 35 patients undergoing radical nephrectomy for renal cancer (24 on the left side and 11 on the right side). The mean age of the patients was 63.2 years (range: 42 to 80 years) and the mean follow-up was 11.6 months. RESULTS: Tone and active control of muscles of the abdominal wall were completely preserved in all of these 35 patients. However, all patients presented a slight sensory loss in the low portion of the transverse skin incision close to the umbilicus, which improved with time and resolved completely in about 50% of cases. CONCLUSION: The mahor advantage of this anatomical incision compared to the conventional technique is to eliminate permanent functional deficits and hypotonia of the abdominal wall. This anatomical approach also allows easy and perfectly safe wound closure in layers, by reconstructing the anterior abdominal wall.

Abdominal Muscles↗
PubMed1997

Radical nephrectomy for renal cell carcinoma: long-term results and prognostic factors on a series of 328 cases.

OBJECTIVES: A series of 328 evaluable patients with renal cell carcinoma operated by radical transabdominal nephrectomy with regional lymphadenectomy was reviewed to assess the prognostic significance of various pathologic parameters (pT, N, M, G and venous involvement) and the value of lymphadenectomy and of surgery of venous tumor thrombus. PATIENTS AND METHODS: The complete charts of 328 patients with renal cell carcinoma available to follow-up, who were operated between 1970 and 1993, were reviewed. All patients underwent transabdominal extrafascial nephrosurrenalectomy and in all but 14 metastatic ones a regional retroperitoneal lymphadenectomy was performed. Surgery of venous tumor thrombus was performed in 79 patients. Life expectancy according to pT stage, pN stage, M stage, nuclear grade and venous involvement was calculated by means of the life tables method and differences in survival were evaluated by means of the log rank test. Correlation analysis and multivariate data analysis according to the Cox model were also performed. RESULTS: Overall survival of the 328 patients was 50.70% at 5 years, 35.10% at 10 years and 29% at 15 years. At multivariate data analysis the most important prognostic factors is the presence of metastases (8% survival at 5 years and no patient surviving more than 7 years after surgery), tumor grade was the second prognostic factor and statistically significant differences were also found at life tables analysis among G1, G2 and G3 tumors. Local tumor stage was the third leading prognostic factor at multivariate data analysis and statistically significant differences were also found at life tables analysis. Nodal and venous involvement had only minor importance at multivariate data analysis although statistically significant differences were found at life tables analysis between the pN+ and the pN0 patients, also in the absence of venous involvement and distant metastases. Anyway survival of the pN + M0V0 patients was satisfactorily high (53.20% at 5 years, 39.10% at 10 years and 16% at 15 and 20 years). In patients with venous involvement no differences in survival were observed depending on the level reached by the tumor thrombus; differences in survival were observed between patients with venous involvement alone (38% surviving at 5 and 10 years) and patients who also had nodal or distant metastases (5.20% at 5 years and 0% at 10 years). CONCLUSIONS: From the review of our series it seems that the most important prognostic factors are synchronous metastases, tumor grading and the completeness of tumor exeresis. In fact, the low impact on survival of nodal involvement by itself is probably due to the completeness of lymphadenectomy. The value of regional lymphadenectomy is sustained by the high long term survival of N + M0V0 patients. Regarding venous involvement, it seems that V+ patients free from nodal and distant metastases may benefit from radical surgery, which on the contrary has only minimal impact on survival of V+M+/N+ patients.

Carcinoma, Renal Cell↗
PubMed1997

Effects of short-term treatment with the alpha 1-blocker alfuzosin on urodynamic pressure/flow parameters in patients with benign prostatic hyperplasia.

OBJECTIVE: The objective of this double-blind, placebo-controlled urodynamic pressure/flow study was to assess the efficacy of short-term treatment with the alpha 1-blocker alfuzosin in outflow obstruction of patients with symptomatic benign prostatic hyperplasia (BPH). MATERIAL AND METHODS: Urodynamic pressure/flow parameters were assessed after 2 weeks of placebo run-in, 4 weeks of placebo (47 patients) or 2.5 mg t.i.d. alfuzosin treatment (47 patients), followed by an 8-week extension period with alfuzosin (single-blind). RESULTS AND CONCLUSION: Four weeks of alfuzosin treatment significantly increased maximum flow (+29.0%) and decreased detrusor pressure at maximum flow (-30.2%), detrusor opening pressure (-39.4%) and maximum detrusor pressure (-28.7%). Short-term alfuzosin treatment improved outflow conditions in BPH by reducing prostatic urethral obstruction.

Adrenergic alpha-Antagonists↗
PubMed1996

The Giuliani muscle splitting and nerve-sparing anterolateral transabdominal approach to the kidney.

We report on an anterolateral transabdominal approach to the kidney, which is appropriate when vascular control is important (such as, radical nephrectomy, traumatic renal injury, and difficult nephrectomy). The technique splits muscles and spares nerves and that allows good exposure both downward as far as the aortic bifurcation and upward as far as the diaphragm. This approach has been used in 42 patients during the last 20 months (mean follow-up, 6.5). In all these patients the active control of the abdominal wall muscles has been completely preserved, while, during the period from 1974 to 1994, about half of 434 patients who underwent the same approach, but with muscle and nerve transection, showed abdominal wall relaxation.

Abdominal Muscles↗
PubMed1996

Obstetric and gynaecological ureteric injuries: treatment and results.

OBJECTIVE: To compare endourological techniques and open surgery in the treatment of ureteric injuries following obstetric and gynaecological surgery. PATIENTS AND METHODS: From January 1982 to February 1994, 63 women (mean age 51 years, range 22-70) were treated for 72 ureteric lesions consequent upon obstetric or gynaecological surgery. In nine patients, 10 ureteric lesions were detected intra-operatively and repaired immediately. In the remaining 54 patients, the 62 ureteric injuries were diagnosed and treated after a delay; 29 patients with 37 ureteric injuries underwent repair by open surgery while 25 patients with a unilateral ureteric lesion underwent elective primary endourological treatment. RESULTS: The results of repair were not related to the type of treatment; the cure rate was 87, 88 and 90% for delayed open surgical, endourological and immediate intra-operative repair, respectively. The site (vesico-ureteric junction, uterine artery or infundibulopelvic ligament) and the type (fistula or stenosis) of ureteric lesion had no influence on the results, regardless of the type of treatment. The results of ureteric repair were related to the surgery that caused the lesion; 88% of the poor results occurred in the patients who underwent radical hysterectomy alone or combined with radiotherapy and approximately half of the irradiated patients required major surgery. CONCLUSION: When the patients are correctly selected, endourological treatment plays an equally important role in the treatment of gynaecologically-related ureteric injuries when compared to open surgery. Special attention should be paid to the treatment of lesions caused by radical hysterectomy alone or associated with radiotherapy, as these may lead to poor results.

Adult↗
PubMed1990

Radical extensive surgery for renal cell carcinoma: long-term results and prognostic factors.

We studied 200 consecutive patients with renal cell carcinoma who underwent radical nephrectomy and extensive lymphadenectomy. Of the patients 25% already had distant metastasis at operation. Higher T stages tended to be associated with positive nodes (p less than 0.01) and distant metastasis (p less than 0.001). However, in patients with stage N0M0V0 tumors we found no statistically significant difference in survival in relationship to the T stage of the disease (5-year survival: stage T1 80%, stage T2 68% and stage T3 70%). Of all patients 10% had positive nodes without distant metastases and no venous spread of the tumor, and the 5-year survival rate was 52%. The 5-year survival rate of patients with distant metastases was 7%. Patient survival in the presence of a vena caval tumor thrombus is similar to that of patients with distant metastases. Based on our results the different stages in disease progression may be classified as having a good prognosis--intracapsular tumors (stages T1 to T2, N0M0V0) and tumors with involvement of perirenal fat (stage T3N0M0V0), an intermediate prognosis--tumors with nodal metastases alone (stages T1 to T3, N1 to 2, M0V0) and a poor prognosis--tumors with venous invasion and/or distant metastases. Histological grading and size of tumor can be used to assess prognosis but are not more accurate than pathological staging.

Adult↗
PubMed1988

Estramustine phosphate (estracyt) following androgens in men with refractory stage D2 prostate cancer.

Twenty-two orchiectomized men with progressive stage D2 prostate cancer were treated with a 3-week cycle of estramustine phosphate (EMP: from day 3 to day 21) and androgen priming (from day 1 to day 4). A partial response according to the NPCP-USA criteria was shown in 4 of 20 evaluable patients. Median progression-free survival of all patients was 24 weeks (range, 4-48) and median survival, 42 weeks (range, 4-112). Although in two cases treatment had to be stopped due to a marked increase in bone pain, no life-threatening side effects were observed. The androgen sensitivity of tumors was supported by the occurrence of increase in prostatic phosphatase and in bone pain in most patients. In this group of patients, androgen priming did not seem to potentiate the effectiveness of EMP, our results being comparable to those previously reported using EMP alone.

Aged↗
PubMed1988

Long-acting (depot) D-TRP-6 LH-RH (Decapeptyl) in prostate cancer. An Italian multicentric trial.

Ninety-five patients with stage C (C1 + C2) or D (D1 + D2) prostatic carcinoma were treated with the long-acting formulation of D-TRP-6 LH-RH (Decapeptyl) for up to 39 months. Of 88 patients evaluable for response, about one-half showed an objective response. In most cases, subjective improvement with relief of bone pain and/or urinary symptoms was obtained. Five patients claimed a mild increase in bone pain and one patient a slight worsening of dysuria following the first injection. Median progression-free survival was 13.1 and 16.4 months in patients with stage D2 and D1, respectively. Median survival in stage D2 patients was 27.6 months. These results indicate that the depot formulation of D-TRP-6 LH-RH offers an effective therapeutic alternative for patients with advanced prostatic cancer.

Aged↗
PubMed1988

Sustained impairment of pituitary and testicular function in prostatic cancer patients treated with a depot form of a GnRH agonist.

Seven patients suffering from prostatic cancer were treated with a slow-release D-Trp-6-LHRH preparation for a period of 24-32 months. LH, FSH, PRL and testosterone levels were evaluated before and at the end of treatment and then 40 days later. Baseline and GnRH-, TRH-, and HCG-stimulated hormonal values decreased after treatment. The possibility that a long-term treatment with GnRH analogues induces a sustained suppression of pituitary and testicular function is suggested.

Aged↗
PubMed1988

Hormonal pattern and testicular histology in patients with prostatic cancer after long-term treatment with a gonadotropin-releasing hormone agonist analogue.

Seven patients suffering from prostatic cancer were treated with a depot form of D-Trp-6-luteinizing hormone-releasing hormone (LH-RH), a LH-RH agonist analogue (3 mg i.m. every 28 days) for a period of 24-32 months. The peptide induced a sharp and long-lasting inhibition of both gonadotropin and testosterone secretion. A sustained suppression of pituitary and testicular function was observed 40 days after the treatment was suspended. Testicular biopsies performed in all patients showed a marked impairment of Leydig cell mass and a complete spermatogenic arrest with a tubular derangement and fibrosis. Results indicate that the long-term continued gonadotropin-releasing hormone agonist analogue therapy induces not only a functional inhibition of testicular androgenesis but also anatomical testicular damage whose reversibility does not seem to be probable.

Aged↗
PubMed1988

Treatment of urinary tract infections with ciprofloxacin.

Urinary tract infections in 32 patients were treated with 250 mg of ciprofloxacin twice daily for seven to eight days. Clinical and laboratory examinations were performed before and after treatment. The infections were eradicated in 30 of the 32 patients. Ciprofloxacin was well tolerated by all patients.

Adolescent↗