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Biomedical subjects

C Gozzi

Publications and source records attributed to C Gozzi.

13 recordsLinked to original sources
PubMed2006

Interim outcome of the single stage dorsal inlay skin graft for complex hypospadias reoperations.

PURPOSE: Despite high success rates for primary hypospadias repair, some cases require multiple procedures for ultimate reconstruction. We report our experience with single stage dorsal inlay urethroplasty using skin grafts for complex reoperations. MATERIALS AND METHODS: A total of 31 patients (mean age 13.8 years) with failed previous hypospadias surgery were included in the study. Indications included fistulas, strictures, diverticula and repair breakdown. The urethral plate had been removed or was severely scarred in all patients. A free penile or groin skin graft was sutured and quilted to the corpora cavernosa, guaranteeing sufficient blood supply. The neourethra was tubularized and covered with a tunica vaginalis or dartos flap, followed by glanuloplasty. Outcome analysis included urethrograms, urethral ultrasound and flow measurements. RESULTS: Foreskin was used in 15 cases, penile skin in 12 and inguinal skin in 4. Average graft length was 3.92 cm. A total of 20 patients required glanuloplasty with a skin graft extended to the tip of the glans. After a mean followup of 30.71 months 5 patients underwent redo surgery, for a complication rate of 16.1%. Urethral stricture of the proximal anastomosis was the most frequent finding. CONCLUSIONS: This single stage approach using dorsal skin grafts is a reliable method to create a substitute urethral plate for tubularization. Complication rates are equivalent to those of staged procedures. Foreskin should be used as a graft donor site to optimize the outcome if available. This approach represents a safe option for reoperations even if the urethral plate or midline penile skin is grossly scarred.

Adolescent↗
PubMed2006

[Vaginal colonization of the Streptococcus agalactiae in pregnant woman in Tunisia: risk factors and susceptibility of isolates to antibiotics].

Streptococcus agalactiae or Group B Streptococcus (GBS) is one of the main bacterial causes of serious infections in newborns. We have evaluated prospectively GBS vaginal colonization in pregnant women and we have tried to determine the risk factors of the colonization by GBS and the particularities of the different isolated strains. We have screened 300 pregnant women with vaginal and anal sample in a same swab. Thirty nine (13%) pregnant women are colonized by SGB, 0% in the first trimester, 10.2% in the second trimester and 17% in the third trimester. Different factors are associated significantly with GBS colonization: past history of infection in newborns, genital infection during pregnancy and parity The highest rates of resistance are found in tetracycline (97.4%), erythromycin (51.3%) and lincomycin (46.2%). All the strains were susceptible to amoxicilin and pristinamycin.

Adolescent↗
PubMed2005

[Urethral trauma].

Urethral lesions may be caused by blunt or penetrating objects in the course of accidents, or can be iatrogenic resulting from invasive measures such as catheterization or other major surgical measures (prostatectomy or sling operations for continence). They can also be caused by foreign bodies deliberately introduced into the urethra. Injuries may primarily affect the anterior or posterior urethra. Urethral reconstruction presupposes knowledge of the precise anatomy of the pelvic region. The surgical techniques used and the timing of reconstructive procedures will depend on the cause and nature of the urethral injury. A definitive surgical intervention in most cases of lesions resulting from accidents is not generally recommended, especially when the lesion is in the posterior urethra. A treatment algorithm should prevent post-surgical complications such as incontinence, impotence, recurring urinary tract infections, etc., necessitating multiple operations, and assure an adequate quality of life. Diagnostic clarification of the exact nature of urethral injuries requires high quality imaging studies by specialists in the field.

Adult↗
PubMed2005

Late occurrence of bilateral tuberculous-like epididymo-orchitis after intravesical bacille Calmette-Guérin therapy for superficial bladder carcinoma.

We report a case of bilateral tuberculous-like epididymo-orchitis occurring 3 years after intravesical bacille Calmette-Guérin instillation therapy in an 83-year-old patient with proven superficial bladder carcinoma. The patient had no previous history of tuberculosis. Because of persistent inflammation and painful swelling of the epididymides and testes, the patient underwent bilateral orchiectomy. This case demonstrates the late adverse effects that can occur after intravesical BCG therapy, which in our patient ended in surgical removal of both gonads.

Adenocarcinoma↗
PubMed2004

Three-dimensional transrectal ultrasound of the male urethral rhabdosphincter.

The rhabdosphincter of the male urethra is an omega-shaped loop of striated muscle fibers that surrounds the membranous urethra at its lateral and anterior aspects. We investigated whether this muscle can be visualized by means of three-dimensional ultrasound to define morphological and dynamic ultrasound criteria. We examined the rhabdosphincter of the male urethra in 77 patients by means of this new imaging technique; 37 patients presented with urinary stress incontinence after transurethral resection of the prostate or radical prostatectomy while 40 were fully continent after radical prostatectomy and served as a control group. Contractility of the muscle was quantified by a specially defined parameter (rhabdosphincter-urethra distance). The anatomical arrangement and the contractions of the rhabdosphincter-loop could be clearly visualized in three-dimensional transrectal and transurethral ultrasound; during contraction the rhabdosphincter retracts the urethra, pulling it towards the rectum. We detected defects and postoperative scarrings in the majority of the patients with postoperative urinary stress incontinence. Furthermore, the patients presented with thinnings in parts of the muscle and atrophies of the rhabdosphincter. The rhabdosphincter-urethra distance was significantly lower in the incontinent group than in the continent group (59 vs. 1.42 mm). Our study shows that the rhabdosphincter of the male urethra can be visualized by means of three-dimensional transrectal ultrasound. The sonographic pathomorphological findings of postoperative urinary stress incontinence are well correlated well with the clinical symptoms.

Humans↗
PubMed2004

Late urologic effects after adjuvant irradiation in stage I endometrial carcinoma.

OBJECTIVES: To evaluate the incidence and type of incontinence after external beam radiotherapy (RT) and brachytherapy. Distinct late effects on the urinary bladder can occur and are frequently mild after adjuvant RT for Stage I endometrial carcinoma. Not all side effects that impair quality of life (eg, urinary incontinence) are classified in the commonly used grading system. METHODS: Forty-one patients were evaluated for newly occurred urinary incontinence after adjuvant RT. The mean follow-up was 64.8 months, and the mean age was 62.1 years. The validated incontinence score from Gaudenz was used. Additionally, quality-of-life questions were asked. RESULTS: Overall, 22 (53.7%) of 41 patients complained of urinary incontinence. Urge incontinence was classified in 45.5% (10 of 22 patients) and stress urinary incontinence in 54.5% (12 of 22 patients). CONCLUSIONS: The onset of stress urinary incontinence after brachytherapy can be explained by anatomic findings, such as adverse affects to the nerve supply of the rhabdosphincter. According to our results, the exposure to additional external beam RT can cause urge incontinence. Patients and doctors must be aware that urinary incontinence, with an occurrence rate of more than 50%, represents the most common side effect after surgery and RT for Stage I endometrial carcinoma. We conclude that, depending on the type of RT, a stress incontinence rate of 24.4% and an urge incontinence rate of 29.2% is possible.

Adenocarcinoma↗
PubMed2004

Pro-oxidant and antioxidant factors in acute intermittent porphyria: family studies.

Given the crucial role of iron and porphyrins in oxidative cellular damage in the chronic porphyrias, we undertook an extensive study in families with acute porphyrias to evaluate the possible role of similar oxidative damage in these diseases, whose natural history is often also complicated by neoplastic evolution. Four unrelated patients with acute intermittent porphyria (AIP) were studied together with 37 members of four different families. Aminolevulinic acid and porphobilinogen were measured in urine, and porphyrins in urine, plasma and stools. The activity of the congenitally deficient enzyme, porphobilinogen deaminase, and the concentrations of plasma iron, transferrin, ferritin, and various antioxidants (ascorbic acid, retinol, tocopherol, alpha- and beta-carotene, by a personal HPLC method) and the urinary and plasma metabolites of nitrous oxide were also assayed. The results showed no relationship between the observed increase of porphyrin metabolites and the presence of markers of oxidative damage or the decrease of circulating antioxidants: however, when such a decrease was registered, it depended on spontaneous or iatrogenic iron accumulation. We conclude that family screening, recommended for the identification of AIP carriers, must also include evaluation of iron stores with a view to preventing the oxidative damage and in order to forestall the neoplastic evolution of the disease.

Adolescent↗
PubMed2000

[Solitary synchronous bladder metastasis from renal cell carcinoma treated by transurethral resection].

Metastases to the bladder from renal cell carcinoma are extremely rare. The prognosis is poor and seems not related to the type of treatment. Most patients die within 1 year of diagnosis. The treatment should be therefore as conservative as possible. We report a case of solitary, synchronous bladder metastasis treated by transurethral resection. At 24 months the patient is free of recurrence.

Aged↗
PubMed1999

Vesicocutaneous fistula 23 years after hip arthroplasty. A case report.

Vesicocutaneous fistula after total hip replacement is a very rare but severe complication, which can appear months or years after operation. Intrapelvic cement (methylmethacrilate) spilling, loosening and dislocation of the prosthesis and infection are believed to be the cause of fistula formation. Only 4 cases of this kind of fistula have been reported in the literature. A new case of vesicocutaneous fistula is presented. The fistula developed 23 years after arthroplasty mainly because of hip-joint infection. Urinary tract symptoms caused by urinary infection appeared only few months earlier.

Arthroplasty, Replacement, Hip↗
PubMed1999

[Symptomatic angiomyolipoma of the kidney: report of 2 cases].

Renal angiomyolipoma is an uncommon benign tumor composed of adipose tissue, dysplastic blood vessels and smooth muscle. The tumor may occur as a distinct entity or in association with tuberous sclerosis. The diagnosis is usually easy but a malignant neoplasm can not always be excluded. Tumors smaller than 4 cm are mostly asymptomatic and usually do not need to be treated. For larger lesions a treatment is advisable especially in case of symptoms because of the risk of a severe hemorrhage. The treatment should be as conservative as possible and nephrectomy preformed only when a malignant tumor can not be excluded or in cases of life-threatening hemorrhage or widespread infiltration or complete destruction of the kidney. Today the treatment of choice should be embolisation and on second line resection of the lesion. Two cases of symptomatic angiomyolipoma are presented. Both cases are treated by radical nephrectomy.

Angiomyolipoma↗
PubMed1999

[Seminal vesicle cysts (and ejaculatory duct cysts) with ipsilateral renal agenesis. Report of five cases and review of the literature].

Cystic malformations of the pelvic seminal tract associated with ipsilateral renal agenesis are rare. The cause of this malformation is a maldevelopment of the mesonephric duct between the 4th and 13th weeks of gestation. Usually the disease is discovered in the late second and in the third decade of life, at a time of great sexual activity. Accumulation of fluid in the seminal tract with insufficient drainage leads to complaints like chronic prostatitis, to perineal discomfort and to disturbances of sexual sphere. For the diagnostic evaluation, ultrasound studies (suprapubic and transrectal) are very useful. Treatment should be restricted to symptomatic cases only. The treatment modality ranges from conservative medical treatment to surgical excision. Five cases are presented. Four are treated conservatively and one is treated by transurethral aspiration and alcohol injection.

Adult↗
PubMed1982

Sources of bile pigment overproduction in Gilbert's syndrome: studies with non-radioactive bilirubin kinetics and with delta-[3,5-3H]aminolaevulinic acid and [2-14C]glycine.

1. The kinetics of non-radioactive bilirubin were investigated in 100 patients with chronic non-haemolytic unconjugated hyperbilirubinaemia and in nine normal volunteers. 2. The patients with Gilbert's syndrome were divided on the basis of a two-compartment model into two distinct groups: group 1 (74 patients) with decreased hepatic uptake and conjugation of bilirubin and a bilirubin turnover rate within the normal range, and group 2 (26 patients) having normal uptake, impaired conjugation and increased bilirubin turnover rate. 3. On the basis of these findings, studies were made of early pigment production in four patients of group 1, in six patients of group 2 and in four of the normal volunteers, with [14C]glycine and delta-[3H]aminolaevulinic acid. 4. After receiving injections of labelled haem precursors, the four patients in group 1 had a normal rate of incorporation of both tracers, whereas abnormalities in incorporation were found in group 2. Four patients showed an increase of the first component of the early peak of [14C]bilirubin as well as of the early peak of [3H]bilirubin, suggesting an increased turnover of hepatic haem. Two patients showed an increased incorporation of [14C]glycine characterized by the fusion of the two early peaks, whereas the incorporation of the delta-[3H]aminolaevulinic acid was normal, indicating the presence of a primary shunt hyperbilirubinaemia. 5. The results confirm that Gilbert's syndrome is a heterogeneous condition with respect to bilirubin turnover rate. The population of Gilbert's syndrome with increased bilirubin turnover rate comprises not only patients with an increased haem erythroid turnover, but also patients with increased metabolism of non-erythroid haem protein in the liver.

Adolescent↗