Biomedical subjects

Chiara Castelnuovo

Publications and source records attributed to Chiara Castelnuovo.

6 recordsLinked to original sources

PubMed2005

Calcium stone disease: a multiform reality.

In calcium renal stones, calcium oxalate and calcium phosphate in various crystal forms and states of hydration can be identified. Calcium oxalate monohydrate (COM) or whewellite and calcium oxalate dihydrate (COD) or weddellite are the commonest constituents of calcium stones. Calcium oxalate stones may be pure or mixed, usually with calcium phosphate or sometimes with uric acid or ammonium urate. The aim of this study was to compare the clinical and urinary patterns of patients forming calcium stones of different composition according to infrared spectroscopic analysis in order to obtain an insight into their etiology. The stones of 84 consecutive calcium renal stone formers were examined by infrared spectroscopy. In each patient, a blood sample was drawn and analysed for serum biochemistry and a 24-h urine sample was collected and analysed for calcium, phosphate, oxalate, citrate and other electrolytes. We classified 49 patients as calcium oxalate monohydrate (COM) stone formers, 32 as calcium oxalate dihydrate (COD) stone formers and three as apatite stone formers according to the main component of their stones. Patients with COM stones were significantly older than patients with COD stones (P < 0.002). Mean daily urinary calcium and urinary saturation with respect to calcium oxalate were significantly lower in patients with COM than in those with COD stones (P < 0.000). Patients with calcium oxalate stones containing a urate component (< or = 10%) presented with higher saturation (P < 0.012) with respect to uric acid in their urine (and lower with respect to calcium oxalate and calcium phosphate, respectively P < 0.024 and P < 0.003) in comparison with patients without a urate component in the stone. Patients with calcium oxalate stones with a calcium phosphate component (> or = 15%) showed higher (P < 0.0016) urinary saturation levels with respect to calcium phosphate (and lower with respect to uric acid (P < 0.009), compared with patients forming stones without calcium phosphate or with a low calcium phosphate component. Patients with calcium stones mixed with urate had a significantly lower urinary pH (P < 0.002) and urinary calcium (P < 0.000), and patients with calcium phosphate >15%, higher urinary pH (P < 0.004) and urinary calcium (P < 0.000). In conclusion, in the evaluation of the individual stone patient, an accurate analysis of the stone showing its exact composition and the eventual presence of minor components of the stone is mandatory in order to plan the correct prophylactic treatment. Patients with "calcium stones" could require various approaches dependent on the form and hydration of the calcium crystals in their stones, and on the presence of "minor" crystalline components that could have acted as epitaxial factors.

Adult↗

PubMed2005

'Straightening-reinforcing' technique for congenital curvature and Peyronie's disease.

OBJECTIVES: We report an initial randomised study on surgical techniques with subsequent intensive application of our procedure. MATERIALS AND METHODS: We modified Ebbehoj-Metz technique by a 'straightening-reinforcing' (S-R) double stitch: the first performs the plication, the second tightens it, thus preventing tension during erection. This is different to the simple Ebbehoj-Metz stitch that only provides plication but, as it does not provide reinforcement, does not prevent recurrence. From 1995 to 2000 78 plications were performed: 60 for congenital curvatures (age range 18-32 years) and 18 for Peyronie's disease (PD; age range 36-58 years). During the first 3 years, i.e. between 1995 and 1998, patients were randomised to S-R plication (20 congenital and 5 PD) and Nesbit procedure (20 congenital and 5 PD), for a total number of 50 patients (40 congenital and 10 PD). The last 28 patients, operated between 1998 and 2000, were assigned exclusively to S-R plication. We delayed study publication in favour of an adequate follow-up. RESULTS: No patient reported a decrease in erectile function and all reported easy vaginal penetration within 3 months. In 60% of the patients undergoing the Nesbit technique, restoration of a fully satisfactory coital activity was delayed because of pain during erection; 35% of all patients had some problems with the coronal suture which disappeared 1 month after the operation, and 15% reported decreased sensibility of the glans. Recurrence rate was not significant for all patients of all groups, even if 3 PD patients of the S-R plication group and 1 PD patient of the Nesbit group received no benefit from the operation. CONCLUSION: S-R plication is not better than the Nesbit procedure. However, for low degrees of penile bending, both congenital and acquired, we do not think it strictly necessary to perform the more invasive Nesbit operation (requiring opening of Buck's fascia, detachment of the neurovascular dorsal bundle or urethra and albuginea excision). Modified plication may be a minimally invasive and effective treatment suitable for most curvatures treated in day clinics and under local anaesthesia.

Adolescent↗

PubMed2004

ReMeEx device (External Mechanical Regulator) for incontinence: implantation and regulation procedure, complications and results at 3 years follow-up.

UNLABELLED: A new sling technique that allows a postoperative adjustment of the sling tension is presented with encouraging results in the treatment of female stress urinary incontinence. The readjustment prevents the need of a reoperation in case of relapse with great compliance of the patients. Indications for surgical treatment of female stress urinary incontinence by ReMeEx included patients with: fixed urethra, urethral hypermobility, intrinsic sphyncteric deficiency and previous incontinence surgical interventions. Out of 32 patients treated, 31 were cured with transitory urge in 2 and readjustment in 3. In one case the device was removed for infection. IN CONCLUSION: the ReMeEx system offers the possibility to modify the sling support level whenever needed during patient's life. Wiyh the ReMeEx system we can and should improve the outcome of these patients leaving them completely dry, without any urine leakage.

Female↗

PubMed2003

Reconstructive urethroplasty using porcine acellular matrix.

Long tract urethral reconstruction nowadays still has no other resolution than two-stage techniques or graft and flap procedures that are neither simple nor trouble-free both for the patient and the surgeon. Tissue engineering simplifies this surgery using "porcine acellular matrix", obtained from small intestine submucosa. It is thin but strong, just ready for grafting, without rejection, because it is not immunogenic, being deprivated of cells. It serves as biological bridging of the reconstruction, promoting the generation of surrounding tissue in which it is completely transformed. We report the first use of porcine intestine submucosa in urethroplastic surgery. The up to date follow up is sixteen months with satisfactory urodynamic and subjective outcome.

Aged↗

PubMed2002

Urinary patterns of patients with renal stones associated with chronic inflammatory bowel disease.

OBJECTIVE: The aim of this study was to analyze the frequency of renal stone patients with chronic inflammatory bowel disease and their urinary patterns. METHODS: During a 20-year period, 1941 consecutive patients with renal stone disease underwent routine laboratory procedures including a fasting blood sample for chemistry profile and a 24-hour urine collection for analyses of electrolytes. Thorough histories including chronic inflammatory disease or ileal resection were obtained. Patients with inflammatory bowel disease together with a control group comprising 47 idiopathic renal calcium stone formers were submitted to a xylose absorption test for evaluation of intestinal absorption. RESULTS: We observed 10 patients with Crohn's disease, 12 with ulcerative colitis and one patient with ileal bypass for obesity. Six patients underwent ileal resection and 10 patients total colectomy. Urinary oxalate excretion was significantly higher and urinary citrate lower in stone patients with ileal disease (Ox 60 +/- 23, Cit 113 + 7-118 mg/day) than in idiopathic stone formers (Ox 28.2 +/- 11.5, Cit 381 +/- 205) and stone patients with ulcerative colitis (Ox 20.3 +/- 14.8, Cit 369 +/- 247). Urinary volume was significantly lower in patients with ulcerative colitis. A significant inverse correlation (-0.38, p < 0.01) between oxalate urinary excretion and blood xylose level was found 2 hours after ingestion of xylose. No significant reduction of xylose absorption was demonstrated in both normoxaluric and hyperoxaluric idiopathic stone patients. CONCLUSIONS: Crohn's disease and ulcerative colitis are characterized by recurrent inflammatory involvement of different intestinal segments involving distinctive urinary patterns. Malabosorption associated with ileal disease causes increased oxalate absorption by increasing oxalate solubility in the intestinal lumen and permeability of the colonic mucosa; a reduced citrate excretion is associated in relation to mild acidosis due to the loss of bicarbonate in the liquid stool. In ulcerative colitis, especially if an ileostomy is present, urine are scanty and concentrated, and urine pH falls, leading to uric acid or mixed stones. Mild hyperoxaluria of idiopathic renal stone formers is not related to subtle intestinal malabsorption.

Adult↗

PubMed2002

[Reconstructive urethroplasty using porcine acellular matrix: preliminary results].

OBJECTIVE: The use of "porcine acellular matrix", obtained from small intestine submucosa, could simplify the repair of long urethral strictures, whereas single stage techniques can be carried out only by means of grafts, as buccal mucosa; or flaps, as prepucial skin. To our knowledge we report the first use of porcine intestine submucosa in urethroplastic surgery. MATERIALS AND METHODS: From May 2001 to December 2001, five urethral reconstructions were completed using "porcine acellular matrix". Four male patients had urethral strictures longer than 10 cm. After circumcision and penile degloving, we extended the surgical approach to the perineum-scrotal region by a midline longitudinal incision. The urethra was exposed, dissected from corpora cavernosa, then rotated of 180 degrees and on this side longitudinally incised throughout all the stenotic length. Urethroplasty was accomplished with matrix tissue modelled according to the length of the stenosis and grafted by a 5-0 polyglycolic acid running suture. The enlarged urethra was then derotated, laying the graft dorsally, closed to corpora cavernosa, to prevent pouching. A further graft was accomplished in a female patient with a 3 cm long urethral stricture. All urethroplasties were stented for 14 days. No complication developed. RESULTS: After 1 month urethral patency was satisfactory compared with preoperatory images and the urinary flow was normal. After 2 months the urethra was endoscopically verified: it was easy to appreciate the homogeneous transformation of the graft into the native tissue. At 6-month follow-up radiological and urodynamic outcome is still satisfactory in all patients. CONCLUSIONS: According to our preliminary experience "porcine acellular matrix" is a promising approach for the repair of long urethral strictures. Its safety and effectiveness encourage us to treat more cases in male and female patients.

Aged↗