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Biomedical subjects

E Alcini

Publications and source records attributed to E Alcini.

At least 37 records · Page 2Linked to original sources
PubMed1997

The ileocaeco-urethrostomy with multiple transverse taeniamyotomies for bladder replacement: an alternative to detubularized neobladders. Morphological, functional and metabolic results after 9 years' experience.

OBJECTIVE: To evaluate the results from the long-term follow-up of ileocaeco-urethrostomy with multiple transverse taeniamyotomies for bladder replacement. PATIENTS AND METHODS: Since 1987, 60 male patients have undergone bladder replacement using a technique of ileocaeco-urethrostomy with multiple transverse taeniamyotomies. Avoiding detubularization, sectioning the caecal taeniae improved reservoir morphology and reduced internal pressures and wall tension, limiting the potential complications of the operation. RESULTS: All patients achieved diurnal continence with socially acceptable intervals between micturitions. Immediately after the operation, the nocturnal continence rate was good (79% of patients with a follow up < 3 years), reaching 86% after > 3 years. After 5 years, the reservoir capacity remained within the physiological range (mean volume 469 mL) with a mean maximum internal pressure of 47.6 cmH2O, while the mean post-micturition residual volume was 28 mL; no patient needs to use self-catheterization. Given the short intestinal length used, no metabolic clinical problems have occurred. CONCLUSIONS: The concept of using the caecum arose from physiological and anatomical assumptions, i.e. receptive relaxation, the presence of taeniae and ileocaecal sphincter. Taeniamyotomies can achieve the same goals as detubularization, i.e. a reduction of wall tension and internal pressure and a near-spherical shape, but, in contrast, by leaving the circular muscle intact, they allow a good basal tone to be maintained thus obtaining optimal emptying and avoiding deterioration of the reservoir.

Aged↗
PubMed1997

A rare case of perirenal myelolipoma. Diagnostic approach and therapeutic strategy.

A very rare case of perirenal myelolipoma and the problems of differential diagnosis are reported. The non-specificity of, and sometimes even the lack of, radiological and haematological data prevents physicians from preoperatively excluding a malignant neoplasm with a certain degree of confidence. Surgical exploration remains a compulsory step in myelolipoma management and its simple removal seems to be the therapy of choice.

Adrenal Gland Neoplasms↗
PubMed1997

[Serum ferritin determination: is it useful in the early diagnosis of renal carcinoma?].

The aim of the study was to evaluate the usefulness of ferritin as an early marker in the diagnosis of renal cell carcinoma (RCC). The Authors dosed the pre-operative concentration of ferritin in the sera of 22 patients (16 males and 6 females) affected by stage I-II, according to Robson's classification, RCC. Plasma concentrations of ferritin were matched for the presence of tumor and for the tumor volume. The results did not evidence any relationship between plasma concentration of ferritin and the presence of renal cancer. In the same way a linear correlation did not show any significant relationship between serum concentration of ferritin and tumor diameter. Ferritin does not seem to be a usefull marker in the early diagnosis of renal cell carcinoma.

Adult↗
PubMed1996

Corpus cavernosum electromyography (CC-EMG): a new technique in the diagnostic work-up of impotence.

We have studied cavernous electrical activity in 42 subjects, healthy volunteer controls and groups of impotent patients using a nonspecific electromyographic device (PICO-MENFIS) and a specific one, the SPACE-recorder 7500 designed to achieve electric recordings from the corpora cavernosa. In all of the patients, we detected under basal conditions a mean amplitude of 583 +/- 323 microV, a mean duration of 4.9 +/- 7 s, a mean polyphasicity of 3.5 +/- 1.4. It should be emphasized that a significant reduction of potential amplitudes was recorded after pharmacological stimulation in both the controls and the impotent patients. The healthy controls showed amplitudes significantly higher than the impotent patients after radical cystectomy (715 +/- 141 microV versus 381 +/- 227 microV, p < 0.01). The patients after a "nerve-sparing" radical cystectomy with a mean amplitude similar to the controls (500-700 microV) reacted well to the intracavernous drugs in a high percentage of cases. In our experience, CC-EMG seems to be a reliable method which can pinpoint directly lesions to the cavernous smooth muscle and penile autonomic nerves. It has also been able to assess the effects of stress, anxiety and pain on the erectile mechanisms.

Adolescent↗
PubMed1996

Signal-averaged electrocardiography and echocardiography in the evaluation of myocardial involvement in progressive systemic sclerosis.

To assess the myocardial involvement in progressive systemic sclerosis we evaluated the presence of late potentials by signal-averaged electrocardiography (signal-averaged ECG) and the left ventricular function by M-mode, two dimensional and Doppler echocardiography. Fifteen outpatients, 7 with diffuse progressive systemic sclerosis and 8 with CREST syndrome variant, without clinical or electrocardiographic evidence of cardiac disease were studied and compared with 18 normal subjects. Late potentials occurred in 5 out of 15 progressive systemic sclerosis patients (33%) with a significant difference versus controls (P < 0.05) and were present only in the patients with diffuse progressive systemic sclerosis (P < or = 0.001 vs. controls). All progressive systemic sclerosis patients showed a normal left ventricular systolic function. Abnormal left ventricular filling was found in 9 progressive systemic sclerosis patients (5 with diffuse progressive systemic sclerosis and 4 with CREST). A more severe impairment of the mean values of diastolic function indexes was found in diffuse progressive systemic sclerosis than in CREST. In all diffuse progressive systemic sclerosis patients at least one method showed altered results, whereas half the CREST patients showed no pathological findings with both techniques. These results confirm a lower myocardial involvement in the CREST syndrome than in diffuse progressive systemic sclerosis and consequently this is probably related to a better prognosis.

Adult↗
PubMed1996

Penile Mondors' disease: an underestimated pathology.

OBJECTIVE: To report the aetiological, diagnostic and therapeutic aspects of penile Mondor's disease treated with non-steroidal anti-inflammatory drugs (NSAIDs) or surgery. PATIENTS AND METHODS: During the last 3 years, 10 patients (mean age 35 years, range 20-57) were treated for superficial penile vein thrombophlebitis. The main aetiological factors were prolonged and excessive sexual intercourse, operations for inguinal hernia and deep vein thrombosis. All patients had noticed sudden and almost painless cord-like induration on the penile dorsal surface. Doppler ultrasonography was useful in both diagnosis and follow-up. Eight patients were treated with NSAIDs and platelet drugs. RESULTS: The mean interval to resolution of symptoms was 3 weeks. Two patients who did not respond to drug therapy underwent surgery (dorsal vein resection). CONCLUSION: Medical therapy and, when indicated, vein resection are successful and effective in treating penile Mondor's disease.

Adult↗
PubMed1996

Immunohistochemical quantitation of 4-aminobiphenyl-DNA adducts and p53 nuclear overexpression in T1 bladder cancer of smokers and nonsmokers.

An immunoperoxidase method, using a monoclonal antibody which recognizes 4-aminobiphenyl (4-ABP)-DNA adducts, was developed for the detection and quantitation of DNA damage in bladder tissue and applied to stored paraffin blocks of transurethral resection specimens of 46 patients with T1 bladder cancer. Mean relative staining intensity for 4-ABP-DNA adducts was significantly higher in current smokers (275 +/- 81, n = 24) compared to nonsmokers (113 +/- 71, n = 22) (P < 0.0001). There was a linear relationship between mean levels of relative staining and number of cigarettes smoked with lower levels in the 1-19 cig/day group (205 +/- 30, n = 5), compared to the 20-40 (289 +/- 40, n = 7) and the >40 cig/day group (351 +/- 57, n = 3)(P < 0.001). Nuclear overexpression of p53, analyzed by immunoperoxidase staining, was observed in 27 (59%) of the 45 stage T1 tumors analyzed. There was a significant correlation between p53 overexpression and recurrence of disease (odds ratio = 12.3, P < 0.01). Nuclear staining of p53 was also correlated with smoking status, cig/day and 4-ABP-DNA adducts. This work demonstrates that the immunohistochemical method has sufficient sensitivity for detection of 4-ABP-DNA adducts in human bladder samples. The method has several advantages including small sample size, the possibility of retrospective analysis of stored paraffin blocks, the ability to analyze binding in specific cell types, and a relatively low cost.

Aged↗
PubMed1996

Early experience of corpora cavernosa electromyography in impotent patients after radical cystoprostatectomy.

OBJECTIVES: To assess the effects of autonomic nerve damage on the basis of cavernous electrical changes. METHODS: A study was carried out on the cavernous electrical activity in healthy volunteers (controls) and impotent patients after radical cystoprostatectomy using a specific electromyographical device, the 'SPACE-recorder 7500'. RESULTS: A significant reduction in the amplitude of potentials was recorded after pharmacological stimulation in both the controls and impotent patients. The healthy controls showed amplitude values which were significantly higher than the impotent patients after radical cystectomy (715 +/- 141 vs. 381 +/- 227 microV, p < 0.01). After 'nerve-sparing' radical cystectomy with a mean amplitude similar to controls (500-700 microV), the patients showed rigid erections after injection of intracavernous drugs in a high percentage of cases. CONCLUSION: In our experience, corpora cavernosa electromyography seems a reliable method which can directly point out damage in the cavernous smooth muscle and the penile autonomic nerves.

Adult↗
PubMed1996

Non-Hodgkin's lymphoma: a case report of a secondary bladder involvement.

Bladder secondary involvement rate in non-Hodgkin's lymphoma (NHL) reaches 13%. Nevertheless, clinical evidence of such an involvement is very rare (less than 0.5%). We report a case of a NHL arising from the Peyer's plaques of the gut and involving secondly the bladder. The onset symptomatology was urologic. Pathophysiology and clinical features of secondary bladder lymphoma are discussed.

Adult↗
PubMed1996

Could standardized cavernosometry be helpful in therapeutic management of veno-occlusive dysfunction?

PURPOSE: Due to the lack of a gold standard for performing cavernosometry, we selected 30 patients with veno-occlusive dysfunction to evaluate the internal relationships of cavernosometric parameters and their reliability for therapeutic decisions. MATERIALS AND METHODS: Cavernosometry was performed after injection of 20 to 40 micrograms of prostaglandin E1. Maintenance flow rates, intracavernous pressure decay following cessation of flow and intracavernous pressure changes after compression maneuvers were the main parameters considered. RESULTS: Cavernosometric results were standardized as grade 1-7 patients with maintenance flow rate less than 20 ml. per minute (mean 18 +/- 2.5) and intracavernous pressure decay 27.5 +/- 15%, grade 2-11 with maintenance flow rates significantly lower (p < 0.001) than grade 1 (mean 37 +/- 11 ml. per minute) and intracavernous pressure decay 33 +/- 20%, and grade 3-12 with only recorded induction flows greater than 70 ml. per minute and intracavernous pressure less than 50 mm. Hg. A strong statistical correlation (p < 0.01) was noted between maintenance flow rate and percent of intracavernous pressure decays. CONCLUSIONS: These parameters allowed us to choose different therapies, such as complex venous surgery, mixed pharmacotherapy or prosthetic implants. Good sexual function was restored in 85% of the cases. We can conclude that our model of standardized cavernosometry has made easier the therapeutic choices in patients who do not respond to intracavernous drugs.

Adult↗
PubMed1996

Bladder replacement by detubularized ileal loop: 10 years of experience using a personal technique.

OBJECTIVE: To evaluate the results obtained with a technique of bladder replacement using a detubularized ileal tract, developed by the authors. PATIENTS AND METHODS: Since 1983, 34 patients have undergone an orthotopic bladder replacement using 35-40 cm of ileum, detubularized and shaped into an 'S' to create a neobladder with a capacity of 100-120 mL. The ureters were anastomosed directly to a 10 cm long intact afferent loop which serves as an anti-reflux mechanism, while a 2 cm long efferent, spatulated loop was used for urethral anastomosis. The mean (SD) follow-up was 32 (33) months. RESULTS: All the patients were continent during the day, with socially convenient intervals between voids; 3 years after the operation, 10 of 12 patients were continent during the night, with intervals of 2-4 h between voids. The mean post-void residual urine volume was 41 mL and no patient required self-catheterization. There were no derangements of the metabolic status of patients. CONCLUSION: This technique was applied knowing that a detubularized intestinal loop has the remarkable ability to increase in capacity over time. Therefore, to maintain the reservoir in good condition over a long period it is important to construct it with an intra-operative capacity of < 120 mL, thus reducing the length of intestine required. This may explain the satisfactory metabolic status of these patients. Moreover, the triplication of the mesentery helps to maintain the sphericity of the neobladder and provides support for the neobladder in the lower pelvis, where it retains the same position as a normal bladder.

Adult↗
PubMed1996

Three consecutive cases of adenomatoid tumour of the epididymis: histological considerations and therapeutical implications. Review of the literature.

Adenomatoid tumour is an uncommon neoplasm of the male genital tract. The Authors report their recent observation of three consecutive cases of adenomatoi tumour of the epididymis. In all cases the diagnosis was difficult and done only by an accurate histological examination. The treatment was conservative, consisting in the removal of the neoplasm. After a follow up of at least two years the patients do not show any sign of relapses confirming the validity of the surgical therapeutical approach performed. Because of the unfrequent observation of these forms and the difficulty in the diagnosis, the Authors stress the necessity of the surgical exploration with an accurate microscopic examination of the specimens. Moreover a review of the literature from a histological and therapeutical point of view was done and reported.

Adenomatoid Tumor↗
PubMed1996

Should venous surgery be still proposed or neglected?

Forty-four men aged 20-56 years (mean 42) complaining a venous erectile dysfunction underwent penile venous surgery. Fifteen patients (34.1%) were treated by DDVL, 29 cases (65.9%) underwent DDVL + corporopexy. All patients were followed-up at short and long-term periods. In short-term follow-up, eight patients (57.2%) of 15 treated by DDVL showed spontaneous erection, six patients (42.8%) showed persistent erectile dysfunction. In long-term follow-up, four patients of this group (28.6%) showed spontaneous erection. The others, 10 patients (71.4%), were then treated by other therapeutical alternatives. Twenty-two patients (75.8%) of 29 operated with DDVL + corporopexy showed spontaneous erection in short-term follow-up. After one year, in long-term follow-up, whereas total 15 patients (51.7%) of them were obtaining full erection, the others required other forms of treatments. In both groups in a long-term follow-up, total 19 patients of 43 (44.2%) showed full spontaneous erection, four patients (9.3%) needed intracavernous injection and six patients (13.9%) were treated with penile prosthetic implants. A total of 29 patients (67.4%) were able to have acceptable sexual intercourse. We concluded that venous surgery is still useful in selected patients having no better therapeutical alternatives.

Adult↗
PubMed1996

Cardiac involvement in connective tissue diseases and primary antiphospholipid syndrome: echocardiographic assessment and correlation with antiphospholipid antibodies.

The aim of this study was to determine the incidence of cardiac involvement in systemic lupus erythematosus (SLE), progressive systemic sclerosis (PSS), rheumatoid arthritis (RA) and primary antiphospholipid syndrome (PAPS), and to evaluate the correlation between cardiac involvement and antiphospholipid autoimmunization. M-mode, two-dimensional and Doppler echocardiography was performed in 101 consecutive patients (46 with SLE, 23 with PSS, 12 with RA, 20 with PAPS) and in 20 healthy subjects. None of the patients and of the controls had clinical evidence of cardiac disease. IgG anticardiolipin antibodies (aCL) were measured by an enzyme-linked immunosorbent assay. Valvular lesions were found in 18 SLE patients (39.1%), in 4 PSS patients (17.4%) and in 3 RA patients (25%). In comparison with the control subjects abnormal indexes of left ventricular filling (characterized by a reduced E/A end E/A-VTI ratios, a lower deceleration rate of EF slope and a prolonged IVRT) was only found in patients with connective tissue disease (15.1% in SLE patients, 30% in PSS patients and 40% in RA patients). The presence of aCL was not related to a different prevalence of valve alterations or alterated left ventricular diastolic function. None of the patients with PAPS showed valvular involvement or altered left ventricular filling. It is concluded that cardiac involvement is frequent in patients with connective tissue diseases but is apparently unrelated to increased aCL levels.

Adult↗
PubMed1995

Cardiac valve involvement in systemic lupus erythematosus and primary antiphospholipid syndrome: lack of correlation with antiphospholipid antibodies.

The aim of this study was to determine the prevalence of cardiac valve disease in systemic lupus erythematosus or in patients with primary antiphospholipid syndrome and to assess the role of the antiphospholipid antibodies as risk factor for endocardial lesions. We studied 39 consecutive patients with systemic lupus erythematosus (mean age 34 +/- 12 years, 38 female and one male), 20 women with primary antiphospholipid syndrome (mean age 32 +/- 4 years) and 20 normal subjects (mean age 35 +/- 8 years, 15 female and five male). All patients with primary antiphospholipid syndrome had increased levels of serum anticardiolipin antibodies and recurrent fetal abortions; some of them also had arterial and/or venous thrombosis and/or thrombocytopenia. M-mode, two-dimensional and Doppler echocardiography were performed in all patients. IgG anticardiolipin antibodies were measured by an enzyme-linked immunosorbent assay. Valvular lesions were observed in 15 patients (38%) with systemic lupus erythematosus. These abnormalities included: mitral valve thickening or vegetation, mitral valve prolapse and aortic valve vegetation; mitral, aortic and tricuspid regurgitation; mitral stenosis. None of the patients with primary antiphospholipid syndrome and of the normal subjects was found to have valvular abnormalities. In systemic lupus erythematosus, high levels of anticardiolipin antibodies were detected in 73% of the patients with valvular lesions and in 67% of the patients without valvular lesions (P > 0.05). We conclude that valvular involvement is frequent in patients with systemic lupus erythematosus but it is apparently unrelated to antiphospholipid autoimmunization.

Abortion, Habitual↗
PubMed1995

[Struma cordis: right intraventricular ectopic thyroid].

The authors report the case of a benign tumour composed of hyperplasic thyroid tissue in the right ventricle, diagnosed in a 43 year old woman by echocardiography after a syncopal episode. The outcome was favourable with a 13 year follow-up after surgery.

Adult↗
PubMed1995

Bilateral renal tumours: a hard surgical problem. Case report.

Three cases of bilateral renal tumours are reported. A radical nephrectomy in the side with the larger tumour and a nephron-sparing surgery (partial nephrectomy or enucleo-resection) in kidney with smaller lesions was performed in two cases. A bilateral partial nephrectomy was performed in the last patient (tumours larger than 5 cm). Two of them performed a needle CT-guided biopsy before surgery, but full disagreement was found between pre and post-operative histological results. In addition, we outline that a second lesion was found intraoperatively in the case n. 3, without any radiological and sonographic finding. We stress the importance of a conservative surgery in case of bilateral neoplasms. Only surgery could assure a careful staging and histological diagnosis.

Adenocarcinoma↗