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E Costantini

Publications and source records attributed to E Costantini.

At least 19 recordsLinked to original sources
PubMed2006

[Intraoperative transesophageal echocardiography in the endovascular treatment of thoracic aortic aneurysms].

AIM: Endovascular surgery is an efficacious alternative to conventional surgery in the treatment of descending thoracic aorta aneurysms. However, primary and delayed endoleaks are some endovascular technology's weak points. They are usually detected by angiography or angio CT, but many information may be obtained by transesophageal echocardiography (TEE) both as to endoleaks and to endograft's correct placement. Our purpose is to confirm, on the basis of our experience, the validity of this technique chosen both by us and by other groups with a wider casuistry. METHODS: We positioned endografts for the treatment of degenerative or post-traumatic aneurysms of the descending thoracic aorta using TEE, together with angiography, during surgery in 8 out of 9 patients. TEE was carried out on the same 8 patients also before surgery, and for some patients even in the follow-up together with angio CT, after 6 and 12 months. RESULTS: In the situations where TEE was used we found 5 cases of endoleaks and 1 of these was not detected by angiography because of its small dimensions. All of these endoleaks were immediately corrected with more angioplasty or graft extensions; in a case, where we could not utilize the TEE, the problem solved spontaneously after 30 days as it was confirmed both by angiography and angio TC. The statistical analysis with the Student t test is significant for P < 0.005. CONCLUSIONS: We think that using TEE during the placement of an endograft on the descending thoracic aorta may help to obtain useful information in addition to those that we can obtain with angiography. Therefore, this may lead to improve the technique and to reduce possible both immediate or delayed complications.

Adult↗
PubMed2004

New therapeutic options for refractory neurogenic detrusor overactivity.

AIM: Current pharmacologic treatment of detrusor overactivity relies on anticholinergic drugs. However, they often have untolerable side effects so that they are administered in doses insufficient to restore urinary continence. Recently, intravesical instillations and injections into the detrusor muscle of new pharmacological agents have been developed. The present study report our own experience in the treatment of detrusor overactivity with intravesical administrations of vanilloid agents and with botulinum-A toxin injections into the detrusor muscle in a group of spinal cord injured patients. In particular, we compared the clinical and urodynamic effects of the 2 drugs in an attempt to find a new and valid therapeutic option in those cases unresponsive to conventional treatment. METHODS: Seventy-five patients with spinal cord injury and refractory detrusor overactivity were included in the study: 35 patients received repeated intravesical instillations of resiniferatoxin (RTX) dissolved in normal saline; 40 patients received repeated injections of 300 units botulinum A-toxin diluted in 30 ml normal saline. Clinical assessment and urodynamics were performed at baseline and 6, 12 and 24 months after treatment. RESULTS: With both treatments there was a significant reduction in mean catheterization and episodes of incontinence and a significant increase in mean first involuntary detrusor contraction and in mean maximum bladder capacity at 6, 12 and 24 months after therapy. We did not detect any local side effects with either treatment. Botulinum-A toxin significantly reduced also the maximum pressure of uninhibited detrusor contractions more than RTX at all follow-up time points. CONCLUSION: In patients with spinal cord injury and refractory detrusor overactivity intravesical RTX and botulinum-A toxin injections into the detrusor muscle provided beneficial clinical and urodynamic results with reduction of detrusor overactivity and restoration of urinary continence in most patients. Botulinum-A toxin injection provided better clinical and urodynamic benefits than intravesical RTX.

Administration, Intravesical↗
PubMed2003

Four-corner colposuspension: clinical and functional results.

We report our experience with four-corner colposuspension and the long-term functional and objective results. Thirty-seven women aged 42-74 affected by cystocele, associated with stress incontinence in 27, underwent four-corner colposuspension, combined with posterior colpoperineoplasty in 5 and vaginal wall sling in 5. Preoperative work-up included clinical examination, a symptoms questionnaire, transrectal dynamic ultrasonography and a urodynamic test. The mean follow-up to date is 62 months (range 36-83). Check-ups included a clinical examination, responses to a questionnaire on symptoms, uroflowmetry, transrectal ultrasound, and a urodynamic test in 25. All patients underwent four-corner colposuspension, together with vaginal wall sling in 5 with severe incontinence and colpoperineoplasty in another 5 with symptomatic rectoceles. There were no major complications. The urethrocele was stably corrected in all. No relapses occurred in 19 patients with grades I-II cystocele preoperatively. Various forms of prolapse recurred in 12/18 patients with grade III cystocele. Incontinence was successfully resolved in 23/27 patients (85%). Instability persisted in 8/14 patients. Obstruction persisted in 6 patients with prolapse recurrence. The ideal candidate for four-corner suspension is a patient with moderate cystocele and no signs of uterine prolapse who may, or may not, be incontinent.

Adult↗
PubMed2003

Renal cell carcinoma: histological findings on surgical margins after nephron sparing surgery.

PURPOSE: We evaluated the incidence of peritumoral satellite lesions in nephron sparing surgery and examined whether these findings have a negative effect on cancer specific survival and on the percent of local recurrence. MATERIALS AND METHODS: We performed nephron sparing surgery in 63 patients with kidney cancer, including 53 elective (group 1) and 10 imperative (group 2) operations. In all cases we removed 10 mm. of apparently healthy peritumoral parenchyma with the tumor. This tissue was subsequently examined by an anatomical pathologist to identify any satellite lesions. RESULTS: Four satellite lesions were identified, including 3 in group 1 and 1 in group 2, at a mean of 5.3 mm. from the primary lesion. None of the patients in either group had local recurrence at followup. Cancer specific survival was 96.3% in group 1 (mean followup 61 months) and 58% in group 2 (mean followup 39 months). It was not influenced by the presence of satellite micro-lesions. CONCLUSIONS: Despite common perplexities concerning the risk of multifocality in renal cell carcinoma we believe that the nephron sparing procedure in select patients is as effective as radical surgery. Based on our experience the surgical safety margin must be at least 10 mm. of macroscopically healthy, peritumoral tissue.

Adolescent↗
PubMed2003

Stage pT1 renal cell carcinoma: review of the prognostic significance of size.

INTRODUCTION: The last TNM classification (before 1997) defined T1 kidney tumour as a tumour <2.5 cm, limited to the kidney: this cut-off point was changed in 1997 and T1 neoplasm was defined as <7 cm. This new cut-off now includes past T1 and T2 diseases, without any differences in terms of prognoses. We performed a retrospective analysis of our cases and specifically investigated if there were any differences in terms of prognosis in a group of patients, currently identifiable as pT1, if they were divided into two subgroups based on tumour pathological sizes. MATERIALS AND METHODS: Our analysis involved 128 patients (mean age 57.6 years) who underwent radical nephrectomy or nephron-sparing surgery in the period between 1990 and 2000. All these patients were pT1 according to the new TNM classification and were divided into two groups according to different cut-off point sizes (from 2.5 to 5 cm). We analysed the surgical approach, overall survival and cancer-specific mortality in the two subgroups, renamed as pT1a and pT1b, and performed a statistical analysis of the results using the Kaplan-Meier method to prove if this substaging identified changes in survival outcome. RESULTS: We obtained more interesting results for a 5-cm cut-off: the two groups showed a similar follow-up and overall survival rate but different cancer-specific mortality rate (6 vs. 12.1%). The statistical analysis showed that the two survival curves (pT1a vs. pT1b disease) had a similar trend up to about 60 months; after this period the two curves diversify with a drop in survival rate among patients with larger tumours (pT1b patients). CONCLUSIONS: It would seem reasonable to reassess the TNM classification of stage pT1 in order to better define prognosis in this group of patients.

Adult↗
PubMed2002

Intrinsic sphincter deficiency: do the maximum urethral closure pressure and the Valsalva leak-point pressure identify different pathogenic mechanisms?

A prospective analysis of 166 women with genuine stress incontinence was performed comparing Valsalva leak-point pressure (VLPP) and maximum urethral closure pressure (MUCP) with age, previous urogynecologic surgery and/or hysterectomy, poor urethral mobility, weight, menopause and vaginal deliveries, to find correlations with intrinsic sphincter deficiency (ISD). Cut-off value for VLPP were 60 cmH2O and for MUCP 30 cmH2O. MUCP < or = 30 cmH2O identifies a group of patients with more severe incontinence, a shorter urethral functional length (UFL) (P = 0.02), more previous urogynecologic operations and the menopause (P = 0.004 and P = 0.000), and older age (P = 0.000). VLPP < or = 60 cmH2O identifies a group of patients with more severe incontinence, a shorter UFL (P = 0.005), more previous urogynecologic surgery (P=0.006) and poorer urethral mobility (P = 0.004). As these two tests measure different components of urethral functions we can hypothesize that they detect different pathogenic processes contributing to ISD. When one or both tests is abnormal incontinence is more severe and the incidence of poor prognostic factors is increased.

Aged↗
PubMed2002

Peyronie's disease: corporoplasty using saphenous vein patch graft.

OBJECTIVE: To establish who the best candidates for corporoplasty are. The standard guidelines include patients with partial erections, and/or recurvature preventing normal and satisfying intercourse. In our unit we prefer to implant prostheses even in patients with slight erectile dysfunction, therefore patients with full erections routinely undergo corporoplasty. MATERIALS AND METHODS: We report our experience with corporoplasty using a vein patch graft after plaque incision or excision in 12 patients affected by Peyronie's disease. RESULTS: The operation is easy to perform. Recovery of normal spontaneous erectile activity was observed in 10/12 (83%) patients at a mean of 1 month postoperatively. The results of checkups with Rigiscan and EchocolorDoppler have confirmed the stability of the graft and recovery of potency. DISCUSSION: Autologous material is easy to harvest and it is elastic enough to support traction during erection. The patch can be modelled to fashion patches in any shape required. The risk of scar shrinkage, with the consequent onset of recurvature, is lower than with other materials such as Gore-tex or Derma. Corporoplasty ensured rapid rehabilitation of sexual functions in all patients. We do not usually perform the Nesbit procedure as shortening of the penis (which is characteristic of Peyronie's disease) would, in most patients, be accentuated by albuginea plication.

Humans↗
PubMed2000

Detubularized rectosigmoid neobladder in women after cystectomy for bladder cancer.

BACKGROUND AND OBJECTIVES: We present the long-term functional results of a new technique for bladder substitution after cystectomy for bladder cancer in women. METHODS: Between 1991 and 1995, 10 women underwent radical cystectomy for bladder cancer with a new technique. We created a detubularized rectosigmoid neobladder associated with either a terminal colostomy or intrasphincteric perineal colostomy section (Heitz-Boyer-Hovelacque). We evaluated neobladder functioning over almost 5 years by means of urodynamic studies, ultrasound scans, urograms and pouchgrams, and renal function tests. RESULTS: Neobladder function was excellent in all patients, with good diurnal and nocturnal urinary continence, voiding patterns, and preservation of the upper urinary tract. CONCLUSIONS: This new technique, which is a modification of the standard rectal or rectosigmoid neobladder technique, is a valid alternative to the ortothopic neobladder in women, with good functional results.

Colon, Sigmoid↗
PubMed2000

Surgical repair of infected peripheral graft and abdominal aortic aneurysm using arterial homograft.

We report a case of combined surgical repair including lower limb revascularization (below-knee bypass) and abdominal aortic aneurysm repair using cryopreserved arterial homograft. The patient experienced lower limb ischemia due to repeated thrombosis of a long-infected polytetrafluoroethylene (PTFE) graft, and was also shown to have a complicating abdominal aortic aneurysm. Infection was eradicated with total graft excision and intravenous antibiotics. Two-year patency of the in situ arterial homograft revascularization was demonstrated with hemodynamic and tomographic controls; no degenerations have been found to date. Benefits of the use of in situ arterial homograft for arterial reconstruction may include improved hemodynamics and greater resistance to infection compared to when alloplastic materials are used. Because of the risk of allograft deterioration, close follow-up of the patient is required.

Anti-Bacterial Agents↗
PubMed2000

Paraanastomotic aneurysms of the abdominal aorta: a 15-year experience review.

The aim of the study is a retrospective review of clinical presentation and management of paraanastomotic aneurysms of the abdominal aorta (PAAA) surgically treated in our Department. From January 1984 to December 1998, 2183 aortic prosthetic grafts were implanted. During the same period, 24 patients were treated for PAAA, 19 false and five true aneurysms. Symptoms were present in 10 patients. Surgical management included tube grafting interposition (14), aortobifemoral bypass (2), graft removal with extraanatomic bypass (2) and with in situ revascularization by arterial homograft (4). Nine patients died during operation or in the early postoperative period, six died during follow-up. Mortality in symptomatic patients was 70%, while in asymptomatic group was 14% (P=0.01). Rupture of false PAAA was very frequent (47% of cases). PAAA are infrequent complications of proximal aortic graft revascularization and tend to be asymptomatic until rupture occurs. The incidence of mortality is very different in asymptomatic versus symptomatic group; rupture is particularly frequent in false PAAA, which must soon undergo surgery when diagnosed. Since PAAA may develop at any time after surgery, their incidence increase in relationship with the length of postoperative interval: therefore, all patients submitted to abdominal graft revascularization need a lifetime surveillance program.

Aged↗
PubMed2000

Biofeedback successfully cures detrusor-sphincter dyssynergia in pediatric patients.

PURPOSE: We assessed the efficacy of voiding and bladder biofeedback for achieving perineal synergy and curing symptoms in children with detrusor-sphincter dyssynergia MATERIALS AND METHODS: A total of 16 boys and 27 girls 4 to 14 years old with detrusor-sphincter dyssynergia diagnosed by uroflowmetry and electromyography underwent biweekly voiding biofeedback therapy consisting of perineal floor electromyography during uroflowmetry. The 6 patients with enuresis and an unstable bladder also underwent bladder biofeedback training during cystometry. Biofeedback continued until detrusor-sphincter dyssynergia resolved. Followup consisted of electromyography and uroflowmetry 1 month after completing biofeedback training, and telephone interviews after 2 and 4 years. RESULTS: Biofeedback resolved detrusor-sphincter dyssynergia in all children, although the condition disappeared significantly sooner in girls (p <0.02). Secondary enuresis disappeared significantly earlier than primary enuresis (p <0.0001). The 2-year success rate of 87.18% for enuresis decreased to 80% at the 4-year followup. CONCLUSIONS: Voiding and bladder biofeedback achieves perineal synergy and cures symptoms in children with detrusor-sphincter dyssynergia

Adolescent↗
PubMed2000

Management of infected peripheral bypass by selective partial graft removal and arterial homograft insertion. Two case reports.

We present two cases of partial graft removal and cryopreserved arterial homograft insertion for treatment of patent axillobifemoral (AXB) polytetrafluoroethylene (PTFE) prosthesis with infection confined only to a part of the graft. In the first patient, infection was confined to the left inguinal site; in the second, there was a cutaneous fistula in the middle prosthetic thoracic tract. Neither patient presented signs of systemic sepsis and radio immunological tests were positive only in a confined tract. After surgery, both patients showed early recovery and currently (mean follow-up 21-month) they are disease-free. Selective partial graft removal appears to give satisfactory results and may reduce the risk of complications compared with total graft removal Moreover, arterial homograft shows greater resistance to infection compared to alloplastic materials, when autologous veins are not available and/or not suitable.

Adult↗
PubMed2000

Left sided heartport approach for combined mitral valve and coronary bypass surgery.

BACKGROUND: To explore the possibility of achieving adequate exposure of the mitral valve (MV) and the entire coronary anatomy using a limited (Port-Access) left lateral thoracotomy incision. METHODS: Using this incision, four patients underwent a single bypass to the left anterior descending, combined with MV repair (1), MV replacement (2), and left atrial (LA) myxoma excision (1). This approach required single lung ventilation, femoral venous cannulation, and cannulation of the femoral artery or thoracic aorta. Exposure of the MV was achieved through a LA incision parallel to the atrio-ventricular groove, extending into the pulmonary vein or behind the pulmonary artery as necessary. RESULTS: Excellent exposure of the MV and coronary anatomy was achieved in all patients. There were no surgical complications and all were discharged home within one week. CONCLUSION: Left-sided Port-Access is a valid technique particularly suitable for combined primary MV and coronary bypass surgery. It does not allow exposure of the tricuspid or aortic valve, however, and is not recommended in repeat MV surgery due to the fragility of the LA appendage in such cases.

Aged↗
PubMed1999

Popliteal aneurysms: current management and outcome.

BACKGROUND: Peripheral artery aneurysm is the most common peripheral arterial aneurysm. Clinical pictures, perioperative diagnostic evaluations, surgical treatment and results are described. METHODS: From January 1982 to September 1998, 65 popliteal aneurysms in 48 patients were treated in the Department of Vascular Surgery of Busto Arsizio Hospital. The series comprises 44 men (91.7%) and 4 women (8.3%) with mean age 65 years (range 44 to 87 years). At the time of surgery, 38 of the 65 aneurysms (58%) were treated because symptomatic: 31 (82%) for limb ischemia (17 for acute ischemia, 14 for chronic ischemia), 6 (16%) for compression on the adjacent popliteal vein and 1 (2%) for rupture. Forty-seven (72.3%) aneurysms were treated electively: 27 cases were asymptomatic and 20 others had chronic leg ischemia or compression on the popliteal vein. The operations performed are listed as follows: 1 primary limb amputation for irreversible ischemia, 1 lumbar sympathicectomy and 62 leg limb revascularizations with graft interposition (vein or synthetic prosthesis). The patient with aneurysmal rupture underwent leg amputation. RESULTS: Mean follow-up is 6.5 years (ranging from 2 months to 10 years) and revealed important differences between symptomatic versus asymptomatic patients in limb salvage and graft patency: inferential analysis of amputation incidence is significant for p < 0.01 (Fisher exact test). CONCLUSIONS: We think that surgery is the best treatment also for small popliteal aneurysms, because of their frequent complications.

Adult↗
PubMed1998

Colposacropexy with Gore-tex mesh in marked vaginal and uterovaginal prolapse.

This study focusses on abdominal sacral colpopexy which appears to provide the most anatomically correct restoration and secure and durable support for advanced vaginal or uterovaginal prolapse. 21 patients underwent colposacropexy or hysterocolposacropexy using Gore-tex mesh. All patients referred symptoms of vaginal heaviness and urinary dysfunctions. Five presented with complete vaginal vault prolapse, 7 with third-degree anterior colpoceles and 9 with uterovaginal prolapse. Hydronephrosis was present in 4. Five patients had previously undergone total hysterectomy, and underwent only sacropexy; 9 underwent standard total abdominal hysterectomy before sacropexy; 7 underwent hysterocolposacropexy, preserving the uterus. In colposacropexy anchorage was designed to provide a large vagina-mesh contact area thus reducing the risk of suspension failure. Hysterocolposacropexy was performed using 3 stitches to anchor the synthetic mesh to the vagina and the uterine isthmus. Postoperative follow-up times range from 12 to 68 months. Overall results for 19/21 patients were satisfactory. In all 21 patients the descensus was markedly reduced. Hydronephrosis was completely resolved. Slight incontinence persisted in 3, but protection was not required. Slight dysuria persisted in 2. First-degree cystoceles recurred only in 3 patients who underwent hysterocolposacropexy. Sacropexy with synthetic mesh seems to be the most valid support of uterovaginal prolapse as the physiological vaginal axis is restored and vaginal function is preserved. Our success rate and the overall satisfaction expressed by 19/21 patients have encouraged us to continue in this surgical approach.

Adult↗
PubMed1998

[Stromal tumors of the stomach. Our experience with 25 patients].

Stromal tumors (GIST) represent 5% of gastric neoplasms. Twenty-five patients with GIST underwent surgical operation: the tumor was benign, malignant, and borderline in 11, 12, and 2 cases, respectively. Main symptoms were abdominal pain (36%), and digestive haemorrhage (32%); 4 patients (16%) complained of abdominal mass. In 5 patients the diagnosis was incidental. Surgical operations (12 local resections, 9 partial gastric resections, and 4 total gastrectomies) were macroscopically curative in all the patients. In 3 patients the resection was extended to liver (1 case), spleen, pancreatic body-tail, and left kidney (1 case), and diaphragm (1 case) because of contiguous involvement of these organs. Postoperative mortality and morbidity were 4% and 20%, respectively. A patient with benign GIST passed away 36 months after operation because of breast cancer disease; other 9 patients are alive from 3 months to 25 years after operation. Three patients with low grade malignant GIST are well at mean follow up of 53 months. The 9 patients with high grade neoplasms are all dead (median survival time: 18 months). The 2 patients with borderline tumors are alive without evidence of disease at 3 and 8 years.

Adult↗
PubMed1998

[The use of allografts in the surgical treatment of patients with infected vascular prostheses].

The article is devoted to analysis of surgical treatment of patients with such a dangerous complication as infection of the vascular prosthesis. The authors have performed 25 operations for substituting the infected prostheses for allografts. In 18 patients the infected prostheses were located in the aorto-iliac segment, in 5 patients in the femoro-popliteal segment, 1 patient had it in the aorta, and 1 in the subclavian segment. The prostheses were removed and a simultaneous revascularization was made. The authors make a conclusion that it is very expedient to use alloprostheses as a protective measure against persistent or recidivating infections. The allografts have both early and long-term resistance to infection.

Aged↗