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Biomedical subjects

G A Tiberio

Publications and source records attributed to G A Tiberio.

At least 19 recordsLinked to original sources
PubMed2001

Right subclavian artery aneurysms of fibrodysplastic origin: two case reports and review of literature.

Right subclavian aneurysms involving the intrathoracic portion of the artery are rare and those of fibrodysplastic origin are mentioned in literature only as sporadic cases. In this article, we present two cases of this uncommon pathologic condition and discuss problems concerning diagnostic tools and technical choices. The two patients underwent a successful vascular graft substitution; an echo-Doppler scan revealed that they had no disease 1 and 2 years after the operation.

Adult↗
PubMed2001

Endothelial dysfunction in small resistance arteries of patients with non-insulin-dependent diabetes mellitus.

OBJECTIVE: Arterial hypertension is frequently associated with the presence of endothelial dysfunction in human subcutaneous small resistance arteries, as evaluated by responses to acetylcholine or bradykinin; however it is not known whether patients with diabetes mellitus show similar alterations. Therefore, we have investigated endothelial function in subcutaneous arteries of normotensive subjects (NT), of patients with essential hypertension (EH), of patients with non-insulin-dependent diabetes mellitus (NIDDM), as well as of patients with both essential hypertension and non-insulin-dependent diabetes mellitus (NIDDM+EH). PATIENTS AND METHODS: All subjects were submitted to a biopsy of the subcutaneous fat Small arteries were dissected and mounted on a micromyograph. The media to lumen ratio (M/L) was calculated. A concentration-response curve to acetylcholine, to bradykinin as well as to the endothelium-independent vasodilator sodium nitroprusside were performed. We also evaluated the contractile response to endothelin-1. Intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1) plasma levels were also measured. RESULTS: The vasodilatation to acetylcholine and bradykinin (but not to sodium nitroprusside) was significantly and similarly reduced in EH, in NIDDM, and in NIDDM+EH compared with NT. The contractile response to endothelin-1 was similarly reduced in EH, in NIDDM and in NIDDM+EH. Plasma ICAM-1 and VCAM-1 concentrations were higher in EH, NIDDM and NIDDM+EH than in NT. CONCLUSIONS: An evident endothelial dysfunction was detected in patients with NIDDM, and the simultaneous presence of EH did not seem to exert an additive effect. The contractile responses to endothelin-1 were reduced possibly as a consequence of ET(A) receptor down-regulation.

Arteries↗
PubMed2000

Suprarenal aortic cross-clamping in elective abdominal aortic aneurysm surgery.

INTRODUCTION: this retrospective study was undertaken to evaluate whether suprarenal aortic cross-clamping increased the perioperative mortality and morbidity as compared to infrarenal clamping, in order to create the rationale for a more extensive application of this apparently more traumatic manoeuvre. MATERIALS AND METHODS: in a series of 734 elective aortic substitutions for abdominal aneurysm (AA), performed consecutively from January 1992 to June 1999, aortic cross-clamping was performed at a suprarenal level in 56 juxtarenal aneurysms, i.e. aneurysms extending to the lower edge of the renal arteries (8%, Group 1), and at an infrarenal level in 634 subrenal aneurysms (92%, Group 2). When analysing preoperative data, the diameter of aneurysms was larger in Group 1 than in Group 2 (p<0. 005). No significant differences were found between the two groups as regards age, sex, postinfarction cardiomyopathy, chronic obstructive pulmonary disease, chronic renal insufficiency and ASA classification of operative risks. RESULTS: the average time of renal exclusion in the juxtarenal aneurysms was 20 min (range 12-35 min). There is no difference between the two groups as regards the time of aortic clamping (mean 50 vs. 60 min) or the need for homologous blood transfusion (7% vs. 11% of patients). Perioperative (30 days) mortality did not differ: 3.6% vs. 1.9% (n.s.); nor did the incidence of acute myocardial infarction (3.6% vs. 2.3%). Renal function deteriorated in 8 (14%) vs. 0 (0%) (p<0.001) and 1 patient (2%) required permanent dialysis, as compared to 0% in Group 2. The incidence of ischaemic colitis was also significantly higher in Group 1 (7%) than in Group 2 (2%, p<0.01). CONCLUSION: this data shows that suprarenal clamping, which is necessary for the radical treatment of juxtarenal aortic aneurysms, can be performed with a low risk.

Aged↗
PubMed1999

D2 lymphectomy in the treatment of gastric cancer: a retrospective view on our experience (1990-1997).

From 1990 to 1997 we observed, in our department, 267 patients affected by gastric cancer. In the first four years of our experience (1990-93) we resected 87 patients out of 136 gastric cancers observed (63.9%): 56 pts. (64.4%) were classified as ASA I-II, 21 (24.1%) as ASA III, 10 (11.5%) as ASA IV. In 2 cases (2.3%), operated in emergency, a DO-1 lymphectomy was performed, with a mean of 4 nodes resected; 67 pts. (77.0%) had a D2, with a mean of 36.5 nodes resected; in 18 pts. (20.7%) we performed a D3, with a mean of 64.3 nodes resected. Post-operative technical complications were 13 (14.9%). We observed 5 post-operatory deaths (5.7%), 3 due to technical complications. Absolutely and relatively curative resections have been 62 (71.3%). In the second period (1994-97) we resected 89/131 patients (67.9%): in this group 50 pts. (56.2%) were classified as ASA I-II, 24 (26.9%) as ASA III, 15 (16.9%) as ASA IV. With the exception of 3 patients (3.4%) who were operated in emergency (D0-1 procedures, with a mean number of 2.3 nodes resected) we adopted D2 lymphadenectomy plus hepatic peduncle as the procedure of choice, performed in 86 pts. (96.6%), with a mean of 34.1 nodes resected. Post-operative technical complications were 5 (5.6%). We observed 5 post-operatory deaths (5.6%), 1 due to technical problems. Absolutely and relatively curative resections have been 76 (85.4%). Morbidity and mortality due to technical complications in the second period are lower than observed in the first period, without any difference in the curability rate. D2 lymphectomy seems to be an effective procedure, safe even in high anesthesiological risk patients. Increasing experience and standardization of the technique reduced risk of surgical complications and mortality.

Aged↗
PubMed1998

[Emergency surgical management of lesions from ingestion of caustics. Role of primary endoscopic classification].

Management of caustic ingestion in adults improved in the last decade due to the new diagnostic developments, the better predictability of injuries from signs and symptoms, the intensive care improvements and the more aggressive surgical approach for the most severe lesions. In fact, the early surgical treatment of severe lesions for ingestion of caustic and corrosive substances may reduce mortality, morbidity and hospitalization. The role of early endoscopic examination is today worldwide accepted: is herein proposed a new endoscopic classification of caustic lesions adjusted after a retrospective analysis of a twenty years experience in this field, and applied in twelve patients affected by severe esophageal and gastric injuries then submitted to emergency surgical treatment and survived. It showed a great usefulness in selection of patients to submit immediately to surgery and may play a fundamental role in indications and timing of surgical management of severe injuries by caustic ingestion.

Adult↗
PubMed1998

[Duodenal gangliocytic paraganglioma: intraoperative ultrasound evaluation].

Case report. A case of obstructive jaundice due to a preoperative unrecognized rare periampullary tumor, histologically demonstrated to be a gangliocytic paraganglioma of duodenum associated with Von Recklinghausen's disease, is herein reported. Intraoperative ultrasonography guided identification and evaluation of the obstructing lesion, suggesting in Whipple's procedure the most suitable treatment. The clinical case and ultrasonographic and Color Doppler findings are in detail described.

Ampulla of Vater↗
PubMed1998

[Carotid endarterectomy in patients with neurological non-side related (NSRS) symptoms].

Out of 970 carotid endarterectomies (CE) performed for high-grade (> 80%) stenosis of the internal carotid artery (ICA) until 1995, 147 patients with neurological non side-related symptoms (NSRS) and without any cardiac, ocular or vestibular significant pathology have been evaluated, analyzing the medium and long-term functional results (mean follow-up 37.6 months) related to the morphological status of the ICA contralateral and the vertebral arteries. NSRS disappeared in 126 pts (85.71%): contralateral ICA was non-stenotic in 32 cases (25.39%), stenotic < 75% in 68 cases (53.96%), stenotic > 75% in 7 cases (5.55%) and occluded in 19 cases (15.09%); vertebral arteries were pathological in only 6 cases (4.75%), among which 4 were on the same side and 2 on the opposite side of CE. NSRS persisted in 20 pts (13.6%): contralateral ICA was non-stenotic in 5 cases (25%), with a stenosis < 75% in 11 cases (55%) and with stenosis > 75% in 4 cases (20%); vertebral obliterative lesions were 3 (15.78%), among which 1 on the same and 2 on the opposite side of CE. No one statistical comparison among the groups of cases obtained on the ground of the status of ICA and vertebral arteries were significant (p always > 0.05 at chi-square analysis). Authors' data confirmed that high grade stenoses of ICA can cause NSRS and that CE--always performed at the aim to prevent major neurological attacks--can relieve also these functional disorders in the most of cases, independently from the status of the contralateral ICA and the vertebral arteries.

Aged↗
PubMed1997

[Smooth-muscle-cell tumors of the gastroenteric tract. A review of cases].

Smooth muscle tumors of the gastrointestinal tract are difficult to evaluate and to stage. Twenty-four patients surgically treated during the last ten years have been evaluated using a TGM staging to identify the more rational criteria for the therapeutic choice. Six gastric leiomyomas, 1 ileal leiomyoma, 4 gastric leiomyosarcomas, 1 esophageal leiomyosarcoma, 4 ileal leiomyosarcomas, 2 rectal leiomyosarcomas and 6 gastric leiomyoblastomas were included. 62.5% of cases presented acute clinical features. Preoperative histological diagnosis was adequate in 29% of cases. We performed 7 excisions, 6 gastric subtotal resections, 3 total gastrectomies, 1 esophageal resection, 5 ileal resections, 2 rectal low anterior resection. Fourteen patients were staged I/II, 8 staged III and 2 staged IV. The overall median survival time was 27.5 months (56, 20 and 5 months concerning stage I/II, III and IV respectively; p < 0.01). In relation to T and G factors overall survival was statistically significant. TGM staging was highly significant to predict long-term survival. Radical surgical procedure was highly effective to guarantee long-term survival. Extended follow up is requested because recurrences after many years seem to be possible also with low histologic grade at first presentation.

Aged↗
PubMed1995

Surgery for obstructive lesions of the main trunk of the renal artery. A review of the literature and personal experience of 41 operated patients.

Today, surgical revascularization of the renal artery seems to maintain interest in the therapy of renovascular hypertension and chronic ischemic nephropathy because both medical therapy and angioplasty show limits and inconveniences. The authors present here their experience of 45 revascularized renal arteries in 41 patients and they discuss early and late morphological and functional results related to isolated arterial renal pathology (Group 1 of 23 patients) and associated to aorto-iliac pathology (Group 2 of 18 patients). Mortality related to arterial renal reconstruction was nil. There were 3/45 arteries (6.6%) with early thromboses and 4/32 (9.3%) with late thromboses. Early functional results, with respect to renovascular hypertension and/or chronic ischaemic renal insufficiency, showed 16/41 (39%) healed patients, 16/41 (39%) improved patients and 9/41 (22%) unvariated patients. Late results among 28 observed patients (average follow up at 49 months, range from 18 to 144 months) showed 14/28 (50%) healed patients, 11/28 (39%) improved patients and 3/28 (11%) unvariated patients. Results of the Group I were significantly better than results of Group 2 with regards to healed patients (p < 0.01) but not summarizing healed and improved cases. These data have been discussed in comparison with the Literature review of 46 references.

Adult↗
PubMed1995

[Hepatic injuries: diagnostic and therapeutic features].

Sixty-four consecutive patients with hepatic trauma were examined. Five (7.8%) patients were managed nonoperatively and 59 (92.2%) underwent immediate laparotomy. Nonoperative management is appropriate in hemodinamically stable patients. It requires increasing use of computed tomography instead of peritoneal lavage to evaluate stable patients with blunt abdominal trauma. Patients with complicated associated injuries must be excluded. Analysis of patients who underwent immediate abdominal exploration showed that grade I through grade III injuries of AAST classification are the most common in blunt hepatic trauma (84.75%). Associated intra-abdominal injuries requiring operation for ongoing hemorrhage were observed in 50% of these patients. In the management of grade I through grade III hepatic injuries a simple suture was a safe and highly effective treatment. More complex injuries actively bleeding were controlled by finger fracture technique to achieve intrahepatic hemostasis with selective vascular ligation. Hepatic resection was exceptionally required (2%). On the contrary, resection was required in grade IV injuries with extensive parenchymal destruction and in grade V lesions for a better vascular control of the ruptured suprahepatic veins.

Adolescent↗
PubMedDate not supplied

Complete in vitro prosthesis endothelialization induced by artificial extracellular matrix.

This report presents our research on the conditions necessary to substain optimal in vitro prosthetic endothelialization using human endothelium cultures. Human vein endothelial cells were seeded at a concentration of 3 x 10(5)/cm2 in a gelatinized Dacron patch graft coated with a commercial collagen film, using a solution of fibrin glue. Endothelium adhesion, proliferation, and survival were measured by [3H]thymidine incorporation, after 7 days of incubation. Finally, the morphology of prosthetic endothelialization was analyzed by scanning electron microscopy. We observed that the Dacron patch grafts coated with collagen film were able to promote endothelialization better than the prostheses coated with highly concentrated collagen solution or gelatin. We therefore concluded that the collagen film that supports endothelial cell adhesion and proliferation uniformly covers the entire synthetic endoluminal surface of the Dacron graft, thus preventing endothelial cell alterations induced by direct contact with the synthetic prosthetic surface.

Adhesives↗
PubMedDate not supplied

Early and long-term prognostic factors after liver resection for HCC.

The Authors discuss the principal early and long term predictive factors after liver resection in patients with hepatocellular carcinoma (HCC). The Authors report (131 cases) early mortality as 7.6%, entirely confined in the group, numerically prevalent and affected by cirrhosis. None of the 50 patients with chronic hepatitis (29 cases) or normal liver (21 cases) died after hepatic resection. Mortality is higher in Child B patients (20.7%) and in cases in which a massive haemotransfusion was given (p < 0.05), apart from the width of resection and from the number of hepatic resections. None of 41 cirrhotic Child A patients undergoing a limited hepatic resection (< or = 1 segment) died during the perioperative period. In the group of patients which survived to the resection, global survival at 5 years was 45%. The most important prognostic factor is local recurrence while cirrhosis and the degree of liver failure are not statistically significant. No feature can identify a subgroup of patients with a higher risk of recurrence, which is observed in 52% of patients with a follow up observation after more than 1 year. Among the 29 patients alive after more than 4 years from liver resection, only 11 didn't have local recurrence. The others were treated with iterative hepatic resections or with radiological techniques. In conclusion, the present experience suggests that, in selected cases, hepatic resection could be a low risk therapy (in cirrhotic patients as well). The long term results could improve with an aggressive attitude towards recurrence.

Adult↗
PubMedDate not supplied

[Video laparoscopic cholecystectomy in a female patient with cholelithiasis in Steinert's myotonic dystrophy].

Steinert's disease (SD) is a rare (3-5/100000) myotonic myopathy responsible for chronic restrictive respiratory insufficiency and dilatative myocardiopathy. The authors report the case of a 52-years-old female patient with SD who underwent laparoscopic cholecystectomy for cholelithiasis. Postoperative course was uneventful and the patient was discharged after 4 days. Laparoscopic surgery was effective and safe in the treatment of this pathology.

Anesthesia, General↗
PubMedDate not supplied

Is there an association between Helicobacter pylori cytotoxin Cag A seropositivity and risk for gastric cancer?

BACKGROUND: Since discovered in 1990, Cag A, a protein expressed by specific strains of Helicobacter pylori, was thought able to explain why only a few Helicobacter infected patients develop peptic diseases and gastric cancer. However, clinical trials provide discordant results. MATERIALS AND METHODS: In this study we evaluate Helicobacter pylori and Cag A seropositivity in 35 cancer affected patients, in 36 gastritis affected patients and in 40 healthy blood donors by means of two commercially available fluorescence enzyme-immunoessay (ELISA). RESULTS: Odds ratios determination strongly suggests that Cag A bearer Helicobacter strains play a pathogenetic role in gastric diseases (OR 4.23, 95% CI 3.22-5.24 for cancer versus healthy volunteers, OR 3.2, 95% CI 2.19-4.21 for gastritis versus asymptomatic patients), but is unable to demonstrate a direct carcinogenic activity (cancer-gastritis difference is not significant: OR 1.32, 95% CI 0.39-1.25). CONCLUSIONS: Cag A seropositivity can be considered a risk factor for peptic disease, and only indirectly for gastric carcinoma. The paper also discuss some sampling, laboratory and statistical bias that can explain a wide eterogenity of the results reported in the literature.

Adult↗
PubMedDate not supplied

[The complications of pulmonary resection surgery: the experience of 200 consecutive cases].

Postoperative complications observed in 200 patients after pulmonary resection (66 pneumonectomies--30%, 106 lobectomies--53% and 28 wedge resections--17%) are presented. Surgical operations were carried out in 86% of cases for cancer, in 16% for benign lesions. Major complications were: lobar atelectasis, bronchopneumonia, pulmonary embolism, respiratory insufficiency, bronchial fistula, ventricular tachyarrhythmia, altogether they concerned 21% of the cases. Their incidence was not significantly influenced by the extension of resection (the latter, on the contrary, influenced postoperative mortality as much as 4.5% after pneumonectomy, 2.8% after lobectomy and 0% after wedge resection), age of patients under or over 70 years, functional respiratory reserve, or associated cardiovascular diseases. On the contrary, the advanced stage of disease in neoplastic patients was significant for major complications. An adequate monitoring of minor respiratory and cardiac complications is recommended to reduce the incidence of major ones and their control when present. In authors' experience, in fact, postoperative mortality was overall 3% following such behaviour.

Adult↗
PubMedDate not supplied

[Indications and short and medium time results of crossover bypasses in the treatment of obstructive arteriopathies of the lower limbs].

The authors evaluate the indications, the hemodynamical aspects, the short and medium term results over their track record of 49 crossover bypass (44 dacron and 5 PTFE grafts) performed between 1981 and 1993. Crossover bypass grafts were mainly inserted for unilateral iliac arterial disease in order to avoid aortic manipulation. This procedure was particularly selected when in presence of: young patients (< 60 years old), high surgical risk, poor run-off, high risk of prosthetic infection, thrombosis and/or infection of orthotopic grafts. 3 ilio-iliac, 27 iliofemoral, 18 femorofemoral and 1 femoropopliteal bypass have been performed. The postoperative resting pressure Index increase was highly significant in recipient limbs. There wasn't perioperative mortality; during the follow up (mean 24.4 months) no amputation of recipient limb was observed. 4 patients died of A.M.I. and 1 of neoplastic disease. Late cumulative patency rate was 81% at 2 years and 67.3% at 3 years. These values rise to 97.2% and 86.1% respectively when considering patients with "ideal" indication (excluding 7 patients operated on for complications of previous bypass grafts and 6 with extremely poor run-off). An accurate evaluation of the lesion topography and haemodynamic pattern of donor and recipient iliofemoral districts are stressed as key points for a correct surgical indication.

Adult↗
PubMedDate not supplied

[Total pancreatectomy. Which indications?].

This a review of the different topics held by literature for and against total pancreatectomy (TP) for adenocarcinoma of the pancreas. Technical and oncological aspects are discussed as are the metabolic effects of TP; metabolic data of our series of 6 TP are also referred. Postoperative mortality and morbidity decreased to less than 5% during the last decade both for TP and the Whipple procedure; long term survival is also similar for the two procedures. Even if the metabolic consequences of both exocrine and endocrine function deprivation are generally well compensated, they can still threaten the patient's life; furthermore their long term effects are only partially known. These are the reasons that force most authors to choose TP only in selected patients in which a multifocal neoplasia is demonstrated or whose pancreatic remnant is particularly soft and friable with high risk of pancreatojejunostomy complication. A pancreatic remnant in fact grants the hormonal milieu that makes easy the pharmacological control of any pancreatic function deficiency.

Carcinoma↗