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Biomedical subjects

G Gulino

Publications and source records attributed to G Gulino.

At least 19 recordsLinked to original sources
PubMed2003

Blood gas changes in the corpora cavernosa: metabolic and histomorphometric implications in the patient with erectile dysfunction.

PURPOSE: We evaluated corpora cavernosa metabolism in flaccidity and in erection, analyzing some blood gas analytical parameters and comparing them by histomorphometric examination to find a direct relation between biochemical-metabolic parameters and histological data. MATERIALS AND METHODS: We selected 33 patients with erectile dysfunction and divided them into 2 groups, including 1-those with congenital penile deviation who were responders to prostaglandin E1, and 2-those with severe organic erectile dysfunction who were not responders to prostaglandin E1. We evaluated O(2) and CO(2) pressure, pH and O(2) saturation in blood samples. We then made a histomorphometric study of cavernous tissue. We obtained specimens by cavernous biopsies and calculated O(2) and CO(2) exchange, the Haldane effect and the respiratory quotient into the corpora cavernosa. All data were evaluated by statistical analysis. RESULTS: Mean O(2) arterial pressure and saturation +/- SD were lower in group 2 than in group 1 (74.85 +/- 8.78 versus 96.43 +/- 14.87 and 94.98 +/- 1.4 versus 97.35 +/- 0.83, respectively). Mean CO(2) arterial pressure was 35.59 +/- 4.78 group 1 versus 38.8 +/- 2.71 in group 2 with borderline statistical significance. The Haldane effect was superior in flaccidity than in erection because of the influence of arterial-venous O(2) difference and the respiratory quotient, which was also an inverse ratio. Cavernous histomorphometry showed that in group 1 smooth muscle was a mean of 38.8 +/- 8.94% of cavernous tissue versus 24.9% in group 2. CONCLUSIONS: Our study shows that starting with blood gas analytical data we can completely study the metabolism of the corpora cavernosa and its relationships to erectile dysfunction. Cavernous histomorphometry can suggest the presence of smooth muscle into cavernous tissue, whereas our mathematical elaboration allowed us to evaluate all data in a more complete manner.

Alprostadil↗
PubMed2002

Cyclic sciatica related to an extrapelvic endometriosis of the sciatic nerve: new concepts in surgical therapy.

Sciatic pain caused by endometriosis of the sciatic nerve is an uncommon clinical finding and seems to have been verified histologically in only a few cases. Patients complain of typical signs and symptoms of common sciatica that are cyclic in nature. Suggested compression of lumbar root or sciatic nerve or its plexus could be confirmed by electromyography, computed tomography, or magnetic resonance imaging, and by prompt response to hormonal suppression of ovarian function with regression of the radiologic findings. Patients often have required radical surgery with total hysterectomy and bilateral salpingo-oophorectomy. However, conservative surgery with excision of the endometriosis from the nerve can be successful in selected patients who wish to preserve reproductive function. We report a case of sciatic nerve involvement explored by magnetic resonance imaging, with endometriosis in contact with the nerve in the right sciatic trunk.

Adult↗
PubMed2002

Radical surgery in Peyronie's disease. Graft comparison.

The paper concerns the experience of our Institute in the field of radical plaque removal in Peyronie's disease with special focus to the new biomaterials used as a graft on replace the fibrotic tunica albuginea. This is a retrospective study that evaluated clinical outcomes with a follow-up ranging from the early post-operative period to six years later. Ninety-eight patients aged from 32 to 64 with compliant of high stage Peyronie's disease have been treated. Which surgery meanly occurred 12 months after the first diagnosis. The different biomaterials implanted have been studied in terms of biophysical properties and clinical features at short and long term follow-up. These results suggest that surgical therapy appears as the main option in the treatment of Peyronie' disease, specially in the advanced state, plaque surgery being the most radical one; today we have a lot of different materials for substitution of albuginea but maybe noone represents the real gold standard. As concerns elasticity and biocompatibility, vein gave the best results, even if the operating time is longer. A new enthusiasm comes from SIS (porcine intestinal sub-mucose), whose early clinical and biological results are satisfactory in terms of elasticity and reduced operating time.

Adult↗
PubMed1999

Patient selection criteria in the surgical treatment of veno-occlusive dysfunction.

PURPOSE: We evaluated short and long-term results of simple and complex venous surgery in patients with veno-occlusive dysfunction unresponsive to maximum recommended doses of intracavernous alprostadil, who were selected with newly developed diagnostic indicators. MATERIALS AND METHODS: A total of 23 impotent men with a mean age of 41 years (range 20 to 50) underwent complex penile venous surgery. Only patients fulfilling at least 3 criteria were included in study. The criteria were mild cavernous leak assessed by cavernosometry (grades 1 and 2), more than 30% cavernous smooth muscle tissue (histomorphometric analysis), normal analogical corpus cavernosum electromyography recordings according to international standards, cavernosal oxygen tension greater than 65 mm. Hg at erection and age younger than 50 years. RESULTS: Of 23 patients 17 (74%) had normal erections within a year after surgery, and 5 of them (29%) complained of recurrent erectile dysfunction. At long-term followup 6 of 12 patients had spontaneous erections. CONCLUSIONS: Careful selection with advanced diagnostic techniques should be mandatory before performing venous surgery in patients with high degree veno-occlusive dysfunction as the only alternatives are major therapeutical solutions.

Adult↗
PubMed1997

Immunologic findings in Peyronie's disease: a controlled study.

OBJECTIVES: Recent literature suggests the hypothesis of an immune etiology of Peyronie's disease. In this controlled study, the immune response pattern of the disease is investigated. METHODS: Sixty-six patients with Peyronie's disease and 20 age-matched controls were studied. In all patients, skin test (multitest), in vitro lymphocyte transformation test (LTT), serum immunoglobulin (Ig) A, G, and M, anti-DNA, antinuclear and anti-smooth muscle cell antibodies, C3 and C4 complement fractions, antistreptolysin, and C-reactive protein titers were evaluated. RESULTS: A fair percentage (75.8%) of the patients with Peyronie's disease exhibited at least one abnormal immunologic test, in comparison to only 10% among controls (chi-square = 27.8, df = 1; P < 0.0001). Alterations of cell-mediated immunity (multitest, LTT) were observed in 48.5% of patients, alterations of humoral immunity (Ig) in 31.8%, and alterations of markers of autoimmune disorders (autoantibodies, complement activation) in 37.9% of the cases. CONCLUSIONS: Our results support the hypothesis that there is some involvement of the immune system in the pathogenesis of Peyronie's disease, although the available data still appear to be insufficient to formulate a definite pathogenetic hypothesis.

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

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

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

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

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↗
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↗
PubMed1995

[Correlation between ultrasonography imaging and surgical findings in scrotal trauma].

The Authors report their experience of 20 cases of scrotal trauma. The etiopathogenesis of lesions are stressed as well as the importance of an early diagnosis, in order to plan a correct treatment avoiding immunological and atrophic outcomes. All of the patients underwent a diagnostic ultrasonographic examination. Eighteen of them were surgically treated, whereas last two recovered by means of a week antibiotic and anti-inflammatory medical therapy. The scrotal sonography showed a 100% sensibility for testis injuries and a 80% specificity for albuginea fractures. In fact a fracture of the tunica albuginea was found in two cases although they showed a normal scrotal sonogram. It is worth of mention that in the authors' experience the ultrasonography generally understages the testis damages. Only the surgical exploration is believed to be able to make a sure diagnosis of type and seriousness of the scrotal injury.

Adolescent↗
PubMed1994

The role of ultrasonography in scrotal traumas.

Fourteen patients with a variety of scrotal lesions have been investigated. In 12 cases surgical exploration was performed, and 2 patients with scrotal wall haematoma received drug treatment. In the early detection of scrotal traumas ultrasonography is of utmost importance for the definitive diagnosis to be set up.

Adolescent↗
PubMed1993

Urethrospongiosal fistulas: clinical and therapeutic considerations.

From 1986 to 1990, 8 cases of urethrospongiosal fistulas were observed. All the patients had a history of bleeding after a difficult catheterization. The symptoms were not pathognomonic but the fistulas were visible only by X-ray examination. The authors suggest that urethrospongiosal fistulas are more common than one expects, especially in cases of bleeding after complicated catheterization. This is more frequent when coexistent urethral strictures or prostatic hypertrophy make the maneuver difficult. The authors also suggest that the urinary extravasation in the corpus spongiosum could explain the pathophysiology of the urethral manipulation syndrome according to Kelamy.

Aged↗
PubMed1985

Clinical and radiographic long term results of acetabular fractures associated with dislocations of the hip.

The authors carried out a long term review of 246 cases of fracture dislocation of the hip, based on a new classification of these injuries into six types. The average follow-up was 10 years (minimum 4 years). The review was aimed at ascertaining and comparing the clinical and radiographic results in each group in relation to type of treatment, age, sex, quality of reduction and time to weight-bearing. The survey revealed discrepancies between the clinical and radiographic results that underlined the essential difference between idiopathic osteoarthritis and post-traumatic arthritis. The most important factor in reducing the incidence of ischaemic necrosis was reduction of the dislocation within 24 hours. Arthritis was more dependent on the quality of reduction than on the method of treatment used to achieve it, and was also less frequent when weight-bearing had been delayed for 60 days. The overall results were better in younger subjects.

Acetabulum↗
PubMed1979

Fat embolism as a cause of idiopathic necrosis of the head of the femur. Review of forty five cases of post traumatic fat embolism.

It has been postulated in recent years that idiopathic necrosis of the head of the femur may possibly be caused by arteriolar obstruction by fat emboli emanating from a fatty liver, which would act as a reservoir, due to various causes such as alcoholism and prolonged steroid therapy. A similar situation has been found in human pathology in post traumatic fat embolism. The writers have reviewed forty five cases of post traumatic fat embolism which had passed the pulmonary filter. All the cases were reviewed after a minimum of two years, since this is considered the minimum time within which necrosis can manifest itself radiologically. In none of these cases was there any evidence of necrosis of the head of the femur. These findings, supported by other critical considerations. do not lend support to the theory of fat embolism as a case of idiopathic bone necrosis.

Embolism, Fat↗