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Biomedical subjects

G Simoni

Publications and source records attributed to G Simoni.

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

[Performance and complications of totally implantable port device in bolus hepatic intra-arterial chemotherapy].

The performances of totally implantable ports were analyzed in patients with colorectal metastases undergoing intraarterial treatment. Seventy-nine patients received bolus infusion of Cisplatin (DDP, 57 cases) or Epirubicin (EPI, 22 cases) every 21 and 7 days, respectively. Disease progression or toxicity were the most common causes of interruption of treatment, whereas failure of ports occurred in six and two patients out of DDP and EPI groups, respectively. The incidence of single problems for each port was 65% in DDP group and 64% in EPI group, whereas rate of complications for each patient was 30% and 32%, respectively. The 12-months device duration rate in the two groups was 65% (median 17 months) in DDP group and 78% (median 18 months) in EPI group. The implantable ports employed for bolus arterial infusion, allowed adequate treatment periods in most cases, without any difference as far as intervals between cycles is concerned.

Aged↗
PubMed1997

[Analysis of risk factors in patients operated for abdominal aortic aneurysm].

BACKGROUND: The incidence of the associated risk factors on the early results of elective repair of abdominal aortic aneurysms has been evaluated in a series of 270 consecutive patients. Clinical, hematological and instrumental data concerning cardiovascular, pulmonary and metabolic diseases have been collected for each patient, as well as the type and the results of the surgical procedure. METHODS: The graft was straight aortic in 82 cases (30.3%), aorto-bisiliac in 130 (48.1%) and aorto-bifemoral in 58 cases (21.6%); the 237 uneventful patients (87.8%) have been discharged 8 days after the operation (mean) and 24 (8.9%) underwent to coronary-aortic bypass graft (CABG) previously. RESULTS: Postoperative complications have been observed in 33 patients (12.2%): 24.3% pulmonary, 21.2% cardiac and 15.1% renal and among these 13 patients died (4.8% of the complete series and 39.4% of those with complications) because of pulmonary (38.4%), cardiac (30.7%) and renal causes (23.3%) mainly. Despite the complications occurred mainly in patients with associated risk factors, the multivariate analysis has shown that only the chronic obstructive pulmonary disease (COPD) plays a fundamental role (p < 0.005). On the contrary, among the patients died not one single risk factor reached statistical significance, although the COPD was close (p = 0.1). CONCLUSIONS: These data underline the need of a careful evaluation and treatment of associated diseases in patients undergoing elective repair for an AAA; namely a screening for asymptomatic coronary artery disease, since the CABG can significantly reduce morbility and mortality rates, and for COPD. In addition a more careful monitoring of patients with long clamping time could reduce the possible related renal complications. Up to now, since the surgical procedures is already standardized, the precise diagnosis and treatment of associated risk factors represent the winning strategy for the achievement of better results.

Aortic Aneurysm, Abdominal↗
PubMed1996

First-trimester chromosome diagnosis by lavage of the uterine cavity.

Fetal karyotyping of trophoblast cells obtained by lavage of the uterine cavity was evaluated on 86 first-trimester irrigation fluid samples. Villus fragments were observed in 72 fluid samples indicating an 83.7 per cent sampling success rate. The amount of villi in these samples ranged from 1 to 32 mg. In most cases, villus fragments showed degeneration of the external syncytiotrophoblast layer and absence of blood vessels. In the first phase of this study (15 samples), a high degree of maternal cell contamination was observed after long-term cultures. In the following phase (71 samples), this obstacle was overcome by the application of a semi-direct method. Chromosome preparations were set up after 24 h incubation of villus fragments and QFQ-banded metaphase spreads were scored for chromosome number and sex. Sixty samples showed the presence of villus fragments and the fetal karyotype was established in 40. Male and female chromosome complements were observed in 16 and 24 cases, respectively. In four cases, an abnormal fetal karyotype was diagnosed. These included trisomy of chromosomes 13, 15, and 16, and one mosaic with trisomy 12. Our results indicate that first-trimester fetal karyotyping might be feasible by a semi-direct method using chorionic villus fragments obtained at intrauterine lavage.

Cell Culture Techniques↗
PubMed1996

Does the presence of heparin and dexamethasone in the vitrectomy infusate reduce reproliferation in proliferative vitreoretinopathy?

BACKGROUND: Reproliferation following vitrectomy for proliferative vitreoretinopathy (PVR) causes redetachment in up to 55% of cases. Heparin and corticosteroids have each been shown to inhibit the development of proliferative vitreoretinopathy (PVR) in experimental models. However, little information is available on the use of these agents in humans. METHODS: In this pilot study, 62 eyes of 62 patients with severe PVR requiring vitrectomy were prospectively randomized to receive either BSS Plus (control) or BSS Plus with heparin and dexamethasone (HD) in the infusate. RESULTS: After one operation, the retina was reattached in 42 (71%) of 59 eyes: 22 (65%) of 34 eyes in the control group and 20 (80%) of 25 eyes in the HD group (P = 0.16). Reproliferation developed in 26.5% of the control group (9 of 34 eyes) and 16% of the HD group (4 of 25 eyes; P = 0.26). Postoperative hemorrhage was significantly more frequent in the HD group (P = 0.02) but did not influence final visual or anatomic outcome. Hypotony was less frequent in the HD group but the difference was not significant (P = 0.063). CONCLUSION: The trend from this randomized pilot study suggests that HD supplementation of the vitrectomy infusate may reduce the reproliferation rate in PVR and possibly reduce the rate of hypotony. Postoperative hemorrhage was more frequent with HD but did not cause redetachment or alter visual outcome. A multicenter trial involving more patients would be required to better evaluate the efficacy of HD as a pharmacologic adjunct to PVR surgery.

Adolescent↗
PubMed1996

Screening study of abdominal aortic aneurysm in a general population: lipid parameters.

The level of blood lipids and apolipoproteins in subjects being screened for abdominal aortic aneurysms have been investigated. As part of an ultrasound screening programme in a population of 65- to 75-year-olds, blood samples were collected from 1460 of 1504 subjects with a normal aorta (97.1%) and 69 of 70 patients with an abdominal aortic aneurysm > 29 mm (99%). Samples were also taken from 22 of 27 patients (81%) with an ectatic aorta (26-29 mm). Total cholesterol, HDL-cholesterol, LDL-cholesterol, Apo-AI and Apo-B levels were significantly higher in women than in men (P < 0.01). Levels of HDL-cholesterol and Apo-AI were significantly lower in patients with an abdominal aortic aneurysm than in normal subjects (P < 0.001). The mean(s.d.) body mass index was 25.1(3.9) in women and 25.5(3.2) in men with aneurysms and not significantly greater than that of normal subjects (25.2(3.61) and 25.2(3.38) respectively).

Aged↗
PubMed1996

Helical CT for the study of abdominal aortic aneurysms in patients undergoing conventional surgical repair.

OBJECTIVES: To evaluate the reliability of helical computed tomography (CT) as sole preoperative diagnostic technique for abdominal aortic aneurysms (AAA) and to compare these results with the surgical findings. MATERIALS: Thirty-three patients undergoing elective surgical repair. METHODS: Helical CT, Doppler exam of lower limbs, digital angiography, in case of peripheral vascular disease, and intraoperative evaluation. RESULTS: Helical CT correctly detected, in all cases, the proximal and distal extent of the AAA. The coeliac axis and its branches, the superior mesenteric artery and renal vessels as well as the inferior vena cava were always clearly depicted, showing anatomical variants or pathological involvement in 14 patients (42.4%). CONCLUSIONS: Helical CT can be used as the sole method for preoperative imaging of AAA. It allows a complete and precise evaluation of size, extent and relationship of the AAA, the surrounding vessels and other abdominal structures.

Aged↗
PubMed1996

HIV-1 proviral DNA polymerase chain reaction detection in chorionic villi after exclusion of maternal contamination by variable number of tandem repeats analysis.

OBJECTIVE: The study of the placental HIV infection in cases of seropositive pregnant women after exclusion of maternal contamination of chorionic villi samples by variable number of tandem repeats (VNTR) analysis. METHODS: We studied 30 HIV-positive women: 17 terminated their pregnancy (11 in the first trimester and six in the second) and 13 delivered at term (one was a twin gestation). We selected chorionic villi and ruled out maternal contamination by VNTR analysis. DNA from chorionic villi and cord and maternal blood were tested for HIV by PCR. All infants underwent a paediatric follow-up. RESULTS: All maternal blood samples tested positive for HIV-1 by polymerase chain reaction. No maternal contamination was revealed and HIV was found in six out of 11 first trimester placentas, in all second trimester samples, and in 10 out of 14 at term. Cord blood tested positive in all second trimester cases and in seven out of 14 liveborns. In no case was HIV found in cord blood without infection of the corresponding placenta; conversely, three placentas tested positive but cord blood was negative. Two infants were HIV-positive, 11 were uninfected (one case was lost to follow-up). CONCLUSION: Our study indicates that HIV-1 can infect the placenta from first trimester onwards. HIV was found in two-thirds of our cord blood samples but it is possible that some viral DNA in cord blood may have come from infected placental cells. Additional studies are needed to assess the source of HIV in cord blood and the possible contribution of placental or maternal cells infected with HIV to vertical transmission of the virus.

Blotting, Southern↗
PubMed1996

Pharmacological control of intimal hyperplasia in small diameter polytetrafluoroethylene grafts. An experimental study.

OBJECTIVE: The efficacy of a postoperative treatment with Low molecular weight heparin (LMWH) vs Ticlopidine in controlling early thrombosis, intimal hyperplasia and growth of true endothelial cells in small prosthetic expanded polytetrafluoroethylene (ePTFE) grafts (4 mm) interposed in the carotid artery of sheep has been evaluated. EXPERIMENTAL DESIGN: Thirty animals were randomized into three different groups: control group (CTRL); ticlopidine hydrochloride (TICL) 250 mg/b.d. by month for 4 weeks from day 1; LMWH 3,085 IU AXa s.c. preoperatively and once a day for the same period. RESULTS: Complete thrombosis of the graft occurred in 7 sheep in the CTRL group and 5 in the TICL group while 2 partial thrombosis were observed in the LMWH group (n.s.). In all the evaluable cases, hyperplasia was observed in both anastomotic areas and did not involve the middle portion of the graft. The mean +/- SD intimal thickness was 603 +/- 20 micron in the CTRL group, 356 +/- 10 in the TICL group and 152 +/- 17 in the LMWH group (p < 0.001) compared to the 60 +/- 12 of the normal intima. True endothlial cells were found mainly in the LMWH group close to the arterial anastomosis. CONCLUSIONS: The postoperative use of LMWH seems to inhibit intimal hyperplasia, with interesting results also on patency and cellular coverage. Further studies are necessary to support this promising trend.

Animals↗
PubMed1996

[Postoperative evaluation of vascular bifurcation prostheses by means of helical CT].

The dilatation of the vascular grafts is a well known phenomenon. It is usually evaluated by means of ultrasounds or, in selected cases, by CT scans or MRI; nevertheless its characteristics are far beyond to be fully recognized. Following our promising preliminary experience with helical CT as sole preoperative imaging for AAA, we have evaluated its reliability in the postoperative follow-up. We have studied 12 patients with aorto-iliac and 11 with aorto-femoral bypass for AAA, with a follow-up ranging between 1 and 3 years. A helical CT acquisition was performed during a single breath-holding with a 5-mm slice thickness, thus resulting in a 30 cm z-axis coverage. Axial images were reconstructed at 2-mm increments and used to generate high quality multiplanar reformatted (MPR) and three-dimensional (3D) surface rendered images. For each patient we evaluated the characteristics of the graft, the maximal diameters and the wall modifications. The average expansion was 28% at 1 year, stable at 2 years and then increased up to 44% at 3 years. Considering the different types of Dacron grafts, the dilatation was ranging between 22% and 46% (21 cases). The mean expansion was 31.3% and 29.5% for the trunk and for the branches of the graft respectively. No perigraft seroma nor anastomotic aneurysms were detected. A peculiar observation, both with and without contrast medium injection, was that all the grafts made on Dacron were not anymore depictable from the aortic wall after 1 year; the contrary was observed for the ePTFE grafts.

Aged↗
PubMed1996

[Preoperative imaging of aneurysms of the abdominal aorta. Role of CT scan].

The reliability of helical CT as sole preoperative diagnostic technique for abdominal aortic aneurysms (AAA) and its accuracy in detecting vascular anomalies in the abdominal region was evaluated retrospectively in 42 patients with asymptomatic AAA > 40 mm. A single breath-holding helical scan was performed with 5 mm slice thickness, during a single injection of contrast medium, resulting in a 20 cm z-axis coverage. Axial images were reconstructed and used to generate high quality multiplanar reformatted images. Digital subtraction angiography (DSA) was performed in the first 18 patients and then in case of associated peripheral vascular disease (6 patients). Helical CT exactly showed, in all cases, the proximal and distal extent of the AAA. The visceral vessels as well as the inferior vena cava and renal veins were always clearly depicted, showing anatomical variants or pathological involvement in 19 patients. DSA gave sufficient details on the distal run-off but did not allow a reliable visualization of the visceral branches, venous anomalies and true extent of AAA. In our experience helical CT should be considered as the sole method for preoperative imaging of AAA. It allows a complete and precise evaluation; it is fast, with low doses of radiations and does not require hospitalization.

Aged↗
PubMed1995

Gemfibrozil and Mediterranean diet for patients with high plasma levels of lipoprotein [Lp(a)] and cholesterol--pilot study.

Plasma levels of lipoprotein-a [Lp(a)] > 30 mg/dl represent an independent risk factor for cardiovascular diseases with both proatherosclerotic and prothrombotic activity. The results of dietary or pharmacological treatment are not encouraging and are often controversial. We have evaluated a combination of medical treatment with Gemfibrozil (600 mg bid) and a Mediterranean diet for 2 months in 15 patients with both hypercholesterolemia (> 240 mg/dl) and high levels of Lp(a) (> 30 mg/dl). Three patients dropped out within the first 2 weeks, complaining of epigastric pain and burning; the remainder (5 females and 7 males, mean age 70 years) completed the treatment without any side effects. The median values of Lp(a) decreased from 36.5 to 8.4 mg/dl (p < 0.0002) and total cholesterol from 254.5 to 208.0 mg/dl (p < 0.0001). The small number of patients does not permit any definitive conclusion on effectiveness to be drawn, but the results indicate further randomized studies might prove worthwhile.

Aged↗