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Biomedical subjects

L Ansaloni

Publications and source records attributed to L Ansaloni.

At least 19 recordsLinked to original sources
PubMed2004

Lichtenstein repair of inguinal hernia with Surgisis inguinal hernia matrix soft-tissue graft in immunodepressed patients.

While polypropylene mesh remains the preferred prosthesis material for hernioplasties, there are some problems with infections, intestinal obstruction and fistulization, and migration particularly in immunodepressed patients. A new degradable and reabsorbable material, the porcine small intestinal submucosa (Surgisis) has been developed for hernia repairs in humans. This prospective study evaluated the safety and efficacy of Lichtenstein hernioplasty using the Surgisis inguinal hernia matrix soft-tissue graft as a mesh in ten immunodepressed subjects. Six subjects were HIV-positive in the immunodepressive phase, and the other four had undergone transplantation (three kidney, one liver). There were no intraoperative or postoperative complications, recurrences, or wound infections. Thus Lichtenstein's hernioplasty using the Surgisis inguinal hernia matrix soft-tissue graft in immunodepressed patients promises safety and efficacy.

Absorbable Implants↗
PubMed2002

Oral lacidipine in the treatment of anal fissure.

The aim of this prospective study was to assess the effectiveness in healing anal fissure (AF) of lacidipine, a calcium channel blocker with a better tolerability in comparison to other calcium antagonists. Twenty-one consecutive patients (16 women, 76.2%) with AF (16 chronic, situated posteriorly in 17 patients (81.0%), anteriorly in 4) with a mean age of 37.1 years (SD, 13.6, range, 20-6) were treated with oral lacidipine (6 mg daily) and warm sitz baths for 28 days, adding only stool softeners for patients with constipation. Blood pressure, pain scores (assessed from 0 to 10 on a visual analogue scale) and fissure healing were monitored at 14 days, 28 days and 2 months. At the 14-day and 28-day follow-ups, the mean systolic and diastolic pressures were not significantly different from pre-treatment levels. Seven patients (33.3%) developed side effects, but only one, who developed dyplopia, withdrew from the study at the 14-day control (non-compliance rate with treatment, 4.8%). Pain scores were significantly reduced after 14 days and continued to show a significant reduction throughout the treatment period. Three fissures (14.3%) healed by 14 days and a total of 19 (90.4%) after 28 days: among the healed AF no recurrences were seen at the 2-month control. Among the two treatment failures, one was the patient who withdrew from the study at the 14-day control due to dyplopia and the other was a patient who failed to heal up to the 2-month follow-up, although completely asymptomatic. Both patients underwent left lateral sphincterotomy and healed. In conclusion, oral lacedipine is quite well tolerated and may offer a promising alternative treatment for AF.

Administration, Oral↗
PubMed2001

Prospective, randomized, comparative study of Misgav Ladach versus traditional cesarean section at Nazareth Hospital, Kenya.

Cesarean section (CS) is the commonest major operation carried out in many low income countries. A new technique for CS, called the Misgav Ladach procedure, was evaluated in a randomized trial in Nazareth Hospital (Kiambu District, Kenya). A total of 160 patients were assigned to the Misgav Ladach procedure (n = 80) or to the traditional CS as performed in most rural hospitals in low income countries (n = 80). The two groups were analyzed by operating time, presence of infection and febrile morbidity, grade of postoperative pain, starting of fluid and solid alimentation, and development of incisional hernia and hypertrophic scar. The operating time of the Misgav Ladach procedure was significantly shorter. 20.4 (SD 6.1) minutes versus 30.4 (SD 6.1) minutes (p < 0.001). A total of 5 wound infections (6.2%) were seen with the Misgav Ladach procedure versus 16 (20.0%) in the control group (p = 0.01). The number of analgesic doses required during the postoperative period were significantly less in the Misgav Ladach group: 1.3 (SD 0.6) versus 1.9 (SD 0.7) ampuls of pethidine (p < 0.001) and 15.1 (SD 2.0) versus 16.4 (SD 1.8) tablets of ibuprofen (p < 0.001). Incisional pain was significantly less in the Misgav Ladach group: Visual Analogue Scale score 3.0 (SD 1.5) versus 4.9 (SD 2.0), p < 0.01. The patients in the Misgav Ladach group began drinking fluids voluntarily [19.1 (SD 4.5) hours versus 20.6 (SD 4.0) hours; p = 0.01] and eating solid food [41.2 (SD 9.3) hours versus 46.1 (SD 9.0) hours; p < 0.01] significantly before than those in the control group. At the 6-week follow-up, the presence of hypertrophic scar was significantly associated with the traditional procedure (2.1% vs. 48.8%; p < 0.001). We conclude that the Misgav Ladach operation should become the standard method for performing CS in low income countries, particularly in rural hospitals.

Adult↗
PubMed2001

Pulmonary blastoma: report of two cases.

Pulmonary blastomas are a group of rare malignant neoplasms subdivided into three categories: classic biphasic pulmonary blastoma (CBPB), well-differentiated fetal adenocarcinoma (WDFA), and pleuropulmonary blastoma (PPB). We report herein the cases of two men with CBPB. Both were heavy smokers and presented with a history of hemoptysis. Physical examination revealed slightly significant findings, chest radiographs showed a large pulmonary mass, confirmed by computed tomography, and bronchoscopic biopsies were not diagnostic. A left and right inferior lobectomy was performed and a diagnosis of CPBP was confirmed by histological examination. In the first patient, local recurrence with multiple bilateral lung metastases was found 6 months later and despite chemotherapy, he died of respiratory failure 1 year after his operation. In the second patient, a subcutaneous metastasis was found in the right subscapular region 2 months later, and a cerebral metastasis in the right posterior parietal lobe 4 months later. Partial remission was achieved by cerebral irradiation, but 6 months later the patient died of cardiac failure while in a coma. We conclude that more aggressive and multidisciplinary treatment should be adopted for CBPB, and because of its low incidence, it is important to unify individual experiences in a central registry to gather as much information as possible regarding the biological and clinical features of this unusual disease.

Aged↗
PubMed2001

Tumoral calcinosis: case report.

Tumoral calcinosis (TC) is a rare disease of obscure aetiology. In its classic form, it is characterised by solitary or multiple large foci of mineralisation in the soft tissue adjacent to the bone around large joints in the absence of disorders of calcium metabolism and visceral calcification. A case is presented of TC in a 75-year old Kenyan woman.

Aged↗
PubMed2000

Bilateral recurrent pneumothorax complicating chemotherapy for pulmonary metastatic breast ductal carcinoma: report of a case.

Secondary spontaneous pneumothorax (SSP) is a rare complication of chemotherapy for pulmonary metastases and to the best of our knowledge, only 28 cases have been described, most of which occurred in patients with osteosarcoma or germ cell tumors. We present herein the case of a 56-year-old woman in whom bilateral and recurrent SSP was caused by the rupture of pulmonary lacunae induced by chemotherapy, given for bilateral lung metastases secondary to breast carcinoma. Our experience of this case led us to conclude that: patients with pulmonary metastases may develop bilateral and/or recurrent pneumothoraces following chemotherapy; computed tomography scan is essential for defining the cause of SSP; and closed chest tube drainage remains the therapy of choice, while chemical pleurodesis may also be used to prevent recidivant SSP.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2000

[Bronchial carcinoids. Our experience with 35 cases].

BACKGROUND: The aim of this study was to review personal experience regarding bronchial carcinoids. METHODS: This study investigated retrospectively 35 patients with bronchial carcinoids treated in our institution (Unit of General and Thoracic Surgery, University of Bologna) in 20 years (from 1978 to 1997). RESULTS: The m/f rate was 0.6, the average age 42.5 years and the smokers' percentage 42.8. The patients were symptomatic in 88.6% of cases. The carcinoid was located in the right lung in 17 patients (48.5%) and central in 29 patients (82.8%). Surgical treatment included pneumonectomy (6), lobectomy (17), bilobectomy (3), sleeve lobectomy (2), sleeve bilobectomy (1), sleeve resection of main bronchus (1), bronchotomy and tumorectomy (3) and wedge parenchymal resection (2). Thirty patients (85.7%) presented a typical carcinoid and five (14.3%) atypical carcinoid. Peribronchial and/or hilar lymphonodal metastases were present at surgery in 2 cases (5.7%), both centrally located and atypical. The typical carcinoids showed a real 5 years survival rate of 95.8% (with only one death, not related to the neoplasm), while that of the atypical carcinoids was 80% (one patient died of multiple metastases). CONCLUSIONS: The conclusions is drawn that although the carcinoid tumours are a distinct group of neuroendocrine lung neoplasms with a good prognosis in the majority of the cases, lobectomy and sleeve lobectomy are still the standard resection procedure for the majority of carcinoids. For atypical carcinoids lobectomies are the minimal oncologic surgical treatment.

Adolescent↗
PubMed1999

A pitfall with the use of 111In-pentetreotide scintigraphy in the resected bronchopulmonary carcinoids follow-up: a case report.

AIM: To re-evaluate the use of 111In-pentetreotide scintigraphy (Octreoscan) in the follow-up of patients operated for carcinoids, as second-step investigation, after chest X-ray, CT-scan and serological marker' levels. METHODS AND RESULTS: We describe the case of a female patient, 58-year-old, operated on for a non-secretory lung carcinoid. Five years after surgery, the CT-scan showed the enlargement of the bilateral hylo-mediastinal lymph nodes, suggestive for carcinoid recurrences. In order to confirm that, the patient was submitted to an Octreoscan that showed the presence of enlarged hylo-mediastinal adenopathies matching with the lesions observed at the CT-scan. Because the serological examination of NSE, chromogranin and serotonin, and the 5-HIIA were in the normal range, the patient was submitted to a lymph node biopsy through a mediastinoscopy. The histological examination of the specimens revealed a sarcoidosis and the patient was started on steroid therapy with good outcome. CONCLUSIONS: We conclude that: 1. the octreoscan scintigraphy in the follow-up of resected carcinoids can give false-positive results and 2. in consequence, the mediastinoscopy is a discriminating investigation in case of mediastinal lymph nodes disease.

Carcinoid Tumor↗
PubMed1999

Difficulties with CT-guided needle biopsy and VATS, as combined approach for the diagnosis and treatment of peripheral pulmonary nodules: a case report.

AIM: To re-evaluate the use of CT-guided needle biopsy and VATS, as our combined approach protocol for the diagnosis and treatment of peripheral pulmonary nodules. METHODS AND RESULTS: We describe the case of a male smoking patient, 50-year-old, who came to our service for the histological diagnosis of a right pulmonary lesion incidentally revealed. He was submitted to our diagnostic and therapeutic protocol for peripheral pulmonary nodules, that is a combined approach of CT-guided needle biopsy, anchorage of the lesion and VATS resection. Difficulties with this technique can raise when: 1. the cytological CT-guided needle biopsy is not diagnostic, 2. the anchorage is not successful, 3. the malignancy of the lesion cannot be surely determined by the extemporary histological examination. In this patient all these difficulties were encountered. CONCLUSIONS: We conclude that our diagnostic and therapeutic protocol for peripheral pulmonary nodules is not invalidated by this experience, even in consideration of the fact that we applied successfully the protocol in several previous cases.

Adenocarcinoma, Mucinous↗
PubMed1997

Chloroquine versus pyrimethamine/sulphadoxine in the treatment of uncomplicated P. falciparum malaria in northern Kenya.

The response of P. Falciparum to chloroquine (CQ) and pyrimethamine-sulphadoxine (PSD) in vivo was investigated in 173 indigenous uncomplicated malaria patients at Sololo Hospital, Moyale district in northern Kenya. All the patients were symptomatic and parasitaemic. They were divided in two age groups (children < 10 years, adults > 10 years). They were randomly assigned to receive either CQ or PSD standard treatment and then followed up at 7 and 14 days. In the child group, out of 91 patients enrolled, 65 (71.4%) completed the seven-day study; among these 38 (17 females and 21 males with mean age of 41.9 months) were treated with CQ and 27 (11 females and 16 males with mean age 39.1 months) with PSD. Parasites were significantly (p < 0.001) more resistant to CQ (18/38, 47.4%) than PSD (0/27, 0%). In the adult group, out of 82 patients enrolled, 54 (65.9%) completed the 7-day-study, and among these 27 (10 females and 17 males with mean age of 22.5 years) were treated with CQ and 27 (11 females and 16 males with mean age of 23.2 years) with PSD. Parasites were significantly (p = 0.01) more resistant to CQ (7/20, 25.9%) than PSD (0/27, 0%). Overall, considering the 119 patients who completed the follow-up, the resistance of P. falciparum was significantly higher (p < 0.001) to CQ (25/65, 38.5%) than to PSD (0/54, 0%). Out of the 94 patients with negative slide at day 7, fifty seven came at the control of the day 14 (30 children and 27 adults). Among them, 22 were in CQ group and five were found positive (22.7%), while the 35 patients in PSD group all tested negative (p = 0.006). The resistance to CQ in the children group was 25% (p = 0.05) and 20% in the adult group (p = 0.13). We conclude that the significant parasitological resistance to CQ in the area under study questions the continued use of CQ as first line antimalarial treatment. On the contrary, PSD can still be considered a very effective drug against P. falciparum in northern Kenya.

Adolescent↗
PubMed1996

Tropical pyomyositis.

Tropical pyomyositis (TP), a suppurative disease caused predominantly by Staphylococcus aureus, is responsible for 3% to 4% of surgical admissions in some hospitals in certain tropical countries. This study describes the clinical features of 35 patients with TP (20 males, 15 females; mean +/- SD age 28.3 +/- 14.1 years) admitted to our hospital during a 1-year period and analyzes the causal association between ancylostomiasis, human immunodeficiency virus (HIV) infection, and TP. Concerning the supposed etiologic association between Ancylostoma duodenale infection and TP, among the 35 patients with TP the stool examination of 22 (62.8%) revealed the presence of eggs of A. duodenale. In a control group of 100 asymptomatic subjects the prevalence of ancylostomiasis was 55%. The Odds ration between the two groups is 1.38 (exact 95% confidence limits = 0.59 < OR < 3.34). Furthermore, the pus from all TP abscesses (41 in 35 patients) was carefully collected and examined microscopically, but nematode larvae were not detected in any of the specimens. Hence these results do not support an association between ancylostomiasis and TP. With the aim of correlating TP with HIV infection, I carried out a case-control comparison of HIV seroprevalence among the patients affected by TP and an age- and sex-matched control group of healthy subjects. Eleven patients with TP were HIV antibody-positive (seroprevalence 31.42%), as were two controls (seroprevalence 5.71%). The matched analysis produced a Mantel-Haenszel matched Odds ratio of 5.50 and a maximum likelihood estimate of OR (MLE) of 5.50 (exact 95% confidence limits for MLE: 1.20 < OR < 51.07). Among the 11 patients HIV-seropositive, 9 (81.8%) fulfilled the World Health Organization clinical case definition (CCD) for AIDS, compared with 1 of 24 (4.1%) HIV-negative subjects. The chi-square test for difference in fulfilling the CCD for AIDS between patients with TP seropositive and seronegative result was statistically significant (p < 0.0001). It is concluded that TP is a bacterial infection highly significantly associated with HIV infection and thus must be considered a strong sign of stage III-IV of HIV disease.

Adolescent↗
PubMed1995

Evaluation of performance of reused HIVCHEK 1 + 2 test blocks which have shown negative result: a reliable method for rural hospital?

The performance of the reusing of test membranes which have been used previously for negative tests for the detection of antibody to HIV (HIVCHEK 1 + 2 of Ortho Diagnostic Systems, Paris, France) was evaluated under field conditions. The sensitivity and specificity of the reusing strategy compared with a HIV determination obtained by using new HIVCHECK 1 + 2 tests were 89.1% and 100%, respectively. The positive predictive value was 100% and the negative predictive value was 91.5%. The authors conclude that the reduction in sensitivity of the reusing strategy in comparison with the use of new tests makes this strategy ethically unacceptable for the detection of HIV infection in blood donors. On the other hand, the reusing strategy could be very useful for diagnostic purpose and for epidemiological HIV surveillance in resource-poor countries.

AIDS Serodiagnosis↗