Biomedical subjects
Publications and source records attributed to L Maniscalco.
The Authors report their experience in the treatment of groin hernias. Over the years, hospital stay and anaesthetic procedure were modified without compromising the quality of results. The Authors conclude that groin hernia may be treated in a outpatient or day surgery regimen saving money.
An increased fetal DNA concentration in maternal plasma has been observed in placental pathological conditions associated with hypertension and preeclampsia. To confirm these data, we performed real-time quantitative PCR on the SRY gene in a group of physiological and pathological male-bearing pregnancies. In 78 physiological pregnancies, fetal DNA concentration in maternal plasma was 20.7, 13.4, 23.6, and 74.8 genome-equivalents (g.e.)/mL during the first, second, and third trimesters and at term, respectively. In 10 preeclamptic women, fetal DNA concentration ranged from 59.3 to 615.2 g.e./mL (median: 332.9). In 7 women with preeclampsia and IUGR (intrauterine growth retardation), fetal DNA ranged from 96.5 to 859 g.e./mL (median: 146.8). In 4 women with IUGR and hypertension, fetal DNA ranged from 34 to 473.5 g.e./mL (median: 142.4). In 3 patients with IUGR, fetal DNA ranged from 168.6 to 519.7 g.e./mL (median: 308.1). In 2 patients with IUGR and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, fetal DNA concentration ranged from 105 to 394.1 g.e./mL (median: 249.7). Four women who developed preeclampsia some weeks later showed fetal DNA levels within the physiological range. These data suggest that increased fetal DNA concentrations might represent a valuable marker of placental abnormalities and suggest that this rise may precede clinical manifestation of preeclampsia by only a few weeks.
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The authors report their experience of 21 cases of post-traumatic hernias of the diaphragm. On the basis of the results obtained by discussion of etiologic, diagnostic and therapeutic patterns they make at the conclusion that the high mortality, associated with diaphragmatic hernias, can be reduced only with a short time of diagnosis and a prompt surgical treatment of the associated lesions.
The objective of the study was to evaluate the significance of the determination of antithyroid antibodies in hyperthyroid patients. Two-hundred-fifteen untreated Graves' hyperthyroid patients (active toxic diffuse goiter-TDG), 54 Plummer's hyperthyroid patients (focal hyperthyroidism) and 46 subjects with other forms of hyperthyroidism were studied. Serum levels of T4, T3, TSH, TSH receptor antibody (TRAb), microsomal antibody (TMAb), and thyroglobulin antibody (TGAb) were evaluated before starting treatment, at regular intervals during therapy, and during the follow-up period after therapy was withdrawn. The antibodies were positive in all patients with active and non-active TGD but positive in only two patients (3.7%) with focal hyperthyroidism. During the treatment interval, TRAb, TMAb and TGAb serum levels fell with a nadir in the 7th month of therapy. In particular, TRAb fell to normal levels in all patients who had basal levels less than 500 U/l (97.7% of the cases) while TMAb and TGAb remained positive. Relapses, following the completion of therapy, occurred in 20.4% after one year and in 33% after two years. Relapses were always linked to a new increase in TRAb. In conclusion, TRAb can be useful in the determination of early disease and in diagnosing remission. It did not appear useful as a prognostic indicator for relapse in individual patients.
The authors illustrate the cases of spontaneous pneumothorax observed in their institute along with the diagnostic and therapeutic aspects. In accord with the experience of others as reported in the literature, they stress the importance of a precise, immediate diagnosis for the purposes of adopting the treatment of choice: in the presence of closed, partial forms a conservative approach is to be preferred, whereas in open and/or hypertensive cases an aspirative thoracic drainage must be provided without delay. Aggressive surgical treatment, with resection of the bullous lesions responsible for bronchopleural fistulas, will resolve the condition and should be implemented after a reasonable waiting period with aspirative drainage, or even, electively, in the first instance, in the presence of multiple relapses. In any event, the authors stress the need to avoid uncertainty and delay in view of the youthful age of most of the subjects affected and the potential danger of the complications of this apparently banal disease.
The authors considered a series of 13 patients undergone surgical operation for primary malignant lymphoma of digestive system, with gastric, gastro-jejunal, jejunal, ileal and colic localization. They examined diagnostic and therapeutic features and the follow-up data. According to literature, the authors remark the importance of roentgenology and endoscopy, that together with bioptic data may reach a definite and early diagnosis; an elective and wide surgical exeresis seems useful in early stages, showing a better prognosis and epithelial malignancies. IV stage patients, however, had a very poor survival; a quick management appears today the only factor affecting long-term results in these patients.
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The authors considered the possibility, for purposes of total parenteral nutrition, to use lyophilized amino-acids as an alternative to the traditional amino-acid solutions, and resolved to check their nutritional and metabolic effectiveness. For this purpose, they appraised some parameters concerning the proteic metabolism in two homogeneous groups of surgical patients, subjected to T.P.N., one with crystallized amino-acids in solution and the other with lyophilized amino-acids. The supply in glucides and in lipides was identic in both groups. It appears evident from the results that the lyophilized amino-acids not only show the advantage of being administrable in nutritional mixtures with reduced volume, but also represent a valid plastic source, and can surely replace the traditional commercial amino-acid solutions.
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Ten patients, undergone major hepatic resections, treated with parenteral hyperalimentation in the postoperative period, were studied. Considered parameters were: free plasma amino acid levels and daily nitrogen balance. By comparing the trends of parameters under study with a group of patients, also hepatectomized but not treated with T.P.N., the importance of a high energetic and plastic post-operative intake is outlined. T.P.N. following major hepatic surgery appears particularly useful when the quality of the exogenous Nitrogen intake is carefully selected.
The Authors study the effect of intravenous L-Carnithine on the free plasma amino acid pattern in the post-operative course of a group of 25 selected patients who underwent toracic and abdominal elective surgical procedures. They compared the results with the data from another group of patients, in conditions similar to the former, but who did not receive Carnithine. The results show that Carnithine is able to reduce gluconeogenesis and proteolysis, probably by an improvement of lipolysis; so the Authors believe that Carnithine carries a useful contribution in the post-operative care of the surgical patient.
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Three cases of carotid body paragangliomas are reported. The authors underline the critical diagnostic role of carotid arteriogram whenever such disease is suspected. Surgical treatment can lead to good results even in malignant forms. In the latter, treatment should be completed with radiotherapy.
The Authors examined the seminal liquid of 60 patients suffering from non-obstructive oligosperma after different treatments. On the basis of the results obtained, they emphasize the importance, after operation, of the medical treatment in the normohormonal varicocelic patients. They suggest the surgical treatment in the non-varicocelic subjects, in who an inversion of the veenous flux in an inside spermatic vein was ascertained.
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