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Biomedical subjects

M De Pasquale

Publications and source records attributed to M De Pasquale.

17 recordsLinked to original sources
PubMed2002

A long-term follow-up of autoaugmentation in myelodysplastic children.

OBJECTIVE: To evaluate the long-term results of patients who underwent bladder autoaugmentation (BA) in whom BA was used to treat a neuropathic bladder secondary to myelomeningocele, and who presented with a high-pressure/poorly compliant bladder. PATIENTS AND METHODS: Eleven patients (eight girls and three boys, mean age 12.8 years, mean follow-up 6.6 years) were selected who had undergone BA between June 1991 and June 1994. At surgery, the patients had a poorly compliant bladder with a mean leak point volume (LPV) of 94 mL and a mean leak point pressure (LPP) of 58 cmH2O. None of the patients had vesico-ureteric reflux (VUR) at BA; five with grade III or IV VUR had undergone endoscopic correction in a day-surgery procedure using a suburethral collagen injection 1-3 weeks before BA. The patients were evaluated using clinical, urodynamic, radiological and endoscopic assessments. The LPV, LPP and safe bladder capacity (SBC, the cystometric volume at an intravesical pressure of 40 cmH2O) were recorded. RESULTS: At 1 year after surgery the mean LPV was 297 mL; none of the patients had VUR. The most recent mean LPV was 198 mL and the SBC 167 mL. The mean LPP remained stable at 60 cmH2O. At the last follow-up four patients had recurrent uni- or bilateral grade III-V VUR. At endoscopy the 'augmented' bladder portion had a smooth surface, compared with the grossly trabeculated lower half. From this finding all patients on clean intermittent catheterization were treated with oral oxybutynin. Some patients reported slightly less abdominal pain at maximum bladder volume; four needed pads to treat intermittent incontinence. On voiding cysto-urethrography, one patient had an hourglass-shaped bladder. Five patients recently underwent ileocystoplasty because of recurrent urinary tract infection, high-grade VUR and incontinence. CONCLUSION: These results do not justify the routine use of BA in hypertonic/poorly compliant bladders secondary to myelomeningocele. The mean follow-up of 6.6 years showed that this procedure failed in seven of 11 patients. Further studies might be able to identify subgroups in which this approach may be more appropriate.

Child↗
PubMed2001

Functional evaluation of tubularized-incised plate repair of midshaft-proximal hypospadias using uroflowmetry.

OBJECTIVE: To determine objectively, using uroflowmetry, the functional results of the tubularized-incised plate urethroplasty to repair midshaft-proximal hypospadias. PATIENTS AND METHODS: Twenty-one patients (mean age 4 years, mean follow-up 1.8 years) were selected from those undergoing surgery between January 1996 and January 1998 at our institution. All patients had midshaft-proximal hypospadias and were treated using the Snodgrass technique. Patients were included if they were able to void volitionally and had no fistula. The flow pattern, maximum (Qmax) and mean flow rate (Qave) were measured; the results were expressed as percentiles and compared with published values from normal children. The Qmax and Qave were considered normal if > 25th percentile, as equivocally obstructed when in the 5-25th percentile and obstructed if < 5th percentile. RESULTS: Fourteen patients were considered normal, four as equivocally obstructed and three as obstructed. Of the second group, one patient had a urethral diverticulum at the native meatus (confirmed by voiding cysto-urethrography) and the remaining three patients had meatal stenosis that responded to dilatation, with normal flow in two and improvement in the other. Of the obstructed group, one patient responded to dilatation and two underwent meatoplasty. CONCLUSION: The tubularized-incised plate repair provides satisfactory functional results for midshaft-proximal hypospadias; uroflowmetry is an important noninvasive tool to evaluate this technique. A long-term follow-up is needed to confirm these results.

Child, Preschool↗
PubMed2001

MAGPI procedure in meatal regression after hypospadias repair.

OBJECTIVE: To evaluate the efficacy of MAGPI's procedure in children who had a meatal regression after hypospadias repair. PATIENTS AND METHODS: Twenty-one children affected by post-hypospadias repair meatal regression underwent a modified MAGPI repair between January 1992 and January 1999: the patients, aged between 3 and 12 years (mean 5.9), had previously undergone hypospadias repair according to the techniques of Duplay (11 patients), Mathieu (2 patients), Snodgrass (5 patients) or the onlay buccal mucosa graft (3 patients). The outcome of the procedure was evaluated in terms of urinary stream and cosmetic appearance. RESULTS: The results were good in 18 patients, fair in 2, unchanged in 1. CONCLUSIONS: MAGPI's repair has proven to be very effective as a secondary procedure in meatal regression after hypospadias correction, with minimal morbidity and a highly successful outcome in terms of satisfactory functionality and cosmetic appearance, and the recovery of gaps as large as 9 mm.

Child↗
PubMed2001

Electromyographic and manometric anorectal evaluation in children affected by neuropathic bladder secondary to myelomeningocele.

BACKGROUND: Fecal incontinence, with or without persistent constipation is often underestimated in children affected by spina bifida. Medullar lesions to the L-S metameres result in a slowing of rectal and/or rectal-sigmoid motility, loss of anal or rectal sensation, deranged external anal sphincter function, altered motility of the anal levator muscles, and loss of motor coordination of the internal sphincter. We conducted an electromyographic and electromanometric evaluation of the anorectal tract in a group of children affected by myelomeningocele (MMC) in an attempt to evaluate the degree of functional damage and to provide appropriate treatment. METHODS: Anorectal manometry was conducted in 83 children affected by MMC (2-16 yrs, mean age: 8.4 yrs); surface electromyography was also performed in 37 of these children. We thus evaluated overall sphincter pressure, the inhibitory anal reflex, the rectal sphincteric reflex and rectal motility during stimulation and at rest. Recording perfusion catheters (0.1 ml/sec) were placed at rectal and anal level; rectal stimulation was conducted with an endorectal balloon. RESULTS: In all patients there was a reduction in overall sphincter pressure (15-25 mmHg; n.v. 45+/-25 mmHg) and the functional length of the anal canal (1-1.8 cm) compared with age matched controls. The inhibitory anal reflex was normal in all patients, although its amplitude, duration and sensitivity were not constant. Similar findings were obtained for the rectal-sphincteric reflex. The rectal sigmoid motility results were difficult to interpret: sudden, fast and high pressure waves of peristaltic progression were followed by prolonged pauses. No correlation was found between urodynamic and anorectal manometric data. Treatment consisted in daily emptying of the rectum so as to avoid fecal retention. Fifteen patients, who presented prolapse and sphincteric hypotonia ( </=10 mmHg), underwent cerclage by 2/0 prolene, with sustained good RESULTS. CONCLUSIONS: While evaluation parameters of the neuropathic bladder are well standardised, data on the neuropathic rectum are contradictory. Moreover, the results of functional examination are not always an aid to treatment strategy. Therefore, further studies are required to establish an appropriate diagnostic-therapeutic protocol.

Adolescent↗
PubMed2000

[Mouth mucosa free-flap grafts in repeat operations of hypospadias].

BACKGROUND AND AIMS: Buccal mucosal grafts are widely used in the treatment of primary hypospadias and urethral stenosis owing to their elasticity, optimal attachment, possibility of generous harvesting and easy preparation. The aim of this study was to check whether buccal mucosal flaps are also valuable in redo surgery for hypospadias complicated by large breaks in the urethra and with scarce residual genital tissue. METHODS: Fourteen patients aged between 3 and 11 years old (mean age 6.6) were selected and operated between December 1993 and June 1999. The patients presented extensive fistulous tracts, roughly ellipsoidal in shape and with a maximum diameter of between 7 and 42 mm (mean length 18 mm). The original technique was: Duplay (7 patients); Onlay buccal graft (1 patient); Snodgrass (1 patient); Tubulised preputial flap (2 patients); Onlay preputial graft (2 patients); Tubulised vesical mucosal flap (1 patient). The mucosal flap, taken from the lower lip, was used to cover the gap as an onlay patch and recovered with residual genital skin with the interposition, where possible, of a de-epithelised flap. RESULTS: An optimal cosmetic and functional result was achieved in 10/14 cases with flowmetry > 25 percentile according to Toguri nomograms. Three patients presented fistulas: one punctiform fistula resolved spontaneously. The other two cases resolved after corrective surgery. One patient showed meatal regression with slight stenosis that was resolved with MAGPI. CONCLUSIONS: These results appear to be encouraging. Buccal mucosal graft may represent a valid alternative also in the treatment of secondary hypospadia with large breaks in the urethra. No complication was reported in the harvesting area, even if this was carried out at a second stage in the labial area.

Child↗
PubMed1998

The use of laparoscopy in the diagnosis and treatment of abdominal complications of ventriculo-peritoneal shunts in children.

Ventriculo-peritoneal shunts (VPS) are the most frequent operative procedures used to treat hydrocephalic children. Abdominal complications of VPS are now a rare event; however, their frequency varies from 5% to 47% according to reports. Anything that causes an obstruction or impediment of the VP derivation system will lead to intracranial hypertension, which requires immediate surgery. From 1985 to 1995 at the Division of Pediatric Surgery of the Federico II University of Naples, ten laparoscopies were performed in ten children with VPS complications. Cerebrospinal fluid pseudocysts were found in four infants. There was one case of abdominal wall perforation by the tip of the catheter at the umbilical level, two bowel obstructions, and one catheter was lost in the abdominal cavity. Finally, two children had malfunctioning of the peritoneal limb of the catheter. The laparoscopic technique was curative in all ten cases, thus avoiding a conventional laparotomy and the consequent risk of adhesions, which could cause further complications.

Abdominal Injuries↗
PubMed1998

Laparoscopic management of ovarian cysts in newborns.

BACKGROUND: Cysts are the most common ovarian masses found in newborn girls. Spontaneous regression, which occurs in approximately 25-50% of cases, is more frequent with smaller cysts. Pre- or postnatal complications are common; these complications may consist of intracystic bleeding, torsion of the cyst or corresponding annex, or self-amputation of the cyst. When the cyst is <4 cm it is possible to perform a simple echographic monitoring to check for the possibility of spontaneous involution; all other cases require surgery. METHODS: Between February 1985 and June 1997, we treated 22 neonatal ovarian cysts laparoscopically. In 14 cases, the right side was involved; in eight cases, it was the left. The patients' ages ranged between 7 days and 5 months (median, 45 days). In all cases, we used three trocars. An intraperitoneal cystectomy was done in eight cases, a transparietal cystectomy in four cases, an ovariectomy in seven cases, and the simple removal of the cyst in one case where self-amputation had occurred. In two cases of bilateral pathology, the cysts, which were <1 cm, were left untreated. RESULTS: Average operating time was 40 min (range, 25-60 min). Intraabdominal pressure never exceeded 6-8 mmHg during the intervention. The postoperative course was always under 3 days. No intra- or postsurgical complications were recorded, and long-term ultrasonographic follow-ups were all normal. CONCLUSION: Our experience indicates that the laparoscopic approach is a reliable and safe technique in the treatment of neonatal ovarian cysts.

Female↗
PubMed1998

Splenectomy in childhood. The laparoscopic approach.

BACKGROUND: We set out to analyze the results of the first 19 laparoscopic splenectomies performed by our team in order to show the advantages and limitations of the laparoscopic approach to this kind of procedure in children. METHODS: Between March 1994 and June 1997, 19 children underwent laparoscopic splenectomy; two of them also had a concomitant cholecystectomy. Their ages ranged between 4 and 14 years (median, 7.2 years). There were 14 girls and 5 boys. All the patients underwent elective laparoscopic splenectomy: seven children had hereditary spherocytosis, six were affected by a beta thalassemia, five had an idiopathic thrombocytopenia purpura, and one presented with sickle cell disease. RESULTS: Mean operating time was 145 min (range, 110-240 min). Hospital stay ranged from 2 to 5 days (median, 3 days). In three patients, the spleen was removed with a 7-cm mini-laparotomy, according to the technique of Pfannenstiell, in the suprapubic region. In the other 16 cases, the spleen was captured into a extraction bag, finger-fragmented, and removed from the umbilical orifice. CONCLUSIONS: Laparoscopic splenectomy can be performed only when the spleen can be removed through the umbilical orifice with an extraction bag. For this reason, preoperative ultrasonography is necessary to measure the exact spleen volume. When the spleen is very large, an open splenectomy is preferable.

Adolescent↗
PubMed1997

Laparoscopic versus traditional fundoplication in the treatment of children with refractory gastro-oesophageal reflux.

BACKGROUND/AIMS: A retrospective study has been carried out on the last 20 consecutive patients operated for gastro-oesophageal reflux to compare the results of the traditional operation with those using the laparoscopic approach. METHODS: In ten cases, the operation was performed with an open traditional approach and in the other 10 cases using laparoscopy. The mean age of the patients was 7 years and their mean weight was 20 kg. There were 11 girls and 9 boys. We used a 360 degrees Nissen fundoplication in the patients operated on via laparotomy and a Nissen-Rossetti fundoplication in patients operated on via laparoscopy. RESULTS: Mean operating time was 65 minutes for traditional surgery and 100 minutes for laparoscopy. There were two complications: 1 case of oesophageal perforation in a child affected by endo-brachyoesophagus with peri-oesophagitis, operated using the laparoscopic technique, and one case of wound infection in a child operated with the open technique. The hospital stay was remarkably shorter and less painful for the children operated on laparoscopically. At 13-month mean follow-up, all 20 patients are alive and present no reflux symptoms. CONCLUSIONS: Our results demonstrate that laparoscopic surgery is a valid alternative to the traditional surgical approach for the treatment of gastro-oesophageal reflux.

Adolescent↗
PubMed1995

Reduced left ventricular mechanical efficiency in elderly patients with coronary artery disease.

We evaluated left ventricular (LV) mechanical efficiency in 23 elderly patients (mean age 67 +/- 2) with coronary artery disease (CAD) and in 22 patients younger than 65 years (mean age 49 +/- 8) with similar severity of CAD (2.4 +/- 0.8 and 2.2 +/- 0.8 vessels per patient, respectively) and history of myocardial infarction (34% and 41%, respectively). LV mechanical efficiency was calculated as the ratio of LV work per minute and myocardial O2 consumption. LV stroke volume was calculated from left ventriculography. Coronary blood flow was measured by thermodilution. Older patients had lower values of LV stroke volume (49 +/- 16 vs 73 +/- 16 mL, p < 0.005), ejection fraction (41 +/- 17 vs 58 +/- 17%, p < 0.05), LV stroke work (93 +/- 26 vs 131 +/- 41 g.m., p < 0.02) and LV work per minute (6.7 +/- 2.6 vs 9.3 +/- 2.7 kg.m./min, p < 0.05). Since myocardial O2 consumption was similar in the two groups, LV mechanical efficiency was lower in older CAD patients (16.2 +/- 15 vs 23.8 +/- 12%, p < 0.05). Thus, elderly patients with CAD show a reduced LV mechanical pump performance and efficiency, compared with younger patients with similar disease severity and history of myocardial infarction. These observations may contribute to understanding the higher frequency of congestive heart failure in elderly patients with CAD.

Adult↗
PubMed1989

Interference of prenatal and postnatal exposure to Ca2+-antagonist agents on rat functional development of vascular system.

Exposure to drugs during pregnancy can alter functional development of the vascular system. The present investigation was carried out in order to evaluate the effects of prenatal and postnatal exposure to Ca2+-antagonist (diltiazem, verapamil, and nimodipine) drugs on the development of rat vasomotor reactivity. Studies were carried out on pregnant female albino rats exposed from the first day of pregnancy until weaning to diltiazem and verapamil (6 and 24 mg/kg in their drinking water ad libitum) and nimodipine (3 and 12 mg/kg in their food ad libitum). After weaning, pups were exposed until the 60th day of age to the same treatment as their mothers were. Afterwards, pups from the 60th to 90th day of age were fed with a normal diet. In 30-, 60-, and 90-day-old conscious and anaesthetized pups, we evaluated the following: 1) systolic arterial blood pressure; 2) vasomotor responses elicited by various agents: L-noradrenaline (0.1, 1, and 5 micrograms/kg IV), L-isoprenaline (0.01, 0.1, and 1 micrograms/kg IV), and acetylcholine (0.01, 0.1, and 1 micrograms/kg IV) and by sinus-carotid baroreceptor stimulation; and 3) catecholamine, acetylcholinesterase, and adenosinase plasma levels. Prenatal and postnatal exposure to Ca2+-antagonist drugs significantly (P less than .05) decreased the pressor response to sinus-carotid baroreceptor stimulation and to L-noradrenaline and increased the hypotensive responses to L-isoprenaline and acetylcholine. Moreover, this type of treatment, although it induced a significant (P less than .05) decrease of catecholamine plasma levels, did not modify the acetylcholinesterase and adenosinase plasma levels in 30- and 60-day-old rats. On the 90th day of age, the evaluated parameters were not different from those of control rats. Our results showed that exposure to Ca2+ antagonists during pregnancy and the postnatal period may alter the functional development of rat vasomotor reactivity.

Acetylcholinesterase↗
PubMed1987

Azlocillin and the immune response in intensive care.

The authors have followed the course of the immunological cellular and humoral parameters in 12 patients in the Intensive Care Unit at the University Polyclinic of Messina having grave infections of the respiratory apparatus, for which an antibiotic therapy with azlocillin, semisynthetic penicillin was carried out; all this with the aim of pointing out any possible interferences with the already precarious immune system in such patients. The results obtained seem to exclude any immunodepressing activity by the molecule.

Adolescent↗