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Biomedical subjects

M Raffaelli

Publications and source records attributed to M Raffaelli.

At least 37 records · Page 2Linked to original sources
PubMed2000

Minimally invasive video-assisted parathyroidectomy: lesson learned from 137 cases.

BACKGROUND: Since February 1997, a technique of minimally invasive video-assisted parathyroidectomy (MIVAP) was developed at our institution for the treatment of sporadic primary hyperparathyroidism (sPHPT). In this study we analyzed the entire series of patients who underwent MIVAP during the last 3 years. STUDY DESIGN: One hundred thirty-seven patients with sPHPT were selected for MIVAP. Selection criteria were: diagnosis of single adenoma based on preoperative localization studies (ultrasonography, sestamibi scintigraphy, or both), and no previous neck surgery or concomitant large multinodular goiter. The procedure, already described, is performed by a gasless video-assisted technique through a single 1.5-cm central skin incision above the sternal notch. Quick, intraoperative parathyroid hormone assay was used in 134 cases (97.8%) to confirm the complete removal of all hyperfunctioning parathyroid tissue. RESULTS: Mean operative time was 54.3 +/- 22.6 minutes. The conversion rate was 8.8%. One laryngeal nerve palsy was registered (0.7%), as was one case of persistent hyperparathyroidism. In six patients (4.4%) a transient symptomatic postoperative hypocalcemia was observed. Two thyroid lobectomies were associated using the same minimally invasive access. At a mean followup of 15.4 +/- 10.6 months, all but two patients were normocalcemic. The cosmetic result was considered excellent by most of the patients (92.8%). CONCLUSIONS: Although not all patients with sPHPT are eligible for MIVAP, this approach can now be proposed in a bigger proportion (67% of patients). As already demonstrated in a previous study, also in a large series of patients, after greater experience has been achieved, the results and the operative time are the same as in traditional surgery, with better cosmetic result and a less painful course.

Adenoma↗
PubMed2000

The "false" nonrecurrent inferior laryngeal nerve.

BACKGROUND: Communicating branches between the cervical sympathetic system and the inferior laryngeal nerve (ILN) have been described. They usually originate from the middle cervical sympathetic ganglion (MCSG). These branches (sympathetic-inferior laryngeal anastomotic branch [SILAB]), usually thin, sometimes have the same diameter as the ILN. In this study we prospectively evaluated the frequency of this condition and its implications during surgical neck exploration. METHODS: From November 1998 to October 1999, 791 patients underwent surgical neck exploration, and 1253 ILNs were dissected: 656 on the right side (52.3%) and 597 on the left side (47.7%). RESULTS: On the right side, a nonrecurrent ILN was found in 3 cases (0.46%), and a large SILAB was found in 10 cases (1.5%). The SILAB originated from the superior cervical sympathetic ganglion in 2 cases and directly from the sympathetic trunk above the MCSG in 8 cases. No anomalous branch was found on the left side. CONCLUSIONS: The SILAB may originate not only from the MCSG but also from the superior cervical sympathetic ganglion or directly from the sympathetic trunk. When the SILAB is as large as the ILN, it could be mistaken for a nonrecurrent ILN. The awareness of this anatomic condition during neck dissection may help to avoid injuries of the genuine ILN running in the usual pathway.

Adolescent↗
PubMed2000

The hemodynamic and metabolic effects of tourniquet application during knee surgery.

UNLABELLED: We evaluated the effects of tourniquet application on the cardiovascular system and metabolism in 10 young men undergoing knee surgery with general anesthesia. The duration of inflation was from 75 to 108 min. Heart rate, mean arterial pressure, cardiac index (CI) by pulse contour method, and systemic vascular resistance were measured before, during, and after tourniquet inflation. pH, PaO(2), PaCO(2), and lactate blood concentrations were also measured. VO(2) and VCO(2) were assessed every minute from tracheal intubation up to 15 min after tourniquet deflation and VO(2) in excess of the basal value over the 15 min after deflation (VO(2)exc) was calculated. Mean arterial pressure increased 26% (P: < 0.05) during inflation and returned to basal values after deflation. CI did not change immediately after inflation; although, thereafter, it increased 18% (P: < 0.05). Five minutes after deflation, CI further increased to a value 40% higher than the basal value. Therefore, systemic vascular resistance increased 20% suddenly after inflation (P: < 0.05) and decreased 18% after deflation (P: < 0.05). VO(2) and VCO(2) remained stable during inflation and increased (P: < 0.05) after deflation. VO(2)exc depended on duration of tourniquet inflation time (Tisch) (P: < 0.05). After deflation, PaCO(2) and lactate increased (P: < 0.05) while Tisch increased. We conclude that tourniquet application induces modifications of the cardiovascular system and metabolism, which depend on tourniquet phase and on Tisch. Whether these modifications could be relevant in patients with poor physical conditions is not known. IMPLICATIONS: The clinical effects of tourniquet application were evaluated in 10 young men undergoing knee surgery. Our data indicate that tourniquet application causes hemodynamic and metabolic changes which may become clinically relevant after a long period of tourniquet inflation, particularly in patients with concomitant cardiovascular diseases.

Adolescent↗
PubMed2000

Influence of abuse and partner hypermasculinity on the sexual behavior of Latinas.

This study investigated whether abuse and partner hypermasculinity influenced sexual behavior change among 46 Latinas (mean age = 34.5 years) who participated in an HIV prevention study. After completing a baseline interview, women were randomized to either an HIV prevention intervention or a health promotion control. Three months later, they took part in follow-up interviews, including an assessment of relationship characteristics. The majority (93%) of participants reported psychological abuse from their sexual partner during the study period, and over two fifths experienced physical abuse. Contrary to expectations, sexual behavior change was not related to abuse or partner hypermasculinity. However, women in the HIV prevention condition who gave their partner higher hypermasculinity ratings reported fewer conversations regarding condoms. Moreover, most of the sexual risk reduction observed at follow-up was the result of abstinence rather than consistent condom use. The findings provide insight into the reality that characterizes the relationships of many Latinas.

Adolescent↗
PubMed1999

Should laparoscopic approach be proposed for large and/or potentially malignant adrenal tumors?

INTRODUCTION: Laparoscopic adrenalectomy (LA) is safe and effective for small, benign, functioning tumors. Whether it should be performed for other adrenal tumors is questionable. The aim of this study was to evaluate and compare the complications and results of 150 consecutive LAs performed either for small benign tumors or for large and/or potentially malignant tumors. METHODS: Between June 1994 and August 1998, we performed 150 LAs in 142 patients. We used a transperitoneal flank approach in the lateral decubitus position. Initially, our indications for LA were limited to small (<4 cm) benign tumors (group I, n=102): 56 aldosteronomas, 33 Cushing's syndrome, 11 pheochromocytomas and 2 nonfunctional tumors. Progressively, based on increasing experience, LA was also proposed for tumors larger than 4 cm or potentially malignant (group II, n=48): 5 Cushing's syndrome, 1 androgen-producing tumor, 14 pheochromocytomas and 28 nonfunctional tumors. Preoperative demonstration of invasive extra-adrenal carcinoma remained an absolute contraindication for LA. RESULTS: Mean tumor size was 21.1 mm in group I and 51.6 mm in group II. All tumors in group I were benign. Six of the 48 tumors in group II were malignant (12.5%). The rate of complication was, respectively, 7.8% and 8.3% in groups I and II. The rate of conversion was, respectively, 4.9% and 6.2% in groups I and II. Mean operative time was 131 min in group I and 129 min in group II. The endocrinopathy was cured in all patients. To date, no recurrences have been observed. CONCLUSIONS: LA can be proposed for large (<12 cm) or potentially malignant adrenal tumors provided preoperative investigations have not demonstrated invasive carcinoma. An open procedure should be performed instead if local invasion is observed at the start of the operation.

Adrenal Gland Neoplasms↗
PubMed1999

Minimally invasive, totally gasless video-assisted thyroid lobectomy.

BACKGROUND: Neck surgery is one of the newest fields of application of video-assisted surgery. We developed a technique for minimally invasive, totally gasless video-assisted thyroid lobectomy. METHODS: The procedure was accepted by a patient with a follicular nodule of the left lobe of the thyroid. We performed a left thyroid lobectomy through a single 20-mm horizontal skin incision, just above the sternal notch, after inserting a 5-mm 30 degrees laparoscope, by using both endoscopic and conventional instrumentation. RESULTS: The recurrent laryngeal nerve and the parathyroid glands were easily identified and preserved. The operating time was 2.5 hours. No complication occurred. The postoperative stay was 2 days. The cosmetic result was excellent CONCLUSIONS: We concluded that our technique is feasible and safe. This makes us optimistic about the future of minimally invasive, video-assisted thyroid surgery.

Humans↗
PubMed1998

CMF + radiotherapy in the primary treatment of operable breast cancer: preliminary results of a phase II pilot study.

BACKGROUND AND OBJECTIVES: Chemotherapy and radiotherapy have been investigated in several studies about their role in primary (neoadjuvant) treatment before surgery in breast cancer. We proposed a pilot study to evaluate a primary scheme of alternate radio-chemotherapy in the treatment of operable (T2- small T3) breast cancer. METHODS: 14 patients were recruited. Cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) were administered on days 1 and 8, every 4 wk, for two cycles. Radiotherapy was administered during the 3rd and 4th wk (5 d/wk) after the beginning of chemotherapy. The patients were operated on within 24 wk. All the patients received four additional cycles of chemotherapy within 1 mo after surgery. RESULTS: We observed: 1 (8.3%) complete remission (CR), 8 (66.7%) partial remission (PR), 3 (25%) stationary disease (SD); no progressive disease was observed. Modified radical mastectomy was performed on 7 patients (58.3%). Conservative surgery was performed on 5 cases (41.7%). No major complications were observed. No patient has shown local or distant recurrence. CONCLUSIONS: This study shows the feasibility of a primary chemoradiotherapy treatment for breast cancer. But to evaluate the impact of this therapy on overall survival and recurrence risk and its possible introduction in clinical practice, we need larger series and longer follow-up.

Adult↗
PubMed1998

Prognostic factors in differentiated thyroid carcinoma: a multivariate analysis of 234 consecutive patients.

BACKGROUND AND OBJECTIVES: The clinical characteristics and patient outcome of a group of patients treated for differentiated thyroid carcinoma (DTC) were analyzed in order to assess the relative influence of different prognostic factors. MATERIALS AND METHODS: We retrospectively reviewed data about sex, age, size and histologic behavior of the tumor, extrathyroid extension of the tumor, lymph node status, distant metastasis at diagnosis, surgical procedures, and overall survival from 234 patients treated for DTC. Data were submitted to a statistical analysis. RESULTS: Using a univariate analysis, we found that survival rates were significantly influenced by age (P = 0.0001), size (P = 0.018), extrathyroidal extension (P = 0.000001), lymph node involvement (P = 0.03), and distant metastases (P = 0.049). Age and size were independent prognostic factors at multivariate analysis (t = 2.694 and t = 2.443, respectively). CONCLUSIONS: On the basis of our results and of a review of the literature, we conclude that total thyroidectomy is the treatment of choice in DTC, except for small (<1 cm) papillary carcinoma, that could be treated by lobectomy plus isthmectomy, while lymphadenectomy is indicated only in case of macroscopic involvement.

Adolescent↗
PubMed1998

Adrenal cystic lesions: report of 12 surgically treated cases and review of the literature.

Adrenal cysts are rare (0,064%-0,18% in autopsy series) and less than 500 cases have been reported in the western literature. Incidental diagnosis of adrenal cysts, however, is reported with increasing rates. We observed 12 patients with adrenal cyst. Each of them had a careful laboratory and instrumental evaluation; all the patients were operated. In our series about 67% of the patients were symptomatic (6 patients with abdominal pain, 1 with palpable mass, 1 with hemorrhagic shock). No biochemical alteration was observed. Conversely we observed an unusual subclinically hyperfunctioning cystic adenoma, potentially progressive to a clinically recognizable endocrine syndrome. US, CT and MRI had a sensitivity of 66,7%, 80% and 100% respectively. Adrenalectomy was performed in all patients. The pathological findings were: 1 epithelial cyst (cystic adenoma), 2 endothelial cysts (vascular cystic ectasia with adenomatous adrenocortical hyperplasia and 1 vascular cyst) and 9 pseudocysts. On the basis of these results, we conclude that a careful hormonal, morpho-functional and instrumental evaluation is indicated in all adrenal cysts, even if the available diagnostic procedures, even when combined, cannot always define their nature. Surgical excision, when possible by laparoscopic approach, is indicated in presence of symptoms, endocrine abnormalities (even when subclinic), complications, suspicion of malignancy and/or large size (>5 cm). Adrenal gland must be excised en bloc, also because of the possible presence of other adrenal lesions.

Abdominal Pain↗
PubMed1998

Effects of an HIV risk reduction project on sexual risk behavior of low-income STD patients.

A 10-hour small-group informational and skill-building intervention was tested among patients (N = 472) attending publicly funded sexually transmitted disease clinics in Maryland, Georgia, and New Jersey. After completing a 90-minute interview concerning HIV risk behaviors, condom use self-efficacy and condom outcome expectancies, participants were randomized to either an intervention or a control condition. Participants in both conditions displayed significant reductions in unprotected encounters and number of partners and increases in condom use. No differences between treatment conditions were observed, indicating that the motivational effects of the interview may have been stronger than the effects of the intervention in this population.

Adolescent↗
PubMed1998

Parent influences on adolescent peer orientation and substance use: the interface of parenting practices and values.

This study examines how experiences in the family domain may magnify or mitigate experiences in the peer domain, and how processes in both milieus may influence adolescent substance use. The data derived from 666 European American mother-adolescent dyads and 510 European American father-adolescent dyads. Consistent with individuation-connectedness theory, mothers' responsiveness lessened their adolescents' orientation to peers, which, in turn, reduced adolescent substance use. This process was moderated by maternal values regarding adolescent alcohol use; that is, the relation of maternal responsiveness to adolescent substance use depended on the extent of maternal approval or disapproval of adolescent alcohol use. Among fathers, closer monitoring was directly associated with less adolescent substance use, with stronger effects among fathers who held more disapproving values regarding adolescent alcohol use. Theoretical, methodological, and pragmatic implications are given.

Adolescent↗
PubMed1996

Use of folk healing practices by HIV-infected Hispanics living in the United States.

In the absence of a medical cure for AIDS, HIV-infected individuals may seek alternative treatments that are consistent with cultural and social beliefs. This paper examines beliefs about, and use of, folk healing practices by HIV-infected Hispanics receiving care at an HIV/AIDS clinic in inner-city New Jersey. Anonymous individual interviews were conducted with 58 male and 18 female HIV-infected Hispanics aged 23-55, primarily of Puerto Rican origin (61%) or descent (29%). The majority of respondents believed in good and evil spirits (73.7%); among the 56 believers, 48% stated that the spirits had a causal role in their infection, either alone or in conjunction with the AIDS virus. Two thirds of the respondents engaged in folk healing (spiritualism and/or santeria). The main desired outcomes of folk healing included physical relief (44%), spiritual relief (40%), and protection from evil (26%). A number of respondents (n = 9) stated that they hoped to effect a cure by engaging in folk healing. These results indicate that health care professionals treating HIV-positive Hispanics should be aware of the prevalence of folk beliefs and alternative healing practices in this population.

Adult↗
PubMed1995

HIV-related knowledge and risk behaviors of street youth in Belo Horizonte, Brazil. The Street Youth Study Group.

Individual interviews were conducted with 379 youth who work and/or live on the streets of a large Brazilian city to assess HIV-related knowledge, sources of information, risk behaviors, and prevention beliefs and strategies. Respondents demonstrated high levels of factual knowledge about HIV transmission (84% correct) coupled with high levels of misconceptions about casual transmission (53% correct) and intermediate levels of knowledge about prevention (64% correct). Only 54% of the respondents had heard about AIDS recently, and 37.5% said they talked to someone about AIDS. The most common sources of information about HIV/AIDS were the mass-media and friends. Over half the sample reported taking precautions to reduce their risk of HIV infection; however, the proportion of youth taking effective precautions was low. Among the 247 youth (65% of the sample) who had initiated sexual activity, lifetime condom use was reported by 18%, and condom use at last intercourse by 10%. Youth with higher levels of knowledge were more likely to report behavior changes to avoid HIV infection. These findings underscore the urgent need for prevention programs tailored to street youth in developing countries.

Acquired Immunodeficiency Syndrome↗
PubMed1994

[Complications in thyroid surgery].

Since the first years of the century, the improvement in surgical techniques has drastically reduced the main postoperative complication, profuse bleeding. More experience in thyroidectomy has highlighted other specific problems of the procedure, which has received substantial benefits by the adoption of targeted surgical techniques. The Authors describe the most important topics reported for each complication, on the basis of the latest literature and their own experience, with particular reference to the oncologic surgery of the thyroid.

Hemorrhage↗
PubMed1994

Social networks and daily activities of street youth in Belo Horizonte, Brazil. Street Youth Study Group.

Social networks and daily activities of children and adolescents living and/or working on the streets of a large Brazilian city were examined. Drawing on data collected through structured surveys, in-depth interviews, focus group discussions, and field observations, we described street youths' family situation, social resources, institutional experiences, survival activities, and problem behaviors and investigated differences attributable to age, gender, and living situation (at home or on the street). Youngsters who lived at home and worked on the street appeared to be experiencing orderly development despite their impoverished circumstances. Youngsters who lived on the street showed hallmarks of psychological and physical risk, including parental loss, diminished social support, substance abuse, and early onset of sexual activity. Possible implications of these contextual differences for development are discussed, and directions for future research are suggested.

Activities of Daily Living↗
PubMed1993

Sexual practices and attitudes of street youth in Belo Horizonte, Brazil. Street Youth Study Group.

Street youth are at risk of HIV infection worldwide. To develop effective prevention strategies, information about the meanings and functions of sexual activity for street youth is needed. In this paper, data from structured questionnaires, focus group discussions, in-depth interviews and field observations are used to build up a picture of the sexual culture of 9-to-18-year-olds living and/or working on the streets of a large Brazilian city. The findings reveal that these children and adolescents engage in sexual behavior that puts them at risk of sexually transmitted diseases, including HIV/AIDS, and reinforce that sex is a multi-determined and entrenched behavior in this population. Interventions must take into account the fact that for street youth, sex is used as a means of ensuring survival, seeking comfort, finding pleasure, and dealing with psychological issues that arise during adolescence.

Acquired Immunodeficiency Syndrome↗