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Biomedical subjects

P Silvestre

Publications and source records attributed to P Silvestre.

At least 19 recordsLinked to original sources
PubMed2000

AMS three-piece inflatable implants for erectile dysfunction: a long-term multi-institutional study in 200 consecutive patients.

OBJECTIVES: The aim of this study was to assess the longterm mechanical reliability of AMS (American Medical Systems) three-piece inflatable implants and their impact on patient-partner satisfaction in 200 consecutive patients with erectile dysfunction who underwent surgery in five different institutions. METHODS: Patient charts included in the study were collected and extensively assessed to record pre- and intraoperative data and postoperative complications. All patients and 120 partners were then seen often in the office at a mean follow-up of 59 months (range 6-130) and they were extensively questioned about function of the device and its impact on the couple's sexual life. RESULTS: At the long-term follow-up, 185 patients (92.5%) were still engaging in sexual intercourse with a mean frequency of 1.7/week. Patients and partners reported prosthetic erections as excellent, satisfactory or poor in 96 (48%), 100 (50%) and 4 (2%) cases, and in 20 (17%), 80 (66%) and 20 (17%) cases, respectively. Postoperative sexual activity was considered excellent, satisfactory or poor by 140 (70%), 44 (22%) and 16 (8%) patients and by 34 (28%), 81 (68%) and 5 (4%) partners, respectively. Reasons for patients' complaints included postoperative penile shortening in 60 (30%) cases and poor glandular engorgement in 40 (20%) cases. Partners' main complaint was unnaturalness of the prosthetic erection, a factor reported by 30 (25%) subjects. Complications requiring surgical exploration included infection in 12 patients (6%) and mechanical failure in 8 patients (4%). Kaplan-Meier estimates demonstrated significantly decreased mechanical survival for the Ultrex type of cylinders compared to the CX type of cylinders. CONCLUSIONS: AMS three-piece inflatable implants provide an overall patient and partner satisfaction rate of 92 and 96%, respectively. However, postoperative penile shortening and poor glandular engorgement were the causes of some complaints among the patient population as well as the unnaturalness of prosthetic erection among female partners. In the long-term, mechanically speaking, CX cylinders seem to be more reliable than the Ultrex ones.

Adult↗
PubMed1997

Laparoscopic unroofing of adrenal cysts.

OBJECTIVES: This study was aimed to demonstrate the feasibility of laparoscopic conservative surgery of the adrenal gland in the treatment of adrenal cysts. METHODS: Two cases of laparoscopic decortication of symptomatic adrenal cysts with preservation of the adrenal parenchyma are presented. RESULTS: Surgery was uneventful in both cases and patients returned to preoperative activity within 10 days from the operation. At the 3-month follow-up, computerized tomography demonstrated the absence of any cystic recurrence and adrenal endocrine function was normal. These findings were confirmed at the 1-year follow-up by ultrasonography. CONCLUSIONS: Symptomatic adrenal cysts can be effectively and safely treated by laparoscopic unroofing, a minimally invasive procedure which leaves the nondiseased adrenal parenchyma intact.

Adolescent↗
PubMed1996

Correction of stress urinary incontinence: laparoscopy combined with vaginal suturing.

The authors review the published techniques of laparoscopic colposuspension combined with vaginal suturing. Particular emphasis is given to their own technique, first published in 1992, and to that of Harewood (1993), which is similar. Both involve a Burch-like colposuspension using a technique similar to that of Gittes and Loughlin. This is possible looking inside the pelvis through a laparoscope and using a handle-needle. Published results are similar (about 70% success rate), but the authors point out that the Breda technique is simpler, cheaper, and less time consuming (only one trocar instead of three) and has had a longer follow-up (up to 3 years instead of 19 months). The authors review many other similar techniques reported between 1993 and 1995 with good results but based on rather limited experience. The conclusion is that the laparoscopic technique with vaginal suturing seems a promising way to approach stress urinary incontinence in the female patient.

Female↗
PubMed1996

[Laparoscopic surgery of stress urinary incontinence in women].

The Authors carried out a literature review on stress urinary incontinence (SUI) treatment using laparoscopy or pelvioscopy. They report their experiences in using a pubo-vaginal percutaneous colposuspension assisted by pelvioscopy. Of 22 treated patients, there was a total correction of the incontinence in 15 patients. (68.12%) with a median follow-up of 18.6 months. They report also their first experience with the Retzius plasty of Manhes by laparoscopy (3/4 patients treated are continent, 1/4 has recurrent SUI during times of stress). They conclude that laparoscopy and pelvioscopy treatment can be valid alternatives to traditional surgery if made on selected patients.

Female↗
PubMed1994

Stage A1 prostate cancer: follow-up with digital rectal exploration, prostate markers, fine-needle aspiration, ultrasonographically guided needle biopsy and biopsies of the residual prostate with resectoscope.

From January 1985 to December 1990, we performed 921 TURP and 23 retropubic adenomectomies. In 70 patients (7.4%) histological examination revealed an incidental carcinoma of the prostate (stage A), 51 of which (72.8%) were A1 and 19 (27.2%) stage A2. In our classification A1 covers cases with < 3 G1 focal lesions [Boxer, 1977]. Thirteen of the A2 cases underwent radical prostatectomy: 1 pT1G1-2, 9 pT2G1-2, 3 pT3G2 (TNM 1978); the remaining 6 were given palliative treatment. The 51 stage A1 patients were recalled for follow-up evaluation, only 20 came for checking. They were reassessed by means of DRE, markers, prostate cytologic aspiration, echo-guided transperineal needle biopsy and resection of the prostatic cavity. Our experience seems to suggest that, if we define A1 as < 3 G1 chips or less, this stage is to be considered an incidental illness that seems not to require further treatment, but only a policy of surveillance with yearly markers, DRE and echo-guided needle biopsy.

Aged↗
PubMed1993

Laparoscopic nephrectomy with vaginal delivery of the intact kidney.

The first case of laparoscopic nephrectomy in Italy is described. The patient was a 51-year-old woman with a small, nonfunctional, tuberculous left kidney. The organ, once detached from its lumbar site, was brought in to the pelvic cavity and extracted from the body via a posterior colpotomy. In this way, the integrity of the organ is preserved, hence, this could be the preferable route when dealing with a little kidney tumor in a woman.

Female↗
PubMed1992

Treatment of hydrocele: randomised prospective study of simple aspiration and sclerotherapy with tetracycline.

Following reports in the literature on the efficacy of tetracycline sclerotherapy in the treatment of hydroceles, we carried out a randomised prospective study of 45 patients (50 hydroceles), comparing simple evacuation with tetracycline sclerotherapy. The results revealed no statistically significant difference in the percentage of success between the 2 groups, but complications were more common in the patients treated with tetracycline. The good results reported by other authors in non-randomised studies are, therefore, not confirmed.

Adolescent↗
PubMed1992

Pharmacological approach in the treatment of insulin resistance.

Insulin resistance syndromes are heterogeneous in either severity or mechanism. Many drugs have been shown to counteract various elements of insulin resistance. Some of them, by normalization of metabolic parameters, decrease insulin resistance induced by chronic hyperglycemia in diabetes. Insulin and, to some extent, sulfonylureas are in this group, but these drugs are not stricto sensu medication of insulin resistance. Some drugs sensitize peripheral tissues to the action of insulin. For instance, biguanides and thiazolidine-dione facilitate translocation to the membrane of glucose transporter in presence of insulin. Other compounds as vanadate or IGF-1 mimic some peripheral action of insulin. Finally, blockade of FFA oxidation by specific inhibitors (methylpalmoxyrate) can limit insulin resistance. In 1992, among these compounds, specific of insulin resistance, biguanides are mostly used. However, the efficacy of these drugs is moderate and limited to type 2 diabetes.

Diabetes Mellitus, Type 2↗
PubMed1991

Nomogram for penile biothesiometry.

Three hundred and fifty men, aged between 17 and 80 years, with normal sexual anamnesis and without any neurological pathology, underwent finger (index) and penile biothesiometry using a biothesiometer. Tabular and graphical nomograms were obtained according to age and instrumental values. The use of the above-mentioned nomograms is an effective aid in detecting each individual case.

Adolescent↗
PubMed1990

[Cost-benefit relationship between endoscopic resection (TURP) and open surgery (Millen) in prostatic hypertrophy ].

Evaluation of the cost/benefit relationship between TURP (50 cases) and Millin (30 cases). The factors considered are as follows: average post-operative hospitalization, average catheterisation time, average operation time, cost of materials, number of operators employed, number of transfused blood units. The post-operative hospitalization relating to the two kinds of operation varies considerably with a difference of 5.15 days less for the TURP, while the average catheterisation time doesn't seem to be affected. Blood transfusion was necessary in the 43.3% (0.75 unit/patient) of cases for the Millin compared to the 14% (0.26 unit/patient) for the TURP. Evaluation of economical advantages between TURP and Millin shows a relationship of 1:2.3 in favour for of TURP.

Aged↗
PubMed1987

[Epididymitis in adults. Retrospective study of 110 cases].

A review was conducted of 110 cases of epididymitis, most of these patients (71.9%), especially those under 50 years of age, having negative urine cultures: this appears to confirm the high frequency of Chlamydia T infection in the age group 20 to 50 years when sexual activity is at its maximum. Urinary output was normal in 60 of 79 patients and urography exploration provided normal results in 69 of the 110 patients (63%), particularly in those under 50. It is concluded, therefore, that urography is not necessary in patients under 50 but remains necessary in those in older age groups.

Acute Disease↗
PubMed1980

Relationship between increased aerobic glycolysis and DNA synthesis initiation studied using glycolytic mutant fibroblasts.

Reports from several laboratories have suggested increased rates of glycolysis play an essential part in the initiation of DNA synthesis. This is based on observations that aerobic glycolysis: (1) occurs at low rate in resting mammalian cells and at very high rate in tumour cells; (2) increases rapidly after DNA synthesis is initiated by addition of serum or purified growth factors, and (3) correlates with the expression of the transformed phenotype. Also, specific inhibitors of aerobic glycolysis prevent the initiation of DNA synthesis. To determine whether the rapid activation of phosphofructokinase--and therefore glycolysis--by purified growth factors is necessary for the initiation of cell proliferation, we have isolated and studied two classes of glycolytic mutants. The first, isolated from Chinese hamster fibroblasts, has a total block in the glycolytic pathway. The second, from hamster and Fisher rat fibroblasts maintains a permanent high rate of glycolysis. We have found that both classes of mutants retain normal control of DNA synthesis in response to serum. This dissociation indicates that growth-factor-stimulated glycolysis is not involved in the control of initiation of DNA synthesis and cell proliferation.

Aerobiosis↗
PubMed1980

Isolation of a Chinese hamster fibroblast mutant defective in hexose transport and aerobic glycolysis: its use to dissect the malignant phenotype.

A procedure is described for the selection of glucose uptake mutants based upon radiation suicide of Chinese hamster fibroblasts by 2-deoxy[3H]glucose. In one of these mutants, DS 7, the ability to transport either 2-deoxyglucose or 3-O-methylglucose was decreased to one-fifth to one-fourth. Besides this defect, DS7 produces 1/14th the lactic acid produced by the parent when grown on 5 mM glucose. This block in aerobic glycolysis is due to a mutation that affects the expression of the phosphoglucose isomerase gene because no isomerase activity is detected in cell extracts of DS7. This glycolytic block makes that cell line dependent exclusively on respiration for its energy requirement. Consequently, DS7 survives well after removal of glucose but dies quickly in the presence of oligomycin. The parental line O23 (subclone of CCl39) grows at low serum concentration, is anchorage-independent, and is tumorigenic in nude mice. The derived glycolytic mutant DS7 has retained both the in vitro transformed phenotype (low serum dependence and loss of anchorage dependence) and the tumor-forming capability. The tumor cells derived from the injection of DS7 cells have kept the original glycolytic defect. This finding suggests that the transformed properties (high hexose transport and aerobic glycolysis) that can be uncoupled from abnormal growth control are not necessary for the expression of the malignant phenotype in fibroblasts.

Animals↗
PubMed1980

Cell mutants as a tool to study malignant transformation of fibroblasts.

From 3T3 Balb/c cells, mutants with low adhesiveness to plastic substratum were selected. One of these clones, AD6, was found to be deficient in glucosamine-6-phosphate N-acetylase. A result of this block is a decrease by 60-70% of cell surface carbohydrates, and as a consequence there is a general reduction in the exposure of glycoproteins at the cell surface. This biochemical defect is fully reverted to normal, simply by growing the mutant cells in presence of 10 mM N-acetylglucosamine. This specific and reversible enzymatic block allows us to conclude that the abnormal properties of AD6 cells--low adhesion, round shape, increased agglutinability by lectins, loss of directional locomotion, and absence of microfilament bundles--are the result of the surface carbohydrate defect, since reversion of glycoprotein synthesis to normal results in the general reversion of the altered phenotype. However, in spite of this apparent transformed phenotype, AD6 cells have normal growth control and are not tumorigenic. Using [3H]-2-deoxyglucose suicide, we selected from a spontaneously transformed clone of Chinese hamster lung fibroblasts a mutant (DS7) impaired in glucose metabolism, DS7 has a fourfold to fivefold decreased ability to transport either 2-deoxyglucose or 3-O-methylglucose and produces 14 times less lactic acid than the wild-type when grown on 5 mM glucose. This block in aerobic glycolysis, which is located at the level of phosphoglucose isomerase, makes that cell line dependent exclusively on respiration for its energy requirement. The parenteral line grows at low serum concentration, is anchorage-independent, and is tumorigenic in nude mice. The derived DS7 cells have retained both the in vitro transformed phenotype and the tumor-forming capability. A general conclusion of these studies is that the altered properties and cell behavior of transformed fibroblasts, such as low adhesiveness, round morphology, increased agglutinability by lectins, altered motility, absence of microfilament bundles, and increase in hexose transport and in aerobic glycolysis, are dissociable from malignant transformation. These phenotypic alterations should therefore be considered as events secondary to the mechanism that leads to the loss of growth control.

Animals↗