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Biomedical subjects

R Ruggiero

Publications and source records attributed to R Ruggiero.

At least 19 recordsLinked to original sources
PubMed2005

Treatment of primary inguinal hernias by "held in mesh repair": our experience related to 3,520 cases.

In the last 15 years, a rapid evolution occurred from the traditional hernioplasties toward prosthetic techniques, in Italy. Outpatient procedures under local anaesthesia are now most commonly performed. We report our experience with a personal modification of the sutureless mesh repair, called "held in mesh repair". From 1990 to 2003 we treated 3,520 cases of primary hernia with the "held in mesh repair". 2,370 patients were affected by a unilateral hernia and 575 by a bilateral one. Local anaesthesia was used in 92% of the cases, loco-regional in 6% and general in 2%. Sixteen (0.4%) hernias recurred after 2 years, while two further recurrences (total 0.5%) were observed after 3 years; three femoral pseudo-relapses (0.08%) occurred before the first postoperative year. An overall incidence of 1.3% of major complications were observed. One mortality case (0.02%) occurred 3 days after the operation for cardiovascular complications. The favourable results of the "held in mesh repair" and the simplicity of the procedure suggest that it can be considered a safe and reliable technique for most primary inguinal hernias.

Anesthesia, Local↗
PubMed2004

[Surgical treatment in day surgery of uncertain breast lesions].

AIM: New models of care are proposed to reduce the costs of traditional hospitalization and to improve the utilization of resources in surgery. Day surgery is widely employed in breast surgery. In this study we report the conversion rate and causes in ordinary hospitalization and we identify some contraindications related to breast surgery in day surgery. METHODS: A cohort study was performed on 306 patients operated on between July 1999 and December 2001 for breast lesions with uncertain interpretation at the clinical and/or instrumental examination. Those patients who lived at a distance of less than 50 km from the hospital, had a telephone, a suitable house, direct family support and, if necessary, could benefit from home health care in addition to hospitalization, were considered as eligible to day surgery. The kind of anesthesia and hospital admission were established after clinical, psycho-emotional, and socio-familiar evaluation of the patients by the surgeon and the anesthetist. RESULTS: A total of 250 excisional biopsies and 56 biopsies with a Mammotome were performed. Surgery was performed under local anesthesia in 278 patients and general anesthesia in 28 subjects. Observation exceeding 24 hours was only necessary in 10 patients reporting hypotension syndrome and anxiety. The conversion rate in ordinary hospitalization was 0.3%. Postoperative morbidity was 1%. CONCLUSION: Day surgery is an effective model of care in breast surgery for diagnostic and therapeutic purposes without axillary dissection. A good selection of patients, perfect interdisciplinary collaboration, and an efficient structural organization are necessary to control the complication and conversion rates of traditional hospitalization.

Ambulatory Surgical Procedures↗
PubMed2003

Laparoscopic procedures in patients who have previously undergone laparotomic operations.

BACKGROUND: Patients who have undergone laparotomy can undergo laparoscopic procedures and thus benefit from the advantages that the technique offers without significantly increasing the risk of the operation. METHODS: We present the results of 240 patients, chosen at random who underwent laparoscopic procedures and who had already had 1 or more laparotomic abdominal operations. We carried out 180 cholecystectomies, 12 of which for acute inflammation of the gall bladder, 10 for acute biliary pancreatitis, 3 with exploration of the common bile duct, 45 Nissen fundoplication procedures, of which 16 with removal of the gall bladder, 4 subtotal gastrectomies, 2 GEAs, 2 left colectomies, 4 adhesiolyses. RESULTS: The duration of the procedure varied from 40 to 300 minutes, and hospitalization time after the operation from 1 to 15 days, depending on the previous operation and on the laparoscopic procedure used. A traditional operation (conversion) became necessary in 1.35% of patients. Complica-tions arose in 4% of cases: 4 hematomas, 1 infected wound, 2 bile leaks and 2 bowel fistulas at low flow. CONCLUSIONS: Laparoscopic surgery in pa-tients who have previously undergone abdominal operations is difficult. The extent of conversions and complications can be contained within acceptable limits by choosing carefully the insertion point of the first trocar and dissecting the bowel with great precision.

Cholecystectomy, Laparoscopic↗
PubMed2002

The contribution of laparoscopy to the treatment of gastric cancer.

BACKGROUND: Laparoscopy plays a role in the preoperative diagnosis of gastric cancer, particularly in determining the location and extent of the neoplasia. In addition to its use in staging, laparoscopy is indicated for the gastric resection of T1-T2, and its middle- and long-term results are comparable to those obtainable with open surgery. Herein we describe our experience with the laparoscopic resection of gastric carcinomas, including the dissection of lymph nodes and the Billroth II reconstruction of digestive continuity with gastrojejunostomia. METHODS: We carried out laparoscopic gastric resections in 25 patients with adenocarcinomas. Our method involved installing five trocars, tying the left and right gastric vessels and the right gastro-epiploic vessels, sectioning the duodenum 3 cm from the pylorus, sectioning the remaining portion of the stomach obliquely 3 cm from the cardias, and performing Billroth II reconstruction. RESULTS: The average duration of the operation was 4 h 45 min. The average number of removed lymph nodes was 30.5 (range, 22-41). Five patients were converted to laparotomy. Significant complications were observed in four cases (16%). Hospitalization ranged from 5 to 16 days. The average follow-up was 38 months (range, 7-63), without evidence of relapse. CONCLUSION: In terms of morbidity, our results were similar to those obtained with open surgery. Lymphectomy according to the extent and number of lymph nodes is acceptable in the treatment of tumors of the lower third of the stomach. More case studies are needed to provide further indications of the applicability of the technique (which is currently used only in a few centers) and long-term results.

Abdomen↗
PubMed2002

Glutathione peroxidase (GPX) activity in seminal plasma of healthy and infertile males.

Human spermatozoa are more dependent on glutathione peroxidase/glutathione reductase (GPX/GR) system, via reduced glutathione (GSH), to inactivate reactive oxygen metabolites (ROMs) such as hydrogen peroxide and organic hydroperoxides. To demonstrate whether there is a substantial difference in GPX activity between normal and pathological seminal plasma, we decided to evaluate the activity of this enzyme in healthy subjects and infertile males with normal hormonal patterns. Our results demonstrate that in healthy subjects the seminal plasma contains a GPX activity that is about 10 times greater than the GPX activity detected in the seminal plasma of infertile males. By using specific antibodies against plasmatic GPX (GPX3), we also demonstrate that enzymatic activity, detected in the seminal plasma of both healthy and infertile males is GPX3. Therefore, the evaluation of GPX activity in human seminal plasma could be a new useful marker of gonadal function in men.

Adult↗
PubMed2001

[Role of the subfascial endoscopic perforator vein surgery in the treatment of venous ulcers].

BACKGROUND: Limbs phlebostatic ulcers are in many cases associated with perforator reflux veins often caused by post-thromboflebitis syndrome. The origin operation consisting in perforating vein interruption, described by Linton in 1938, allowed high quality exposition of these vessels and gave successful therapeutic results only affected by complications which prolonged hospitalisation. The most unfavorable prognostic factor was the need of performing an incision in skin sites affected by dermo-hypodermic degeneration induced by phlebopathy which inhibits post-surgery cicatrization. The therapeutic importance of reflux perforator vein interruption induced vascular surgeons to improve various procedures not affected by post-surgery complications and able to excise as much incontinent vessels as possible. METHODS: By video-surgery and new surgery tools nowadays available, the Subfascial Endoscopic Perforating Veins Surgery (SEPS) was established as a feasible and valuable method. At present, there are many surgical techniques differing from each other for the tools and the subneurotic compartement from which the perforating veins start. The results obtained from 45 SEPS procedures performed on 45 patients presenting lymphodermatosclerosis or venous ulcers caused by chronic venous insufficiency have been retrospectively evaluated. RESULTS: Thirty-six patients reached ulcer healing within 4 weeks after the operation; 7 ulcers healed over a 2 month time, while for 2 patients no clinical improvement has been recorded yet. CONCLUSIONS: SEPS is a valid alternative to the Linton procedure and provides remarkable advantages both in economic and clinical terms since it yields a more rapid lesions healing of small incisions which makes it one of the most minimally invasive surgical technique.

Adult↗
PubMed2001

[Role of the subfascial endoscopic perforating veins surgery in the treatment of venous ulceration: physiopathology and diagnosis].

Chronic venous insufficiency is a recurrent pathology, but affected patients often undergo clinical observation at a most severe and clearly symptomatic stage of the disease. In this late stage, therapy can only relieve symptoms of the disease which often lead to disability. In the clinical course of chronic venous insufficiency, phlebostatic ulceration constitutes a recurrent finding and it is responsible of compromising patients quality of life. The role of perforating veins, made refluxive by various pathogenic noxa, in the genesis of ulcerative lesions has been known since long time. For many years the interest in perforating veins surgery has been limited because of the several negative consequences of the operations. The possibility of modifying the hemodynamics of perforating veins compartment without causing post-operation complications by video-supported surgery, led to the debate on the role of these vessels in the chronic venous insufficiency. The phlebostasis non-invasive diagnosis uses imaging techniques consisting in tests which mostly are cheap, simple and easy to perform, thus representing the best early approach to the patient. It is widely thought that even though complex examinations are available, most precious information can be obtained by only two examinations: color-Doppler ultrasonography and, limitedly, plethysmography. By these diagnostic directions it is possible to better identify the site and the hemodynamic origin of the venous insufficiency.

Angioscopy↗
PubMed2001

Laparoscopy in acute biliary pancreatitis.

BACKGROUND: The high mortality rates (20-30%) still occurring in some forms of acute pancreatitis demands adequate clinical and instrumental protocols in order to establish the most suitable therapeutic option to employ. The use of laparoscopic surgery can reduce hospital stay and time for functional recovery. METHODS: The study enrolled 73 patients referring for acute biliary pancreatitis in whom staging with clinical, laboratory and instrumental criteria was performed. According to Ranson classification 63 patients (86.3%) had a mild-moderate acute biliary pancreatitis, 10 (13.6%) a severe one. In the first group laparoscopic cholecystectomy with retrograde cholangiography was performed within seven days of admission, in the second group surgical procedure followed medical treatment between eight and 30 days after the onset of the disease. No preoperative ERCP was performed. RESULTS: The rate of main biliary tract calculosis was 8.2% in group A: six cases all treated through laparoscopy. Two switches (2.7%) due to intolerance to the pneumoperitoneum, eight major postoperative complications (10.9%), and two deaths (2.7%) occurred and a mean hospital stay of 7.4 days was observed in group A versus 8.2 days in group B. CONCLUSIONS: The management suggested in this study for mild-moderate acute biliary pancreatitis showed consistent results with those of the recent literature, as far as morbidity (6.3%) and mortality (1.5%) are concerned. A higher number of severe biliary pancreatitis (10 cases) should be observed to assess the role of ERCP with endoscopic sphincterotomy rather than laparoscopic or combined treatment.

Acute Disease↗
PubMed2001

Combined cardio-renal transplantation (CCRT) from the same donor: report of two cases and review of the literature.

Two patients with successful combined cardio-renal transplantation (CCRT) using allografts from the same donor are reported. Both patients underwent staged procedure with hearts being transplanted first followed by kidneys. One patient suffered simultaneous acute rejection of both allografts, indeed a very rare event, which was successfully treated with pulse steroids. Because of the successful patient and graft outcomes, we propose that staged CCRT offers a reasonable therapeutic option for patients with co-existing, irreversible cardiorenal failure.

Acute Disease↗
PubMed2000

Photocatalytic degradation of lignin and lignin models, using titanium dioxide: the role of the hydroxyl radical.

The role of hydroxyl radicals on the degradation of lignins during a cellulosic pulp bleaching process including a photocatalytic stage, was assessed using peroxyformic acid lignins EL1 and REL1 and two phenolic niphenyl lignin models 1 and 2. The irradiations were performed in the absence of photocatalyst TiO2 and H2O2 (condition a), in the presence of TiO2 (condition b) and in the presence of H2O2 (condition c). The experiments were conducted in alkaline (pH approximately 11) aqueous ethanol solutions with oxygen bubbling. The relative phenolic content of the irradiated solutions, which is indicative of the involvement of hydroxyl radicals, was determined by ionization absorption spectroscopy. The results obtained show that the catalyzed reaction involves both degradation of the phenolate groups by electron transfer and hydroxylation of the lignin aromatic structure. Benzyl alcohol structural elements in sodium borohydride reduced lignin REL1 and compound 2 were also found as good trapping agents for the hydroxyl radicals. The degradation of EL1 was studied by measuring its fluorescence emission by comparison to the fluorescence of compound 2. The emission spectra indicate that some biphenyl phenolate anions in EL1 are reacting under UV/visible irradiation and some others, probably polyphenolic chromophores emitting less fluorescence, are formed.

Catalysis↗
PubMed1998

Right ventricular infarction during left ventricular assist system support.

Left ventricular assist devices are frequently used to bridge patients to cardiac transplantation. As this experience grows, new and unanticipated complications will occur. This report describes a 50-year-old man with ischemic cardiomyopathy being bridged to cardiac transplantation who suffered an acute right ventricular infarction during the interval of support.

Fatal Outcome↗
PubMed1996

Laparoscopic Billroth II distal subtotal gastrectomy with gastric stump suspension for gastric malignancies.

BACKGROUND: Laparoscopy has played an ill-defined role as a diagnostic tool for the staging of gastric and other intra-abdominal malignancies for a long time. The widespread use of the laparoscopic approach for the treatment of some benign abdominal diseases, such as biliary lithiasis and gastroesophageal reflux disease, has encouraged the authors toward its use in the treatment of malignant gastric neoplasms, both for palliation and for curative surgery. METHODS: A five-puncture technique for laparoscopic distal subtotal gastrectomy, omentectomy, division of the left gastric artery at its origin, and D1 lymph node dissection has been developed by the authors, and is fully depicted and discussed. Reconstruction of digestive continuity is achieved through a posterior transmesocolic side-to-side stapled gastrojejunostomy, facilitated by an original method of suspension of the gastric stump to the anterior abdominal wall. RESULTS: In a preliminary series of 10 cases, this technique was demonstrated to be safe, showing no mortality, and having morbidity rates comparable to those of open surgery. CONCLUSION: The operation is effective, with a mean number of resected nodes comparable to that usually achieved in open surgery, and no cases of conversion to laparotomy.

Abdominal Muscles↗
PubMed1996

[Laparoscopic surgery in patients over 75 years of age].

Laparoscopic surgery in over-75-year-olds. Surgery in the elderly is becoming increasingly frequent and in some series accounts for around 40% of operations performed. Morbidity and mortality are still high in relation to the type of surgery and anesthesiological risk, with complications linked above all to respiratory and thromboembolic pathologies. The use of a laparoscopic technique in elective and emergency digestive tract surgery may reduce the problems linked to the onset of cardiorespiratory failures and parietal infections. This prospective study aims to evaluate the results of laparoscopic surgery in over-75-year-old patients hospitalised in the Department of Laparoscopic Surgery at Bellvitge Hospital compared to data reported in the literature. Out of 379 patients undergoing laparoscopic surgery, 32 were over-75-year-olds (range 75-89). Ten patients had been diagnosed with gallstones, 9 with acute cholecystitis, 10 with biliary pancreatitis, 2 with iatal hernia and 1 with cancer of the sigma. A total of 29 cholecystectomies were performed, of which 10 in association with pancreatic drainage, 2 Nissen and one left hemicolectomy. Overall mortality was 6.2% following the death of 2 patients: 1 patient, who had been admitted for acute cholecystitis and had undergone laparoscopic cholecystectomy, presented an acute pulmonary edema three days after surgery with cardiac tamponade which represented the cause of death; another patient, admitted for acute biliary pancreatitis, presented a cerebral thromboembolism on the sixth day after surgery leading to death. Other complications included: parietal abscess, basal atelectasis, 2 residual choledochal calculosis and one case of external biliary fistula, with an overall mortality of 9.3%. The results reported in the literature do not report extensive series of over-75-year-olds undergoing laparoscopic surgery. Some authors report high percentages of laparotomic conversion, others a slightly higher morbidity rate with nil mortality. The present results are comparable to those of other authors with regard to the lower morbidity (3.1%) of laparoscopic compared to laparotomic (18.3%) surgery in elderly, high-risk patients. Even if the present series is relatively small (32 patients), the results obtained encourage the use of laparoscopic techniques in over-75-year-old patients so as to reduce mortality and morbidity compared to conventional surgery.

Age Factors↗
PubMed1995

Canine skeletal muscle ventricles: functional assessment using the pressure-volume plane.

In five dogs, skeletal muscle ventricles (SMVs) were constructed from the latissimus dorsi muscle, and placed within the thoracic cavity. After a 3-week delay period, SMVs were electrically preconditioned with 2-Hz continuous stimulation for 6 weeks. At a second procedure, SMVs were connected to a mock-circulation system, and performance was evaluated according to pressure-volume relationships at three different SMV contraction rates (33, 54, and 97 per min) and three stimulation protocols (25, 43, and 85 Hz) under varying loading conditions. Under appropriate conditions of afterload, the end-diastolic pressure-volume relation of SMVs was comparable with that of the cardiac ventricles, although SMVs were less compliant. At higher burst stimulation frequencies, SMV compliance was increased. Compliance was not affected by varying the rate of SMV contraction. End-systolic elastance, a reflection of contractility, appeared to be constant for each SMV, in contrast to cardiac ventricles, and was not influenced by changes in burst stimulation frequency or contraction rate. In this study, SMVs were capable of a level of stroke work 180% of that of the native right ventricle (RV) at rest (0.397 +/- 0.047 x 10(6) ergs) and 37% of that of the left ventricle (LV) at rest (0.298 +/- 0.61 x 10(6) ergs), at 33 contractions per minute (CPM), 25-Hz burst frequency, and physiological preload, but this level could not be sustained at higher contraction rates. Nevertheless, power output (SMV stroke work x contraction rate) was maximal at 97 CPM. These findings demonstrate important function differences between pumping chambers constructed from conditioned skeletal muscle, and those composed of cardiac muscle, which must be considered when using skeletal muscle ventricles for cardiac support or replacement.

Animals↗
PubMed1994

Cardiomyoplasty: probable mechanism of effectiveness using the pressure-volume relationship.

The mechanism of effectiveness of cardiomyoplasty was evaluated in the setting of chronic left ventricular dysfunction in terms of the pressure-volume relationship. The distal branches of the left coronary artery were ligated in 12 sheep. Seven sheep died and the 5 survivors underwent cardiomyoplasty using a left latissimus dorsi graft 10 to 12 weeks later. These muscle grafts were then electrically conditioned for 2 months. The systemic pressure and cardiac output were not different between the postinfarction and postcardiomyoplasty period with the pacemaker off or on. However, the pressure-volume loops were altered by cardiomyoplasty in all 5 animals. Emax, which is an index of ventricular contractility, increased after cardiomyoplasty from 2.66 +/- 0.92 to 4.59 +/- 1.73 mm Hg/mL (mean +/- the standard deviation; p < 0.05), but did not change between the pacemaker off and on situations. The pressure-volume area, which strongly correlates with myocardial oxygen consumption, decreased after cardiomyoplasty (1,932 +/- 615 mm Hg.mL), compared with before cardiomyoplasty (3,776 +/- 1,201 mm Hg.mL) (p < 0.05), but did not change between pacemaker off and on. The probable mechanism responsible for the effectiveness of cardiomyoplasty is an "active" support or constraint of the damaged myocardium by the latissimus dorsi and the prevention of further ventricular dilation. This suggests that left ventricular systolic function can be augmented by cardiomyoplasty, but that it is a secondary mechanism of action.

Animals↗