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Biomedical subjects

A Caroli

Publications and source records attributed to A Caroli.

At least 55 records · Page 3Linked to original sources
PubMed1995

Reverse neurovascular homodigital island flap.

We describe a homodigital island flap with a reverse vascular pedicle based on the anastomoses between the radial and ulnar digital arteries. These anastomotic branches lie between the posterior wall of the tendon sheath and the periosteum to form the three digitopalmar arches. The vascularization of the reverse homodigital island flap is obtained using the middle transverse palmar arch. This flap was performed in 11 patients as a neurovascular "sensitive" flap, including the digital nerve in the pedicle, which was then sutured to the contralateral one at the defect. This technique achieves cover of the tactile pad in one operative stage and provides well-vascularized skin, allowing early mobilization. The quality of skin cover was confirmed in all the patients at follow-up ranging from 7 to 43 months postoperatively. We believe that the benefits of the procedure outweigh the disadvantages related to the section of the digital nerve and artery.

Adult↗
PubMed1995

Transfer of vessels in the management of thumb and ring avulsion injuries.

The main problem in avulsion or degloving injury is the extensive damage to long segments of vessels which makes direct suture of the structures difficult. Various techniques have been proposed over the years to bypass the segment of an injured vessel. Many of these are difficult and often require the execution of several vascular anastomoses. The transfer of vessels from adjacent fingers, as proposed by Doi, is a valid alternative. During the 5-year period from 1988 to 1993, vessel transfer from adjacent fingers was carried out on 15 patients. Three patients suffered incomplete amputation and 5 patients suffered complete amputation of the thumb. In 5 cases these were severe crush injuries and in 3 cases they were avulsion injuries. Seven patients suffered ring avulsion injuries of various degrees. The simplicity and reliability of the method (one case was unsuccessful) make this an important technique in the treatment of crush and avulsion injuries of the thumb as well as of ring avulsion injuries.

Adolescent↗
PubMed1995

Coronary angiography and aorto-coronary bypass surgery in type 2 diabetic patients.

Diabetic and non-diabetic subjects with angina who underwent angiography and were subsequently treated surgically or medically and followed up for 5 years were analysed in order to assess coronary angiographic findings, efficacy of coronary artery bypass grafting and prognostic criteria in Type 2 diabetic patients with angina as compared to non-diabetic subjects. A total of 1853 of non-diabetic and 145 diabetic subjects underwent angiography, including respectively 857 and 68 who had surgery. Perioperative mortality, survival, reinfarction and asymptomaticity rates were measured. Multivariate analysis of risk factors and clinical features was performed. Diabetic patients had a higher frequency of multi-vessel stenoses (p < 0.001), a greater diffusion of stenoses (p < 0.005) and worse left ventricular motion (p < 0.005). No differences were found in perioperative infarction and mortality. Operated diabetic patients had a higher survival rate (p < 0.001) and a longer symptom-free period (p < 0.05) than unoperated diabetic patients. Operated diabetic patients had similar survival and more frequent recurrence of angina (p < 0.05) than operated non-diabetic patients. Survival rate was lower for unoperated diabetic patients than unoperated non-diabetic patients (p < 0.05). Recurrence of angina was similar. Multivariate analysis did not indicate diabetes as a factor affecting survival. It is concluded that surgery for Type 2 diabetic patients with coronary artery disease is a suitable therapeutic option conferring a reduction in mortality regardless of the presence of diabetes.

Adult↗
PubMed1995

Evaluation of cyst fluid analysis in the diagnosis of pancreatic cysts.

The pre-operative differential diagnosis of pancreatic cystic lesions is often difficult because of the lack of reliable clinical or radiological criteria. In order to improve the pre-operative recognition of these lesions, we performed cyst fluid analysis for enzymes (amylase and lipase), tumour markers (CEA, CA 19-9, CA 125, CA 72-4), and cytology in 52 pancreatic cysts. The cases included 21 pseudocysts, 12 mucinous cystic neoplasms, 7 ductal carcinomas, 7 benign lesions, and 5 rare malignancies observed from 1989 to 1994. Cyst fluid amylase, lipase, CEA, and CA 19-9 were variable and not discriminant between the groups. CA 125 fluid levels were high in 63% of malignant cysts. CA 72-4 fluid levels were significantly higher in mucinous cystic tumours than in pseudocysts (p < 0.0001), showing 95% specificity in detecting mucinous or malignant cysts. Cytology showed a sensitivity of 61% and a specificity of 100%. CA 72-4 determination raised the sensitivity of cytology to 92% in detecting mucinous or malignant cysts. This study confirms the low sensitivity of cytologic examination and low amylase specificity in distinguishing cystic neoplasms from pseudocysts. Cyst tumour markers assay is useful to improve the sensitivity of cytology, and CA 72-4 shows the best specificity in detecting (pre)malignant neoplasms.

Adenocarcinoma, Mucinous↗
PubMed1995

The "kite flap" for dorsal thumb reconstruction.

Skin cover for losses of substance on the dorsum of the thumb is often difficult. The "kite flap", introduced by Foucher, is ideal for this purpose. In the period between 1988 and 1993, this flap was used in five patients presenting with skin defects on the dorsum of the thumb. The results obtained have convinced us to consider this technique as the first method of choice in this area of reconstructive surgery.

Adult↗
PubMed1994

Ultrastructural and immunocytochemical study on normal human palmar aponeuroses.

BACKGROUND: Human palmar aponeurosis can be affected by a fibrotic process whose aetiopathology is unknown. As the organization of that normal tissue has not been completely investigated, the aim of the present study was to define the ultrastructure of the aponeurosis in order to better understand its biology and behaviour in pathology. METHODS: Bioptic samples from normal subjects of different ages were analysed by optical and electron microscopy and by immunocytochemistry. RESULTS: The aponeurotic branches consisted of thick, almost parallel collagen bundles containing columns of prominent cells, characterized by long cytoplasmic projections. Cells did not change in number and distribution with age and appeared longer and slighter in the old than in the young subjects. They exhibited plasma membrane almost completely decorated by pinocytic vesicles, intracytoplasmic bundles of thin filaments with zonal thickenings close to the cell membrane, and well-developed subcellular structures. Cells expressed smooth muscle cell alpha-actin, as revealed by immunostaining. The external surface of the plasma membrane was underlined by a discontinuous basement membrane-like structure and by a thick coat of interwoven filaments, highly positive to hyaluronan-recognizing antibodies. Immunocytochemical analyses revealed that collagen fibrils were positive for collagen types I, III, and VI and that elastin fiber composition was rather complex. CONCLUSIONS: Independently of the age, normal palmar aponeurotic cells show peculiar morphological features and peculiar cell-matrix interactions, very likely mediated by hyaluronan. These findings indicate that normal aponeurotic cells cannot be regarded as typical tenocytes and suggest the need for a better definition of their phenotype in order to understand their behaviour in pathological processes.

Adult↗
PubMed1994

Natural history of gallstones in non-insulin-dependent diabetes mellitus. A prospective 5-year follow-up.

This prospective study was undertaken to assess the natural history of gallstones in patients with non-insulin-dependent diabetes. Four hundred forty outpatients with diabetes mellitus were studied; 81 of these had gallstones diagnosed by ultrasound. On the basis of the information they gave, they were divided into two groups: A, asymptomatic; and B, symptomatic (previous episode(s) of biliary pain) at recruitment. Five years after diagnosis, the patients were recalled and questioned about their symptoms. Three of 81 could not be traced and eight had died from diseases not related to gallstones. Seventy were finally evaluated, 47 belonging to group A, 23 to group B. The cumulative percentage of initially asymptomatic patients who presented with biliary pain or complications during the follow-up was 14.9% (4.2% for complications). Of group A patients, 17% underwent cholecystectomy (one prophylactic, six elective and two emergency). One patient (2.1%) died after operation of obstructive jaundice. Of group B patients, 47.8% had biliary symptoms or complications (8.7% cholecystitis); 21.7% were operated (17.4% elective, 4.3% emergency cholecystectomy). Since few patients with asymptomatic gallstones and non-insulin-dependent diabetes mellitus develop pain or complications over time, prophylactic cholecystectomy is probably not advisable.

Adult↗
PubMed1994

A comparative study of the heterodigital neurovascular island flap in thumb reconstruction, with and without nerve reconnection.

41 heterodigital neurovascular island flaps were used to cover defects of the tactile pad of the thumb in 17 years. With an average follow-up of 75.5 months, 30 patients were reviewed. 17 were treated by the original Littler technique and 13 were treated with the same flap reconstruction but with division of the digital nerve innervating the flap and re-anastomosis of this nerve to the proximal nerve end of the ulnar digital nerve of the thumb. Good aesthetic and functional results were achieved in both groups. Sensory acuity did not appear to decrease with time. The nerve reconnection technique solves the "double sensibility" phenomenon (present in 41.1% of our cases treated by the original technique), but two-point discrimination is less than that achieved by the Littler technique. Most complaints were related to the donor site such as hypertrophic scarring or scar contracture and cold intolerance, but these did not cause any real functional impairment.

Adolescent↗
PubMed1994

[Clinical and instrumental elements predictive of left ventricular insufficiency in acute myocardial infarct: multivariate analysis in patients treated with thrombolytic therapy].

BACKGROUNDS: During the course of acute myocardial infarction (AMI), the appearance of signs of left ventricular failure (LVF) (cardiogenic shock, acute pulmonary edema, congestive heart failure) is a prognostically negative event which is still relatively frequent even in patients receiving fibrinolytic therapy. The early identification of patients exposed to such a risk would allow adequate diagnostic and therapeutic preventive measures to be taken. AIM: To evaluate, in a population of AMI patients undergoing thrombolysis and without any serious complications at the moment of hospitalisation, which anamnestic, clinical and instrumental data obtained within the first 24 hours best identify those who will subsequently develop full-blown LVF. Secondary aim is to evaluate the role that extension of coronary disease plays in determining the occurrence of LVF. METHODS: The study involved 104 consecutive patients aged < 75 years admitted to hospital for AMI with ST-segment elevation, within 12 hours of the onset of symptoms, in Killip class 1-2 upon entry to the CCU, and treated with thrombolytic therapy. The study design included the collection of anamnestic and clinical data upon admission to the CCU; an enzymatic curve during the first 4 days; the ECG at entry, and 4 and 24 hours after the beginning of fibrinolysis; the chest X-ray, the 2D-echocardiography (2D-echo) and the hemodynamic measurements within the first 24 hours; a coronary angiography on the tenth day (or earlier if clinically necessary). RESULTS: Seventeen patients (16%) presented signs of LVF; 8 (7.6%) with cardiogenic shock, 9 with congestive heart failure: 3 died (3%), all for shock. Univariate analysis correlated LVF with: 1) the indices of the extension of ischemic/necrotic damage: number of derivations with ST elevation (p < 0.04) and Q waves (p < 0.05) at first ECG, maximum peak of myocardial enzyme (p < 0.02), wall motion score index (p < 0.001), percentage extension of asynergy (p < 0.001), presence of remote asynergy (p < 0.001), left ventricular (LV) end-systolic (p < 0.001) and end-diastolic volume (p < 0.01), and LV ejection fraction (EF) (p < 0.001) at 2D-echo; 2) the indices of hemodynamic involvement: Killip class 2 at entry (p < 0.02), pulmonary venous flow diversion at chest X-ray (p < 0.001), systolic (p < 0.05), diastolic (p < 0.01) and mean (p < 0.01) pulmonary pressure, capillary wedge pressure (p < 0.01), and the LV systolic work index (p < 0.05). Multivariate analysis showed that the only independent variable predictive of LVF was the EF at 2D-echo (p < 0.001): the sensitivity and specificity of EF was respectively 36% and 97% at cut-off value of 0.30, and 93% and 69% at cut-off value of 0.45. Multivessel coronary disease was found more frequently in patients who developed LVF (p < 0.05) and was correlated with 2D-echo LV involvement: presence of remote asynergies (p < 0.0001), lower EF (p < 0.01), higher wall motion score index (p < 0.001) and percentage extension of asynergy (p < 0.01). CONCLUSIONS: The incidence of LVF in patients with AMI, without serious complications at onset, is still relatively high (16%) even if they are treated with thrombolysis. Of all evaluated clinical and instrumental indices, multivariate analysis showed that EF at 2D-echo was the only independent variable predictive of LVF. Extension of coronary disease correlated with development of LVF. Moreover, worse LV performance and greater regional contractility involvement at 2D-echo correlated with extension of coronary disease. Consequently, echocardiography would appear to be bed-side, simple, reliable and accurate mean of establishing a prognosis from the moment a patient with AMI is admitted to a CCU.

Aged↗
PubMed1993

The spectrum of left ventricular size in dilated cardiomyopathy: clinical correlates and prognostic implications. SPIC (Italian Multicenter Cardiomyopathy Study) Group.

To address the issues of variability and prognostic role of left ventricular dimensions in dilated cardiomyopathy (DCM), 144 patients with DCM were studied. They were arbitrarily assigned to two groups according to an echocardiographic left ventricular end-diastolic diameter index < or = 15% (45 patients with mildly dilated cardiomyopathy) and above 15% (99 patients with typically dilated cardiomyopathy) of the upper normality range. Among the patients with mildly dilated cardiomyopathy, there were more men (89% vs 66%; p < 0.01). This group of patients also had a greater prevalence of atrial fibrillation (22% vs 3%; p < 0.001) higher left ventricular fractional shortening (15 +/- 6% vs 13 +/- 5%; p < 0.05), higher ejection fraction (28 +/- 8% vs 24 +/- 8%; p < 0.01), and a lower exercise tolerance (5 +/- 2 MET vs 6 +/- 2 MET; p < 0.05). At the time of follow-up examination (30 +/- 15 months), event-free survival was not significantly different between patients with mildly dilated cardiomyopathy and those with typically dilated cardiomyopathy. Pulmonary capillary wedge pressure (p < 0.001) and left atrial dimension index (p < 0.01) were significant predictors of prognosis as determined by Cox multivariate analysis. Minimal or mild ventricular dilatation is not uncommon in DCM, and it identifies a heterogenous group of patients--some who are in the early stages of disease and others with severe pump dysfunction and persistently small hearts. Ventricular dilatation is not an independent predictor of prognosis.

Adult↗
PubMed1993

A clinical, ultrastructural and immunochemical study of Dupuytren's disease.

Aponeurotic tissue from seven normal subjects and from apparently unaffected branches, nodules and cords of 16 Dupuytren's patients were compared. Control tissue was characterized by polymorphous cells, showing cytoplasmic microfilament bundles, numerous pinocytic vesicles, basement membrane-like structures, and a thick coat of interwoven filaments, and by type I- and III-positive heterogeneous collagen fibrils, fibronectin, vitronectin, decorin and proteoglycans. The clinically normal branches consisted of fibroblast-like cells, small type III-highly positive collagen fibrils, fibronectin and proteoglycans. Nodules and fibrotic cords contained fibroblast-like cells, type I and III collagen, fibronectin and proteoglycans. Myofibroblast-like cells in only five out of 16 patients were present. There was no relation between clinical stage and structural alterations; the whole aponeurosis always seemed to be involved; cord retraction would seem to depend on the interactions among fibroblast-like cells and matrix components and among matrix macromolecules themselves.

Adolescent↗
PubMed1993

Dorsalis pedis flap with vascularized extensor tendons for dorsal hand reconstruction.

We describe three cases of combined loss of skin and tendons on the dorsum of the hand treated with the use of cutaneotendinous dorsalis pedis free flap. The functional and aesthetic results are excellent in the hand and aesthetically acceptable in the foot. This technique is the first choice when the treatment of these injuries requires three or four tendon grafts.

Adolescent↗
PubMed1992

Ventricular arrhythmias in dilated cardiomyopathy as an independent prognostic hallmark. Italian Multicenter Cardiomyopathy Study (SPIC) Group.

Prevalence and characteristics of ventricular arrhythmias (VA) on Holter monitoring were evaluated in 218 patients with invasively documented idiopathic dilated cardiomyopathy to clarify their relation to pump dysfunction, and their prognostic role. VA were observed in 205 patients (94%) and were high grade (ventricular pairs or tachycardia) in 130 (60%). No simple or multiform ventricular premature complexes were present in 88 patients (group 1; 41%), ventricular pairs in 63 (group 2; 32%), and ventricular tachycardia in 67 (group 3; 27%). Only echocardiographic right ventricular dimensions (p less than 0.05) and prevalence of VA during effort (8% in group 1, 15% in group 2, and 14% in group 3; p = 0.0005) differed significantly between groups. VA severity, and number of ventricular premature beats and tachycardia episodes were not correlated to right/left ventricular dimensions and pump function indexes. During a mean follow-up of 29 +/- 16 months, 27 patients died from cardiac events, and 16 received transplants. Three-year survival probability was lower in groups 2 (0.82) and 3 (0.81) than in group 1 (0.94). By Cox multivariate analysis, VA severity (p less than 0.01) was a major independent predictor of prognosis after markers of ventricular dysfunction such as left ventricular ejection fraction (p less than 0.001) and stroke work index (p less than 0.001).

Adolescent↗
PubMed1992

A cross sectional survey on breast self examination practice, utilization of breast professional examination, mammography and associated factors in Romagna, Italy.

In 1988, a cross-sectional survey was carried out in the Romagna region (Italy) to evaluate the association between knowledge of breast pathophysiology and preventive attitudes and screening tests practice for breast cancer. A self-administered questionnaire was distributed to a sample of asymptomatic women aged 20-64 years living in the city of Faenza (Northern Italy). Of the 657 responders, 58% reported that they practiced breast self-examination; 55% had had a professional breast examination, and only 9% had had a mammogram as a screening test. Logistic regression analysis (including variables such as age, education, employment) was performed to explore the relationship between screening tests practice and factors associated with their use. Breast self-examination practice (n = 590) was associated with preventive attitudes (aOR = 1.67, 95% CI = 1.09-2.53) and with a positive history of breast disease (aOR = 3.48, 95% CI = 1.72-7.04). Professional breast examination (n = 480) was related to preventive attitudes (aOR = 2.37, 95% CI = 1.51-3.71), knowledge of breast pathophysiology (aOR = 2.07, 95% CI = 1.31-3.28), and use of oral contraceptives (aOR = 1.81, 95% CI = 1.12-2.91). Mammography use (n = 540) was associated with preventive attitudes (aOR = 3.08, 95% CI = 1.40-6.76). The results show an inadequate utilization of screening tests in our population. Breast self-examination is strongly related to a positive history of breast disease, and this could reflect the lack of health educational programs aimed at the general population.

Adult↗
PubMed1992

[Correlation between Dupuytren's disease and arcus senilis: is dyslipidemia a common etiopathological factor?].

Because of the frequent presence of corneal arcus senilis in patients affected by Dupuytren's disease in order to evaluate this association, the authors conducted a biomicroscopic examination of the cornea in 336 patients treated surgically for Dupuytren's disease, at the Hand Surgery Unit of the University of Modena from November 1985 to December 1989. They observed corneal arcus senilis in 259 patients, i.e. in 77.1% of patients with Dupuytren's disease. Due to the statistically significant correlation between arcus senilis and hyperlipidemia as reported by Tschetter (1980) and Felder (1981), the Authors collected a blood sample from all 336 patients to evaluate serum cholesterol and tryglicerides. This study revealed a dyslipidemia in 54.8% of patients with Dupuytren's disease and in 60.2% of patients suffering from both Dupuytren's disease and arcus senilis. Because of the high frequency of dislipidemia in patients with Dupuytren's disease and arcus senilis, which are apparently two well-distinguished disease, the authors suggest that a lipid disorder may be a common aetiopathogenic factor. In particular, in favour of the possible role of hyperlipidemia in Dupuytren's disease, Electron Microscope Studies revealed lipid inclusions within fibroblasts and in the extracellular connective tissue of all pathologic palmar aponeurosis from 11 patients with Dupuytren's disease: these lipid inclusions were never seen in the normal aponeurosis taken from 5 control patients treated for traumatic palmar injuries.

Adult↗
PubMed1992

Computed tomography in predicting gall stone solubility: a prospective trial.

This prospective study was undertaken to evaluate the correlation between densitometric values of gall stones assessed by computed tomography and the success rate of litholytic therapy in 28 patients eligible for oral treatment. A densitometric study of the stones was performed in all patients before treatment. A cut off point of 60 Hounsfield units (HU) was chosen to divide the subjects into two groups--group 1, 14 patients with low density stones (less than 60 HU) and group 2, 14 patients with high density stones (greater than 60 HU). All patients were treated with ursodeoxycholic acid (8-10 mg/kg/day) for 12 months and followed up by ultrasound. In group 1, dissolution was complete in 50% of the patients and partial in a further 20%. In group 2 patients, complete dissolution was not observed but 33% showed partial dissolution. The number of patients with total dissolution at 12 months was significantly higher in group 1 compared with group 2 (p less than 0.02). These results suggest that computed tomography can be used to select patients with a better likelihood of successful stone dissolution after bile acid therapy.

Adult↗