Results of a comparative study on insulin radioimmunoassay in 36 Italian laboratories.
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Humans↗
Biomedical subjects
A Costantini
Publications and source records attributed to A Costantini.
[Difficult endoscopic extraction: pneumomediastinum and bilateral pneumothorax after attempted endoscopic extraction of needle incarcerated in hiatal hernia].
From June 1987 to April 2000, 167 (74%) of 223 patients suspected of swallowing foreign bodies were treated. Hundred-sixty-three were successfully treated endoscopically. The surgery rate was 2.4%. There was failure to remove a tablespoon, a tooth-brush, a dental prostheses with metallic hook, a knitting-needle. The sharp and pointed foreign bodies were 35 (20.9%). Endoscopic removal of sharp and pointed foreign bodies in the upper gastrointestinal tract can be very difficult to manage. The Authors report iatrogenic perforation of esophagus-gastric-fundus in a patient with hiatus hernia who ingested a big knitting-needle in order to suicide. They think that it is absolutely necessary to use special endoscopic equipment during the taking out of foreign-body procedure, especially when pointed and sharp-edge shaped bodies are involved and when there is high risk of iatrogenic lesions.
Adult↗
[Small intestine tumors: our experience in emergencies].
Small bowel tumours are relatively rare neoplasms; unusual occurrence associated with nonspecific symptoms, and low-sensitivity tests availability, are responsible for diagnostic delay. A retrospective study was performed on 42 cases with acute presentation, from 1972 to 2001; median age was 52 years (range 14-79) and there was a slight female prevalence (57.1% vs 42.9%). The most common acute presentation was occlusion (57.1%), followed by gastrointestinal (GI) bleeding (23.8%), perforation (14.3%) and occlusion/perforation (4.8%). Benign neoplasia were 38.1% (16 cases) and adenoma is was the most common type; malignant forms were 61.9 (26 cases) and adenocarcinoma and lymphomas were the most common histotype. Radical surgical procedures were possible only in 57% of malignant forms (24 patients); morbility was 4.8% (2 cases: 1 anastomotic dehiscence and 1 subphrenic abscess); mortality was 14.3%. From our retrospective study, we can state that survival for malignant lesions is strictly dependent of early TNM staging and possibility of radical surgical procedure. An extremely high index of suspicion in evaluating mild and often misleading symptoms, integrated with specific diagnostic studies, should be the proper approach. Prognosis for benign from is excellent in all cases.
Abdomen, Acute↗
Flat foot: a comparison of surgical methods.
The authors present a comparative review of cases concerning the results obtained in the treatment of idiopathic flat foot: the methods compared were Castaman exosinotarsal arthrorisis and Giannini endosinotarsal arthrorisis. Between 1990 and 1198 a total of 80 patients, of which 40 with calcaneo-stop, and 40 with Giannini screws, were submitted to surgery at the Orthopaedic and Traumatology Department of the University of Rome "La Sapienza". The clinical, radiographic and functional results were classified as good, fair and poor. The authors agree on the effectiveness of both methods based on the results obtained and the facility of implantation techniques, however emphasizing the minor injury of the anatomical structures of the subtalar joint when the calcaneo-stop method with Castaman conical screws was used.
Adolescent↗
The treadmill test in the assessment of peripheral arterial occlusive disease.
Results of a study using the treadmill test on 32 patients with peripheral Fontaine's stage II arterial disease are described. The aim of the study was to evaluate the utility of the test in assessing useful information concerning the site of the lesion. Patients were divided in three classes depending on the arterial segment involved (iliac-femoral, femoro-popliteal, associated lesions) as resulted from the velocimetric and angiographic evaluation. Ankle pressure and WI, at rest and after stress test, PFWD and RT were evaluated. The authors conclude that data achieved with the dynamic test are related to the arterial involvement, allowing to differentiate obstructive and stenotic lesions, but do not give information concerning the site of the lesion. Nevertheless it is a valuable means of highlighting arterial lesions well compensated at rest and with normal pressure values.
Aged↗
[Traumatic lesions of the diaphragm].
The Authors studied 30 cases of diaphragmatic traumatisms from 1972 to 2003 to stress the difficulty to achieve an early diagnosis and the need of their immediate treatment: 26 of these patients were male and 4 female (6.5:1); the pathogenesis was in 50% of cases an open trauma and in 50% a closed trauma. The mean age was 36.6 years (33.4 in the open trauma and 41.4 in the closed). The left hemi-diaphragm was affected more frequently (63%) than the right (37%). The associated lesions were mainly of the parenchymatous abdominal organs (spleen 43.3% and liver 49%), while in the thorax lung was involved in 20% of cases and heart in 3.3%. All patients underwent plastic surgical intervention of the diaphragm. In only one case, particularly severe, the operation consisted in placing a pleuric drain and death occured a few hours later. Mean mortality was 30% (33.3% in open and 26.6% in closed traumas) and mean hospital stay was 36.2 days. Accurate diagnosis in emergency is difficult because of the frequent associated lesions, typical of these patients. Despite of the optimisation of the rescue and the new imaging technologies, the gold standard for treatment is not yet reached. There is still a considerable amount of misdiagnosis, a relevant mean hospitalization, a high mortality and a very high morbidity. The best approach to thoraco-abdominal traumas is still to fear a diaphragmatic lesion up to contrary demonstration, in order to achieve precocious diagnosis and surgical treatment, to avoid complications of delayed treatment.
Abdominal Injuries↗
Spinal cord stimulation.
Spinal cord stimulation (SCS) is a neuromodulation technique using electricity, proposed for the first time by Shealy in 1967, as an alternative to neuroablation. Technological improvements in the last 20 years (percutaneous electrodes, single and dual leads, octopolar electrodes, high energy internal pulse generators) have allowed to obtain good results with SCS in various clinical situations of chronic pain. The main clinical indications to SCS are: vascular pain--refractory angina and peripheral vascular diseases (PVD); rachidian pain--failed back surgery syndrome (FBSS), degenerative low back leg pain (LBLP), nerve root lesions, incomplete spine lesions, spinal stenosis; neuropathic pain; chronic regional pain syndrome (CRPS) type 1 and type 2; perineal pain and urological diseases (urge-incontinence, interstitial cystitis). There are important differences between Europe and USA in the SCS use in various indications, especially about PVD. Really, in Europe this technique has been widely used and, finally, there are prospective studies establishing the utility of SCS in: limb survival; pain control; regression to Fontaine stage II; improvement of free interval of claudication. All of this is going to change the attitude towards SCS in USA, where the amputation incidence for critical ischaemia is considerably higher than in Europe. An indication to SCS not very mentioned in literature and that seems to have good results is LBLP due to acquired or mixed (constitutional-acquired) spinal stenosis. In this situation SCS seems to improve notably pain control and quality of life index of patients.
Chronic Disease↗
Femoral noninfected anastomotic aneurysms. A report of 56 cases.
Fifty-six femoral non infected anastomotic false aneurysms (FAAs) were observed in 49 patients admitted to the Institute of Vascular Surgery, University of Milan, from 1975 to 1988; in 6 patients they were bilateral. These aneurysms developed after primary revascularization procedures at a mean interval of 66 months (range 12 to 156 months); one recurred after reparative surgery. Forty-four FAAs (78.6%) were asymptomatic, whereas 3 (5.3%) were complicated by acute expansion and 9 (16.1%) by thrombosis. Host vessel degeneration was the cause of aneurysm formation in most cases. A history of hypertension was present in 30% of the patients. All anastomotic aneurysms were operated upon except for one small aneurysm that was asymptomatic. In 5 patients aneurysm resection was carried out on both sides. The surgical technique was endoaneurysmectomy in all the cases with insertion of an interposition graft in 48 cases, a fabric patch in 2 cases and prosthesis re-anastomosis in 5 cases. One case of peripheral embolization occurring in the early postoperative period was successfully treated and there was no operative mortality. In our opinion elective repair of these aneurysms should be recommended whenever possible because of their propensity to develop serious complications and the operative morbidity is low.
Aged↗
Slow release nifedipine in the treatment of Raynaud's phenomenon.
An ever increasing interest is shown towards calcium-antagonist drugs and in particular to nifedipine in the treatment of Raynaud's Phenomenon (R.P.) On this matter a randomized double-blind study with 40 mg/die slow release nifedipine versus placebo was carried out for 30 days on 24 patients affected by R.P.-idiopathic in 16 cases and secondary in the remaining 8 cases. The evaluation of the clinical situation (hand ischemic attacks, pain, skin trophism) and the structural one (capillaroscopy of the finger nail bed and strain-gauge digital plethysmography) could be performed on 17 patients since 7 dropped out. From the clinical point of view an improvement was observed especially in the reduction of the ischemic attacks (88.8% of patients treated with nifedipine vs. 25.0% treated with placebo). Capillaroscopic results showed an improvement in 100% of the cases treated with nifedipine vs. 12.5% with placebo (p less than 0.001), as well as an improvement of the basal digit blood pressure values and after cold test in 88.8% of patients treated with nifedipine vs. 12.5% treated with placebo (p less than 0.005) and (p less than 0.0025) respectively.
Adult↗
[Norfloxacin in the prevention of postoperative infection].
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Adult↗
The role of regional nerve block anesthesia for carotid endarterectomy: an experimental comparison with previous series with the use of general anesthesia and barbiturates for cerebral protection.
A retrospective analysis was performed on a consecutive series of 60 cases divided into two groups given carotid endarterectomy (C.E.) for atherosclerotic disease. In the first group general anesthesia and barbiturate cerebral protection were employed; in group two, loco-regional anesthesia. Indications and risk factors were similar in the two groups; the surgical procedure was identical. The differences in the results are reported and factors contributing to cerebral protection or reduction in the risk of stroke are analyzed. The analysis indicates that loco-regional anesthesia for C.E. is a reliable method for detecting cerebral ischemia and guaranteeing cerebral protection by means of a temporary shunt when strictly necessary.
Anesthesia, General↗
Comparison of modified automatic Dumas method and the traditional Kjeldahl method for nitrogen determination in infant food.
This study compares 2 methods for determining nitrogen and protein in various types of infant food: the Kjeldahl method, developed in 1883, which is time consuming and labor intensive, and a newer, automatic method, based on the Dumas method. In each category of infant food considered, the results obtained from both methods are shown to be comparable; however, the modified Dumas method is quicker, easier, and does not pollute the laboratory environment.
Autoanalysis↗
Bypass procedures in the management of juxtarenal aortic occlusion.
Juxtarenal aortic occlusion is one of the most important though less frequent atherosclerotic lesions. The indications for surgical treatment using bypass techniques, are well known. However, controversy remains about the pathogenesis of the lesion; from either a thrombosis developing on an atherosclerotic lesion of the terminal aorta, or a primary atherosclerosis of the subrenal aorta. In our series of 1,180 patients submitted to surgery for aorto-iliac occlusive disease, we encountered 91 cases (7.7%) of juxtarenal occlusion. Apart from the different angiographic pictures, the patients were grouped on the operative finding of either thrombosis or atheroma. An aortobifemoral bypass graft was implanted on all but three of the cases; in these three we performed an axillo-bifemoral bypass. A different technique was used, for juxtarenal disobliteration, using a different (end-to-end, or end-to-side) suture of the proximal anastomosis. The operative indications and results are discussed.
Adult↗