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A Guarneri

Publications and source records attributed to A Guarneri.

At least 19 recordsLinked to original sources
PubMed2003

In vitro retention force changes of prefabricated attachments for overdentures.

Changes in the retention force of six prefabricated spherical and cylindrical attachments were examined in vitro under continuous loading. The testing machine permitted insertion-separation cycles to be tested under reproducible conditions while a calibrated measuring device determined the insertion and retention forces. At the beginning, during the so-called run-in period, all anchoring elements showed a very unstable behaviour characterized by a varying marked increase and subsequent decrease in the retention force. During the ensuing functional period, the retention force followed a more stable course. In this phase, the frictional attachments having lamellae for activation proved more stable than did the spring-loaded retention attachments. Furthermore, in two of five cylindrical anchors by Gerber, the spring broke. This provides support to the concept that prefabricated attachments should be constructed as robust elements composed of as few individual parts as possible. This would help to ensure that service and repairs remain at a minimum. Frictional attachments with lamellae for activation are to be preferred for use in matrices and patrices over attachments having spring-loaded retention.

Dental Prosthesis Retention↗
PubMed2002

A new technique for augmentation phalloplasty: albugineal surgery with bilateral saphenous grafts--three years of experience.

OBJECTIVES: Penile augmentation surgery is a highly controversial issue due to the low level of standardisation of surgical techniques. The aim of the study is to illustrate a new technique to solve the problem of enlarging the penis by means of additive surgery on the albuginea of the corpora cavernosa, guaranteeing a real increase in size of the erect penis. METHODS: Between 1995 and 1997, 39 patients who requested an increase in the diameter of their penises underwent augmentation phalloplasty with bilateral saphena grafts. The patients considered eligible for surgery were patients with either hypoplasia of the penis or functional penile dysmorphophobia. All the patients included in our study presented normal erection at screening. The average penis diameter in a flaccid state and during erection was found to be 2.1cm (1.6-2.7 cm) and 2.9 cm (2.2-3.7 cm), respectively. Before surgery the patients were informed of the experimental nature of the surgical procedure. The increase in volume of the corpora cavernosa was achieved by applying saphena grafts to longitudinal openings made bilaterally in the albuginea along the whole length of the penis. RESULTS: No major complications and specifically no losses of sensitivity of the penis or erection deficiencies occurred during the post-operative follow-up period. All the patients resumed their sexual activity in 4 months. A measurement of the penile dimensions was carried out 9 months after surgery. No clinical meaningful increases in the diameter of the flaccid penis were documented. The average penis diameter during erection was found to be 4.2 cm (3.4-4.9) with post-surgery increases in diameter varying from 1.1 to 2.1cm (p<0.01). CONCLUSIONS: The penile enlargement phalloplasty technique with albuginea surgery suggested by the authors definitely is indicated for increasing the volume of the corpora cavernosa during erection. Albuginea surgery with saphena grafts has been found to be free from aesthetic and functional complications with excellent patient satisfaction.

Adult↗
PubMed2002

Timing of radiotherapy in breast cancer conserving treatment.

The optimal timing and sequencing of adjuvant radiotherapy and chemotherapy after breast-conserving surgery for early invasive breast cancer is controversial. Several studies demonstrated that postoperative radiation therapy significantly reduces the incidence of breast recurrences. For patients who do not need systemic treatment, the interval between surgery and the start of radiotherapy should not exceed eight weeks. For node-positive and high-risk patients receiving breast-conserving treatment, adjuvant chemotherapy should be administered prior to radiotherapy, but the delay of radiation should not exceed 20-24 weeks. Side effects and complications of radiotherapy can be expected to increase when chemotherapy is administered concurrently. In particular, antracycline-based chemotherapy regimens increase the damage to heart muscle and coronary arteries: to avoid the risk of ischemic cardiovascular disease, radiotherapy must be performed after the end of systemic treatment.

Breast Neoplasms↗
PubMed2002

CT-MRI image fusion for delineation of volumes in three-dimensional conformal radiation therapy in the treatment of localized prostate cancer.

The objective of this study was to assess the utility of CT-MRI image fusion software and compare both prostate volume and localization with CT and MRI studies. We evaluated the differences in clinical volumes in patients undergoing three-dimensional conformal radiation therapy for localized prostate cancer. After several tests performed to ensure the quality of image fusion software, eight patients suffering from prostate adenocarcinoma were submitted to CT and MRI studies in the treatment position within an immobilization device before the start of radiotherapy. The clinical target volume (CTV) (prostate plus seminal vesicles) was delineated on CT and MRI studies and image fusion was obtained from the superimposition of anatomical fiducial markers. A comparison of dose-volume histograms relative to CTV, rectum, bladder and femoral heads was performed for both studies. Image fusion showed a mean overestimation of CTV of 34% with CT compared with MRI. Along the anterior-posterior and superior-inferior direction, CTV was a mean 5 mm larger with CT study compared with MRI. The dose-volume histograms resulting from CT and MRI comparison showed that it is possible to spare a mean 10% of rectal volume and approximately 5% of bladder and femoral heads, respectively. This study confirmed an overestimation of CTV with CT images compared with MRI. Because this finding only allows a minimal sparing of organs at risk, considering the organ motion during each radiotherapy session and the excellent outcomes of prostate cancer treatment with CT based target identification, we are still reluctant to reduce the CTV to that identified by MRI.

Adenocarcinoma↗
PubMed2001

Thyroid metastases from renal clear cell carcinoma: a cyto-histological study of two cases.

AIMS: We report about two cases of thyroid metastases, with neoplastic thrombosis of the jugular vein, originating from a renal clear cell carcinoma and arising respectively 5 and 18 years after the original nephrectomies. MAIN RESULTS AND CONCLUSIONS: The first patient had also a synchronous transitional cell carcinoma of the bladder and a poorly differentiated prostatic adenocarcinoma, further complicating the location of the primary sources of the metastases. The metastases of the first case were firstly diagnosed by mean of fine needle aspiration biopsy, and subsequently histologically confirmed. Histochemical (diffuse PAS-positive cytoplasms) and immunohistochemical stains (wide spectrum cytokeratins low molecular cytokeratins+, Ck8+, CD10+, Vimentin+, Ck20-, Ck7-, Ck19-, PSA-, thyreoglobulin-, TTF-) performed both on cytologic and histological material helped to define the metastases as oriinating from the renal clear cell carcinoma. For the first patient, the other two possible primary sources were ruled out and a possible primary thyroid tumor with clear cell change was also excluded for both patients.

Adenocarcinoma, Clear Cell↗
PubMed2000

FEC (5-fluorouracil, epidoxorubicin and cyclophosphamide) versus EM (epidoxorubicin and mitomycin-C) with or without lonidamine as first-line treatment for advanced breast cancer. A multicentric randomised study. Final results.

From May 1991 to December 1996, 326 patients with advanced metastatic breast cancer were enrolled in a multicentre, randomised, phase III clinical trial with four arms. Patients were randomised to receive chemotherapy according to the FEC regimen (5-fluorouracil (5-FU) 500 mg/m2, epidoxorubicin (EPI) 75 mg/m2 and cyclophosphamide (CFA) 500 mg/m2, intravenously (i.v.). every 3 weeks) or the EM regimen (EPI 75 mg/m2, i.v. every 3 weeks; mitomycin C (MMC) 10 mg/m2, i.v. every 6 weeks) or the same regimens with the addition of lonidamine (LND) until disease progression (orally, thrice daily, 150+150+300 mg); a maximum of eight chemotherapy cycles were planned. The aim of the trial was 2-fold: to compare the EM regimen with the commonly used FEC regimen and to evaluate the possible role of the addition of LND. Patients were eligible if they had histologically proven breast carcinoma, metastatic or locoregional relapse with measurable and/or evaluable disease and were aged between 18 and 70 years: 318 patients were considered eligible. Patients with previous anthracycline-based adjuvant chemotherapy or those who relapsed within 6 months after any adjuvant chemotherapy regimen were excluded. Chemotherapy-related toxicity of grade > or = 3 was manageable and there was no significant difference between the arms in terms of haematological side-effects. The impact on heart function was mild. No increased toxicity was observed in the LND arms (apart from myalgias in 27-30% of the cases). A significant increase in the complete response rate was observed for the FEC/EM + LND group (20.4%) versus the FEC/EM group (10.8%). The median survival time and the median time to progression for the overall series were 608 days and 273 days, respectively; EM+/-LND achieved significantly improved survival and time to progression versus FEC+/-LND (P=0.01). This result was confirmed also when the analysis was restricted to patients previously treated with adjuvant CMF schedules. On the basis of these results, we conclude that EM may represent a valuable alternative to FEC for patients requiring a first-line regimen for advanced/ metastatic breast carcinoma, especially in patients previously treated with CMF in an adjuvant setting. Furthermore, we conclude that, in spite of a better complete response rate in the LND arms, as there was no clear advantage in time to progression or survival resulting from the addition of LND to the FEC or EM regimens, the routine use of LND is not warranted outside a clinical trial.

Adult↗
PubMed2000

[Thymoma in childhood. Clinical case].

Thymoma, the most common tumor mediastinum, is a neoplasm arising from the epithelial cells of thymus. Nearly all thymomas present in adult life. Thymomas in children are exceptional. Chest X-ray, CT, magnetic resonance and fine-needle aspiration help for diagnosis. Surgical resection represents the treatment of choice and the outcome of surgery has been shown to depend on the local invasiveness of the tumor.

Child↗
PubMed1999

Penile elongation and thickening--a myth? Is there a cosmetic or medical indication?

Penile lengthening and thickening techniques can be performed in different ways for treatment of congenital penile hypoplasia and dysmorphophobia in terms of aesthetics or function. Particularly for penile lengthening, a combination of surgery and stretcher device is suggested. Surgery for lengthening comprises three different stages: suture with plane alternating edges of the pubo-penile skin, infrapubic lipectomy, and section of the suspensory ligament. Our approach to penile thickening differs depending on whether dysmorphophobia is related to aesthetics or function. While pericavernosal apposition of autografts is suggested in the first case, a technique developed by the authors is performed in the latter, which comprises bilateral longitudinal incision of the corpora cavernosa and enlargement of the tunica albuginea by means of saphenous grafts. The endothelial lining, which constitutes the internal surface of the veins, is highly compatible with the endothelium of the corpora cavernosa; therefore, the incidence of postoperative subareolar fibrosis and occlusive vein pathology is lower than after surgery performed with techniques using grafts of other material. The described procedure did not cause postoperative complications in terms of infection, wound healing and cosmetic appearance. All subjects resumed regular sexual activity after 4 months without any disturbance or functional limitation. Diametrical measurements at the 9-month follow-up revealed an increase of 1.1-2.1 cm. The reliability and efficiency of these procedures are strongly influenced by factors other than technical problems; however, expert diagnosis and psychological consultation in the case of dysmorphophobia will confirm and specify the indications.

Humans↗
PubMed1999

[Percutaneous drainage of abdominal abscess. A clinical case and issues of operative ultrasonography in urology].

Percutaneous drainage of intrabdominal abscesses currently is a well established technique. The use of ultrasound, ever more frequently utilized in urology department, made urologists autonomous in ultrasound diagnosis and operative stage. We report on a patient admitted to emergency department in whom acute prostatitis was diagnosed. Urological consultation was obtained. The ultrasound examination performed, permitted to reveal the real syntomatology origin and to make an evaluation about the possible application of ultrasound in diagnosis and treatment of abdominal abscesses. This was also an occasion to re-examine some not urological ultrasound cases and their treatment. We believe that, also for the urologists, morphological knowledge of most frequent abdominal pathologies, visible by ultrasound, is useful to avoid diagnostic mistakes and useless and hazardous treatments. In our experience we confirm that percutaneous and non invasive techniques, if well utilized, have a good cost/benefit ratio. The percutaneous treatment is also useful to convert an urgent surgical operation into a well established and programmed one.

Abdominal Abscess↗
PubMed1999

Contact laser treatment for benign prostatic hypertrophy.

Transurethral resection of the prostate (TURP) is still the standard treatment of benign prostatic hypertrophy (BPH) but the surgical lasers recently introduced seem to offer the patient a very low perioperative complication rate, a short learning curve, the reduced operating time and the health care system a very low cost/benefit ratio. We report our personal experience with contact vaporizing laser ablation of the prostate (CLAP) paying attention to efficacy, safety and costs. Between December 94 and March 97, 67 pts (mean age 62.8 +/- 9 years) underwent CLAP for BPH (mean prostate volume 40.4 +/- 17.1 cc). Five pts presented coagulation disorders, five were renal transplant recipients and one had chronic renal failure requiring peritoneal dialysis. All patients were preoperatively submitted to digital rectal examination, transrectal prostatic ultrasound, dosage of serum PSA, determination of the International Prostatic Symptom Score (IPSS), the post voiding residual urine and maximum flow rate. All these exams were repeated at 1, 3, 6, 12 and 24 months after CLAP. The bladder pressure at maximum flow (Pdet-Qmax) was preoperatively determined in 23 patients and repeated at the six months follow up. For CLAP we used an SLT neodynium-YAG laser or diode laser with maximum potency 60 W. For statistical analysis we used Student's t-test for paired data. The mean operating time was 47.9 +/- 12.5 min (range 18-75 min) and the laser energy averaged 17.707 +/- 11.239 J (range 3000-58,000 J). The mean catheter time after CLAP was 2.5 days and the mean hospital stay was 4.8 days. No intraoperative complications occurred. Two patients 48/72 h after surgery presented macrohematuria requiring laser revision, three patients presented an acute urinary retention post catheter removal and one patient had acute prostatis. At the follow up, the IPSS score, Q max, Pdet-Qmax and PVU showed a significant statistical difference respect to baseline values. The prostate volume at the 180-day follow up was not significantly different from baseline values (42.1 +/- 16.8 cc vs 40.4 +/- 17.1 cc). Contact laser ablation of the prostate has been demonstrated to be efficacious and comparable to TURP in relieving BPH obstruction however the higher costs exceeding the TURP ones by 13%, the longer operative times and the lower durability of laser disobstruction impede to replace TURP with the CLAP.

Humans↗
PubMed1998

[Extracorporeal SWL in the treatment of reno-ureteral calculosis in day hospital].

Eighteen years after the first clinical shock wave lithotripsy (SWL), no doubt remains as to its therapeutic efficacy in ureterorenal lithiasis. The advent of lithotriptors with a large shock wave energy range and integration of both ultrasound and radiologic imaging equipment at the shock wave source has meant that outpatients treatment of urolithiasis is now feasible in a good proportion of cases. In our lithotripsy center, from January 1995 to August 1996, 208 out of 310 patients who underwent SWL treatment for renal and ureteral stones, were outpatients. Pretreatment manoeuvres were performed in 10.6% of the patients. No major complications occurred during the treatment. Only three patients (1.4%) were admitted to hospital because of fever, colics or perirenal haematoma in the first two days after SWL therapy. The stone free rate was 67 and 84% respectively one and three months after treatment. In our experience, the possibility of performing SWL treatments without anesthesia and even analgosedation, the absence of complications and the high success rate, make outpatient treatment of urolithiasis safe and suitable in a large number of patients.

Adult↗
PubMed1998

[Clear cell renal carcinoma metastatic to the thyroid. A case report].

A case of clear cell renal carcinoma metastatic to the thyroid 5 years after surgical removal of the primary tumor is presented. The differential diagnosis related to cyto-histologic findings, the uncommon occurrence and the unpredictable behaviour of clear cell renal carcinoma are discussed.

Adenocarcinoma, Clear Cell↗
PubMed1997

Renal stone fragments following shock wave lithotripsy.

PURPOSE: We describe a select group of asymptomatic patients with fragments and dust 3 months after extracorporeal treatment, who were followed to evaluate the long-term outcome and therapeutic implications. MATERIALS AND METHODS: A total of 129 patients with dust and residual fragments (less than 4 mm.) at 3 months was re-examined at 12 months, and 95 were also evaluated at 24 months. Followup examinations consisted of radiographic studies, renal ultrasonography and urine culture. Dust and residual fragments were sought, and patients were defined as free or as having persistent lithiasis or stone regrowth. At 24 months recurrences in the patients stone-free at 12 months also were considered. RESULTS: At the 12-month followup 60 patients (46.5%) were stone-free and 56 (43.5%) still had dust or residual fragments. The localization of the stones or fragments at 3 months and their sizes did not have a significant influence on the stone-free rate but regrowth was greater in patients with stones larger than 10 mm. (11 of 40 patients, 27.5% versus 2 of 89, 2.2%, p = 0.001). The probability of eliminating residual lithiasis at 12 months was significantly greater in patients with dust than in those with residual fragments (42 of 79 patients, 58% versus 18 of 50, 36%, p = 0.026). Regrowth of residual lithiasis was observed in 13 patients (10%). CONCLUSIONS: Based on our results, we do not believe that patients with fragments require systematic re-treatment in the short term but they may be followed long term and re-treated if symptoms persist or stones recur.

Adult↗
PubMed1997

[Complicated urachal cyst: a difficult differential diagnosis].

Embryologically, the allantois connects the urogenital sinus with the navel. Normally, the allantois is oblitered before the birth and is represented by a fibrous cord, called urachus, extending from the dome of the bladder to the navel. Urachal formation is directly related to bladder descent. Incomplete obliteration sometimes occurs. Disease rarely occurs in urachus, but adenocarcinoma is the most fearful and rare, and it represents the 0.01% of the whole adult carcinoma, the 0.17-0.34% of the whole bladder malignancy, and the 20-30% of the bladder adenocarcinoma. Yet urachus may be seat of other kinds of benign pathologies characterized by incomplete obliteration of its lumen. Only if the ends of the urachus seal off, a cyst of that body may form and may become quite large, presenting a low midline abdomen mass. Adenocarcinoma may occur in a urachal cyst, particularly at its vescical extremity. Cystis usually have an asymtomatic course. Occasionally these cystis can be discovered during sonographic examination. If the cyst becomes infected, signs of general and local sepsis will develop, sometimes involving the peritoneum. Sometimes, in these cases, it is difficult to diagnose the presence of an adenocarcinoma and, particularly, its cystic variant. By using the common diagnostic instrumental device, we cannot reach a certain diagnosis, essential to perform a correct medical or surgical treatment. The case reported concerns a twenty-five years old man, over and over again examined, complaining of ipo-mesogastric abdominal pain, mild fever, increment of flogosis index and transaminasis, microscopic hematuria and urinal discomfort. Sonographic suprapubic examination, performed during urological consultation, showed an urachal neoplasm. Cystoscopy and TC evaluation didn't permit a certain preoperative diagnosis. A surgical explorative operation was performed and the neoplasm, a part of a bladder dome, omental flap and a part of rectus muscles, were removed. In order to reconstruct the abdominal wall we used a large Polypropilene patch. The hystological report outlined a large urachal cyst, a flogosis and a purulent necrosis invading the surrounding tissue and the peritoneum. The patient was discharged after twenty-five days and he had a good functional performance. In the light of the reported case, the surgical treatment seems to be the best solution before the onset of complications that should expose patients to difficult and demolitive surgical operations and that should protract the hospitalization.

Adenocarcinoma↗
PubMed1996

Extracorporeal shock wave lithotripsy in the treatment of ureteral lithiasis: methodological controversies and therapeutic efficacy.

The treatment of ureteral stones has undergone a radical change in the last 15 years. First, the increased use of endoscopic procedures and then the introduction of extracorporeal lithotripsy relegated traditional surgery to a marginal role for this type of disorder. The best available treatment modality for ureteral lithiasis, particularly distal ureteral stones, is still a matter of great controversy among urologist. With the introduction in clinical use of second- and third generation lithotripters, which are even less invasive and require no anesthesia, interest has increased in treating patients by extracorporeal lithotripsy, reducing endoscopic monoeuvres to a minimum. The absolute contraindications to extracorporeal lithotripsy for ureteral stones are the same as those for renal stones: intractable hemostatic alterations, pregnancy, physical structure that limits positioning and altered patency of the urinary tract. From June 1990 to December 1994, 270 patients with ureteral stones were treated by extracorporeal lithotripsy at our center. The Dornier MPL 9000 lithotripter was used in 68 cases (25%) and the modified HM3 Dornier in 202 (75%). Pretreatment manoeuvres were performed in 130 patients (48%). Endoscopic manoeuvres were not performed in 140 patients treated in situ. 18 patients (13%) treated initially in situ subsequently underwent post-treatment manoeuvres which were required only in 3 patients who had undergone pretreatment. All patients were examined as outpatients 3 months after the treatment. A total of 241 patients (89%) were stone free, 121 who had undergone pretreatment manoeuvres and 119 who had been treated in situ. 29 patients (11%) were not stone free: 23 patients subsequently underwent endoscopic lithotripsy, 2 surgery and 4 stone removal by Dormia probe. The possibility of performing treatment without anesthesia, the absence of complications and the high proportion of successes make extracorporeal lithotripsy, particularly the in situ procedure, the treatment of choice for ureteral stones. Ureterorenoscopy has been proposed by some authors as the first treatment for mid and pelvic ureteral stones which are difficult to localize with the lithotripter. However, although this method is very efficacious and less expensive, the percentage of complications is greater and patient compliance is less.

Evaluation Studies as Topic↗
PubMed1995

[Etiopathogenesis of benign prostatic hypertrophy].

The pathogenesis of benign prostatic hyperplasia (BPH) remains largely unresolved. The natural history of the disease involves two distinct phases, a pathological and a clinical one, whose pathogenesis is different. The pathologic phase is composed of two stages microscopic and macroscopic neither of which produces clinical dysuria. Nearly all men develop microscopic BPH if they live long enough but only in 50% of men microscopic BPH grows to produce a macroscopic enlargement of the gland and the evolvement happens in a period between 5 and 7 years. So different etiologies for the microscopic and macroscopic evolution of prostate can be argued. The clinical phase of BPH involves the progression of pathologic BPH to the clinical form in which the patients develop symptomatic dysuria. Again only about 50% of the men with macroscopic BPH progress to the clinical form: although macroscopic enlargement of the prostate is necessary for the development of clinical BPH it is not sufficient by itself for the progression to clinical phase and additional factors are required such as phlogosis, vascular infarct, enanchement of alpha adrenergic tone. These remarks on natural history suggest a multiple approach to BPH not addressed to treat the pathologic phase but the clinical one.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Extracorporeal lithotripsy in patients with acquired or congenital coagulopathies].

Post ESWL haemorragic complications are frequent and most patients experience temporary haematuria and focal intrarenal bleeding or perirenal haematoma are detected by NMR or US imaging. By tradition coagulation troubles have been a contraindication for ESWL but literature describes cases of coagulopathic patients treated with ESWL. From January 1992 to July 1993, 4 of our patients with severe haemostatis troubles (severe haemophilia A in two cases, acquired deficit of coagulation factors and mild thrombocytopenia secondary to post-necrotic hepatitis in 1 case and Glanzmann's thrombasthenia in 1 case) underwent ESWL using Dornier HM3 mod. or MPL 9000. An extensive haematological and clinical evaluation pre and post-ESWL with an adequate haematological prophylaxis (transfusion of blood derivatives) has been performed depending on the coagulation disorder. In our patients we did not observe any haemorragic complication and we propose a reappraisal of the contraindications of ESWL in subjects with coagulation disorders: careful evaluation of haemorragic risk factors, by suitable correction measures and close clinical and instrumental monitoring, allows a reduction of the risk of haemorragic complications in coagulopathic patients who undergo ESWL treatment.

Adult↗