Biomedical subjects
Publications and source records attributed to A Tagliaferri.
Transurethral resection of the prostate (T.U.R.P.) has indeed replaced open surgery in the great majority of cases, particularly when the gland is estimated to weight 50-60 g or less. After prostatectomy the patient resumes a normal voiding pattern and obstructive symptoms quickly disappear, although irritative symptoms tend to persist for some time.
Between July 1989 and June 1994 32 men (48-73 years old) underwent radical retropubic prostatectomy for prostate cancer. 26 patients (70%) presented with symptoms of bladder outflow obstruction. The primary tumour was understaged preoperatively in 5 patients (15.5%). At follow-up (6-66 months, average 24) significant urinary incontinence not occurred in our patients; sixty-two per cent reported a substantial problem with reduced or absent erection. A total of 23 patients was free of clinical or biochemical progression, observed in 28% of cases as distant or local progression. Radical prostatectomy is being performed with increasing frequency: trends in morbidity have been identified.
In July 1985, all coagulation factor concentrates were withdrawn from the market in Italy and replaced with virally inactivated concentrates. A retrospective survey comparing the prevalence of the antibody to the hepatitis C virus (anti-HCV) in hemophiliacs multitransfused with nonvirally inactivated concentrates until 1985 with that in previously untreated hemophiliacs transfused exclusively with virally inactivated concentrates since 1985 has been conducted in 9 Italian hemophilia centers. The centers, which follow about one-fourth of all the Italian hemophiliacs, provided information about 708 patients infused for the first time before 1985 (group A) and 80 patients infused for the first time between 1985 and 1991 (group B). The prevalence of anti-HCV was 83% (591/708) in group A and 6% (5/80) in group B. For the 5 anti-HCV-seropositive patients from group B, dry heating, hydrophobic interaction chromatography plus dry heating (2 patients), hot vapor and pasteurization were the virucidal methods used for the concentrates implicated in HCV transmission. In the case associated with pasteurization, there is the possibility of intrafamilial transmission of HCV. It appears from this retrospective analysis that there has been a substantial reduction in the risk of HCV transmission since the adoption of virucidal methods. However, these methods do not eliminate completely the risk, which might be further reduced by the recent adoption of anti-HCV screening for plasma donations used to manufacture concentrates.
To evaluate the role of low-molecular weight heparin (LMWH) as an alternative to oral anticoagulants in the prevention of recurrent venous thromboembolism, we compared in a randomized trial conventional warfarin treatment with a three-month course of enoxaparin 4000 anti-Xa units once a day subcutaneously. 187 patients with symptomatic deep-vein thrombosis (DVT), diagnosed by strain-gauge plethysmography plus D-dimer latex assay and confirmed by venography in most cases, were treated with full-dose subcutaneous heparin for ten days and then randomized to secondary prophylaxis. During the 3-month treatment period, 6 of the 93 patients who received LMWH (6%) and 4 of the 94 patients on warfarin (4%) had symptomatic recurrence of venous thromboembolism confirmed by objective testing (p = 0.5; 95% confidence interval [CI] for the difference, -3% to 7%). Four patients in the LMWH group had bleeding complications as compared with 12 in the warfarin group (p = 0.04; 95% CI for the difference, 4% to 14%). In the 9-month follow-up period, during which 34 patients on warfarin prolonged treatment for other 3 months and 14 up to one year, 10 patients in the enoxaparin group and 4 patients in the warfarin group suffered a documented recurrence of venous thromboembolism. Of these 14 late recurrences, just one occurred in patients with postoperative DVT. After one year there were 16 recurrences (17%) in the LMWH group and 8 (9%) in the warfarin group (p = 0.07; 95% CI for the difference, 1% to 16%).(ABSTRACT TRUNCATED AT 250 WORDS)
Nuclear Magnetic Resonance (NMR) is a new diagnostic technique with great opportunities of application in the field of the penile pathologies. A new interest for this diagnostic technique was born when the use of vasoactive agents, like papaverine or PGE1, and the use of para-magnetic contrast agents, like gadolinium, were introduced. The introduction of dynamic NMR in andrology allowed a better definition of anatomical details and a better knowledge of penile micro-circulation. N.M.R. is showing a great diffusion, because of a little invasiveness (X-rays are not used in this technique). The Authors show a wide spread of possible applications of NMR in penile pathologies, helping in the interpretation of the images. In conclusion the authors describe NMR as a diagnostic technique with great possibilities of improvement, even if the high costs don't allow a better diffusion until now.
OBJECTIVE: Galanin is believed to play a role in the control of prolactin (PRL) secretion in the rat. Such a role is uncertain in humans where the neuropeptide is expressed by the corticotrophs. However, in clinical conditions of enhanced ACTH secretion, increased PRL levels are often observed. Therefore, we evaluated the effect of galanin infusion on serum PRL levels in patients with Cushing's disease and in control subjects. For comparison, the PRL responses to TRH and metoclopramide were also investigated in the same patients. DESIGN: Four tests were performed: (a) 40-minute infusion of 0.3 micrograms/kg/min of galanin; (b) infusion of normal saline only; (c) metoclopramide test (10 mg as i.v. bolus); (d) TRH test (200 mg as i.v. bolus). PATIENTS: Twenty-four normal subjects and nine patients suffering from active Cushing's disease were investigated. MEASUREMENTS: Serum concentrations of PRL were measured by radioimmunoassay on blood samples collected before and for 90 minutes after drug or saline administration. RESULTS: Serum baseline PRL levels were superimposable in normal subjects and in patients with Cushing's disease. In normal subjects, infusion of galanin induced a distinct PRL increase compared to saline (mean +/- SEM incremental areas 6514 +/- 2572 vs 540 +/- 571 mU/l/90 min, P = 0.05, respectively). In patients with Cushing's disease, galanin evoked a remarkable PRL rise with hormone levels which were significantly greater (P < 0.001) than those observed in the same patients after infusion of saline (21908 +/- 4180 vs 534 +/- 1556 mU/l/90 min) or after galanin administration in controls (P < 0.01). The PRL response to TRH and, much more so, to metoclopramide was significantly lower in patients with Cushing's disease than in normal subjects (42125 +/- 8000 vs 73181 +/- 7246 mU/l/90 min, P < 0.01 after TRH and 79095 +/- 27265 vs 229049 +/- 10602 mU/l/90 min, P < 0.01 after metoclopramide). CONCLUSIONS: Galanin appears to be a specific, though weak, PRL secretagogue in normal subjects. The galanin-induced PRL release was significantly increased in patients with Cushing's disease. A number of hypothetical mechanisms may underlie the enhanced PRL reactivity to galanin in Cushing's disease. This finding together with the impaired PRL responsiveness to TRH and metoclopramide, also observed in this study, is a further example of a dysregulation of PRL secretion in patients with Cushing's disease.
From the beginning of the eighties papaverine was well established as the drug of choice for diagnosis and management of vasculogenic impotence. In the second half of the eighties decade many authors referred on experimental use of PGE1 in erection disease. PGE1 has been showed a safe and effectiveness drug. During the period September 1989-October 1990 at our Institution 98 pts. with erectile disorders were managed by I.C.I. with PGE1. Out of 98 cases 88 had success. Prolonged erection occurred in 4 pts. (4.2%). 10 pts. showed only tumescence. So there are been treated by I.C.I. with combined papaverine and PGE1 with better results. No side effects were formed in 10 pts. managed by self-injection of PGE1.
271 patients with acute symptomatic deep venous thrombosis of lower limbs, confirmed by strain-gauge plethysmography and/or venography, were randomly assigned to receive intermittent subcutaneous heparin calcium or heparin sodium by continuous intravenous infusion for 6-10 days. Heparin dosage was adjusted to maintain activated partial thromboplastin time values (Thrombofax reagent) at 1.3-1.9 times the basal ones. Strain-gauge plethysmography was repeated at the end of heparin treatment, and evaluation of therapy was performed by comparing the indexes of venous hemodynamics and by assessing the incidence of pulmonary embolism and of bleeding complications. In the intravenous group, Maximal Venous Outflow (MVO) increased from 20.8 +/- 12.8 to 28.4 +/- 17.5 ml/min per 100 ml of tissue and Venous Capacitance (VC) from 1.39 +/- 0.92 to 1.94 +/- 1.0 ml/100 ml of tissue (mean +/- SD). In the subcutaneous group, MVO increased from 21.0 +/- 12.7 to 27.5 +/- 18.1 and VC from 1.60 +/- 0.86 to 2.06 +/- 1.0. The median improvement of MVO and VC were 22% and 36% respectively in the IV group and 20% and 24% in the SC group. Clinical pulmonary embolism occurred in 2 patients in the intravenous group (1 fatal) and in 4 in the subcutaneous group (1 fatal). 9 major bleeding complications occurred in the intravenous group (1 fatal) and 5 in the subcutaneous group (1 fatal). The differences were not significant at the statistical analysis. The results suggest that subcutaneous intermittent heparin has a comparable efficacy to continuous intravenous heparin in the treatment of deep venous thrombosis. To the same conclusion points an overview of the seven randomized trials which compared these treatment modalities.
Cloacogenic carcinoma is a rare form of neoplasia (4-14% of tumours of the colon-rectum) which occurs on the transitional epithelium of anal canal. An extra-visceral location is rare. The paper reports a case of cloacogenic carcinoma sited on the perianal skin, treated with radiotherapy and local surgical excision. It is important to perform a biopsy and a thorough endoscopic examination of all ano-perianal lesions in order to separate those of dermatological relevance from those of surgical relevance, and at the same time to determine the exact histological type of the latter group so as to select the correct therapeutical approach.
Percutaneous nephrolithotomy has been proved an efficient management of renal calculi. We report, in present review, the complications of PCNL procedure referred by several authors and our casistic since 1985. Major complications occurred in 3-6% of treated patients: severe bleeding, arteriovenosal fistulas, haematoma perirenal, water syndrome, sepsis, DIC, etc.). Nephrectomy was necessary in less than 1% of reported cases. 5 patients died for complications related to PCNL. Early complications occurred during the percutaneous puncture, tract dilation and lithotripsy. Postoperatively bleeding at the time of nephrostomic tube removal was reported in 0.5-1% of cases. Late sequelae of PCNL: stricture, fistulas, renal damage, renal function loss, high lithiasis recurrence rate were reported rarely. We, herein, believe PCNL is a safe and effective procedure with minimal rate of complications and late effects, according to other important authors.
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Strain-gauge plethysmography (SGP) is currently employed in the diagnosis of deep venous thrombosis (DVT), but its accuracy has not been adequately tested. In this study we evaluated SGP against venography in 209 consecutive patients referred to us because of clinically suspected DVT of lower limbs. Venography was performed bilaterally if symptoms or signs suggesting DVT were present in both limbs. It was always performed after SGP and independently assessed. A total of 269 limbs could be evaluated with both SGP and venography, which disclosed DVT in 128 limbs of 110 patients. There were 109 proximal and 19 distal DVT. Out of the 128 limbs with DVT, SGP was positive in 114 (sensitivity = 89%) using Maximal Venous Outflow (MVO) as the diagnostic parameter, and positive in 116 (sensitivity = 91%) using an index obtained multiplying MVO for Venous Capacitance (VC). Out of the 141 venographically negative limbs, there were 6 false positive results using MVO and 9 using MVO X VC (specificity = 96% and 94% respectively). SGP sensitivity in acute proximal venous thrombosis was 97%, while it was about 60% in distal DVT. Most false positive results occurred in patients with edema of cardiac origin. SGP appears to be a useful diagnostic test in suspected DVT of lower limbs, particularly when both MVO and the index MVO X VC are used.
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The authors have studied the behavior of Aminoacids (AA), GH, Prolactin (PRL), Insulin (IRI) and blood sugar (BS) after fast intravenous injection of 1 mg of Glucagon (G), in eight normal volunteers. The rise in BS levels soon after G. administration at time 10', 20', 30', 45', 60' prompted to consider the initial phase of the experimental to be under G predominance, although IRI did respond to the infusion with a sharp rise, at time 10', 20', 30', 45'. Glycine, serine, threonine, alanine, lysine, phenylalanine and arginine displayed a significant reduction already at time 10' or 20', when G metabolic effects were dominant, a selective G influence on these AA can be supposed. At time 45' and 60' tyrosine, histidine, methionine, valine, leucine, isoleucine, proline, decreased significantly and glycine, serine, threonine, lysine, alanine, phenylalanine, evidenced further reduction. GH and PRL were not affected by the administration of G.
In order to study the effect of iodoamide (a contrast medium widely used for urographic and arteriographic studies) on thyroid function, seventeen subjects were studied before and after arteriographic examinations employing this contrast compound. Serum concentrations of T4, T3, rT3 and TSH were not modified during the observation period by the administration of iodoamide. This finding is in contrast with the observation that iopanoic acid and ipodate, used for cholecystographic examinations, can reduce the serum concentrations of T4 and T3 with a concomitant increase in rT3. Therefore, iodoamide is not useful in the treatment of hyperthyroidism.
The constantly workload increase has led to the development of Computerised Decision Support Systems (CDSS) for a better management of patient care. Many clinical situations have been investigated to verify the utility of CDSS: few have demonstrated stable effects. One area where success has been reported is the field of oral anticoagulation management. CDSS system has demonstrated to be able to improve the treatment quality in comparison to manual method. In the future scenario of oral anticoagulant management CDSS will have a pivotal part, the constant increase of patients number and their pressure on thrombosis centres had led to the development of alternative models for delivery OAT: Primary care, General Practitioner, Patient self testing and self management and the use of CDSS has been central to the decentralisation process and may be useful in maintaining the efficacy and quality of anticoagulant control. GP with the aid of CDSS are able to deliver OAT as well as expert physician of Thrombosis Centre in terms of time spent by patient in therapeutic range.
Efficacy and safety of a low molecular weight heparin (Alfa LMWH) was compared with unfractionated heparin (UFH) in the prevention of post-operative venous thromboembolism after hip fractures. Forty-nine patients were randomized to treatment with Alfa LMWH 7500 anti-Xa coagulometric units twice daily or with UFH 5000 IU t.i.d. Screening for thrombosis was performed with 125-I-fibrinogen leg scanning and strain-gauge plethysmography. Positive results were confirmed by venography. Five patients in the Alfa LMWH group (20 per cent) developed venographycally proven deep vein thrombosis (DVT) versus seven (29 per cent) in the UFH group. One pulmonary embolism and two deaths occurred in the UFH group and none in the LMWH group. No differences in haemorrhagic complications and blood loss indices were observed. Alfa LMWH appears to be a promising drug for prevention of venous thromboembolism after orthopaedic surgery. A "flexible" schedule of administration is proposed on the basis of the results of plasma anti-Xa assays.