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Biomedical subjects

B Palmieri

Publications and source records attributed to B Palmieri.

At least 19 recordsLinked to original sources

[Vitamin C. Its clinical use and state of the art].

This is a review of the most relevant articles on the vitamin C-based therapy with emphasis to high per os and parenteral doses that might be effective on calories utilization, energy production, mythocondrial red-ox function, gene expression and metabolism. Ascorbic acid treatment in tumor bearing patients is a puzzling issue whose rationale is based on low vitamin plasma concentration and cancer uptake and sequestration; furthermore high parenteral dosages should be required to achieve a putative oxidative damage on tumor DNA, by this antioxidant molecule; thus bioavailability and metabolism as well as clinical effectiveness are reviewed on the basis of the evidence based medicine: specific evidence of vitamin C efficacy is quite limited, but areas like diabetic vascular complications and sideropenia might benefit of the treatment; high parenteral doses might be useful, perspectively also in relapsing urinary tract infection, after conventional treatment failure, due to the high output of ascorbic acid and potential saturation of the target tissues.

Ascorbic Acid↗

The encircling mesh in abdominal wall surgery: rationale and technical details of a dorso-ventral physiological restoration.

We describe a new, functional surgical technique, known as 'encircling mesh', designed to address abdominal wall problems. The rationale of the procedure is to connect the anterior and posterior trunk muscle compartments by means of a purpose built polypropylene mesh that encloses a belt shifted posteriorly across the spine subcutaneously, through use of a disposable introducer. The technical details and a case presentation, with specific references to the cosmetic and functional outcomes are described.

Abdominal Neoplasms↗

[Endoluminal diode laser vein damage: preclinic study for vein insufficiency].

BACKGROUND: The ex-vivo phase of this research aims to define fibre laser activity ranges with the intent of using a safety protocol on the operating table to ensure maximum results in occluding the vein lumen with minimum necessary energy parameters. METHODS: The study was performed on 20 human saphenous veins removed during phlebological surgery. A 1 mm diameter optical fibre was inserted in the vein to the proximal extremity where administration of laser energy began along the vein axis. The veins were subdivided into three groups based on the parameters used: Group 1: treated with 20 Watt power; Group 2, treated with 15 Watt power; Group 3, treated with 10 Watt power. On conclusion of the procedure the veins were immersed in formalin and sent for histological examination. RESULTS: The greatest endothelial damage was observed in the group of veins treated with fluence above 300 J/cm(2), in which carbonisation of the endothelium was observed; in those treated with lower fluence (200-100 J/cm(2)) damage consisted in coagulation necrosis and interstitial oedema; at fluence of 100 J/cm(2) endothelial damage was less uniform. CONCLUSIONS: Experimental evidence would appear to support the hypothesis that the optimal protocol is below 300 J/cm(2) fluence with 15 Watt power and pulse train 100-300 ms.

Adult↗

Relationship of unrecognised myocardial infarction, diabetes mellitus and type of surgery to postoperative cardiac outcomes in vascular surgery.

OBJECTIVES: to evaluate preoperative clinical, surgical and instrumental variables as predictors of postoperative cardiac events in patients undergoing different types of elective major vascular surgery. MATERIAL AND METHODS: on the basis of an algorithm including clinical and test echocardiographic data, we prospectively stratified 604 consecutive patients into low, intermediate and high-risk groups. The value of the variables in predicting postoperative cardiac events was assessed by means of multivariate analysis. RESULTS: there were 16 major postoperative cardiac events and six of 16 postoperative deaths were cardiac related (1%). Significant predictors of cardiac complications were unrecognised myocardial infarction (odds ratio - (OR) 5.6), coronary artery disease (OR 2.5), severe hypertension (OR 2.1) and peripheral vascular surgery (OR 1.9). In the intermediate-risk group, the best correlates with cardiac complications were unrecognised myocardial infarction (OR 3.3) and diabetes (OR 2.5). CONCLUSIONS: our results suggest the importance of identifying patients with unrecognised ischaemic heart disease and of using aggressive perioperative protocols for managing diabetic patients undergoing peripheral vascular procedures.

Aged↗

Abdominal aortic aneurysm resection following cholecystectomy and heart transplantation. Case report.

The case of a patient who underwent heart transplantation and cholecystectomy in 1993 and admitted for resection of abdominal aortic aneurysm in May 1997, is reported. About 25 minutes after unclamping the abdominal aorta the patient s blood pressure fell suddenly to 70/40 mmHg. In spite of vigorous fluid administration and infusion of Dopamine and Adrenaline the hemodynamic pattern returned to normal only 15 minutes later. The authors discuss the possible explanations of this behaviour (mesenteric traction syndrome, hypovolemia) and conclude that heart transplant patients are particularly affected by hypotension. Of paramount importance remains therefore the correct evaluation of adequate filling pressures which should be maintained slightly above normal range.

Aortic Aneurysm, Abdominal↗

Evaluation of polyamide synthetic hair. A long-term clinical study.

BACKGROUND: Different methods of hair restoration surgery exist: expanders, rotation flaps, autotransplantation and artificial hair implant. METHODS: The authors reviewed 196 patients who underwent hair implantation 2 years before with a highly biocompatible polyamide fiber. Indications, contraindications and complications of the procedure are outlined. RESULTS: Clinical subjective and photographic objective judgement, evaluation of Hamilton scale grading and covered area rate show very satisfactory improvements. Relevant adverse events were limited to 1.02%. CONCLUSIONS: A careful medical follow-up with regular scalp check-up minimizes complications to a very acceptable rate and overall results are definitely satisfying.

Adult↗

[Photography methods in general and esthetic surgery: clinical significance and impact on surgical performance].

The authors outline and emphasize the use of Polaroid technique in the surgical practice, either in emergency room (pre-, intra- and postoperative photography) or in plastic-reconstructive surgery, where informed consent is needed on the basis of surgical plan. Polaroid photos are suitable to be enclosed in the patient record as well as in the legal documentation. The Polaroid Macro-5SLR camera is specifically useful in the medical practice to improve the doctor-patient relationship.

General Surgery↗

Preoperative assessment of cardiac risk in noncardiac major vascular surgery.

We evaluated whether a preoperative clinical algorithm allows an adequate stratification in cardiac risk and the predictive value of dipyridamole thallium-201 scintigraphy and rest echocardiography for postoperative adverse cardiac outcomes. Three hundred twenty patients undergoing 338 vascular surgery procedures were prospectively stratified into low, intermediate, and high risk. The low- and intermediate-risk patients underwent surgery without further diagnostic evaluation. In 7 high-risk patients the vascular procedure was canceled (1 died of myocardial infarction at 6-month follow-up), 9 underwent presurgical myocardial revascularization (1 died of myocardial infarction), and 49 underwent vascular surgery with perioperative intensive care treatment. Hospital mortality was 3.8%. Cardiac mortality and morbidity were 1.5% and 10.4%, respectively. We observed a significant difference in "hard" (death, myocardial infarction, pulmonary edema, major arrhythmias) and "soft" (myocardial ischemia, minor arrhythmias) events between groups, p <0.001. Previous pulmonary edema was a predictive variable of cardiac outcomes (multiple logistic regression analysis). Ninety-nine of 220 intermediate-risk patients randomly underwent dipyridamole thallium-201 scintigraphy: 37 had redistribution, 10 persistent, and 52 no defects; 7 of 13 soft and hard cardiac events occurred in patients without redistribution defects. Sensitivity, specificity, and positive and negative predictive values of redistribution defects for postoperative adverse outcomes were 38%, 63%, 14%, 87%, respectively. This algorithm may provide a safe and cost-effective approach (average cost saving per patient $1,500) to cardiac risk stratification. These results suggest that routine use of dipyridamole thallium-201 scintigraphy for screening of intermediate-risk patients may not be warranted.

Adult↗

[The prevention of adhesions in surgery. A clinical review and experimental contribution].

BACKGROUND: The well-known soft tissue healing properties in some rat models as well as the modulating fibroblasts activity of heterologous collagen led us to the hypothesis that it is possible to prevent the peritoneal adhesions in the rat by interposition of the collagen after peritoneal surgery. METHODS: In this study, the use of Type I heterologous collagen in different physical forms (1% gel, lyophilized sponge, dehydrated film) for the postoperative peritoneal adhesions prevention has been evaluated. In the second part of the experiment; the 1% gel heterologous collagen including the recombinant tissue plasminogen activator (rtPA) has been applied. RESULTS: The results of both the experiments don't show any improvement in the number and the quality of the adhesions. CONCLUSIONS: It is cannot be excluded that, increasing the rtPA concentration it is possible to obtain better results, but the great cost and its potential systemic toxicity are limiting factors for its widespread use in order to prevent peritoneal adhesions.

Abdomen↗

[Lipoemulsification. A histological study on the action of ultrasound, access site and adipose tissue].

A new mini-invasive technique for the lysis of subcutaneous adipose tissue has emerged in recent years. This directly applies ultrasounds to the tissue by titanium probes. Ultrasounds act on parenchyma tissues, saving the structure and integrity of the blood vessels. Our study show histological features of the subcutaneous adipose tissue evolution just ultrasound-treated up to 30 days after surgery. Five obese female patients underwent the treatment by anesthesia. Before surgery the sites to treat were topically injected with sterile, hypotonic, apyrogen saline solution added with adrenaline, Biopsies have been taken intraoperatively from the border cutis of the holes made for the introduction of the titanium probes and from the subcutaneous adipose tissue. Biopsies have also been taken during a follow-up at 2, 5, 15 and 30 days postoperatively. Drains were positioned in the treated sites for at least 72 hours. The same sites were sutured so at to make later follow-up biopsies easier. Histological specimens were considered according to three dying methods: eosin-haematoxylin, Gomori and acetic orcein. We observed, as a confirmation the safety of the adipose tissue blood vessels, and the substitution of the destroyed adipose tissue with a microfibrillar connective tissue not subject to a sclerogenic evolution.

Adipose Tissue↗

[Lipoemulsification versus lipoaspiration. Comparison of intraoperative blood loss and surgery time].

Blood loss due to liposuction is one of the main problems in this kind of surgery, blood volume being up to 30%-35% of the whole liposucked volume. We studied the possible lower impact of ultrasound lipolysis in order to obviate this non negligible problem. For this purpose we treated 10 patients, females, aged between 28 and 55, such obese to overweight between 50% and 200%. These patients underwent ultrasound lipolysis surgery after any dietetic or any other treatment against obesity. No patient dropped out of the study. Each patient was treated, under general anesthesia, in a region included between an imaginary horizontal line passing through the umbilicus and another one through the middle of the femur. Thirty minutes after a bilateral infiltration with an epinephrine solution (1:500000 diluted, 28 C) 2 1 volume each side, the right side was treated with the liposucking cannula (0.4 cm diameter), the left one underwent ultrasound lipolysis with a titanium probe (0.5 cm diameter, SMEI Casale Monferrato, Italy). A liposucking probe every 10 minutes into the left side was inserted. Haemoglobin was detected (according to the method of Goodpasture) in the liposucked material. The result showed a statistically significant difference between the blood rate in the lipoaspirate and that one in the ultrasound lysed material. Ultrasound lipolysis is slower than lipoaspiration, but it also shows less risk of hemorrhage and fat embolism.

Adult↗

Vitamin E added silicone gel sheets for treatment of hypertrophic scars and keloids.

BACKGROUND: Trauma of various origins can induce a connective tissue disorder that leads to keloids. This condition has yet not been clearly distinguished from scars and hypertrophic scars. Only electronmicroscopic and biochemical data can help to do this. Among some more or less therapeutic approaches, the use of silicon (polydimethylsiloxane) plates, wrapped on the keloid surface, has been reported effective by some authors. These authors also demonstrated that it is not the mechanical pressure that is the mechanism of action, but a direct action on fibroblasts and a hyperhydration of subcutaneous tissue. The authors of this study conceived that the silicon plate may be able to improve the transdermal penetration of a compound such as vitamin E. This vitamin is capable of preserving some important morphologic and functional features of biological membranes by means of its phytilside chain of the molecule acting as a stabilizer of lysosomal membranes. MATERIALS AND METHODS: Eighty patients of both sexes, aged between 18 and 63 years, who had hypertrophic scars and keloids, were admitted to the trial. The patients were randomized to two groups in a simple-blinded study. Group A: Forty patients whose scars have been covered with silicon plates with added vitamin E. Group B: Forty patients treated with simple silicone gel sheets. No pressure bandages were used, only tape fixing the sheet for 10 hours overnight. The trial lasted for 2 months. The results were recorded at 4 and 8 weeks, evaluating the improvement according to a Scott-Husskinson scale. For objective assessment photos were taken. The results were analyzed by the chi-square test. RESULTS: At the end of the first month, group A had improved by more than 50% in 85% of cases, whereas the improvement in group B was 55% (P < 0.01). At the end of the second month, 95% of patients in group A had improved by 50%, whereas 75% had improved by 50% in group B (P < 0.05). CONCLUSIONS: Vitamin E added to the silicon plate scored better than the simple silicon plate at the end of both periods. We have reported the successful combined action of vitamin E and silicone gel sheets in scar treatment, especially in the short-term prophylaxis of hypertrophic scars or keloids.

Administration, Topical↗

[Carotid stenosis with contralateral occlusion. Surgical indications and results].

Recent American and European trials have clearly defined that surgery provides best treatment for unilateral critical stenosis of internal carotid artery. Isolated reports seem to confirm this trend also in cases with carotid critical stenosis with controlateral occlusion, even if a major surgical risk may be expected. In our experience in the last two years, out of 96 carotid enderterectomies 20 presented a controlateral occlusion. After routine pre-operative assessment, with particular regard to DSA "cross-filling" study, intervention has been performed under general anesthesia with BP+EEG cerebral monitoring in both groups of patients. In the non occluded group temporary shunt has been used in 19.7% of cases, in occluded the incident of shunting was 40%. Operative morbidity and mortality in the second group was surprisingly absent, with cumulative 4.1% complication rate. Our experience confirms that risks and results in carotid endoarterectomy are similar in both groups of patients.

Aged↗

[Ultrasonic suction lipectomy. A mini-invasive treatment of obesity].

The safety of ultrasounds lipolysis in the treatment of local obesity and lipodystrophies versus suction lipectomy (less blood loss because of a lower impact on blood vessels network, and less mortality) induced us to combine these mini-invasive techniques in the treatment of obese patients. Between 1991 and 1994 we treated 205 patients (146 females, 59 males, 18-59 range age), affected by 1st degree obesity (44.4%), 2nd degree obesity (27.3%) and 3rd degree obesity (28.3%), accordingly to the following schedule: 1) general anesthesia; 2) subdermal infiltration of the operating sites of a cold sodium chloride (0.9%) epinephrine solution (1:10(5), 8 degrees C); 3) 0.5 cm cutaneous incisions; 4) introduction of titanium tips as ultrasounds source; 5) insertion of suction lipectomy probes to remove the adipose tissue destroyed by ultrasounds; 6) drainage of the wide subcutaneous space; 7) setting of elastic bandages. Mortality was zero and very low side effects have been observed. We report an improvement of blood glucose and triglycerides level and blood pressure 30 days after surgery. Fair late postoperative improvement of the blood glucose tolerance test have been seen in 3 cases.

Adolescent↗

Use of color photocopying machine in surgical imaging.

BACKGROUND: The photographic imaging of operative specimens is quite a puzzling procedure, especially in emergency situations and whenever a professional photographer is not available. A careful documentation of the gross pathology therefore is not always possible, and this is detrimental for the full clinical information on the patient. We suggest an original, quick, simple, and inexpensive use of a regular color photocopying machine to produce a real time 1:1 and magnified picture of operative specimens, biopsies, etc. STUDY DESIGN: Fresh specimens recovered from the operating room are quickly cut to obtain two hemisections with planar surfaces. The blood is gently squeezed out and absorbed from the specimen that is put on a transparent sheet of acetate. The specimen is covered by a polyurethane soft block, in order to obtain a better image. It is also possible to make enlargements to highlight interesting details or small structures (lymph nodes). RESULTS: We obtain color photocopies of the gross specimen in real time at the end of the operative procedure. This is useful for the physicians involved in diagnostic or therapeutic procedures. Copies are made also for the patient record. The specimen is then transferred unmodified to the pathology laboratory for routine analysis. CONCLUSIONS: Minoltype is a quick, simple, inexpensive, and effective method for producing and recording medical images. The cost of each photocopy is estimated to be one-third to one-fifth that of color photographs.

Color↗

[Pilonidal cysts: the state of the art and the authors' personal experiences].

After a historical review of the pathogenesis and several therapies suggested for the treatment of pilonidal cysts the authors report the results of a retrospective study performed in the Department of Surgery during a period of four years, with at least 12 months follow-up. This study involved 53 patients (35 males and 15 females, 23 years average age) affected by pilonidal cyst. These patients were treated for a month with antibiotic therapy and underwent surgery by general anaesthesia. Before surgery blue methylene was injected in the cyst. Between 4 months and 2 years 5.7% of operated patients relapsed. After 10 days antibiotic therapy they underwent surgery again by local anaesthesia and then they followed an open treatment protocol including collagen and silver sulfadiazine, healing by delayed wound closure. Furthermore a depilating cream for the border of the wound was suggested to the patient. These patients healed in a period between 4 weeks and 2 months. No relapses were observed after at least 12 months. In our opinion there is the rationale to suggest an open treatment of relapsed pilonidal cyst based on the use of heterologous lyophilized collagen and silver sulfadiazine: it is well accepted by the patient and effective in relapses.

Adolescent↗

[Ultrasonic liquid medium for lipo-emulsification. An experimental study].

The technique of ultrasonic lipo-emulsification is currently gaining increasing support. This method consists in the dissolution of human adipose tissue using ultrasound generated by a special appliance and transmitted using (mini-invasive) titanium probes inserted into the subcutis. This procedure is preceded by the infiltration of subcutaneous fat using specially studied hypotonic solutions. On the basis of their previous experience and using data reported in the literature, the authors carried out a study to establish whether among the solutions routinely used there are alternative saline solutions which might enhance the lipolytic efficiency of ultrasound or allow possible saving in terms of time and money. Samples of ex-vivo subcutaneous adipose tissue weighing 5 g were exposed to ultrasonic energy at a frequency of 19800 Hz and an output of 65 Watt until fully dissolved. Prior to this the samples were immersed in a saline solution commonly used in clinical practice for perfusion at a different osmotic pressure. The authors succeeded in identifying saline solutions able to mediate the lipolytic ultrasonic action with greater efficiency than the solutions currently used by other authors.

Adipose Tissue↗

[Use of color photocopying machine in the reproduction of images in surgery].

Diagnostic imaging is becoming more and more important and effective in modern medicine. The author describes a quick, inexpensive and simple technique suitable for reproducing immediately colour images of surgical specimens (recovered from the operating room) by means of a colour photocopying machine. Untrained people too are able to run this method that allows the production of well defined images helpful for a closer and more careful real time communication between the surgeon and the pathologist. This document can also be part of the patient's record, and it's useful for the discussion with other physicians involved in diagnostic or therapeutic procedures. The method saves the specimen from every injury and allows its investigation by the pathologist.

Color↗