[Diagnosis and treatment of an unusual case of idiopathic priapism].
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Adult↗
Biomedical subjects
C Fava
Publications and source records attributed to C Fava.
[Percutaneous transcatheter therapy of visceral pseudoaneurysms].
BACKGROUND: The purpose of this work is to show the effectiveness of percutaneous embolization therapy in the treatment of visceral arterial pseudoaneurysms and to propose the method as a valid alternative to surgery. METHODS: Twenty-eight patients with visceral artery pseudoaneurysms were treated: 10 of them were hepatic; 9 renal; 7 duodenal-pancreatic; 1 splenic and 1 of the celiac trunk. Materials employed were: Gianturco metallic coils, Spongostan and Poli-Vinyl-Alcohol. RESULTS: Immediate success was obtained in all cases; recurrences occurred in 5 patients (18%) and they have all been successfully retreated with percutaneous method; complications occurred in 3 patients (10%) and they were all directly related to the pre-existing pathology and not to the percutaneous treatment. CONCLUSIONS: To obtain the best results from embolization, it is necessary to respect some conditions regarding the correct choice of embolic materials, the superselective catheterization of the injured artery and the low injection pressure of the contrast medium in order to avoid rupturing the thin pseudoaneurysmatic wall. The advantages of the percutaneous treatment are: less trauma, local anesthesia, reduction of the time between diagnosis and therapy, reduction of hospitalization stay and limitation of parenchymal destruction, Complications are relatively not frequent and in no cases the percutaneous therapy compromised the surgical intervention when it became necessary.
Aneurysm, False↗
Effects of erythropoietin administration on blood pressure and urinary albumin excretion in rats.
The effects of recombinant human erythropoietin (rHuEPO) administration on blood pressure and urinary albumin excretion were studied in normotensive Wistar-Kyoto rats (WKY), in spontaneously hypertensive rats (SHR), and in SHR rats treated with an angiotensin converting enzyme inhibitor (SHR-ACEi). Rats were housed in metabolic cages and treated with rHuEPO (150 U/kg body weight [bw] three times a week) for 6 weeks. Control animals received the vehicle only (0.25 mL of physiological saline). An angiotensin converting enzyme inhibitor was administered in the drinking water for 6 weeks (spirapril 5 mg/kg bw). Systolic blood pressure (SBP), and 24 h urinary albumin excretion (UAE) were measured once a week. No significant differences in SBP were observed between rHuEPO and vehicle-treated normotensive animals at the end of the treatment (171.9 +/- 4.9 v 172.1 +/- 5.6 mm Hg, respectively). After 6 weeks, SBP was significantly higher in SHR and SHR-ACEi groups treated with rHuEPO than in control groups (239.8 +/- 7.3 and 243.0 +/- 7.3 mm Hg v 218.1 +/- 6.0 and 187.9 +/- 4.6 mm Hg, respectively); UAE was significantly higher in groups treated with rHuEPO than in control groups (WKY: 265.9 +/- 19.5 v 127.0 +/- 12.3 microg/100 g bw, SHR: 1668.4 +/- 564.6 v 234.8 +/- 22.9 microg/100 g bw, and SHR-ACEi: 1522.7 +/- 448.3 v 143.0 +/- 18.9 microg/100 g bw, respectively). We concluded that erythropoietin treatment causes an increase in arterial pressure in SHR only, and an increase in UAE in both normotensive and hypertensive rats. The albuminuric effect was not entirely dependent on increased blood pressure. The treatment with an angiotensin converting enzyme inhibitor did not modify either the proteinuric or the pressor effects.
Albuminuria↗
[The percutaneous placement of intra-arterial catheters with "reservoirs" for subcutaneous infusion. The technic and preliminary results].
INTRODUCTION: We report our personal technique and the preliminary results of percutaneous implantation of intraarterial catheters connected to a subcutaneous infusion reservoir (Port-a-cath) for the regional chemotherapy of hepatic and extrahepatic tumors. January, 1996, to February, 1997 fifty patients underwent the procedure: 44 had liver cancers (42 had metastases and 2 hepatocellular carcinomas), 4 pelvic tumors (2 bladder carcinomas, one uterine cancer and one vaginal cancer), one had inoperable pancreatic tumor and one breast cancer. MATERIALS AND METHODS: The access was the left axillary artery in 45 cases, the femoral artery in 4 and both the femoral and the axillary artery in one case. The infusion catheter was placed in the hepatic artery in 44 cases, in the splenic artery in one case of pancreatic cancer, in the hypogastric artery in 4 cases and in the internal mammary artery in one case. When the catheter was positioned in the hepatic artery, embolization of the gastroduodenal or accessory hepatic arteries was performed using metallic coils; when the catheter was positioned in the hypogastric artery, the contralateral hypogastric artery and the ipsilateral gluteal branches were embolized. The catheter was then tunnelled and connected to a subcutaneous reservoir, sutured to the pectoral fascia or to the inguinal ligament. After the injection of heparinated solution, infusion chemotherapy was started the day after the procedure. RESULTS: We obtained immediate technical success in all cases. Four major complications occurred: a pseudoaneurysm of the left axillary artery (percutaneously treated by placement of a covered stent), 2 thromboses of the hepatic artery and one case of gastritis. Among minor complications, the catheter was displaced in 9 cases and 7 catheters were percutaneously replaced. Side-effects, not related to the procedure, were pain, nausea, vomiting and mucositis. During the follow-up, 7 patients died (6 for tumor progression); median catheter patency was 5.14 months. Though the aim of this work is to present the technical aspects of the procedure, we report the preliminary clinical data: radiological examinations showed partial tumor regression in 15 of 33 patients with 3-month follow-up; no change was shown in 2 patients and disease progression was found in 4; the response could not be assessed in the other cases. CONCLUSIONS: In conclusion, the percutaneous placement of intraarterial catheters for continuous regional chemotherapy is a feasible, safe and tolerable procedure and can represent an alternative to the surgical implantation of catheters in the hepatic artery for the treatment of liver metastases from colorectal cancer. The technique opens new therapeutic possibilities for the local treatment of extrahepatic tumors (such as gynecologic, vesical, pancreatic and breast cancers), even though its clinical efficacy must be assessed in selected trials.
Aged↗
Assessment of the RSCL quality of life instrument during chemotherapy in an Italian setting.
Evaluation of the quality of life of oncological patients is now perceived as a major element of cancer treatment, and various instruments for measuring it have been proposed. However, whatever instrument is used must be capable of reflecting the different ways in which different contexts and cultures respond to cancer. We administered the Italian version of the Rotterdam Symptom Checklist (RSCL) to 60 patients with advanced disease attending five oncological centres in Romagna (central Italy). The RSCL was found to be able to measure both psychological and physical well-being and to detect a difference between patients on low/medium and those on high-burden chemotherapy. The Italian version of the RSCL is an adequate scale that is capable of capturing patient perceptions and could be used for monitoring the quality of life of Italian patients participating in clinical trials.
Adult↗
The quality of life of patients with newly diagnosed M1 prostate cancer: experience with EORTC clinical trial 30853.
This study was undertaken to evaluate the quality of life (QoL) of previously untreated patients with M1 prostate cancer before and during androgen-suppressive treatment. Assessment of QoL was included as an optimal component of EORTC protocol 30853, a phase III trial comparing LH-RH (luteinising hormone-releasing hormone) analogue combined with a non-steroidal anti-androgen versus orchiectomy in patients with M1 prostate cancer. At pretreatment and during the follow-up period, patients were asked to complete a questionnaire assessing their physical and psychosocial functioning, and their symptom levels. Physicians rated the patients' performance status, pain, urological symptoms and erectile function. Due to its optional nature, only a minority of the patients in the trial were recruited for the QoL investigation. 63 patients completed a pretreatment questionnaire, of whom 49 completed a second questionnaire at least once during the initial 15 month follow-up period. While statistically significant correlations were observed between patients' and physicians' ratings of physical functioning and pain, these were of only a moderate magnitude (r = 0.43 and 0.30, respectively). No significant association was observed between physicians' and patients' ratings of micturation problems or of erectile function. Before treatment, fatigue, pain and decreased social role and sexual functioning were the problems most frequently reported by patients. With an average of approximately 1 year follow-up, statistically significant improvements were observed in patients' self-reported urological symptoms and metastatic pain. No significant changes were noted for the other QoL domains assessed. The results of this study confirm earlier findings that physicians' ratings may not reflect accurately the functional health and symptom experience of their patients. Patient-based QoL questionnaires offer the most direct means of evaluating the subjective morbidity associated with prostate cancer and its treatment. To increase participation and compliance rates in future studies, it is recommended that QoL assessment be made mandatory in those clinical trials in which QoL is considered to be an important study endpoint.
Aged↗
A critical appraisal of the small-diameter portacaval H-graft.
BACKGROUND: The ideal portasystemic shunt should prevent variceal hemorrhage and preserve portal flow to reduce hepatic encephalopathy. The partial shunting proposed by Sarfeh effectively controls variceal bleeding while preserving prograde hepatic portal flow. PATIENTS AND METHODS: We analyzed results of the partial portacaval shunt prospectively in 43 patients undergoing small-diameter (8-mm or 10-mm) portacaval H-graft. Patients entered into the study had Child-Pugh class A and class B cirrhosis, and all had documented previous variceal hemorrhages. We used the Sarfeh technique without performing portal collateral ligation. RESULTS: Operative mortality was 5%. Acute graft thrombosis occurred in 3 patients, 2 of whom were successfully lysed by urokinase infusion angiographically, while later graft occlusion occurred in 1 case. Only 1 patient rebled from varices in our late follow-up (14 to 65 months). Prograde portal flow was maintained in 90% of patients undergoing repeat angiography 27 +/- 13 months postoperatively. The incidence of all encephalopathy episodes was 16%, with only 1 patient having this complication chronically. CONCLUSIONS: The small-diameter portacaval H-graft of Sarfeh is an effective operation for controlling variceal hemorrhage. It preserves hepatic portal perfusion over time in the majority of patients, reducing the risk of encephalopathy. The procedure may be particularly suited for alcoholic cirrhotic patients with less advanced liver disease.
Adult↗
Benign prostatic hyperplasia. Age and type of treatment.
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Adrenergic alpha-Antagonists↗
[Therapy of malignant hepatic tumors using percutaneous hot saline injections. Feasibility study and preliminary results].
PURPOSE: To investigate the feasibility and the results of percutaneous hot saline injection therapy (PSIT) of liver tumors. MATERIAL AND METHODS: Eight patients with hepatocellular carcinoma (11 nodules), 1 with cholangiocarcinoma and 1 with a metastasis from colon cancer underwent PSIT. The patients were selected according to variable criteria; thus, each patient was considered apart. A boiling saline solution was injected into the hepatic lesions through a needle like those commonly used for percutaneous ethanol injection (PEI). The results were assessed with US, CT, angiography, the measurement of tumor marker levels, the histopathologic examination of needle biopsy material, resected specimens, explanted liver material and follow-up. RESULTS: PSIT was more easily performed and altogether better accepted than PEI; in particular, pain immediately regressed upon infusion interruption. For this reason and for the atoxicity of the injected liquid, relatively large lesions could be treated with a greater volume per session and fewer sessions than with PEI. Treatment outcome was positive in all patients, except for the cholangiocarcinoma patient who required surgery. The only major complication was moderate peritoneal bleeding in a patient with severe coagulopathy. CONCLUSION: PSIT can be considered a useful tool for the local treatment of hepatic tumors. Its systematic use to treat hepatocellular carcinoma must be proceeded by further comparative studies with PEI.
Aged↗
[Loose bodies of the temporomandibular joint. A rare pathology].
Loose bodies of the temporomandibular joint (TMJ) are an uncommon condition which can be caused by various complaints that can now be diagnosed with high resolution CT. The authors report on 10 cases observed from 1983 to 1992 which were studied with both conventional radiography and CT. The most common conditions were synovial chondromatosis and osteochondrosis dissecans. In the two cases of synovial chondromatosis, the demonstration of ossified loose bodies made the diagnosis easier. The cases of osteochondrosis dissecans presented with more complex diagnostic problems: in two instances the characteristic subchondral bone fragment in the condylar head was clearly visible, but in the third case this small fragment was difficult to identify as it had migrated backwards, making the disorder troublesome to diagnose. An osteophyte fracture and the presence of a bone fragment following condylar head fracture were easily diagnosed by correctly assessing the associated articular changes resulting from an arthrosic and a traumatic condition, respectively. The only case of loose body due to previous TMJ remodeling was easily diagnosed as the totally ossified formation was not seen on the preoperative X-ray film. Finally, two very similar cases, characterized by the presence of an elongated radiopaque formation in the site of the posterior meniscal ligament, were difficult to interpret as no such case is reported in the literature. In both cases an anatomical variant was presumed, characterized by posterior meniscal ligament ossification.
Adult↗
[Transjugular intrahepatic portasystemic shunt (TIPS). Role of ultrasonographic methods].
The transjugular intrahepatic portosystemic shunt (TIPS) is a new interventional radiology procedure which may be assisted by modern ultrasound techniques (US). Color-Doppler US can be used for patients selection, during TIPS and in the follow-up. In a 20-month period, 71 patients were examined: 3 of them were excluded because of the absolute contraindications shown by US; in 14 of the remaining 68 patients, US demonstrated relative contraindications, such as hepatocellular carcinoma, partial portal vein thrombosis and right internal jugular vein occlusion. During the maneuver, US helped to select the most adequate veins for shunt creation and was especially useful in guiding portal vein puncture, thus allowing technical success to be achieved in 65/68 patients. The mean number of passes per patient was 2.7 and no procedure-related complications were observed. US was also used to investigate TIPS patency the day after the maneuver and to monitor shunt function during the follow-up. Color-Doppler US correctly diagnosed both 3/65 early occlusions and 9/65 late stenoses; in particular, in 18/65 patients US showed gradual flow reduction through TIPS, but clinical and endoscopic findings of malfunction appeared only in 9/65 patients whose mean reduction rates exceeded 50% at Doppler US.
Adult↗
Snoring: measurement and analysis.
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Adult↗
[Percutaneous transjugular intrahepatic portosystemic shunt (TIPS). The preliminary experience and proposal of a new method].
A new interventional procedure employing metallic stents has been recently suggested to perform percutaneous portosystemic shunts in the treatment of variceal bleeding in portal hypertension; the technique is called TIPSS (transjugular intrahepatic portosystemic stent shunt). This percutaneous treatment presents several advantages over surgery: the shunt diameter can be calibrated according to the degree of portal hypertension; moreover, TIPSS can be performed in patients waiting for liver transplantation because it does not alter the vascular anatomy of liver. The original technique employed transhepatic portography. In this paper the authors report on their personal experience and present their series of 4 patients with portal hypertension and variceal bleeding, in whom TIPSS was performed utilizing noninvasive US guidance. Variceal bleeding was successfully treated in all patients and variceal distension was also obtained.
Adult↗
[Percutaneous transcatheter embolization of deep visceral pseudoaneurysms].
The authors present their experience with the percutaneous embolization of 13 splanchnic aneurysms and pseudoaneurysms (2 pseudoaneurysms of gastroduodenal artery, 3 of the hepatic artery, 7 renal pseudoaneurysms, 1 aneurysm of the splenic artery). In 9 of 13 cases the lesions were iatrogenic. Embolizing devices and techniques are described. Percutaneous embolization was successful in 12 of 13 cases, and useless in 1 case of renal pseudoaneurysm. In the 12 successfully treated cases the lesions were still occluded in the follow-up period. Transcatheter percutaneous embolization is the elective treatment in splanchnic aneurysms and pseudoaneurysms; surgery must be performed only when embolization fails.
Adult↗
Combined evaluation of total and functional liver plasma flows and intrahepatic shunting.
A diagnostic protocol was studied, designed to evaluate the main parameters of liver circulation in man. A water solution of D-sorbitol (S) and indocyanine green (ICG) was infused intravenously in six controls and nine cirrhotics. Steady-state renal and hepatic S clearances as well as hepatic ICG clearance were calculated. In controls the values (mean +/- SD) of the independent measurements of S and ICG hepatic clearance were 978 +/- 107 and 519 +/- 142 ml/min, respectively, while in cirrhotic patients they were 554 +/- 238 and 231 +/- 90 ml/min. Owing to the kinetic properties of S, its hepatic clearance may be regarded as a measure of functional liver plasma flow (FLPF). The total liver plasma flow (TLPF) values (mean +/- SD), calculated according to Fick's principle, were 1091 +/- 157 ml/min (S method) and 1033 +/- 153 ml/min (ICG method) in controls, and 1251 +/- 554 and 1284 +/- 677 ml/min in cirrhotics. In controls, FLPF was found to be very close to TLPF. In cirrhotic patients the difference between TLPF and FLPF (ranging from 169 to 2093 ml/min when measured by S method) was considered as an approximate estimate of intrahepatic shunting. The procedure is safe and simple and may add a new dimension to the investigation of hepatic circulation.
Adult↗
Radiologic-prosthetic planning of the surgical phase of the treatment of edentulism by osseointegrated implants: an in vitro study.
An original prosthetic planning involving CT scan is described; it provides the surgeon with a template for use during the surgical phase of osseointegrated implant treatment. The final prosthodontic reconstruction was planned in a preliminary in vitro study. The CT scan provided a three-dimensional study of the underlying bone, to determine the position, angulation, and depth of the fixture to be used. The specially developed "positioner" decreased the possibilities of error in perforating the mandible. A second CT scan verified whether there were errors in positioning the fixtures. The satisfactory results and the predictability of the final rehabilitation led to the adoption of this method in a clinical research program on human patients.
Dental Implantation, Endosseous↗
[Percutaneous unblocking of porto-systemic shunts. Personal experience with 11 cases].
The authors report their personal experience in percutaneous treatment of portosystemic shunt occlusion and stenosis. Eleven patients with portosystemic shunt stenosis or occlusion were percutaneously treated. Seven patients were treated with PTA alone; in 2 cases, with recurrent variceal bleeding, percutaneous variceal embolization was associated with PTA. Four patients were treated with local fibrinolytic infusion through the catheter inserted into the thrombus; in 3 cases this treatment was followed by PTA. In all 11 patients recanalization was possible, no complications arose. Six patients died in the following 15 months, none due to rebleeding; in 5 patients of this group the shunt was patent at autopsy. In one patient autopsy was not performed but the shunt was functioning at the last duplex US control. Of 5 patients still alive in the follow-up period (2-25 months) the shunt was patent in 3 and occluded in 2.
Adult↗
[Percutaneous treatment of splenic arterio-venous fistula. Description of a case].
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Aged↗