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Biomedical subjects

G Carmignani

Publications and source records attributed to G Carmignani.

At least 19 recordsLinked to original sources
PubMed2005

Prulifloxacin versus ciprofloxacin in the treatment of adults with complicated urinary tract infections.

INTRODUCTION: The present study was performed to evaluate the efficacy and safety of a 10-day regimen of prulifloxacin 600 mg once daily as compared to ciprofloxacin 500 mg twice daily in the treatment of patients with complicated urinary tract infections (UTIs). MATERIALS AND METHODS: 257 patients (mean age +/- SD 62.3 +/- 16.5) were enrolled and orally treated with prulifloxacin (127 patients) or ciprofloxacin (130 patients). The study was designed as a randomized, double-blind, double-dummy, controlled clinical trial. The primary efficacy parameter was the eradication of infecting strains (<10(3) cfu/ml). The clinical outcome and tolerability were also assessed. RESULTS: At baseline, the most common infecting strains were Escherichia coli (62.8%), Proteus mirabilis (7.1%) and Klebsiella pneumoniae (4.1%). At the early follow-up, the rate of patients showing successful treatment was 90.8% in the prulifloxacin group, and 77.8% in the ciprofloxacin group (p = 0.008). A positive clinical outcome was observed in 94.8 and 93.3% of prulifloxacin- and ciprofloxacin-treated patients. Both drugs were well tolerated. Two patients dropped out for treatment-related adverse events. CONCLUSIONS: The high urinary concentrations of prulifloxacin, combined with a broad-spectrum antimicrobial activity, allow its use in the empiric therapy of UTIs.

Adult↗
PubMed2004

Medical therapy of prostate carcinoma.

Medical treatment of prostatic cancer is one of the most complex and challenging issues in oncologic urology, and probably of oncology itself. In fact, in spite of the well known sensitivity of the disease to hormonal manipulations, it is still substantially unclear whether hormonal therapy achieves survival improvement. Furthermore, many prostate cancers become hormone refractory within 18 to 36 months from the onset of therapy, and until now, no further treatment has been able to improve their prognosis, in spite of the often promising early results. Medical treatment is now being used as an adjunct to radical surgery and to radiotherapy, in both the adjuvant and the neoadjuvant setting, and this raises further controversies. This paper is an attempt to give to the readers the state of art of medical therapy, even within the limits of a concise review. The authors are aware of these limits but hope that this paper can be useful to the reader.

Androgen Antagonists↗
PubMed2003

Patch urethroplasty using a fascia lata autograft in male rabbits.

INTRODUCTION: Urethral reconstruction is difficult when the genital skin is not available for surgery. We evaluate the feasibility of using the autologous fascia lata as a graft for urethral repair. MATERIALS AND METHODS: 10 male rabbits underwent urethroplasty after creation of a ventral urethral defect. The defect was repaired using a graft harvested from the fascia lata. The animals were divided into three groups and sacrificed at 2, 4 and 12 weeks postoperatively. Radiologic control was performed after 10-12 days and before sacrifice. RESULTS: In the 10 rabbits subjected to surgery, no case of death or wound infection was observed. During urethrography, a fistula was observed in 2 animals. In the remainder (n = 8), histological analysis showed the preservation of the original laminar structure without graft shrinkage or fibrosis. On the luminal side of the patch, a new line of urothelium appeared in the 2nd week after surgery. After 3 months, the new epithelium was multilayered and the graft edges were not detectable. No voiding dysfunction was detectable in 8 rabbits. CONCLUSIONS: Our study suggests the feasibility of using the autologous fascia lata for urethral patch repair.

Animals↗
PubMed2002

Combined oral therapy with sildenafil and doxazosin for the treatment of non-organic erectile dysfunction refractory to sildenafil monotherapy.

The purpose of this work was to investigate the efficacy and safety of sildenafil in combination with doxazosin for the treatment of non-organic erectile dysfunction in patients who did not respond to sildenafil. We enrolled 28 patients with non-organic erectile dysfunction, for whom 3 months of sildenafil monotherapy had failed. They were divided in two random and homogeneous groups: 14 were treated with doxazosin (4 mg daily) and sildenafil (100 mg 1 h before sexual intercourse); the other 14 patients received sildenafil and placebo. The results were assessed by means of the IIEF questionnaire before the beginning of the study, after 30 days of therapy and after 60 days. Of the 14 patients treated with doxazosin and sildenafil, 11 (78.6%) showed a statistically significant increase of IIEF; in the placebo group, only one patient (7.1%) recorded a significant IIEF increase. The differences observed in the two groups were statistically very significant (P=0.0016). Blood pressure did not show significant alterations. Side effects were minimal and even present during sildenafil monotherapy. The combination therapy with sildenafil and doxazosin resulted in the safe and effective treatment of men with non-organic erectile dysfunction for whom sildenafil alone had failed.

Adult↗
PubMed2002

Histological changes following two-step flap gastrocystoplasty in rats.

INTRODUCTION: A gastric segment used to increase bladder capacity can undergo considerable changes over time, as can all intestinal segments implanted in the urinary tract and in contact with urine. This experimental study reports the differences between the histological alterations observed in the gastric patch transposed in the bladder both with its own pedicle and after deafferentation from the stomach. MATERIALS AND METHODS: A group of 30 young male Sprague-Dawley rats underwent gastrocystoplasty. Survivors were divided into 3 groups: gastrocystoplasty alone (8 rats); gastrocystoplasty with vascular deafferentation at 15 days (7 rats), and at 2 months (8 rats). 5 rats were used as controls. Urinary pH was evaluated during a 6-month follow-up. RESULTS: Histology showed that early devascularization hindered the fusion of the two mucosae in the junctional area but reduced papillary hyperplasia (p = 0.013) of the gastric mucosa. No changes were observed in urinary pH after patch devascularization. CONCLUSIONS: Vascular deafferentation creates a gastric flap on the bladder which, even if it does not prevent urinary acidification, reduces the frequency of histologically detected changes susceptible for transformation into neoplasms.

Animals↗
PubMed2001

Traumatic rupture of the corpora cavernosa: new physiopathologic acquisitions.

OBJECTIVES: To investigate the physiopathologic mechanisms of the rupture of the corpora cavernosa by means of a histologic study of the tunica albuginea. METHODS: In 6 patients (age range 28 to 49 years, mean 38) with traumatic penile rupture, samples of the tunica albuginea were taken during corrective surgery far from the site of the lesion. These specimens were analyzed with light microscopy by the same pathologist and compared with other samples of tunica albuginea taken from 7 patients who underwent penile surgery for other reasons. RESULTS: Five of the 6 patients with traumatic penile rupture had histologic anomalies of the tunica albuginea (fibrosclerosis in all 5 patients [83%] and phlogistic cellular infiltrations composed of lymphocytes or histiocytes in 3 patients [50%]). Only 1 patient (17%) with traumatic rupture of the corpus cavernosum had a completely healthy tunica albuginea. None of the control specimens revealed any histologic alterations. CONCLUSIONS: Structural anomalies could alter the mechanical properties of the tunica albuginea, representing a weakening factor of the corpora cavernosa and thus a predisposing factor for traumatic rupture of the penis. Therefore, patients with anomalous albuginea could undergo penile rupture even at intracavernous pressures inferior to pressures usually necessary to cause rupture in patients with healthy albuginea.

Adult↗
PubMed2001

Arterial priapism and cycling: a new worrisome reality?

Arterial priapism is a rare condition caused by the traumatic formation of an arteriolacunar fistula. We report 2 cases of arterial priapism after cycling injuries. Both patients sustained a violent perineal trauma against the top tube on the bicycle. In both cases, penile detumescence was obtained by superselective arteriographic embolization of the fistula with gelatin sponge or microcoil. The fistula was monolateral in the first case and bilateral in the second. Cycling should be considered a possible risk factor for arterial priapism as it is for urethritis, prostatitis, hematuria, testicular torsion, scrotal and penile numbness, and erectile dysfunction.

Adult↗
PubMed2001

Adult testicular pure yolk sac tumor.

Here we describe the clinical, ultrasonographic and histological features of a rare pure adult yolk sac tumor detected in the right testis of a 44-year-old male. Due to the rarity of this neoplasm (less than 10 cases have been reported), there is no unanimous consensus for therapy following inguinal orchiectomy. We believe that nerve-sparing retroperitoneal lymph node dissection could be potentially curative and useful for future interpretations of this tumor's potential evolution.

Adult↗
PubMed2001

Incidental splenectomy during left radical nephrectomy: reasons and ways to avoid it.

INTRODUCTION: Left radical nephrectomy is the second most common cause of incidental splenectomy during transabdominal oncological surgery in the upper left quadrant of the abdomen. The potential sequelae of splenic ablation are often underestimated and generally no systematic planned efforts have been undertaken to avoid a splenic injury. MATERIAL AND METHODS: We evaluated the incidence of iatrogenic splenectomy in 333 cases of left radical nephrectomy for renal cancer performed at our institute between 1970 and 1999. Two slightly different surgical techniques were adopted and after 1995 particular attention was paid to the possible causes of intraoperative splenic injury and how to avoid it. In the first group of patients (1970-1994) an anterolateral xipho-umbilical-subcostal approach was used, and in the second group (1995-1999) a cruciate "Mercedes-like" incision was always adopted. RESULTS: The incidence of iatrogenic splenectomy in the first group of patients was 13.2%, and only 2.6% in the second group. The mortality rate in the first group of patients was 6%; no mortality has been recorded in the second group. Postoperative infections averaged 12.1% in the first group and 11.6% in the second, without any difference between the two groups. However, if we consider the incidence of postoperative infections in splenectomy cases, the incidence reaches 24.2% in the first group versus no cases in the second. CONCLUSIONS: Incidental splenectomy is a potentially severe complication of transabdominal left radical nephrectomy and is often considered a price that has to be paid, particularly in cases of large tumoral masses. A more detailed knowledge of splenic anatomy, a critical consideration of the intraoperative factors that may lead to splenectomy, and the adoption of a surgical tactic borrowed from the techniques of liver transplant significantly lower the incidence of iatrogenic splenectomy.

Adult↗
PubMed2001

Scrotal extraperitoneal hernia of the ureter: case report and literature review.

Ureteral herniation is a rare, often misdiagnosed event and serious surgical complications are possible. Until 1992, 128 cases of ureteral herniation were reported and in 54 (42%) the inguino-scrotal region was involved. From an anatomical and pathogenic standpoint, two types of uretero-inguinal hernias can be identified: paraperitoneal (more frequent, acquired, always presenting a peritoneal hernia sac, frequently associated with other herniated abdominal structures) and extraperitoneal (very uncommon, congenital, never associated with a true peritoneal sac, always composed only of the ureter). We describe a new case of scrotal extraperitoneal ureteral hernia and review the current urological, surgical and radiological literature to analyze the main clinical characteristics of this pathology and its ideal treatment.

Aged↗
PubMed2001

[Priapism: decisional algorithm, our experience, and role of sildenafil in sexual rehabilitation].

OBJECTIVE: We report our experience in the management of priapism. MATERIALS AND METHODS: In a 2-year period we observed 7 patients of whom 4 presented with low flow and 3 with high flow priapism. RESULTS: In 2 of the patients with ischemic priapism, simple blood aspiration from the corpora allowed for a quick detumescence, while in the other 2 cases a derivative intervention (1 spongio cavernous and 1 glans cavernous) had to be performed. In all the 3 patients with high flow priapism we performed a superselective arteriography that obtained the visualisation of the arteriovenous fistula. These patients restarted their sexual activity after about three months. At six months a patient with low flow priapism restored sexual activity due to sildenafil 50 mg. CONCLUSION: The importance of distinguishing low and high flow priapism was confirmed.

Adult↗
PubMed2001

[Evaluation of the association between benign prostatic hyperplasia and sexual disorders].

OBJECTIVE: The aim of this study was to determine the incidence of sexual dysfunction in patients with benign prostatic hyperplasia (BPH). METHODS: During the last 6 months 88 patients (mean age 65 years, range 55-78) suffering from BPH, without other chronic disease, were studied. RESULTS: Andrological evaluation enabled us to find erectile dysfunction in 52% of patients, ejaculation problems in 41% and decrease of libido in 54%. CONCLUSION: Due to the great impact of these disturbances in patients' quality of life, we believe that clinical and therapeutic approach in BPH patients should be global, with both urological and andrological assessment.

Aged↗
PubMed2000

AMS three-piece inflatable implants for erectile dysfunction: a long-term multi-institutional study in 200 consecutive patients.

OBJECTIVES: The aim of this study was to assess the longterm mechanical reliability of AMS (American Medical Systems) three-piece inflatable implants and their impact on patient-partner satisfaction in 200 consecutive patients with erectile dysfunction who underwent surgery in five different institutions. METHODS: Patient charts included in the study were collected and extensively assessed to record pre- and intraoperative data and postoperative complications. All patients and 120 partners were then seen often in the office at a mean follow-up of 59 months (range 6-130) and they were extensively questioned about function of the device and its impact on the couple's sexual life. RESULTS: At the long-term follow-up, 185 patients (92.5%) were still engaging in sexual intercourse with a mean frequency of 1.7/week. Patients and partners reported prosthetic erections as excellent, satisfactory or poor in 96 (48%), 100 (50%) and 4 (2%) cases, and in 20 (17%), 80 (66%) and 20 (17%) cases, respectively. Postoperative sexual activity was considered excellent, satisfactory or poor by 140 (70%), 44 (22%) and 16 (8%) patients and by 34 (28%), 81 (68%) and 5 (4%) partners, respectively. Reasons for patients' complaints included postoperative penile shortening in 60 (30%) cases and poor glandular engorgement in 40 (20%) cases. Partners' main complaint was unnaturalness of the prosthetic erection, a factor reported by 30 (25%) subjects. Complications requiring surgical exploration included infection in 12 patients (6%) and mechanical failure in 8 patients (4%). Kaplan-Meier estimates demonstrated significantly decreased mechanical survival for the Ultrex type of cylinders compared to the CX type of cylinders. CONCLUSIONS: AMS three-piece inflatable implants provide an overall patient and partner satisfaction rate of 92 and 96%, respectively. However, postoperative penile shortening and poor glandular engorgement were the causes of some complaints among the patient population as well as the unnaturalness of prosthetic erection among female partners. In the long-term, mechanically speaking, CX cylinders seem to be more reliable than the Ultrex ones.

Adult↗