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Biomedical subjects

G Guazzoni

Publications and source records attributed to G Guazzoni.

At least 37 records · Page 2Linked to original sources
PubMed1998

Laparoscopic bilateral adrenalectomy for persistent Cushing's disease after transsphenoidal surgery.

BACKGROUND: We performed bilateral laparoscopic adrenalectomies on four patients (three women and one man) with Cushing's disease (pituitary-dependent Cushing's syndrome) showing persistent hypercortisolism after transsphenoidal surgery. METHODS: The technique for bilateral transperitoneal laparoscopic adrenalectomy was derived from the one previously adopted by our group for unilateral adrenalectomy and previously described. Eight trocars were used, of which two were used for both left and right adrenalectomy. RESULTS: Bilateral laparoscopic adrenalectomy was performed in a one-stage procedure in the three women and, because of the abundant abdominal fat of the patient, in a two-stage procedure (after a 1-week interval) in the man. Operating times for the three women were 255 minutes, 230 minutes, and 220 minutes, and for the man 170 minutes for right adrenalectomy and 140 minutes for left adrenalectomy. No surgical or anesthesiologic complications were encountered. All patients were discharged from the hospital within 5 days after operation. At present, after follow-up periods of 23, 8, 6, and 18 months, all patients show remission of Cushing's disease and undetectable cortisol levels. CONCLUSIONS: Our experience suggests that bilateral laparoscopic adrenalectomy is a safe and effective procedure and a valid therapeutic option in patients with Cushing's disease showing persistent hypercortisolism after transsphenoidal surgery. However, the decision to remove both adrenal glands in such patients needs to be weighed against the risk of their having Nelson's syndrome or other long-term complications.

Adrenalectomy↗
PubMed1997

Laparoscopic unroofing of adrenal cysts.

OBJECTIVES: This study was aimed to demonstrate the feasibility of laparoscopic conservative surgery of the adrenal gland in the treatment of adrenal cysts. METHODS: Two cases of laparoscopic decortication of symptomatic adrenal cysts with preservation of the adrenal parenchyma are presented. RESULTS: Surgery was uneventful in both cases and patients returned to preoperative activity within 10 days from the operation. At the 3-month follow-up, computerized tomography demonstrated the absence of any cystic recurrence and adrenal endocrine function was normal. These findings were confirmed at the 1-year follow-up by ultrasonography. CONCLUSIONS: Symptomatic adrenal cysts can be effectively and safely treated by laparoscopic unroofing, a minimally invasive procedure which leaves the nondiseased adrenal parenchyma intact.

Adolescent↗
PubMed1997

Recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomized trial.

PURPOSE: This study was aimed at assessing prospectively the effect of postoperative intracavernous injections of alprostadil on the recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy. MATERIALS AND METHODS: A total of 30 potent patients with clinically localized prostate cancer (clinical stage B1 or B2, Gleason sum 7 or greater, prostatic specific antigen less than 20 ng./ml.) underwent nerve-sparing radical retropubic prostatectomy and was subsequently randomized to alprostadil injections 3 times per week for 12 weeks (group 1, 15 patients) or observation without any erectogenic treatment (group 2, 15 patients). Patients were assessed at the 6-month followup by sexual history, physical examination, color Doppler sonography of the cavernous arteries and polisomnographic recording of nocturnal erections. RESULTS: In group 1, 12 patients (80%) completed the entire treatment schedule and were evaluated at the long-term followup. Eight patients in this group (67%) reported the recovery of spontaneous erection sufficient for satisfactory sexual intercourse, compared with 3 patients (20%) in group 2. The difference between the 2 groups was statistically significant (p <0.01). In group 1, all but 1 patient reporting normal postoperative erections also showed normal erections at nocturnal testing, whereas color Doppler sonography demonstrated normal penile hemodynamics in all of them. In these patients, failures were the result of cavernous veno-occlusive dysfunction (2 cases, 17%) and cavernous nerve injury (2 cases, 17%). In group 2, patients with normal erections showed both normal nocturnal testing and penile hemodynamics, whereas failures were the result of cavernous veno-occlusive dysfunction (8 cases, 53%), cavernous arterial insufficiency (2 cases, 13%) or cavernous nerve injury (3 cases, 20%). Complications in patients treated with alprostadil injections accounted for 2 cases (13%) of a penile nodule and 1 further case (6%) of prolonged penile erection. Complications were not seen in group 2 patients. CONCLUSIONS: Early postoperative administration of alprostadil injections significantly increases the recovery rate of spontaneous erections after nerve-sparing radical retropubic prostatectomy. It is our belief that programmed vasoactive injections improve cavernous oxygenation, thereby limiting the development of hypoxia-induced tissue damage. The potential complications related to the use of intracavernous injections must be clearly explained to patients.

Aged↗
PubMed1996

The impact of sleep deprivation on erotic erections.

OBJECTIVE AND METHODS: The audiovisual stimulation penogram seems to be an appropriate screening test for erectile failure. However, falsely abnormal findings in psychogenically impotent patients with severe excitement inhibition can be found. Since disinhibitory effects may occur after sleep deprivation, we evaluated RigiScan results during audiovisual stimulation before and after sleep deprivation in 36 psychogenically impotent men. RESULTS: In our patients, sleep deprivation induced an increase in penile tumescence and rigidity before intracavernous injection of prostaglandin E1 as well as after the injection. CONCLUSION: Our data suggest that sleep deprivation combined with vascular testing and visual stimulation might lead to more precise diagnosis in male impotence.

Adult↗
PubMed1996

The effect of intracorporeal injection plus genital and audiovisual sexual stimulation versus second injection on penile color Doppler sonography parameters.

PURPOSE: We assessed whether genital and audiovisual sexual stimulation following 1 or 2 intracorporeal injections caused the greatest changes in penile hemodynamics as recorded by color Doppler sonography. MATERIALS AND METHODS: A total of 50 impotent patients underwent multiphasic color Doppler sonography of the cavernous arteries before and after intracorporeal injection (phase 1), subsequent genital and audiovisual sexual stimulation (phase 2), a second injection (phase 3) and repeat genital and audiovisual sexual stimulation (phase 4). Peak systolic velocity, end diastolic velocity, resistance index and erectile response were studied. RESULTS: Penile erection after injection 1 was upgraded in 41 patients (82%) by genital and audiovisual sexual stimulation. Further upgrading due to injection 2 with stimulation was noted in 11 patients (22%). Among the patients who completed the 4 phases of the test the maximal peak systolic velocity was noted after 1 and 2 injections in 20 (59%) and 14 (41%), respectively. The resistive index was always increased by genital and audiovisual sexual stimulation compared to post-injection values. The maximal resistive index occurred after initial and repeat genital and audiovisual sexual stimulation in 15 (48%) and 16 (52%) patients, respectively. After injection 1 with genital and audiovisual sexual stimulation, impotence was diagnosed as nonvasculogenic in 14 patients (28%), arteriogenic in 9 (18%), venogenic in 17 (34%) or mixed arteriovenogenic in 10 (20%). After injection 2 with stimulation these results were noted in 18 (36%), 9 (18%), 13 (26%) and 10 (20%) patients, respectively. Thus, there were 4 false-positive cases (8%) of venogenic impotence. CONCLUSIONS: To study cavernous artery inflow and veno-occlusive function, color Doppler sonography should be performed after injection plus genital and audiovisual sexual stimulation. When the erectile response does not equal the maximal physiological erection reported by the patient, a second injection with stimulation should be given.

Audiovisual Aids↗
PubMed1996

AMS 700 CX inflatable penile implants for Peyronie's disease: functional results, morbidity and patient-partner satisfaction.

This study was designed to clarify the functional results, morbidity and the patient-partner satisfaction observed with, the American Medical System 700 CX three-piece inflatable prosthesis in the treatment of impotence associated with Peyronie's disease. Thirty-three patients were treated and additional plaque surgery was performed in 13 cases (40%). Within 10 days of surgery, four patients (12%) developed a wound infection which was treated conservatively and one patient (3%) experienced glandular ischemia. At the 6-week follow-up, complete penile straightening was achieved in 23 patients (70%), while penile rigidity was considered optimal by all patients. On the contrary, the penis was considered short by 10 patients (30%). Five diabetic patients (15%) complained of severe scrotal and penile pain during full activation of the implant and in one of these patients (3%) the implant had to be removed. Due to spontaneous erections occurring after implant activation one patient (3%) required replacement of the reservoir from the Retzius space into the peritoneum. At the long-term follow-up (mean +/- SE: 17 +/- 2.2 months), 23 patients were evaluated and all found to be engaging in intercourse with the prosthesis. However, five patients (21%) and three of the 13 partners (25%) assessed were not yet completely satisfied. The American Medical System CX700 inflatable penile prosthesis obtains complete penile straightening in 70% and rigidity in 100% of impotent patients with Peyronie's disease. Patients should be fully informed about possible surgical morbidity and actual post-operative penile length.

Coitus↗
PubMed1996

[Percutaneous echo-guided drainage and sclerotherapy of symptomatic renal cysts: critical comparison with laparoscopic treatment].

Nowadays, the minimally invasive treatment of symptomatic renal cyst has been progressively gaining wide acceptance while classic open surgery has been almost abandoned. It is a still controversial which minimally invasive approach provides the major advantages and results. Fifty-two patients with symptomatic simple renal cyst underwent ultrasound guided percutaneous drainage and sclerotherapy (ethanol 95 degrees) and 20 patients underwent laparoscopic unroofing of simple renal cysts in our department. No major complication was recorded with both the techniques. Even if we reported a higher recurrence rate (82%) with sclerotherapy than that with laparoscopic treatment (5%) we consider the percutaneous drainage a valid approach because it is a safe, easy and at low cost procedure.

Cholecystectomy, Laparoscopic↗
PubMed1995

An original balloon-expanding urethral suture guide for radical prostatectomy.

Between August 1991 and July 1994, an original balloon-expanding urethral suture guide (24 F) was used in 157 consecutive cases of radical retropubic prostatectomy. Both the instrument and its clinical use are described. This guide guarantees good intraoperative exposure of the sectioned urethral stump during vesical reanastomosis, thus improving the technical feasibility of radical prostatectomy.

Equipment Design↗
PubMed1995

Is there a role for transrectal microwave hyperthermia in the treatment of benign prostatic hyperplasia? A critical review of a six-year experience.

We critically reviewed our 6-year experience with transrectal microwave hyperthermia of the prostate for benign prostatic hyperplasia (BPH) in 320 patients either at high surgical risk or refusing surgery. Transrectal prostatic hyperthermia was given in five to ten 60-minute sessions with an intraprostatic temperature ranging from 42 degrees to 43.5 degrees C. Although an amelioration of symptoms and urodynamic measures was seen initially in most patients, only residual urine volume showed a statistically and clinically significant improvement at the long-term follow-up. According to maximum flow nomograms, bladder outlet obstruction was not resolved by the treatment. We conclude that although the transrectal hyperthermia proved to be a safe procedure, it did not cure BPH in the long term. Considering the results seen with newer nonsurgical procedures such as prostatic stents and prostatic lasers, we believe that transrectal hyperthermia should not be recommended to symptomatic BPH patients.

Aged↗
PubMed1995

Benefits and complications of laparoscopic pelvic lymphadenectomy for detection of stage D1 prostate cancer: a multicenter experience.

One hundred fifty-eight consecutive patients with clinically localized prostate cancer were submitted to staging laparoscopic pelvic lymphadenectomy (LPL) at 5 cooperative centers with one or more of the following conditions which were considered as risk factors for nodal disease: clinical stage C (or T3) disease, serum prostate-specific antigen > 20 ng/ml, Gleason sum > 6. The mean number of lymph nodes removed was 11 (range 2-29). Metastases from prostate cancer were found in 41 patients (25.9%). The proportion of lymph node-positive patients increases significantly with the presence of one, two or three of the conditions considered as risk factors (p < 0.00005). The benefit of LPL is limited to the lymph node-positive patients who can be spared a second operation.

Humans↗
PubMed1995

Pharmacological management of erectile dysfunction.

Pharmacological treatment of erectile dysfunction includes all therapeutic modalities based on the use of erectogenic drugs, regardless of the route of administration. Intracavernous vasoactive injection therapy is the most commonly used treatment for erectile dysfunction. Most patients respond to intracavernous injection of either single or multiple vasoactive drugs. Major adverse effects related to this treatment include priapism, corporeal pain and the formation of nodules or plaques in the corpora cavernosa. Oral administration of drugs aimed at improving erectile function has not produced results comparable with those obtained with intracavernous injection therapy. However, in patients with psychogenic or mild organic impotence, oral treatment with drugs that influence either central or peripheral pathways controlling erection may improve erectile function. Topical administration of vasoactive drugs in the form of gels, liquid solutions or plasters is another attractive alternative for the treatment of psychogenic and mild organic erectile dysfunction. Although the ideal drug for the treatment of erectile dysfunction has not yet been identified, extensive laboratory and clinical research is ongoing and successful results are expected in the near future.

Administration, Oral↗
PubMed1995

Improved minimally-invasive assessment of penile haemodynamics: the combination of colour Doppler sonography and injection-stimulation test.

The aim of this study was to assess the diagnostic value of erotically enhanced penile colour Doppler sonography as a minimally invasive tool to evaluate penile haemodynamics. Colour Doppler sonography was used to study the cavernosal arteries of 135 consecutive impotent patients after intracavernous injection of a vasoactive mixture (injection phase) and after subsequent genital and audiovisual sexual stimulation (stimulation phase). The erectile response was upgraded after the adjunct of genital and audiovisual stimulation in 36% of patients. Colour Doppler assessment performed after the stimulation phase identified 16% of patients as arteriogenic despite normal erections, and 7% of patients falsely diagnosed as venogenic after the injection phase. When colour Doppler sonography and the injection-stimulation test are performed together as a single diagnostic procedure the overall diagnostic accuracy is significantly enhanced.

Adult↗
PubMed1995

Transperitoneal laparoscopic versus open adrenalectomy for benign hyperfunctioning adrenal tumors: a comparative study.

In our retrospective study we compare the effectiveness and safety of transperitoneal laparoscopic versus open adrenalectomy in 40 patients with benign hyperfunctioning unilateral adrenal tumors. Patients 1 to 20 underwent open adrenalectomy between July 1988 and July 1992, and patients 21 to 40 underwent the laparoscopic procedure between September 1992 and January 1994. Student's t test for unpaired data was used to compare intraoperative and postoperative results, and morbidity observed in the 2 groups. The affected adrenal gland was successfully removed in all cases. Mean operative time was significantly longer for laparoscopy, although it shortened progressively due to the learning curve effect. Blood loss was significantly less with laparoscopy, while only 3 patients undergoing open surgery required blood transfusions. Overall invasiveness and analgesic requirement were significantly lower with laparoscopy. The intervals to oral intake and ambulation, hospital stay and return to preoperative normal activity were shorter with laparoscopy. Major complications were noted only in open surgery patients. At 3 months all patients in both groups were cured of the underlying adrenal disease. We conclude that transperitoneal laparoscopic adrenalectomy is equally effective and less invasive than open surgery, and that it should be considered the first choice therapy for benign hyperfunctioning adrenal tumors.

Adrenal Gland Neoplasms↗
PubMed1994

A comparison of transrectal hyperthermia, transurethral thermotherapy, urolume wallstent, and prostatic spiral for benign prostatic hyperplasia patients at poor operative risk.

Transrectal hyperthermia, transurethral thermotherapy, prostatic stent, and prostatic spiral were used to treat 120 poor operative risk patients with symptomatic benign prostatic hyperplasia. The preoperative subjective and objective conditions of the four groups (each of 30 patients) were comparable. None of the patients had an indwelling catheter, but according to flow nomograms, all were obstructed. The greatest increase in peak flow rate was observed after stent placement, while the greatest decrease of residual urine volume was seen after the insertion of the stent and transrectal hyperthermia. According to maximum flow nomograms, only the placement of the stent resolved bladder outlet obstruction. The greatest improvement in subjective symptoms was the result of stent insertion, but the heating procedures also caused a significant reduction of symptom scores. The spiral produced satisfactory results only in the short term.

Aged↗
PubMed1994

Clinical reliability of multi-drug intracavernous vasoactive pharmacotherapy for diabetic impotence.

The aim of this study was to assess the effectiveness and safety of intracavernous injections of a four-drug vasoactive mixture in diabetic patients with organic impotence. A group of 60 diabetic patients with either pure neurogenic, pure vasculogenic or mixed neurovasculogenic impotence were treated with intracavernous injections of a combination of 12.1 mg/ml papaverine hydrochloride, 1.01 mg/ml phentolamine mesylate, 10.1 micrograms/ml prostaglandin E1 and 0.15 mg/ml atropine sulphate ('full-dose' mixture). A mixture of the same drugs but at one-third concentrations ('reduced-dose' mixture) was also used. The mean (+/- SEM) volumes of the full-dose and reduced-dose mixtures used were 0.21 +/- 0.03 ml and 0.31 +/- 0.02 ml, respectively. All the patients were able to sustain a rigid erection at the end of the titration phase of the study. At a mean follow-up of 18 months, 48 patients (80%) were successfully using the mixture, 6 patients (10%) were using the mixture at a dose lower than the initial dose and 6 patients (10%) had dropped out from the injection therapy. No major complications were seen. The association of multiple vasoactive drugs which use different mechanisms of action, thus exerting a pharmacological synergism, is an effective and safe procedure in intracavernous pharmacotherapy for diabetic patients with organic impotence.

Adult↗
PubMed1994

Laparoscopic unroofing of simple renal cysts.

OBJECTIVE: The aim of this study was to assess the clinical reliability of laparoscopic treatment for simple renal cysts. METHODS: Twenty patients with symptomatic simple renal cysts underwent laparoscopic unroofing of the cysts. Four of these patients also underwent concomitant laparoscopic cholecystectomy because of symptomatic gallbladder stones. RESULTS: In all cases the cyst wall was widely resected with no significant surgical complication. Cholecystectomy was easily performed without additional morbidity. Postoperative renal ultrasonography and intravenous urography demonstrated the absence of cyst recurrences and the integrity of the excretory tract. Symptoms were resolved by the operation in all cases. CONCLUSIONS: Laparoscopic unroofing is a safe, effective, and minimally invasive treatment for selected symptomatic simple renal cysts.

Adult↗
PubMed1994

Effectiveness and safety of laparoscopic adrenalectomy.

A laparoscopic approach was used to remove the adrenal gland in 7 patients with aldosterone-producing adenoma (Conn's disease), 2 with corticosteroid-producing adenoma (pituitary-independent Cushing's syndrome) and 2 with pheochromocytoma. The affected gland was on the right side in 3 patients and on the left side in 8. Mean operative time was 3 hours 10 minutes (range 140 to 370 minutes). The operation was uneventful in all patients and blood transfusions were never required. Mean postoperative hospitalization was 2.9 +/- 0.8 days (standard error). Only minimal doses of analgesics were used postoperatively. All patients returned to work within 10 days postoperatively (mean 8.4 +/- 1.2 days). Two months postoperatively no patient had clinical, biochemical or hormonal evidence of recurrent or persistent disease. We conclude that laparoscopic adrenalectomy is a safe and effective, minimally invasive approach for patients with benign adrenal neoplasms.

Adrenal Gland Neoplasms↗