Search PubMed⌕ Search

Biomedical subjects

G Rossetti

Publications and source records attributed to G Rossetti.

At least 19 recordsLinked to original sources
PubMed2007

Ultrasonographic patterns in patients with obstructed defaecation.

BACKGROUND: Anal ultrasound is helpful in assessing organic anorectal lesions, but its role in functional disease is still questionable. The purpose of the present study is to assess anal-vaginal-dynamic perineal ultrasonographic findings in patients with obstructed defecation (OD) and healthy controls. MATERIALS AND METHODS: Ninety-two consecutive patients (77 women; mean age 51 years; range 21-71) with symptoms of OD were retrospectively evaluated. All patients underwent digital exploration, endoanal and endovaginal ultrasound (US) with rotating probe. Forty-one patients underwent dynamic perineal US with linear probe. Anal manometry and defaecography were performed in 73 and 43 patients, respectively. Ultrasonographic findings of 92 patients with symptoms of OD were compared to 22 healthy controls. Anismus was defined on US when the difference in millimetres between the distance of the inner edge of the puborectalis muscle posteriorly and the probe at rest and on straining was less then 5 mm. Sensitivity and specificity were calculated by assuming defaecography as the gold standard for intussusception and rectocele and proctoscopy for rectal internal mucosal prolapse. Since no gold standard for the diagnosis of anismus was available in the literature, the agreement between anal US and all other diagnostic procedures was evaluated. RESULTS: The incidence of anismus resulted significantly higher (P < 0.05) in OD patients than healthy controls on anal (48 vs 22%), vaginal (44 vs 21%), and dynamic perineal US (53 vs 22%). A significantly higher incidence of rectal internal mucosal prolapse was observed in OD patients when compared to healthy controls on both anal (61.9 vs 13.6%, P < 0.0001) and dynamic perineal US (51.2 vs.9% P = 0.001). For the diagnosis of rectal internal mucosal prolapse, anal US had a 100% sensitivity and specificity. For diagnosis of rectal intussusception, anal US had an 83.3% sensitivity and 100% specificity and perineal US had a 66.6% sensitivity and 100% specificity. In the diagnosis of anismus, anal ultrasonography resulted in agreement with perineal and vaginal US, manometry, defaecography, and digital exam (P < 0.05). Other lesions detected by US in patients with OD include solitary rectal ulcer, rectocele and enterocele. Damage of internal and/or external sphincter was diagnosed at anal US in 19/92 (20%) patients, all continent and with normal manometric values. CONCLUSION: Anal, vaginal and dynamic perineal ultrasonography can diagnose or confirm many of the abnormalities seen in patients with OD. The value of the information obtained by this non-invasive test and its role in the diagnostic algorithm of OD is yet to be defined.

Adult↗
PubMed2006

Crura ultrastructural alterations in patients with hiatal hernia: a pilot study.

BACKGROUND: Laparoscopic fundoplication for gastroesophageal reflux disease (GERD) and hiatal hernia has been validated worldwide in the past decade. However, hiatal hernia recurrence still represents the most frequent long-term complication after primary repair. Different techniques for hiatal closure have been recommended, but the problem remains unsolved. The authors theorized that ultrastructural alterations may be implicated in hiatal hernia. Thus, this study was undertaken to investigate the presence of these alterations in patients with or without hiatal hernia. METHODS: Samples from Laimer-Bertelli connective membrane and muscular crura at the esophageal hiatus were collected from 19 patients with GERD and hiatal hernia (HH group), and from 7 patients without hiatal hernia enrolled as the control group (NHH group). Specimens were processed and analyzed by transmission electron microscopy. RESULTS: Muscle and connective samples from the NHH group did not present any ultrastructural alteration that could be detected by transmission electron microscopy. Similarly, connective samples from the HH group showed no ultrastructural alterations. In contrast, all muscle samples from the HH group exhibited sarcolemmal alterations, subsarcolemmal vacuolar degeneration, extended disruption of sarcotubular complexes, increased intermyofibrillar spaces, and sarcomere splitting. CONCLUSION: The evidence of ultrastructural alterations in all the patients in the HH group raises the suspicion that the long-term outcomes of antireflux surgery depend not only on the surgical technique, but also on the underlying muscular diaphragmatic illness.

Adult↗
PubMed2006

Postnatal weight increase and growth velocity of very low birthweight infants.

BACKGROUND: Only a few studies have dealt with postnatal growth velocity of very low birthweight (VLBW) infants. OBJECTIVE: To analyse weight growth kinetics of VLBW infants from birth to over 2 years of age. PATIENTS: A total of 262 VLBW infants were selected; inaccurate estimate of gestational age, major congenital anomalies, necrotising enterocolitis, death, and loss to follow up within the first year were the exclusion criteria. METHODS: Body weight was recorded daily up to 28 days or up to discontinuation of parenteral nutrition, weekly up to discharge, then at 1, 3, 6, 9, 12, 18, and 24 months of corrected age. Individual growth profiles were fitted with a seven constant, exponential-logistic function suitable for modelling weight loss and weight recovery, two peaks, and the subsequent slow decrease in growth velocity. RESULTS: After a postnatal weight loss, all infants showed a late neonatal peak of growth velocity between the 7th and 21st weeks; most also experienced an early neonatal peak between the 2nd and 6th week. VLBW infants who were small for gestational age and those with major morbidities grew less than reference VLBW infants who were the appropriate size for gestational age without major morbidities: at 2 years of age, the difference in weight was about 860 g. The more severe growth impairment seen in VLBW infants with major morbidities is almost entirely due to the reduced height of the late neonatal peak of velocity. CONCLUSIONS: The growth model presented here should be a useful tool for evaluating to what extent different pathological conditions or nutritional and medical care protocols affect growth kinetics.

Aging↗
PubMed2005

[Treatment of atopic dermatitis: practical approach].

Atopic dermatitis (AD) is a chronic disease frequent in childhood. The treatment is based on regular moisturizing of the skin, information to the parents on the chronic course with recurrent flares, topical anti-infectious therapy for superinfections and colonization of the skin by staphylococcus aureus, and topical steroids. The immuno-modulatory macrolides (tacrolimus and pimecrolimus) represent a new alternative to topical steroids. These molecules are well tolerated, but theirs effects on the long-term are unknown. A food allergy may be responsible for a AD flare in up to a third of the cases, but the presence of an allergy should be demonstrated before the prescription of an elimination diet. AD is often the first manifestation of atopy: the physician should be aware of the future occurence of respiratory symptoms.

Adrenal Cortex Hormones↗
PubMed2005

Pneumatic balloon dilatation for chronic anal fissure: a prospective, clinical, endosonographic, and manometric study.

PURPOSE: Pneumatic balloon dilation has been shown to be effective in the management of chronic anal fissure, but its effect on the anal sphincter has not been fully investigated. The aim of this study was to evaluate prospectively the clinical, anatomic, and functional pattern in a group of patients treated by pneumatic balloon dilation. METHODS: A series of 33 consecutive patients suffering from chronic anal fissure underwent pneumatic balloon dilation. Anal manometry and ultrasonography were performed prior to and 6 to 12 months after the treatment. Manometry was accomplished by means of an endoanal 40-mm balloon inflated with a pressure of 1.4 atmospheres that was left in situ for six minutes under local anesthesia. All patients were interviewed daily for three days after surgery and then clinically evaluated between the third and fifth postoperative weeks. Most patients were interviewed after 25.7 +/- 8.4 months (mean +/- standard deviation). Anal incontinence was evaluated by means of a validated score of 1 to 6. RESULTS: The chronic anal fissure healed between the third and fifth weeks in 31 patients (94 percent), who became asymptomatic 2.5 +/- 1.4 days after pneumatic balloon dilation. None of them reported anal pain two years after the treatment (n = 20). The first post-pneumatic balloon dilation defecation was painless in 27 cases (82 percent). Two multiparous females (6 percent of the patients) complained of minor transient anal incontinence (score, 3). Chronic anal fissure recurred in one case (3 percent) after treatment. At manometry, the preoperative anal resting pressure decreased from 91 +/- 11.2 to 70.5 +/- 5.6 and to 78 +/- 5.7 mmHg, 6 and 12 months after pneumatic balloon dilation, respectively (P < 0.0001). Anal ultrasonography did not show any significant sphincter defect. CONCLUSIONS: Pneumatic balloon dilation seems to be an effective, safe, easy procedure that decreases anal resting pressure without endosonographically detectable significant sphincter damage.

Adult↗
PubMed2005

Dental procedures in adult patients with hereditary bleeding disorders: 10 years experience in three Italian Hemophilia Centers.

Excessive bleeding after dental procedures are one of the most frequent complications occurring in patients with hereditary bleeding disorders. In this retrospective study we collected data from 10 years of experience in the oral care of patients with congenital haemorrhagic disorders in three Italian Hemophilia Centers. Between 1993 and 2003, 247 patients with inherited bleeding disorders underwent 534 dental procedures including 133 periodontal treatments, 41 conservative dentistry procedures, 72 endodontic treatments and 288 oral surgery procedures. We recorded 10 bleeding complications (1.9%), most of which occurred in patients with severe/moderate haemophilia A undergoing multiple dental extractions. Thus, our protocol of management of patients with hereditary bleeding tendency undergoing oral treatment or surgery has been shown to be effective in preventing haemorrhagic complications.

Adolescent↗
PubMed2004

Laparoscopic esophagectomy in the palliative treatment of advanced esophageal cancer after radiochemotherapy.

BACKGROUND: Esophageal cancer is associated with a poor long-term prognosis. Only a 10% 5-year survival rate is reported. This article aims to evaluate the feasibility and efficacy of laparoscopic esophagectomy for the palliative treatment of advanced esophageal cancer (T3-T4 Nx-N1) after neoadjuvant therapy. METHODS: From March 1998 to July 2002, 35 patients (mean age, 64.6 years; range, 35-72 years) affected by advanced cancer of the middle lower third of the esophagus came to the authors' observation. All received neoadjuvant radiochemotherapy. Of the 35 patients, 22 (62.9%) showed a positive response to treatment (>or=50% reduction of maximal cross-sectional area of the tumor), and surgical intervention was performed 4 weeks after the end of the therapy. The operations were accomplished through the laparoscopic approach and left lateral cervicotomy. RESULTS: The mean operative time was 160 min (range, 120-260 min). One patient (4.5%) experienced a cervical anastomotic leak. Three patients (13.6%) died in the postoperative period: one of myocardial infarction and two of acute respiratory failure. The mean postoperative hospital stay was 12.1 days (range, 9-23 days). After a mean follow-up period of 20.2 months (range, 10-40 months), 13 patients (68.4%) were alive. CONCLUSIONS: The laparoscopic approach seems to be effective for the palliative treatment of advanced esophageal cancer. Further trials will be necessary to evaluate the advantages of this technique.

Adult↗
PubMed2004

Laparoscopic approach in the treatment of epiphrenic diverticula: long-term results.

BACKGROUND: Thoracotomy represents the traditional surgical approach for the treatment of epiphrenic diverticula. A mini-invasive procedure has been reported in only few series. This article describes the authors experience with the laparoscopic approach for performing diverticulectomy, myotomy and Nissen-Rossetti fundoplication. METHODS: From 1994 to 2002, 13 patients (6 men and 7 women), mean age 57 years (range 45-71 years), with symptomatic epiphrenic diverticulum underwent laparoscopic diverticulectomy, myotomy, and Nissen-Rossetti fundoplication. RESULTS: The mean operative time was 145 min (range 110-180 min). No operative mortality was observed. The mean hospital stay was 13.9 days (range 7-25 years). The first three patients (23.1%) who underwent surgery experienced a partial disruption of the suture staple line. One patient (7.7%) died of a myocardial infarction. After a mean clinical follow-up period of 58 months (range 3-96 months), all the patients were symptom free. CONCLUSIONS: Laparoscopic management of epiphrenic diverticula seems to be as safe and effective as the traditional approach, although a longer follow-up period is necessary to confirm the study results.

Aged↗
PubMed2003

Laparoscopic treatment of Bochdalek hernia without the use of a mesh.

Bochdalek hernia is a rare pathology. The preoperative diagnosis is difficult, and few reports are available regarding its treatment. Herein we report the case of a 25-year-old woman referred for symptoms of dyspepsia, dysphagia, and thoracic pain exacerbated by pregnancy. Preoperative radiography, EGD, and CT scan revealed a paraesophageal hiatal hernia. Laparoscopic exploration showed the complete thoracic migration of the stomach through a left posterolateral diaphragmatic foramen. The diagnosis of a Bochdalek hernia was then made. The diaphragmatic defect was repaired without inserting a prosthesis, using five separate non-reabsorbable stitches (Rieder technique). The procedure was completed with a Nissen-Rossetti fundoplication. The duration of the procedure was 150 min. Hospital stay was 12 days. There were no complications. Postoperative Gastrografin radiography of the esophagus and stomach showed a normal-shaped fundoplication and confirmed the subdiaphragmatic location of the stomach. We conclude that the laparoscopic approach represents the gold standard for the diagnosis and treatment of Bochdalek hernia and any associated complications.

Adult↗
PubMed2002

Interferon and ribavirin in HIV-negative haemophiliacs with chronic hepatitis C who were nonresponders to a previous interferon treatment.

Between January 1999 and December 2001, 33 HIV-negative haemophiliacs with interferon-nonresponsive chronic hepatitis C were treated with interferon (IFN) alpha2b (5 MU three times weekly) and ribavirin (1-1.2 g daily) for 12 months. Four patients (12.1%) dropped out of the study due to adverse effects. At the end of therapy, normalization of ALT occurred in 14/33 treated patients (42.4%) and HCV-RNA was cleared in 12 (36.4%). Eleven patients (33.3%) became sustained responders. Genotype 1 was the only factor associated with a poor response to therapy (P < 0.001). Our study shows that IFN and ribavirin combination therapy is effective in HIV-negative chronically HCV-infected haemophiliacs who do not respond to a previous IFN treatment.

Adult↗
PubMed2001

The natural history of chronic hepatitis C in a cohort of HIV-negative Italian patients with hereditary bleeding disorders.

This study looked at 102 anti-hepatitis C virus (HCV)-positive, hepatitis B virus (HBV)-negative, and HIV-negative patients (median age, 45.1 years; range, 15-71) affected by hereditary bleeding disorders who have been infected with HCV for 15 to 34 years (median, 25.1). All these patients were infected before the mid 1980s because of non-virally inactivated pooled blood products. Fourteen patients (13.7%) were HCV-RNA negative with no signs of liver disease and were considered to have cleared the virus. Eighty-eight patients (86.3%) were HCV-RNA positive. The HCV genotype distribution was 1a in 20.5%, 1b in 36.4%, 2 in 17.0%, 3 in 15.9%, 4 in 3.4%, and mixed in 6.8% of cases. Twenty-four patients (23.5%) had serum cryoglobulins, symptomatic in 4 cases, and associated with liver disease and with genotype 1. Among the 88 HCV-RNA-positive patients, 15 (17.0%) had normal alanine aminotransferase levels and abdominal ultrasound, 61 (69.3%) had nonprogressive chronic hepatitis, and 12 (13.7%) had severe liver disease (6 [6.9%] liver cirrhosis, 4 [4.5%] hepatic decompensation, and 2 [2.3%] hepatocellular carcinoma) after a follow-up period of 25 years. There were 3 (3.4%) liver-related deaths. HCV genotype 1, patient's age at evaluation, duration of infection, and severity of congenital bleeding disorder were associated with more advanced liver disease. The results confirm the slow progression of HCV infection in HIV-negative hemophiliacs.

Adolescent↗
PubMed2000

[Neonatal anthropometry and early differentiations in embryo-fetal growth].

It is well known that the biologic variability in fetal size increases as pregnancy advances, although the embryonal and early fetal growth patterns as well as how early and how much the genetic, hormonal and environmental variables play a role in its modulation are still debated. It is accepted that growth in the first trimester of pregnancy is relatively uniform, with a minimal biologic variability; this variability may be underestimated, because the transversal studies do not permit the identification of the growth pattern. The aim of this work is to evaluate, by means of a longitudinal study, the time of embryo-fetal growth differentiation related at neonatal anthropometric measurements. We evaluated 238 neonates (123 female; 115 male) delivered at term after low risk, uncomplicated pregnancies. The subjects were divided into three tertles (low, mid and high) according to birth weight, length and head circumference. For each tertle, distance curves, velocity curves, and rate of increase were calculated by using respectively fetal abdominal circumference (for birth weight), fetal femural length (for neonatal length) and fetal head circumference (for neonatal circumference). The distance curves showed clear differences among the tertles only in the second period of pregnancy, whereas the velocity curves showed clear differences among tertles already in the first 12 weeks. The value of growth rates were similar for all the variables during the entire time considered. This study shows that the anthropometric differences between newborn subgroups exist already at the end of the first trimester of pregnancy and, in physiological conditions, until the end of pregnancy. The anthropometric differences observed early in our study, at twelve weeks of gestational age, are still present at the end of pregnancy and let us suppose a very early expression of the genetic potential for individual growth.

Anthropometry↗
PubMed2000

[Microbiological monitoring in neonatal intensive care].

There is no "ideal" method of infection diseases control, but there are some different methods according to the risk degree of patient, the problems, the information accuracy and also the available resources. Some important points need to be stressed about infectious diseases control in Neonatal Intensive Care Unit:--continuous microbiological surveillance in Neonatal Intensive Care Unit is necessary, because newborns admitted are at very high risk of infection disease;--continuous microbiological data review is needed: therefore criticism and integration with other clinical and laboratory data are necessary to exclude simple colonisation;--critical analysis of data allows more rational use of antimicrobical agents to avoid the selection of multiresistant bacteric streams;--a rational analysis of laboratory data needs necessarily a strict collaboration among neonatologists, microbiologists and the Committee for infectious diseases control;--in epidemics, techniques of bacterial streams typization are needed, and methods of molecular biology (DNA and proteins analysis) are better;--this implies a collection of microbiological data, by database integrating microbiological, clinical and anamnestic data and allowing retrospective studies too.

Cross Infection↗
PubMed1998

Prevalence of late potentials after myocardial infarction treated with systemic thrombolysis or primary percutaneous transluminal coronary angioplasty.

BACKGROUND: The presence of late potentials (LP) after myocardial infarction (MI) is related to an occluded infarct-related coronary artery (IRA). However, the effects of the signal-averaged electrocardiogram (SAECG) of systemic thrombolysis are contradicting. Reperfusion in the IRA is more frequently observed after primary percutaneous transluminal coronary angioplasty (PTCA) than after systemic thrombolysis. The aim of this prospective study was to compare the prevalence of LP in survivors of acute MI treated with either systemic thrombolysis or primary PTCA. METHODS: Between October 1994 and January 1997, 134 patients (pts) with acute MI were treated with reperfusion therapy within 12 hours of the onset of symptoms: seventy-four pts received systemic thrombolysis and 60 underwent primary PTCA. All pts (mean age 61 +/- 10 years, 120 males) had a control coronary angiography 9 +/- 5 and 10 +/- 4 days after acute MI, respectively. The recorded signals were amplified, averaged and filtered with bi-directional Butterworth filtering (band-pass filter range of 40-250 Hz). LPs were defined as the presence of 2 or 3 of the following criteria: filtered duration of the QRS complex > 114 ms, root mean square voltage of signals in the last 40 ms of the QRS < or = 20 mV and duration of the low amplitude signals > 38 ms. RESULTS: The two groups of pts did not differ significantly with respect to age, gender, presence of either diabetes or hypertension, site of MI, previous MI, Killip class, time to treatment, peak CK-MB level, incidence of reinfarction, extent of coronary artery disease and left ventricular ejection fraction. One hundred pts (75%) had patency (TIMI 3 grade flow) of the IRA at control coronary angiography. Twenty-seven pts (20%) had LP: 16 pts (22%) among those treated with systemic thrombolysis and 11 pts (18%) among those treated with primary PTCA (p = ns). Pts treated with primary PTCA had higher patency rates [95% (57/60) vs 58% (43/74); p = 0.00002] and less severe residual stenosis (19 +/- 15% vs 72 +/- 18%; p = 0.0001) in the IRA. LP were found in 15 pts (15%) with TIMI 3 grade flow and in 12 pts (35%) with TIMI 0-2 grade flow (p = 0.017). By multivariate analysis, including 18 clinical and electrocardiographic variables, an occluded IRA was the only independent predictor of the development of LP (Wald chi 2: 6.1453; p = 0.0132). CONCLUSION: Results of this prospective study suggest that primary PTCA alone does not reduce the prevalence of LP when compared to systemic thrombolysis. Only the patency of the IRA, as determined before the hospital discharge, affected the development of LP after acute MI.

Adult↗