Biomedical subjects

Gennaro Selvaggi

Publications and source records attributed to Gennaro Selvaggi.

25 records · Page 2Linked to original sources

PubMed2004

Neurocutaneous island flap:: an experimental model using the rabbit ear.

The rabbit ear has often been used as an experimental model; however, a neurocutaneous flap has never been described before. The authors examined the reliability of a skin cartilage flap with a pedicle composed only of a sensory nerve with its vascular network in a rabbit model: A 2 x 2-cm cutaneous cartilage flap was harvested on the dorsal side of the ear bilaterally. Vessels were tied and cut on the 4 sides of the flap, including the central auricular artery and vein. The nerve was cut at the distal side of the flap and was "skeletonized" to the extent of 1 cm on the proximal side, meticulously preserving its vascular network. Subsequently, the flap was elevated with the cartilage as a composite flap and was sutured back to its natural site. The authors elevated 28 skin cartilage flaps on the dorsal side of both the ears of 14 New Zealand White rabbits, centered on the central neurovascular axis. All 28 flaps survived. In the control group of 7 rabbits, the artery, vein, and nerve (pedicle) were severed, and the skin cartilage island was sutured back as a composite graft. None of these 14 grafts survived. In 4 additional rabbits, the authors performed a histologic examination 1 day, 3 days, 7 days, and 3 weeks postoperatively of the neurovascular axis after the same skin cartilage flap was harvested. They compared these results with the histologic examination of the nerve of the contralateral nonoperated ear, and noted a marked dilatation and multiplication of blood vessels in the operated ear beginning on day 1 postoperatively. The presence of this neurocutaneous vascularization should be considered when other kinds of flaps (venous flaps or others) are used as experimental models using the rabbit ear.

Animals↗

PubMed2004

Twenty years of clinical islet transplantation at the Diabetes Research Institute--University of Miami.

Transplantation of allogeneic pancreatic islets for the treatment of patients with Type 1 diabetes mellitus (T1DM) is now a reality. The steady progress that has allowed for the recent successful clinical trials world-wide follows a steep learning curve and the perseverance of the international islet transplantation community. The Clinical Islet Transplant Program at the Diabetes Research Institute - University of Miami has contributed to the progress in the field with a 20-year track record. It has been a long journey and despite the intermediate success, more work is needed in order to achieve the ultimate goal of a safe and long-lasting treatment for patients with T1DM.

Academies and Institutes↗

PubMed2003

Creation of a neovagina with use of a pudendal thigh fasciocutaneous flap and restoration of uterovaginal continuity.

OBJECTIVE: To create a neovagina and an endocervival canal in two patients with vaginal aplasia and a functioning uterus. DESIGN: Technique and instrumentations. SETTING: University hospital. PATIENT(S): A 31-year-old woman with vaginal aplasia and a double noncommunicating uterus (classified as Mayer-Rokitansky-Kuster-Hauser syndrome) and a 19-year-old woman with partial vaginal aplasia and a functional uterus. INTERVENTION(S): Creation of a neovagina by using the bilateral pudendal thigh fasciocutaneous flap procedure and laparotomy to establish uterovaginal continuity. MAIN OUTCOME MEASURE(S): Clinical follow-up evaluation of restoration of outflow of menstrual blood and coital satisfaction. RESULT(S): Uterovaginal continuity was established in both patients, resulting in normal menstruation. Granulomatous polyps occurred in one patient, and stenosis at the site of anastomosis occurred in the other patient; these conditions were successfully managed. Unimpeded menstrual flow continued after 1 year of follow-up in one patient and 3 years of follow-up in the other patient. CONCLUSION(S): Bilateral fasciocutaneous pudendal thigh flaps permit vaginal reconstruction and a uterovaginal connection in patients with vaginal agenesis and a functional uterus. The main advantages of this technique are that postoperative dilatation is not necessary, sensation is maintained, and the resulting scar is inconspicuous. The main disadvantage is the presence of some sebaceous vaginal secretion and hair in the vaginal lining; the latter can be managed by preoperative and postoperative laser depilation.

Adult↗

PubMed2003

Ball lightning burn.

Ball lightning is a rare physical phenomenon, which is not yet completely explained. It is similar to lightning but with different, peculiar characteristics. It can be considered a mix of fire and electricity, concentrated in a fireball with a diameter of 20-cm that most commonly appears suddenly, even in indoor conditions, during a thunderstorm. It moves quickly for several meters, can change direction, and ultimately disappears. During a great storm, a 28-year-old man and his 5-year-old daughter sustained burn wounds after ball lightning came from the outdoors through a chimney. These two patients demonstrated signs of fire and electrical injuries. The father, who lost consciousness, sustained superficial second-degree burn wounds bilaterally on the zygomatic area and deep second-degree burn wounds on his right hand (total body surface area, 4%). His daughter demonstrated superficial second-degree burn wounds on the left part of the face and deep second-degree and third-degree burn wounds (total body surface area, 30%) on the left neck, both upper arms, and the back. In this article, the authors report the first two cases of burn injuries resulting from ball lightning contact indoors. The literature on this rare phenomenon is reviewed to elucidate the nature of ball lightning. Emphasis is placed on the nature of injuries after ball lightning contact, the therapy used, and the long-term complications.

Adult↗

PubMed2003

Liver and gastrointestinal transplantation at the University of Miami.

The field of liver and intestinal transplantation is continuously evolving. At present, we cannot escape the need for long-term immunosuppression. Management of side effects and complications of immunosuppression is difficult, as well as recurrence of viral disease after transplantation. Similar challenges are present in virally induced diseases such as PTLD. The clinical applicability of tolerance inducing protocols in the future will rely more and more on the ability to decrease the total amount of immunosuppression given around the time of transplant. The introduction of induction protocols using Campath 1-H has allowed us to decrease the average dose of calcineurin inhibitors and virtually avoid the use of steroids. We have been able to achieve, at least in the short run, patient and graft survivals similar to historical controls, without any added infectious complication. It has still to be proven whether these short-term results will translate in longterm avoidance of calcineurin inhibitors nephrotoxicity and steroid-related diabetes, osteoporosis and so forth. We continue to pursue an active program of intestinal and combined liver-intestinal or multivisceral transplantation, with survival rates constantly improving. The monitoring of graft function and rejection represents the major challenge in intestinal transplantation. The development of laboratory tests such as citrulline levels, combined with the use of advanced endoscopic techniques such as the use of the zoom video endoscope has allowed us to integrate the clinical and histopathological information in an effort to diagnose early and treat appropriately intestinal rejection.

Academic Medical Centers↗

PubMed2002

Effect of protocol Doppler ultrasonography and urgent revascularization on early hepatic artery thrombosis after pediatric liver transplantation.

HYPOTHESIS: Protocol Doppler ultrasonography of the liver (DUSL) is useful for detecting early hepatic artery thrombosis (HAT). Urgent exploration based on DUSL findings and immediate revascularization of the liver may avoid HAT-related sequelae, namely, biliary complications and retransplantation after pediatric liver transplantation. DESIGN: Case-control study. SETTING: University hospital. PATIENTS: Group 1 included 96 liver transplantations performed in 75 pediatric patients from June 1, 1994, to August 31, 1999. Group 2 included 43 liver transplantations performed in 39 pediatric patients from September 1, 1999, to September 30, 2001. INTERVENTION: In group 1, DUSL was performed on the first posttransplantation day or on request. Angiographic confirmation of suggested HAT was treated with thrombolysis, angioplasty, or thrombectomy. In group 2, protocol DUSL was performed every 12 hours in the first week and every 24 hours in the second week. The suspicion of HAT warranted urgent surgery without the patient undergoing angiography. MAIN OUTCOME MEASURES: Incidence of HAT, biliary complications, and retransplantation. Graft and patient survival. Hospital stay, and number of admissions and operations after undergoing HAT. RESULTS: The incidence of HAT was 10.4% (10 of 96 transplantations) in group 1 and 7.0% (3 of 43 transplantations) in group 2. The incidence of biliary complications after HAT was 100% in group 1 and 0% in group 2 (P=.02). The incidence of retransplantation after HAT was 90.0% (9 of 10 patients) in group 1 and 0% in group 2 (P=.01). Of the 10 patients who experienced HAT in group 1, 5 patients underwent early retransplantation (mean length of time, 13.2 days). All 5 patients who did not undergo early retransplantation had biliary complications. Four of these 5 patients underwent retrasplantation at a later time (mean length of time, 687 days). In group 2, DUSL identified early HAT in 3 patients (7.0%). Emergent thrombectomy and arterial reconstruction were undertaken. All 3 (100%) have their original graft and are alive. None experienced biliary complications. One-year graft and patient survival is 72.0% and 84.0%, respectively, in group 1 and 80.0% and 85.0%, respectively, in group 2. Shorter hospital stay, fewer readmissions, and surgery after HAT were noted in group 2. CONCLUSIONS: Protocol DUSL detects early HAT and urgent revascularization based on DUSL can significantly reduce the incidence of biliary complication and graft loss requiring retransplantation in pediatric liver transplantation.

Case-Control Studies↗

PubMed2002

Repair of vaginal prolapse following penoscrotal flap vaginoplasty in a male-to-female transsexual.

Penis and testicle amputation, vaginoplasty, and clitoroplasty are procedures that help male-to-female transsexuals to accept their body and to increase psychosocial well-being. We describe a successful correction of prolapse of the neovagina with abdominovaginal sacropexy in a male-to-female transsexual who had undergone penoscrotal flap vaginoplasty. Although the reasons for a neovaginal prolapse are not completely known, in our case vaginal sacropexy was successful, with good functional and cosmetic results.

Adult↗