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Biomedical subjects

M Gallucci

Publications and source records attributed to M Gallucci.

At least 55 records · Page 3Linked to original sources
PubMed1999

Treatment of BPH with transurethral electrovaporization of the prostate (TUVP) using vaportrode VE-B. Two years follow-up.

The Authors report their experience on trasurethral vaporization of the prostate with Vaportrode for the treatment of BPH. In January 1996 we treated 24 patients suffering from cervico-urethral obstruction caused by BPH with electrovaporization of the prostate using a cutting current of between 180 and 250 Watts (average 200 Watts). Exclusion criteria was: PSA > 3 ng/ml. The catheter was removed after 24 hours. Follow-up of all patients is 27 months. 23 patients were evaluated. Results at follow-up were: mean maximum flow (Qmax) 9.31 ml/sec preoperative was 19.5 ml/sec after 6 months, 18.3 after 12 months and 18.0 after 24 months; mean symptom score decreased from 18.1 to 10.4 after 6 months, to 3.2 after 12 months and to 4.8 after 24 months; QL index decreased from 4.6 to 2.3 at 6 months, to 1.4 after 12 months and 24 months; the average voiding pressure decreased from 62.8 cm/H20 to 23.2 cm/H20 after 6 months, to 21.2 after 12 months and to 23.8 after 24 months. There was no post voiding residual urine 2 days after treatment in all patients. Follow-up shows transurethral electrovaporization of the prostate is an efficient and safe technique for treatment of BPH.

Aged↗
PubMed1999

[Intestinal anastomosis in urology. Comparison of techniques].

BACKGROUND: Three different intestinal anastomosis were compared during reconstructive urologic surgery; time, cost and incidence of complications were evaluated. METHODS: From November 1993 to February 1997, 45 patients (43 males and 2 females) were submitted to ileal resection to fashion 30 ileal neobladder, 8 ileal conduits and 7 augmentation ileocystoplasties. The patients were randomized in 3 groups. In the first group the intestinal continuity was performed by BAR; the second one was treated by GIA stapling device; the last underwent a manual suture with interrupted stitches double layer (vicryl). RESULTS: The mean follow-up was 18 months. The mean time of canalization was 6.3 days. The complications were: one intestinal subocclusion (group 1); one abdominal wound infection (group 2); one anastomotic leak and one pulmonary embolism (group 3). The mean time of anastomosis was 18, 12 and 39 minutes respectively. The average total cost was 915,000 lire in group 1; 1,280,000 lire in group 2; 632,000 lire in group 3. CONCLUSIONS: The conclusion is drawn that mechanical devices (BAR and stapler) are more convenient and advisable in reconstructive urologic surgery, for their quickness, effectiveness and final total cost.

Costs and Cost Analysis↗
PubMed1999

Treatment of benign prostatic hyperplasia with transurethral electrovaporization of the prostate (TUVP) using Vaportrode VE-B. Two years follow-up.

BACKGROUND: The authors report their experience on transurethral vaporization of the prostate with Vaportode for the treatment of BPH. METHODS: In January 1996 we treated 24 patients suffering from cervico-urethral obstruction caused by BPH with electrovaporization of the prostate using a cutting current of between 180 and 250 Watts (average 200 Watts). Exclusion criteria was: PSA > 3 ng/ml. The catheter was removed after 24 hours. Follow-up of all patients is 27 months. Twenty-three patients were evaluated. RESULTS: Results at follow-up were; mean maximum flow (Qmax) 9.31 ml/sec preoperative was 19.5 ml/sec after 6 months, 18.3 after 12 months and 18.0 after 24 months; mean symptom score decreased from 18.1 to 10.4 after 6 months, to 3.2 after 12 months and to 4.8 after 24 months; QL index decreased from 4.6 to 2.3 at 6 months, to 1.4 after 12 months and 24 months; the average avoiding pressure decreased from 62.8 cm/H2O to 23.2 cm/H2O after 6 months, to 21.2 after 12 months and to 23.8 after 24 months. There was no post voiding residual urine 2 days after treatment in all patients. CONCLUSIONS: Follow-up shows transurethral electrovaporization of the prostate is an efficient and safe technique for treatment of BPH.

Aged↗
PubMed1998

Prevalence of papillomavirus, Epstein-Barr virus, cytomegalovirus, and herpes simplex virus type 2 in urinary bladder cancer.

Recent epidemiological studies suggest that the risk for urological malignancies may be related to the exposure to infectious agents. Human Papillomaviruses type 16 and 18 (HPV 16, HPV 18), Epstein-Barr virus (EBV), cytomegalovirus (CMV) and herpes simplex virus type 2 (HSV-2) have been suggested previously as cofactors in the pathogenesis of some malignancies in humans. The present paper, the presence of HPV 16, HPV 18, EBV, CMV and HSV-2 genomes was investigated in a panel of 35 biopsies from urinary bladder carcinomas using the polymerase chain reaction (PCR). Sequences of EBV, HPV, CMV and HSV-2 genomes were detected in 34%, 31%, 11% and 9% of tissue samples respectively, while in 20% of patients we found more than one viral infection. Absence of viral genomes was found in normal bladder. To our knowledge, this is the first report concerning the association of EBV, CMV and HSV-2 with bladder cancer. This finding may raise the question whether such viral infection may contribute to development and progression of some types of urological malignancies in humans.

Adult↗
PubMed1998

Quality-of-life evaluation: when do terminal cancer patients and health-care providers agree?

A multicenter study involving six palliative care units in Italy was carried out on 159 terminal cancer patients seen at home or in hospital. The physician or the nurse completed independently from the patient the Therapy Impact Questionnaire (TIQ), a questionnaire devised for quality-of-life evaluation in terminal cancer patients. The patient's assessment was used as the valid reference measurement to compare with the health-care workers' evaluation to assess the validity of the latter. The results showed that percentages of agreement were higher for physical than for psychological and cognitive symptoms, and that there was a greater agreement on the absence rather than on the presence of a problem. None of the characteristics of the patient nor of the proxy showed any statistically significant relationship with the two disagreement indexes. The results suggest that caution is needed in the use of health-care workers as alternative sources of information regarding patients' quality of life.

Evaluation Studies as Topic↗
PubMed1998

High levels of transforming growth factor-alpha (TGF-alpha) mRNA may predict local relapses in early stage urinary bladder cancer.

Elevated expression of transforming growth factor-alpha (TGF-alpha) gene has been previously reported in some types of human neoplasms, but its role in the pathogenesis of bladder cancer has still not been investigated. In the present study, we analysed 28 samples of early stage bladder tumours for the presence of TGF-alpha mRNA using reverse transcription-polymerase chain reaction (RT-PCR). We detected TGF-alpha mRNA in 71% (20/28) of these samples. When we related the expression levels of TGF-alpha with local relapses of patients during a follow-up of 2 years, we found that a high TGF-alpha expression level in bladder cancer was significantly associated with local relapses in patients with early stage tumours. The appearance of early relapses in tumours with high TGF-alpha expression levels may suggest the existence of an additional marker in the prediction of local relapses in patients with superficial disease.

Adult↗
PubMed1998

Management of hemorrhage after percutaneous renal surgery.

Percutaneous renal surgery is routine therapy for a number of renal pathologies. It is a technique not without complications, often serious ones, of which the worst is bleeding. We reviewed our experience of the incidence, etiology, and management of this serious complication to determine a protocol of treatment that will minimize the consequences. Between 1984 and 1996, we carried out 976 percutaneous operations for reno-calix stones, pyeloureteral junction stenosis, neoplasia of the renal pelvis, diagnosis, and ureteral prostheses. In all cases, the percutaneous access was achieved through a lower calix in the posterior axillary line with the patient in a prone position. The lithotripsy was performed with ultrasound and balistic energy lithotripters. Antegrade endopyelotomy was performed according to our technique. At the end of the procedure, a nephrostomy tube was positioned, 24F for lithotripsy and 16F for endopyelotomy. The nephrostomy tube was removed after 24 to 48 hours. In this series, 146 patients (15%) presented significant perioperative bleeding. In 97 cases (10%), this complication was resolved with the repositioning of the nephrostomy tube, bedrest in a supine position, and observation, whereas in 49 cases (5%), clamping of the nephrostomy tube for 24 hours was necessary. In 56 patients (5.7%), two blood transfusions were necessary, and three patients (0.3%) had bleeding 10, 12, and 20 days after the operation, which was resolved by embolization of the lacerated vessel.

Adult↗
PubMed1998

Transurethral electrovaporization of the prostate vs. transurethral resection. Results of a multicentric, randomized clinical study on 150 patients.

AIM OF THE STUDY: To evaluate clinical, urodynamic efficacy and safety of TURP and TVP in patients with symptoms due to obstructive benign prostatic hypertrophy with a prospective multicentric randomized study. MATERIALS AND METHODS: 150 patients with BPH, urodynamically obstructed, were randomized to receive TURP or TVP. At the end of the recruitment phase, 80 patients underwent TURP and 70 patients underwent TVP. Patients were clinically evaluated by the I-PSS score at months 0, 1, 3, 6 and 12. Preoperative evaluation included complete blood routine examination, PSA, transrectal ultrasound and pressure/flow studies. Pressure/flow studies were also performed after 3 months. RESULTS: There was no statistical difference between groups in any of the preoperative parameters. All patients were considered urodynamically obstructed at preoperative pressure studies. As for catheter days and hospitalization days, statistical differences between TVP and TURP were found; catheter days were 2.71 days (SE 0.12) in the TURP group vs. 1.9 (SE 0.24) in the TVP group (p < 0.000). Hospitalization was 4.7 days (SE 0.22) after TURP and 3.9 days (SE 0.24) after TVP (p < 0.000). Mean preoperative I-PSS score was 18.84 and 18.19 in the TVP and TURP groups, respectively. At 3, 6 and 12 months, IPSS was 5.52 and 5.50, 3.77 and 4.94, 3.52 and 4.04 for TURP and TVP, respectively. Mean preoperative peak flow rate (PFR) was 8.78 and 7.26 ml/s for TURP and TVP, respectively; after 3, 6 and 12 months, PFR was 19.21 and 18.8, 20.77 and 20.13, 20.30 and 20.31 ml/s, respectively. After 3 months, 6 patients in the TURP group (7.5%) and 7 patients in the TVP group (10%) were borderline obstructed. 1 patient in the TVP group (1.4%) was still obstructed and underwent TURP. As for complications, 4 patients (5.7%) in the TVP group had stress urinary incontinence after 12 months vs. 1 (1.25%) in the TURP group. DISCUSSION: The present study clearly demonstrates that TVP is as effective as TURP in relieving urinary obstruction due to BPH, it offers some advantages in terms of catheterization and hospital stay, but at the price of a higher incidence of postoperative urine incontinence. Technical improvements might solve this problem in the future, perhaps combining TVP with TURP of the apical tissue.

Aged↗
PubMed1997

Recurrent cerebral venous infarcts and superior vena cava obstruction: case report.

We report a patient with repeated venous infarcts in the occipital lobe and occlusion of the superior vena cava. The pathogenetic relationships between the superior vena cava occlusion and the brain infarcts are discussed. High pressure in the superior venous territory and incomplete patency of the transverse sinus are probably responsible for the venous infarcts.

Cerebral Infarction↗
PubMed1997

Diverticula of the female urethra.

OBJECTIVE: To determine the optimum procedure for the diagnosis and therapy of diveticula of the female urethra. PATIENTS AND METHODS: The study included 18 patients with urethral diverticula treated at the Cristo Re Hospital in Rome between 1987 and 1995. Most of the patients were suffering from cystitis (eight), dysuria (seven) and recurring urinary infections (11). Less frequently, more specific symptoms were present such as post-voiding dribbling (two) and anterior vaginal mass (three). The pre-operative evaluation included a history, physical examination, voiding and positive pressure voiding cysto-urethrography (VCUG) and urodynamic tests. A 'typical' surgical excision of the diverticula was carried out in all cases. Surgical excision was combined with cystopexis (Raz operation) in four patients with urinary stress incontinence and three with detrusor instability were treated postoperatively with anticholinergics for 3 months. The outcome was evaluated by a physical examination and urodynamic tests at 3, 6 and 12 months postoperatively; the mean (range) follow-up was 34 (2-80) months. RESULTS: All the urethral diverticula were in the distal two-thirds of the urethra, along the posterolateral wall. The VCUG was sufficient for diagnosis in eight patients while the other 10 required a positive-pressure VCUG. Fifteen patients were evaluated; complications included a urinary tract infection for 2 months in four patients and stress incontinence for 2 months in two. There were no recurrences or urethrovaginal fistulae. CONCLUSIONS: Diverticula in the female urethra are difficult to diagnose because the symptoms can be misleading; the positive-pressure VCUG is useful in doubtful cases. However, a detailed history and physical examination are mandatory.

Adult↗
PubMed1997

Ureteral occlusion prosthesis.

Although temporary or definitive complete ureteral occlusion is rarely needed, there is a considerable number of reports introducing different devices to achieve this goal, most of which can be inserted with minimally invasive procedures. Easy placement is considered of paramount importance, as the candidates are very often in bad general condition as a result of previous surgery, radiotherapy, or other palliative treatments for cancer. A device that can be inserted and removed percutaneously is presented herein. It can be employed in cases of ureteral fistulas resulting from radiotherapy and ureterosigmoidostomy with good results. The technique is simple and not time consuming.

Aged↗
PubMed1997

Localization, by linkage analysis, of the cystinuria type III gene to chromosome 19q13.1.

Cystinuria is an autosomal recessive aminoaciduria in which three urinary phenotypes (I, II, and III) have been described. An amino acid transporter gene, SLC3A1 (formerly rBAT), was found to be responsible for this disorder. Mutational and linkage analysis demonstrated the presence of genetic heterogeneity in which the SLC3A1 gene is responsible for type I cystinuria but not for type II or type III. In this study, we report the identification of the cystinuria type III locus on the long arm of chromosome 19 (19q13.1), obtained after a genomewide search. Pairwise linkage analysis in a series of type III or type II families previously excluded from linkage to the cystinuria type I locus (SLC3A1 gene) revealed a significant maximum LOD score (zeta max) of 13.11 at a maximum recombination fraction (theta max) of .00, with marker D19S225. Multipoint linkage analysis performed with the use of additional markers from the region placed the cystinuria type III locus between D19S414 and D19S220. Preliminary data on type II families also seem to place the disease locus for this rare type of cystinuria at 19q13.1 (significant zeta max = 3.11 at theta max of .00, with marker D19S225).

Chromosome Mapping↗
PubMed1997

[Magnetic resonance of the brain: comparative assessment of conventional sequences versus fast sequences].

The conventional Spin-Echo sequences have been the most used acquisition techniques on Magnetic Resonance Imaging (MRI) of the brain, since the beginning of 1990s. Recently, however, technological developments proposed such new fast acquisition techniques, with a dramatic reduction in acquisition time as Gradient Echo, Turbo Spin Echo, Gradient Spin Echo ed Echo Planar sequences. We investigated the comparative adequacy of the new fast sequences, in brain MR studies versus conventional sequences, on medium field strength MR equipment (.5 T). On in vitro exams S/N ratio was evaluated and on in vivo study C/N ratio between white substance grey substance and fluid were evaluated, in 15 healthy volunteers. All the exams were carried out on Philips NT5 Gyroscan MR unit operating at .5 T, with 15 mT/m power gradients. Both conventional and fast sequences Spin-Echo (SE), Inversion Recovery (IR), Gradient-Echo (GE), Turbo Spin-Echo (TSE), Gradient Spin-Echo (GRASE) and Echo Planar (EPI), all optimized to obtain T1, T2 and T1-IR weighted images, were performed. The sequences were evaluated separately comparing different acquisition techniques relative to the same type of contrast (T1, T2, and T1-IR). The results indicate the superiority of the fast acquisition techniques, both in terms of quality and acquisition times, except for T1-weighted images, where the conventional Spin-Echo sequences confirmed to be superior. In conclusion, the present study suggests that fast acquisition techniques can improve the conventional protocol of sequences, in the anatomical representation of the normal brain even with medium field strength equipment only on T2 and T1-IR weighted images. On T1-weighted imaging conventional SE acquisition technique is still the best choice. The time saving obtained with fast sequences can therefore be used for an overall improvement in the quality of images, and to apply accessory acquisition plans on routine exams.

Brain↗
PubMed1997

[Magnetic resonance study of patellofemoral cartilage with a fat-suppressed T1-3D gradient-echo sequence: a comparison with other acquisition technics at medium field strength].

PURPOSE: We compared GRE T1 3D FS sequence with other acquisition techniques available on medium field strength MR units (.5 T) in patellofemoral cartilage studies. MATERIAL AND METHODS: The imaging protocol scheduled Spin Echo (SE), Inversion Recovery (STIR), Gradient Echo (GRE), Turbo Spin Echo (TSE), Turbo-Inversion Recovery (Turbo-STIR), Gradient Spin Echo (GRASE) and Echo Planar (EPI) sequences, in some cases combined with Fat Suppression (FS) or Magnetization Transfer Contrast (MTC) sequences when suitable. In vitro studies were carried out for signal-to-noise ratio (SNR) evaluation, and in vivo on 10 healthy volunteers for contrast-to-noise ratio (CNR) evaluation between cartilage, bone marrow and fluid. The exams were carried out on MR equipment operating at .5 T, with 15 mT/m power gradients. RESULTS: In both in vitro and in vivo studies, GRE T1 3D FS sequences yielded better results in SNR and CNR than other sequences. The GRE T1 3D FS technique combines the advantages of the increased resolution of 3D images with the increased dynamic range of fat suppressed images, for better CNR between cartilage, fluid and bone marrow. CONCLUSION: GRE T1 3D FS sequences are the MR acquisition technique of choice in the assessment of the hyaline cartilage of the knee, even at medium field strength.

Adult↗
PubMed1996

Bcl-2/bax mRNA expression ratio as prognostic factor in low-grade urinary bladder cancer.

Apoptotic cell death represents an important mechanism for the precise regulation of cell numbers, and a defence mechanism against tumoral cell. bcl-2 and bax genes are known to be involved in the control of apoptotic pathways; in particular, the ratio between bcl-2 and bax represents a cell rheostat that is able to predict a cell's response toward life or death to an apoptotic stimulus. In the present study we investigated the role of bcl-2 and bax gene expression in a panel of 37 low-grade tumours of the urinary bladder, and correlated the expression of these genes to the prognosis of patients in a follow-up of more than one year. We found that levels of bax expression higher than bcl-2 in bladder tumours well correlates to a better outcome for patients. Early relapses are much more frequently observed in those patients whose tumours express more bcl-2 than bax mRNA. We conclude that the bcl-2/bax expression ratio may be considered as a marker for disease progression in low grade bladder tumours, independently of clinical staging and histological grading.

Adult↗
PubMed1996

Molecular analysis of the cystinuria disease gene: identification of four new mutations, one large deletion, and one polymorphism.

A cystinuria disease gene (rBAT) has recently been identified, but evidence strongly suggests that only Type-I cystinuria is due to mutations in this gene. Sixteen point mutations and a large deletion causing the disease have so far been described in the rBAT gene sequence. To identify new mutated alleles, genomic DNA was analyzed, after the determination of the entire genomic structure of the rBAT gene, by RNA-single strand conformation polymorphism analysis, an accurate and sensitive method able to detect nucleotide changes. Four new point mutations, a large deletion, and a common intragenic polymorphism were detected. These new mutations increase to 22 the number of mutated alleles so far characterized in rBAT. In addition, the frequency of 21 mutations was assessed in a sample of accurately defined Type-I cystinuria chromosomes. They account for about 58% of all Type-I chromosomes, mutation M467T being the most common (0.26).

Alleles↗
PubMed1996

Antegrade transpelvic endopyelotomy in primary obstruction of the ureteropelvic junction.

The authors present a 5-year follow-up of endopyelotomy using a personal technique for cases of primary ureteropelvic junction obstruction. After percutaneous access has been gained via a lower calix, the technique involves wide opening of the renal pelvis and exploration of the peripelvic space before a 3- to 4-cm long sectioning of the ureter. The aim is to carry out all of the operation in full view and without the need for a large-caliber stent, in order to perform endopyelotomy also in pediatric patients or in presence of anomalous vessels. The follow-up demonstrates a good result in 80% of 46 patients aged 5 to 62 years; two patients underwent surgical repair. The authors think the antegrade transpelvic endopyelotomy is an endourologic operation whose results and feasibility parallel those of open surgery.

Adolescent↗