Search PubMed⌕ Search

Biomedical subjects

M Iannuccelli

Publications and source records attributed to M Iannuccelli.

At least 19 recordsLinked to original sources
PubMed2004

Laparoscopic relief of obstructing folded muscular cuff after transanal pull-through for aganglionosis.

Transanal endorectal resection and colonic pull-through (TERPT) is a good technique for the management of Hirschsprung's disease. This procedure is feasible in the vast majority of patients and is associated with excellent results, early postoperative recovery, and no visible scars. We report the case of a patient who developed early postoperative severe constipation after TERPT due to unusual folding of the muscular cuff rim, which tightly narrowed the pulled-through colon. This complication was diagnosed and treated by laparoscopy. To prevent it, we recommend splitting of the aganglionic muscular cuff during TERPT.

Anastomosis, Surgical↗
PubMed2004

Laparoscopic relief of obstructing folded muscular cuff after transanal pull-through for aganglionosis.

Transanal endorectal resection and colonic pull-through (TERPT) is a good technique for the management of Hirschsprungs disease. This procedure is feasible in the vast majority of patients and is associated with excellent results, early postoperative recovery, and no visible scars. We report the case of a patient who developed early postoperative severe constipation after TERPT due to unusual folding of the muscular cuff rim, which tightly narrowed the pulled-through colon. This complication was diagnosed and treated by laparoscopy. To prevent it, we recommend splitting of the aganglionic muscular cuff during TERPT.

Constipation↗
PubMed2003

Retroperitoneal abscess and omphalitis in young infants.

AIM: To evaluate the aetiopathogenetic factors in cases of retroperitoneal abscess in young infants, particularly the correlation with omphalitis. METHODS: We describe the cases of two infants, aged 8 and 3 wk, respectively, with a history of omphalitis during the first weeks of life and subsequent development of a retroperitoneal abscess. Both infants underwent surgical drainage of the abscess. RESULTS: In case 1, Staphylococcus aureus was found in cultures from abscess pus, and in case 2 from umbilical pus, abscess purulent material and blood. Both infants are in good health after a follow-up of 6 mo and 8 y, respectively. CONCLUSION: Retroperitoneal abscesses in young infants are usually considered to be idiopathic. A correlation with omphalitis was found in both of the reported cases and it is thought that this could have been due to an aetiopathogenetic factor. Furthermore, we stress the importance of suspicion of retroperitoneal abscesses for early diagnosis and treatment, and discuss the therapeutic strategies.

Hernia, Umbilical↗
PubMed2000

Use of "Gore-Tex surgical membrane" to minimize surgical adhesions in multistaged extrathoracic esophageal elongation for esophageal atresia.

The procedure of choice in the surgical correction of "long gap" esophageal atresia should, when possible, preserve the native esophagus. We present a modification of "the multistaged extrathoracic esophageal elongation method," designed to facilitate esophageal elongation and use of a Gore-Tex (W.L. Gore and Associates, Flagstaff, AZ) surgical membrane to minimize surgical adhesions. We used this technique to successfully treat a 1-kg infant, with type A esophageal atresia, associated aortic coartation, and severe necrotizing enterocolitis with multiple perforations. Multistaged extrathoracic esophageal elongation was begun at the age of 9 months and concluded at 17 months.

Enterocolitis, Necrotizing↗
PubMed2000

Pyloric atresia: an attempt at anatomic pyloric sphincter reconstruction.

BACKGROUND: The standard method of surgical correction of pyloric atresia is gastro-duodenostomy. The authors report a case of pyloric atresia associated with junctional epidermolysis bullosa, treated with a new technique of pyloric sphincter reconstruction by gastric and duodenal mucosa cul-de-sacs advancement and end-to-end anastomosis. METHODS: The patient was a premature 2,100-g baby girl. X-ray showed gastric dilatation suggesting a congenital gastric obstruction. At surgery a pyloric atresia was found, with the appearance of a well-vascularized solid cord about 1.5 cm long. By longitudinal pyloromyotomy the cul-de-sacs of gastric and duodenal mucosa were reached and then isolated in the respective gastric and duodenal sides to obtain better mobilization. The mucosal cul-de-sacs, thus mobilized, were advanced easily into the pyloric canal, opened longitudinally, and were sutured together using end-to-end anastomosis. The longitudinal pyloromyotomy then was closed diagonally above the reconstructed pyloric neocanal. RESULTS: The postoperative course was uneventful: oral feeding was started on the 11th postoperative day. At 4 year follow-up the child was well; no gastrointestinal disorders were present, confirmed by x-ray barium meal and by HIDA technetium Tc 99m hepatic scintiscan, which excluded any bilious duodeno-gastric reflux. CONCLUSION: This technique of pyloric sphincter reconstruction allows preservation of the pyloric sphincter, whose sphincter muscular layer, although hypoplastic, is present in cases of pyloric atresia.

Anastomosis, Surgical↗
PubMed1997

Biliopancreatic diversion with pylorus-preserving technique: a new method for the surgical control of hypercholesterolaemia and diabetes II?

OBJECTIVE: The aim of this study was to evaluate the efficacy of biliopancreatic diversion by Scopinaro's method, with a pylorus-preserving modification, in correcting hypercholesterolaemia and diabetes II not controllable by diet or medical treatment. DESIGN: Besides weight loss, Scopinaro's operation produces a correction of hypercholesterolaemia and diabetes. These results encouraged us to perform BPD without gastric resection, thus preserving the functions of the stomach and pylorus in moderately overweight patients with hypercholesterolaemia and diabetes. SETTING AND PATIENTS: The pylorus-preserving technique has been performed on two patients suffering from severe hypercholesterolaemia and hyperglycaemia and who were not more than 30% overweight, at Clinica Chirurgica and Chirurgia d'Urgenza Department, University of Sassari, Italy. Both patients had a six-month follow-up assessment. MAIN OUTCOME MEASURES. Examination of cholesterol and glycaemia levels after the operation, and the moderate weight loss. INTERVENTION: The operation is the same as Scopinaro's with regard to the length of intestine forming the alimentary loop and the common tract. The difference lies in the fact that instead of resecting the stomach and creating a gastroileostomy, we resect the duodenum, and perform a duodenoileostomy. RESULTS. In both patients the cholesterol and glycaemia levels had returned to normal 1 month after the operation and are stable after six months. Weight loss was only moderate. CONCLUSION: By the preliminary data on two patients treated with our modified technique this method seems to be as effective in controlling lipidic metabolism and diabetes II as the original version of biliopancreatic diversion.

Biliopancreatic Diversion↗
PubMed1997

Simultaneous ileal intussusception and volvulus after jejunoileal bypass for morbid obesity.

OBJECTIVE: The aim of this work is to consider the mechanical complications of jejunoileal bypass for morbid obesity which can have a serious outcome because of the occult nature of the symptoms. DESIGN: The mechanical complications of jejunoileal bypass are mainly intussusception of the bypassed ileal segment, internal herniation of the ileal loops through the mesenteric defects and laparocele. SETTING AND PATIENTS: A recent case is reported in which, most unusually, intussusception and volvulus were both present, with ischaemia and necrosis of the bypassed segment. Moreover, the general health of the patient remains normal despite the severity of the complication. MAIN OUTCOME MEASURES: Examination of blind loop with CT scan which showed an abdominal mass of uncertain interpretation. INTERVENTION: A laparotomy revealed a volvulus of bypassed ileal loops, probably caused by a simultaneous ileal intussusception and an adhesion. On account of the extensive nature of the process and the degree of advanced ischaemia and gangrene patches in the folds of the ileum, resection of the entire bypassed segment as far as the previous jejunoileal anastomosis was necessary. CONCLUSION: The authors point out the occult nature of the manifestations of this type of complication: aspecific abdominal pains in all quadrants, fever, non vomiting, normal passing of faeces and gas and suggested that simultaneous diverticulitis of the colon (frequently found in the obese) can further complicate and delay diagnosis.

Female↗
PubMed1997

A case of relapsing polychondritis presenting as mediastinal syndrome, diagnosed by CT scans of the trachea and head.

OBJECTIVE: The aim of this study is to evaluate the significance of CT scans of the trachea and head in the diagnosis of Relapsing Polychondritis (RP). DESIGN: Relapsing polychondritis is a disease involving cartilaginous structures, particularly those of the ears, nose and trachea. Diagnosis is based on specific clinical features and immuno-histopathological evaluation of the cartilages involved. SETTING AND PATIENTS: We describe a case of RP in which the most evident clinical signs (cough, dyspnoea, vertigo, tinnitus, headache, oedema of the face and shoulders and fever), led us first to suspect a mediastinal compression syndrome. INTERVENTION: A CT scan of the trachea and head revealed details which established the correct diagnosis, supported by other typical RP symptoms and by histopathological examination of the cartilage. MAIN OUTCOME MEASURES: Evaluation by CT scan of the chest, the mediastinum, the head and the pinnae. RESULTS: CT scanning revealed thickening and calcification of the anterolateral tracheal wall and main bronchi besides marked narrowing of the trachea. CT of the head showed calcification also of the external auditory meatus and part of the pinnae. CONCLUSION: We consider that CT scan of the trachea and head is helpful in evaluating the bronchial tree, the auditory meatus and pinnae as well as being a valid tool for the final diagnosis and in following the course of the disease.

Diagnosis, Differential↗
PubMed1990

Acetyl-L-carnitine in the treatment of mildly demented elderly patients.

It has been hypothesized that acetyl-L-carnitine has a cholinomimetic action. It is for this reason that it has been used in the therapy of Alzheimer's type senile dementia impairment. In the present controlled double-blind study the authors followed two randomized homogeneous groups of both sexes of 30 patients each, aged over 65 years and suffering from mild mental impairment. One group of patients underwent therapy with acetyl-L-carnitine, 2 g/day for three months, while the other group was treated with a placebo. The statistical evaluation of the results was carried-out using non-parametric methods (Friedman-Nemenyi two-way ANOVA). It was possible to affirm that the acetyl-L-carnitine treated patients showed statistically significant improvement in the behavioural scales, in the memory tests, in the attention barrage test and in the Verbal Fluency test. These satisfactory results confirm the therapeutic importance of acetyl-L-carnitine in the treatment of elderly patients with mental impairment, which could be related principally to acetylcholine defects.

Acetylcarnitine↗
PubMed1990

Neuropsychological changes in demented patients treated with acetyl-L-carnitine.

The study was carried out on 24 patients suffering from mild to moderate dementia. The diagnosis of dementia was made according to DMS III criteria. Patients with cerebrovascular pathologies were excluded by using Hachinski Ischaemic Score less than or equal to 4 and computerized tomography parameters. Patients with depression (Hamilton Rating Scale for Depression greater than or equal to 18) were excluded. All the patients, after a wash-out period of two weeks were treated on a simple blind method with acetyl-L-carnitine (No. = 12 patients) and piracetam (12 patients) by intravenous route (two weeks) followed by an oral one for further 10 weeks. A battery of clinical neuropsychological tests was applied to evaluate the cognitive, attentive and behavioural aspects. The results, analysed by non-parametric variance analysis (Friedman Test) show a statistically significant improvement of the behavioural profile, of attention and of psychomotricity in the patients treated with acetyl-L-carnitine. No significant improvement was found in the piracetam group.

Acetylcarnitine↗
PubMed1988

Mental impairment in aging: selection of patients, methods of evaluation and therapeutic possibilities of acetyl-L-carnitine.

The authors carried out a double-blind study in two randomized homogeneous groups of both sexes of 15 patients each, over 65 years of age and suffering from mild mental impairment. One group of patients underwent therapy with acetyl-L-carnitine, 2 g/day for three months, while the other group was treated with a placebo. The statistical evaluation of the results were carried out using nonparametric methods (Friedman-Nemenyi two-way Anova and Mann Whitney U-Test). However, the two groups did not differ significantly in either test at the end of treatment. It is possible to affirm that the acetyl-L-carnitine treated patients showed statistically significant improvement in the behavioural performances (Blessed Dementia Scale p less than 0.02; Stuard Hospital Geriatric Rating Scale p less than 0.01), in the memory tests (Rey short-term p less than 0.02; Rey long-term p less than 0.05; Corsi p less than 0.05), in the attention test (Barrage test p less than 0.01) and in the Verbal Fluency test p less than 0.01).

Acetylcarnitine↗
PubMed1987

Headache in association with sleep disorders in children: a psychodiagnostic evaluation and controlled clinical study--L-5-HTP versus placebo.

Forty-eight elementary and junior high school students presenting the association of recurring headache and sleep disorders were selected for this study on the basis of a questionnaire filled out by the entire school population. The selected students had normal intellectual capacity but often showed inadequate progress in school, attentive-mnemonic deficiencies, and psychopathological elements of a depressive nature. The clinical characteristics predicted that this group would be responsive to treatment with L-5-hydroxytryptophan. The results of a double-blind, cross-over trial with placebo confirmed these expectations for headache and some sleep disorders, in particular frequent awakenings and some parasomnias.

5-Hydroxytryptophan↗
PubMed1984

Changed plasma prolactin levels after etoperidone and placebo.

A neuroendocrinological study was carried out by evaluating plasma prolactin levels after etoperidone i.m. (100 mg) and placebo. Fourteen male inpatients (mean age: 35.36 +/- 11.7 years) with chronic schizophrenia were selected for the study, whose aim was to improve interpretation of the pharmacological activity of etoperidone. The results suggest that etoperidone plays the role of an atypical psychotropic drug since it does not affect prolactin levels. In addition, the drug is devoid of anticholinergic effects, which facilitates its prospective clinical use for medium-term and long-term therapy.

Adolescent↗
PubMed1983

Treatment of depression with L-5-hydroxytryptophan combined with chlorimipramine, a double-blind study.

A double-blind clinical trial was carried out involving 26 hospitalized, depressed patients who were randomized into two groups. Patients in each group received chlorimipramine (50 mg/day), combined with L-5-HTP (300 mg/day) in Group A, and with placebo in Group B. The trial lasted 28 days. Two Group B patients dropped out. All the patients were evaluated by HRSD each week, and by ZDSI and CGI at the beginning and end of treatment. Several statistical analyses of the mean HRSD scores of each item presenting initial positive response and of ZDSI scores for both reactive and endogenous depression were performed, using Student's t-test. To evaluate the efficacy of the chlorimipramine +L-5-HTP combination versus control therapy the Mann-Whitney test was applied to the reduction in HRSD scores, showing 0.05 significance. The results for both types of pathology were quantitatively and qualitatively more positive for Group A than for Group B. Cluster analysis of HRSD item scores alone and between this scale and ZDSI, according to Carrol's correlation method for the symptoms of the cluster (mood, anxiety and somatic symptoms), was carried out to confirm the above results.

5-Hydroxytryptophan↗
PubMedDate not supplied

[Treatment of essential headache in developmental age with L-5-HTP (cross over double-blind study versus placebo)].

Thirty patients (mean age: 10.38 years) affected by primary headache were selected for a double-blind cross-over clinical trial. The patients were randomized into 2 homogeneous groups of 15 and treated for 12 weeks with L-5-HTP (100 mg/day) and placebo as per the following design: placebo - L-5-HTP (group A) and L-5-HTP - placebo (group B). Evaluation was carried out every 3 weeks by the Migraine Index supplying a general assessment of the attacks, i.e. severity, duration and frequency. The decrease in mean score values was directly proportional to L-5-HTP treatment, and statistical significance (Wilcoxon's test) was observed only for L-5-HTP in both groups, from 0.05 to 0.01. Improvement, as evaluated by CGI on percentage distribution of the patients, was homogeneous in both groups.

5-Hydroxytryptophan↗
PubMedDate not supplied

Mental impairment in Parkinson's disease. The role of anticholinergic drugs.

The trial has been carried out on 33 treated Parkinsonian patients and 14 healthy controls. A series of psychometric tests were employed in order to show a possible intellectual deterioration in Parkinsonian patients. Bender's test showed greater motor-perceptive deterioration in Parkinsonian patients respect to control, the Wechsler-Bellevue Intelligence Scale evidenced in patients significant deterioration of mnesic and psychomotor capacity. When considering drug treatments patients undergoing combined treatment or anti-cholinergics alone obtained worse results in all tests made whilst patients on L-Dopa alone obtained the best results.

Aged↗