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Biomedical subjects

P Graziotti

Publications and source records attributed to P Graziotti.

At least 19 recordsLinked to original sources
PubMed2001

[Recovery of urinary incontinence after retropubic radical prostatectomy. Results in 100 patients].

AIM OF THE STUDY: To shorten the time to recovery of full urinary continence after radical retropubic prostatectomy and to increase the postoperative continence rate. MATERIALS AND METHODS: One hundred and five consecutive patients were submitted to radical retropubic prostatectomy for prostate cancer, with curative intent, focusing our attention on three steps of the operation. First, to achieve a complete control of bleeding from the dorsal vein complex and to perform a minimal touch dissection of the urethral stump; second, to perform a conservative dissection of the bladder neck, and, third, to implement a vascular type, watertight, vesico urethral anastomosis. Continence was assessed 24 hours after catheter removal and at monthly follow up visits until full recovery and graded as dry if no dropping was visible and the patient was able to interrupt the urinary stream during micturition; stress incontinence, if any dropping was observed during abdominal strain between micturitions; and wet, if uncontrollable dropping occurred, and the number of pads needed per day recorded. RESULTS: At a median follow-up time of 18 months, range 6 to 30, a total of 87 of 100 evaluable patients (87%) resulted as dry; 10 patients (10%) resulted as having a variable degree of stress incontinence needing one to three pads per day, and 3 patients (3%) resulted as wet. In 41 of the 87 dry patients (47.1%) continence was achieved within the first day from catheter removal, and in a median time of 4 weeks, range 2 to 16 in the remaining 46 patients (52.9%). CONCLUSIONS: The results of total continence rate of the present study seem to compare to the recent literature except for the time to full recovery which is shorter; it is difficult to identify the contribution of each single surgical step.

Aged↗
PubMed1996

[T1G3 transitional cell carcinoma of the bladder: our experience with 44 patients treated with intravesical BCG after TUR].

Forty-four patients affected by poorly differentiated (G3) superficial TCC invading lamina propria (stage T1) were treated with intravesical BCG. They underwent weekly instillations of 75 mg BCG for six week after trans-urethral resection (TUR) of bladder cancer. An additional induction course was given to patients who relapsed. A maintenance course with monthly instillations for twelve months followed in complete responder patients. After the first induction course, 34/44 patients (77.2%) showed complete response. In 10 patients a second induction course was necessary, with complete response in four. After one or two induction course, 38/44 patients (86.5%) showed complete response. The maintenance course was administered to 38 patients with 35/38 complete responses. After a median follow-up of 30 months, there were 29/44 (65.9%) disease free patients, 11/44 (25%) tumor recurrences and 4/44 (9%) tumor progressions. The drug has been well tolerated with few side effects. Our data suggest that intravescical BCG after TUR is effective in the treatment of high-risk superficial bladder cancer and we believe that it can be used a first approach in treating patients affected by T1G3 bladder cancer.

Administration, Intravesical↗
PubMed1996

Low dose Pasteur bacillus Calmette-Guerin regimen in stage T1, grade 3 bladder cancer therapy.

PURPOSE: We assessed the effectiveness of intravesical bacillus Calmette-Guerin (BCG) for high risk transitional cell carcinoma of the bladder. MATERIALS AND METHODS: A total of 51 patients with stage T1, grade 3 disease was treated with weekly instillations of 75 mg. Pasteur strain BCG for 6 weeks after transurethral resection for bladder cancer. An additional induction course was given to patients with relapse. Tumor-free patients followed a maintenance course with monthly instillations for 12 months. RESULTS: After the initial induction course 37 of 51 patients (72.5%) remained tumor-free. A second induction course was necessary in 13 patients. After 1 or 2 induction courses 44 of 51 patients (86.3%) were tumor-free. The maintenance course was administered to 44 patients, with 41 remaining tumor-free. After a median followup of 33 months (range 3 to 63) 28 patients (54.9%) were disease-free, 12 (23.5%) had recurrent tumors and 7 (13.7%) had progression. The risk of treatment failure was significantly greater for solid than papillary tumors (p = 0.0006), recurrent than primary tumors (p = 0.0052) and coexisting carcinoma in situ (p = 0.124) in multivariate analysis, and for early recurrence (p = 0.0001) in univariate analysis only. The drug was well tolerated with few side effects. CONCLUSIONS: Our data suggest that this low dose Pasteur BCG regimen is effective in the treatment of high risk superficial bladder cancer. Some tumor characteristics, such as solid appearance, coexisting carcinoma in situ, history of superficial transitional cell carcinoma and early relapse after the initial induction course, seem to be negative prognostic factors.

Adjuvants, Immunologic↗
PubMed1995

[Surgical treatment of benign prostatic hypertrophy: what and when TURP vs adenomectomy].

Surgical treatment is the gold standard for Benign Prostatic Hyperplasia (BPH) therapy. At the present diagnostic approach allows better patient selection and treatment assignment. In this work we have studied retrospectively the outcome of 120 BHP patients who underwent trans urethral resection (TURP) and of 145 BPH patients underwent "open" prostatectomy. In all the patients surgical time, prostate weight, indwelling catheter standing, rest in bed, early and late complications were evaluated. Irritative symptoms occurred after TURP in 10% of the cases. The two therapeutical options are not comparable for they technically different. The choice between the two depends on the accurate patient characterization and selection.

Bed Rest↗
PubMed1995

[Our current indications for radical prostatectomy].

Radical prostatectomy is the golden standard for localized prostate cancer. The identification of patients with intraprostatic disease who can be cured and will live long enough to benefit from a surgical therapy represents the primary goal of the authors. Target of this article is underlining the importance of an accurate preoperative staging through ultrasound-guided biopsy of seminal vesicles and periprostatic spaces. The positivity of the surgical margin after radical prostatectomy is also taken into account as it represents, according to the authors, an extremely important but often overlooked parameter.

Humans↗
PubMed1994

Assessment of upper airway anatomy in awake, sedated and anaesthetised patients using magnetic resonance imaging.

Magnetic Resonance Imaging was used to quantify the effects of 1. sedation and 2. general anaesthesia with a laryngeal mask airway (LMA) in place on the minimum antero-posterior (A-P) diameters of the naso-, oro- and hypopharynx and on the angle of the epiglottis relative to the adjacent posterior pharyngeal wall. Median sagittal T1-weighted images of the pharynx were obtained in 46 patients (16 awake, 14 sedated, 16 under general anaesthesia). In sedated patients, the A-P diameters of the pharynx were less than in awake patients, in particular at the levels of the epiglottis and soft palate. General anaesthesia and placement of a LMA was also associated with a reduced A-P diameter at the level of the soft palate, but with increased diameters at the levels of the tongue and epiglottis. Placement of a LMA caused abnormal downfolding of the epiglottis in most cases but this did not cause clinically significant airway obstruction.

Adult↗
PubMed1994

Patient-controlled analgesia: a comparison with nurse-controlled intravenous opioid infusions.

Patient-controlled analgesia (PCA) with intravenous pethidine was compared with nurse-controlled pethidine infusions for pain relief in 200 patients after major abdominal or thoracic surgery. Pain, level of sedation, nausea and presence of other adverse effects, in addition to cumulative pethidine requirement, were measured for the first 24 hours after surgery. Both groups were similar for age, weight and type of surgery. There was no significant difference between the quality of analgesia achieved in both groups. The frequency and severity of adverse effects was also similar. The cumulative pethidine dose administered to both groups was identical. It is concluded that nurse-controlled opioid infusions are as effective as PCA and may be used as an alternative to PCA where this is either unavailable or unsuitable.

Analgesia↗
PubMed1994

[Nerve-sparing retroperitoneal lymph node dissection in patients with non-seminomatous testicular tumors at clinical stage 1].

Retroperitoneal lymph node dissection (RPLND) for low stage testicular cancer involves a low rate of dry ejaculation. The nerve-sparing technique avoids the damage of sympathetic fibers. 7 cases of non seminomatous testicular cancer have been treated by the Author. Through midline incision and intestinal derotation the vascular plane and the sympathetic fiber are identified before starting lymph node dissection. All the patients report physiological ejaculation; the post-operative follow-up is still short but at the present all patients are tumor free. In low stage testicular cancer nerve-sparing lymphadenectomy preserve physiological ejaculation and reducing surgical morbidity as well.

Erectile Dysfunction↗
PubMed1993

[What not to do when confronted with a iatrogenic lesion of the ureter].

Starting from their experience, the Authors report about steps to avoid in case of ureteral injury. They make a distinction between emergencies and planned surgery. In particular they underline that it is always advisable to confine surgery to transcutaneous or surgical nephrostomy when the experience in reconstructive surgery of upper urinary tract is limited. The Authors further suggest strict follow-up so as to avoid loosing functioning renal units due to a silent progression of an ureteral lesion. Ureteral reconstruction is the golden standard of an ureteral lesion repair; long term stenting has to be limited to the cases where a definitive surgery is not possible either for general conditions or for primary malignant disease. The discussion is integrated with pictures of several cases.

Emergencies↗
PubMed1992

IVAC PCA pump.

Explore the source record for details and available documents.

Analgesia, Patient-Controlled↗
PubMed1991

[Conservative therapy of parenchymal renal carcinoma].

From January 1987 to October 1990, 20 patients (16 M. 4 F.) affect by localized renal cell carcinoma, underwent a conservative surgical treatment. This case study includes 8 patients with bilateral (4 synchronous-4 asynchronous), and 12 patients with unilateral renal carcinoma. In the latter group only two patients had a pathological contralateral kidney. A parenchyma sparing operation was performed electively in 10 cases and was necessary in the other 10. The tumors were found to be PT1 or pT2 in all the elective cases, except one unexpected pT3a; 1pT1, 5pT2, 1pT3a and 3pT3b in the remaining group. The follow up ranges between 1 and 36 months, two deaths in bilateral tumors cases were observed. No local recurrences have been detected up to now.

Adult↗
PubMed1990

[Neoadjuvant chemotherapy of infiltrating carcinoma of the bladder: our experience].

From January 1987 until October 1989, 96 patients have been treated with radical cystectomy for locally advanced bladder cancer. Nineteen, out of 96 underwent chemotherapy (either M-VAC or M-VEC) before cystectomy. Five had T1G3 bladder tumor. After chemotherapy the results had been the following: 5 complete responses (CR) 26%, 7 partial responses (PR) (37%) and no changes in 7 patients (37%). During the first two courses of chemotherapy, 36 administrations out of 152 scheduled should have not been done because of drug toxicity. The seven patients who had no changes had a drug administration reduced of 41% with respect of a rate of reduction of 12% in the group of patients who had complete response. The urinary diversion after cystectomy were performed with a neobladder according to Reddy in 4 patients, with a colon conduit in 1 patient and with an ileal conduit in 12 patients. All the patients survived the surgery. We did not notice any difference in the follow up after surgery in those patients treated before cystectomy with chemotherapy with respect to the patients who underwent cystectomy without chemotherapy. Despite the fact that by now we can not state any conclusion about the efficacy of neoadiuvant chemotherapy, due both to the short follow up and to the small number of patients treated, we should however perform cystectomy in all the patients after chemotherapy because up to now we have no evidence that a conservative treatment of the bladder after chemotherapy could be safe.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Therapeutical aspects of intrarenal artery aneurysms.

The relative infrequency of aneurysms of the branches of the renal artery produces some indecision as to the surgeon's therapeutical choice. The purpose of this study is to carefully examine the indications for surgical treatment and to select precise therapeutical criteria on the basis of 8 patients in whom aneurysms of the main renal artery or of its branches were diagnosed from 1978 to 1986. In 1 patient, the disease was bilateral with a ruptured main artery aneurysm. 5 aneurysms were treated surgically (the ruptured one by nephrectomy, 2 by ex situ revascularization and 2 by in situ revascularization). In the remaining cases, only periodical controls were performed. In 4 surgically treated patients, angiographic follow-up demonstrated a regular renal revascularization and in 1 patient a thrombosis on the site of the anastomosis. On the basis of personal experience, surgical treatment is required for aneurysms larger than 1.5 cm in size without or with partial calcification, aneurysms occurring in pregnant women or in patients likely to conceive in the future, expanding aneurysms, and renin-mediated hypertension. The introduction of microsurgical techniques and renal preservation makes it possible for the urologist to chose between various therapeutical means for the treatment of intrarenal aneurysms. Reconstruction of anatomical continuity of the arterial supply avoiding unnecessary operative demolishment is feasible.

Aneurysm↗
PubMed1988

[Verrucous carcinoma of the penis. 2 cases and review of the literature].

The Authors report general experience with two cases of penis verrucous carcinoma. Such a neoplasia, slowly evolving and not infiltrating the surrounding tissues, needs deep biopsies for a correct diagnosis. Surgical excision of the tumor is the choice treatment at an early stage: at an advanced stage demolitive therapy consisting in a partial or total penectomy is necessary. Recent findings of frank malignant squamous cell carcinoma arising in verrucous carcinoma raise serious concerns on the use of conservative therapies.

Adult↗
PubMed1985

[Uretero-nephroscopy. Personal experience].

The authors present the personal experience concerning with the use of the rigid ureteropyeloscopes. Two groups of patients have been studied. In the first one (14 subjects) the ureteropyeloscopy was performed either with diagnostic or therapeutic purposes, in the second one, just as upper urinary tract endoscopic control in patients previously submitted to distal ureteral resection and ureteroneocystostomy for urothelial neoplasia of the distal ureter. The authors presenting the personal results and complications, discuss the indications for the upper urinary tract endoscopy with rigid instruments.

Endoscopy↗