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ABSTRACT: BACKGROUND: The aim of this study was to determine the hemodynamic and clinical changes after occlusion of polytetrafluoroethylene (PTFE) femorotibial grafts. METHODS: Twenty-seven patients were randomly selected from all patients who underwent femorotibial bypass grafting in our department. In 10 patients, the reversed autologous saphenous vein was used as graft, and in 17 patients a PTFE prosthesis was used. Out of the latter 17 patients, 10 began long-term aspirin therapy and 7 began oral anticoagulation with warfarin. RESULTS: Nine out of the 10 patients with occluded PTFE grafts and who received only aspirin therapy had a critical ischemia after occlusion of the graft, and 4 underwent major amputation. Among the 10 patients with occluded autologous vein bypass, critical ischemia was present in only 4 patients, and only 2 required some form of surgical therapy with no case of major amputation. CONCLUSIONS: After occlusion of a PTFE femorotibial graft, there is a condition of critical ischemia that is less common after occlusion of a vein graft. Oral anticoagulation seems to prevent these negative changes.
Annals of Vascular Surgery 01/2013; · 1.03 Impact Factor
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Surgery 12/2012; · 3.10 Impact Factor
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ABSTRACT: A total of 10 patients randomly selected from those who had reversed saphenous vein femoropopliteal bypass at our Institution and who had a postoperative angiogram were included into the study.
The occurrence of degenerative changes at the control angiography was correlated to the quality of the distal runoff as seen at the preoperative angiography and to the level of the index of distal resistances, calculated as the difference between the upper calf pressure and that at the ankle, divided by the arm pressure.
Three patients had degenerative changes which were more common in case of poor distal runoff and high index of distal resistances.
Degenerative changes in reversed saphenous vein grafts are more common in case of poor distal runoff and high distal resistance. These factors should be added to the many risk factors that have been analyzed previously.
Annals of Vascular Surgery 04/2011; 25(6):766-9. · 1.03 Impact Factor
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ABSTRACT: Endovascular techniques are often applied, but they have occasionally been reported in the treatment of popliteal vascular entrapment (PVE). A case of bilateral PVE is presented with an acute occlusion of the right popliteal artery. This was twice unsuccessfully treated with arterial recanalization and stenting at another Institution. The patient required an arterial reconstruction with his reversed saphenous vein, in addition to resection of the medial gastrocnemius muscle laterally inserted on his right limb. The left limb was treated with a simple myotomy. Recanalization and stenting is not recommended for PVE treatment.
Annals of Vascular Surgery 11/2010; 24(8):1135.e1-3. · 1.03 Impact Factor
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ABSTRACT: Introduction: The incidence of pheochromocytomas is about 1–2/100000 in the adult population. Nearly 10% have an extra-adrenal location or multiple locations and are defined as paragangliomas. They might be catecholamine-secreting as ordinary pheochromocytomas or clinically asymptomatic with compression symptoms.
Patients and Methods: Three cases of abdominal paraganglioma with different clinical onset are reported.
Discussion: Incidentally diagnosed asymptomatic retroperitoneal tumors with secondary hypertension suggest paraganglioma. Increased levels of catecholamine and extra-adrenal lesions identified at CT or MR imaging with positive MIBG scintigraphy support the diagnosis. Optimal care requires a multidisciplinary approach, accurate preoperative exact localization and adequate preoperative medical treatment to reduce perioperative cardiovascular complications.
The Endocrinologist 02/2010; 20(2):63-65. · 0.09 Impact Factor
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Giuseppe Cavallaro,
Alessandra Cucina,
Pierpaolo Coluccia,
Luigi Petramala,
Dario Cotesta,
Andrea Polistena,
Laura Zinnamosca,
Claudio Letizia,
Lodovico Rosato, Antonino Cavallaro,
Giorgio De Toma
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ABSTRACT: Primary hyperparathyroidism (pHPT) is caused by a single monoclonal adenoma in more than 80% of patients. Biomolecular mechanisms causing pHPT are still not completely known, even if a great amount of studies have been developed recently, mainly regarding angiogenesis and growth factors. Among the latter, insulin-like growth factor 1 (IGF-1), basic fibroblastic growth factor (bFGF), vascular endothelial growth factor (VEGF), and transforming growth factor beta 1 (TGF-beta1) and their effects have been extensively evaluated in different kinds of endocrine disease.
Parathyroid cell cultures were prepared from six human adenomatous parathyroid glands that were surgically removed. After 7 days of culture, the cells were refed with DMEM supplemented with 2% FCS alone (control group), or containing hrTGFbeta1, or hrIGF-I, or hrbFGF, or hrVEGF. Then, after 48-hour incubation, cell count was performed by a particle count and size analyzer, and prevalence of cell cycle was analyzed by using a flow cytometer.
Cell count (x10000) in the control group was 3.73 +/- 0.32. Low-dose TGF-beta1 stimulation resulted in 5.25 +/- 0.38 cells, and high-dose TGF-beta1 stimulation resulted in 2.35 +/- 0.37 cells. IGF-1 stimulation resulted in 5.4 +/- 0.65 cells, bFGF stimulation in 5.68 +/- 0.86 cells, and VEGF stimulation resulted in 6.03 +/- 1.03 cells. Statistical analysis revealed significant differences in the control group compared with the growth factor-stimulated groups. Cytometry showed different results in the percentage of cells in S-phase, in particular 22.65 +/- 4.98% of IGF-1-stimulated cells were found in S-phase compared with 7.55 +/- 3.2% of control group cells (p < 0.0001).
Growth factors seem to play an important role in parathyroid adenoma cell proliferation; IGF-1, bFGF, VEGF, and low-dose TGF-beta1 promote cell proliferation, whereas high-dose TGF-beta1 inhibits these phenomena.
World Journal of Surgery 01/2010; 34(1):48-54. · 2.36 Impact Factor
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ABSTRACT: Lumbar hernias, which are rare hernias of the posterolateral abdominal wall, can be divided into two groups: primary lumbar hernias, often the expression of a congenital defect, which typically arise in two areas of weakness, the superior triangle and inferior triangle and acquired (or diffuse) lumbar hernias which are usually due to previous lumbar trauma or surgery. Clinical examination may be adjuvated by ultrasound or CT scan, which can reveal the abdominal wall defect with the hernia content (viscera or extraperitoneal tissue). Surgical repair of lumbar hernias, both primary and acquired, has rapidly developed through recent years, similarly to the treatment of more frequent kinds of hernia (groin, epigastric), evolving from direct repair to mini-invasive techniques, even if, since the rarity of these hernias, precise knowledge of this complex anatomic region is required. Nowadays there are two valid alternatives: open tension-free repair (with use of mesh), and mini-invasive repair. Both are safe and effective, even if smaller hernias can be treated by open approach, with loco-regional anesthesia and good cosmetic effect. Larger hernias, or hernias with suspected viscera involvement, should require larger incisions and viscera exploration. For this reason laparoscopic access would be preferable.
The American surgeon 12/2009; 75(12):1238-41. · 1.28 Impact Factor
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The American surgeon 11/2009; 75(11):1153-5. · 1.28 Impact Factor
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ABSTRACT: S-adenosylmethionine is a metabolite regulating many biological processes; S-adenosylmethionine effect on ubiquitin-proteasome system (UPS) has not been studied yet. We investigated S-adenosylmethionine effects on UPS activity both in vitro, by inhibitor screening assay, and in rat vascular smooth muscle cells, by Western Blot of proteasomal targets. We found that S-adenosylmethionine inhibited UPS activity.
Protein and Peptide Letters 02/2008; 15(1):58-62. · 1.94 Impact Factor
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ABSTRACT: Atherosclerosis and neointimal hyperplasia formation are induced by alterations in the homeostatic balance between cell growth and cell death. Apoptosis is a physiological cell death process that, when deregulated, may be involved in many pathological conditions. Cigarette smoking is a primary risk factor for vascular disease and nicotine seems to exert its atherogenic effects in part through the increase of smooth muscle cell (SMC) proliferation. The aim of this study was to investigate the effect of nicotine on SMC apoptosis. Nicotine added for 24 and 72 h to serum deprived cell cultures resulted in a decrease of apoptotic SMCs. The inhibition was direct and not mediated by platelet-derived growth factor, basic fibroblast growth factor, and transforming growth factor beta(1), autocrinally released by nicotine-treated SMCs, because it was not influenced by addition of specific neutralizing antibodies. Apoptosis inhibition as well as the proliferation increase, and basic fibroblast growth factor expression on nicotine-treated SMCs were blocked by nicotinic acetylcholine receptor antagonists, including alpha-bungarotoxin, a competitive antagonist of alpha subunits of nicotinic receptor. In conclusion, we propose that nicotine could lead to the increase of neointimal SMCs in vascular lesions by inducing the inhibition of physiological SMC apoptosis and the increase of SMC proliferation. We also showed that nicotine signaling occurs as a result of activation of the classical nicotine receptor pathways.
Journal of Surgical Research 12/2007; 150(2):227-35. · 2.25 Impact Factor
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ABSTRACT: In vascular reconstructive surgery, myointimal hyperplasia contributes to the adverse outcome of synthetic grafts. This phenomenon is because of unregulated extracellular matrix degradation and remodeling, and excessive smooth muscle cell proliferation and migration. Matrix metallopreoteinase 2 (MMP-2) is known as an important contributor to these events. The aims of our study was to investigate the effects of selective MMP-2 inhibitor (TIMP-2) in endothelialization rate, SMC proliferation, and myointimal hyperplasia in experimental ePTFE arterial grafts.
In 20 male Lewis rats, a 1-cm long ePTFE graft has been inserted at the level of the abdominal aorta. Animals were randomized in two groups (10 animals each): group A received six subcutaneous inoculations of TIMP-2 (2.5 microg) after surgery, group B received only the vehicle of TIMP-2.
Neointimal thickness, as well as SMC density, were augmented in group B, whereas endothelial cells density was augmented in group A, and these findings were statistically significant. In group A SMC were better organized, just like SMC of thoracic aorta. In group B SMC were no organized. Furthermore, anti-TIMP-2 and anti-MMP-2 coloration revealed higher levels of TIMP-2 and lower levels of MMP-2 in group A versus group-B.
Use of TIMP-2 affects the neointimal formation of experimental e-PTFE arterial grafts, leading to a better-organized neointima, with improved endothelialization.
Journal of Surgical Research 02/2007; 137(1):122-9. · 2.25 Impact Factor
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ABSTRACT: Increase in plasma low density lipoprotein (LDL) levels and/or decrease in high density lipoprotein (HDL) levels are major risk factors for the development of atherosclerosis. An oxidative modification of LDL represents a key process in atherogenesis. It is well known that the LDL/HDL ratio is more important than the individual LDL and HDL levels to predict atherosclerosis. The purpose of our study was to investigate the effects of mildly oxidized LDL (minimally modified LDL: MM-LDL) and HDL, administrated alone or in combination, on the production and release of basic fibroblast growth factor (bFGF) by bovine aortic smooth muscle cells (SMCs) in culture. MM-LDL and HDL have opposite effects on aortic SMCs: MM-LDL increases both bFGF production and release and SMC proliferation, while HDL decreases both bFGF production and release and SMC proliferation. The effects of either MM-LDL or HDL on SMCs are mediated through a Gi-protein-coupled receptor. The simultaneous treatment of SMCs with MM-LDL and HDL (MM-LDL/HDL ratio=4.0) produced the inhibition of MM-LDL effects. Our data suggest that the protective role of HDL could also be exerted through the inhibition of the pro-atherosclerotic effects of MM-LDL on SMCs.
Atherosclerosis 01/2007; 189(2):303-9. · 3.79 Impact Factor
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ABSTRACT: We investigated the role and influence of platelet derived growth factor (PDGF) and transforming growth factor beta1 (TGF) in the pathologic mechanism at the basis of plaque instability regulating the expression of matrix metalloproteinases (MMPs).
Plaques obtained from 70 patients who underwent carotid endarterectomy were classified histologically as stable or unstable. Serum levels of PDGF and TGF were measured pre- and postoperatively. The serum activities of MMP-2 and MMP-9 were also analyzed. Human umbilical artery smooth muscle cells (HUASMCs) were stimulated in vitro with PDGF at various concentrations (20 and 50 ng/mL) and TGF (2 and 5 ng/mL) in a serum-free medium. The release of MMPs in the conditioned medium was assessed by enzyme-linked immunosorbent assay. Release of the MMPs was confirmed by Western blot analysis; their activity and expression were determined by zymography and reverse transcription-polymerase chain reaction. Specific inhibition tests were performed on HUASMCs to evaluate the role of these growth factors.
Forty-two (60%) patients had an unstable carotid plaque and 28 (40%) a stable plaque. Preoperatively, patients affected with unstable carotid plaques had higher PDGF and lower TGF plasma levels than patients with stable carotid plaques (P < .001); the levels returned to normal at 1 and 30 days postoperatively, compared with 20 non-operated healthy volunteers. Release, activity, protein level, and expression of MMPs in PDGF-stimulated HUASMCs were greater than in the controls (P < .001), whereas these values in the TGF-stimulated HUASMCs were lower (P < .001). The addition of monoclonal anti-PDGF antibodies decreased the release, activity, protein level, and expression of MMPs, whereas the addition of monoclonal anti-TGF antibodies increased the release, activity, protein level and expression of MMPs (P < .001).
TGF seems to be an important stabilizing factor and prevents plaque rupture through the decrease of MMPs.
Surgery 10/2006; 140(3):454-63. · 3.10 Impact Factor
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ABSTRACT: Hydatid disease affects most commonly the liver, and rupture into the bile ducts is a frequent complication, occurring in 5% to 25% of cases. These complications can cause major clinical problems either preoperatively or postoperatively with post-resectional abscess or prolonged biliary fistula. We reviewed our experience with preoperative endoscopic retrograde cholangiography (ERC) and the diagnosis of major cyst-biliary fistula.
During a 7-year period, 78 patients underwent surgery for hepatic hydatid disease. Ten patients, in whom a major intrabiliary rupture of the cyst was suspected on the basis of clinical and radiological criteria, underwent preoperative ERC, with clearing of the biliary tree. Endoscopic sphincterotomy was performed in 7 cases when the fluid contained daughter cysts or pus. Three patients, in whom the biliary content was fluid only, did not undergo sphincterotomy. One patient in whom a preoperative ERC was not feasible underwent operative transduodenal sphincterotomy. In all 11 patients the cyst was resected. Two patients underwent preoperative ERC, but no fistula was detected . They were compared with the remaining group of 67 patients who underwent resectional surgery during the same period, for apparently uncomplicated echinococcal cysts, and with an historical group of 569 patients operated on from January 1966 to January 1995.
According to the clinical and radiological preoperative criteria, there were 2 false positives. Preoperative ERC allowed visualization of the fistula, clearing of the biliary tree, and sphincterotomy in selected cases. The incidence of postoperative fistula was significantly decreased after the introduction of selective preoperative ERC, on the basis of preoperative clinical and radiological criteria.
Preoperative ERC is very helpful in patients with cyst-biliary fistula, allowing visualization of the fistula and drainage of the biliary tree, and reducing the incidence of postoperative complications from 11.1% to 7.6%. In selected cases it can solve the problem, without further surgical therapy.
The American Journal of Surgery 03/2006; 191(2):206-10. · 2.78 Impact Factor
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ABSTRACT: The treatment of cancer in elderly patients has become a global clinical issue, considering the increasingly longer life expectancy. Three quarters of patients with pancreatic adenocarcinoma are older than 60 years. Surgical resection is the only chance of cure, and early outcome of pancreaticoduodenectomy in elderly patients is comparable with that obtained in a younger population.
During an 11-year period, 166 patients underwent curative pancreaticoduodenectomy for pancreatic adenocarcinoma. Clinical and demographic factors were evaluated by univariate and multivariate analyses to test their effect on early outcome.
State university medical school tertiary care center.
One hundred sixty-six patients underwent curative pancreaticoduodenectomy for pancreatic adenocarcinoma. They were divided into 2 groups according to age (group A for patients older than 70 years, group B for patients younger than 70 years).
Pancreaticoduodenectomy was performed using a Whipple procedure. An end-to-end pancreaticojejunostomy was constructed. Lymphadenectomy was carried out along the hepatoduodenal ligament, common hepatic artery, vena cava, superior mesenteric vein, and along the right side of the superior mesenteric artery. Four abdominal drainage sites were routinely used.
The postoperative hospital stay was calculated and morbidity and mortality were assessed.
Significantly higher operative morbidity and mortality were observed in group A (group A, 49.1% vs group B, 45.8% and 10.5% vs 3.7%, respectively). Underlying comorbid conditions in group B patients influenced postoperative morbidity but not mortality. Rate and nature of surgical complications were indicated as causes of significant higher mortality in group B patients.
An aggressive surgical approach is justified for elderly patients with pancreatic adenocarcinoma. However, surgical complications that lead to reoperation are responsible for a high mortality in elderly patients. In addition to general causes, such as concomitant disorders, reduced functional reserve, poor tolerance to stress, and the texture of the pancreatic remnant, there are specific prognostic factors affecting pancreaticojejunostomy leakage and related mortality.
Archives of Surgery 03/2006; 141(2):137-42. · 4.24 Impact Factor
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The American Journal of Surgery 08/2005; 190(1):156. · 2.78 Impact Factor
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ABSTRACT: Our aim was to investigate the release, activity, and expression of matrix metalloproteinases (MMPs)-1, -2, -3 and -9, and tissue inhibitors of metalloproteinases (TIMPs)-1 and -2 in patients undergoing carotid endarterectomy and to determine whether altered plasma levels of MMPs and TIMPs may be correlated with carotid instability.
The carotid plaques of 53 consecutive patients who underwent carotid endarterectomy were classified histologically as stable or unstable. The release of MMPs and TIMPs was analyzed in the serum of patients with stable and unstable carotid plaques, and in 15 age-matched healthy volunteers. The production, activity, and expression of MMPs and TIMPs were determined by Western blotting, zymography, and reverse transcriptase polymerase chain reaction in the carotid specimens.
Twenty-nine (55%) patients had an unstable carotid plaque and 24 (45%) a stable plaque. Plasma levels of MMPs were higher in patients with unstable plaques compared to patients with stable plaques and healthy volunteers ( P < .001), whereas plasma levels of TIMPs were lower in patients with unstable plaques compared to patients with stable plaques and healthy volunteers ( P < .001). In the carotid specimens, we found increased activity, production, and expression of MMPs, and decreased activity, production and expression of TIMPs in unstable plaques compared to stable plaques ( P < .001). After endarterectomy, plasma levels of MMPs and TIMPs in patients with unstable and stable plaques returned to the values found in healthy volunteers.
Our study demonstrated that an imbalance exists between MMPs and TIMPs in unstable carotid plaques, which is reflected in the plasma levels of these markers. These data may help in selecting patients at high risk for cerebral events.
Surgery 04/2005; 137(3):355-63. · 3.10 Impact Factor
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ABSTRACT: Evidence has accumulated that 1,25-dihydroxyvitamin D(3) [1,25-(OH)(2)D(3)] is involved in the regulation of the proliferation of breast tumor cells. For complete tumor suppression high hypercalcemic doses of 1,25-(OH)(2)D(3) are needed. The aim of this study was to assess the effect of combined treatment of 1,25-(OH)(2)D(3) at low doses and melatonin (MEL) on the proliferation of estrogen-responsive rat breast cancer cell line RM4.
RM4 cell proliferation was assessed by [3H]thymidine uptake. The presence of TGF-beta(1) in serum-free conditioned medium was determined by inhibition antibody binding assay.
In 17-betaE cultured RM4 cells both MEL and 1,25-(OH)(2)D(3) alone and in combination significantly reduced [3H]thymidine incorporation in a dose-related fashion. MEL by itself was ineffective in inhibiting the FCS-cultured RM4 cells, while 1,25-(OH)(2)D(3) strongly inhibited [3H]thymidine incorporation. Meanwhile, MEL increased the sensitivity of the FCS-cultured RM4 cells to 1,25-(OH)(2)D(3) in the combined regimen, from 20- to 100-fold. MEL significantly enhanced the TGF-beta(1) secretion from RM4 cells and vitamin D(3) increased the TGF-beta(1) secretion in a dose-dependent manner, from 2- to 7-fold. Moreover, a further enhancement of the TGF-beta(1) release was obtained with the combined treatment, but only for low 1,25-(OH)(2)D(3) concentrations. The addition of monoclonal anti-TGF-beta(1) antibody to the medium of RM4 cells exposed to vitamin D(3) alone or in combination with MEL increased the [3H]thymidine uptake compared to the correspondent cells cultured without antibody.
Our data point to a potential benefit of combination therapy with 1,25-(OH)(2)D(3) and MEL in the treatment of breast cancer and suggest that the growth inhibition could be related, at least in part, to the enhanced TGF-beta(1) secretion.
Journal of Surgical Research 05/2003; 110(2):332-7. · 2.25 Impact Factor
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ABSTRACT: Vascular endothelial growth factor (VEGF), a highly specific chemotactic and mitogenic factor for vascular endothelial cells (EC), appears to be involved in the development of atherosclerosis. The purpose of our study was to assess if VEGF might indirectly stimulate SMC migration and proliferation in a EC-SMC coculture system, through the mediation of growth factors released by EC.
Bovine aortic SMC were cocultured with bovine aortic EC treated with hrVEGF, to assess SMC proliferation and migration. The release and mRNA expression of basic fibroblast growth factor (bFGF) and transforming growth factor beta(1) (TGFbeta(1)) were assessed by ELISA and PCR analysis.
hrVEGF (10 ng/ml), added to EC cocultured with SMC, induced a significant increase in tritiated thymidine uptake by SMC as compared to controls (P < 0.01) and a significant increase in SMC migration in respect to control (27%; P < 0.01). EC stimulated with hrVEGF increased the release and the expression of bFGF and decreased the release and the expression of TGFbeta(1) with a statistically significant difference in respect to controls (P < 0.001).
VEGF indirectly stimulates SMC proliferation and migration through the modulation of bFGF and TGFbeta(1) released by EC.
Journal of Surgical Research 02/2003; 109(1):16-23. · 2.25 Impact Factor
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ABSTRACT: Ex vivo rat brain microvessels express receptors for native as well as for oxidized low-density lipoproteins. In brain microvessels-derived endothelial cells, the expression levels of both receptors were enhanced by co-cultivation with rat astrocytes, even in the absence of actual contact between the two cell types, suggesting a soluble factor(s)-based mechanism of induction. No modulation effect could be evidenced in a heterologous cellular system. Since both receptors were found to be expressed also in astrocytes, these cells are likely to contribute substantially to the lipoprotein management at the blood-brain barrier and in the brain compartment.
FEBS Letters 08/2002; 522(1-3):19-23. · 3.54 Impact Factor
