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Giunta R, Gervasi L, Torrisi I, Aliotta R, Marcantoni C. Lesson for the clinical nephrologist: diagnostic approach to polyuria-polydipsia syndrome in the adult. J Nephrol 2024:10.1007/s40620-024-01945-4. [PMID: 38709446 DOI: 10.1007/s40620-024-01945-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/24/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Rosa Giunta
- Nephrology Unit, University Hospital Gaspare Rodolico San Marco, Catania, Italy.
| | - Luciano Gervasi
- Nephrology Unit, University Hospital Gaspare Rodolico San Marco, Catania, Italy
| | - Irene Torrisi
- Nephrology Unit, University Hospital Gaspare Rodolico San Marco, Catania, Italy
| | - Roberta Aliotta
- Nephrology Unit, University Hospital Gaspare Rodolico San Marco, Catania, Italy
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2
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Somsen YBO, De Winter RW, Giunta R, Schumacher SP, Van Diemen PA, Jukema RA, Stuijfzand WJA, Danad I, Lissenberg-Witte B, Verouden NJ, Nap A, Galassi AR, Henriques JP, Knaapen P. Predicting success of the retrograde approach in percutaneous coronary intervention of chronic total coronary occlusions as guided by collateral grading systems. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Retrograde chronic total coronary occlusion (CTO) percutaneous coronary intervention (PCI) requires selection of appropriate interventional collaterals. At present, utilization of the Rentrop and Werner grading systems are encouraged to assess the collateral channels (CCs) prior to attempted guidewire (GW) crossing [1]. The J-Channel score was recently introduced to predict CC GW crossing difficulty, yet data on its applicability is lacking [2].
Purpose
To investigate the predictive ability of the J-Channel score for CC GW crossing success and technical CTO-PCI success compared to the Rentrop and Werner grading systems.
Methods
A total of 262 patients who underwent single-vessel retrograde CTO-PCI were prospectively recruited in a single-center registry. The J-Channel score, Rentrop and Werner grade were assessed by invasive coronary angiography. Crossing of CCs was considered successful if the GW reached the distal cap of the CTO body. Technical CTO-PCI success was defined as Thrombolysis in Myocardial Infarction flow grade 3 and residual stenosis <30%.
Results
Mean J-Channel score was found at 1.9±1.2. Median Rentrop and Werner grade were 3 [IQR 2–3] and 1 [IQR 1–2]. Technical CTO-PCI success was 90%. In 211 (81%) cases, CC GW crossing was successful. Receiver operating characteristics analysis showed comparable discriminatory capacity for Rentrop and Werner grade (AUC 0.67 and 0.65, p=0.611), whereas the predictive ability of the J-Channel score (AUC 0.74) was superior to the Werner grade (p<0.001). A high J-Channel score was inversely associated with CC GW crossing success (p<0.001). For technical CTO-PCI success, overall performance of all grading systems weakened, wherein Rentrop grade was numerically highest, followed by the J-Channel score and Werner grade (AUC 0.69, 0.67, and 0.58, respectively). Notably, a high Rentrop grade was associated with increased CC GW crossing and technical CTO-PCI success (p<0.001).
Conclusions
In retrograde CTO-PCI, there is limited incremental value of the J-Channel score, Rentrop classification and Werner grade in predicting technical CTO-PCI success. However, their application might aid in strategic collateral channel selection prior to attempted guidewire crossing.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y B O Somsen
- Vrije Universiteit Medical Centre (VUMC) , Amsterdam , The Netherlands
| | - R W De Winter
- Vrije Universiteit Medical Centre (VUMC) , Amsterdam , The Netherlands
| | - R Giunta
- University of Palermo, Cardiology , Palermo , Italy
| | - S P Schumacher
- Vrije Universiteit Medical Centre (VUMC) , Amsterdam , The Netherlands
| | - P A Van Diemen
- Vrije Universiteit Medical Centre (VUMC) , Amsterdam , The Netherlands
| | - R A Jukema
- Vrije Universiteit Medical Centre (VUMC) , Amsterdam , The Netherlands
| | - W J A Stuijfzand
- Vrije Universiteit Medical Centre (VUMC) , Amsterdam , The Netherlands
| | - I Danad
- Vrije Universiteit Medical Centre (VUMC) , Amsterdam , The Netherlands
| | | | - N J Verouden
- Vrije Universiteit Medical Centre (VUMC) , Amsterdam , The Netherlands
| | - A Nap
- Vrije Universiteit Medical Centre (VUMC) , Amsterdam , The Netherlands
| | - A R Galassi
- University of Palermo, Cardiology , Palermo , Italy
| | - J P Henriques
- Academic Medical Center, Cardiology , Amsterdam , The Netherlands
| | - P Knaapen
- Vrije Universiteit Medical Centre (VUMC) , Amsterdam , The Netherlands
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3
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Lech L, Loucas R, Leitsch S, Vater A, Mayer JM, Giunta R, Holzbach T. Is there a need for postoperative monitoring after open carpal tunnel release under WALANT? Hand Surg Rehabil 2022; 41:638-643. [PMID: 35850181 DOI: 10.1016/j.hansur.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/27/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Open carpal tunnel release (OCTR) under wide-awake local anesthesia with no tourniquet (WALANT) is a common outpatient procedure in hand surgery worldwide. In our clinic, WALANT has replaced intravenous regional anesthesia with a tourniquet (IVRA, or 'Bier block') as standard practice in OCTR. We therefore wondered what the optimal postoperative setting after OCTR under WALANT is. In this study, we compared patient satisfaction in two postoperative settings: immediate discharge (ID) after the operation, or short postoperative monitoring (PM) period in the outpatient clinic. Our hypothesis was that older patients would prefer a brief postoperative surveillance. We retrospectively analyzed patient satisfaction with the two settings using an adjusted questionnaire based on the standard Swiss grading system. We also assessed postoperative pain, satisfaction with the perioperative preparations and the reasons for unscheduled postoperative consultations, as secondary outcomes. One hundred and nine patients (ID, n = 63; PM, n = 46) were included in this single-center retrospective observational study. Patients were highly satisfied with both postoperative settings (Mean: ID 5.1/6; PM 5.5/6; p = 0.07). Even patients aged ≥80 years reported extremely high satisfaction with both settings (ID 5.6/6; PM 6.0/6; p = 0.08). Fifteen patients (ID, n = 11 [17.5%]; PM, n = 4 [8.7%], p = 0.72) unexpectedly consulted a doctor after surgery. OCTR under WALANT as an outpatient procedure with immediate discharge was associated with high patient satisfaction. However, detailed postoperative monitoring could contribute to the patient's well-being and education on how to cope with the postoperative course, and help with any questions.
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Affiliation(s)
- L Lech
- Department of Hand and Plastic Surgery, Thurgau Hospital Group, Pfaffenholzstraße 4, 8500 Frauenfeld, Switzerland; Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080 Würzburg, Germany.
| | - R Loucas
- Department of Hand and Plastic Surgery, Thurgau Hospital Group, Pfaffenholzstraße 4, 8500 Frauenfeld, Switzerland.
| | - S Leitsch
- Department of Hand and Plastic Surgery, Thurgau Hospital Group, Pfaffenholzstraße 4, 8500 Frauenfeld, Switzerland.
| | - A Vater
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080 Würzburg, Germany.
| | - J M Mayer
- Department of Plastic and Hand Surgery, Inselspital, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
| | - R Giunta
- Divison of Hand-, Plastic and Aesthetic Surgery, University Hospital LMU Munich: Marchioninistraße 15, 81377 Munich, Germany.
| | - T Holzbach
- Department of Hand and Plastic Surgery, Thurgau Hospital Group, Pfaffenholzstraße 4, 8500 Frauenfeld, Switzerland.
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Suzumoto Y, Columbano V, Gervasi L, Giunta R, Mattina T, Trimarchi G, Capolongo G, Simeoni M, Perna AF, Zacchia M, Toriello G, Pollastro RM, Rapisarda F, Capasso G, Trepiccione F. A case series of adult patients affected by EAST/SeSAME syndrome suggests more severe disease in subjects bearing KCNJ10 truncating mutations. Intractable Rare Dis Res 2021; 10:95-101. [PMID: 33996354 PMCID: PMC8122315 DOI: 10.5582/irdr.2020.03158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
EAST/SeSAME syndrome is a rare disease affecting the Central Nervous System (CNS), inner ear, and kidney. The syndrome is due to loss-of-function mutations in the KCNJ10 gene encoding the inward-rectifying potassium channel Kir4.1. EAST/SeSAME syndrome is mainly diagnosed during childhood with a tonic-clonic seizure being the usual first symptom. Due to a limited number of patients and recent identification of the disease, few data are available on the clinical progress of this disease in adulthood. In particular, neurologic and nephrological outcomes have not been reported. We present a case series of 4 adult patients harbouring homozygous missense mutation p.Ala167Val and homozygous frameshift mutations p.Asn232Glnfs*14 and p.Gly275Valfs*7. Effects of these mutations were predicted by in silico modelling and bioinformatic tools. Patients with truncating mutations were associated with more severe outcomes, both in tubulopathy severity and neurological symptomatology. Conversely, either missense or truncating mutations were correlated with similar severity of epilepsy, with a long free-of-event period up to 20 years old. No eGFR decline was documented. Modelling predicted that truncating mutations lead to complete Kir4.1 dysfunction. Finally, all patients had a mild increase in urinary protein excretion. Our study indicates that the prognosis of patients suffering from EAST/SeSAME syndrome is related to the severity of the mutation causing the disease. As predicted by in silico modelling, truncating mutations of KCNJ10 are associated with more severe disease, with recurrence of symptomatic hypokalemia and more severe neurological phenotype. The type of mutation should be considered for the therapy tailored to patients' phenotype.
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Affiliation(s)
| | - Valeria Columbano
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Luciano Gervasi
- School of Nephrology, Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - Rosa Giunta
- School of Nephrology, Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - Teresa Mattina
- Department of Biomedical and Biotechnological Sciences, University of Catania, Italy
| | - Gabriele Trimarchi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Italy
| | - Giovanna Capolongo
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mariadelina Simeoni
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Alessandra F. Perna
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Miriam Zacchia
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - Rosa M. Pollastro
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Francesco Rapisarda
- School of Nephrology, Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - Giovambattista Capasso
- Biogem Research Institute, Ariano Irpino, Italy
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Francesco Trepiccione
- Biogem Research Institute, Ariano Irpino, Italy
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
- Address correspondence to:Francesco Trepiccione, Department of Translational Medical Sciences University of Campania "L.Vanvitelli", Via Pansini n5, 80131 Naples, Italy. E-mail:
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Giunta R, Di Mario F, Greco P, Di Motta T, Maccari C, Parenti E, Rossi GM, Morabito S, Pistolesi V, Regolisti G, Fiaccadori E. [Extracorporeal renal replacement therapies in lithium intoxication]. G Ital Nefrol 2020; 37:37-03-2020-6. [PMID: 32530151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Drug poisoning is a significant source of morbidity, mortality and health care expenditure worldwide. Lithium, methanol, ethylene glycol and salicylates are the most important ones, included in the list of poisons, that may require extracorporeal depuration. Lithium is the cornerstone of treatment for bipolar disorders, but it has a narrow therapeutic window. The therapeutic range is 0.6-1.2 mEq/L and toxicity manifestations begin to appear as soon as serum levels exceed 1.5 mEq/L. Severe toxicity can be observed when plasma levels are more than 3.5 mEq/L. Lithium poisoning can be life threatening and extracorporeal renal replacement therapies can reverse toxic symptoms. Currently, conventional intermittent hemodialysis (IHD) is the preferred extracorporeal treatment modality. Preliminary data with prolonged intermittent renal replacement (PIRRT) therapies - hybrid forms of renal replacement therapy (RRT) such as sustained low efficiency dialysis (SLED) - seem to justify their role as potential alternative to conventional IHD. Indeed, SLED allows rapid and effective lithium removal with resolution of symptoms, also minimizing rebound phenomenon.
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Affiliation(s)
- Rosa Giunta
- Unità Operativa Complessa di Nefrologia, Azienda Ospedaliera Universitaria Parma e Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Italy; Sezione di Nefrologia, Dipartimento di Medicina Clinica e Sperimentale, Policlinico Universitario e Scuola di Specializzazione in Nefrologia, Università degli Studi di Catania, Italy
| | - Francesca Di Mario
- Unità Operativa Complessa di Nefrologia, Azienda Ospedaliera Universitaria Parma e Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Italy
| | - Paolo Greco
- Unità Operativa Complessa di Nefrologia, Azienda Ospedaliera Universitaria Parma e Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Italy
| | - Tommaso Di Motta
- Unità Operativa Complessa di Nefrologia, Azienda Ospedaliera Universitaria Parma e Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Italy
| | - Caterina Maccari
- Unità Operativa Complessa di Nefrologia, Azienda Ospedaliera Universitaria Parma e Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Italy
| | - Elisabetta Parenti
- Unità Operativa Complessa di Nefrologia, Azienda Ospedaliera Universitaria Parma e Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Italy
| | - Giovanni Maria Rossi
- Unità Operativa Complessa di Nefrologia, Azienda Ospedaliera Universitaria Parma e Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Italy
| | - Santo Morabito
- UOSD Dialisi, Dipartimento Medicina Interna e Specialità Mediche, AOU Policlinico Umberto I, Roma, Italy
| | - Valentina Pistolesi
- UOSD Dialisi, Dipartimento Medicina Interna e Specialità Mediche, AOU Policlinico Umberto I, Roma, Italy
| | - Giuseppe Regolisti
- Unità Operativa Complessa di Nefrologia, Azienda Ospedaliera Universitaria Parma e Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Italy
| | - Enrico Fiaccadori
- Unità Operativa Complessa di Nefrologia, Azienda Ospedaliera Universitaria Parma e Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Italy
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6
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Giunta R, Ferrario S, Zanoli L, Orlando S, Conti A, Benintende D, Castiglione G, Rapisarda F. [Giant parathyroid adenoma: a rare cause of severe hypercalcemia]. G Ital Nefrol 2020; 37:37-02-2020-9. [PMID: 32281761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We report the case of a 37-year-old woman that developed severe hypercalcemia due to a parathyroid gland mass. After the initial medical treatment, only a minimal reduction of calcemia was observed and her clinical condition worsened; thus, she required continuous renal replacement therapy (CRRT) that resulted in the normalization of calcium serum level. She then underwent a left thyroid lobectomy with exeresis of the associated parathyroid glands; the histological diagnosis revealed a giant parathyroid adenoma (GPA). CRRT, initially recommended only in case of severe refractory hypercalcemia poorly responsive to pharmacological approaches, is now being evaluated in the first line treatment of life-threatening cases, with or without associated acute kidney injury (AKI).
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Affiliation(s)
- Rosa Giunta
- Sezione di Nefrologia, Dipartimento di Medicina Clinica e Sperimentale, Policlinico Universitario & Scuola di Specializzazione in Nefrologia, Università di Catania, Catania, Italia
| | - Silvia Ferrario
- Sezione di Nefrologia, Dipartimento di Medicina Clinica e Sperimentale, Policlinico Universitario & Scuola di Specializzazione in Nefrologia, Università di Catania, Catania, Italia
| | - Luca Zanoli
- Sezione di Nefrologia, Dipartimento di Medicina Clinica e Sperimentale, Policlinico Universitario & Scuola di Specializzazione in Nefrologia, Università di Catania, Catania, Italia
| | - Silvia Orlando
- Unità di Terapia Intensiva, Ospedale Vittorio Emanuele, AOU Policlinico-Vittorio Emanuele, Catania, Italia
| | - Alessandro Conti
- Unità di Terapia Intensiva, Ospedale Vittorio Emanuele, AOU Policlinico-Vittorio Emanuele, Catania, Italia
| | - Daniela Benintende
- Unità di Terapia Intensiva, Ospedale Vittorio Emanuele, AOU Policlinico-Vittorio Emanuele, Catania, Italia
| | - Giacomo Castiglione
- Unità di Terapia Intensiva, Ospedale Vittorio Emanuele, AOU Policlinico-Vittorio Emanuele, Catania, Italia
| | - Francesco Rapisarda
- Sezione di Nefrologia, Dipartimento di Medicina Clinica e Sperimentale, Policlinico Universitario & Scuola di Specializzazione in Nefrologia, Università di Catania, Catania, Italia
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Spaiardi P, Tavazzani E, Manca M, Russo G, Prigioni I, Biella G, Giunta R, Johnson SL, Marcotti W, Masetto S. K + Accumulation and Clearance in the Calyx Synaptic Cleft of Type I Mouse Vestibular Hair Cells. Neuroscience 2020; 426:69-86. [PMID: 31846752 PMCID: PMC6985899 DOI: 10.1016/j.neuroscience.2019.11.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 11/07/2019] [Accepted: 11/16/2019] [Indexed: 11/29/2022]
Abstract
Vestibular organs of Amniotes contain two types of sensory cells, named Type I and Type II hair cells. While Type II hair cells are contacted by several small bouton nerve terminals, Type I hair cells receive a giant terminal, called a calyx, which encloses their basolateral membrane almost completely. Both hair cell types release glutamate, which depolarizes the afferent terminal by binding to AMPA post-synaptic receptors. However, there is evidence that non-vesicular signal transmission also occurs at the Type I hair cell-calyx synapse, possibly involving direct depolarization of the calyx by K+ exiting the hair cell. To better investigate this aspect, we performed whole-cell patch-clamp recordings from mouse Type I hair cells or their associated calyx. We found that [K+] in the calyceal synaptic cleft is elevated at rest relative to the interstitial (extracellular) solution and can increase or decrease during hair cell depolarization or repolarization, respectively. The change in [K+] was primarily driven by GK,L, the low-voltage-activated, non-inactivating K+ conductance specifically expressed by Type I hair cells. Simple diffusion of K+ between the cleft and the extracellular compartment appeared substantially restricted by the calyx inner membrane, with the ion channels and active transporters playing a crucial role in regulating intercellular [K+]. Calyx recordings were consistent with K+ leaving the synaptic cleft through postsynaptic voltage-gated K+ channels involving KV1 and KV7 subunits. The above scenario is consistent with direct depolarization and hyperpolarization of the calyx membrane potential by intercellular K+.
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Affiliation(s)
- P Spaiardi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia 27100, Italy
| | - E Tavazzani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia 27100, Italy
| | - M Manca
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia 27100, Italy
| | - G Russo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia 27100, Italy
| | - I Prigioni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia 27100, Italy
| | - G Biella
- Department of Biology and Biotechnology, University of Pavia, Pavia 27100, Italy
| | - R Giunta
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia 27100, Italy
| | - S L Johnson
- Department of Biomedical Science, University of Sheffield, Sheffield S10 2TN, UK
| | - W Marcotti
- Department of Biomedical Science, University of Sheffield, Sheffield S10 2TN, UK
| | - S Masetto
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia 27100, Italy.
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Aliotta R, Zanoli L, Lauretta I, Giunta R, Ferrario S, Rastelli S, Rapisarda S, Rahbari E, Rapisarda F. Pancreatitis Is a Silent Killer in Peritoneal Dialysis With Difficult Diagnostic Approach. Clin Med Insights Case Rep 2018; 11:1179547618765761. [PMID: 29636637 PMCID: PMC5888805 DOI: 10.1177/1179547618765761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 02/26/2018] [Indexed: 12/21/2022]
Abstract
Until 2018, 236 cases of acute pancreatitis have been reported in patients who underwent peritoneal dialysis. Here, we presented a patient with double renal transplantation with chronic renal failure, under renal replacement therapy by peritoneal dialysis, who developed acute pancreatitis with abdominal pain, nausea, vomiting, leukocytosis with neutrophil left shift which is complicated by pancreatic pseudocyst, candida peritonitis, fungal sepsis, overlapping of Acinetobacter baumannii sepsis, and pneumonitis. After the percutaneous cystogastrostomy drainage of pancreatic pseudocyst, changes from peritoneal dialysis to hemodialysis, various thoracentesis, and polyantibiotics therapy, the resolution of the sepsis state was seen. The particular aspect of our case is the various comorbidity risks, severe pancreatitis associated with candida and A baumannii sepsis, and treatment strategy that lead to heal this kind of the high mortality rate condition.
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Affiliation(s)
- Roberta Aliotta
- Section of Nephrology, Department of Clinical and Experimental Medicine, Policlinico Universitario, University of Catania, Catania, Italy
| | - Luca Zanoli
- Section of Nephrology, Department of Clinical and Experimental Medicine, Policlinico Universitario, University of Catania, Catania, Italy
| | - Itria Lauretta
- Section of Nephrology, Department of Clinical and Experimental Medicine, Policlinico Universitario, University of Catania, Catania, Italy
| | - Rosa Giunta
- Section of Nephrology, Department of Clinical and Experimental Medicine, Policlinico Universitario, University of Catania, Catania, Italy
| | - Silvia Ferrario
- Section of Nephrology, Department of Clinical and Experimental Medicine, Policlinico Universitario, University of Catania, Catania, Italy
| | - Stefania Rastelli
- Section of Nephrology, Department of Clinical and Experimental Medicine, Policlinico Universitario, University of Catania, Catania, Italy
| | - Sebastiano Rapisarda
- Section of Nephrology, Department of Clinical and Experimental Medicine, Policlinico Universitario, University of Catania, Catania, Italy
| | - Elnaz Rahbari
- Section of Nephrology, Department of Clinical and Experimental Medicine, Policlinico Universitario, University of Catania, Catania, Italy
| | - Francesco Rapisarda
- Section of Nephrology, Department of Clinical and Experimental Medicine, Policlinico Universitario, University of Catania, Catania, Italy
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9
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Mühlbauer W, Biemer E, Steinau H, Olbrisch R, von Mallinckrodt G, Giunta R. Frau Em. Univ.-Prof. Dr. med. Ursula Schmidt-Tintemann 19. Juni 1924 bis 26. Juli 2017. HANDCHIR MIKROCHIR P 2017; 49:374-379. [DOI: 10.1055/s-0043-119122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Wolfgang MühlbauerAls Plastischer Chirurg der frühen Jahre und langjähriger Weggefährte verdanke ich meiner „Chefin“ die Berufung zur Plastischen Chirurgie,
beginnend mit einer stimulierenden Famulatur im Jahre 1960. Sie wurde gefestigt durch eine 4-monatige Tätigkeit als Medizinalassistent und
entscheidend geprägt durch die Rückholung von der University of Colorado in Denver, USA, wohin ich zur Facharztausbildung gegangen war, ans
neugegründete Universitätsklinikum r.d. Isar 1968. Sie begleitete meinen klinischen, akademischen und berufspolitischen Werdegang bis zur
Neugründung 1984 einer eigenen Abteilung am Klinikum Bogenhausen in München vertrauensvoll und fördernd.All die Jahre versuchte ich ihr
nicht nur in der Klinik eine Stütze zu sein, sondern auch privat in schwierigen Lebenslagen beizustehen, nicht zu Letzt im Sinne unseres
Hypokratischen Eids „unsere Lehrer zu achten, zu ehren bis ans Ende ihres Lebens“.
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Maier K, Giunta R, Prommersberger K. HaMiPla Best Paper Sitzungen – Ihre Favoriten 2015. HANDCHIR MIKROCHIR P 2016; 48:377-378. [DOI: 10.1055/s-0042-119655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Cerny M, Schantz JT, Erne H, Schmauss D, Giunta R, Machens HG, Schenck T. Überblick und Vorstellung eines Behandlungskonzeptes zur postoperativen Therapie und Mobilisation nach freier Lappenplastik an der unteren Extremität. HANDCHIR MIKROCHIR P 2016; 48:363-369. [DOI: 10.1055/s-0042-120275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- M. Cerny
- Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München, München
| | - J.-T. Schantz
- Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München, München
| | - H. Erne
- Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München, München
| | - D. Schmauss
- Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München, München
| | - R. Giunta
- Abteilung für Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie, Klinikum der Ludwig-Maximilian-Universität, München
| | - H.-G. Machens
- Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München, München
| | - T. Schenck
- Abteilung für Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie, Klinikum der Ludwig-Maximilian-Universität, München
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Koban K, Schenck T, Metz P, Volkmer E, Haertnagl F, Titze V, Giunta R. Auf dem Weg zur objektiven Evaluation von Form, Volumen und Symmetrie in der Plastischen Chirurgie mittels intraoperativer 3D Scans. HANDCHIR MIKROCHIR P 2016; 48:78-84. [DOI: 10.1055/s-0042-104506] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- K. Koban
- Abteilung für Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie der Ludwig-Maximilians Universität München, Campus Innenstadt und Campus Großhadern
| | - T. Schenck
- Abteilung für Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie der Ludwig-Maximilians Universität München, Campus Innenstadt und Campus Großhadern
| | - P. Metz
- Abteilung für Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie der Ludwig-Maximilians Universität München, Campus Innenstadt und Campus Großhadern
| | - E. Volkmer
- Abteilung für Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie der Ludwig-Maximilians Universität München, Campus Innenstadt und Campus Großhadern
| | - F. Haertnagl
- Abteilung für Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie der Ludwig-Maximilians Universität München, Campus Innenstadt und Campus Großhadern
| | - V. Titze
- Abteilung für Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie der Ludwig-Maximilians Universität München, Campus Innenstadt und Campus Großhadern
| | - R. Giunta
- Abteilung für Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie der Ludwig-Maximilians Universität München, Campus Innenstadt und Campus Großhadern
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Cimini C, Giunta R, Utili R, Durante-Mangoni E. Yellow nail syndrome as a cause of unexplained edema. Monaldi Arch Chest Dis 2016; 71:176-9. [DOI: 10.4081/monaldi.2009.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Yellow nail syndrome is a rare cause of edema due to a disordered lymphatic drainage. We recently observed two cases of long-standing, chronic edema, whose nature could not be understood despite innumerable diagnostic procedures. The diagnosis was suspected based on an attentive clinical exam and confirmed by radionuclide lymph scan. Yellow nail syndrome has to be considered in the differential diagnosis in cases of systemic edema, as well as long standing pleural effusions, particularly in patients with bronchiectasis or sinusitis. Clues to diagnosis are the presence of dystrophic, yellowish nails, peripheral lymphedema and relapsing pleural effusions and/or ascites. Long-term control of symptoms is difficult to achieve and may benefit from the judicious use of diuretics and intravenous albumin and by topical alpha-tocopherol. Pleurodesis may be needed. Other pathologic conditions are often associated to yellow nail syndrome and should be ruled out.
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Engelhardt T, Alghamdi H, Wallmichrath J, Holzbach T, Dürr H, Giunta R. Freie M. gracilis-Lappenplastik zur anatomischen Rekonstruktion nach gliedmaßen-erhaltender Weichteil-Sarkom Resektion. HANDCHIR MIKROCHIR P 2015; 47:111-7. [DOI: 10.1055/s-0035-1545351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- T. Engelhardt
- Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie
| | - H. Alghamdi
- Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie
| | | | - T. Holzbach
- Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie
| | - H. Dürr
- Tumororthopädie der Klinik für Orthopädie, Klinikum der Ludwig-Maximilians Universität München
| | - R. Giunta
- Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie
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Felici N, Marcoccio I, Giunta R, Haerle M, Leclercq C, Pajardi G, Wilbrand S, Georgescu A, Pess G. Dupuytren Contracture Recurrence Project: Reaching Consensus on a Definition of Recurrence. HANDCHIR MIKROCHIR P 2014; 46:350-4. [DOI: 10.1055/s-0034-1394420] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- N. Felici
- Direttore ad interim UOC Chirurgia Plastica e Chirurgie della Mano A.O.R.N. „San Camillo-Forlanini“ Roma – Italy
| | - I. Marcoccio
- Instituto Clinico Città di Bressica, Unità Operativa di Chirurgia della Mano e Microchirurgia Ortopedica, Brescia – Italy
| | - R. Giunta
- Chefarzt der Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie, Campus Innenstadt und Grosshadern der Ludwig-Maximilians Universität München – Germany
| | - M. Haerle
- Head of Department, Plastic and Hand Surgery, Orthopaedic Clinic, Markgroeningen(Stuttgart) – Germany
| | - C. Leclercq
- Institut de la Main Clinique Jouvenet, Paris – France
| | - G. Pajardi
- Director Of Hand Surgery Department – St. Joseph Hospital MultiMedica Group Milan – Italy Plastic Surgery School – University of Milan Italy
| | - S. Wilbrand
- Senior Consultant Department of Hand Surgery Akademiska University Hospital, Uppsala
| | - A. Georgescu
- Professor in Plastic Surgery and Reconstructive Microsurgery University of Medicine Iuliu Hatieganu Spitalul Clinic de Recuperare Clinic of Plastic Surgery and Reconstructive Microsurgery
| | - G. Pess
- Chief, Central Jersey Hand Surgery, Eatontown, NJ Clinical Senior Instructor, Department of Orthopedic Surgery, Drexel University School of Medicine, Philadelphia, PA
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Giunta R. Open Access vs. HaMiPla. HANDCHIR MIKROCHIR P 2014; 46:71-2. [DOI: 10.1055/s-0034-1371850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Koban K, Leitsch S, Holzbach T, Volkmer E, Metz P, Giunta R. 3D Bilderfassung und Analyse in der Plastischen Chirurgie mit Smartphone und Tablet: eine Alternative zu professionellen Systemen? HANDCHIR MIKROCHIR P 2014; 46:97-104. [DOI: 10.1055/s-0034-1371822] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- K. Koban
- Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie, Klinikum der Ludwig-Maximilians Universität München, München
| | - S. Leitsch
- Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie, Klinikum der Ludwig-Maximilians Universität München, München
| | - T. Holzbach
- Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie, Klinikum der Ludwig-Maximilians Universität München, München
| | - E. Volkmer
- Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie, Klinikum der Ludwig-Maximilians Universität München, München
| | - P. Metz
- Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie, Klinikum der Ludwig-Maximilians Universität München, München
| | - R. Giunta
- Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie, Klinikum der Ludwig-Maximilians Universität München, München
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Wallmichrath J, Baumeister R, Giunta R, Notohamiprodjo M, Frick A. Die Vielfalt in der chirurgischen Therapie beim Lymphödem – was ist aktuell? HANDCHIR MIKROCHIR P 2012; 44:334-42. [DOI: 10.1055/s-0032-1323840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
| | - R. Baumeister
- Handchirurgie, Plastische Chirurgie, Äshetische Chirurgie
| | - R. Giunta
- Handchirurgie, Plastische Chirurgie, Äshetische Chirurgie
| | - M. Notohamiprodjo
- Institut für Klinische Radiologie, alle Klinikum der Ludwig-Maximilians-Universität, München
| | - A. Frick
- Handchirurgie, Plastische Chirurgie, Äshetische Chirurgie
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Kernt B, Deiler S, Holzbach T, Giunta R. „Pull Through Technik“ als narbensparende therapeutische Option bei Gynäkomastie. HANDCHIR MIKROCHIR P 2012. [DOI: 10.1055/s-0032-1308850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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20
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Holzbach T, Artunian N, Spanholtz T, Volkmer E, Engelhardt T, Giunta R. Intraoperative Indocyaningrün-Fluoreszenzdiagnostik mittels Operationsmikroskop in der plastischen Chirurgie. HANDCHIR MIKROCHIR P 2012. [DOI: 10.1055/s-0032-1312598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- T. Holzbach
- Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie, Ludwig-Maximilians-Universität München, München
| | - N. Artunian
- Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie, Ludwig-Maximilians-Universität München, München
| | - T. Spanholtz
- Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie, Ludwig-Maximilians-Universität München, München
| | - E. Volkmer
- Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie, Ludwig-Maximilians-Universität München, München
| | - T. Engelhardt
- Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie, Ludwig-Maximilians-Universität München, München
| | - R. Giunta
- Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie, Ludwig-Maximilians-Universität München, München
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Lucivero G, Romano C, Ferraraccio F, Sellitto A, De Fanis U, Giunta R, Guarino A, Auriemma PP, Benincasa M, Iovino F. Lupus mastitis in systemic lupus erythematosus: a rare condition requiring a minimally invasive diagnostic approach. Int J Immunopathol Pharmacol 2012; 24:1125-9. [PMID: 22230423 DOI: 10.1177/039463201102400435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Breast involvement is a rare event in SLE patients. The most frequent presentation is lupus panniculitis with skin erythema, tenderness, and parenchymal nodules. However, when breast masses are detected in SLE patients without significant superficial inflammation, it is mandatory to rule out breast carcinoma. Here, we report the case of a 47-year-old woman with an 18-year-long history of SLE, who presented with a suspicious breast mass. Since surgical trauma has been reported to be able to exacerbate breast inflammation in lupus mastitis, an ultrasound-guided minimally invasive Mammotome biopsy was performed to obtain tissue samples for histological and immunohistochemical examinations. Histology was consistent with lupus mastitis. The patient was already on mycophenolate mofetil and hydroxychloroquine. At the latest follow-up visit 6 years later, no progression of the breast lesion was observed.
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Spanholtz T, Holzbach T, Wallmichrath J, Pototschnig A, Deglmann C, Frick A, Giunta R. Die Behandlung der Dupuytrenschen Kontraktur mittels Kollagenase- Erste klinische Erfahrungen *. HANDCHIR MIKROCHIR P 2011; 43:275-80. [DOI: 10.1055/s-0031-1286323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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23
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Longo A, Puglisi M, Muratore A, Salvaggio A, Marino A, Giunta R. EVALUATION OF MICROBIOLOGICAL AIR QUALITY INSIDE REFRIGERATION CELLS IN "AOSTA" MECHANIZED BRIGADE’S DEPENDENT REGIMENTS LOCATED IN EASTERN SICILY. Ital J Food Saf 2011. [DOI: 10.4081/ijfs.2011.1s.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Marino A, Puglisi M, Muratore A, Giunta R, Longo A, Salvaggio A. BIOCHEMICAL IDENTIFICATION OF FUNGAL SPECIES FROM AIR INSIDE REFRIGERATION CELLS IN “AOSTA” MECHANIZED BRIGADE’S REGIMENTS LOCATED IN ORIENTAL SICILY. Ital J Food Saf 2011. [DOI: 10.4081/ijfs.2011.1s.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Rennekampff HO, Reimers K, Gabka C, Germann G, Giunta R, Knobloch K, Machens H, Pallua N, Ueberreiter K, Heimburg DV, Vogt P. Möglichkeiten und Grenzen der autologen Fetttransplantation – „Consensus Meeting” der DGPRÄC in Hannover, September 2009. HANDCHIR MIKROCHIR P 2010; 42:137-42. [PMID: 20352577 DOI: 10.1055/s-0030-1249672] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Coppola L, Verrazzo G, Esposito G, La Marca C, Mazzarelli R, Guastafierro S, Giunta R, Giugliano D, Varricchio M. Hemorheological and cardiovascular effects of exercise training in the rehabilitation of elderly patients with chronic obstructive pulmonary disease. Arch Gerontol Geriatr 2008; 28:1-8. [PMID: 18656098 DOI: 10.1016/s0167-4943(98)00115-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/1998] [Revised: 06/05/1998] [Accepted: 06/12/1998] [Indexed: 11/25/2022]
Abstract
The purpose of this study is to evaluate hemorheological effects of a single exercise respiratory session (SERS), in the rehabilitation of elderly patients with chronic obstructive pulmonary disease (COPD). Fifteen elderly patients with COPD and 15 controls, matched for demographic variables and body habitus, were submitted to a single session of relaxation and unsupported upper-extremity exercise, coordinated with breathing. We measured hemogasanalytical and cardiovascular parameters: hematocrit value, platelet aggregation, beta-TG and PF(4) plasma levels, blood viscosity and erythrocyte filterability. In both groups, SERS significantly decreased platelet aggregation (P<0.05), beta-TG and PF(4) plasma levels (P<0.05). Erythrocyte filterability and diastolic blood pressure showed a trend to increase in both groups but reached a significant difference in patients with COPD only. Respiratory exercise has a positive influence on platelet and hemorheological parameters in the elderly with COPD. The increase of diastolic blood pressure requires active surveillance.
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Affiliation(s)
- L Coppola
- Department of Gerontology, Geriatric and Metabolic Diseases, II University of Naples, Piazza L. Miraglia 2, 80138 Naples, Italy
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Giunta R, Lanz U. On Plastic Surgery in the Journal Handchirurgie · Mikrochirurgie · Plastische Chirurgie - Scientific Organ of the Vereinigung der Deutschen Plastischen Chirurgen (VDPC). HANDCHIR MIKROCHIR P 2005. [DOI: 10.1055/s-2005-865915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
Extravasations of chemotherapeutic drugs may lead to large soft-tissue losses in the hand and forearm and necessitating surgical excision with secondary flap coverage. Unfortunately, a delayed referral to a hand and plastic surgical unit with an already established soft-tissue defect is most common. Nevertheless, in our unit the method of choice is early emergency subcutaneous "wash-out", which facilitates dilution and reduction of concentration of the extravasation and therefore reliably avoids the development of soft-tissue defects. The aim of this paper is to present the surgical technique.
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Affiliation(s)
- R Giunta
- Abteilung für Plastische und Wiederherstellungschirurgie, Klinikum rechts der Isar, Technische Universität München, Munich.
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Leocata G, Merisi AM, Giunta R, Campisi R, Cortesi F. [Procedure of the management of biological-risk accidents care of the ASL of the Province of Milano 2. Melegnano]. G Ital Med Lav Ergon 2002; 24:343-6. [PMID: 12360824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- G Leocata
- Medico Competente ASL della Provincia di Milano 2 Melegnano, Mi
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Giunta R. Themenheft „Perforans-Lappenplastiken“. HANDCHIR MIKROCHIR P 2002. [DOI: 10.1055/s-2002-36295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Abstract
Perforator flaps allow an individual flap design on the basis of a preoperative ultrasound examination. Aim of the present study is a preliminary evaluation of results and technical pitfalls of this new technique in the use for flap coverage on the dorsum of the hand and the elbow region. Since 1999, seven individually designed pedicled perforator flaps were prepared on the upper extremity. In four cases, defects on the dorsum of the hand and in a further three defects in the elbow region were treated. In the latter cases the flaps were harvested in a mainly epifascial plane, without dissecting the perforating vessels down to their origin. Five flaps were based on perforating vessels of the interosseous arteries, a further two from the lateral collateral humeral artery. Three out of four pedicled perforator flaps used on the dorsum of the hand healed completely. One flap was lost because of venous insufficiency due to the lack of wrist immobilisation. In the elbow region, two out of three defects were successfully covered with an individual perforator flap. One flap was lost due to venous insufficiency, a further needed an additional split-skin graft with a partial flap loss. The main advantage of the presented technique remains the possibility of individual flap design. However, the donor-site defect is almost negligible since in most cases a primary closure of the donor site was possible. The main arteries remained untouched leaving the blood supply to the hand unchanged. Nevertheless, the mainly epifascial harvest of the perforating vessels in the elbow region has the disadvantage of a short pedicle together with a high degree of torsion which leads to an increased risk of flap loss due to venous insufficiency.
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Affiliation(s)
- R Giunta
- Abteilung für Plastische und Wiederherstellungschirurgie, Klinikum rechts der Isar, Technische Universität München, München, Germany.
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Giunta R, Coppola A, Luongo C, Sammartino A, Guastafierro S, Grassia A, Giunta L, Mascolo L, Tirelli A, Coppola L. Ozonized autohemotransfusion improves hemorheological parameters and oxygen delivery to tissues in patients with peripheral occlusive arterial disease. Ann Hematol 2001; 80:745-8. [PMID: 11797116 DOI: 10.1007/s002770100377] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2000] [Accepted: 08/22/2001] [Indexed: 12/19/2022]
Abstract
Twenty-seven subjects suffering from peripheral occlusive arterial disease (POAD, clinical stage II-III according to Fontaine) were enrolled in this study to evaluate the effect of oxygen-ozone therapy upon hemorheological parameters and hemoglobin-oxygen affinity in patients with POAD. All patients underwent a major ozonized autohemotransfusion consisting of the slow reinfusion of 100 ml of autologous blood, previously exposed to a O(2)-O(3) mixture in a glass box for 10 min. Whole blood viscosity, erythrocyte filterability, hematocrit, and fibrinogen levels were assessed at the basal time and 30 min after the reinfusion of ozonized blood. At the same time p50 standard (p50std) values (an indicator of hemoglobin-oxygen affinity) and plasma values of malonyl dialdehyde (MDA, an indicator of lipid peroxidation) were evaluated. At the baseline, patients had significantly higher ( p<0.05- p<0.001) whole blood viscosity, MDA, and p50std values and significantly lower blood filterability ( p<0.01) as compared with 20 matched healthy volunteers (controls). Thirty minutes after the end of a major autohemotransfusion, whole blood viscosity significantly decreased ( p<0.01). This was accompanied by a significant fall in plasma fibrinogen level ( p<0.01) with no change in hematocrit. Blood filterability, MDA plasma level, and p50std values increased significantly at the same time ( p<0.01- p<0.005). The 2,3-DPG value did not change significantly. No significant changes occurred when the same patients received a non-ozonized autohemotransfusion (control test). In conclusion, ozonized autohemotransfusion may be useful to improve both the poor rheological properties of the blood and the oxygen delivery to tissues in patients suffering from POAD.
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Affiliation(s)
- R Giunta
- Department of Geriatrics and Metabolic Diseases, Second University of Naples, Piazza L. Miraglia, 2, 80138 Naples, Italy
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Abstract
Free-tissue transfer is a standard procedure in hand and other plastic and reconstructive surgery. The aim of the present article was to present a new clinical classification of disturbances of the circulation, and to assess the results of treating the specific complication at each of the stages described. Within a period of 29 months, 194 free microvascular flaps were prepared and evaluated in a prospective study. Postoperative monitoring was carried out from a purely clinical point of view. A distinction was made between arterial and venous circulatory disturbances and, in both cases, four stages were characterized, according to the time required for recapillarization, the color of the transfer, and bleeding on puncture. Complications occurred in 69 cases (36 percent), including intraoperative revisions during a first operation. The ratio of arterial to venous insufficiency was 33:35. In the presence of arterial disturbances of the circulation, the proportion of losses increased in progressive stages to 41 percent. With venous disturbances, losses which occurred in stages 1 and 2 were predominantly partial. In 164 cases (85 percent), the flaps remained undamaged. In 15 cases (8 percent), there was partial loss of the transfer and, in a further 13 cases (6 percent), there was complete loss. The authors' results confirmed that the presented clinical classification is, indeed, a measurement of the severity of circulatory impairment. Despite the relatively high complication rate, the use of various methods of treatment finally led, in the overwhelming majority of cases, to a positive result.
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Affiliation(s)
- R Giunta
- Department of Plastic Surgery, Behandlungszentrum Vogtareuth, Germany
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D'Addio F, Giunta R, Scarfiglieri D, De Fanis U, Dalla Mora L, Pezone L, Bresciano E, Mancino D, Lucivero G. [Late onset immunodeficiency with hypo-IgG and hyper-IgM, T CD4+ lymphocytopenia and vitiligo]. Recenti Prog Med 2001; 92:392-4. [PMID: 11433718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The Authors report the clinical case of a patient with a deficit of humoral immunity who developed infections since puberty. The serum levels of IgG and IgA decreased progressively in the fourth decade of life, while serum IgM increased. Moreover, the patient developed a marked CD4+ T lymphocytopenia and a meager B lymphocytopenia, vitiligo, positivity for anti-SSA/Ro autoantibodies and granulomatous phlogosis of the knee. The heterogeneity of the clinical and laboratory data suggests that this patient might present an overlap immunodeficiency syndrome with some of the clinical and immunological features typical of the hyper-IgM syndrome (in the X-linked or autosomal forms) and others that can be referred to a nosologically distinct humoral immunodeficiency such as the common variable immunodeficiency.
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Affiliation(s)
- F D'Addio
- Dipartimento di Gerontologia, Geriatria e Malattie del Metabolismo, Divisione di Medicina Interna e Immunoallergologia, II Università, Napoli
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37
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38
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Giunta R, Marfella MA, Maffei A, Lucivero G. Herpes zoster infection and Ogilvie's syndrome in non-Hodgkin's lymphoma with hypogammaglobulinemia. Ann Ital Med Int 2001; 16:50-3. [PMID: 11688352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The case of a 43-year-old male with non-Hodgkin's lymphoma (stage IV B), and hypo-IgG and IgM, who developed acute colonic pseudo-obstruction or Ogilvie's syndrome during chemotherapy, is presented. The simultaneous occurrence of a unilateral segmental vesicular rash indicative of herpes zoster infection suggests an etiopathogenetic relationship between the colonic pseudo-obstruction and herpetic involvement of the motor celiac sympathetic ganglia. The rapid resolution of the abdominal dilation and the functional recovery from the colonic pseudo-obstruction after anti-viral therapy is also consistent with the diagnostic hypothesis.
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Affiliation(s)
- R Giunta
- VI Division di Medicina Interna ed Immunoallergologia, Dipartimento di Gerontologia, Geriatria e Malattie del Metabolismo, Seconda Università degli Studi di Napoli
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39
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Abstract
In contrast to the classical fasciocutaneous and musculocutaneous flaps, perforator flaps are supplied only by a single perforating branch. The aim of this paper is to present the surgical technique and to discuss the use of perforator flaps in hand surgery. Our previous studies have demonstrated the reliability of a preoperative Doppler for planning perforator flaps in reconstructive surgery of the breast: With 286 preoperatively localized perforating branches, a total of 162 were confirmed in intraoperative dissection. In 37 out of these 46 perforator flaps (80%), a preoperatively localized perforating branch could be used. Based on these results, the individual design of perforator flaps harvested on the forearm for defects on the dorsum of the hand is possible. In a preoperative Doppler exam, a perforating branch, i.e. of the posterior interosseous artery, can be localized. The intraoperative confirmation of the perforating branch allows the successful defect coverage with a distally pedicled flap without taking fascia or septum. In our experience, this possibility of planning an individually designed perforator flap is the major advantage for applications of the perforator flap technique in hand surgery. This is especially true in cases where the harvest of a fasciocutaneous flap is unreliable or impossible due to anatomic variations. On the other hand, the dissection of the pedicle is technically demanding and the individual distribution of the perforating branches requires a high degree of flexibility. However, we do consider this new technique to be a further extension in the armamentarium for soft-tissue coverage of the hand.
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Affiliation(s)
- R Giunta
- Abteilung für Plastische Chirurgie, Behandlungszentrum Vogtareuth.
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40
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Abstract
Because of the loss of mobility, scarring of the median nerve in the carpal tunnel can lead to chronic pain syndrome of the wrist joint, with reduced sensation, muscular dystrophy and severe limitation of the use of the hand. This syndrome most often appears following open carpal tunnel release. Nine patients with scarring of the median nerve in the carpal tunnel were treated with a hypothenar fat-pad flap. Eight of them showed a significant reduction in pain, with improved sensation, trophism and strength. The procedure is suitable as a salvage procedure for restoring a sliding pathway and for cushioning the median nerve in the presence of recurrent lesions in the carpal tunnel.
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Affiliation(s)
- R Giunta
- Hand Center Bad Neustadt/Saale, Germany
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41
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Marfella R, Esposito K, Giunta R, Coppola G, De Angelis L, Farzati B, Paolisso G, Giugliano D. Circulating adhesion molecules in humans: role of hyperglycemia and hyperinsulinemia. Circulation 2000; 101:2247-51. [PMID: 10811590 DOI: 10.1161/01.cir.101.19.2247] [Citation(s) in RCA: 168] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND We assessed the role of glucose and insulin in the regulation of circulating levels of soluble intercellular adhesion molecule-1 (sICAM-1) and vascular adhesion molecule-1 (sVCAM-1) in normal subjects and in patients with type 2 diabetes. METHODS AND RESULTS Plasma glucose concentrations were acutely raised in 10 normal subjects and 10 newly diagnosed, complication-free type 2 diabetic patients and maintained at 15 mmol/L for 2 hours. In normal subjects, plasma sICAM-1, but not sVCAM-1, levels rose significantly (P<0.01) at 1 hour and returned to basal values at 2 hours. In another study, octreotide was infused during the hyperglycemic clamp to block the release of endogenous insulin; this prevented the late fall of plasma sICAM-l levels observed in under control clamp conditions. The diabetic patients had plasma sICAM-1 levels significantly higher (P<0.01) than those of the control subjects; plasma sVCAM-1 levels were similar. Both sICAM-l and sVCAM-1 concentrations did not change significantly during the control hyperglycemic clamp; however, octreotide infusion increased plasma sICAM-1 levels, which remained significantly (P<0.05) above baseline during the whole clamp. In an additional 10 type 2 diabetic patients, overnight euglycemia (plasma glucose 5.5 mmol/L) obtained with the aid of an artificial pancreas or supplementation with l-arginine (10 g PO for 30 days), the natural precursor of NO, normalized the increased plasma sICAM-1 levels. CONCLUSIONS Acute hyperglycemia increases circulating sICAM-1 levels in normal subjects, whereas the correction of hyperglycemia with insulin or l-arginine supplementation restored to normal levels the increased plasma sICAM-1 levels of type 2 diabetic patients.
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Affiliation(s)
- R Marfella
- Department of Geriatrics, Second University of Naples, Naples, Italy
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42
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Abstract
Free tissue transplantation is a routine procedure in reconstructive surgery. Although a lot of free flap techniques have been described, the postoperative management of complications has gained only little interest. Nevertheless, complications of perfusion after free tissue transplantation are not rare and require a systematic approach. The aim of this study is to classify perfusion failures with a simple grading system prospectively on a large clinical series and to evaluate the results of treatment to improve management. In the past ten months, 70 consecutive free flaps have been performed. By the end of the operation, the operating surgeon gave a prognosis concerning the probability of a possible perfusion complication. Postoperative monitoring was done exclusively by clinical examination (colour, time for recapillarisation and bleeding after puncture). According to these parameters, arterial and venous insufficiencies have been classified into four grades. After recording type, time and treatment of a postoperative complication, the result of treatment was rated subjectively and a cause was noted when possible. The final result was classified either as total flap loss, partial flap loss or successful tissue transplantation. A total of 28 (40%) complications, which were treated with an average of 2.1 options, were recorded. The ratio between arterial and venous failure was 15:13. In 21 cases surgical intervention became necessary (intraoperative n = 12, postoperative n = 9). The arising complication was diagnosed correctly in nine cases by the operating surgeon. In ten cases, the cause of the complication remained unclear. In 18 cases, the complication was treated successfully without any flap loss. In six cases partial flap loss was observed and in four cases a total flap loss had to be accepted. Our results confirm that only few objective criteria for treatment options with perfusion failures after free tissue transplantation exist. Nevertheless, the presented classification is a useful tool for standardized evaluation of the results. The various salvage techniques result in positive outcomes for most of the patients.
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Affiliation(s)
- R Giunta
- Abteilung für Plastische Chirurgie, Behandlungszentrum Vogtareuth.
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43
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Abstract
This study was designed to evaluate the effects of crush injuries to the feeding arteries of a muscle flap on microcirculatory haemodynamics. Eighteen male Sprague-Dawley rats were divided into three experimental groups for intravital microscopy of the cremaster muscle flap. Group 1 served as control. In group 2 the common iliac artery and in group 3 additionally the lower abdominal aorta was crushed with a Kocher clamp (17.4 N) over 5 min. Microcirculatory parameters (red blood cell velocity, vessel diameter, and capillary perfusion) were monitored before and 2 h after crush. In the one-level crush group, red blood cell velocities significantly decreased by 39.17% (P=0.046) in first order arterioles and by 32. 91% (P=0.0106) in second order arterioles. In capillary perfusion, a drop of 48.02% (P=0.0039) was noted. In the two-level crush group, red blood cell velocities significantly dropped over 32.06% (P=0. 0250) in first order arterioles, 35.91% (P=0.0065) in second order arterioles, and 45.69% (P=0.0782) in first order venules. Capillary perfusion was reduced by 20.16% (P=0.374). Arterial crush injuries as possible thrombogenic insults may result in a significant decrease in skeletal muscle perfusion although the blood supply through the crushed supplying vessel is maintained.
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Affiliation(s)
- B D Krapohl
- Dep. of Plastic and Hand Surgery, University of Lübeck, Lübeck, Germany
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Frank U, Giunta R, Krimmer H, Lanz U. [Relocation of the median nerve after scarring along the carpal tunnel with hypothenar fatty tissue flap-plasty]. HANDCHIR MIKROCHIR P 1999; 31:317-22. [PMID: 10566133 DOI: 10.1055/s-1999-13543] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
In our study, we present the data of eleven patients suffering from scarring of the median nerve, predominantly after open decompression of the carpal tunnel. Dysaesthesia in the palmar region and loss of grip strength prevented performing normal daily activities. All patients except one were relieved of the palmar discomfort and experienced an increase of grip strength allowing their return to work. The hypothenar fat flap has been shown to be a reliable source of local tissue to cover the median nerve. The sprouting of nerve fibers to the skin is prevented as well as median nerve readherence. We believe that the hypothenar fat flap provides sufficient regenerative conditions and coverage of the median nerve within the carpal tunnel in the surgical treatment of abundant scarring.
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Affiliation(s)
- U Frank
- Klinik für Handchirurgie I, Rhön-Klinikum, Bad Neustadt/Saale
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45
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Krimmer H, Giunta R, Lanz U. Treatment of severe four finger crush avulsion injuries. European Journal of Plastic Surgery 1999. [DOI: 10.1007/s002380050172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Giunta R, Lukas B. Impossible harvest of the posterior interosseous artery flap: a report of an individualised salvage procedure. Br J Plast Surg 1998; 51:642-5. [PMID: 10209472 DOI: 10.1054/bjps.1998.0015] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although the posterior interosseous artery flap represents a reliable technique to provide vascularised skin cover for the dorsum of the hand, the dissection of the flap is often very difficult because of anatomical variants. The weakest part of the vascularisation is the middle third of the posterior interosseous artery. Whenever it is discovered during the operation that such a flap is impossible to harvest, or likely to be unreliable, there is an immediate need to choose an alternative. Such a case is reported here. The individual anatomical situation allowed the dissection of a flap, the pedicle of which carried its blood supply from a perforating branch of the anterior interosseous artery. The technique described offers an individual solution to the problem of skin coverage when the harvest of the posterior interosseous artery is impossible.
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Affiliation(s)
- R Giunta
- Department of Plastic Surgery, Vogtareuth Hospital, Vogtareuth, Germany
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47
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Giunta R, Rock C, Löwer N, Wilhelm K, Lanz U, Müller-Gerbl M. [Stress on the wrist joint in semilunar bone necrosis--a morphologic study in vivo]. HANDCHIR MIKROCHIR P 1998; 30:158-64. [PMID: 9677479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The distribution of subchondral mineralization of the distal articular surface of the radius was examined by CT osteoabsorptiometry in both wrists of twelve patients showing different stages of Kienböck's disease. The pattern of density distribution had already been demonstrated in previous studies to be an adequate parameter for assessing axial loading across the wrist joint in the patients. Contrary to the anticipated presence of predominant stress in the lunate compartment, some patients showed identical stress in the compartment of the scaphoid, and the balanced loading of both compartments, as before. Even when in early stages of the disease the lunate type of mineralization appeared more often, it was still not possible to demonstrate general excessive stress on the lunate. We have therefore concluded that the main stress in the scaphoid compartment might be a secondary effect, which is to be regarded as the expression of the advancing destruction of the lunate and consequent loss of load transmission through this compartment. This hypothesis is also supported by the fact that, in progressive stages of Kienböck's disease, the density maximum in the fovea lunata, generally present in healthy people, is absent. Furthermore, in patients with necrosis of the lunate, the total mineralization in terms of the maximal density values in the distal joint surface of the radius is in the majority of cases less than in the normal subject. In two cases, even the density maximum was absent from the fovea lunata of the contralateral wrist joint, without there being any clinical signs suggesting a possible lunate necrosis on this side. We interpret these pathological changes in the unaffected wrist joint as a further indication that we are dealing with a congenital predisposition which affects both wrist joints.
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Affiliation(s)
- R Giunta
- Klinik für Handchirurgie, Bad Neustadt an der Saale
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Giugliano D, Marfella R, Acampora R, Giunta R, Coppola L, D'Onofrio F. Effects of perindopril and carvedilol on endothelium-dependent vascular functions in patients with diabetes and hypertension. Diabetes Care 1998; 21:631-6. [PMID: 9571355 DOI: 10.2337/diacare.21.4.631] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the effects of the ACE inhibitor perindopril and the beta-blocker carvedilol on blood pressure and endothelial functions in NIDDM patients with hypertension. RESEARCH DESIGN AND METHODS We conducted a double-blind randomized trial in 26 patients with NIDDM and mild hypertension. A 4-week run-in placebo period preceded the active 12-week treatment with perindopril (4-8 mg daily) or carvedilol (25-50 mg daily). Endothelial functions were assessed by evaluating the hemodynamic (mean blood pressure, leg blood flow) and rheological (platelet aggregation, blood viscosity, and blood filterability) responses to an intravenous bolus of 3 g L-arginine, the natural precursor of nitric oxide. RESULTS Both perindopril and carvedilol significantly reduced mean blood pressure (P < 0.001) and increased leg blood flow (P < 0.05) to the same extent; blood filterability remained unchanged in both perindopril- and carvedilol-treated groups. Carvedilol reduced platelet aggregation and blood viscosity significantly (P < 0.05) but perindopril did not. Before treatment, the hemodynamic and rheologic responses to L-arginine were significantly lower in patients (P < 0.05-0.01) than in 20 nondiabetic nonhypertensive control subjects. After 12 weeks of treatment, both drugs normalized the hemodynamic responses to L-arginine. Platelet aggregation response to L-arginine was ameliorated by carvedilol and remained unchanged in the perindopril group. CONCLUSIONS At the doses used, both drugs effectively reduce blood pressure and normalize the hemodynamic responses to L-arginine. The implications of the ameliorated endothelial function for the poor cardiovascular outlook of the NIDDM hypertensive patient need further assessment.
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Affiliation(s)
- D Giugliano
- Department of Geriatrics and Metabolic Diseases, Second University of Naples, Italy
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49
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Giugliano D, Marfella R, Coppola L, Verrazzo G, Acampora R, Giunta R, Nappo F, Lucarelli C, D'Onofrio F. Vascular effects of acute hyperglycemia in humans are reversed by L-arginine. Evidence for reduced availability of nitric oxide during hyperglycemia. Circulation 1997; 95:1783-90. [PMID: 9107164 DOI: 10.1161/01.cir.95.7.1783] [Citation(s) in RCA: 252] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Acute hyperglycemia may increase vascular tone in normal humans via a glutathione-sensitive, presumably free radical-mediated pathway. The objective of this study was to investigate whether or not the vascular effects of hyperglycemia are related to reduced availability of nitric oxide. METHODS AND RESULTS Acute hyperglycemia (15 mmol/L, 270 mg/dL) was induced in 12 healthy subjects with an artificial pancreas. Systolic and diastolic blood pressures, heart rate, and plasma catecholamines showed significant increases (P < .05) starting after 30 minutes of hyperglycemia; leg blood flow decreased significantly (15%; P < .05) at 60 and 90 minutes. Platelet aggregation to ADP and blood viscosity also showed significant increments (P < .05). The infusion of L-arginine (n = 7, 1 g/min) but not D-arginine (n = 5, 1 g/min) or L-lysine (n = 5, 1 g/min) in the last 30 minutes of the hyperglycemic clamp completely reversed all hemodynamic and rheological changes brought about by hyperglycemia. Infusion of NG-monomethyl-L-arginine (L-NMMA; 2 mg/min) to inhibit endogenous nitric oxide synthesis in 8 normal subjects produced vascular effects qualitatively similar to those of hyperglycemia but quantitatively higher (P < .05); however, heart rate and plasma catecholamine levels decreased during L-NMMA infusion, presumably as a consequence of baroreflex activation. Infusion of L-NMMA during hyperglycemia produced changes not different from those obtained during infusion of L-NMMA alone. CONCLUSIONS The results show that acute hyperglycemia in normal subjects causes significant hemodynamic and rheological changes that are reversed by L-arginine. Moreover, the effects of hyperglycemia are mimicked to a large extent, but not entirely, by infusion of L-NMMA. This suggests that hyperglycemia may reduce nitric oxide availability in humans.
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Affiliation(s)
- D Giugliano
- Department of Geriatrics and Metabolic Diseases, Second University of Naples, Italy
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50
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Giunta R, Löwer N, Wilhelm K, Keirse R, Rock C, Müller-Gerbl M. Altered patterns of subchondral bone mineralization in Kienböck's disease. J Hand Surg Br 1997; 22:16-20. [PMID: 9061515 DOI: 10.1016/s0266-7681(97)80006-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The pattern of subchondral bone density, which is supposed to reflect the long-term distribution of stress, was investigated in both wrist joints of nine healthy young subjects and seven patients suffering from Kienböck's disease by means of CT osteoabsorptiometry. Two density maxima were found on the distal articular surface of the radius in the healthy subjects, corresponding to the position of the scaphoid and the lunate. Our relative quantitative results showed three different physiological types of stress indicated by the predominantly monocentric density maxima either on the scaphoid or the lunate surface of the radius and the symmetrical distribution of the mineralization. In Kienböck's disease no type of mineralization predominated. In the progressive stages the lunate density maximum was absent. The overall mineralization was generally less than in controls. Changes in the pattern of mineralization were also found on the contralateral side.
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Affiliation(s)
- R Giunta
- Institute of Anatomy, Ludwig-Maximilians University, Munich, Germany
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