Marco Gasparella

Carotid artery approach as an alternative to femoral access for balloon dilation of aortic valve stenosis in neonates and infants

PURPOSE to evaluate the efficacy of a right common carotid artery cutdown as alternative access in neonates and small infants requiring a balloon dilation of aortic valve stenosis. In infants, the femoral approach is limited by difficulties in advancing the catheter across the valve and by the risk of femoral artery injuries. METHODS from January 1997 to July 2000, 16 infants at our department underwent balloon dilation through a carotid artery cutdown. Infant weight ranged from 2670 to 6450 g; mean weight 3967 g, and age ranged from 1 to 157 days, mean age 42,8 days. Fifteen of 16 infants had aortic valve stenosis; the remaining infant presented with a aortic coartation relapse. RESULTS In 15 infants an adequate dilation of the valve was obtained with no complications. In only one infant an arterial intimal disconnection was caused by inadequate choice of surgical instruments. At the end of the procedure, the carotid arteries were reconstructed with interrupted 7-0 prolene stitches. There were no neurological sequaelae observed. All infants were followed-up and examined by echocolordoppler ultrasound: all carotid arteries were open with no significant stenosis. CONCLUSION Our experience confirms that the carotid access proposed in 1973 by Azzolina et al is a valid and safe alternative to the usual percutaneous femoral access. In particular it could be useful in neonates and infants were the size of femoral vessels could facilitate important and dangerous complications.

Long-Term Follow-Up of Testicular Microlithiasis in Children and Adolescents: Multicenter Prospective Cohort Study of the Italian Society of Pediatric Urology.

Introduction Testicular microlithiasis (TM), characterized by the presence of intratubular calcifications in a single or both the gonads, is an uncommon entity with unknown etiology and outcome in pediatric and adolescent age. In this study, the results of a multicenter long‐term survey are presented. Materials and Methods From 11 units of pediatric urology/surgery, patients with TM were identified and yearly, followed up in a 7‐year period, adopting a specific database. The recorded items were: age at diagnosis, presenting symptoms/associated abnormalities, ultrasonographic finding, surgery and histology at biopsy, if performed. Results Out of 85 patients, 81 were evaluated yearly (4 patients lost to follow‐up). TM was bilateral in 66.6% of the patients. Associate genital abnormalities were present in 90%, more frequently undescended/retractile testis (23.4%) and varicocele (22.2%). TM remained unchanged at 4.7 years follow‐up in 77 patients (93.8%) and was reduced in 4 patients after 1 to 5 years of inguinoscrotal surgery. Orchiectomy was performed in three patients (3.7%), one for severe testicular hypoplasia and two for seminoma (2.5%), respectively, concurrent and metachronous to diagnosis of TM. Tumorectomy with parenchymal sparing surgery was performed in a teratoma associated with TM. Conclusion TM is a controversial entity, often associated with several inguinogenital features, which rarely can recover. Testicular malignancy, although present in TM, has not proven definitively associated to microliths. Proper counseling, yearly ultrasound, and self‐examination are long‐term recommended.

Neuronal commitment of human circulating multipotent cells by carbon nanotube-polymer scaffolds and biomimetic peptides

AIM We aimed to set up a self-standing, biomimetic scaffold system able to induce and support per se neuronal differentiation of autologous multipotent cells. MATERIALS & METHODS We isolated a population of human circulating multipotent cells (hCMCs), and used carbon nanotube/polymer nanocomposite scaffolds to mimic electrical/nanotopographical features of the neural environment, and biomimetic peptides reproducing axon guidance cues from neural proteins. RESULTS hCMCs showed high degree of stemness and multidifferentiative potential; stimuli from the scaffolds and biomimetic peptides could induce and boost hCMC differentiation toward neuronal lineage despite the absence of exogenously added, specific growth factors. CONCLUSION This work suggests the scaffold-peptides system combined with autologous hCMCs as a functional biomimetic, self-standing prototype for neural regenerative medicine applications.

Fluorescence-based gene reporter plasmid to track canonical Wnt signaling in ENS inflammation

In several gut inflammatory or cancer diseases, cell-cell interactions are compromised, and an increased cytoplasmic expression of β-catenin is observed. Over the last decade, numerous studies provided compelling experimental evidence that the loss of cadherin-mediated cell adhesion can promote β-catenin release and signaling without any specific activation of the canonical Wnt pathway. In the present work, we took advantage of the ability of lipofectamine-like reagent to cause a synchronous dissociation of adherent junctions in cells isolated from the rat enteric nervous system (ENS) for obtaining an in vitro model of deregulated β-catenin signaling. Under these experimental conditions, a green fluorescent protein Wnt reporter plasmid called ΔTop_EGFP3a was successfully tested to screen β-catenin stabilization at resting and primed conditions with exogenous Wnt3a or lipopolysaccharide (LPS). ΔTop_EGFP3a provided a reliable and strong fluorescent signal that was easily measurable and at the same time highly sensitive to modulations of Wnt signaling following Wnt3a and LPS stimulation. The reporter gene was useful to demonstrate that Wnt3a exerts a protective activity in the ENS from overstimulated Wnt signaling by promoting a downregulation of the total β-catenin level. Based on this evidence, the use of ΔTop_EGFP3a reporter plasmid could represent a more reliable tool for the investigation of Wnt and cross-talking pathways in ENS inflammation.

Myogenic potential of human peripheral blood cells

In the search of cell types useful to treat skeletal muscle disfunctions, this work dealt with isolation, characterization and evaluation of myogenic potential of adherent fibroblastic cells from human peripheral blood (hPBCs). hPBCs were obtained by Ficoll density gradient separation and characterized by SEM, RT-PCR, FACS, Western blot, and immunocytochemistry. Myogenic induction was carried out using a differentiation medium containing insulin-like growth factor- 1 and ascorbic acid. hPBCs showed a mesenchymal stem cell profile being CD73+/CD90+/CD105+ and possessed a doubling population time of 48 hours over 31 passages. After induction with myogenic factors, these cells formed multi-nucleated elements and expressed myogenic markers. At one week from injection in the rat tiibialis anterior muscle, previously damaged with bupivacaine [1], transplanted cells were detectable in the muscle and differentiated into skeletal muscle cells, as demonstrated by immunofluorescence. Taken together, our results show that hPBCs possess myogenic potential both in vitro and in vivo and may represent a promising tool for the treatment of skeletal muscle disorders.

Persistence of Varicocele: Comparison of Laparoscopic Vein Division and Ivanissevich Procedure

Background and Purpose: Varicocele is a frequent problem (6% before age 10 years and 16% to 20% from 11 to 18 years) in pediatric surgery. Laparoscopic treatment is proposed as beneficial alternative to Ivanissevichs procedure. The present study aimed at comparing the early and late benefits of laparoscopy and open surgery. Patients and Methods: The overall series consisted of 76 patients undergoing laparoscopic spermatic vessel clipping and transection (L group) and an equal number of patients treated by a modified Ivanissevich procedure (S group). The diagnosis was second-degree varicocele associated with symptoms or hypotrophic testis in 35% and third-degree left varicocele in 65%. The mean age was 13.1 (range 6-19) and 11.9 years (range 8-17) in the S group and L group, respectively. Results: The mean hospitalization time was 40 hours in the S group (range 26-72 hours) and 13.9 hours in the L group (range 9-26 hours). The prevalence of minor postoperative complications was equally low in both groups ...