Giuseppe Brisinda | Università Cattolica del Sacro Cuore (Catholic University of the Sacred Heart) (original) (raw)

Papers by Giuseppe Brisinda

Journal of Gastrointestinal Surgery, 2006

Hepato-gastroenterology

Open tension-free techniques of hernia repair using synthetic meshes are a well-accepted practice... more Open tension-free techniques of hernia repair using synthetic meshes are a well-accepted practice with an excellent patient comfort and a low recurrence rate. Otherwise, the influence of the resulting fibrosis on testicular perfusion is still unclear. In this study, the effect of prosthetic materials on testicular perfusion was evaluated using Duplex ultrasonography. Twenty-four patients participated in this prospective study. A total of 26 procedures were performed under general anaesthesia. All patients underwent standardized scrotal ultrasound study and Duplex imaging preoperatively, 1, 3 and 9 months after the procedure. Scrotal volume, vein diameters and modifications of arterial blood flow, evaluated by the acceleration index (AI), of the funicular and peritesticular vessels were measured. No statistically significant differences were found between preoperative and postoperative measurements which included testicular blood flow parameters and testicular volume. Moreover, in so...

tomy which a surgeon performs is primarily based on the surgeon's experience and training. Nevert... more tomy which a surgeon performs is primarily based on the surgeon's experience and training. Nevertheless, a competently performed Whitehead's hemorrhoidectomy can give satisfying results. These results are explained by improved knowledge of the anatomy of the anal region and a more accurate surgical technique. On the basis of our experience we believe that Whitehead's hemorrhoidectomy still has its place in selected cases with precise indications.

Urology, 2003

To evaluate the therapeutic role of botulinum toxin injection in men with benign prostatic hyperp... more To evaluate the therapeutic role of botulinum toxin injection in men with benign prostatic hyperplasia. Men with benign prostatic hyperplasia were enrolled in a randomized, placebo-controlled study. After a baseline evaluation, each participant received 4 mL of solution injected into the prostate gland. Patients in the control group received saline solution and patients in the treated group received 200 U of botulinum toxin A. The outcome of each group was evaluated by comparing the symptom scores, serum prostate-specific antigen concentration, prostate volume, postvoid residual urine volume, and peak urinary flow rates. Thirty consecutive patients were enrolled. No local complications or systemic side effects were observed in any patient. After 2 months, 13 patients in the treated group and 3 in the control group had subjective symptomatic relief (P = 0.0007). In patients who received botulinum toxin, the symptom score was reduced by 65% compared with baseline values and the serum ...

Infection Control in the Intensive Care Unit, 2005

Expert Review of Pharmacoeconomics & Outcomes Research, 2014

Anal fissure is a split in the lining of the distal anal canal. Lateral internal sphincterotomy r... more Anal fissure is a split in the lining of the distal anal canal. Lateral internal sphincterotomy remains the gold standard for treatment of anal fissure. Although technique is simple and effective, a drawback of this surgical procedure is its potential to cause minor but some times permanent alteration in rectal continence. Conservative approaches (such as topical application of ointment or botulinum toxin injections) have been proposed in order to treat this condition without any risk of permanent injury of the internal anal sphincter. These treatments are effective in a large number of patients. Furthermore, with the ready availability of medical therapies to induce healing of anal fissure, the risk of a first-line surgical approach is difficult to justify. The conservative treatments have a lower cost than surgery. Moreover, evaluation of the actual costs of each therapeutic option is important especially in times of economic crisis and downsizing of health spending.

The American Journal of Gastroenterology, 2003

The Lancet, 1998

Relief by botulinum toxin of voiding dysfunction due to prostatitis. By - Giorgio Maria, Antonio ... more Relief by botulinum toxin of voiding dysfunction due to prostatitis. By - Giorgio Maria, Antonio Destito, Sergio Lacquaniti, Anna Rita Bentivoglio, Giuseppe Brisinda, Alberto Albanese.

Urology, 2009

To present a comprehensive experience with intraprostatic botulinum toxin (BT) injection in men w... more To present a comprehensive experience with intraprostatic botulinum toxin (BT) injection in men with symptomatic benign prostatic hyperplasia (BPH).

The American Journal of Surgery, 1998

Cicatricial stenosis of the anal canal is a disabling complication of anal surgery. Many differen... more Cicatricial stenosis of the anal canal is a disabling complication of anal surgery. Many different surgical techniques have been described for the management of this disorder. In this study we report 42 patients with severe anal stricture treated with anoplasty. Twenty-nine of these patients underwent a Y-V anoplasty while 13 had a diamond flap anoplasty. All patients were seen 4 weeks, 6 months, and 2 years after surgery. Three patients who had undergone Y-V anoplasty experienced, as a minor early operative complication, a suture dehiscence and 1 patient had an ischemic contracture of the leading edge of the flap. Two patients had urinary infections. None of these complications needed further surgical intervention and were all managed with local and medical therapy. At 2 years follow-up 93% of patients had been successfully treated while the remaining 7% had improved. Fifteen percent of patients who had undergone Y-V anoplasty complained of postoperative complications, and all patients with incomplete results had been treated with an Y-V anoplasty. Based on our cohort of patients we believe that both techniques are satisfactory in treating anal stricture but diamond flap anoplasty seems more reliable because of the reduced tension at the suture line and the better blood supply to the flap.

The American Journal of Surgery, 2000

BACKGROUND: Botulinum toxin induces healing in patients with idiopathic anal fissure. METHODS: Fi... more BACKGROUND: Botulinum toxin induces healing in patients with idiopathic anal fissure. METHODS: Fifty patients affected by posterior anal fissure were treated with 20 units of botulinum toxin, injected in the internal anal sphincter on each side of the posterior midline (group I) or on each side of the anterior midline (group II). RESULTS: At 2 months evaluation, a healing scar was observed in 15 patients of group I and in 22 patients of group II (P ‫؍‬ 0.025). Resting anal pressure was significantly different from the baseline values at 1-month as well as at 2-month check-ups in both groups, but the values were significantly lower in patients of group II. CONCLUSIONS: The intersite comparison revealed that anterior injection of the internal anal sphincter resulted in improved lowering of resting anal pressure and produced an earlier healing scar.

Techniques in Coloproctology, 2001

tomy which a surgeon performs is primarily based on the surgeon's experience and training. Nevert... more tomy which a surgeon performs is primarily based on the surgeon's experience and training. Nevertheless, a competently performed Whitehead's hemorrhoidectomy can give satisfying results. These results are explained by improved knowledge of the anatomy of the anal region and a more accurate surgical technique. On the basis of our experience we believe that Whitehead's hemorrhoidectomy still has its place in selected cases with precise indications.

Surgery, 2001

Background. Surgical repair of rectocele does not always alleviate symptoms related to difficulty... more Background. Surgical repair of rectocele does not always alleviate symptoms related to difficulty in defecation, and some patients have impaired fecal continence after surgical treatment. To avoid complications of surgical repair, we investigated the efficacy of botulinum toxin in treating patients with symptomatic rectocele. Methods. Fourteen female patients with anterior rectocele were included in the study. The patients were studied by using anorectal manometry and defecography, and then treated with a total of 30 units of type A botulinum toxin, injected into 3 sites, 2 on either side of the puborectalis muscle and the third anteriorly in the external anal sphincter, under ultrasonographic guidance. Results. After 2 months, symptomatic improvement was noted in 9 patients (P = .0003). At the same time, rectocele depth (mean ± SD) was reduced from 4.3 ± 0.6 cm to 1.8 ± 0.5 cm (P = .0000001) and rectocele area from 9.2 ± 1.3 cm 2 to 2.8 ± 1.6 cm 2 (P = .0000001). Anorectal manometry demonstrated decreased tone during straining from 70 ± 28 mm Hg at baseline to 41 ± 19 mm Hg at 1 month (P = .003) and to 41 ± 22 mm Hg at 2 months ( P= .005). No permanent complications were observed in any patient for a mean follow-up period of 18 ± 4 months. At 1 year evaluation, incomplete or digitally assisted rectal voiding was not reported by any patient, and a rectocele was not found at physical examination. Four recurrent, asymptomatic rectoceles were noted at defecography. Conclusions. Botulinum toxin injections should be considered as a simple therapeutic approach in patients with anterior rectocele. The treatment is safe and less expensive than surgical repair. A more precise method of toxin injections under transrectal ultrasonography accounts for the high success rate. Repeated injections may be necessary to maintain the clinical improvement. (Surgery

New England Journal of Medicine, 1999

Lateral internal sphincterotomy, the most common treatment for chronic anal fissure, may cause pe... more Lateral internal sphincterotomy, the most common treatment for chronic anal fissure, may cause permanent injury to the anal sphincter, which can lead to fecal incontinence. We compared two nonsurgical treatments that avert the risk of fecal incontinence. We randomly assigned 50 adults with symptomatic chronic posterior anal fissures to receive treatment with either a total of 20 U of botulinum toxin injected into the internal anal sphincter on each side of the anterior midline or 0.2 percent nitroglycerin ointment applied twice daily for six weeks.

Nature Clinical Practice Gastroenterology & Hepatology, 2004

Recent reports confirm that the management of chronic anal fissure has undergone extensive re-eva... more Recent reports confirm that the management of chronic anal fissure has undergone extensive re-evaluation during the past few years. This rejuvenation of interest is attributable to the application of neurochemical treatment, which has contributed to the tendency to treat the disease on an outpatient basis. The use of botulinum neurotoxin seems to be a promising and safe approach for the treatment of chronic anal fissure, particularly in patients at high risk for incontinence. Indeed, botulinum neurotoxin has been successfully used selectively to weaken the internal anal sphincter as a treatment for chronic anal fissure. It is also more efficacious than nitrate therapy, and is not related to the patient's willingness to complete treatment.

Movement Disorders, 1997

A parkinsonian patient with severe outlet-type constipation was treated with injection of botulin... more A parkinsonian patient with severe outlet-type constipation was treated with injection of botulinum toxin into the puborectalis muscle. A total of 30 units (Botox) was injected in two sites. Resting anal pressure, maximum voluntary contraction, and pressure on straining were evaluated before treatment and 4, 8, 12. and 16 weeks afterward. Pressure values declined following treatment, the decline of pressure on straining ending by week 12. Proctography performed X weeks after treatment showed improvement in the anorectal angle and evacuation of barium paste. The clinical benefit lasted for -12 weeks. The present data show that botulinum toxin is a promising tool for treating outlet-type constipation in Parkinson's diseas4

Movement Disorders, 2004

Local injections of botulinum neurotoxin are now considered an efficacious treatment for neurolog... more Local injections of botulinum neurotoxin are now considered an efficacious treatment for neurological and non-neurological conditions. One of the most recent achievements in the field is the observation that botulinum neurotoxin provides benefit in diseases of the gastrointestinal tract. Botulinum neurotoxin inhibits contraction of gastrointestinal smooth muscles and sphincters; it has also been shown that the neurotoxin blocks cholinergic nerve endings in the autonomic nervous system, but it does not block nonadrenergic responses mediated by nitric oxide. This aspect has further promoted the interest to use botulinum neurotoxin as a treatment for overactive smooth muscles, such as the anal sphincters to treat anal fissure and outlettype constipation, or the lower esophageal sphincter to treat esophageal achalasia. Knowledge of the anatomical and

The Lancet, 2000

In the trials by M Rowsell and co-workers (March 4, p 779) 1 and Brian Mehigan and others (p 782)... more In the trials by M Rowsell and co-workers (March 4, p 779) 1 and Brian Mehigan and others (p 782), 2 the short-term results of the stapler procedure were compared with those of conventional haemorrhoidectomy. The studies suggest that stapled haemorrhoidectomy is ...

Journal of Gastrointestinal Surgery, 2006

Hepato-gastroenterology

Open tension-free techniques of hernia repair using synthetic meshes are a well-accepted practice... more Open tension-free techniques of hernia repair using synthetic meshes are a well-accepted practice with an excellent patient comfort and a low recurrence rate. Otherwise, the influence of the resulting fibrosis on testicular perfusion is still unclear. In this study, the effect of prosthetic materials on testicular perfusion was evaluated using Duplex ultrasonography. Twenty-four patients participated in this prospective study. A total of 26 procedures were performed under general anaesthesia. All patients underwent standardized scrotal ultrasound study and Duplex imaging preoperatively, 1, 3 and 9 months after the procedure. Scrotal volume, vein diameters and modifications of arterial blood flow, evaluated by the acceleration index (AI), of the funicular and peritesticular vessels were measured. No statistically significant differences were found between preoperative and postoperative measurements which included testicular blood flow parameters and testicular volume. Moreover, in so...

tomy which a surgeon performs is primarily based on the surgeon's experience and training. Nevert... more tomy which a surgeon performs is primarily based on the surgeon's experience and training. Nevertheless, a competently performed Whitehead's hemorrhoidectomy can give satisfying results. These results are explained by improved knowledge of the anatomy of the anal region and a more accurate surgical technique. On the basis of our experience we believe that Whitehead's hemorrhoidectomy still has its place in selected cases with precise indications.

Urology, 2003

To evaluate the therapeutic role of botulinum toxin injection in men with benign prostatic hyperp... more To evaluate the therapeutic role of botulinum toxin injection in men with benign prostatic hyperplasia. Men with benign prostatic hyperplasia were enrolled in a randomized, placebo-controlled study. After a baseline evaluation, each participant received 4 mL of solution injected into the prostate gland. Patients in the control group received saline solution and patients in the treated group received 200 U of botulinum toxin A. The outcome of each group was evaluated by comparing the symptom scores, serum prostate-specific antigen concentration, prostate volume, postvoid residual urine volume, and peak urinary flow rates. Thirty consecutive patients were enrolled. No local complications or systemic side effects were observed in any patient. After 2 months, 13 patients in the treated group and 3 in the control group had subjective symptomatic relief (P = 0.0007). In patients who received botulinum toxin, the symptom score was reduced by 65% compared with baseline values and the serum ...

Infection Control in the Intensive Care Unit, 2005

Expert Review of Pharmacoeconomics & Outcomes Research, 2014

Anal fissure is a split in the lining of the distal anal canal. Lateral internal sphincterotomy r... more Anal fissure is a split in the lining of the distal anal canal. Lateral internal sphincterotomy remains the gold standard for treatment of anal fissure. Although technique is simple and effective, a drawback of this surgical procedure is its potential to cause minor but some times permanent alteration in rectal continence. Conservative approaches (such as topical application of ointment or botulinum toxin injections) have been proposed in order to treat this condition without any risk of permanent injury of the internal anal sphincter. These treatments are effective in a large number of patients. Furthermore, with the ready availability of medical therapies to induce healing of anal fissure, the risk of a first-line surgical approach is difficult to justify. The conservative treatments have a lower cost than surgery. Moreover, evaluation of the actual costs of each therapeutic option is important especially in times of economic crisis and downsizing of health spending.

The American Journal of Gastroenterology, 2003

The Lancet, 1998

Relief by botulinum toxin of voiding dysfunction due to prostatitis. By - Giorgio Maria, Antonio ... more Relief by botulinum toxin of voiding dysfunction due to prostatitis. By - Giorgio Maria, Antonio Destito, Sergio Lacquaniti, Anna Rita Bentivoglio, Giuseppe Brisinda, Alberto Albanese.

Urology, 2009

To present a comprehensive experience with intraprostatic botulinum toxin (BT) injection in men w... more To present a comprehensive experience with intraprostatic botulinum toxin (BT) injection in men with symptomatic benign prostatic hyperplasia (BPH).

The American Journal of Surgery, 1998

Cicatricial stenosis of the anal canal is a disabling complication of anal surgery. Many differen... more Cicatricial stenosis of the anal canal is a disabling complication of anal surgery. Many different surgical techniques have been described for the management of this disorder. In this study we report 42 patients with severe anal stricture treated with anoplasty. Twenty-nine of these patients underwent a Y-V anoplasty while 13 had a diamond flap anoplasty. All patients were seen 4 weeks, 6 months, and 2 years after surgery. Three patients who had undergone Y-V anoplasty experienced, as a minor early operative complication, a suture dehiscence and 1 patient had an ischemic contracture of the leading edge of the flap. Two patients had urinary infections. None of these complications needed further surgical intervention and were all managed with local and medical therapy. At 2 years follow-up 93% of patients had been successfully treated while the remaining 7% had improved. Fifteen percent of patients who had undergone Y-V anoplasty complained of postoperative complications, and all patients with incomplete results had been treated with an Y-V anoplasty. Based on our cohort of patients we believe that both techniques are satisfactory in treating anal stricture but diamond flap anoplasty seems more reliable because of the reduced tension at the suture line and the better blood supply to the flap.

The American Journal of Surgery, 2000

BACKGROUND: Botulinum toxin induces healing in patients with idiopathic anal fissure. METHODS: Fi... more BACKGROUND: Botulinum toxin induces healing in patients with idiopathic anal fissure. METHODS: Fifty patients affected by posterior anal fissure were treated with 20 units of botulinum toxin, injected in the internal anal sphincter on each side of the posterior midline (group I) or on each side of the anterior midline (group II). RESULTS: At 2 months evaluation, a healing scar was observed in 15 patients of group I and in 22 patients of group II (P ‫؍‬ 0.025). Resting anal pressure was significantly different from the baseline values at 1-month as well as at 2-month check-ups in both groups, but the values were significantly lower in patients of group II. CONCLUSIONS: The intersite comparison revealed that anterior injection of the internal anal sphincter resulted in improved lowering of resting anal pressure and produced an earlier healing scar.

Techniques in Coloproctology, 2001

tomy which a surgeon performs is primarily based on the surgeon's experience and training. Nevert... more tomy which a surgeon performs is primarily based on the surgeon's experience and training. Nevertheless, a competently performed Whitehead's hemorrhoidectomy can give satisfying results. These results are explained by improved knowledge of the anatomy of the anal region and a more accurate surgical technique. On the basis of our experience we believe that Whitehead's hemorrhoidectomy still has its place in selected cases with precise indications.

Surgery, 2001

Background. Surgical repair of rectocele does not always alleviate symptoms related to difficulty... more Background. Surgical repair of rectocele does not always alleviate symptoms related to difficulty in defecation, and some patients have impaired fecal continence after surgical treatment. To avoid complications of surgical repair, we investigated the efficacy of botulinum toxin in treating patients with symptomatic rectocele. Methods. Fourteen female patients with anterior rectocele were included in the study. The patients were studied by using anorectal manometry and defecography, and then treated with a total of 30 units of type A botulinum toxin, injected into 3 sites, 2 on either side of the puborectalis muscle and the third anteriorly in the external anal sphincter, under ultrasonographic guidance. Results. After 2 months, symptomatic improvement was noted in 9 patients (P = .0003). At the same time, rectocele depth (mean ± SD) was reduced from 4.3 ± 0.6 cm to 1.8 ± 0.5 cm (P = .0000001) and rectocele area from 9.2 ± 1.3 cm 2 to 2.8 ± 1.6 cm 2 (P = .0000001). Anorectal manometry demonstrated decreased tone during straining from 70 ± 28 mm Hg at baseline to 41 ± 19 mm Hg at 1 month (P = .003) and to 41 ± 22 mm Hg at 2 months ( P= .005). No permanent complications were observed in any patient for a mean follow-up period of 18 ± 4 months. At 1 year evaluation, incomplete or digitally assisted rectal voiding was not reported by any patient, and a rectocele was not found at physical examination. Four recurrent, asymptomatic rectoceles were noted at defecography. Conclusions. Botulinum toxin injections should be considered as a simple therapeutic approach in patients with anterior rectocele. The treatment is safe and less expensive than surgical repair. A more precise method of toxin injections under transrectal ultrasonography accounts for the high success rate. Repeated injections may be necessary to maintain the clinical improvement. (Surgery

New England Journal of Medicine, 1999

Lateral internal sphincterotomy, the most common treatment for chronic anal fissure, may cause pe... more Lateral internal sphincterotomy, the most common treatment for chronic anal fissure, may cause permanent injury to the anal sphincter, which can lead to fecal incontinence. We compared two nonsurgical treatments that avert the risk of fecal incontinence. We randomly assigned 50 adults with symptomatic chronic posterior anal fissures to receive treatment with either a total of 20 U of botulinum toxin injected into the internal anal sphincter on each side of the anterior midline or 0.2 percent nitroglycerin ointment applied twice daily for six weeks.

Nature Clinical Practice Gastroenterology & Hepatology, 2004

Recent reports confirm that the management of chronic anal fissure has undergone extensive re-eva... more Recent reports confirm that the management of chronic anal fissure has undergone extensive re-evaluation during the past few years. This rejuvenation of interest is attributable to the application of neurochemical treatment, which has contributed to the tendency to treat the disease on an outpatient basis. The use of botulinum neurotoxin seems to be a promising and safe approach for the treatment of chronic anal fissure, particularly in patients at high risk for incontinence. Indeed, botulinum neurotoxin has been successfully used selectively to weaken the internal anal sphincter as a treatment for chronic anal fissure. It is also more efficacious than nitrate therapy, and is not related to the patient's willingness to complete treatment.

Movement Disorders, 1997

A parkinsonian patient with severe outlet-type constipation was treated with injection of botulin... more A parkinsonian patient with severe outlet-type constipation was treated with injection of botulinum toxin into the puborectalis muscle. A total of 30 units (Botox) was injected in two sites. Resting anal pressure, maximum voluntary contraction, and pressure on straining were evaluated before treatment and 4, 8, 12. and 16 weeks afterward. Pressure values declined following treatment, the decline of pressure on straining ending by week 12. Proctography performed X weeks after treatment showed improvement in the anorectal angle and evacuation of barium paste. The clinical benefit lasted for -12 weeks. The present data show that botulinum toxin is a promising tool for treating outlet-type constipation in Parkinson's diseas4

Movement Disorders, 2004

Local injections of botulinum neurotoxin are now considered an efficacious treatment for neurolog... more Local injections of botulinum neurotoxin are now considered an efficacious treatment for neurological and non-neurological conditions. One of the most recent achievements in the field is the observation that botulinum neurotoxin provides benefit in diseases of the gastrointestinal tract. Botulinum neurotoxin inhibits contraction of gastrointestinal smooth muscles and sphincters; it has also been shown that the neurotoxin blocks cholinergic nerve endings in the autonomic nervous system, but it does not block nonadrenergic responses mediated by nitric oxide. This aspect has further promoted the interest to use botulinum neurotoxin as a treatment for overactive smooth muscles, such as the anal sphincters to treat anal fissure and outlettype constipation, or the lower esophageal sphincter to treat esophageal achalasia. Knowledge of the anatomical and

The Lancet, 2000

In the trials by M Rowsell and co-workers (March 4, p 779) 1 and Brian Mehigan and others (p 782)... more In the trials by M Rowsell and co-workers (March 4, p 779) 1 and Brian Mehigan and others (p 782), 2 the short-term results of the stapler procedure were compared with those of conventional haemorrhoidectomy. The studies suggest that stapled haemorrhoidectomy is ...