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Biomedical subjects

A Calisti

Publications and source records attributed to A Calisti.

At least 55 records · Page 3Linked to original sources
PubMed1985

Management of pelvi-ureteric junction obstruction in the first six months of life.

The authors report on clinical experience from 20 infants who were under six months of age, and who had been referred during the last five years for pelvi-ureteric junction obstruction. Any over-eagerness to arrive at an early diagnosis, mostly on the basis of prenatal ultrasonographic suspicion, must be tempered. Pyelocaliceal dilatation in newborn infants may not be related to obstruction, and overtreatment must be avoided by careful preoperative evaluation. Tc-DTPA diuretic computerised renography proved extremely reliable, whereas IVP may be unsatisfactory and misleading. Whenever surgical correction was indicated for a documented pelvi-ureteric junction obstruction, Anderson-Hynes pyeloplasty was performed, except in one case, where severe dysplastic changes in the hydronephrotic kidney necessitated nephrectomy. Splinting of the anastomosis was adopted in newborn with thin ureters. An infant with left pelvi-ureteric obstruction and right multicystic kidney died from renal failure a few days after right nephrectomy and left pyeloureteroplasty. No operative failure was otherwise observed, except for a transient anastomotic obstruction in two cases. Treatment of pelvi-ureteric obstruction in the first 6 months is a serious undertaking and should be restricted to experienced centres with facilities for intensive neonatal care, even for dialysis.

Female↗
PubMed1985

Three-dimensional analysis of fibrillar centers and associated chromatin in the nucleolus of human oocytes in primordial follicles.

The intranucleolar localization of fibrillar centers and their relationships with nucleolus-associated chromatin were determined in stereopairs of human oocyte nucleoli obtained by computer reconstruction of serial sections. This study showed that there was no numerical relationship between the number of fibrillar centers and the number of chromosomal NORs. The three-dimensional reconstruction demonstrated that the majority of fibrillar centers was directly connected with the nucleolus-associated chromatin.

Adult↗
PubMedDate not supplied

[Fetal urinoma caused by pyelo-ureteral obstruction; spontaneous remission].

With advances in obstetric ultrasound, prenatal observation of the pathogenesis and natural history of obstructive uropathy is possible. The Authors describe the ultrasonographic appearance of a fetal monolateral urinoma associated with a severe hydronephrosis and the progressive reduction of the urinoma during the last weeks of the pregnancy until complete disappearance in the first month of life. Urinoma detected antenatally, with onset very early in gestation, usually is associated with severe urinary tract obstruction, like posterior urethral valves or ureteropelvic junction obstruction and is always associated with a severe impairment of ipsilateral renal function.

Female↗
PubMedDate not supplied

[Liver metastasis of breast carcinoma. Results of surgical resection. Analysis of 15 operated cases].

AIM OF THE STUDY: The aim of the study was to define the efficacy of liver resection for metastases from operated breast cancer by means of analysis of the results of a single institution compared to the literature data. MATERIALS AND METHODS: Over the period from 1990 to 1998, 15 patients with liver metastases from operated breast cancer were submitted to surgical resection. Thirteen patients were operated on for single metastases and two for multiple liver metastases. In the first group, a simple metastasectomy or wedge resection was sufficient, while in the second a bisegmentectomy and a right hepatectomy, respectively, were performed. Nine patients were subsequently submitted to adjuvant chemotherapy, two to chemo- and hormonotherapy, and two to hormonotherapy alone, while two other patients received no systemic treatment. RESULTS: No major complications or postoperative mortality were observed. Median survival was 44 months. The actuarial 5-year survival rate was 38.3%. Eight patients are still alive, and 7 patients have died as a result of their liver and systemic metastases. CONCLUSIONS: Hepatic metastasis from breast cancer is a good indication for surgical resection. Resection is capable of providing curative treatment and better results in terms of quality of life and survival rates, as compared to chemotherapy and hormonotherapy, especially in patients operated on for primary tumours more than three years earlier.

Adult↗
PubMedDate not supplied

[Influence of the early renal status on natural history of vesico-ureteral reflux diagnosed in the first six month of life].

INTRODUCTION: Ultrasonographic and radionuclide imaging of kidney in presence of major vesicoureteric reflux, diagnosed in the first months of life, reflects a congenital anomaly of development of ureteric bud and metanephric blastema, more than a parenchymal damage secondary to superimposed infections. These lesions are mainly observed in male infants affected by reflux and referred on the basis of a prenatal diagnosis. The impact of therapy on these kidneys is still debated. PATIENTS AND METHODS: Among 273 pediatric patients with VUR observed between 1991 and 2000, 48 cases have been selected where a reflux grade III or greater had been diagnosed within the first six months of life. Cause of admission was prenatal diagnosis in 29 cases and recurrent infection in 19. Reflux was bilateral in 30 patients. Cases of VUR associated to other urological or neurological anomalies were excluded. A complete ultrasonographic, cystographic and radionuclide study was performed in all patients included in the present study within the fourth month of life. Mean Follow up lasted 17 months. Renal damage was graded by ultrasonography and DMSA renal scan on the basis or of a reduction in total kidney size and a poor radionuclide uptake either of an altered renal profile associated to focal defects of uptake. RESULTS: Resolution of reflux within the mean follow up period, was observed in 16 patients, even with high grade VUR, whenever major renal lesions were absent or focal. When severe renal damage was initially demonstrated the expectancy of reduction or resolution of VUR was significantly reduced and surgical option was considered. CONCLUSIONS: Among patients with major VUR diagnosed in the first months of life, early renal status affects prognosis more than the severity of reflux.

Age Factors↗
PubMedDate not supplied

[Torsion of a wandering spleen: ultrasonography and computer tomography in conservative treatment. A case report].

Torsion of the vascular pedicle in a wandering spleen is treated conservatively in most of the cases whenever irreversible necrosis of the organ is not occurred. A case, in a 10 years old boy, is reported. The patient was admitted for acute abdominal pain and was investigated by ultrasounds, which showed an ectopic enlarged spleen at the left flank, without any sign of parenchymal necrosis. A spiral contrast enhanced angio-CT scan confirmed the diagnosis and demonstrated multiple ischemic lesions of splenic pulp mainly at the lower pole. The child was treated with splenopexy followed by un uneventful recovery. CT scan study in cases of torsion of a wandering spleen is of great help in confirming clinical and ultrasonographic diagnosis and in demonstrating the amount of ischemic lesion of the organ before surgical exploration.

Child↗
PubMedDate not supplied

[The efficacy of surgical treatment of hypospadias: analysis of hospital data from Lazio region during the three year period (1996-8)].

INTRODUCTION: The aim of this study is to assess effectiveness of surgical treatment for hypospadia in the Regione Lazio (Italy). Hospital discharge data concerning surgical repair of hypospadia between 1996-1998 were analysed in order to: 1. estimate the trend of demand for hypospadia treatment; 2. correlate clinical results with the type of Surgical Unit of admission (general pediatric, urological, plastic); 3. correlate surgical results with the workload of the Unit; 4. quantify the general risk of a secondary treatment. METHODS: The source of data was the Hospital Information System of the Regione Lazio. Cases have been grouped according to Health District, age at first operation, interval to re-hospitalization after the first treatment for hypospadia. RESULTS: Age at first operation progressively declined in the last years. The annual risk of readmission and reoperation after the first surgical treatment, calculated on a group of 521 cases in 1996, are respectively 6.6% and 5%. CONCLUSIONS: The demand for hypospadia surgery in children was, as expected, stable in the time. However, a tendency to an earlier correction has been observed, mainly in the first and second year of life. Nearly all (99%) of the surgery for hypospadia in the Regione Lazio is performed in four hospitals; one of them accounts for three quarters of the workload. During the observed period a progressive reduction of hospital stay was seen. In the hospital with the best results in term of surgical efficiency, a significant number of patients is treated on a Day Surgery basis. Institutions treating less than 50 cases per year show a significantly high rate of re-hospitalisation within 12 months.

Adolescent↗
PubMedDate not supplied

[Natural history of prenatally diagnosed hydronephrosis: possible recurrence of dilatation after spontaneous reduction, in cases with pelvic diameter larger than 20 mms, recommends long term follow-up].

BACKGROUND: Long term follow-up of a prenatally diagnosed hydronephrosis usually extends no longer than the first two years from diagnosis. During this period spontaneous reduction occurs in most of the dilatations, not sustained by obstruction or reflux. Late recurrence of hydronephrosis is considered to be unusual. The aim of the present work has been to verify the risk of recurrent hydronephrosis long time after reduction and to identify factors associated to recurrence. MATERIALS AND METHODS: In a seven years period (1992-99) 276 patients with hydronephrosis unrelated to Reflux, Duplex kidney, Megaureter of vesical obstruction have been observed. Of these 231 were referred on the basis of a prenatal diagnosis. Hydronephrosis of grade III or more was recorded in 73/231 with a pelvic diameter > or = 15 mm at ultrasonography (US) and a normal counter lateral kidney. Surgical treatment was planned in 39 cases on the basis of a separate function < 40%, either deterioration during follow-up or occurrence of clinical symptoms. Thirty four cases were treated conservatively and four were lost at follow. Of the remaining 30 cases, 14 had a pelvic diameter lager than 20 mm. They were all followed for a mean of 16,6 months (range 7-26) and spontaneous significant reduction of pelvic dilatation was recorded in all of them. RESULTS: Patients were recalled after a mean of 32,1 months from the last US. In 3 cases, of 14 with a pelvic diameter > 20 mm a recurrent severe hydronephrosis was found respectively at 39,56 and 68 months. In two of them, isotopic scan documented a reduced separate function. The third case reported recurrent symptoms. A pyeloplasty was performed in all the cases. CONCLUSIONS: Spontaneous reduction in most of the prenatally detected cases of neonatal hydronephrosis within the first two months of life make follow-up beyond this term controversial, whenever complete disappearance of pelvic dilatation has been documented. The Authors report three cases with severe hydronephrosis (pelvic diameter > 20 mm) among a group of patients treated conservatively. Long time after spontaneous reduction recurrent hydronephrosis was documented in all of them by a new US, associated with deterioration of separate function and symptoms. Long term follow-up is recommendable in major cases of prenatally detected hydronephrosis cases, even after reduction, to warrant from recurrence and renal damage.

Female↗
PubMedDate not supplied

[Natural history of prenatally diagnosed hydronephrosis: possible recurrence of dilatation after spontaneous reduction, in cases with pelvic diameter larger than 20 mms, recommends long term follow-up].

BACKGROUND: Long term follow-up of a prenatally diagnosed hydronephrosis usually extends no longer than the first two years of life. During this period spontaneous reduction occurs in most of the dilatations, not sustained by obstruction or reflux. Late recurrence of hydronephrosis is considered to be unusual. The aim of the present work has been to verify the risk of recurrent hydronephrosis long time after reduction and to identify factors associated to recurrence. MATERIALS AND METHODS: In a seven years period (1992-99) 276 patients with hydronephrosis unrelated to reflux, duplex kidney, megaureter or vesical obstruction have been observed. Among them, 231 were referred after prenatal diagnosis. Hydronephrosis of grade III or more was recorded in 73/231 with a pelvic diameter > or = 15 mms at ultrasonography (US) and a normal counter-lateral kidney. Surgical treatment was elected in 39 cases on the basis of a separate function < 40%, deterioration during follow-up, or occurrence of clinical symptoms. Thirthy four cases were treated conservatively and four were lost at follow. Among the remaining 30 cases, 14 had a pelvic diameter lager than 20 mms. They were followed for a mean of 16.6 months (range 7-26) and spontaneous significant reduction of pelvic dilatation was recorded in all of them. RESULTS: Patients were recalled after a mean of 32.1 months from the last US. In 3 cases among 14 with a pelvic diameter larger than 20 mms a recurrent severe hydronephrosis was found respectively at 39, 56, and 68 months. In two of them, isotopic scans documented a reduced separate function. The third case reported recurrent symtpoms. A pyeloplasty was performed in all cases. CONCLUSIONS: Spontaneous reduction in most of the prenatally detected cases of neonatal hydronephrosis within the first two months of life make follow-up beyond this term controversial, whenever complete disappearance of pelvic dilatation has been documented. The Authors report three cases with severe hydronephrosis (pelvic diameter > 20 mms) among a group of patients treated conservatively. Long time after spontaneous reduction, recurrent hydronephrosis was documented in all by US, associated to deterioration of separate function and symptoms. Long term follow-up is recommendable in severe cases of prenatally detected hydronephrosis cases, even after reduction, to warrant from recurrence and renal damage.

Child, Preschool↗
PubMedDate not supplied

[Congenital megacolon in neonates and infants: impact of early, one-stage repair on morbidity and surgical complications].

Hirschsprung's disease (HD) is a major cause of congenital bowel obstruction in children. Classical management includes stoma creation, a pull-through procedure, and restoration of bowel continuity. Colostomy may be also pulled through directly at second operation. Since the first report of a single stage (SS) primary pull-through without colostomy for HD, in 1980, several patients have been treated according to this procedure, even in neonatal period. All of them had a favourable outcome with better compliance of families and less hospital stay. The Authors reviewed the clinical records of 22 patients selected among 36 treated for HD between 1992 and 2000; in all, disease extended to rectum-sigma-descendent; all cases of "total aganglionosis" or "ultra short" cases were excluded. Fifteen patients underwent SS repair: 11 neonates were operated at mean age of 69 days (range 14-172). In four infants diagnosis was made later (mean age 15 +/- 9 months) and SS repair was performed 8 days after (range 4-14). Seven patients underwent multiple stage (MS) repairs for clinical reasons: pull-through of the previous colostomy was performed at mean age of 171 days (range 47-330). A Duhamel procedure with an Endo-GIA linear stapler was performed in all No differences in gestational age or birth weight were found in both groups. Complications were observed only in the MS group (2 related to colostomy, 1 to postoperative adhesions). The Authors conclude that primary SS treatment of HD is safe and effective even in newborn patient, reduce familiar stress and hospital stay. The lower morbidity and complication rates could be explained by the limited bowel manipulation. Accurate histological-hystochemical diagnosis and meticulous preoperative bowel management should be part of the management.

Digestive System Surgical Procedures↗
PubMedDate not supplied

[One-stage "forced" closure of large congenital defects of the abdominal wall with mechanical ventilation and curarization. Clinical evaluation].

Advantages of primary fascial closure of abdominal wall defects are mainly in reducing the number of staged procedures with related complications and the need of multiple operation. Nevertheless correction of large defects still remains a challenge to pediatric surgeon. Postoperative paralysis and mechanical ventilation after intraoperative milking of intestinal content and abdominal muscles stretching have been reported to reduce the risks of "forced" primary closure. A series of 64 Omphalocele and Gastroschisis has been reviewed. Associated anomalies are still the main cause of mortality among Omphalocele. Prematurity plays a secondary role on survival of Gastroschisis cases; deaths were mainly due to sepsis. Primary respiratory insufficiency affected a large number of Giant Omphalocele cases (larger than 5 cm with herniated liver) and was associated to a restricted chest structure. All these cases died in the first weeks of life. Primary closure with or without postoperative paralysis and mechanical ventilation showed to reduce in a significant way the postoperative complication rate compared to staged procedures. Mortality and hospital stay were not significantly influenced by different kinds of surgical treatment among Omphalocele. Associated anomalies are an unavoidable limiting factor to survival. Among Giant Omphalocele the use of aggressive primary fascial closure with ventilatory support showed in our hands to be a safe procedure provided that a preoperative selection of cases on the basis of chest X-ray and blood gases has been made.

Abdominal Muscles↗
PubMedDate not supplied

[Scintigraphic diagnosis of Meckel's diverticulum using Tc-99m-pertechnetate].

Meckel's diverticulum (MD) is a well-known cause of lower gastrointestinal hemorrhage, particularly in the pediatric age group. The radionuclide 99mTc-pertechnetate has been found useful in visualizing MD which contain gastric mucosa. This test is predicated of the affinity of the isotope for the parietal cells of the gastric glands. In an attempt to evaluate the sensibility and specificity of pertechnetate, the clinical data and scintigrams of 27 patients with suspected MD were reviewed. The scintigram correctly identified MD before operation in 6 of 7 patients. The false negative study occurred in a MD without gastric mucosa.

Adolescent↗
PubMedDate not supplied

[Dumbbell neurogenic tumors in children].

Dumbbell neurogenic tumours are unusual neoplasms in the pediatric age group. Six cases all in children under 10 years of age, have been reviewed with respect to diagnosis, management and results. Neurologic deficits have been found in 4 patients only; in the other 2 cases the tumours were occasionally discovered. Myelograms, sometimes associated with CT scan, allowed a correct diagnosis in all the patients. Initial treatment consisted in all the cases in laminectomy or laminotomy with total excision of the extradural tumour. The primary paravertebral tumours have been removed in one patient during the same neurosurgical operation, and in other three patients at a second stage. Two patients did not require the second operation: one recovered after chemotherapy and the other died few days after the first surgical procedure. Five patients are still alive: two, who had the tumour occasionally discovered, are free from disease; among the other 3 patients, presenting with neurological symptoms, 1 is free from disease without neurological symptoms and 2 have still long lasting sequelae. The authors emphasize the role of early diagnosis to prevent neurologic abnormalities and to achieve better results.

Child↗
PubMedDate not supplied

[Natural history of fetal uropathies. Experience in 40 cases].

Appropriate management of fetal uropathies depends on accuracy in assessing the severity of urinary tract obstruction and renal damage, and in predicting the potential for recovery after surgical correction. A review of 40 fetuses aged between 20 an 39 weeks referred to us for prenatal counseling for a suspected anomaly of the urinary tract, has been made. Reliability of our diagnostic resources has been retrospectively evaluated on the basis of clinical, ultrasonographic and radiological postnatal data. Conservative approach has been adopted in all our cases. None intrauterine surgery was attempted; pre term delivery was advised only in two cases. Our results confirm poor prognosis of fetuses with marked decrease of amniotic fluid within the 24th week of gestational age. After this date the amount of amniotic fluid alone may not be a completely reliable prognostic factor. Ultrasonographic aspect of fetal kidneys and, in some occasions, chemical analysis of fetal urines may accomplish our prenatal study and help to predict the degree of neonatal renal function and potential of survival.

Female↗