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Biomedical subjects

D Miotto

Publications and source records attributed to D Miotto.

At least 55 records · Page 3Linked to original sources
PubMed1992

[Chemoembolization in the therapy of hepatocarcinoma. A 3-year experience].

This study was aimed at evaluating the efficacy of chemoembolization (CE) to improve survival in patients with hepatocellular carcinoma (HCC). Our results were compared with the natural history of HCC. Sixty-two consecutive patients with HCC in Okuda's stages I and II underwent CE. Forty-seven patients were treated with CE alone; 9 patients had CE prior to surgery, and 6 patients had it after surgery because of recurrent HCC. One hundred and nine CEs (mean: 1.8 CEs/patient) were performed with Lipiodol UF, epirubicin and gelatin sponge. Actuarial survival was calculated considering Okuda's stage, neoplasm size, and evidence of pseudocapsule. The mean cumulative survival of the 47 patients treated with CE alone was 13.2 months; survival (+/- SE) at 12, 24 and 36 months was 0.75 (+/- 0.07), 0.46 (+/- 0.10) and 0.28 (+/- 0.12). Survival was not affected by Okuda's stage, neoplasm size, evidence of pseudocapsule (p > 0.05). Nevertheless, the patients with early HCC had better prognosis. Eighteen patients (42.9%) died during follow-up, 12 of whom (66.7%) from hepatic failure. The mean survival of patients with recurrence of HCC after surgery was 41 months (range: 24.8-74.9 months) since initial diagnosis of HCC, and 14.8 months (range: 7.1-29.6 months) since diagnosis of recurrence. Two of these patients died from hepatic failure. All the patients who underwent also surgery after CE are still alive (mean survival: 14.7 months). Histologic findings of resected specimens revealed viable neoplastic cells in all cases. Twenty-one major complications (20.2%) occurred in 18 patients (29%); the outcome of complications was favorable in all but one patient who died from sepsis. CE is a reliable and safe treatment for unresectable HCC. Small HCCs should be preferably treated with surgery or, alternatively, with percutaneous alcohol injection.

Aged↗
PubMed1991

Stimulatory effects of alpha-hANP on testosterone secretion in man.

Several recent observations suggest that atrial natriuretic peptides (ANP) can modulate steroidogenesis in isolated rat Leydig cells. At present, it is unknown whether ANP influence human testicular steroidogenesis. We therefore evaluated the effects of alpha-human ANP (hANP) administration on testosterone plasma levels in peripheral and internal spermatic venous blood of young men (catheterized for contrast study of varicocele). Six subjects were injected with 100 micrograms alpha-hANP in the cubital vein. Six different patients similarly received 50 micrograms LHRH. Three controls received 2 ml saline. Plasma LH, FSH, and testosterone were then determined 15 min before, at time of injection, and 15, 30, 45, and 60 min thereafter in spermatic vein and peripheral venous blood, as well as at 120 min in peripheral blood. LHRH--induced LH increase was followed by a marked increase of spermatic vein testosterone concentrations, but the peripheral testosterone concentration did not increase. Similarly, alpha-hANP administration did not affect peripheral testosterone and LH concentrations, but significantly increased spermatic vein testosterone levels (P less than 0.01). Our findings demonstrate that alpha-hANP exerts its stimulatory effect on testicular steroidogenesis in man without modifying gonadotropin secretion, suggesting that alpha-hANP may directly influence Leydig cell function.

Adolescent↗
PubMed1991

Aortography in the diagnosis of traumatic aortic rupture due to blunt chest trauma. Report of thirty-six cases.

Thirty-six patients were evaluated by aortography after blunt chest trauma with a suspicion of traumatic aortic rupture (TAR). There were 16 isolated TARs at isthmus, 2 multiple injuries both of the thoracic aorta and brachiocephalic arteries and no false negative aortographies. Seventeen aortographic examinations were negative, as confirmed by clinical and radiological follow up one false positive aortography was due to a ductus diverticulum. Aortography had a sensitivity of 100%, specificity of 94.4%, and accuracy of 97.2%. No complications or deaths resulted from angiography. Aortography is a safe, accurate and rapid technique to evaluate patients with suspicion of TAR; aortography is superior to other non-invasive techniques in depicting vascular anatomy and pathology, knowledge of which is essential for surgical planning.

Adolescent↗
PubMed1990

Renal aneurysm and arteriovenous fistula. Management with transcatheter embolization.

Embolization was performed in six patients with renal artery aneurysms (n = 2) and arteriovenous fistulas (AVF) (n = 5). The aneurysms were observed in one patient with fibromuscular dysplasia and in another with Ehlers-Danlos syndrome. All the AVFs were intraparenchymal and secondary to iatrogenic trauma. Elective embolization was performed in five patients with good clinical results at follow-up between 1 and 9 years. Because of rupture of the aneurysm emergency embolization was attempted without success in the patient with Ehlers-Danlos syndrome, and nephrectomy was carried out. A postembolization syndrome complicated three procedures in which Gelfoam and polyvinyl alcohol were used; in two of these cases unexpected reflux of the particulate material occurred, resulting in limited undesired ablation of the ipsilateral renal parenchyma. Embolization is the most reliable and effective treatment for intrarenal vascular abnormalities since it minimizes the parenchymal damage.

Adolescent↗
PubMed1989

Value of plain chest film in predicting traumatic aortic rupture.

Plain chest film performed after blunt chest trauma showed blurring of the left pulmonary hilum in 53% of cases of traumatic aortic rupture (Group A, n = 15), and in no cases with negative aortography (Group B, n = 10). This sign can be explained by diffusion of mediastinal hemorrhage through the peri-bronchovascular connective tissue; the close relationship between aortic isthmus, the side of most frequent rupture, and the left pulmonary hilum is the anatomical basis for this asymmetrical finding. Review of all radiological alterations of the plain chest film shows a statistically significant difference between groups A and B only for mediastinal widening and aortic knob alterations (p less than 0.05). A combination of some findings due to aortic injury (mediastinal widening, aortic knob alterations, shift of trachea and left main bronchus, left apical cap, left hilar blurring, obscuring of descending aorta) was typical of aortic rupture when four or more signs were found (33%); these findings were absent only in patients with negative aortogram (8%). In the remaining cases (60%), the plain chest film showed two or three of these signs in both groups, making it impossible to differentiate between patients with and without aortic injury.

Adult↗
PubMed1987

Transhepatic portal sampling for preoperative localization of insulinomas.

The data of 72 patients with pancreatic insulinomas were analyzed. Twenty-one were obtained from personal experience and 51 from a review of the literature. In all instances, detailed information about insulin levels in the portal tree as obtained by means of a transhepatic portal sampling (THPS) and localization of the tumor as found during the surgical procedure was available. Five different criteria were compared for defining the peak insulin concentrations regarded as indicative of tumor localization: 1, peak above 500 milliunits per liter; 2, peak above 200 milliunits per liter; 3, peak 2.5 times higher than the lowest portal value; 4, peak 2.3 time higher than the distal mesenteric value, and 5, peak higher than mean portal concentration plus or minus 2 standard deviation. Criterion 5, associated with sample numbers larger than 15 and catheterization of the cephalic veins, provided the best results for obtaining valuable information from THPS.

Adenoma, Islet Cell↗
PubMed1986

An unusual complication of chronic pancreatitis: a recanalized portal tree communicating with a pancreatic pseudocyst.

A patient with chronic pancreatitis was admitted for digestive bleeding from esophageal varices. Portal thrombosis and cavernomatous periportal collateral circulation were found at laparotomy. The partially recanalized portal tree was excluded from the portal circulation and filled with pancreatic juice due to a communication with a pancreatic pseudocyst. Splenectomy, partial left pancreatectomy, Roux en Y pancreatico-cysto-jejunostomy, and external drainage of the portal tree were performed. The postoperative course was uneventful and the patient is symptom-free and doing well 2 yr after surgery.

Adult↗
PubMed1985

Percutaneous transluminal renal angioplasty: influence of complications on long-term blood pressure results.

Natural history and outcome of percutaneous transluminal renal angioplasty (PTRA) in renovascular hypertension (RVH) were assessed retrospectively in 52 patients in whom 62 PTRAs were successfully performed. Complications were observed in 16 patients: prolonged and extensive arterial spasms in eight, severe intimal dissection of the main renal artery in five, arterial thrombosis at the site of PTRA in two and acute deterioration of renal function in one. All the complications cleared up with medical treatment except for one major dissection occluding the distal branches, which required surgery. According to the Co-operative Study, after 1-5 years of follow-up, 21 patients (40.4%) were cured, 27 (51.9%) improved and four (7.7%) did not improve. The long-term results on blood pressure in both uncomplicated and complicated cases were better in fibrodysplasia (61.5% cured, 34.6% improved and 3.8% not improved) than in atherosclerosis (17.4% cured, 69.6% improved and 13% not improved). In the last 21 PTRAs performed, in which verapamil (200-1500 micrograms) was given as a bolus injection into the stenotic artery before dilatation, the complication rate was significantly lower. It is concluded that PTRA is an effective treatment for RVH; complications occurred in 25.8% of PTRAs and resulted in poor control of blood pressure in atherosclerosis but not in fibrodysplasia; premedication with verapamil into the stenotic renal artery reduced the complication rate.

Adult↗
PubMed1985

[Radiologic changes of the hands in psoriatic rheumatism].

The radiological features of the psoriatic arthritis, already known in the literature, are reviewed by the authors. On the basis of their own record (33 patients), they underline 3 peculiar features of the disease: thickening of the soft tissue involving the whole finger, three joints involvements of the same finger, association of subchondral proliferation and periostitis.

Arthritis↗
PubMed1984

Parathyroid localization in primary hyperparathyroidism: double-tracer scintigraphy and venous sampling techniques combined. A first evaluation.

The authors report their first experience with two techniques for preoperative localization of hyperfunctioning parathyroid glands: double-tracer (99mTc-201Tl) scintigraphy and venous sampling from thyroid veins. Nineteen patients affected by primary hyperparathyroidism were examined by both methods and subsequently submitted to surgery. Scintigraphy showed a sensitivity of 77.3% while the positivity of sampling was 63.6%; with the two techniques combined a correct localization was obtained in 90.9% of all cases. The authors emphasize the usefulness of both methods combined for locating enlarged hyperfunctioning parathyroids.

Adenoma↗