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Biomedical subjects

E M Bortolani

Publications and source records attributed to E M Bortolani.

At least 19 recordsLinked to original sources
PubMed1992

[Surgery of the carotid: the morphology of plaque and the clinical correlations].

A consecutive series of 256 patients operated on of carotid endarterectomy for cerebrovascular atherosclerotic disease from January 1987 through December 1990 is presented. The following parameters were considered: clinical presentation, morphology of the carotid atherosclerotic plaque and topographic distribution of other concomitant atherosclerotic lesions of epiaortic arteries. 422 carotid lesions and 154 lesions of other epiaortic vessels were investigated by means of echo and color flow imaging, digital subtraction angiography and macroscopic observation of the specimen: 143 plaques proved grossly ulcerated. Unilateral lesions were 90 (35.2%) while bilateral disease was present in 166 cases (64.8%): 38.8% of subjects out of the first group and 30.2% out of the second were asymptomatic. Anterior and posterior neurological symptoms were equally distributed among both the 116 (69.8%) symptomatic subjects harboring bilateral lesions and the 55 (61.1%) symptomatic subjects with unilateral lesion (anterior 78.4% and posterior 21.6% for bilateral and 78.2% and 21.8% respectively for unilateral lesions). According to the degree of stenosis, the lesions were divided into three main groups: < 50%; 50-70%; > 70%. As the degree of stenosis increased, the incidence of focal symptoms increased too; moreover, the presence of ulceration of the stenosing plaque carried an increase in the incidence of focal symptoms within each group: respectively from 7.8% to 30% (< 50%), from 18.6% to 53.8% (50-70%), from 27.7% to 55.6% (> 70%). This study supports the relationship of morphological characteristics of the stenosing atherosclerotic plaques of the internal carotid artery to neurological symptomatology.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Paraganglioma of the neck. Analysis of 32 operated cases].

Between january 1965 and november 1990, 32 operations for neck paraganglioma were performed: 29 chemodectomas (carotid body tumors) and 3 paragangliomas of the vagus nerve. Seven subjects were affected with bilateral chemodectomas and one of them showed concurrent unilateral vagal paraganglioma. Two paragangliomas were malignant, with invasion of the latero-cervical lymphnodes revealed at operation. Four individuals came to observation from two different families, suggesting familiarity. Preoperative diagnosis was correctly made in 12 of 18 asymptomatic chemodectomas (66.6%), ten of whom observed during the last decade: angiography is the gold standard for diagnosis but CT scan, ultrasound and NMR imaging are going to earn the confidence of physicians for precise evaluation of latero-cervical masses. Surgery is to date the treatment of choice, and the results are dependent on the size of the tumor and the involvement of the neighbouring vascular, nervous and visceral structures. According to the majority of the literature, the 29 chemodectomas were classified in the three groups of Shamblin: I: 4 cases; II: 10; III: 15. Twenty out of the 24 transient or permanent postoperative complications took place in the third group: in five instances some procedures of internal carotid artery reconstruction were needed. Fourteen complications for chemodectomas and 2 for vagal paragangliomas affected the cranial nerves; three transient and one permanent ischemic central neurological deficits occurred in the group III chemodectomas. Not any operative mortality was registered in this series.

Adult↗
PubMed1991

[The surgical prevention of pulmonary embolism. Comments on 100 patients treated by different methods].

A series of 100 patients suffering from deep venous thrombosis with prior episodes of pulmonary embolism or ilio-caval floating thrombi, submitted to surgery for the prevention of new embolic episodes, is analysed. Indications are discussed together with the various prevention techniques adopted over the past 5 years. Special attention is paid to the analysis of 11 patients operated on in the last 2 years by thrombectomy of the infra- and suprarenal vena cava.

Adolescent↗
PubMed1991

[Thrombectomy of the infra- and suprarenal cava to prevent pulmonary embolism in the presence of deep venous thrombosis. Personal experience with 11 surgically-treated cases].

DVT is a fairly frequent event and often fails to be recognised. Its main complication, pulmonary embolism, is the third cause of death in Italy with more than 70,000 deaths per annum. In the presence of infra- and suprarenal floating thrombi, cases in which the application of neither intraluminal nor extraluminal filters is indicated, the treatment of choice is thrombectomy with direct surgical access to the cava. Personal experience of 11 patients operated in the past 16 months with excellent surgical success is analysed. The indications and surgical techniques adopted are described.

Adult↗
PubMed1990

[Latero-lateral choledochoduodenostomy in benign pathology of the common bile duct. A prospective study].

Biliodigestive derivations for benign diseases of the biliary tract are currently accepted in case of extended to recurrent choledochal stenosis, excessive dilation of the choledochus, impacted ampullary stones. This paper concerns 19 subjects that underwent laterolateral choledochoduodenostomy (CDS) according to the Roesner technique over the period January 1986 through December 1987 in order to evaluate long-term functional results of this operation. Hepatic serum enzymes and bilirubin were determined at intervals of two weeks during the first three months and of four weeks until the sixth month postoperatively. At this time a battery of controls was performed, namely standard plain X-ray of the abdomen, hepatobiliary sequential scintigraphy with HIDA, endoscopic examination of the anastomosis. The level of serum enzymes was then determined at 18 months postoperatively and scintigraphy was repeated as well. Based on the results of this study and the review of the recent literature, our opinion is that CDS has shown as a safe procedure with good long-term results in the treatment of benign disease of the biliary tract, mostly if high-risk aged subjects are concerned.

Aged↗
PubMed1990

[Use of a new anti-inflammatory drug in the treatment of varicophlebitis of the lower limbs].

The paper reports the results obtained in 20 patients affected by varicophlebitis of the lower limbs following the oral administration of an anti-inflammatory substance. Results were compared with findings in single-blind study performed in a group of 20 patients treated with placebo. The evaluation of residual signs and symptoms and the control of recanalization of venous collectors using Doppler tests revealed a difference between the two groups in favour of the patients treated with the anti-inflammatory agent, although this was not statistically significant. The use of the drug was considered useful as a support to conservative varicophlebitis therapy with the aim of accelerating the resolution of the inflamed condition and thus reducing the functional disability of the limb.

Administration, Oral↗
PubMed1990

[Volvulus of the gallbladder. Presentation of a case and review of the literature].

A case of acute torsion of the gallbladder in a 83-year old woman is presented. According to the literature, the pathogenetic mechanism, the anatomical bases and the clinical presentation of this disease are discussed. The age intervals more often affected are the pediatric and teen-ager and, mostly, the elderly over the 70's. The basic anatomical defect is the gallbladder flotation, congenital or acquired. The clinical feature is that of right acute abdomen, and emergency cholecystectomy is the treatment of choice.

Acute Disease↗
PubMed1990

[Functioning extra-adrenal paragangliomas].

The diagnosis of extra-adrenal paraganglioma requires the recognition of catecholamine hypertension and the site of the lesion. I-131-MIBG scintigraphy, CAT scan and angiography may localize primitive and metastatic lesions. Six cases of extra-adrenal paraganglioma (5 abdominal, 1 thoracic) surgically treated with complete resolution of the hypertensive state are presented here.

Abdominal Neoplasms↗
PubMed1990

[Primary carcinoma of the gallbladder].

Primary carcinoma of the gallbladder, while infrequent, is the most representative among the malignant neoplasms of the biliary tract. The diagnosis of carcinoma of the gallbladder was made in 22 out of 1252 operations performed for gallbladder disease (1.8%) since January 1980 through June 1988: only in 9% of the subjects a malignant tumor of the gallbladder was suspected preoperatively. In 21 cases the carcinoma was associated with chronic lithiasic cholecystitis. The 22 cases were assessed according to the classification proposed by Nevin. The operations performed were: 4 routine cholecystectomies (stages I and II) 4 cholecystectomies with lymphadenectomy (stages I and II); 4 cholecystectomies with lymphadenectomy and liver wedge resection of the bed of the gallbladder (stages II, III, IV, V); 7 explorative laparotomies and 3 gastrojejunal anastomoses (stage V). A complete follow-up was available for each of the 22 subjects: cumulative survival rates were calculated according to Kaplan-Meyer. The overall 5-year cumulative survival rate after operation was 19% for the whole group, whereas it reached 76% for the subgroup of 9 patients classified in stages I and II. This analysis reinforces the statement that surgical therapy can achieve excellent results if brought about before cancer overwhelms the muscular layer of the gallbladder wall. Thus, as the preoperative diagnosis of gallbladder carcinoma is extremely difficult and uncertain, any delay in performing cholecystectomy seems to be unwise in all those cases of chronic benign disease of the gallbladder (whether lithiasic in nature or not) that are suspected to be a major risk factor for cancer degeneration because of their frequent association with the carcinoma of the gallbladder.

Adult↗
PubMed1990

[Malignant cutaneous lymphoma in a case of Wiskott-Aldrich syndrome with long-term survival].

The case of a 24 year old man affected with Wiskott-Aldrich syndrome (WAS) is reported. The review of the charts of previous hospital admissions revealed the presence of an inherited trait and a long history of recurrent infections and hemorrhages. This young man was referred to our surgical department with the diagnosis of right lower limb gangrene, but the biopsy showed the lesion being due to cutaneous malignant lymphoma characterized by large polymorphic cells. All clinical and immunological elements typical of WAS were present: they are discussed with regard to the recent literature.

Adult↗
PubMed1989

[Current indications for percutaneous transhepatic cholangiography (PTC)].

Percutaneous transhepatic cholangiography (PTC) showed its widest diffusion during the late '70s while since the early '80s it was gradually replaced by endoscopic retrograde cholangiopancreatography (ERCP). Anyway, a well definite role for PTC still exists. PTC was performed in 60 of 131 cases of obstructive disease of the biliary tree: the indications are illustrated in detail. The statistical indicators utilized to choose this examination were: echographic determination of the diameter of the biliary tree, bilirubinemia, alkaline phosphatase (ALP) and serum gamma-GT. Data collected during this study showed that biliary dilation has a significant correlation to serum levels of ALP, while bilirubin has not. Biliary dilation is currently well established by echography: in some instances, however, biliary obstruction is earlier suggested by elevated serum enzymes of biliary stasis, while it is clearly demonstrated that biliary dilation is a precursor of jaundice, better defined as an expression of biliary hypertension. Based on these observations and on the review of the literature, the Authors believe that PTC still remains a second choice examination as compared to ERCP: when the latter be not effective for diagnosis or decompression of the biliary tree, then PTC can be resolutive.

Alkaline Phosphatase↗
PubMed1989

[Primary mediastinal masses of benign nature. Clinical classification and criteria of therapy].

A consecutive series of 34 primary mediastinal masses of benign origin was operated on since 1970 through 1988. Many diagnostic techniques were performed, including traditional x-ray of the chest, scintigraphy, angiography; in the more recent years CT and NMR took the place of traditional tomography. In selected cases hormonal dosages were of value in clarifying the endocrine activity of the masses. The various diagnostic techniques performed are discussed as well as their effectiveness in the preoperative diagnosis of nature, benign or malignant, of the masses. This cannot be reached with precision without opening the thorax. The detail of the 34 cases is reported. In the light of the recent literature, the absolute need for surgical treatment of any mediastinal masses, even if asymptomatic, is debated. This aggressive surgical approach is the only effective way to establish the histological nature of the mass and, at the same time, to obtain the radical cure of the lesion.

Diagnosis, Differential↗
PubMed1989

[Protection systems of erythrocytes during intraoperative autotransfusion. Experience with the use of S-adenosyl-L-methionine].

An experiment lasting 2 years in more than 200 patients in single blind conditions (S-Adenosyl-L-Methionine vs placebo) aimed to improve protection of red cells during intraoperative autotransfusion. The two groups are analysed and, on the basis of objective hematochemical data it is concluded that in patients treated with the pharmacological support erythrocyte membrane stability is good.

Blood Transfusion, Autologous↗
PubMed1989

[Diagnostic considerations in 104 cases of aneurysm of the subrenal abdominal aorta surgically treated in 1987].

A series of 104 patients observed and surgically treated for abdominal aortic aneurysms, in the General and Cardiovascular Surgery Department of Milan University during 1987 in analysed. Particular attention is paid to the diagnostic procedures especially in those cases when the condition was found by chance during clinical examinations requested for different pathologies.

Aged↗
PubMed1989

[Loco-regional complications in the surgery of the subclavian artery].

Surgical treatment of subclavian artery atherosclerotic lesions has prophylactic significance in the evolution of cerebrovascular insufficiency. Local complications during interventions on subclavian artery are incidentally more significant than cerebral ischemic complications. Among local complications we reported 2 cases of phrenic nerve involvement and 1 case of thoracic duct lesion in a series of 86 operated patients. We never found cerebral ischemic complications in the surgery of subclavian artery atherosclerotic lesions.

Arteriosclerosis↗
PubMed1989

[Endodermal and coelomic mediastinal cysts].

Eight cases of mediastinal cysts of endodermic and celomatic origin were operated on at Istituto di Chirurgia Generale e Cardiovascolare, University of Milano: two were bronchogenic cysts, two enteric and four pericardial. Embryology, morphologic presentation, clinical feature and diagnostic aspects are discussed for each group of cysts. The most modern techniques, radiological or not, available for the preoperative diagnosis are illustrated and the indication to surgical treatment of these benign mediastinal lesions is discussed.

Adult↗
PubMed1989

[Influence of a prior iliofemoral reconstruction on the patency of the femoro-femoral bypass].

A series of 40 femoro-femoral by-pass grafts (FFBG) is presented; these operations were performed from 1978 to 1987 and the follow-up ranged between 6 and 36 months. The subjects were divided retrospectively into two groups, to evaluate the effect of prior iliofemoral reconstructive operations on the long-term patency of the FFBGs. Thirty-four patients (group A) had no previous surgery and 15 (group B) had 23 previous femoral surgical reconstructions. At operation, 34 recipient deep femoral arteries underwent adjunctive TEA (24 out of group A; 10 out of group B) as well as 9 donor limb deep femoral arteries (all out of group A). No donor limb steal phenomenon was recorded in both groups. FFBG occlusion occurred without any statistically significant differences in the groups (A 12%, B 20%) and only in one case a thigh amputation was needed (group B).

Aged↗