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Biomedical subjects

E Montanari

Publications and source records attributed to E Montanari.

At least 19 recordsLinked to original sources
PubMed1992

Long-term followup after extracorporeal shock wave lithotripsy treatment of kidney stones in solitary kidneys.

A total of 64 treatments by the Dornier HM3 lithotriptor was performed on 52 solitary kidneys with stones. A slight increase but no significant variations in serum creatinine was noted in 15 patients without obstruction just after treatment (p greater than 0.05). No significant increases in serum creatinine were found even at the short-term, mid-term and long-term followup. After 12 to 56 months hypertension developed in only 1 previously normotensive patient. Of 37 patients at mid-term followup (12 to 24 months) 62% were stone-free, 24% had passable fragments, 8% had recurrent stones and 5% had regrowth of the residual fragments. At long-term followup (24 to 56 months) 50% of 26 patients were stone-free, 19% had dust or passable fragments, 19% had recurrences and 11% had regrowth of the residual fragments. The demonstrated effectiveness, small number of complications at the short-term followup, lack of sequelae at the long-term followup and relatively small number of recurrences confirm that extracorporeal lithotripsy is not only effective but also safe. It can be proposed as the treatment of first choice even when the stone is in a single remaining kidney.

Adult↗
PubMed1992

Prognostic significance of prostate-specific antigen in endocrine treatment for prostatic carcinoma.

We have studied the prognostic significance of prostate-specific antigen (PSA), monitored monthly, in 24 patients with prostatic cancer (5 D1, 19 D2) on endocrine therapy. The pretreatment levels of PSA were high in all patients (mean value 41 ng/ml). It was found that PSA levels at the end of the first and sixth months of treatment were reliable prognostic indicators. At the first month evaluation PSA had decreased more than 50% from the initial values in the 16 patients with stable disease, while it had decreased less than 50% in those with progressing disease. At the end of 6 months, patients with stable disease had PSA levels within the normal range, while 8 of the patients who had progressing disease had levels higher than 10 ng/ml. Respectively 6 and 2 patients had also had increases in PSA levels at 3 and 6 months before scintigraphic demonstration of increased bone metastases.

Aged↗
PubMed1992

[Recurrence of lithiasis after extracorporeal lithotripsy, percutaneous surgery, and open surgery for calculi of the upper urinary tract].

The safety and short-term effectiveness of percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL) have already been well established. However, long-term follow-up studies are essential to prove that the recurrence rate after PCNL and/or ESWL is equal or even better than that of surgery. We reviewed 57 patients treated with ESWL monotherapy, 45 patients treated by PCNL (or by PCNL combined with ESWL for complete staghorn stones) and 59 patients treated by open surgery who all had at least three years of follow-up. The overall recurrence rate for ESWL was 37% for PCNL and for open surgery 39%. ESWL, PCNL and open surgery all showed a higher rate of recurrence and persistent bacteriuria when associated with residual stones. Therefore every effort should be made to remove residual fragments following stone treatment. We conclude that because of its efficacy and low morbidity ESWL should be the treatment of choice for most of renal calculi. Complete staghorn calculi are best treated with open surgery because the complete elimination of all calculous material and the eradication of infection are achieved at a higher rate than by PCNL and ESWL.

Adult↗
PubMed1992

[Use of ultrasound-guided percutaneous nephrostomy before and after ESWL: 4 years of experience].

We evaluated the usefulness of percutaneous nephrostomy in 1700 patients treated for reno-ureteral stones by extracorporeal shock wave lithotripsy (SWL). Out of this group 81 patients (5.8%) underwent echo-guided percutaneous nephrostomy (EPCN): the procedure has been performed in local anesthesia in 38% of the cases (31 pts) before SWL and in 62% (50 pts) after. The majority of EPCN were carried out for the presence of acute or chronic ureteral obstruction with echographic evaluable dilation of pyelocaliceal system when retrograde ureteral manipulations failed or were considered unsuitable. EPCN before SWL was performed because of ureteral stone and uncomplicated pyelocalyceal dilation (19 pts); ureteral stone, pyelocaliceal dilation and fever > 38 degrees C (3 pts); ureteral stone, pyelocalyceal dilation and functional IVP exclusion (5 pts); pyelic stone in solitary kidney (1 pts); ureteral stones in pregnancy (2 pts). EPCN after SWL was performed because of uncomplicated, persistent pile-up (31 pts); ureteral pile-up complicated by fever and colics (9 pts); ureteral obstructing fragments (2 pts); double J obstruction by stone dust (3 pts); persistent ureteral pile-up around double J (3 pts); anuria in solitary kidney (1 pt). Out of the patients who underwent EPCN before SWL 13% were stone free and without drainage at discharge, 77% had passable stone fragments at discharge and drainage has been taken out at 15-30 days check up, 10% had unbroken stone and underwent with drainage to ureterolithotripsy.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1991

[Treatment of ureteral calculi with extracorporeal lithotripsy. Comparison between the original Dornier HM3 and the modified lithotriptor].

From January 1985 till June 1989, 222 patients with ureteral stones, underwent ESWL treatment. 109 patients were treated with the original Dornier HM3 under general or epidural anaesthesia and 113 patients were treated with the modified Dornier HM3 under anglosedation. 156 stones were in the upper ureter, 15 in the middle ureter, 51 in the lower ureter. We performed a total of 269 ESWL treatments. Out of 109 patients treated with the original HM3 and 113 patients treated by the modified HM3 12 (11%) and 28 (24.7%) needed, respectively, two or more ESWL sessions. In 89.9% and 88.5% of the patients, respectively, has been performed an ureteral manipulation before the treatment to push up or to localize the stone. The treatment was unsuccessful in 10 patients of whom 3 underwent anterograde lithotripsy by percutaneous access, 4 transureteral lithotripsy and 3 surgery. At three months the percentage of patients stone free was as follows: original HM3 patients 88% modified HM3 patients 92.9%. The extracorporeal lithotripsy is now-day the treatment of choice for the ureteral stone without any limitation, due to the stone localisation. The clinical use of modified HM3 on ureteral stones didn't low our success rate, but increased the shock wave out of session.

Humans↗
PubMed1990

Urinary NAG excretion after anesthesia-free extracorporeal lithotripsy of renal stones: a marker of early tubular damage.

Second generation lithotripters require a higher number of shocks per session as well as an increased rate of secondary treatments for complete stone disintegration compared to the original spark gap lithotripter. The clinical relevance of biological side effects caused by such treatment are less known. We evaluated urinary excretion of N-acetyl-glucosaminidase (NAG) before and after lithotripsy in 50 patients treated with a low pressure spark gap lithotripter (Dornier HM3) and in 36 patients treated with a piezoelectric lithotripter (Wolf Piezolith 2200) in an attempt to evaluate their side effects on renal tissue. The urinary excretion of NAG increased after both spark gap lithotripsy using the modified HM3 and piezoelectric lithotripsy. These changes may be associated with slight tubular damage that would occur after anesthesia-free lithotripsy in patients subjected both to a high number of shocks and to secondary treatments.

Acetylglucosaminidase↗
PubMed1989

[Extracorporeal lithotripsy with low pressure shockwaves using a modified Dornier HM3 lithotriptor: preliminary results].

Extracorporeal shock wave lithotripsy is a well established procedure for the treatment of the renal and ureteral calculi. The technical innovations of the low-pressure generator with a modified ellipsoid installed into the Dornier HM3 lithotripter leads to decrease the pressure in the second focus F2 lowering the painful sensation linked to the treatment and allowing to perform lithotripsy without general or epidural anae sthesia. From January to March 1988 132 patients underwent 144 treatment by modified Dornier Lithotripter HM3, we performed the treatments under a combination of anxiolytic and analgesic drugs in 125 patients (94.6%), only 7 patients needed the general or epidural anaesthesia, because of complex endoscopic pretreatment instrumentations. An average of 2150 Shock waves was applied with a range of 500 to 3800, the shock wave energy was administered at an average 20 Kvolts (16-26 Kv). Stone fragmentation had a success rate of 94.6%. The average postoperative stay was 4.5 days. After a month of follow-up 50.9% of the patients was free of stones, 27.8% had sand or spontaneously passable fragments and 11.1% had residual fragments larger than 4 mm. The treatment was judged as free of pain or with tolerable pain in 60% of the patients, 40% of the patients needed additional medication. The number of secondary treatment was, in our review, 9% but it could increase because we observed after a month of follow-up that 11% of the patients treated presents fragments larger than 4 mm.

Equipment Design↗
PubMed1989

[Enoxacin in the treatment of bacterial prostato-cystitis].

Thirty-three patients suffering from acute, subacute or chronic prostatovesiculitis were admitted to an open, non comparative trial. Enoxacin was administered at the daily dosage of 400 mg every 12 hours for 10 days starting from the enrollment. A second cycle of treatment was performed if cure was not obtained with the first cycle. Treatment efficacy was established by assessing patient symptoms related to the infection, such as pollakiuria and dysuria, consistency and volume of prostate and spermatic vesicles (evaluated by rectal examination and transrectal ultra-sonography); bacterioscopical and bacteriological evaluations of prostate/vesicles secretion with sensitivity testing were also carried out. All observations were collected at baseline, 5 and 30 days after the end of the first cycle and 5 days after the end of the 2nd cycle of treatment. After the first cycle of treatment, cure was obtained in 22 subjects (67%) and clinical improvement in 24 (73%). All but one patients still infected at the end of the first treatment period, showed improvement (5; 45.5%) or cure (6; 54.5%). The end of the second cycle None of the 22 patients cured with one cycle of treatment relapsed within 30 days after the end of treatment, confirming they really achieved cure. Side effects were observed only in 1 case (mild vertigo); no drop outs were observed. These results suggest that enoxacin may be successfully used in the treatment of prostato-vesiculitis.

Acute Disease↗
PubMed1989

[Extracorporeal lithotripsy using the HM3 Dornier lithotriptor and the modified HM3 lithotriptor].

Extracorporeal shock waves lithotripsy is a well established procedure for the treatment of renal and ureteral calculi. From January 1985 to December 1987, 1034 patients underwent 1152 treatments with the Dornier HM3 lithotripter; from January 1988 and December 1988, 466 patients underwent 566 treatments with the modified Dornier HM3. Treatments with the original HM3 were performed mainly under general anaesthesia (97%). Only 2.4% of modified Dornier HM3 treatments have been performed under general anaesthesia; the 97.6% were treated under a combination of anxiolytic and analgesic drugs. An average of 1900 and 2300 shock waves was applied with the original HM3 and the modified one, respectively. The rate of secondary treatment increased from 10.3% to 17.4% respectively. At three month follow-up the 85.6% of the patients treated with the original HM3 and the 76.7% of those treated with the modified Dornier were free from stones. Low energy lithotripsy with the modified semi ellipsoid has proved to be equally effective as the older generators working with high shock wave pressure.

Follow-Up Studies↗
PubMed1989

[An overview of extracorporeal lithotriptors in current clinical use: technical notes].

ASWL ten years ago opened a new era for kidney stone treatment and recently it's showing a new therapeutical approach to biliary stones. Dornier HM3 is since 1983 the first lithotripter with a wide clinical employment. Actually we know about twenty extracorporeal lithotripter in clinical use. Our review try to classify old and new extracorporeal lithotripsy devices looking at technical aspects and lithotripsy center organization.

Cholelithiasis↗
PubMed1989

[Urinary excretion of N-acetyl-glucosaminidase after extracorporeal shockwave lithotripsy: a marker of renal tubule injury].

The major complications of extracorporeal shock wave lithotripsy (ESWL) are perirenal hematomas for an incidence of less than 1 per cent. However in animal experiments histopathological effects of focused electrohydraulic shock waves on renal parenchyma have been reported, the most significant of which are hemorrhagic foci healing rapidly by cicatrization. Furthermore imaging studies have demonstrated morphological changes limited to the area of the kidney exposed to shock waves. Liver, skeletal muscle and pancreatic enzyme changes have been documented after ESWL. In our experience the urinary ratio of NAG (N-acetyl-glucosaminidase) to creatinine, a good marker of renal tubular damage, increased after treatment with both the original and the modified spark gap Dornier HM3 lithotripters and with the piezoelectric Wolf Piezolith 2200. Particularly the threshold of pathological urinary NAG excretion were 2,000 and 2,600 shocks respectively using the original and the modified Dornier HM3 and 7,000 shocks using the Wolf Piezolith 2200. The functional significance of the changes is not known, however in clinical practice it would seem prudent to avoid excessive exposure to shock waves.

Acetylglucosaminidase↗
PubMed1988

[Dissection of the internal carotid artery. Personal case reports and a review of the literature].

The clinical and angiographic features of 20 patients affected by internal carotid artery dissection are reported. In one patient the neurological signs were related to a traumatic event, in two cases the symptoms presented after hyperextension of the neck during athletic events, while their onset was apparently spontaneous in the remaining 17 patients. Plain CT was normal in 14 cases and positive for ischemic necrosis in 6 patients. Angiography demonstrated extensive/segmental stenosis of the internal carotid lumen in 12 cases (60%), pseudoaneurysmal dilatation in 3 cases (15%), and complete carotid occlusion in 5 patients (25%). The "double lumen" feature was seen in 3 cases at the origin of the dissection. One patient died, surgical ligature of the internal carotid artery was performed in two cases, while the other patients received medical treatment with platelet inhibitors, except for the young patient affected by post-traumatic artery dissection. Complete recovery was observed in 82% of the patients. Follow-up angiograms demonstrated normal recanalization of the internal carotid artery in 4 out of 6 patients; one of them had two false aneurysms which following angiograms demonstrated to be completely resolved. Regression of stenosis was observed in 6 of the remaining patients by Doppler US. On the whole, the recanalization of the internal carotid artery was observed in 59% of cases. Angiographic findings seemed not to play a decisive role in the prognosis of carotid dissections, which largely depends on the overall patient's condition and on the presence/absence of ischemic cerebral damages.

Adolescent↗