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Biomedical subjects

E Montanari

Publications and source records attributed to E Montanari.

At least 55 records · Page 3Linked to original sources
PubMed1995

Experimental and clinical urinary diversion.

In order to achieve an appropriate technical experience and explore clinical feasibility of laparoscopic urinary diversion, the authors planned a laboratory experiment. In ten male pigs weighing about 25 kilograms cystoprostatectomy was performed. Ureterocutaneostomy or ureterosigmoidostomy were carried out next. For ureterocutaneostomy a channel was bluntly dissected through the abdominal wall. The ureter was grasped by a clamp passed through the stroma, drawn outside and anstomosed to the skin. Operative time was about 30 minutes. For ureterosigmoidostomy a longitudinal incision of approximately 1 cm was made through the wall of the sigmoid colon in order to reach the mucosa. A very small opening in the angle of the incision was made. A suture was placed in the ureteral tip and secured to the colon wall. Finally, the ureter was covered in its bed with antireflux technique. Operative time was about 180 minutes. Laparoscopic ureterocutaneostomy was also successfully applied in a compromised patient to resolve a particular clinical situation.

Aged↗
PubMed1995

Laparoscopy of the kidney and the adrenal gland.

Diseases of the kidney and of the adrenal gland can be managed surgically by the laparoscopic approach. Laparoscopic nephrectomy, nephroureterectomy, renal cyst resection and adrenalectomy have been reported. This paper describes our early experience with the laparoscopic approach for the treatment of diseases of the kidney and of the adrenal gland. Since June we have performed 4 nephrectomies, 14 renal cyst excisions and one adrenalectomy. Postoperative recovery and need for pain medication were reduced. Complications have been rare. At the present time laparoscopic nephrectomy for benign renal diseases, laparoscopic excision of recurrent renal cysts and laparoscopic adrenalectomy for functioning renal tumours should be considered. The role of laparoscopic approach for treatment of malignant diseases of the kidney and of the adrenal gland is still debatable.

Adrenal Gland Diseases↗
PubMed1995

Bladder laparoscopic surgery.

The advances made in laparoscopic surgery during the last five years have made possible the performance of a variety of bladder level procedures as suspension of the bladder neck, removal of bladder diverticulum and cystectomy. Laparoscopic bladder-neck suspension is purposed by different Authors as a minimally invasive procedure that can be provide efficacious results as like as open surgery, reducing post-operative disconfort. All different laparoscopic technique provide good results at short-term follow-up. A longer follow-up period is required for the evaluation of the effective efficacy of this treatment. In according with other authors, our experience with laparoscopic bladder diverticulectomy demonstrates the feasibility and the potentiality of this technique. Up to now this procedure has been employed in the treatment of diverticula involved in urinary infection or residual urine. At the beginning, laparoscopic cystectomy has been purposed in patients with begin disease; more recently, laparoscopy has been disease; more recently, laparoscopy has been employed for cystectomy in case of bladder cancer. The few cases described demonstrate that the technique is feasible but, until now, laparoscopic cystectomy has been reported just in female patients.

Cystectomy↗
PubMed1995

[Extracorporeal lithotripsy in patients with acquired or congenital coagulopathies].

Post ESWL haemorragic complications are frequent and most patients experience temporary haematuria and focal intrarenal bleeding or perirenal haematoma are detected by NMR or US imaging. By tradition coagulation troubles have been a contraindication for ESWL but literature describes cases of coagulopathic patients treated with ESWL. From January 1992 to July 1993, 4 of our patients with severe haemostatis troubles (severe haemophilia A in two cases, acquired deficit of coagulation factors and mild thrombocytopenia secondary to post-necrotic hepatitis in 1 case and Glanzmann's thrombasthenia in 1 case) underwent ESWL using Dornier HM3 mod. or MPL 9000. An extensive haematological and clinical evaluation pre and post-ESWL with an adequate haematological prophylaxis (transfusion of blood derivatives) has been performed depending on the coagulation disorder. In our patients we did not observe any haemorragic complication and we propose a reappraisal of the contraindications of ESWL in subjects with coagulation disorders: careful evaluation of haemorragic risk factors, by suitable correction measures and close clinical and instrumental monitoring, allows a reduction of the risk of haemorragic complications in coagulopathic patients who undergo ESWL treatment.

Adult↗
PubMed1994

[Validity of superficial echography in the study of urethral pathology].

In male patients routine examination for urethral disease includes retrograde and anterograde urethrography and urethroscopy. In the patients underwent radical cystectomy, detection of cancerous cells in the urethral washing suggest cancer relapse. Nowadays we can achieve a sonographic study of the anterior male urethra, using a superficial high frequency ultrasound probe. Since September 1992 till July 1993, 12 patients underwent cystectomy at our Institution and 13 patients affected by urethral stricture, have been investigated by routine examination and sonographic urethrogram. In the first group of patients, out of 3 patients with urethral tumor, sonourethrography has confirmed the presence of tumor in 2 cases. In these second group of patients, sonourethrography has located the stricture, evaluated the length, calculated the diameter of the stricture and the depth of fibrosis. Sonourethrography is a non-invasive method that can provide valuable information about the urethral lumen and the urethral wall.

Aged↗
PubMed1994

[Dynamic renal echography versus urography in the follow-up of patients who have undergone ureterosigmoidostomy].

The main post uretero-sigmoidostomy complications are stricture of the anastomosis, chronic infection and urolithiasis. In our institution the patients with ureterosigmodostomy undergo a follow-up protocol in which blood chemistry, ultrasonography, intravenous pyelography and C.T. are periodically performed. The aim of the present paper is to compare the accuracy of kidney sonography after diuretic stimulation with intravenous pyelography in the diagnosis of ureteral stenosis. Out of 91 patient with ureterosigmoidostomy 18 patients (34 kidneys) underwent intravenous pyelography, a basal U.S. and then a dynamic one at 5, 10, 15, 30, 45, 60, 90, 120 minutes after administration of furosemide 20 mg i.v. At basal U.S. 27 kidneys were normal and 7 showed a dilations. After diuretic stimulation we observed 16 normal kidneys, 16 dilated units and 2 intermittent hydronephrosis. Out of 16 dilated kidneys 6 became normal in 60 minutes. Out of 10 dilated units 3 were normal in 90 minutes (hipotonic), 2 were normal before 120 minutes (low grade obstruction) and 5 were dilated after 120 minutes (high grade obstruction). With intravenous pyelography we observed 27 normal kidneys and seven dilated units. Dynamic sonography have shown high sensibility (100%), specificity (88.8%) and accuracy (91%) in diagnosis of ureteral obstruction in to I.V.P. in the follow-up of this kind of divesion.

Colon, Sigmoid↗
PubMed1994

[Echo-guided retropneumoperitoneum in laparoscopic renal surgery].

Laparoscopic surgery admits the retroperitoneal approach: the main restriction is the tight manoeuvring space that can be obtained with insufflation. The use of a dilatator balloon in the retroperitoneal cavity offers a solution to this problem. A cutaneous access and a dull parietal path is created, with blind positioning of the apex of the dihedron between the inferior renal pole and the ureter. Peroperative ultrasound control makes it possible to identify the inferior renal pole, to control the position of the apex of the catheter with the balloon and the movements of the retroperitoneal organs in real time. The possibility of following the procedure by ultrasonography have proven usefull in our experience.

Humans↗
PubMed1993

[Orchiopexy].

The Authors illustrate their experience in the treatment of a case of left criptorchidism using laparoscopic technique associated with traditional surgery (Fowler-Stephens technique) without important complications during and after the procedure. The non palpable testis was located in the peritoneal cavity. The first step consists in a laparoscopic clip ligation of the spermatic vessels with the intent of improve the vasal collateral blood flow. After a 6 months interval, the patient underwent laparoscopic orchidopexy.

Adult↗
PubMed1993

[Treatment of prostatitis with a new laser probe with optic fiber].

The present treatment of the subacute abatteric prostatitis, prostatodinia, prostatosis (the most common prostatic flogistic diseases) is represented by the transrectal applications of infrared Laser. The concrete opportunity of applying such an energy directly to the prostate in cases of flogistic diseases--a very frequent pathology treated in many different and controversial ways--is a stimulating therapeutical method which we tested and that we presently use in our clinics. The thanks to the realization of an high technology equipment, easy to handle, cheap, safe, perfectly suitable, formed by a new infrared Laser probe, transrectal, atermical, made by a optical fibre, which we present. Micturition, ejaculation, fertility may draw a relevant improvement, provided that the same treatment is performed after a specific medical diagnosis and following a strict protocol.

Equipment Design↗
PubMed1993

Perineal biofeedback versus pelvic floor training in the treatment of urinary incontinence.

Perineal floor training and perineal biofeedback allow to reach a good improvement of clinical discomfort in the treatment of stress and urge urinary incontinence. The aim of this study is the real evaluation of the benefit due to a 6 week perineal biofeedback and pelvic floor training (PFT) versus PFT alone. 8 female patients have been treated with a 6 week trial with perineal biofeedback plus PFT trial and 22 with a 3 month PFT alone one. PFT alone, permits a good improvement but 10% less than if associated to perineal biofeedback.

Biofeedback, Psychology↗
PubMed1993

Extracorporeal shock-wave lithotripsy with MPL9000 for the treatment of urinary stones in pediatric patients.

Extracorporeal shock-wave lithotripsy (ESWL) is now applied as the treatment of choice in most cases of urinary stones. Its acceptance in pediatry, however has been only gradual despite numerous positive studies. We report on fourteen young patients (mean age: 9.7 years) who were all treated by ESWL with the MPL9000 lithotriptor for renal stones. Each patient received an average of 1440 shocks with generator energy set at 14.4 Kv. Six of these patients required either analgosedation or anesthesia. No observable complications of treatment occurred. At one-month follow up, the kidneys of twelve patients were found to be stone-free, while two still presented fragments that could pass spontaneously. At three-month follow-up, thirteen patients were stone-free and a single patient retained some fragments. From this data we infer that ESWL with the MPL9000 lithotriptor may be used safety and efficiently to treat urolithiasis in younger patients.

Adolescent↗
PubMed1993

Urological laparoscopy: our preliminary results.

From the beginning of urological applications of laparoscopy, this technique has found many clinical indications. In our center, after an experimental training in animals, we performed 48 operations using laparoscopy: 18 pelvic lymphadenectomies (15 for prostate cancer, 2 for bladder tumor and 1 for penis carcinoma), 11 ligatures of the spermatic vein (3 bilateral), 4 orchidopexies, 10 excisions of renal cysts, 4 nephrectomies and 1 adrenalectomy. For cryptorchidism, laparoscopy is a less invasive alternative to surgical exploration; in case of prostate cancer, laparoscopic pelvic node dissection has a lower incidence of complications and requires few days of hospitalisation. The excision of renal cysts by laparoscopy, in case of large symptomatic pathology, is an efficacious operation with low morbidity. In case of nephrectomy for small wrinkled kidneys or severe hydronephrosis, long execution time makes cost/benefit ratio somewhat debatable; adrenalectomy, instead, is easier than nephrectomy and offers many advantages in comparison with traditional surgical approach. All indications will be better evaluated at a later date, with the indispensable learning period and the continuous progress of technical equipment.

Genital Diseases, Male↗
PubMed1993

[Laparoscopic nephrectomy].

Laparoscopic nephrectomy is a new procedure in which the entire kidney is removed introducing it in an Endopouch and, after morcellation pulled out through a 12 mm port. After an initial experimental experience, in our Institute we have performed one laparoscopic nephrectomy for left pyelonephritic kidney and ureteral reflux. The operation required the positioning of 5 trocars and 4 hours for its execution. The discharge of the patient was possible four days after.

Adult↗
PubMed1993

[Laparoscopic lymphadenectomy].

7 patients, suffering by prostatic adenocarcinoma in clinical stage B, were undergone to laparoscopic pelvic lymphadenectomy, to obtain a complete staging. The average time of execution of the operation was 180 minutes. The absence of important complications during and after surgical time, within low surgical trauma, has allowed the dismission of patients 48 hours after the operation. The low morbility demonstrated for this technique has allowed the dissection of a number of lymph node to consent an adequate staging.

Adenocarcinoma↗
PubMed1993

[Renal cysts resection].

Six patients with inferior and middle polar renal cysts of 8-15 centimeters of diameter, underwent the resection of the cyst by laparoscopic technique. The operation required an average time of execution of two hours and the positioning of four trochars to consent an adequate access. The absence of important complications during and after the operation has allowed a quick dismission of the patients. The laparoscopic treatment of renal cysts represent a valid choice to traditional surgery and percutaneous needle aspiration.

Follow-Up Studies↗
PubMed1993

[Section of the spermatic vein].

Surgical treatment of varicocele can be carried out using different techniques. The laparoscopic approach [1-2] represent a new trend that we used to ligate and dissect the spermatic vein in 10 patients, 8 with monolateral left varicocele and 2 with bilateral varicocele. The average time for laparoscopic surgery has been 45 minutes for monolateral varicocele and 65 minutes in the bilateral one. The absence of important complications during and after the operation has allowed to dismiss all patients 48 hours after the surgical treatment. The preferential direction of laparoscopic approach to varicocele is represented by the bilateral form.

Humans↗
PubMed1993

[Laparoscopic cystectomy: an experimental model of urinary diversion].

During our experimental trial we achieved laparoscopic cistectomies with urinary diversion to prove our manual capability with the reconstructive surgery. We executed, on male pigs, 10 cistectomies with urinary diversion using laparoscopic technique. We performed 5 ureterocutaneostomies on 5 pigs and, in the other ones, 5 ureterosigmoidostomies. During UCS the pigs laid in lateral position, and during USS in supine position. The average time of the operation is going to reduce in consideration of the overcoming of the initial techno-instrumental difficulties and is 60 minutes for cistectomy, 30 minutes for ureterocutaneostomy and 120 minutes for ureterosigmoidostomy.

Animals↗