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Biomedical subjects

G Montesano

Publications and source records attributed to G Montesano.

34 records · Page 2Linked to original sources
PubMedDate not supplied

[Major surgery in thoracic injuries].

Chest injuries have a high and steadily increasing incidence in western countries, but only some of the most common problems they create require an emergency thoracotomy or surgical video thoracoscopy. Flail chest, persistent pneumothorax, massive haemothorax, mediastinal emphysema, cardiac tamponade and intrathoracic foreign bodies can be identified as major surgical problems. Some of such patients (i.e. those with flail chest or foreign bodies) would be immediately candidates for major intervention. Other require fast but diagnostic procedures, because the choice of a therapy is dependent upon a precise identification of the damage. Injuries of trachea and primary bronchi, oesophagus, diaphragma, vena cava, great lung vessels, heart and aorta may represent important surgical emergencies; some leading rapidly to death. Fortunately, major surgical procedures are not really frequent in the management of thoracic traumas. Only 42 (3.5%) of nearly 2,000 patients with non-penetrating thoracic injuries had a thoracotomy or an surgical video thoracoscopy. The figure is far different for penetrating wounds; in fact 12 patients (41%) of 29 underwent mayor surgery.

Diagnosis, Differential↗
PubMedDate not supplied

[The surgery of tumors and "limited situations"].

The term "limit" applied to cancer surgery, denotes the ideological moment beyond which one cannot and should not propose any aggressive treatment. Such limits may concern the operability of a patient and may be represented by some general characteristics independent of the patient's current disease status (e.g. very old age, poor performance status, poor cardiac, respiratory, renal hepatic or mental conditions). They may concern the neoplastic involvement of the organ affected by the tumor: if undertaken, surgery should guarantee a reasonable duration of life, and a quality of life that makes it worth living. Other factors to be taken in consideration are the possibility the tumor spread to local or distant sites, as well as certain extreme conditions such as cancer, cachexia, liver/kidney failure, irreversible septic-toxic shock, ect. Moreover, there may be limits related to the structural conditions of the establishment where the operation is to be carried out (facilities, equipment, pharmacological supplies, medical and paramedical personnel) and to the social environment and the economic situation of the patient, in view of the assistance required following surgery. Lastly, a severe assessment of one's own fitness to perform any specific task should be part of the daily preparation of any surgeon.

Humans↗
PubMedDate not supplied

[Angiodysplasia of the large intestine: unusual rectal localization].

The authors report a case of lower gastrointestinal hemorrhage in a 69-year-old male, in which the sequence colonoscopy-angiography identified the source of bleeding as a rare Angiodysplasia (AD) of the rectum. Such vascular abnormalities are one of the most common causes of major lower gastrointestinal tract bleeding in the elderly and usually occurs predominantly in the right side of the colon. The clinical presentation of Angiodysplasia is varied and accurate diagnosis usually requires a combination of diagnostic techniques such as colonoscopy and angiography. The optimal management is uncertain and should be individualized for each patient depending on severity and rate of rebleeding. A conservative medical approach is indicated for many patients, while endoscopic treatment does not seem modify the risk of recurrent bleeding. In case of massive hemorrhage or recurrent bleeding surgery still represents the definitive treatment for Angiodysplasia. However the risk of rebleeding following surgery is a considerable problem and varies in literature from 5% to 30%.

Aged↗
PubMedDate not supplied

[Lymphadenectomy in the surgical treatment of bronchogenic carcinoma].

Bronchogenic carcinoma is one of the tumors with the statistically most markedly rising incidence, at least in western countries. For many years both the resectability and the long-term results have remained invariable due to the serious delay with which the disease is usually diagnosed. In addition, the success of treatment appears to be closely correlated with disease stage; in particular lymph node involvement has a major influence on the long-term survival following adequate treatment. As a consequence, a strong conviction has established itself in recent years, that radical removal of all mediastinal lymph node stations ipsilateral to the operated lung represents not only a necessary staging procedure, but also a useful measure to improve the prognosis of these patients. However, the real utility of radical lymphadenectomy is questioned by a number of groups: on the one hand the supporters of lymph node "sampling", inasmuch as the usefulness of radical lymphadenectomy has not been demonstrated by randomized clinical trials; on the other hand those workers, in particular from Japan, who on the basis of observations of the lymphatic flow in the mediastinum stress the necessity to extend lymph node clearance to the nodal station contralateral to the tumor. The current opinion is changing under the influence of recent developments, for instance the possible use of the sentinel technique also in lung cancer, and the possibility of "reasonable" or targeted lymphadenectomies, planned in relation to the lobar location of individual tumor. Whichever of these approaches is chosen--and this choice is still a matter of debate--many agree about the importance of neoadjuvant treatment not only to render patients eligible for surgery but also to improve the prognosis for patients at the most advanced stages of the disease.

Carcinoma, Bronchogenic↗
PubMedDate not supplied

[Reoperations in lung surgery].

A second thoracotomy in patients who have undergone previous chest surgery can be performed soon or immediately after the first operation and is usually aimed at resolving severe or even life-threatening postoperative complications. Late reoperations, on the other hand, are either performed to resolve complications of previous surgery or to remove second primary lung tumors (SPLCs) or metastases. The most exacting reoperation in this context is completion pneumonectomy, which is particularly indicated in the case of failure of the residual lobe to re-expand after primary surgery; it is also used for--rarely occurring--fistulas of the lobar bronchi and for new ipsilateral primary lung tumors. This type of surgery is technically complicated and has been associated, in our experience and that of others, with a certain mortality. Technically less difficult is a second ipsilateral thoracotomy for exploratory purposes or minor parenchymal resection, and the same is true of contralateral lobar or sublobar resections. Lastly, Abruzzini's operation, for fistulas of the primary bronchus, is relatively complicated but often leads to good results; we have performed 15 such operations with only one death occurring due to acute myocardial infarction.

Adolescent↗
PubMedDate not supplied

[Neurogenic tumors of the mediastinum].

Neurogenic neoplasms represent approximately 20% of the space-occupying lesions in the mediastinum. They are primary tumors originating from structures belonging to the peripheral or sympathetic nervous system, they are most commonly diagnosed in subjects in the age range between 10 and 30 years. Benign forms are significantly more frequent than malignant forms, an observation that was confirmed by our own experience; whether these tumors have a predilection for the male or female sex cannot be concluded from the various case series studied to date. Surgical resection can be considered the treatment of choice on the basis of the long-term results, which are greatly satisfactory in benign tumors and encouraging in the malignant variants.

Adolescent↗
PubMedDate not supplied

Treatment of gunshot wounds to the colon: experience in a rural hospital during the civil war in Somalia.

BACKGROUND: In the last few decades there has been a clear tendency in civilian practice towards primary repair of gunshot wounds to the colon, resulting in a substantial decrease in the number of colostomies performed for this type of injury. METHODS: The series described here comprises 24 patients with gunshot wounds to the colon treated at the hospital of Jowar in the Middle Shebelle region of Somalia between 1999 and 2001. All injuries were caused by war arms firing high-velocity projectiles. RESULTS: In 18 patients surgery consisted of resection and immediate anastomosis, while in the remaining six patients colostomies were performed including five loop colostomies and one terminal colostomy. The sepsis-related mortality was 25% (6/24). CONCLUSION: Our experience had a peculiar setting, namely that of a civil war in a developing country. In this kind of "difficult" situation there probably exists no ideal procedure and the decisions taken at the operating table are influenced by various factors that are often related to subjective assessment.

Adolescent↗
PubMedDate not supplied

Acute pseudo-obstruction of the colon: a clinical contribution and review of the literature.

Acute idiopathic pseudo-obstruction of the colon, or Ogilvie's syndrome, is a rather unfrequent condition. Although it has been associated to a variety of pathological conditions, the etiology is still unknown. The authors refer upon a case of Ogilvie's syndrome observed by them and, confronting the data that emerged reviewing the literature with their experience, they retain that if the conservative therapy fails, and in absence of perforations or ischemic lesions, the treatment to prefer is the positioning of a cecostomy tube in local anesthesia. For elderly patients with unsufficiently good general conditions who present a recurrent acute pseudo-obstruction of the colon, it is advisable to confection a definitive cecostomy.

Acute Disease↗
PubMedDate not supplied

A possible case of carbamazepine induced pancreatitis.

The authors report a case of acute pancreatitis (AP) occurring in a patient under treatment with carbamazepine (CBZ) for post-traumatic petit mal epilepsy, and review the current literature of drug-induced AP. The evidence of high plasmatic levels of CBZ and the absence of other aetiologic factors lead the authors to conclude that the overdose of CBZ could have represented the precipitating of the episode of acute pancreatitis.

Acute Disease↗
PubMedDate not supplied

Acute idiopathic pancreatitis: clinical and diagnostic contribution.

Acute idiopathic pancreatitis is a term used when no underlying cause can be identified on routine investigations. However more specialized investigations, such as endoscopic, endoscopic retrocolangio pancreopathy (CPRE), may detect aetiological factors, particularly biliary sludge and pancreatic duct abnormalities. The authors, reviewing the current literature, report their caseload of idiopathic pancreatitis. They conclude that CPRE is indicated if ultrasonography shows a calibre of the common duct at the superior limits of normal values and in each idiopathic recurrent AP.

Acute Disease↗
PubMedDate not supplied

[Intestinal perforation caused by a chicken bone: apropos of a clinical case].

Ingestion of foreign bodies (FB) seems to be a relatively common occurrence in certain classes of people. The majority of ingested objects reach the stomach end 80% of these pass spontaneously without complications. However nearly 20% of FB that pass from the stomach result in complication distally such to required a surgical operation. The authors report a case of chicken bone perforation of the ileus, which was diagnosed by surgical operation. The case reported is of interest for several reason. The lack of condition that can predispose patients to accidental ingestion of FB, no specific history of FB ingestion and the impossibility to detect chicken bones on plain radiography.

Aged↗
PubMedDate not supplied

Seat-belt injuries to the supra-aortic trunks.

Five seat-belt related injuries to the supra-aortic and cervical vessels occurring in four patients are reported. All patients but one were symptomatic, none presented with stroke, and in one case arterial lesion was revealed by delayed onset of symptoms. Outcome of surgical treatment was overall good. Systematic search of such injuries and surgical repair of those without major neurological signs might be advisable.

Adult↗
PubMedDate not supplied

Calcified retroperitoneal fibroma.

A case of 31-year-old male with a retroperitoneal tumor is described. Abdominal ultrasound revealed a left para-aortic calcific mass, adjacent to the left lobe of the liver and to the upper pole of the left kidney. A CT-scan of the abdomen showed the mass to originate from the left adrenal gland. At operation, a large, retroperitoneal mass, adherent to the left kidney and the spleen, but not infiltrating, was excised. Histologically the tumor was diagnosed as a calcified osteo-producing fibroma. Benign retroperitoneal tumors represent about 25% of all retroperitoneal neoplasm. This reported case represents a retroperitoneal tumor of slow growth and benign clinical course whose characteristic consists of the heavy calcifications which are normally absent in a fibroma type mass.

Adult↗
PubMedDate not supplied

Carcinoid to cecal bowel localization: a case report and literature review.

The authors report a case of cecal malignant carcinoid, diagnosticated in a 68 years old male patient. Carcinoid tumours are rare neoplasm and their behaviour seems to change with the localization. Cecal carcinoid represents only 2-3% of gastrointestinal carcinoid. Some times it is discovered incidentally at autopsy, surgery or endoscopy. The aim of this paper has been to review, in literature, the frequency, treatment and prognosis of this neoplasm.

Aged↗
PubMedDate not supplied

Biofragmentable anastomosis ring (BAR) in intestinal surgery: review of 21 cases and evaluation of postoperative morbidity.

The authors report their experience with the use of biofragmentable anastomosis ring in intestinal anastomosis: 21 patients underwent intestinal resection and anastomosis by BAR. There was no operative mortality. One patient developed an anastomotic leak and three patients had symptoms of intestinal obstruction. The endoscopic follow up showed no late complications. Technical factors regarding the BAR are discussed. Advantages appear to be a safe, rapid and easy alternative to hand and stapled intraperitoneal large bowel anastomosis.

Anastomosis, Surgical↗