Biomedical subjects

M Boneschi

Publications and source records attributed to M Boneschi.

At least 19 recordsLinked to original sources

PubMed1997

[Traumatic lesion of the subclavian and axillary arteries].

This study comprises 11 patients with traumatic vascular injuries of the subclavian and axillary vessels treated in the last 13 years at the Institute of General and Cardiovascular Surgery of Milan. Nine patients were male and two were female. In two patients the cause of injury was a penetrating trauma; blunt trauma occurred in nine patients. The majority of injuries were caused by motor vehicle accidents. Two patients suffered complete brachial plexus palsies with complete transection of the median nerve. Seven patients were affected by multiple bone injuries, while major venous injury was present in one case. Diagnosis was established by angiography performed in all stable patients. Vascular repair was performed in 10 patients; 4 patients were treated by primary repair, and 6 patients by interposition grafts. In one case we performed a transluminal percutaneous angioplasty (PTA) during angiographic examination, with a good result. There were no postoperative vascular complications and no patient died.

Adult↗

PubMed1997

[Prognostic clinical and anatomopathological factors in surgery of carcinoma of the right colon].

Between 1965 and 1990, 52 patients were treated for adenocarcinoma of the right colon at the General and Cardiovascular Institute of University of Milan. We have performed in all patients a curative right hemicolectomy. Five year survival rate was 57.7%. Among 12 clinical and pathological variables, the pathologic stage and the degree of cellular differentiation were the most important prognostic factors. Also other factors, like mucin production, tumor ulceration and duration of symptoms were important prognostic factors, because related to a poor prognosis. Our study emphasize the importance of an early diagnosis and a prompt curative surgical treatment to improve patient's survival rate.

Adenocarcinoma↗

PubMed1996

[Percutaneous angioplasty (PTA) in the treatment of non-penetrating injuries to the subclavian artery. A clinical case].

Non penetrating injuries to the subclavian vessels are uncommon. We present a case of a young patient with an isolated blunt trauma of the right subclavian artery. The patient, a 25 year-old woman, was admitted to our Institute after a motor-vehicle accident, with a physical findings of absent peripheral pulses and right clavicular fracture, confirmed by non-invasive vascular evaluation and X-ray of the chest. Diagnosis was established by an urgent selective angiography that showed a subintimal hematoma with occlusion of the vessel and peripheral ischemia of the arm. The patient clinical status (hemodynamically stable) permitted a conservative management and a transluminal percutaneous angioplasty (PTA) with a trans-femoral catheter balloon. After radiologic treatment, the patient showed good palpable peripheral pulses. Clavicular fracture was treated by esternal stabilization. We believe that in selected patients, without other serious life-threatening injures, the intimal artery injury can be treated by a conservative and now also radiologic Therapy; PTA treatment avoids morbidity and mortality associated with surgical intervention.

Accidents, Traffic↗

PubMed1995

[Malignant neoplasms invading into the inferior vena cava. Surgical indications].

Clinical conditions requiring resection and replacement of the inferior vena cava (IVC) are rare and have included tumors, traumatic or iatrogenic injuries. Intraluminal extension or direct mural involvement of the IVC is seen with a variety of tumors: renal cell carcinomas, adrenal cortical tumors, leiomyosarcomas and pheochromocytomas. Surgical treatment requires tumor resection with simultaneous en bloc resection of the involved IVC. Resection of the lower and middle segments of IVC is possible in nearly all cases and surgical reconstruction is generally made with a polytetrafluoroethylene (PTFE) tube graft. Resection at suprahepatic vein level is indicated only rarely: tumor invasion of the suprahepatic veins require liver transplantation. Venous bypasses have lower patency rates than prosthetic replacement because of the low pressure and lower-flow of the venous system.

Adrenal Gland Neoplasms↗

PubMed1995

[Surgery of abdominal aortic aneurysm and concomitant disease of the digestive tract].

The incidence of intra-abdominal diseases associated with abdominal aortic aneurysm is increasing, and it is difficult to decide whether to operate the abdominal disease first, the aneurysm first or both simultaneously. Variables used in decision analysis include type, stage and life expectancy of the cancer, rupture rate of abdominal aortic aneurysm. Symptomatic lesion should be treated first. Absolute indication for operation initially on the aneurysm is the presence of symptoms of rupture. Aortic abdominal aneurysmectomy combined with surgical removal of an intestinal disease may present severe risks as infection of the graft and anastomotic leakage, especially during lower abdominal surgery. In this paper authors present four cases of AAA which had intra-abdominal surgical disease. They were treated by one-stage operation with no complications. Criteria to assess timing of surgical treatment of abdominal surgical diseases concomitant to AAA are discussed.

Aged↗

PubMed1995

[Intestinal infarction after ruptured aneurysm of the abdominal aorta. Clinical contribution].

Acute mesenteric ischemia is a severe complication after aortic reconstructive surgery for AAA repair. This ischemic event, due to a poor intestinal perfusion especially in ruptured AAA in consequence of the hypotension and the hypovolemic shock, shows different clinical manifestations such as delayed canalization, ischemic colitis or more serious like intestinal infarction. Between 1989 and 1994, 965 cases of abdominal aortic aneurysms have been surgically treated in General and Cardiovascular Surgery Institute of University of Milan. Rupture had occurred in 150 patients, and intestinal infarction was observed in 6 cases (3.9%). Mortality rate of 33% was observed. Etiology and technical procedures to avoid this complication are discussed.

Acute Disease↗

PubMed1994

[Renal arteriovenous fistulae].

Arteriovenous fistulas (AVFs) involving the kidney are rare. They are generally classified as congenital, idiopathic or acquired. The authors present 5 cases of renal arterio-venous communications observed in recent years. These cases don't include the congenital type and represent the forms of AVFs that are more frequently observed (1 idiopathic, 3 iatrogenic, 1 associated with malignancy). This study is aimed at examining the clinical picture and the procedures of detection and monitoring of renal AVFs. The various adopted therapeutic procedures (nephrectomy, surgical ablation, radiological embolization) are analyzed.

Adult↗

PubMed1993

[Acute occlusion of the abdominal aorta].

Acute aortic occlusion is a rare event, usually related to atherosclerotic lesions, cardiac embolism or traumatic events. During the last twelve years, we observed 25 acute aortic occlusions: 12 patients (48%) were affected by aortic bifurcation embolism, and 13 patients (52%) by acute aortic thrombosis. There were 18 men (72%) and 7 women (28%) with a median age of 63 years. Severe cardiopathy was observed in 15 patients (60%). Twenty-four patients (96%) underwent surgical treatment: involvement of the renal arteries was found in only 2 cases (8%). We performed 14 aorto-femoral by-passes (58%). Operative mortality was 20%. Death was due to acute kidney failure in 2 cases and to heart infarction in 3 cases.

Acute Disease↗

PubMed1993

[Primary lymphoma of the small intestine].

Lymphomas of the small bowel are rare tumors with few characteristics. Clinical and radiological diagnosis is difficult, because they may be confused by inflammatory or neoplastic forms, especially in primary involvement of the small intestine. Observation of three cases of primary extranodal lymphomas of the small bowel prompted a review of problems relating to the histology, clinical manifestations and the staging classification. This system is an important aid in the evaluation of the treatment and prognosis of these forms.

Adolescent↗

PubMed1993

[Biliary lithiasis and carcinoma of the gallbladder].

Gallstones are a major risk factor for gallbladder cancer, but only few patients with stone experience develop this tumor. To examine this relationship, twenty-one patients with gallbladder cancer referred to our Institute over a 26-year period were studied. The tumor was most common in older females (95.2%) (median age 69.2 years). Seventy-six percent of patients had gallstones. The cell type in 57.1% of patients was adenocarcinoma. The prognosis is poor, the median survival time was 6.7 months.

Aged↗

PubMed1993

[Caustics-induced lesions of the gastrointestinal tract].

Ingestion of a corrosive agent results in a life-threatening clinical condition that requires emergency intensive care and often surgical intervention. Treatment is multifactorial and varies with the extent and depth of the injury. We report a case of a young 24-year-old man with accidental ingestion of sulphonic acid. After 1 month he developed a progressive dysphagia. Early endoscopic examination showed grade III injury to both the esophagus and stomach with severe and undilatable stricture of the antrum. Therapy included total parenteral nutrition and antibiotics. Repeat endoscopic examinations on days 30 and 40 showed progressive healing of the esophageal injuries, but confirmed a complete antral stenosis. After two months a large antecolic jejuno-gastroplasty was performed on the anterior wall of the stomach. The postoperative course was regular, and endoscopic examination showed complete healing of the injuries.

Adult↗

PubMed1993

[The physiopathology and therapy of esophageal diverticula].

The authors report their experience in the management of 14 patients affected by esophageal diverticula and surgically treated (9 had cervical diverticula, 2 had epibronchial diverticula and 3 had epiphrenic diverticula). All these patients underwent a diverticulectomy: in 3 cases the diverticulectomy was associated with a subdiverticular myotomy. In the last three cases the resection of the diverticulum was performed using an automatic stapler. The follow-up of these patients was prolonged for a period of 5 years with clinical, radiographic and endoscopic evaluations performed at 6 monthly intervals. The most recently operated patient has a minimum follow-up of 22 months. There were no operative deaths and none of the patients complained of recurrence of the diverticulum or of the preoperative symptomatology. No significant complications were observed in the postoperative period in the patients who underwent a simple diverticulectomy or in the cases in which a subdiverticular myotomy was associated. The scant number of observed patients does not allow us to draw any conclusion about the necessity maintained by most authors of an associated myotomy. It is however evident that this adjunctive procedure doesn't cause any further difficulty and is not loaded with an increased risk of complications. Finally the authors believe in the usefulness of performing the diverticulectomy with an automatic stapler, these devices allow in fact a considerable reduction of the surgical time and prevent dangerous contaminations of the operative field.

Adult↗

PubMed1993

[Primary lymphoma of the gastrointestinal tract].

Lymphomas of the gastrointestinal tract are rare tumors with unusual features and few characteristics. Clinical, radiological and endoscopic diagnosis is difficult, because they may be confused with inflammatory or neoplastic forms, especially in primary involvement of the gastrointestinal tract. From 1965 we observed 4 patients with primitive gastrointestinal tract lymphomas. Prognostically important features for GI lymphomas were: stage, site of the primary disease, histological type. Authors report on the clinical findings, diagnostic procedures, surgical treatment and results.

Adolescent↗

PubMed1993

[Functioning paraganglioma].

Pheochromocytomas and functioning paragangliomas are rare tumors arising from indifferent cells of the primitive neural crest. These tumors produce clinical symptoms (pheochromocytoma syndrome) related to catecholamine production. The pheochromocytoma syndrome, constituted by arterial hypertension, headache and sweating, is due in 80% of cases to adrenal pheochromocytomas and only in 20% of cases is due to extra-adrenal secreting paragangliomas. The diffused localization of the Paraganglion System and the common embryologic origin, can explain the occasional identification of multicentric tumors (10%), and the association with multiple endocrine neoplasms (MEN), especially in familial occurrence. Careful follow-up of patients, in order to detect the later development of multicentric or metachronous neoplasms is necessary. The Authors present their experience with 80 patients affected by neoplasms involving the adrenal medulla and the multicentric paraganglion system, surgically treated during the last 25 years. Eight patients (10%) were affected by functioning extra-adrenal paragangliomas: 7 patients (87.5%) had solitary extra-adrenal tumors (6 abdominal and 1 thoracic) with a classic pheochromocytoma syndrome, and 1 patient (12.5%) had a double asymptomatic abdominal paraganglioma.

Adult↗

PubMed1993

[Vagal paraganglioma].

Vagal paragangliomas are rare tumors of neural crest origin. This neoplasm is generally located at various points along the peripheral distribution of the vagus nerve, in the region of the jugular and nodose ganglia, just beneath the perineurium of the nerve, but may arise anywhere along the course of the vagus nerve. Histologically, vagal paragangliomas are similar to carotid body tumors, and occasionally can undergo malignant transformation and metastasize (10-19%) or infiltrate the base of the skull. Selective arteriography can distinguish vagal paraganglioma from carotid body tumor, because the first lies above carotid bifurcation without widening of the vessels. CT scanning and MR are useful for preoperative evaluation of the jugular foramen for neoplastic involvement. Surgical resection is the treatment of choice, but usually it isn't possible to exercise these lesions without sacrifice of the vagus nerve. A careful follow-up examination for the development of metastases and multicentric paragangliomas is necessary. Two cases of vagal paragangliomas one of them with cervical node metastases, are reported. Diagnostic and surgical features of these rare neoplasms are outlined.

Adult↗

PubMed1993

[Mediastinal functioning paraganglioma. A case report].

Functioning paraganglioma of the mediastinum is an uncommon tumor of the paraganglion system. We report a case of a 26 year-old woman with a 6 month history of hypertension refractory to therapy. Urinary catecholamine excretion and plasma noradrenaline concentration were elevated. Chest radiograph and computed tomography (CT) scan revealed high-density mass located on the posterior mediastinum. An mIBG scan showed uptake by the mediastinal tumor. At thoracotomy a 5 cm lesion was resected. Histological examination confirmed that it was a paraganglioma. Authors refer on the clinical finding and diagnostic procedures of this rare disease.

Adult↗

PubMed1993

[Pancreatic insulinomas].

Neuroendocrine pancreatic tumors are neoplasms derived from APUD cells, characterized by hyperincretion of several peptides of hormonal activity. The incidence of these tumor is low. They are usually classified according to the predominant secreted peptide: gastrinoma, insulinoma, VIPoma, glucagonoma. Insulinoma is the most frequent endocrine pancreatic tumor, characterized by a peculiar clinical picture due to insulin action. This neoplasm is prevalently benign (90%), and may cause symptoms due to hypo-glycemia such as epilepsy, asthenia, deep coma, dizziness, hunger and epigastric pain. Surgery still constitutes the principal therapy for insulinoma treatment, but an accurate tumor identification is necessary. Selective arteriography of the pancreas and new diagnostic investigations as intraoperative US, selective sampling of pancreatic veins with insulin Quick-RIA, aid the diagnosis and more precise localization of the tumor. When surgical therapy is not practicable, for diffuse metastases, octreotide has an inhibitory effect upon hormone release, and may be combined with chemotherapy for controlling clinical symptoms. We review the clinical records of 2 patients from our Institute, who had hyper-insulinism due to benign insulinomas of the tail of the pancreas. Surgical treatment was performed with enucleation of the neoplasms.

Aged↗

PubMed1993

[Primary malignant tumors of the small intestine].

The clinical records of 10 patients with small intestinal tumors during a 27 years period were reviewed. The patients, 5 men and 5 women ranged from 17 to 79 years old. There were 6 carcinomas (60%), 3 lymphomas (30%), and 1 sarcoma (10%). Tumors were most frequent in the distal part of the small intestine (70%). The most common complaints were pain (70%) and obstruction (40%). All patients had surgical treatment; curative resection was attempted in 70% of the cases. Prognosis is poor, the mean survival time was 20.4 months.

Adolescent↗