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Biomedical subjects

M Montorsi

Publications and source records attributed to M Montorsi.

At least 91 records · Page 5Linked to original sources
PubMed1983

Primary pulmonary tumours of neurogenic origin.

Primary intrapulmonary neurogenic tumours are extremely rare. In a series of 1664 patients with pulmonary neoplasms observed during 1967-80 only four such tumours were identified (0.2%). All four patients underwent surgical excision. The histological diagnosis was benign neurilemmoma in three cases and malignant schwannoma in the fourth. The patients with neurilemmoma are alive and well four to 12 years after surgery, but the patient with malignant schwannoma died from metastatic spread of the tumour four months after surgery. No association with von Recklinghausen's disease was observed. Macroscopic and microscopic features generally lead to a correct diagnosis in benign types, but the histological diagnosis of malignant schwannoma may present some difficulties and requires the establishment of a definite origin in a nervous structure, identification of benign neurofibroma in different areas of the same tumour, and a high density of cells with appreciable pleomorphism, with mitosis and atypia. Benign tumours carry a good prognosis with little tendency to recur, but malignant schwannoma has a high invasive tendency and is associated with a low survival rate.

Adult↗
PubMed1983

Experimental lymphatico-venous shunt in the rat: pressure controls and long-term patency.

In a series of rats which underwent end-to-side lymphaticovenous shunts, between precaval lymphatic collector and infrarenal cava vein, pressure values in lymphatic and venous systems and long-term patency of the anastomosis have been evaluated. Lymphatic pressure has always been higher than venous pressure, providing a good physiological basis for the functioning of the shunt. Short-term patency (15 days) was 100% and long-term patency (90 days) 80% in all the controlled animals. The results obtained in this experimental model seem to support the efficacy of this procedure also in its clinical use.

Animals↗
PubMed1983

Prophylactic portosystemic shunt: a special indication.

Generally, when a splenectomy is performed to treat either a severe hypersplenism or another splenic affection in a cirrhotic patient with uncomplicated esophageal varices, the question arises whether to associate or not a prophylactic shunt. In fact, splenectomy alone does not lower the portal pressure and does not affect positively the esophageal varices. Because of this, 36% of these patients will eventually undergo a bleeding episode from varices. Furthermore, in the patients surviving the first bleeding, the occurrence of splenoportal thrombosis following splenectomy does prevent a therapeutic shunt to be performed. For this reason splenectomy with a complementary prophylactic shunt was performed in 24 patients. This operation, which showed 16% mortality rate, significantly prevented bleeding (0%). Furthermore in the treated patients, splenectomy has lowered the portal pressure. Encephalopathy occurred in 30% of cases, however the accuracy in the selection of patients together with a proper diet and medical treatment have avoided severe complications. The 5 year survival rate was 60%. Nevertheless, the indication to a prophylactic shunt must be limited to these particular cases.

Adolescent↗
PubMed1982

[Pancreas transplantation. II].

So far no really successful therapy has been found for diabetes mellitus, though it is a common disease and its complications, involving microangiopathy, are extremely serious. The serious limitation of all forms of insulin therapy (various types of insulin and insulin pump) is the impossibility of achieving a fast, successful response to either the variations in blood sugar levels after eating or increased glucogenogenesis caused by glycosteroids and adrenalin. The prolonged hyperglycaemic peaks which result, may well be one of the possible causes of microangiopathy. Only a system which responds to blood sugar variations by stimulating adequate insulin secretion immediately will provide correct prophylaxis for the complications of diabetes mellitus. At the moment only P-pancreatic cells have this capacity and in theory pancreas transplantation seems to be the best treatment for diabetes. However out of 105 complete pancreas transplants only 5 survived for over a year, with the aid of immunosuppressants. Equally none of the 66 allotransplants of pancreatic islands in immunosuppressed patients was successful in the long term. It is also important to bear in mind that long term immunosuppression may prove more dangerous than microangiopathy itself. For these reasons a new cell transplant system using molecular sieve membranes to create an immunological barrier is being investigated. Although it is too early to forecast long-term results, continuous progress is being made and recent discoveries about the physiology of beta pancreatic cells encourage the belief that this approach may be successful in the future.

Cell Division↗
PubMed1980

[Treatment of lymphedema of the extremities with lymphatico-venous anastomosis].

Very encouraging results have been obtained over a number of years with direct lymphaticovenous anastomosis in the treatment of primary and secondary lymphoedema of the limbs. Twelve cases involving the upper and lower extremities have been treated since 1976. An account is given of the personal technique employed. This makes use of dioptric means of magnification, instruments, materials, and microsurgical techniques. In some instances, differences have been observed between the objective results and improvements in the subjective symptomatology, as well as between treatment of the upper limbs (enlarged arms after mastectomy) and both primary and secondary lower limbs involvement. The pre- and postoperative cautions required are explained, together with the indications for treatment. An explanation is offered of some of the failures observed.

Arm↗
PubMedDate not supplied

A technical modification of heart-lung transplantation in rats.

Hemodynamic studies were carried out on a series of rats undergoing heart-lung transplantation according to the technique of Sun Lee. The results suggested a new hypothesis of blood circulation in the heart-lung block by demonstrating the lack of necessity for the venovenous anastomosis. A new technique, with just one aortoaortic anastomosis, was therefore evaluated. Its value and reliability in a series of 30 rats are discussed.

Abdomen↗
PubMedDate not supplied

Reducing the occupational risk of infections for the surgeon: multicentric national survey on more than 15,000 surgical procedures.

The objective of this study was to find the incidence of accidental exposures to blood and body fluids among surgeons during operations and to describe their dynamics. A probabilistic model was also used to predict the cumulative 30-year risk to the surgeon of contracting hepatitis B and C viruses (HBV, HCV) or human immunodeficiency virus (HIV) infection and estimate the effect of preventive strategies in reducing this risk. A multicentric prospective survey, based on self-administered questionnaires, was conducted during a period of 6 months in 39 Italian hospitals. As accidental exposure to blood or body fluids occurred in 9.2% of 15,375 operations. In about 2% of procedures a parenteral-type injury, such as actual skin puncture or eye contamination, was suffered by the operating surgeon. A needle-stick injury was the commonest accident, and its occurrence was found to vary with the phase of the procedure and its length. The current lifetime risk of acquiring HBV, HCV, and HIV infection in our regions was estimated to be as high as 42.7%, 34.8%, and 0.54%, respectively. The adoption of preventive strategies is expected to reduce this risk to 21% for HBV, 16.6% for HCV, and 0.23% for HIV infection. Active immunization of surgeons against HBV is strongly recommended. The case is also made for the use of a face-shield combined with a permanent change in our surgical practice capable of reducing the current high rate of parenteral injuries.

General Surgery↗
PubMedDate not supplied

Laparoscopy with laparoscopic ultrasound for pretreatment staging of hepatocellular carcinoma: a prospective study.

Laparoscopy with laparoscopic ultrasound (L-LUS) has proved to be superior to conventional CT imaging in the staging of hepatocellular carcinoma (HCC). The aim of our prospective study was to evaluate the efficacy of L-LUS as compared with currently available imaging techniques (spiral CT or Lipiodol CT) in patients with HCC and liver cirrhosis. From January 1998 to May 2000, 70 consecutive patients (50 men and 20 women; mean age 67 +/- 7 years) were enrolled. Liver cirrhosis was related to chronic hepatitis C virus infection in 55, hepatitis B virus infection in seven, and alcohol abuse in eight patients. Preoperative diagnostic workup included the following: 70 ultrasound examinations of the liver, 23 CT scans after Lipiodol arteriography, and 53 spiral CT scans. A single lesion was found in 39 patients, two lesions in 20 patients, and three lesions in 11 patients. L-LUS was performed in all patients under general anesthesia using a two- to three-trocar technique. The examination was completed in 68 patients (97%); in two cases extensive adhesions prevented the L-LUS examination. L-LUS yielded additional information in 39 patients (57%). New histologically proved HCC lesions were detected in 14 patients (in the same liver segment in 4 cases and in different liver segments in 10 cases), and an adrenal metastasis was seen in one patient. In 23 patients, benign nodules were identified as regenerative macronodules, low-grade dysplastic nodules, or small hemangiomas. In 10 patients, correct localization of the primary lesion was detected by L-LUS in comparison with the preoperative liver location. In our experience, L-LUS is a safe and reliable procedure. It provides superior information (intraoperative histologic confirmation) for the diagnosis and pretreatment staging of HCC in patients with cirrhosis when compared with current radiologic imaging techniques.

Aged↗
PubMedDate not supplied

Laparoscopic radiofrequency of hepatocellular carcinoma (HCC) in liver cirrhosis.

BACKGROUND/AIMS: In this report, the feasibility and efficacy of laparoscopic radiofrequency interstitial thermal ablation of hepatocellular carcinoma has been evaluated in 20 patients. METHODOLOGY: The laparoscopic approach with the use of intraoperative ultrasonography allowed us to obtain additional information regarding liver nodules and a complete treatment of the liver lesions. RESULTS: The complication rate was low and there was no operative mortality. A complete necrosis has been obtained in 90% of the cases at 1 month dynamic computed tomography following the treatment. CONCLUSIONS: Laparoscopic radiofrequency thermal ablation of hepatocellular carcinoma proved to be a safe and effective technique; its use may be proposed in selected patients. Larger series are needed to accurately assess its role among the other ablative therapies of hepatocellular carcinoma.

Aged↗