Biomedical subjects

M Porena

Publications and source records attributed to M Porena.

At least 19 recordsLinked to original sources

PubMed1998

Colposacropexy with Gore-tex mesh in marked vaginal and uterovaginal prolapse.

This study focusses on abdominal sacral colpopexy which appears to provide the most anatomically correct restoration and secure and durable support for advanced vaginal or uterovaginal prolapse. 21 patients underwent colposacropexy or hysterocolposacropexy using Gore-tex mesh. All patients referred symptoms of vaginal heaviness and urinary dysfunctions. Five presented with complete vaginal vault prolapse, 7 with third-degree anterior colpoceles and 9 with uterovaginal prolapse. Hydronephrosis was present in 4. Five patients had previously undergone total hysterectomy, and underwent only sacropexy; 9 underwent standard total abdominal hysterectomy before sacropexy; 7 underwent hysterocolposacropexy, preserving the uterus. In colposacropexy anchorage was designed to provide a large vagina-mesh contact area thus reducing the risk of suspension failure. Hysterocolposacropexy was performed using 3 stitches to anchor the synthetic mesh to the vagina and the uterine isthmus. Postoperative follow-up times range from 12 to 68 months. Overall results for 19/21 patients were satisfactory. In all 21 patients the descensus was markedly reduced. Hydronephrosis was completely resolved. Slight incontinence persisted in 3, but protection was not required. Slight dysuria persisted in 2. First-degree cystoceles recurred only in 3 patients who underwent hysterocolposacropexy. Sacropexy with synthetic mesh seems to be the most valid support of uterovaginal prolapse as the physiological vaginal axis is restored and vaginal function is preserved. Our success rate and the overall satisfaction expressed by 19/21 patients have encouraged us to continue in this surgical approach.

Adult↗

PubMed1998

Open prostatectomy in benign prostatic hyperplasia: 10-year experience in Italy.

This study reports the experience of 47 Italian urology units together with the urology unit at the University of Perugia concerning open surgery in the management of benign prostatic hyperplasia (BPH). Until 20-25 years ago, open surgery was the most common approach. In the late 1970s the development of endoscopes and their methodology has led to a gradual reduction in open surgery operations, which decreased rapidly with the introduction of mini-invasive endoscopic techniques. Therefore, open surgery for BPH is declining, though still performed. Skill in traditional surgery is mandatory because, until an alternative is devised, indications for open surgery still exist and cannot be ignored. The survey shows the indications and contraindications, complications and results of a 10-year nationwide experience. Guidelines for open surgery in patients with BPH have been drawn up.

Aged↗

PubMed1997

Implant surgery in Peyronie's disease.

The etiology and evolution of Peyronie's disease are not well known, and this certainly affects patient management. If spontaneous regression or stabilization of the disease is lacking, actually all therapies, except surgery, seem to be only partially successful. We attended 88 patients affected by Peyronie's disease, and 21 patients (23.6%) were referred for surgery and penile implantation; plaque excision was necessary in 8 patients (38.1%). We implanted 10 malleable prostheses and 11 soft prostheses. So far, potency has been the only parameter for evaluating the results of surgery, but in our view both the patient and his partner should be satisfied aesthetically and functionally.

Erectile Dysfunction↗

PubMed1996

Autologous adrenal medullary transplant in Parkinson's disease: critical review of our results in 13 patients.

Autotransplantation of the adrenal medullary to the caudate nucleus has been proposed for severe Parkinson's disease (PD). We describe our experience in 13 patients using a transperitoneal approach to the medullary and craniotomy for the implant: the neurosurgical equipe's decision to opt for craniotomy made quick removal of the medullary with minimal morbidity more difficult. The surgical technique are discussed. We evaluated also the impact of the procedure on urinary symptoms and sexual disturbances associated with PD. Results were disappointing. Four patients died post-operatively. The neurological pattern improved in three men and one woman. No significant improvement was observed in the urological and sexual dysfunctions.

Adrenal Medulla↗

PubMed1996

Conservative surgery and quality of life in a young patient with synchronous bilateral embryonal carcinoma.

Synchronous bilateral testicular germ cell tumours are rare. We report a case with retroperitoneal node involvement (stage IIb). Testis-sparing surgery, followed by systemic PEB chemotherapy, was performed instead of bilateral radical orchiectomy plus retroperitoneal lymphadenectomy. A good quality of life was obtained. Management of the case and review of the literature are presented.

Adult↗

PubMed1996

Renal cell carcinoma: histological findings in peritumoral tissue after organ-preserving surgery.

OBJECTIVE AND METHOD: This study assessed the involvement of peritumoral renal cell carcinoma tissue and evaluated the efficacy of partial resection versus enucleation by an anatomopathological investigation into the resection margins in 28 cases of partial nephrectomy. RESULTS: Histological findings showed no peritumoral infiltration in 91.6% of elective partial resections (24 patients) and resection margin involvement in 75% of necessary partial resections (4 patients). CONCLUSION: Although the debate between organ-preserving and radical surgery remains open, the conservative approach can undoubtedly be recommended in selected patients.

Adult↗

PubMed1996

[Milk of calcium renal stone: echographic diagnosis].

"Milk of calcium renal stone" (liquid renal calculosis) is a quite uncommon lithiasis distinguished by the presence of a semiliquid suspension of calcium salts or a "seed-like" sediment in a caliceal diverticulum or an ectasia segment of the collecting system. We reviewed 5 patients (1 male and 4 females, mean age 48.6 years), with a history of urinary tract infection, renal pain or haematuria. All patients underwent renal ultrasonographic assessment in both clinostatic and orthostatic position. Three patients underwent intravenous pyelography before ultrasound. Ultrasonography showed a sonolucent "levelled" image with a posterior acoustic shadow inside a hydro-caliceal dilation (2 pts.) or caliceal diverticulum (3 pts.); the persistence of the "level" in both clinostatic and orthostatic position allowed an immediate diagnosis in all patients. Intravenous pyelography performed before renal ultrasound showed no abnormality in 1 patient and was misleading in two; it otherwise confirmed the diagnosis when performed after renal ultrasonography. Three patients underwent surgery, two patients refused therapy; sonographic follow-up showed no evolution of the morphologic picture. Once considered as exceptional, liquid renal calculosis still remains rare pathology and accounts for 0.6% of all the urinary lithiasis diagnosed by ultrasound in our series. An accurate sonographic assessment allows a reliable diagnosis of this particular lithiasis and an easy discrimination from solid lithiasis, nephrocalcinosis, medullary sponge kidney and hydropyonephrosis. Hence, a correct diagnosis of this rare condition lets uneffective and improper treatments be avoided.

Adult↗

PubMed1996

[Echo-guided drainage of pararenal and pelvic fluid accumulations: technique, indications, and results].

Percutaneous echoguided drainage of retroperitoneal collections is to be considered a recommendable technique which guarantees a good percentage of success and a complete resolution of the effusions and also gives a low percentage of complications. The drainage can be made through a simple percutaneous needle puncture or through a catheter which is kept for some days. The latter technique done by Seldinger or Trocar's method, guarantees more possibilities of success. The systemic echographic control during the post-operatory period of the urological patients have permit to find out the high frequency of small fluid effusions (haematic, urinary or lymphatic) in the operation area; not all the collections need a treatment. The urinary collections or those with clinical signs of anemia have to be drained. In the presence of small haematic or lymphatic collections, the ultrasonography follow-up shows almost always a progressive volume reduction with a following disappearance. Percutaneous drainage has to be performed in the presence of a large collection (more than 5 cm of diameter), in the case of a persistent collection or when patient presents with clinical features of infection.

Drainage↗

PubMed1996

[Uro-gynecologic protocol for studying urinary stress incontinence].

Regarding the difficulty in using a common and standardised language in the diagnosis of Stress Urinary Incontinence (SUI) the authors developed a research protocol based on anamnestic, clinical, urodynamic and imaging forms, in order to have a numerous elements for the evaluation of this pathology. The preliminary study had to identify the most meaningful and common parameters, encoded according to broadly approved literature or the classification proposed by International Continence Society (ICS). One of the fundamental purposes was to clarify the role of ultrasonography technique applied to the field of Stress Incontinence. In this article the authors explain the choices they make, the technique employed for such a study and the ultrasonic images that are pathognomonic of the specific anatomo-functional disorders.

Anthropometry↗

PubMed1996

[Echographic follow-up after radical prostatectomy].

The abdominal and transrectal ultrasound is of a great importance in the follow-up and in the early postoperatory control in the patients which have undergone a radical prostatectomy. The abdominal ultrasonography can be used to identify the presence of abdominal or pelvic fluid collections in the postoperative period or to evaluating the upper urinary tract. Ultrasonography has come to play a primary role in the detection of lymphonodal and/or parenchymal metastasis. Transrectal ultrasound permits to identify the local illness relapse, whereas the ultrasonography examination during micturition allows the functional study of the bladder neck. Moreover, transrectal ultrasound is useful in guiding biopsy needle into a specific lesion seen on the sonogram in the perianastomotic region whereas random ecoguided biopsy in the perianastomotic area is necessary in patients with signs of recurrent cancer even in the absence of suspicious areas.

Adenocarcinoma↗

PubMed1996

[Echographic study of the bladder neck and prostate region after Nd-Yag laser treatment].

The authors describe the ultrasonic images they obtained in the follow up of three groups of patients who were divided according to basic pathology and treated with Nd: Yag Laser with contact (CLAP) and side firing (VLAP) fibers. Next the great differences noted between the results achieved with ultrasonic investigation and those obtained with flowmeter controls and IPSS are presented. The authors discuss the possible causes of these dissonances and hypothesize a new way to evaluate cervico-urethral de-obstruction: no longer an anatomical technique but a functional one.

Adult↗

PubMed1996

[Carcinoma of the prostate: correlation between local staging and systemic progression].

Management of prostate cancer requires considerable economic and social efforts and may causes some discomfort to patient. To attempt a simplification of the prostate cancer follow-up (dosage of PSA, ultrasound and abdominal and pelvic TC and/or RM, bone scan, X-ray chest and X-ray bone), Authors have review the patients with prostatic cancer who were undergone to a conservative treatment with hormonal and/or radiation therapy. From January 1984 to September 1995, 136 patients have been evaluated in the Urological Department of University of Perugia. Local staging cancer has been made according to TNM system. Ultrasound transrectal follow-up study (TRUS) we made through longitudinal and/or transversal scans. The echographic features have been evaluated are the prostate size, volume and echogenic pattern of cancer, extracapsular extention and, finally, the echographic appearance of surrounding tissues (seminal vesicles, rectum, bladder). In 116 patients (85.3%) Authors found a good correlation of clinical course and the results of the investigations whereas in 20 patients (14.7%) such correlation falls to be demonstrated. Although PSA level remains an important prognostic marker for monitoring patients with prostatic cancer, TRUS is useful to determinate not only the local status but also to predict the subsequent clinical course of these patients. The later could be performed at least twice a year whereas further investigations could be prescribed only in presence of clinical suspicious of metastasis. It can be concluded that TRUS and PSA levels are sufficiently safe indexes on follow-up of prostate cancer which can replace the most expensive examinations avoiding an unnecessary cost to the health care system. Furthermore TRUS can recognize patients with urine flow obstruction who may benefit by treatment with improvement of their quality of life.

Adenocarcinoma↗

PubMed1994

Urethral syndrome: clinical results with antibiotics alone or combined with estrogen.

The urethral syndrome is very frequent in women but the etiology is unknown. In all 77 patients suffering from the syndrome, endoscopy revealed characteristic lesions in the trigonal area. As unidentified bacteria may be responsible, a microbiological investigation was carried out. Wide-spectrum or specific antibiotic therapy was prescribed as required. All patients were also randomized to 2 groups to assess the efficacy of local estrogen therapy. The authors concluded that wide-spectrum antibiotic therapy with macrolide and mepartricin should be the first choice of treatment and that local administration of estrogen does not significantly enhance the benefits achieved through antibiotic therapy. A detailed microbiological investigation is necessary when symptoms persist. Overall a positive result was obtained in 75.32% of the cases (58 patients). The presence of Streptococci negatively influenced the results of specific antibiotic therapy.

Adult↗

PubMed1994

[Urethral diverticuli in women: role of diagnostic methods in the preoperative assessment].

From 1985 to 1993 we observed 9 female patients with urethral diverticula. All patients underwent first clinical examination and then US (suprapubic and transrectal or transvaginal scans) and X-ray cystography which demonstrated the communication between the diverticula and the urethra, MRI was also performed, in order to explain the rapports between the diverticulum and the sphyncter. All patients underwent surgery and 8 were cured. No cases of incontinence were observed.

Adult↗

PubMed1994

[Locally advanced prostatic cancer and systemic involvement].

In a group of 115 patients with prostatic cancer, the correlation between the local and systemic evolution of the neoplasm has been evaluated. In 80 patients non local and systemic up-staging of the tumor was observed. In further 18 patients both local and systemic staging uppers and in the remaining 17 patients no correlation between local and systemic evolution was observed. In conclusion, in this series, the prostatic cancer demonstrated an high concordance in both local and systemic evolution and then the modifications of local staging can be used as a predictive parameter of systemic evolution of the prostatic cancer.

Follow-Up Studies↗

PubMed1994

[Echographic features of testicular neoplasms. Our experience].

14 patients with primitive testicular cancer underwent US and afterwards surgery. A comparison between echo-pattern and hysto-pathology was done with the following results: sharp limits and ipoechoic homogeneous pattern in leydigioma and low-staging seminoma. Presence of anechoic areas and irregular limits: teratoma and embrionary carcinoma with no correlation with the staging. Inclusively no correlation between echo-pattern and staging of neoplasm or presence of neoplastic lymphnodes was observed.

Humans↗

PubMed1994

[The clinician's need in renovascular hypertension].

Clinician questions in nephrovascular hypertension are: 1) Is hypertension secondary to nephrovascular disease? 2) Is vascular obstruction susceptible of surgical management? 3) Which is the best technical approach? In this review of recent international literature we have focused diagnostic value of echo-color Doppler in the screening of patients with secondary hypertension. The sensibility and specificity of this diagnostic test reach 89% and 99.5%. Respectively when the stenosis is over 70%. Anyway when the stenosis is under 70% the accuracy of this examination is lower. Angiography remains the gold standard test in patient eligible for surgery, although its invasiveness. Diagnostic tests of the renin-angiotensin axis (e.g. Captopril test) are useful too, but morphologic evidence is not provided. Surgical approach is the best choice in elective patients.

Humans↗

PubMed1993

Intralesional alpha interferon therapy in papillary superficial transitional cell carcinoma of the bladder. A pilot study.

The tolerability, toxicity and therapeutic efficacy of recombinant interferon alpha-2a (rIFN alpha-2a), administered by intralesional injection, were evaluated in 15 patients with papillary superficial transitional cell carcinoma of the bladder, rIFN alpha-2a was delivered endoscopically in a single weekly dose of 3 x 10(6) IU for 4 weeks (total 12 x 10(6) IU). Transurethral resection of residual tumours was then performed. The response to treatment was assessed according to ultrasonographic, endoscopic and pathological findings. One patient achieved complete remission, 6 partial remission, 6 minor remission and 2 stabilisation of disease. All patients completed the course of treatment. A mild, transient, flu-like syndrome was documented after every injection. Immunological findings suggest that the antitumour effects of rIFN alpha 2a are not mediated through the immune system.

Aged↗