Biomedical subjects

S Bonardelli

Publications and source records attributed to S Bonardelli.

40 records · Page 3Linked to original sources

PubMedDate not supplied

[The role of magnetic resonance angiography in the assessment of arterial stenosis in the transplanted kidney].

Artery stenosis in the transplanted kidney is the most frequent vascular complication; hypertension onset or worsening may be associated and, at an end stage, also renal insufficiency. The diagnosis must be early and accurate and provide guidelines for medical, interventional or surgical therapy. To assess the diagnostic reliability or MRA, 27 patients were examined. On the basis of clinical, biochemical, pharmacological (Captopril test) and instrumental (color-Doppler US) examinations, the artery of the transplanted kidney was considered normal in 6 patients and stenotic in 21. In the control group, MRA results were in agreement with color-Doppler findings. On the contrary, in 8 of 21 abnormal conditions, the two techniques were in disagreement. Digital angiography, considered as the gold standard, was performed in any questionable case, confirming a slight overestimation of the stenoses by MRA (3 cases) and 2 false positives by color-Doppler US. The authors believe color-Doppler US to be a reliable technique for screening stenosed arteries in the transplanted kidney. MRA is proposed as a complementary investigation useful to define stenosis type and to provide guidelines for treatment.

Adult↗

PubMedDate not supplied

Arterial chemoembolization in hepatocellular carcinoma suitable for resective surgery.

BACKGROUND/AIMS: Authors examined transcatheter arterial embolization (TAE) reliability in modifying diagnosis, staging, choice of treatment after a common instrumental evaluation and in increasing results in patients with hepatocarcinoma(s) potentially suitable for surgery; this value was compared to TAE-related mortality and morbidity. MATERIALS AND METHODS: Thirty-nine patients underwent TAE. Diagnostic value, reduction in tumor size and necrosis' percentage after treatment were computed. Immediate and long term results were compared to those obtained by primary liver resection in 62 patients. RESULTS: TAE showed more lesions than any other diagnostic tool, thus excluding 4 patients (10.2%) from surgery. TAE-related mortality (1 patient) and severe morbidity (11 patients) excluded 4 more patients. Complications were correlated to Gelfoam embolization (p < 0.01). After TAE tumor size reduction was sporadic; tumor necrosis > 70% was present in 13/29 resected tumors. Intraoperatively 16/25 patients had TAE-related anatomical alterations; a choledochus' wall necrosis and a tumor' explosion must be mentioned. TAE and intraoperative echography had an equivalent diagnostic value. Immediate and long term results were comparable to those obtained by primary liver resection. CONCLUSIONS: TAE has a high diagnostic accuracy but the capacity in changing the final judgment after a good instrumental evaluation is low. The specific risk-benefit ratio is not favourable, in particular after mechanical embolization, and clinical benefit is not evident.

Aged↗

PubMedDate not supplied

[Total pancreatectomy. Which indications?].

This a review of the different topics held by literature for and against total pancreatectomy (TP) for adenocarcinoma of the pancreas. Technical and oncological aspects are discussed as are the metabolic effects of TP; metabolic data of our series of 6 TP are also referred. Postoperative mortality and morbidity decreased to less than 5% during the last decade both for TP and the Whipple procedure; long term survival is also similar for the two procedures. Even if the metabolic consequences of both exocrine and endocrine function deprivation are generally well compensated, they can still threaten the patient's life; furthermore their long term effects are only partially known. These are the reasons that force most authors to choose TP only in selected patients in which a multifocal neoplasia is demonstrated or whose pancreatic remnant is particularly soft and friable with high risk of pancreatojejunostomy complication. A pancreatic remnant in fact grants the hormonal milieu that makes easy the pharmacological control of any pancreatic function deficiency.

Carcinoma↗

PubMedDate not supplied

[Splanchnic aneurysms: 10 treated cases and review of the literature].

The splanchnic aneurysms, which are complicated by rupture in 25% of cases with a mortality of 25-70%, are usually a surprise during diagnostic tests for other abdominal pathologies or emergency laparotomies. 10 cases treated (8 in elective and 2 in emergency surgery) are presented here: the aneurysm was in celiac trunk (1 patient), common hepatic artery (1 pt.), hepatic artery (2 pts.), gastroduodenal artery (1 pt.), superior mesenteric artery (1 pt.), inferior pancreaticoduodenal artery (1 pt.), right colic artery (1 pt.) and inferior mesenteric artery (1 pt.). There were 1 case of Marfan syndrome and 9 cases of atherosclerosis, 4 of which arteries presenting hyperdynamic flow consequent to occlusions of the superior mesenteric artery and/or the celiac trunk. The 2 cases operated on for hemoperitoneum underwent aneurysmectomy and ligation of the inflow vessels (1 death from pulmonary embolism on 5th postoperative day), whereas the 8 cases electively treated (with no deaths and I case of transient diarrhoeal syndrome) underwent 4 aneurysmal resections with end-to-end arterial reconstruction, 3 PTFE-graft substitutions and 1 autologous saphenous vein substitution. At follow-up (12-74 months; mean 30.6) all the reconstructions resulted successful. These data confirm the consistent indications of the recent Literature suggesting the indication to the surgical treatment of the incidental aneurysms in the splanchnic area.

Aged↗