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Biomedical subjects

A Montori

Publications and source records attributed to A Montori.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Integrated anastomosis using the Knight and Griffen technique].

The widespread use of mechanical staplers in gastrointestinal surgery has recently resulted in a simpler and faster operative technique. The double-stapled anastomosis (Knight and Griffen, 1980) seems to further simplify the technique of colo-rectal anastomosis, with reduced risks of pelvic contamination. Moreover, this technique can be used to reconstitute bowel continuity following an Hartmann's procedure or to perform an ileo-rectal anastomosis. The results obtained in 21 patients treated by this technique are presently reported.

Anastomosis, Surgical↗
PubMed1988

Is ERCP manometry useful in the choice of treatment of stones of the common bile duct?

To verify the appropriateness of sphincterotomy as the treatment of choice of choledocholithiasis, since 1980 we have been using endoscopic retrograde cholangiopancreatographic (ERCP) manometry of the sphincter of Oddi (SO). This method allows direct investigation of SO motor activity and provides useful information regarding the presence of benign papillary stenosis (BPS). Thirty-four patients were investigated because the radiological examination indicated BPS might be present. Of these, 20 had common bile duct (CBD) stones, while the remaining 14 presented with biliarylike pain and one or more of the following: CBD dilation (larger than 12 mm); emptying of the ERCP contrast medium took longer than 45 min; abnormal liver function tests. Moreover, 8 healthy volunteers served as controls. Our results show that the incidence of SO motor anomalies is very low in the presence of choledocholithiasis, while it is substantial in patients with suspected SO dysfunction. These observations would suggest that, unlike the traditional view, BPS is rarely secondary to biliary lithiasis. Therefore, most of the sphincterotomies performed that are based on the assumption of underlying SO pathology should be considered unnecessary. Under these circumstances, the physiological role of a functioning SO has induced us to advocate sphincterotomy, surgical or endoscopic, in selected cases only.

Adult↗
PubMed1988

Impact of biliary tract endoscopy on benign and malignant diseases.

In the last 15 years, the management of patients affected with obstructive jaundice has been greatly improved by the introduction into clinical practice of diagnostic and therapeutic biliary tract endoscopy. This method has provided better knowledge of the pathophysiology of diseases of the common bile duct (CBD), with enormous benefit for surgical decision making. Moreover, it has reduced morbidity and mortality in emergency patients as well as in high-risk patients with CBD stones. Even the incidence of retained stones has been reduced to almost 1%-2%. The impact of endoscopy on diseases of the biliary tract has been tremendous.

Biliary Tract Diseases↗
PubMed1987

Endoscopic lymphoscintigraphy. A new tool for target surgery of rectal cancer.

To define the "in vivo" lymphatic drainage from the rectum and the anal canal, 79 subjects (normal controls and patients with rectal cancer) underwent endoscopic rectal lymphoscintigraphy. This method consists of endoscopically injecting a radiolabelled colloid into the rectal and anal submucosa. The diffusion of the tracer, which is drained preferentially by the lymphatic vessels, was determined by means of a computerized gamma camera. Our results suggest a different pattern of lymphatic drainage from the rectum as compared to traditional anatomical studies. Moreover, analysis of our data yields a new hypothesis about the lymphatic spread of rectal cancer. Therefore, lymphoscintigraphy could be employed in the preoperative assessment of "N" staging of these neoplasms. This should provide better selection of patients for different surgical approaches and for adjuvant therapy. The results of 2 years of experience and possible future applications of this technique are discussed.

Anal Canal↗
PubMed1987

Morphological appearance of low-level echoes in the gallbladder. Interpretation with microscopic biliary analysis and clinical correlation.

A total of 743 patients affected by various gastrointestinal disorders were examined by ultrasound. The presence in the gallbladder bile of low-level echoes (LLE) was observed in 56 (7.5%). Twenty-six of these patients had surgery: 24 underwent cholecystectomy for important biliary-like painful symptomatology, and 2 had cephalopancreatectomy for pancreatic head carcinoma. Both macro- and microscopic controls of the bile were carried out in all 26 patients. In 20 cases, only microscopic cholesterol crystals and calcium bilirubinate granules were observed in the bile. The microscopic evidence of these crystals was associated in four cases with macroscopic evidence of so-called "biliary sludge" and in four cases with macroscopic evidence of highly viscous bile. In the other 6 cases these crystals were associated with the presence of cholesterol stones. The authors consider that the observation of LLE in the gallbladder bile is an important index of the presence of cholesterol crystals and/or calcium bilirubinate granules. These LLE can assume polymorphic aspects, described by the authors, which may simulate other pathologies and lead to incorrect echographic diagnosis. The high incidence of LLE in an alithiasic population (5.1%), together with the elevated frequency, according to the authors, of association of these echoes with a painful biliary-like symptomatology (52.6%), underlines the diagnostic importance of an accurate ultrasound investigation in this type of pathology.

Adult↗
PubMed1986

Transrectal ultrasonography: three years' experience.

Since 1983 we have used radial and linear ultrasound probes in the laboratory and clinical examination of the rectum. Normal endosonographic appearances have been characterised by examining polyethylene membranes and resection specimens. Twenty normal subjects and 11 patients with rectal cancer have been examined, and of these 9 were correctly staged.

Humans↗
PubMed1986

Transrectal ultrasonography: interpretation of normal intestinal wall structure for the preoperative staging of rectal cancer.

An in vitro ultrasonographic study was carried out to four polyethylene membranes of different thicknesses and on four normal surgical specimens from the rectal wall, to assess its various layers and their anatomical structure. Three different techniques were used, and an electronic equipment measured the thickness of the membranes and of the surgical specimens. Polyethylene membranes less than 1000 microns thick gave linear echoes; the 1000-microns-thick membrane gave a three-layer image--two hyperechogenic layers separated by a hypoechogenic one. The rectal wall was separated into the mucosa-submucosa and the muscularis propria-serosa or muscularis propria (in the extraperitoneal rectum); their thickness ranged from 900 to 1000 microns and from 1500 to 8000 microns, respectively. Even though the mucosa-submucosa, the muscularis propria-serosa, and the muscularis propria each gave a three-layer ultrasonographic image (hyper-hypo-hyper), the resulting image of the entire rectal wall was of five layers (hyper-hypo-hyper-hypo-hyper). Transrectal scan carried out on 20 control patients confirmed the results obtained in vitro, even though at times it was difficult to detect clearly the fifth layer. Interpretation of the five layers was as follows: the second and fourth corresponded to the mucosa-submucosa and muscularis propria, respectively; the first, third, and fifth were considered to reflect interfaces originating from different acoustic impedance structures. The fourth layer was always thicker than the second one. There was no difference between intra- and extra-peritoneal images. A further study carried out on nine patients with rectal cancer by transrectal ultrasonography proved the reliability of this method in assessing the cancer infiltration of the wall and its importance in the preoperative staging of rectal cancer.

Adult↗
PubMed1982

Endoscopic removal of foreign bodies in the large bowel.

Endoscopic removal of foreign bodies from the intestinal tract is an extremely useful method. In our series, foreign bodies passing down from the upper intestinal tract were removed endoscopically from the rectum and colon of 13 patients. No complications were observed. It can be concluded that endoscopy is a simple, safe and effective method which, in many cases, avoids surgical procedures.

Colon↗
PubMed1981

Endoscopic sphincterotomy: indications and results.

Endoscopic sphincterotomy (ES) is a simple, effective and remarkably safe method of treatment of choledocholithiasis and papillary stenosis. In this series, ES was technically successful in 255 (86.1 per cent) of 296 patients in whom it was attempted. Forty-nine of the successful cases had papillary stenosis complicated by pain, cholangitis and/or jaundice in patients after cholecystectomy; 205 had choledocholithiasis, of whom 164 had a cholecystectomy and 41 were poor surgical risks and did not have cholecystectomy. One patient had a tumour of the ampulla of Vater. ES has been performed as an emergency in 16 subjects because of severe septic cholangitis in 11 and acute biliary pancreatitis in 5. Of the 205 patients with choledocholithiasis, spontaneous passage of calculi after ES occurred in 151 cases (73.6 per cent), and instrumental extraction of stones was possible in 44 (21.5 per cent); 10 patients (4.9 per cent) had residual stones and required surgery. In this series the overall success rate of ES in removing common bile duct stones was 82 per cent in 238 cases; in the patients with benign papillary stenosis ES was successful in relieving symptoms and biochemical cholestasis in 72 per cent of 57 cases. Complications occurred in 18 cases (7 per cent): cholangitis in 4 (1.6 per cent) and haemorrhage in 14 (5.4 per cent). Two patients (0.8 per cent) with acute bleeding following ES died; in one of these surgery had been performed to arrest the haemorrhage, but the patient died 3 days after operation of hepatorenal failure. The other complications were treated conservatively without mortality.

Adult↗
PubMed1980

Neomycin and the combination of neomycin and bacitracin in the prevention of bacterial infection in surgery of the colon and/or rectum.

In two groups of patients submitted to surgery of the colon and/or rectum, treatment to prevent bacterial infections using a combination of 100 mg neomycin and 10,000 U bacitracin every 6 h for 48 h gave the same results as neomycin employed alone at a dosage of 500 mg every 6 h for 48 h. Results confirm the synergism of action between neomycin and bacitracin.

Adult↗