Biomedical subjects

E M Bortolani

Publications and source records attributed to E M Bortolani.

At least 19 recordsLinked to original sources

PubMed2000

[Type "A" aortic dissection. Surgical technique, caseload, and follow-up].

BACKGROUND: The authors analyse the indications for the various surgical strategies through a retrospective study of the morbility and mortality rates in their own series of cases and during follow-up. METHODS: 107 patients were operated for type A aortic dissection between 1978 and 1998: 69 using a technique performed under moderate hypothermia (Group A) and 38 in deep hypothermia (Group B). All patients who survived from 1978 to 1994 underwent an accurate follow-up. RESULTS: The mortality rate in Group A was 21.7% and 26.3% in Group B. 61.9% patients in Group B presented thrombosis of the false lumen, compared to 30.6% in Group A. Patients with a false perfused lumen underwent re-do surgery in 9.5% compared to 3.5% in those with thrombosed false lumen, and 16.6% showed an aortic dilatation rate of over 5 cm compared to 7.1%. CONCLUSIONS: From an analysis of these data, and in line with the data reported in the literature, although it is impossible lo indicate an ideal surgical strategy for this severe pathology, it is extremely important to achieve thrombosis of the false lumen.

Aortic Dissection↗

PubMed2000

[Gastrointestinal stromal tumors (GIST). Our experience].

Nine cases of gastrointestinal stromal tumors (GISTs) observed in the period between 1993 and 1999 and treated with radical surgery are presented. Patients were studied with instrumental examinations (ultrasonography, TC, EGDS, RSCS, endoscopic ultra-sound) which permitted to make a temporary diagnosis of "suspect gastric or bowel neoplasm". Only after surgical resection of the neoplasm it was possible to make a definitive diagnosis, based on histologic examination of the operating piece. According to personal experience and literature data, we could affirm that GISTs' clinical manifestations are extremely heterogeneous and so these tumors are often diagnosed casually. Prognosis isn't correlated as much to neoplasm histologic and cytologic characteristics, as to next organs infiltration, which represents a sign of particular aggressiveness of lesions.

Adult↗

PubMed1999

[Primary hyperparathyroidism and acute pancreatitis. A rare clinical association].

Hyperparathyroidism and hypercalcaemia are considered to be a rare cause of acute pancreatitis. The relationship between hyperparathyroidism and pancreatic inflammatory disease remains controversial, but it may be related to the translation from inactive to active trypsinogen by hypercalcaemia. Surgical correction of parathyroid disease and normalization of serum calcium levels may ameliorate the acute pancreatitis. Also the mechanism of pathologic zymogen activation during acute pancreatitis remain unknown; probably the pancreatic "autodigestion" is the result of anomalous intracellular transport of secretory proteins activated by lysosomal hydrolases. A case of acute pancreatitis and hyperparathyroidism due to solitary parathyroid adenoma occurred in a 66-years-old woman is reported. After the excision of parathyroid adenoma the serum calcium levels and the function of the pancreas returned to normal. This suggests a cause and effect relationship between hyperparathyroidism and acute pancreatitis.

Acute Disease↗

PubMed1999

[Primary retroperitoneal tumors. Treatment modality and prognostic factors].

BACKGROUND: Primary Retroperitoneal Tumors (PRT) form a heterogeneous group of malignant mesenchymal and neuroectodermal neoplasms making up only 1% of all solid neoplasms. METHODS: From 1965 to 1997, 27 patients (16 females and 9 males, age range 19-79 years) underwent operations at the General and Cardiovascular Institute of University of Milan for primary retroperitoneal tumors (22 malignant and 5 benign, sarcomas represented 68% of all malignant tumors). A retrospective analysis of these patients was performed to determine the prognostic parameters associated with a favourable prognosis. All patients were admitted with severe abdominal pain or a palpable mass, other symptoms included fewer and weight loss. The median duration of symptoms before presentation was 16 months (range 15 days-5 years). Before surgical treatment abdominal and pulmonary CT scanning and MRN were undertaken on all patients with PRT to define the size of the tumor and the involvement of other retroperitoneal structures. RESULTS: Complete resection was possible in 54% of malignant tumors (n = 12), incomplete resection was performed in 14% (n = 3) and in 31% (n = 7) only biopsy was possible. Recurrent tumor developed in 25% of patients with total resection (n = 3), (median time to recurrence 5 years). Independent treatment variables (size, signs and symptoms, histopathologic findings and grade) and treatment-dependent variables (type of surgical treatment and adjuvant chemotherapy) were analyzed. Patients with complete resection had a 12 month survival of 100% (n = 12) compared to 50% (n = 1) for those undergoing partial resection and 14.2% (n = 1) for those with simple biopsy. A 24-month survival of the patients undergoing complete resection was 25% (n = 3). Median survival for type of surgical treatment was 28 months for complete resection compared to 14 months for partial resection and only 8 months for biopsy. Twelve-months survival for tumor grade was 100% (n = 7) for low grade tumor (G1), compared to 66.6% (n = 4) for median differentiated tumors (G2), and 37.5% (n = 3) for high grade tumors (G3). Twenty-four-months survival was 28.5% (n = 2) for low grade tumors compared to 16.6% (n = 1) of median differentiated tumors. High grade tumors were associated with a 35-month median survival time compared to 17 months for median differentiated tumors and 10 months for low grade tumors. Other variables (histopathologic findings, size, symptoms) had not significant impact on survival. Operative mortality rate was 3.7% (n = 1). The overall 2 years survival rate in patients with totally resected tumors was 25% (n = 3), (2G1, 1G2), while the 5 year survival rate was 16.6% (n = 2), (2G1). CONCLUSIONS: Complete surgical excision and low grade of the tumor are the most important parameters of survival. Recurrent disease is a vexing problem; a careful and prolonged follow-up based on the use of CT and MRN is recommended.

Adult↗

PubMed1998

[Adrenal carcinoma. Clinical and anatomopathological prognostic factors].

We performed on 9 patients with adrenal cortical carcinoma a retrospective study during 1967-1995 to evaluate the most important prognostic factors. Four patients were males and five females (mean age: 40.3 years). Five patients had endocrine symptoms (55%) and four had "non-functioning" tumors (45%). The tumor involved the left adrenal gland in 5 cases and the right in 4. The mean diameter of the neoplasm was 9.5 cm, with a mean weight of 411 g. The average duration of symptoms before diagnosis was 7.3 months. One patient had invasion of the inferior vena cava with liver metastases. Eight patients underwent curative surgery, the median survival time was 13.7 months, only 1 patient is alive after 18 months from surgical resection. We concluded that adrenal carcinomas have poor prognosis; staging and grading of the neoplasm, and age of the patient at diagnosis are predictors of survival.

Adolescent↗

PubMed1998

[Long-term results of radical lumbar ganglionectomy. Our experience].

We present our experience of 15 patients operated on by lumbar sympathectomies between 1987-1993, to confirm the effective and permanent efficacy of sympathectomy in peripheral vascular disease of the lower limbs. The patients, 9 men and 6 women (age 58-86) presented with rest pain (12), and minimal toe lesions (3). After an eco color-Doppler and angiography of the lower limbs, a radical operative sympathectomy (L2-L5) was performed in all patients. Associated diseases were: ischemic cardiopathy (61.7%), renal failure (25%), diabetic disease (61.7%), carotid stenosis (25%), abdominal aortic aneurysm (12%). In four patients, was performed during the same surgical time, 2 abdominal aortic aneurysm repairs, and 2 aorto-bifemoral bypasses. No patients died, operative morbidity was 12.5% (2 cases). The clinical and instrumental follow-up performed on 6 patients (38.3%) after 3 years, demonstrated in all cases the regression of the rest pain (12 patients) and the healing of the toe lesions (3 diabetic patients). Our results confirm the efficacy of sympathectomy especially when performed in young patients. The small number of diabetic patients in our study made statistical evaluation difficult, but it is generally considered that the results are worse in diabetic patients, because the microvascular lesions in these patients reduce peripheral vasodilatation.

Aged↗

PubMed1998

[Infection prophylaxis in cardiovascular surgery].

MATERIALS AND METHODS: In the period 1986-1994, 2950 patients with cardiovascular diseases were surgically treated. In 2104 cases we placed biological or synthetic grafts to maintain vascular continuity. The most common has turned out to be abdominal aortic aneurysm. We treated 783 cases in emergency conditions. Staging and localization of infection has been the first aim in patients with synthetic vascular grafts. We studied signs and symptoms related to infections. In all cases we discovered the microorganism responsible of infection we started antibiotic therapy. RESULTS: Surgical infection incidence is 4.9% (154 cases). Series analysis has evidenced a decrease in infection incidence in the period 1986-1994. The most frequent infections are: the urinary tract infection (59 cases, 38.5%) followed by surgical wound infection (37 cases, 24.1%), respiratory tract infection (27 cases, 17.5%), vascular graft infection (23 cases, 14.4%). All patients underwent a preoperative antibiotic prophylaxis with 2 degrees-3 degrees generation cephalosporines. We noted a higher graft infection incidence in patients treated with aortobifemoral reconstruction. We handled surgical infection following two main directions: 1-antibiotic therapy, 2-surgical treatment and antibiotic therapy. CONCLUSIONS: We noted surgical technique improvement and correct application of an antibiotic prophylaxis form has turned out to be the "gold standard" in order to reduce cardiovascular surgical infections. To reduce sepsis or graft infection we can work on either of the following: 1) antibiotic therapy; 2) operative time reduction; 3) try to limit vascular surgery in case of concomitant gastrointestinal surgical disease; 4) using alloplastic vascular grafts with high biological compliance; 5) patency time reduction of invasive diagnostic technique.

Antibiotic Prophylaxis↗

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↗

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

[Hemostatic factors of endothelial origin in major vascular pathology].

There is an altered hemostatic balance in vascular-based diseases. The aim of this study was to compare a group (no. = 38) of vascular patients (aortic aneurysm, carotid obstructions arteriopathies of lower limbs) and a control group (no. = 40) and assess variations in the following endothelial factors: tPA, PAI1, vWf, fibronectin and dimer D, in differentiated degrees according to the type of pathology. These were the indicative signs of endothelial mobilization resulting in the renewed continuity of the stratum with the formation of a hemostatic plug. vWf was found to be particularly significant as a marker of an ongoing atheromasic process and its extension to various vascular districts.

Adult↗

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↗

PubMed1992

[Surgery of the carotid: the morphology of plaque and the clinical correlations].

A consecutive series of 256 patients operated on of carotid endarterectomy for cerebrovascular atherosclerotic disease from January 1987 through December 1990 is presented. The following parameters were considered: clinical presentation, morphology of the carotid atherosclerotic plaque and topographic distribution of other concomitant atherosclerotic lesions of epiaortic arteries. 422 carotid lesions and 154 lesions of other epiaortic vessels were investigated by means of echo and color flow imaging, digital subtraction angiography and macroscopic observation of the specimen: 143 plaques proved grossly ulcerated. Unilateral lesions were 90 (35.2%) while bilateral disease was present in 166 cases (64.8%): 38.8% of subjects out of the first group and 30.2% out of the second were asymptomatic. Anterior and posterior neurological symptoms were equally distributed among both the 116 (69.8%) symptomatic subjects harboring bilateral lesions and the 55 (61.1%) symptomatic subjects with unilateral lesion (anterior 78.4% and posterior 21.6% for bilateral and 78.2% and 21.8% respectively for unilateral lesions). According to the degree of stenosis, the lesions were divided into three main groups: < 50%; 50-70%; > 70%. As the degree of stenosis increased, the incidence of focal symptoms increased too; moreover, the presence of ulceration of the stenosing plaque carried an increase in the incidence of focal symptoms within each group: respectively from 7.8% to 30% (< 50%), from 18.6% to 53.8% (50-70%), from 27.7% to 55.6% (> 70%). This study supports the relationship of morphological characteristics of the stenosing atherosclerotic plaques of the internal carotid artery to neurological symptomatology.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

[Paraganglioma of the neck. Analysis of 32 operated cases].

Between january 1965 and november 1990, 32 operations for neck paraganglioma were performed: 29 chemodectomas (carotid body tumors) and 3 paragangliomas of the vagus nerve. Seven subjects were affected with bilateral chemodectomas and one of them showed concurrent unilateral vagal paraganglioma. Two paragangliomas were malignant, with invasion of the latero-cervical lymphnodes revealed at operation. Four individuals came to observation from two different families, suggesting familiarity. Preoperative diagnosis was correctly made in 12 of 18 asymptomatic chemodectomas (66.6%), ten of whom observed during the last decade: angiography is the gold standard for diagnosis but CT scan, ultrasound and NMR imaging are going to earn the confidence of physicians for precise evaluation of latero-cervical masses. Surgery is to date the treatment of choice, and the results are dependent on the size of the tumor and the involvement of the neighbouring vascular, nervous and visceral structures. According to the majority of the literature, the 29 chemodectomas were classified in the three groups of Shamblin: I: 4 cases; II: 10; III: 15. Twenty out of the 24 transient or permanent postoperative complications took place in the third group: in five instances some procedures of internal carotid artery reconstruction were needed. Fourteen complications for chemodectomas and 2 for vagal paragangliomas affected the cranial nerves; three transient and one permanent ischemic central neurological deficits occurred in the group III chemodectomas. Not any operative mortality was registered in this series.

Adult↗

PubMed1991

[The surgical prevention of pulmonary embolism. Comments on 100 patients treated by different methods].

A series of 100 patients suffering from deep venous thrombosis with prior episodes of pulmonary embolism or ilio-caval floating thrombi, submitted to surgery for the prevention of new embolic episodes, is analysed. Indications are discussed together with the various prevention techniques adopted over the past 5 years. Special attention is paid to the analysis of 11 patients operated on in the last 2 years by thrombectomy of the infra- and suprarenal vena cava.

Adolescent↗

PubMed1991

[Thrombectomy of the infra- and suprarenal cava to prevent pulmonary embolism in the presence of deep venous thrombosis. Personal experience with 11 surgically-treated cases].

DVT is a fairly frequent event and often fails to be recognised. Its main complication, pulmonary embolism, is the third cause of death in Italy with more than 70,000 deaths per annum. In the presence of infra- and suprarenal floating thrombi, cases in which the application of neither intraluminal nor extraluminal filters is indicated, the treatment of choice is thrombectomy with direct surgical access to the cava. Personal experience of 11 patients operated in the past 16 months with excellent surgical success is analysed. The indications and surgical techniques adopted are described.

Adult↗

PubMed1990

[Latero-lateral choledochoduodenostomy in benign pathology of the common bile duct. A prospective study].

Biliodigestive derivations for benign diseases of the biliary tract are currently accepted in case of extended to recurrent choledochal stenosis, excessive dilation of the choledochus, impacted ampullary stones. This paper concerns 19 subjects that underwent laterolateral choledochoduodenostomy (CDS) according to the Roesner technique over the period January 1986 through December 1987 in order to evaluate long-term functional results of this operation. Hepatic serum enzymes and bilirubin were determined at intervals of two weeks during the first three months and of four weeks until the sixth month postoperatively. At this time a battery of controls was performed, namely standard plain X-ray of the abdomen, hepatobiliary sequential scintigraphy with HIDA, endoscopic examination of the anastomosis. The level of serum enzymes was then determined at 18 months postoperatively and scintigraphy was repeated as well. Based on the results of this study and the review of the recent literature, our opinion is that CDS has shown as a safe procedure with good long-term results in the treatment of benign disease of the biliary tract, mostly if high-risk aged subjects are concerned.

Aged↗

PubMed1990

[Use of a new anti-inflammatory drug in the treatment of varicophlebitis of the lower limbs].

The paper reports the results obtained in 20 patients affected by varicophlebitis of the lower limbs following the oral administration of an anti-inflammatory substance. Results were compared with findings in single-blind study performed in a group of 20 patients treated with placebo. The evaluation of residual signs and symptoms and the control of recanalization of venous collectors using Doppler tests revealed a difference between the two groups in favour of the patients treated with the anti-inflammatory agent, although this was not statistically significant. The use of the drug was considered useful as a support to conservative varicophlebitis therapy with the aim of accelerating the resolution of the inflamed condition and thus reducing the functional disability of the limb.

Administration, Oral↗