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Biomedical subjects

G Maggi

Publications and source records attributed to G Maggi.

At least 73 records · Page 4Linked to original sources
PubMed1995

Trigonocephaly associated with anterior basal meningocele. Case report.

Pathogenesis of craniosynostosis is poorly understood. Several different factors (primary fusion of a cranial vault suture, abnormal tensile forces acting on the cranial sutures, genetic control, fetal constraint) may be responsible for the malformation. Trigonocephaly is a relatively rare form of cranial malformation ranging from 5 to 20% of all the craniosynostotic syndromes. This form of craniosynostosis may be simple not associated with other cerebral defects or complex, associated with arhinencephaly and hypoplasia of frontal lobes; three gradations of malformation (marked, mild, incomplete) may be considered. A case of trigonocephaly associated with anterior basal meningocele is reported. The operative treatment and radiological findings are described. The pathogenetic role of the basal meningocele to determine the premature sutural fusion through tensile forces transmitted by abnormal dural attachments is evaluated.

Craniosynostoses↗
PubMed1994

Combined radiosurgical treatment of Pancoast tumor.

Operative technique and long-term results of 60 consecutive patients with Pancoast tumor treated with combined radiosurgical treatment were evaluated. External radiation therapy was administered preoperatively in a dose of 30 Gy in 50 patients. Operation was considered radical (R0) in 36 patients (60%). A microscopic invasion of the margin of resection (R1) was observed in 5 patients (8.3%). In 19 patients (31.6%) the operation was considered presumably not radical (R2). Three patients died in the postoperative period (5%). Fourteen major postoperative complications occurred in 13 patients (21%). Seven patients had recurrence of pain postoperatively. Overall 3- and 5-year actuarial survival rates were 34% and 17.4%, respectively. The corresponding figures for the R0 and combined R1-R2 groups were 45.8% and 23.5% (R0), and 11.4% (R1-R2; no 5-year survivors were observed in this group) (p < 0.025). Median survivals in the R0 and combined R1-R2 patients were 19 and 7 months, respectively. Different median survivals for the patients with residual tumor were as follows: intervertebral foramina, 5 months; subclavian artery (isolated), 9 months; subclavian artery (in association), 7 months; brachial plexus, 4 months; and vertebral body, 7 months. We conclude that combined radiosurgical treatment represents a valuable therapeutic option in the treatment of Pancoast tumor. In case of residual tumor a poor outcome may usually be anticipated, but in the majority of these patients the operation permits good control of the pain.

Adult↗
PubMed1994

Intramedullary haemorrhage due to AVM located within the medulla oblongata in a three year old child. Case report.

Intramedullary arteriovenous malformations are rare in childhood. Yasargil reports only two cases in children under ten years of age out of a total of forty-one cases of AVM operated on between 1967 and 1983 in which microsurgical techniques were used. The early symptoms of these lesions are those due to intramedullary or subarachnoid haemorrhage with neurological deficit, pain and/or weakness or numbness of one or more limbs. We report the case of an intramedullary haematoma due to arteriovenous malformation within the medulla oblongata in a three year old child admitted for cervical pain and right arm hypostenia. The CT scan and MRI showed an intramedullary expansive lesion with associated internal haematoma between C1-C7 level. Because of the rapid clinical deterioration upon the onset of right hemiparesis we procedeed to empty the intramedullary haematoma and to remove the intrabulbar AVM. A swift improvement of neurological deficit was observed along with a total regression of the symptomatology in a month's time. The excellent results reported in this case, very likely the only case in the literature occurring in a very small child at this spinal cord level, are mostly due to the early surgical treatment and to the exact information that MRI provided.

Child, Preschool↗
PubMed1994

[Askin's tumor in a young adult: a rare occurrence. Apropos one case observed].

Askin's tumour is a rare malignant small cell neoplasia of the thoracic wall; it most often effects females during childhood and is characterised by limited survival. The authors report a recent case of Askin's tumour in a young adult male. The case was characterised by multiple recidivation but a long survival. The authors discuss its diagnosis and treatment.

Adult↗
PubMed1994

Preoperative concurrent radiation therapy and cisplatinum continuous infusion in IIIa (N2) non small cell lung cancer. A pilot study.

From April 1991 to September 1993, 18 patients affected by a presumed operable IIIa (N2) non small cell lung cancer (NSCLC) with histologically confirmed bulky mediastinal metastases, received preoperative concurrent radiation therapy and continuous infusion of cisplatinum (CDDP). The radiotherapy consisted of 2 Gy given 5 days a week for a total dose of 50 Gy; CDDP was administered by means of a central catheter and a portable pump at the daily dose of 6 mg/m2 given on the same days as the radiation therapy (total dose: 150 mg/m2). Two weeks after the end of the treatment, the patients were reevaluated: 5 patients had either local or distant disease progression, the other 13 were submitted to thoracotomy: 12 received a complete resection and 1 patient underwent only a mediastinal lymphadenectomy, because pneumonectomy was impossible due to lack of respiratory function. No histological evidence of cancer cells was observed in the specimens of 6 patients (33%). Radiological response rate was 61% (11/18); resection rate was 66% (12/18) and complete resection rate was 61% (11/18). There was one postoperative death (5%). The 3 year actuarial survival rate is 63.6% for the patients who received a resection with a median survival time of 18 months. All non operated patients died within one year. Combined preoperative treatment was well tolerated. Better results were achieved in patients with squamous cell carcinoma who had a complete resection following a total tumor sterilization with radio-chemotherapy.

Actuarial Analysis↗
PubMed1994

Videothoracoscopy and video-assisted small thoracotomy for the treatment of pulmonary malignancies.

Video-assisted thoracic surgical procedures continue to be performed with increased frequency; the role of this new technique in the treatment of pulmonary malignancies or metastatic mediastinal adenopathies is not yet defined. Out of a series of 100 consecutive video-assisted thoracic operations, 22 patients resulted affected by a malignancy in the lung or in the subcarinal lymphnodes: six patients had a primary lung cancer and were operated with a video-assisted small thoracotomy of 5 cm (three lobectomy and three segmentectomy) because of a very poor respiratory reserve. Nine patients received a video-assisted wedge resection of a nodule resulted at the frozen section a metastasis of a carcinoma: a small thoracotomy of 8 cm was made and a hand entered the thoracic cage to obtain a careful palpation of the entire lung; five patients had enlarged lymphnodes only in posterior and inferior mediastinum, inaccessible by cervical mediastinoscopy or anterior mediastinotomy: thoracoscopic exploration obtained a useful mediastinal nodal sampling for these adenopathies. In selected cases video-assisted thoracic surgery can be used for resection or assessment of thoracic malignancies.

Biopsy↗
PubMed1994

Successful management of hemorrhage from the pulmonary artery stump after lobectomy for bronchogenic carcinoma.

Pulmonary bleeding from the arterial stump following lung resection is a life-threatening complication requiring immediate surgical correction. Predisposing conditions are almost always represented by bronchopleural fistula and empyema. The operation often represents a major challenge to the thoracic surgeon, because of the choice of the most appropriate surgical access, the optimal technique to control the bleeding, as well as to treat the associated bronchopleural fistula. We present a case of successful treatment of hemorrhage from the pulmonary artery stump associated with BPF and empyema following lobectomy for bronchogenic carcinoma. A standard postero-lateral thoracotomy using the previous incision was used with adequate exposure of the source of bleeding and the bronchopleural fistula.

Aged↗
PubMed1994

[Moderate cardiac failure: oxygen consumption during exercise predicts ultrafiltration results].

Extracorporeal ultrafiltration (UF) can improve the clinical condition, as assessed by cardiopulmonary exercise evaluation, of patients with moderate heart failure (HF); the pre-UF level of physical performance above which UF does not induce clinical benefits, is not defined. For this purpose, we studied 29 patients with stable HF in functional class II-III (NYHA), who underwent UF (veno-venous bypass, removal of 1,830 +/- 550 ml of plasma water), regardless their baseline oxygen consumption at peak exercise (VO2p) and at anaerobic threshold (VO2AT). All patients experienced cardiopulmonary exercise tests (cycloergometer, increasing workloads of 25 W every 3 min) before (pre-UF), and 4 days and 3 months following UF. According to VO2 changes following UF 2 groups of patients were identified: in Group I (9 patients) no differences in VO2p and VO2AT were observed, while in Group II (18 patients) VO2p rose by 2.7 ml/min/kg (p < 0.001) at 4 days and 4.5 ml/min/kg (p = 0.04) at 3 months, and VO2AT rose by 1.2 ml/min/kg (p < 0.001) at 4 days and 2.8 ml/min/kg (p = 0.03) at 3 months. In unresponsive patients baseline values of VO2p > or = 18 ml/min/kg and VO2AT +/- 13 ml/min/kg were detected. Pre-UF VO2p inversely correlated with the shift of VO2p (delta VO2p) both at 4 days (r = -0.62, p < 0.001) and at 3 months (r = -0.53, p = 0.005), and pre-UF VO2AT inversely correlated with delta VO2AT at 4 days (r = -0.71, p < 0.001) and at 3 months (r = -0.63, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Bronchial sleeve resection distal to the main bronchi with complete pulmonary preservation. Report on three successful cases.

Three successful cases of low grade malignant bronchial tumors resected by means of a bronchial sleeve resection distal to the main bronchi with complete pulmonary preservation are presented. Reconstruction of the bronchial tree was accomplished by suturing together the distal lobar bronchi and then anastomosing the double-barrel suture to the proximal residual bronchus. All patients presented excellent results, although in one patient postoperative course was complicated by persistent mucopurulent secretions. Bronchial sleeve resection distal to the main bronchi can be successfully performed for benign or low-grade malignant bronchial tumors. Technically, the operation is more complex than standard sleeve resection of the main bronchus and requires an experienced team. Postoperatively, an increased morbidity rate, mostly represented by secretions retention, may usually be anticipated, necessitating an aggressive medical and bronchoscopic management.

Adult↗
PubMed1993

Computer-assisted diagnosis of postmenopausal osteoporosis using a fuzzy expert system shell.

This paper shows how the AMDIS (Automated Medical Diagnosis with Intelligent Systems) integrated system can be employed to build a fuzzy medical expert system in the domain of postmenopausal osteoporosis. The fundamental aims of the expert system are to standardize knowledge and support physicians in the early detection of postmenopausal osteoporosis. A wide range of diagnostic situations has been considered for both categories of the disease, with judgments that range from disease is excluded to disease is definite. The salient aspects of the approach are the use of fuzzy logic as an analytic language for the representation and manipulation of knowledge and strategies and the integration of structured interview techniques and learning-by-example to address the knowledge acquisition task.

Adult↗
PubMed1993

Bronchoplastic and angioplastic techniques in the treatment of bronchogenic carcinoma.

From 1979 to 1991, 51 bronchoplasties, 18 angioplasties, and 4 combined broncho-angioplasties were performed for bronchogenic carcinoma. Sixteen patients underwent operation because of compromised pulmonary function; bronchoplasty, angioplasty, or the combined procedure was performed in the remaining 57 patients because of a suitable anatomic location of the neoplasm. Twenty-four patients had stage I disease, 32 stage II, and 17 stage IIIa. Three patients died postoperatively (3.65%). Major postoperative complications occurred in 20 patients (27.3%) (10 early, and 10 late). A completion pneumonectomy was required in 4 patients (5.4%), 2 for anastomotic stricture, 1 because of vascular thrombosis after angioplasty, and 1 for local recurrence after angioplasty. Three-year and 5-year survival rates for the entire group were 55.4% and 40.8%, respectively. One-year and 3-year survival rates after angioplasty were 78.6% and 31.4%. Of the 4 patients who underwent a combined bronchoangioplastic procedure, 1 died after 23 months and 3 are alive and well after 11, 15, and 20 months. Survival was more favorable in the combined N0-N1 group (62% and 43.1%) than in the N2 group (23.4%), but the difference was not significant (p < 0.2). Three-year survival after angioplasty was found to be lower than, although not significantly different from, the overall 3-year survival rate (31.4% versus 55.4%; p = not significant). No statistically significant differences were found among survival rates of patients with compromised and noncompromised pulmonary reserve. We conclude that bronchoplastic and angioplastic procedures are valid techniques as curative operations in carefully selected patients with bronchogenic carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty↗
PubMed1993

Morphological and structural characteristics of the myopathic bone.

The aim of the present paper was to study the myopathic bone both from the morphological and structural viewpoints. To this end, samples from 8 patients affected by different neuromuscular diseases (DMD, SMA and CMD) have been examined. Thus, by SEM analysis a quantitative reduction of the trabeculae and an increase in porosity of the myopathic bone were found and also, by diffractometric analysis, the presence of pathologic crystalline phases (beta-TCP and beta-TCP-Mg).

Adolescent↗
PubMed1993

Thermodynamical aspects of the polymerization reaction of PMMA cement mixed with phosphatic mineral phases.

The main problem related to the use of polymeric cement in orthopaedics is the high temperature reached during the polymerization, causing necrosis. This paper reports a thermodynamical study of the polymerization reaction of an acrylic cement mixed with powdered phosphatic phases. In particular, mixing of alpha-tricalciumphosphate, beta-tricalciumphosphate and hydroxyapatite was proposed. Important preliminary results indicated that amounts of about 66% by weight of alpha-tricalciumphosphate reduced the polymerization temperature to about 58 degrees C in respect to 100 degrees C of pure acrylic cement. In addition, a special chamber was designed and realized to monitor the temperature variations involved during the polymerization reaction of the different mixtures.

Bone Cements↗
PubMed1992

Aggressive treatment of intrathoracic recurrences of thymoma.

Between 1974 and 1988, 21 patients with intrathoracic recurrences of thymoma received radiotherapy with radical intent; surgery was always attempted when considered feasible: 11 patients were partially (6 cases) or totally (5 cases) resected before irradiation, while in the other 10 radiotherapy was the only treatment. In 7 cases the recurrence was confined to the anterior mediastinum, 9 had pleural nodules without mediastinal lesions and 5 had both mediastinal and pleural lesions. Mediastinal recurrences were treated by opposed parallel mediastinal fields with 2/3 of the dose delivered through the anterior port: doses ranged between 38 and 44 Gy; a boost of 10-16 Gy was given in patients not radically resected. Pleural nodules were treated with a variety of techniques according to the extent of the lesions. The 7-year survival of the whole group was 70%; 5 patients died: 4 with intrathoracic progression and one with distant metastases. The survival was 74% in the 11 patients having received surgery, either radical or subtotal, and 65% in the 10 patients treated with radiotherapy alone: the difference is not significant. Patients with Karnofsky index greater than 70 had a significantly better survival (100%, versus 28%, p = 0.0015). This is a selected series of patients presenting recurrences still amenable to a radical treatment either by surgery and radiotherapy or by radiotherapy alone: the results confirm that an aggressive approach is warranted in patients in good general conditions with recurrences confined to the mediastinum and/or 1 hemithorax.

Adult↗