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M Montanari

Publications and source records attributed to M Montanari.

At least 19 recordsLinked to original sources
PubMed1990

Malignant lymphoma involving the mandible. Clinical, morphologic, and immunohistochemical study of 17 cases.

We present 17 cases of non-Hodgkin's lymphoma of the mandible, collected over a span of 10 years. Clinically, the patients showed a male:female ratio of 1:2.4 and a mean age of 60.6 years. Swelling was the most common symptom. In 11 of 17 patients, the disease presented in stage I. Radiotherapy alone was employed in 11 patients, in conjunction with chemotherapy in 5 patients, and was preceded by surgery in the remaining case. At this writing ten of the subjects are still alive, five died following progression of the disease, and two were lost during follow-up while in complete remission. Histopathology revealed 15 B-cell lymphomas (1 centroblastic/centrocytic, nine centroblastic, one Burkitt's, two immunoblastic, and two lymphoblastic) and two peripheral T-cell lymphomas (pleomorphic). The above diagnoses were confirmed by immunohistochemical analysis with a wide panel of reagents against fixative-resistant molecules. Our data suggest that (a) lymphomas of the mandible are principally represented by high-grade B-cell varieties (88%); (b) primitive T-cell lymphomas (here documented for the first time) have the same incidence in the mandible as they have in lymph nodes; and (c) immunohistochemistry, besides confirming histogenetic interpretations based on morphologic findings, provides the key to the differential diagnosis from malignant large-cell nonlymphoid tumors.

Adult↗
PubMed1989

Automated selection of high-risk patients with acute pancreatitis.

One hundred six early features were retrospectively collected on 44 patients with acute pancreatitis and stored in a database programmed on a microcomputer. Intraoperative/autopsy findings or clinical course categorized patients as having severe (n = 16) or mild (n = 28) pancreatitis. The frequency of 88 early available variables was analyzed. Twenty significant differences were found and used to program a Bayesian prediction of severity, assuming their independence. The computer's performance was assessed by retrospective testing of the patients, and a further 47 (14 severe, 33 mild) were studied prospectively, with a comparison carried out involving the unaided prediction of the clinicians. Finally, all 91 patients were retrospectively tested with the early predictive Ranson's signs and the results were compared with the computer's output. In the prospective evaluation, the computer's performance was 89.4% accuracy, 100% sensitivity, 84.8% specificity, while that of the physicians was 65.9%, 71.4%, 63.6%, respectively, like the performances of Ranson's criteria. Methodologic problems were: selecting patients to study, based on wide inclusion and exclusion in hindsight of the false-positives; dividing them into groups, based on both pathologic and clinical criteria; and the assumption of independence within the variables. The use of the procedure in other populations requires a specific analysis of the discriminant variables, but this study suggests a method to compare several samples of patients which allows prospective and controlled clinical trials.

Acute Disease↗
PubMed1989

Histology and immunohistology of bone marrow biopsy in multiple myeloma.

B5-fixed/paraffin-embedded Jamshidi needle biopsies from 125 multiple myeloma patients were reviewed according to both morphological and immunohistological criteria. At microscopic examination, the following parameters were evaluated: i) grade of malignancy (low = 56; intermediate = 50; high = 19); ii) growth pattern (interstitial +/- sheets/nodules = 90; nodular = 13; packed marrow = 18; sarcomatous = 4); III) histological stage (I = 64; II = 35; III = 26). Comparison of the findings in trephine biopsies and aspirates showed that in 30% of the cases the latter led to an underestimation of the tumor burden. Immunohistochemical determination of Ig easily allowed: i) differential diagnosis from exuberant reactive plasmacytosis; ii) recognition and counting of neoplastic plasma cells; iii) detection of minimal residual disease after treatment. Immunohistochemistry also confirmed phenotypic aberration of neoplastic plasma cells, showing positivity for CD45, EMA, and cytokeratins in 14%, 59%, and 25% of the cases, respectively. Furthermore, it displayed expression of the P-glycoprotein in 4/8 resistant cases. These findings underline that routinely processed Jamshidi needle biopsies can be of great value in the study of patients with multiple myeloma.

Acute Disease↗
PubMed1989

Telethermographic evaluation of NSAIDs in the treatment of sports injuries.

In a multicenter double-blind clinical trial, forty-five athletes, 39 males and 6 females, mean age 20.87 yr (SD 4.48), affected by sports injuries were treated with diclofenac, suprofen, or placebo, orally administered for a period of 1 wk. An objective examination like telethermography was performed with the clinical evaluations (pain on movement or at pressure, motility, and swelling) before and after the treatment period, in all patients. Moreover, at the end of the trial both investigator and patient gave their global judgement of efficacy. The statistical analysis showed a significant superiority of diclofenac sodium versus suprofen and placebo both in patients' and in investigators' global evaluations (P less than 0.05--Kruskal-Wallis tests). This superiority appeared particularly clear in the telethermographic evaluation (P less than 0.05), which is more objective than the clinical one, attesting to the usefulness of the early administration of anti-inflammatory drugs in management of sports injuries. Furthermore, a correlation analysis showed that telethermography is a good technique in controlling the recovery process.

Adult↗
PubMed1989

[Clinical implications of the infiltration level of early gastric cancer].

Sixty-nine cases of early gastric cancer (EGC) were taken into consideration, out of a series of 585 operations for gastric cancer, carried out between January 1976 and June 1988. Differences between two groups (I: EGC limited to the mucosa; II: EGC with invasion of both the mucosa and submucosa) have been assessed with reference to familiarity for gastric cancer, previous gastric and duodenal pathology, symptoms, site of the lesion, histological features, lymph node metastatic involvement and results. Despite some pathological and clinical differences, modification of current surgical treatment with endoscopic management is not justified by any features, even when dealing with intramucosal, intestinal type EGC, because of possible lymph node involvement or long-term recurrences.

Aged↗
PubMed1988

Age and blood pressure changes. A 20-year follow-up study in nuns in a secluded order.

In a prospective study, 144 white nuns belonging to a secluded monastic order and 138 white control laywomen were followed for 20 years to investigate whether living for a long time in a stress-free environment influences the effect of aging on blood pressure. Silence, meditation, and isolation from society are the distinctive features of the life-style examined. At study entry, blood pressure was not dissimilar in the nuns and the control group, but it increased over time only in the controls, with a mean slope of the regression line (beta coefficient) of 0.089 in the nuns (NS) and 2.171 in the controls (p less than 0.0001) for systolic blood pressure and of 0.054 in the nuns (NS) and 0.742 in the controls (p less than 0.0001) for diastolic blood pressure. Weight and body mass index increased similarly over time in the two groups. Family history of hypertension was not dissimilar between the groups. Serum cholesterol and triglycerides, higher at study entry in the nuns, increased similarly over time in the two groups. Twenty-four-hour urinary sodium excretion, collected randomly in both groups, did not differ over time between nuns and controls. None of the women smoked or used oral contraceptives. Educational level was higher in the control group, but subgroups of 48 nuns and 52 laywomen of comparable educational level maintained the same difference in the blood pressure trend over time as in the main cohort. Parity affected the increase of systolic, but not of diastolic, blood pressure with age among the laywomen, but nuns and no-childbirth controls maintained a significantly different blood pressure trend over time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Slow-release metoprolol and nifedipine in essential hypertension: 24 hour noninvasive ambulatory blood pressure monitoring.

To assess the efficacy and tolerability of metoprolol (MET), 200 mg slow release (SR) q.d., and nifedipine (NIF), 20 mg SR b.i.d., 20 mildly to moderately hypertensive outpatients (14 men and 6 women; mean age 41.5 years, range 27-49 years) were studied. After being withdrawn from previous antihypertensive treatments, the patients were given single-blind placebo for 2 weeks and thereafter, in double-blind, randomized sequence, MET and NIF, both for 2 weeks. At the end of each period of the study, blood pressure (BP) was recorded for 24 h using a noninvasive ambulatory BP monitoring device (ICR System) with readings taken every 10 min (from 6 a.m. to 6 p.m.), 15 min (from 6 to 12 p.m.), and 20 min (from 12 p.m. to 6 a.m.). Five patients did not complete the study because of the occurrence of unwanted effects (one patient on MET and four patients on NIF). In the 15 patients who concluded the study both drugs significantly reduced (p less than 0.01), in comparison with placebo, systolic BP (SBP), mean arterial pressure (MAP), and diastolic BP (DBP) throughout the 24 h (MET: -16.9, -11.5, and -8.9 mm Hg; NIF: -12.7, -8.4, and -6.6 mm Hg, respectively). In comparison with NIF, SBP and MAP but not DBP were significantly reduced by MET (p less than 0.01 and p less than 0.05, respectively). We conclude that in our patient population MET was more effective and better tolerated than NIF. A possible explanation could be the relatively young age of the subjects we studied.

Adult↗
PubMed1986

Effect of perioperative somatostatin administration of sphincteroplasty-induced increase of amylase.

Twenty patients undergoing sphincteroplasty for cholelithiasis were randomly divided into two groups of 10. The former (T) were treated with a 4-h somatostatin intravenous drip (250 micrograms/h), started at the beginning of operation, while the latter (C) made up the control group. Serum and urine amylase, amylase creatinine clearance ratio, and liver function tests were assessed for 2 days before surgery, after the operation and for a period of 5 postoperative days. Homogeneity between the two series was verified in experimental conditions. Statistical differences occurred postoperatively in amylase creatinine clearance ratio, which proved higher in C group, and gamma-GT, which was higher in T group. Short-term somatostatin administration proved effective in reducing the postoperative amylase creatinine clearance ratio, although more evident results are reported after long-term administration. Cholestasis or any serious impairment in liver function did not occur, suggesting the suitability of somatostatin use even in patients with jaundice. Since a relationship between postoperative amylase levels and risk of pancreatitis has not yet been proved, the value of somatostatin in the prevention of postoperative pancreatitis after sphincteroplasty needs to be further verified.

Aged↗
PubMed1985

[Colon-rectal anastomosis with mechanical sutures (personal experience in 96 cases)].

From 1 October 1981 to 30 September 1985 ninety-six patients underwent colorectal resection with EEA Auto-suture stapled anastomosis for cancer or diverticula. As compared with manual suture, the mechanical procedure involved some technical problems and peroperative drawbacks (partial leakage, hemorrhage), which decreased after the initial phase of our experience. The EEA Stapler proved a reliable and useful procedure, especially in low colo-rectal anastomoses, which present a higher risk of leakage, owing to difficulties with manual technique. Clinical or x-ray fistulas occurred in four patients after colon-to-colon (5.8%) and were six following colorectal anastomoses (22.2%). Only in three cases a colostomy was necessary. In spite of suitability of the mechanical procedure, a colostomy was carried out to protect low colo-rectal anastomoses, when general risk factors were present or when the suture was improperly performed or transection circles were incomplete. The introduction of the EEA Stapler allowed for a higher number of anterior resection of the rectum, with a corresponding decrease of abdominoperineal procedures, and promoted a more extensive indication to palliative anterior resection. It is still a matter of concern whether the high number of anterior resections would be followed by an increased local recurrence rate, in consideration that radicality depends on a wide exeresis with a complete lymphoadenectomy.

Aged↗
PubMedDate not supplied

[Present position of non-shunt surgery for bleeding oesophageal varices (author's transl)].

This is a critical retrospective study of a homogeneous group of 24 patients with hepatic cirrhosis and portal hypertension who underwent emergency surgery for bleeding oesophageal varices. The adopted procedure was the porta-azygos disconnection, according to Torres-Degni, with or without splenectomy. The criterion derived from the need to stop bleeding, from contraindications to a portal-systemic shunt, or from other situations which are illustrated. The difficulty of selecting in these cases the appropriate surgery and the high operative death rate (46%) is commented. In survivors, the long-term outcome depends on the progress of the underlying liver disease.

Adult↗
PubMedDate not supplied

[Further comments on changes in hepatic function after interposition meso-caval shunt (author's transl)].

Further to a previous paper, the Authors followed up ten cirrhotic patients who had all undergone meso-caval shunt with Dacron prosthesis, for ascites or haemorrhage, Functional and anzymatic investigations were carried on over periods up to 10 months. No constant changes in hepatic function parameters were found during the post-operative period, compared to those before surgery. This observation suggests that these investigations might be more useful in defining liver disease than in practical assessment of transient, post-operative liver failure.

Adult↗
PubMedDate not supplied

[Neuroleptic malignant syndrome and related conditions].

Neuroleptic malignant syndrome is characterised by muscular rigidity, fever and signs of severe vegetative nervous system involvement. Its etiopathogenesis is still unclear and the disease is potentially fatal. Its clinical aspects, which are often only partially manifested, make it difficult to formulate a correct diagnosis in time, not least due to the problem of differential diagnosis with other syndromes with similar symptoms but a different pathogenesis, psychopathology and therapy: acute lethal catatonia, fatal acute delirium, heat-stroke, malignant hyperthermia. The speed of the diagnosis is vital for effective therapy, but this is made even more difficult by the need approach. The paper presents eleven case studies; after an analysis of the numerous clinical aspects of the syndrome and the definition of its diagnostic parameters, an appropriate therapeutic protocol is outlined. Lastly, the problem of retreatment using a neuroleptic of the same or a different class is discussed once the acute phase has been overcome.

Amantadine↗
PubMedDate not supplied

[Dynamic psychopathology for a unified approach to psychogenic eating disorders].

The paper focuses on psychopathological problems relating to psychogenic dietary disorders. Using a psychodynamic approach, the Authors hypothesise the existence of a structural "continuum" which links these diseases to the contexts of either exaggerated food consumption or reduced or insufficient food intake. The discussion in centered on the dynamic-genetic aspect, also taking into account intermediate psychopathological morphologies, which underlies this branch of clinical psychiatry. The failure to overcome "infantile dependence" is identified as the most important genetic factor. The type and efficacy of strategy used to neutralise the persistent anxiety caused by this unresolved "separation/identification" of the Ego shape the individual symptomatology of each dietary disorder described in the study.

Anxiety, Separation↗