Biomedical subjects
Publications and source records attributed to G B Meloni.
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Lobular carcinoma in situ is an uncommon noninvasive breast neoplasm; it accounts for about 0.8-3.8% of breast cancers and presents 3 peculiar characteristics: multicentricity (60-90%), bilaterality (35-59%), and the risk of invasive cancer (17-37%). The latter feature led some authors to consider this lesion as a marker of the development of an invasive cancer rather than a real malignant neoplasm. The main problem after histologic diagnosis is the choice of treatment: follow-up or surgery? Some authors reported, in the patients with lobular carcinoma in situ, the same incidence of ipsilateral invasive carcinoma as that in the normal population, which suggests a "wait and see" policy. This study, carried out on 27 patients (mean age: 49 years) with histologic diagnosis of lobular carcinoma in situ yielded the following aspecific mammographic findings: clustered microcalcifications; stellate masses and irregular nodular lesions with or without calcifications; architectural distortion with calcifications. In 10 surgical patients, 2 ductal carcinomas were demonstrated near the lobular carcinoma in situ. In the 17 patients submitted to follow-up, lobular carcinoma in situ recurrences were found in 4 patients at biopsy; a comedocarcinoma associated with a metastatic axillary node was found in one patient. Thus, we conclude that, in the patients with lobular carcinoma in situ, a "wait and see" policy of close observation should be adopted.
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The authors reviewed the complications occurred in 393 patients who underwent needle localization breast biopsy from September, 1987, through September 1994. The lesions were located using 20-22 G needles with a teminal hook wire. The maneuver was carried out under US guidance in 7 patients, using stereotaxic equipment in 88 patients and without stereotaxic equipment in 298 patients. Clinical and guide-wire related complications were reported. The former complications were: severe vagal crises (in 3 patients), mild vagal crisis (10 patients) and bleeding (1 patient). Guidewire complications were: wire breakage (in 8 patients) and wire dislodgment (3 patients). Vagal crisis occurred above all in anxious patients. Guide-wire breakage or dislodgement may prevent lesion removal and, subsequently, lead to a diagnostic error. Our experiences suggests that information and continuous radiologist attendance positively influence patient's psychology reducing clinical complications. Moreover, operator's experience and care in choosing the appropriate devices greatly reduce the incidence of maneuver-related complications.
The authors report on the use of interventional radiology modalities in the treatment of some gastrointestinal diseases (intussusception, stenosis, hemorrhage, etc). The results are compared with literature data relative to both interventional radiology and conventional therapeutic procedures. In our series, hydrostatic reduction of ileocolic intussusception was successful in 60% of cases. Transluminal dilatation with a balloon catheter was attempted in 108 patients with alimentary tract stenosis and was successful in 93. Hemorrhage and ischemia can be treated by means of transcatheter therapy (vasopressin, embolization) and percutaneous angioplasty. Percutaneous gastrostomy appears to be an effective alternative to surgical gastrostomy. Tapeworm infections can be cured by intraduodenal injection of "Gastrografin" (Schering). The success achieved in the different applications is such as to suggest a wider use of interventional radiology procedures, for they offer a more favorable cost/benefit ratio and often yield better results than conventional techniques.
The authors report on the diagnostic role of radiological imaging in the study of the patients who underwent gastric surgery. This kind of intervention is often followed by postoperative complications, so that accurate clinical-instrumental investigations are required. Routine controls both in the immediate postoperative period and during follow-up are useful especially when a neoplastic lesion was the underlying condition leading to surgery. Radiological imaging plays a fundamental role especially in evaluating such postoperative conditions as afferent and efferent loop syndromes. Radiology is thought to be essential to demonstrate the syndrome and to identify the mechanical/functional nature of the factors causing the disease, all of which are essential to an appropriate and safe therapy. Both the duration of follow-up (early and late controls) and the choice of contrast (water-soluble contrast medium or double contrast enema) are very important factors depending on the time of surgery and the clinical indication.
The use of mammography as a screening examination has considerably increased our ability to detect non-palpable breast lesions less than 1 cm phi. A conclusive diagnosis frequently requires surgical biopsy. However, breast lesions can be localized prior to surgical biopsy by placing a wire in the lesion, with/without the use of stereotaxic equipment. Our method for lesion localization consisted in acquiring two orthogonal radiographs (cranio-caudal and latero-lateral) centered on the nipple. We used 20-21 G needles, 6-10 cm long, with curved-end wire. Mammographic findings possibly suggesting cancer were: microcalcifications, nodules, spiculated opacities, and architectural distortions. From January 1987 to January 1990, 223 patients were submitted to needle localization of breast lesions under mammographic guidance and without stereotaxic equipment. Sixty-seven cases (30%) were positive for malignancy, with a 2.3:1 benign/malignant ratio. Patients' age ranged 30-70 years, but most of them were 50-60 years old. No significant complications were observed: in one case only the hook wire broke, within breast parenchyma, which was at any rate resected together with the surgical specimen.
Thirteen patients with urethral stenoses of different etiopathology underwent TUP with an angioplasty balloon catheter. At follow-up, more than 10 months later, 8 out of 10 patients had normal urinary function. Excluding cases of urethral compression due to prostatic hyperplasia, 90% of the stenoses were successfully dilated. The gradualness of the dilatation, the application of a Foley catheter to maintain the dilatation obtained and the prevention of urinary infections are important factors for the success of this method.
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The authors describe the importance of embolization of the splenic artery by means of Gianturco coils in splenomegalic portal hypertension. They propose their first experience of six cases and the good results on the basis of clinical parameters, of bleeding of esophageal varices, of hematological values. They also show the influence of this method on hemodynamic, metabolic, and respiratory parameters, altered in cirrhotic patients.
The authors analyze their experience on 9 cases of esophageal stenosis dilated by "Grüntzig" type balloon catheter under fluoroscopic examination (transluminal esophagus plastica: TE). This procedure also allows dilatation of severe narrowing, offering distinct advantages represented by: low risk, easy performance, good tolerance, reduction or disappearance of disphagia. Esophageal perforation is possible, though it never appeared in author's experience.
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We treated 35 patients who had hepatic cysts (30 congenital cysts, 5 hydatid cysts) with percutaneous puncture and sclerotherapy. After puncture and drainage of the cyst, a 95% alcohol solution was instilled as sclerosing agent into the cystic cavity. In all the patients, cyst puncture and drainage was successful. Follow-up in all cases was at least 12 months. In three uncooperative patients, cysts recurred due to incomplete sclerosis of the lining epithelium of the cyst wall. No major complications were encountered in all cases. All congenital cysts were treated on an outpatient basis. Patients with hydatid cyst were hospitalized for 48 h after puncture and aspiration. In our opinion, percutaneous drainage and sclerosis of congenital hepatic cysts can be considered an effective alternative to surgical treatment.
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