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Biomedical subjects

P Pizzetti

Publications and source records attributed to P Pizzetti.

At least 19 recordsLinked to original sources

Endoscopic treatment of polyps in the resected stomach.

Between 1974 and 1992, at the Department of Diagnostic and Surgical Endoscopy of Istituto Nazionale Tumori, in Milan, 27 patients with resected stomach and suffering from epithelial polyps of the gastric stump (10 lesions) and/or anastomosis (25 lesions), were endoscopically treated using electroresection (13 cases), electrocoagulation (2 cases), combined methods (electroresection plus Nd:YAG photocoagulation) (1 case) and biopsy forceps (19 cases). Complications occurred in 4 cases and consisted of hemorrhage. Seven patients developed 15 recurrences. Endoscopic treatment of polyps in patients with resected stomach is a safe and effective treatment, considering the low rate of complication.

Adult

Endoscopic treatment of gastric carcinoids.

Carcinoids are the most common endocrine tumours, and arise from a multipotential primitive stem cell; the gastric location represents 2% of all carcinoids. From 1979 to 1992 at the Endoscopy Division of Istituto Nazionale Tumori, Milan, 2 patients suffering from single gastric carcinoid were endoscopically treated by electro-resection. No complication occurred during the treatment; 2 year- and 5-year-follow-up was performed in these patients, and no recurrence are observed. Surgical treatment represents the therapy of choice for gastric carcinoids, but endoscopic resection can represent an alternative in selected cases (lesions less than 1 cm or carcinoids with multicentric growth). Endoscopy can be used also in patients at high surgical risk.

Carcinoid Tumor

Endoscopic treatment of upper gastrointestinal tract malignancies.

Palliative endoscopic treatment of the upper gastro-intestinal (UGI) tract includes: dilation, Nd:YAG laser photocoagulation and intubation, used alone or in combination. These procedures are usually performed on an outpatient basis and are associated with a low rate of morbidity and mortality. From 1978 to 1992, 836 patients were treated at the Endoscopy Division of the Istituto Nazionale Tumori, Milan, for inoperable primary or recurrent malignancies of the UGI-tract. Recanalization was obtained in 96% of patients treated; functional results have been computed according to the site and to the endoscopic method. Overall median survival was 6.2 months. The complication rate was 8%. Relief of dysphagia is the goal of palliative treatment in patients with inoperable neoplasms of the UGI-tract.

Aged

Esophageal intubation for malignant fistulas.

Between April 1978 and December 1989 at the Endoscopy Division of the National Cancer Institute of Milan, 140 patients were intubated for esophageal neoplasms; 19 of these subjects underwent endoscopic intubation for malignant fistulas complicated by pneumonia and/or mediastinitis. The prostheses were tolerated well and enabled the restoration of oral nutrition. The mean survival was 4.7 months (range, 0.5-17 months). No major complications occurred. Tube dislodgement was observed in 2 cases (10.5%). Two patients died of causes that were not related to the procedure.

Aged

Laparoscopic repair of full-thickness stomach injury.

A case of laparoscopic repair of gastric perforation caused by a trocar is reported. Suturing was carried out by the apposition of clips. The potential advantages of this approach are that the treatment is performed at the time of the complication, the duration of the operation is reduced, and the discharge of the patient from hospital is accelerated.

Female

[Endoscopic polypectomy of the stomach].

Until 1970 endoscopy of the digestive tract was the only diagnostic method available. After this date, the introduction of endoscopic polypectomy enabled patients affected by these lesions to be treated, and at the same time considerably reduced their length of stay in hospital. The paper reports the results of 346 gastric polypectomies performed in 187 patients from 1974 to the present.

Adult

MOv18 monoclonal antibody in diagnostic applications: capability to recognize the histotype of the original tumor.

Cells from 52 ascitic fluids and 28 abdominopelvic cavity washings, obtained from 46 ovarian cancer patients, 17 patients bearing malignancies of non ovarian sites and 17 patients with non-malignant ovarian diseases, were tested using 2 methods: traditional cytology and monoclonal antibody immunofluorescence. The immunologic test using the MOv18 MAb, raised against ovarian carcinoma, revealed immunoreactive cells in 83% of the 36 cytologically positive fluids and in one of the 8 negative fluids from ovarian carcinoma patients and in 18% of the 17 fluids from patients with non-malignant ovarian disease. Forty six cytologically positive ascitic fluids from malignant patients were analyzed in order to evaluate the ability of this MAb to identify the histotype of metastatic cells. Ninety-three percent (26/28) of the effusions from nonmucinous ovarian carcinomas contained MOv18-positive cells, whereas no reactive cells were found in cytologically malignant fluids from patients with ovarian tumors of other oncotypes or with carcinomas of non-ovarian origin. The MOv18 reagent, used as an adjuvant in cytological analysis, can help in the identification of the histotype of metastatic cells of unknown origin.

Adenocarcinoma

Immunohistochemical reactivity of a monoclonal antibody prepared against human ovarian carcinoma on normal and pathological female genital tissues.

The reactivity profile of the monoclonal antibody (MAb) MOv18, raised against a poorly differentiated ovarian carcinoma specimen, was studied on normal tissues and tumors from the female reproductive system and on the kidney, which like the oviducts, vagina and uterus, also derives from the intermediate mesoderm. The obtained results indicate that MOv18 recognizes an epitope present on the normal epithelium of the oviducts, on 14-week old fetal kidney and, focally, on proximal and distal tubules of normal adult kidney. A strong reactivity was found on ovarian carcinomas, on invasive squamous carcinomas of the cervix and on endometrial carcinomas and hyperplasias. The antigen recognized by MOv18 (CaMOv18) therefore seems to be an epithelial cell marker associated with intermediate mesoderm differentiation, which can be derepressed during the neoplastic transformation of the ovary and the uterus.

Adult

First-line chemotherapy with intraperitoneal cisplatin and intravenous cyclophosphamide in ovarian carcinoma. A preliminary report.

Between August 1982 and October 1986, the feasibility and activity of five cycles of intraperitoneal (i.p.) cisplatin (CDDP) (90 mg/m2 in 6 h dwelling) and i.v. cyclophosphamide (600 mg/m2) were studied in 24 previously untreated patients with ovarian carcinoma having small or no residual disease after cytoreductive surgery. Six patients (25%) had local complications requiring catheter removal before the end of therapy. Fifteen of the 21 patients (71%) evaluable for activity achieved or maintained a pathologic complete remission. The median disease-free survival was 29+ months (range 18-58+ months). Three patients with tumor progression (two patients previously without evidence of disease, and one patient with minimal residual disease), and three partial responders were documented by laparotomy at the end of therapy. Two patients who achieved pathologic complete response relapsed at 20 and 36 months. All treatment failures (eight cases, 38%) occurred in the peritoneal cavity. Since patients were selected for having the most favorable tumor characteristics to benefit from i.p. treatment, our findings may cast some doubt on the actual contribution of i.p. CDDP at a dose of 90 mg/m2 in the treatment of patients with ovarian carcinoma and small residual disease in the peritoneal cavity.

Adult

Sensitivity of Hemoccult test for large bowel cancer in high-risk subjects.

From 1979 to 1982, 1233 symptom-free subjects at high risk for colon cancer because of family history and/or personal history of bowel neoplasia (cancer or adenomatous polyp) were examined with a guaiac test (Hemoccult II) for occult blood in stools. The test was positive (H+) in 98 subjects (7.9%). Endoscopy was subsequently performed on 86% of the H+ and on 64% of the H- subjects. Of 20 in invasive cancers found, 15 had been H+ [75.0%; 95% confidence interval (CI), 54.3-91.0%]. Of 96 patients with adenoma(s), 23 were H+ (24%; 95% CI, 16.0-33.0%). However, the sensitivity for adenomas was higher in patients with multiple adenomas or with a single adenoma measuring 2 cm or more in its largest diameter (37.5%; 95% CI, 21.8-54.7%). Of 699 subjects free of neoplastic lesions at endoscopy, 47 had been H+, ie, false positive (6.7%; 95% CI, 5.0-8.7%). Adjusting for differential compliance of H+ and H- subjects to endoscopy, a corrected estimate for sensitivity would be 69% for cancer and 19% for adenomas; the corrected estimate for the false-positive rate would be 5%.

Adenoma

Radiologic diagnosis of invasive carcinoma on adenomatous polyps of the colon.

The radiographic appearance at double contrast enema of 33 cases of invasive cancer on adenomatous polyps (AP) of the colon is reviewed. The radiologic diagnosis of malignancy was prospectively made in 54.5% of the cases. In 45.5% of the cases, malignancy was not suspected at the time of examination. The endoscopic appearance of these lesions was identical to that seen on the barium study. There are no radiologic criteria able to entirely rule out the possibility of a carcinomatous transformation of an AP. However, the radiologic features of malignancy (indentation of the intestinal wall and/or irregular outline of the surface of the polyp) have to be considered quite reliable.

Adenocarcinoma

Accuracy of the double contrast enema in evaluation of the abdominal diffusion of ovarian carcinoma.

The results of 103 double contrast enemas in 72 patients with ovarian carcinoma (stage III and IV) were compared with laparoscopic and/or laparotomic findings at comparable times. The evaluation of the validity of radiology in detecting the presence of abdominal disease showed an 84% overall accuracy, 75% specificity and 86% sensitivity. The accuracy in detecting signs of adhesion and parietal infiltration of the large bowel was 76.3%, due to the limited size of most of the lesions. Forty-seven of the 72 patients underwent a double contrast enema and laparoscopy during presurgical staging: accuracy in detecting lesions was the same for both examinations (80.4%). When double contrast enema and laparoscopy were used together in the evaluation of abdominal extension of the disease, the diagnostic accuracy rose to 93.6%.

Abdominal Neoplasms

Ultrasonography versus laparoscopy in the diagnosis of hepatic tumors.

129 patients, with suspected primary or secondary benign or malignant liver neoplasm after clinical, biochemical and/or instrumental investigation underwent liver ultrasound and laparoscopy. Echographic findings were compared with laparoscopy when liver neoplasms were detected by the latter. When laparoscopy was negative, to evaluate the diagnostic accuracy of the two methods employed, the following variously associated parameters were analysed: clinical follow-up, liver biochemistry, computed tomography, liver selective arteriography and explorative laparotomy. In the 129 patients examined, echography showed 86.7% diagnostic accuracy and laparoscopy 89.4%. The association of the two methods led to a diagnosis of hepatic lesion in 98.4% with no further diagnostic investigations. The two procedures can be considered complementary to such an extent that, in case of suspected primary or secondary liver neoplasm, the association of ultrasound and laparoscopy represents a quick and ultimate diagnostic approach. Furthermore, the association of these two procedures seems the least expensive and the most feasible, even in not particularly well equipped units.

Adult

Lymphomatous involvement of intrahepatic and extrahepatic biliary ducts. PTC and ERCP findings.

The intra- and extrahepatic biliary ducts were examined by endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography in 10 patients with malignant lymphoma and suggested hepatic involvement. Different radiologic appearances of the biliary tract are described, related to lymphomatous involvement of the liver or extrahepatic tissues, and compared with laparoscopic findings and final diagnosis. The results demonstrate the accuracy of cholangiography by PTC and ERCP and its usefulness in patients in whom non-invasive techniques fail to provide a reliable diagnosis.

Bile Duct Neoplasms