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Biomedical subjects

P Spinelli

Publications and source records attributed to P Spinelli.

At least 55 records · Page 3Linked to original sources
PubMed1994

Self-expanding tracheobronchial stents using flexible bronchoscopy. Preliminary clinical experience.

Endoscopic insertion of tracheobronchial stents is indicated to achieve patency of the airway in case of malignant or benign obstructing lesions. Until now, the placement of prostheses has required a rigid bronchoscope with specially designed insertion instruments. Self-expanding stents are currently used to treat stenoses of different hollow organs (vessels, urinary tract, gastrointestinal tract, bile duct, respiratory tract). We report the first case of a self-expanding stent implanted in the trachea and right main stem bronchus using flexible videobronchoscope under local anesthesia. The procedure was easy, safe, effective, and well tolerated. No complications occurred.

Aged↗
PubMed1994

Comparative analysis of results of guaiac and immunochemical tests for faecal occult blood in colorectal cancer screening in two oncological institutions.

The performances of three faecal occult blood tests, rehydrated Hemoccult (HOR), Hemoccult sensa (HOS) and Hemeselect (HSEL) on 3 days were compared in 1,725 subjects consecutively recruited in two oncological institutions in Milan and Florence. Significant differences between the results were evident as far as HOR positivity rates (7.5% vs 4.0%, respectively) and specificity (94.3% vs 97.5%, respectively) are concerned. Overall positivity rates of HOR, HOS and HSEL were 5.9%, 5.4% and 12%, respectively; significant differences were evident between HSEL and each of the two guaiac tests. Cancer was detected in eight subjects, adenoma/s in 47. Specificity estimates were 95.8%, 90.2% and 90.5% for HOR, HOS and HSEL, respectively; significant differences were evident between HSEL and the other two tests. No significant difference between tests was evident for sensitivity or positive predictive values for cancer or adenomas. In the CSPO (Florence) population (1,223 subjects; five with cancer, 16 with adenoma/s) the performances of 1-day HSEL testing were determined on the basis of the first faecal sample only and compared with 3-day HOR, HOS and HSEL testing. The positivity rates of 1-day HSEL, 3-day HOR, HOS and HSEL testing were 7.0%, 5.0%, 5.5% and 12.9%, respectively. Only 3-day HSEL positivity rate was significantly higher than 1-day HSEL. One-day HSEL specificity (94.9%) was significantly higher than 3-day HSEL (90.0%), whereas no significant difference was seen between 1-day HSEL, HOR (96.5%), and HOS (96.1%) specificity. No significant difference between tests is evident in the CSPO population as far as positive predictive values and sensitivity for cancer and adenomas are concerned.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗
PubMed1994

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↗
PubMed1994

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↗
PubMed1993

Endoscopic treatment of malignant dysphagia.

Palliative endoscopic treatment of dysphagia in patients with inoperable oesophageal cancer includes: dilation, Nd:YAG laser photocoagulation and intubation, used alone or in combination. Such procedures are usually performed on an outpatient basis and are associated with a low rate of morbidity and mortality. From 1978 to 1988, 476 patients (401 males, 75 females) were treated at the Endoscopy division of the National Cancer Institute of Milan for inoperable primary or recurrent malignancies of the oesophagus or cardia or for extra-oesophageal neoplasms causing dysphagia. Dilation was used in 172 cases, Nd:YAG laser photocoagulation in 90, prosthesis insertion in 72, dilation and laser in 97, and prosthesis and laser in 45. Functional improvement was reported in 75% of patients after dilation, in 89% after laser treatment, in 80% after intubation, in 80% after dilation and photocoagulation, and in 89% after laser and intubation. The median duration of dysphagia-free interval was 4 weeks in dilated patients, 6-8 weeks in photocoagulated patients and 20 weeks intubate patients. Overall median survival was 6.2 months. The complication rate was: 1.4% in dilation treatment, 1.4% in laser photocoagulation, and 8.8% in prosthesis intubation. Mortality related to endoscopic treatment was 2.1% (10/476 patients). Relief of dysphagia is one of the most important goals of palliative treatment in patients with inoperable oesophageal neoplasms. Moreover, endoscopic palliation improves the quality of life in the patients, with a low complication rate.

Aged↗
PubMed1993

Endoscopic treatment of postradiation strictures.

BACKGROUND: Esophageal stricture is a rare complication of radiotherapy: reports on its incidence and management are therefore anecdotal. METHODS: From January 1978 to September 1992, 44 patients presenting with an esophageal stricture related to a previous radiation treatment were endoscopically dilated at the Endoscopy Division of the Istituto Nazionale Tumori of Milan. RESULTS: Esophageal recanalization was obtained in 95% of the patients treated, and in 79% of these normal eating habits were restored. No strict correlation was observed between radiation dose and severity of the stricture, or time elapsed between first treatment and endoscopic dilation. CONCLUSIONS: In our experience, endoscopic dilation was a safe effective procedure and represented an effective palliative tool in dysphagic patients with esophageal strictures due to previous local radiotherapy.

Adult↗
PubMed1993

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↗
PubMed1993

Congenital hypertrophy of retinal pigment epithelium (CHRPE) as a marker for familial adenomatous polyposis (FAP).

Seventy-eight patients from 26 families were examined to evaluate the potentiality of congenital hypertrophy of retinal pigment epithelium (CHRPE) as a phenotypic marker for familial adenomatous polyposis (FAP). The examined subjects were divided into three different groups: Group I, patients with FAP without extra colonic manifestations (ECM); Group II, patients with FAP and ECM (desmoids/osteomas/upper gastrointestinal adenomas); and Group III, individuals at risk without FAP. Of 24 Group I patients (median age 18 years) 16 had CHRPE compared with 14 out of 24 patients (median age 29 years) in Group II and only three out of 30 patients in Group III. The overall sensitivity of CHRPE for FAP was 70% (+/- 13%) without any difference related to ECM; the predictive value was 92%. The specificity calculated from Group III (median age 26 years) was 90%, but the results should not be considered as definitive because a longer follow-up to determine the appearance of adenomas is required. The data suggest that examination for CHRPE is an inexpensive, non-invasive test for FAP, but the absence of retinal lesions does not eliminate the necessity for adequate follow-up of individuals at risk.

Adenomatous Polyposis Coli↗
PubMed1993

Rectal metal stents for palliation of colorectal malignant stenosis.

Thirteen patients with colorectal obstructing tumors were submitted to endoscopic insertion of self-expanding metal stents to restore luminal patency. The procedure was performed entirely under endoscopic control, without using fluoroscopy, during a 1-day hospitalization. The prostheses were correctly placed in 12/13 patients (92%), with no immediate complications. The mean follow-up is 7 months. Ten out of 12 patients (83%) had a permanent restoration of the luminal patency; they experienced no pain, tenesmus or any other discomfort during the follow-up period. In the remaining 2 patients long-term complications occurred and were treated by endoscopy in 1 case, and by surgical resection in the 2nd case. Self-expanding metal stents proved to be safe and effective; the main drawbacks, at present, are the lack of effectiveness of these devices in case of a fistula and their high costs.

Adult↗
PubMed1993

A new technique of endoscopic implantation of self-expanding mesh stents for inoperable tracheo-bronchial malignancies.

When malignant or benign lesions obstruct the tracheobronchial tree in patients unsuitable for surgery, patency of the lumen can be maintained using endoprostheses. This procedure is traditionally performed by rigid bronchoscopy. Recently, self-expanding metal stents have been developed and used in clinical practice. We employed these stents in 3 patients suffering from advanced tracheo-bronchial tumors; in all cases the procedure was carried out with flexible videobronchoscopes under local anaesthesia.

Adenocarcinoma↗
PubMed1992

Light-induced fluorescence spectroscopy of adenomas, adenocarcinomas and non-neoplastic mucosa in human colon. I. In vitro measurements.

In an attempt to evaluate whether induced fluorescence could be exploited to discriminate neoplastic from non-neoplastic tissue, fluorescence spectroscopy was performed at 450-800 nm on 83 biopsy specimens of colonic mucosa. Measurements showed that fluorescence spectra of adenoma, adenocarcinoma and non-neoplastic mucosa manifest dissimilar patterns. Nine variables, whose photophysical and/or biological bases need further investigation, were derived from the spectra. Discriminant functions between the groups of lesions were determined by using a stepwise discriminant analysis. The diagnostic test had a sensitivity of 80.6% and 88.2%, and a specificity of 90.5% and 95.2% in discriminating neoplastic from non-neoplastic mucosa and adenoma from non-neoplastic mucosa respectively. These results suggest that fluorescence spectroscopy has the potential to improve endoscopic diagnosis of premalignant and malignant lesions of colonic mucosa.

Adenocarcinoma↗
PubMed1991

Endoscopic palliation of malignancies of the upper gastrointestinal tract using Nd:YAG laser: results and survival in 308 treated patients.

Three hundred eight patients with obstructing malignant tumors of the gastrointestinal tract were submitted to endoscopic Nd:YAG laser palliation. The number of sessions as well as the number of days and total energy required for initial recanalization of the stenosis were related to tumor length. Luminal patency was obtained in 94% of patients, but improved swallowing was achieved in 74% of patients. The technical success rate did not depend on tumor site, whereas functional positive results are related to the location of the stenosis, with worst results for tumors involving the upper third of the esophagus. Life-table analysis revealed that 1-year survival was 23% when a luminal patency was achieved and 7% when treatment failed.

Adult↗
PubMed1991

Diagnostic accuracy of the double-contrast enema for colonic polyps in patients with or without diverticular disease.

The accuracy of the double-contrast enema for the diagnosis of polypoid lesions in the presence or absence of diverticula was evaluated by retrospectively reviewing the medical records of 202 patients subjected to examination and endoscopy. Analysis of the data on 215 polypoid lesions showed that (a) the diagnostic accuracy of the examination is not affected significantly by the presence of diverticula; (b) the sensitivity of the examination is highly dependent on the size of the polyps (smaller or larger than 0.5 cm) but not on the form (sessile or pedunculated); and (c) the positive predictive value is higher in patients without diverticula. The double-contrast enema was confirmed to be a valid method for the diagnosis of polypoid lesions.

Barium Sulfate↗
PubMed1991

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↗
PubMed1991

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↗