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Biomedical subjects

P Spinelli

Publications and source records attributed to P Spinelli.

At least 73 records · Page 4Linked to original sources

Pharyngo-esophageal prostheses in malignancies of the cervical esophagus.

Cervical location of inoperable esophageal carcinoma is usually considered a contraindication of palliative intubation due to technical limitations and complications of the procedure. Between 1978 and 1989, 32 patients with inoperable cancer of the cervical esophagus were treated endoscopically at the Endoscopy Division of the National Cancer Institute, Milan. Eight of them underwent endoscopic intubation. The prostheses were tolerated well and did not cause any respiratory impairment. No complications related to the procedure were observed. In seven of the patients resumption of oral nutrition led to improvement of the general condition. The mean survival time was 5.5 months (range 0.5-23 months).

Aged↗

[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↗

Esophageal tumors--treatment by endoscopic intubation.

Esophageal tumors are often inoperable, because of the poor general condition of patients or the coexistence of metastatic disease. Endoscopic intubation is a safe method of palliation in these patients which can restore esophageal patency and lead to an improved nutritional status. At the Endoscopy Division of the National Cancer Institute in Milan, 141 patients with inoperable esophageal cancer underwent endoscopic intubation between 1978 and 1989. The 7-day mortality was 9/141 (6.3%) patients. In 114/132 surviving patients there was an improvement in the nutritional status and general condition. The complication rate was 17.7% (25/141 patients) and the mean survival was 5.9 months.

Adult↗

Small-cell carcinoma of the esophagus. Treatment by endoscopy.

A case of primary carcinoma of the esophagus is presented that consisted of poorly differentiated small-cell carcinoma. The patient underwent endoscopic treatment, first with an Nd:YAG laser and, finally, with bougienage and the insertion of a prosthesis in order to relieve dysphagia and improve the nutritional status and quality of life. Even though it is generally uncommon for laser therapy to be chosen as a primary mode of treatment, the results obtained should permit to overcome this lack of confidence in the choice of laser treatment for small-cell carcinoma of the esophagus.

Aged↗

The use of videoendoscopy in the study of fluorescence.

Diagnosis of malignancies by means of fluorescence detection is effected, at present, using fiberoptic endoscopes. Difficulties in the detection of fluorescence arise from the low fluorescent efficiency of the most widely used drug (hematoporphyrin derivative), and from the loss of intensity of the signal within the fiberoptic bundles and the ocular lens of the fiberendoscope. The electronic video-endoscope, carrying a microchip camera at its tip, permits a more sensitive detection of fluorescence, since the signal is drawn directly from the cavities. Furthermore the electronic image, stored in a computer, can be manipulated to produce a more enhanced contrast between the fluorescence of normal and malignant tissues. An example of electronic manipulation would be the subtraction of the image obtained under green light excitation from that obtained under violet light excitation.

Endoscopy↗

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↗

Endoscopic dilation of the cystic duct.

In a case of gallbladder and common bile duct lithiasis, the selective cannulation of the cystic duct and gallbladder by a balloon catheter after endoscopic papillosphincterotomy fulfilled both diagnostic and therapeutic purposes. A choledochal stone was retrieved with the Dormia basket. The endoscopic dilation of the cystic duct by the balloon permitted spontaneous elimination of all the gallbladder stones.

Adult↗