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Biomedical subjects

D A Cortese

Publications and source records attributed to D A Cortese.

At least 73 records · Page 4Linked to original sources
PubMed1983

Neodymium-YAG laser therapy of malignant airway obstruction. A preliminary report.

Neodymium-YAG laser therapy of malignant obstructing airway lesions via a flexible endoscope offers a promising new means of treatment. Twenty-two patients with obstructing airway lesions were treated. Two fatal complications occurred. The patients experienced increased comfort in breathing, increased exercise tolerance, and more effective cough with clearance of secretions. Treatment of larger numbers of patients with careful monitoring of the results should be performed to define further the usefulness, complications, and limitations of this new therapeutic tool.

Adenocarcinoma↗
PubMed1983

Roentgenographically occult lung cancer. A ten-year experience.

During the past 10 years, 54 patients, all men, were found to have roentgenographically occult lung cancer. The mean age was 61 years (range 45 to 76 years). All patients had abnormal findings on sputum cytologic study (carcinoma in 41 patients and squamous cell atypia in 13). The cancer was localized by bronchoscopy in all patients (range one to five examinations, mean 1.5). Seventy-five percent of the tumors were localized within 169 days of the abnormal sputum cytologic examination. Pulmonary resection for cure was performed in all patients: lobectomy in 38, pneumonectomy in nine, and bilobectomy in seven. Operative mortality was 5.6% (three patients). Fifty-eight cancers were resected, all squamous cell carcinomas (two had a component of large cell cancer). Tumor TNM classification (AJC) was TIS N0 M0 in 19 patients, T1 N0 M0 in 25, T1 N1 M0 in five, T2 N1 M0 in four, and T3 N0 M0 in one. Overall 5 year actuarial survival rate (lung cancer deaths only) was 90%. Five-year survival rate for the 44 patients with TIS N0 M0 and T1 N0 M0 neoplasms was 91%. Currently, 21 patients have died, but only 10 of lung cancer. Subsequent additional lung cancer developed in 12 patients (22%). Eleven of these patients had a second primary squamous lung cancer, six of which again were occult. We conclude that patients with occult lung cancer have a strong likelihood of long-term survival if treated early. Close surveillance is indicated because of the high incidence of a second primary lung cancer.

Aged↗
PubMed1982

Hematoporphyrin derivative in the detection and localization of radiographically occult lung cancer.

Hematoporphyrin derivative used in conjunction with the Mayo Clinic bronchofiberscopic fluorescence detection system allows accurate localization of radiographically occult early squamous cell carcinoma. Thirteen tumors were localized in 10 patients with radiographically occult lung cancer. Six were in situ with or without microinvasion and were also bronchoscopically occult. Localization of these 6 tumors was expedited by the use of hematoporphyrin derivative and the bronchoscopic fluorescence detection system. Hematoporphyrin-derivative fluorescence was not specific for carcinoma and was also detected in areas of moderate and marked squamous cellular atypia. Thus, although detection of hematoporphyrin-derivative fluorescence suggests the presence of cancer, proof depends on histologic or cytologic confirmation.

Bronchoscopy↗
PubMed1982

Endoscopic management of lung cancer with hematoporphyrin derivative phototherapy.

This paper demonstrates the potential use of hematoporphyrin derivative in the phototherapy of bronchogenic cancer. We report on 10 patients (a total of 11 carcinomas) with cancer involving the tracheobronchial tree who completed one course of this new treatment administered via the flexible fiberoptic bronchoscope. Four superficial carcinomas showed a complete response; five larger carcinomas showed a partial response, Two patients, each with a large cancer extending beyond the bronchial wall, died within 11 days after treatment.

Bronchoscopes↗
PubMed1982

Detection and localization of In situ carcinoma of the bladder with hematoporphyrin derivative.

The extent and localization of in situ carcinoma of the urinary bladder are frequently difficult to assess. We have studied this problem by employing intravenous hematoporphyrin derivative, an endoscopic detection device, and complete pathologic bladder mapping. These preliminary investigations indicate that hematoporphyrin derivative localizes in dysplastic and neoplastic transitional cell epithelium and that these abnormal areas can be detected during a cytoscopic examination with the use of our detection device.

Carcinoma in Situ↗
PubMed1981

Bronchoscopic biopsy and brushing with fluoroscopic guidance in nodular metastatic lung cancer.

Forty-five patients with endoscopically invisible metastatic cancer of the lung underwent flexible fiberoptic bronchoscopic examination under fluoroscopic guidance, with biopsy specimens and brushing being obtained. In all patients, the lesions were single or multiple nodules. A diagnostic specimen was obtained by biopsy or brushing (or both) in 53 percent, by biopsy alone in 47 percent, and by brushing alone in 6 percent. Brushings were diagnostic in three patients when the biopsy specimen was normal. Washings did not add to the overall diagnostic value of the procedure. In 36 patients, the lesions were 2 cm or greater, yielding diagnostic specimens in 23 patients (64 percent).

Adenocarcinoma↗
PubMed1981

The value of bronchoscopy in the diagnosis of mycobacterial disease. A five-year experience.

During five years, 6,879 patients underwent bronchoscopic study at the Mayo Clinic. Mycobacterial cultures were obtained from 4,120 (60 percent). Mycobacterial organisms (typical or atypical) other than Mycobacterium gordonae were isolated in 70/4,120 (1.7 percent) patients. During the same period, 209 patients had culture-proved M tuberculosis from various sources. Bronchoscopy was performed on 34/209 (16 percent) patients. Washings or secretions from bronchoscopy grew M tuberculosis in 32/34 (94 percent) cases. Bronchoscopy and bronchoscopic cultures were important in the diagnosis of M tuberculosis in 16/34 (47 percent) patients. Atypical mycobacteria were cultured from various sources in 428 patients during the period of study. In 254 of these, M gordonae was isolated, but it was considered to be nonpathogenic in all. Of the remaining 174 patients with culture-proved atypical mycobacteriosis, 40 (23 percent) underwent bronchoscopic studies. Of these 40 patients, 24 had active disease and 11 had saprophytic colonization; in five, the disease activity was indeterminate. Bronchoscopic cultures of secretions or washings or both were positive for atypical organisms in 38/40 (95 percent) patients.

Bronchoscopy↗
PubMed1981

Photodynamic effect of hematoporphyrin derivative as a function of optical spectrum and incident energy density.

Tumor cell killing effect of hematoporphyrin derivative (HPD) and light was studied in culture to determine the dependence of this effect on treatment variables. Particular attention has been given to the spectral characteristics of the light and the absorption properties of hematoporphyrin. A human tumor cell line was treated using HPD and three broad bands of light ranging from the short- to the long-wavelength end of the visible spectrum. Cell killing was assessed by trypan blue exclusion. A transformed mouse embryo cell line was treated in a similar manner, and its reproductive efficiency was determined following treatment. Results of both studies are consistent with the hypothesis that the photocytotoxic action of HPD plus light is directly proportional to the number of light quanta absorbed by the HPD in each cell. For thin layers of cells, such as in situ carcinoma, it appears that short-wavelength radiation falling in the porphyrin Soret band around 400 nm may have from 12 to 30 times the killing power as does red light.

Animals↗
PubMed1980

Transthoracic needle biopsy: accuracy and complications in relation to location and type of lesion.

Transthoracic needle biopsy has become a frequently used method for obtaining tissue for diagnosis of pulmonary lesions. The procedure carries an inherent risk of pneumothorax and hemorrhage, the latter usually manifested by transient hemoptysis. Data on 430 patients who underwent transthoracic needle aspirations from 1968 through 1977 were studied to determine accuracy and complications of this procedure as related to lesion type and location. Malilgnant disease, most often metastatic, was present in all but 10 patients. Also, 86% of patients were more than 50 years of age and most were not candidates for operation. Sufficient tissue for diagnosis was obtained in 82% of cases. The diagnostic yield diminished significantly in central lesions less than 2 cm in size. Pneumothorax and hemoptysis or pulmonary hemorrhage were the most common complications. Biopsy of central lesions, especially those in the mediastinum, were more often associated with pneumothorax, whereas lesions near the hilar region were more susceptible to hemorrhagic complications. Two deaths occurred, both from hemorrhage after biopsy in cavitating lesions with air/fluid levels. The incidence of pneumothorax was also higher in cavitating lesions. Fewer complications occurred with biopsy of lesions along the pleural surface and lesions in the periphery of the lung.

Adult↗
PubMed1979

Biopsy and brushing of peripheral lung cancer with fluoroscopic guidance.

Forty-eight patients underwent flexible fiberoptic bronchoscopic examination under fluoroscopic guidance, with biopsy and brushing of an endoscopically invisible primary cancer of the lung. A diagnostic (abnormal) specimen was obtained by biopsy of brushing (or both) in 29 patients (60 percent), by biopsy alone in 22 (46 percent), and by brushing alone in 19 (40 percent). Success in obtaining diagnostic tissue was related to cellular type, location by bronchopulmonary segment, size of the tumor, and distance of the tumor from the hilum.

Biopsy↗
PubMed1979

Clinical application of a new endoscopic technique for detection of in situ bronchial carcinoma.

Hematoporphyrin is preferentially concentrated by cancer tissue and therefore is a potentially useful chemical marker. This report demonstrates the effectiveness of a photoelectric hematoporphyrin fluorescence detector used simultaneously with flexible fiberoptic bronchoscopy as a means of detecting and localizing bronchogenic carcinoma. The detector generates an audio signal when fluorescence is within the visual field of the bronchoscope. Of interest is that an audio signal was generated which indicated hematoporphyrin fluorescence in areas where no mucosal abnormality had been seen. These areas proved to be carcinoma in situ.

Aged↗
PubMed1978

Pericardial reconstruction of the membranous trachea after resection of adenoid cystic carcinoma (cylindroma).

An intraluminal adenoid cystic carcinoma (cylindroma) in the patient reported herein involved just the membranous portion of the distal region of the trachea and extended caudally to include the carina and the membranous portions of both main-stem bronchi--a total linear involvement of 6 cm. The tumor occluded 90% of the airway in its greatest extension. Conservative resection of this extensive tumor was successfully performed by membranous tracheal reconstruction with a pedicled autogenous pericardial patch graft.

Bronchial Neoplasms↗
PubMed1978

Pulmonary function in mitral stenosis.

The reported results of pulmonary function testing in patients with mitral stenosis are summarized, including a few studies done after operative correction of the mitral stenosis. The physiologic effects of increased pulmonary water explain most of the reversible abnormalities in pulmonary function. Fixed pathologic changes that occur with longstanding interstitial edema may account for the irreversible nature of other alterations in pulmonary function.

Airway Resistance↗
PubMed1978

Detection of hematoporphyrin fluorescence during fiberoptic bronchoscopy to localize early bronchogenic carcinoma.

Photoelectric detection of fluorescence from hematoporphyrin-containing "occult" bronchogenic carcinoma is a potentially useful technique for localizing and delineating such cancers. A method is presented which would enable use of a fluorescence-detection system simultaneously with conventional illumination during flexible bronchofiberscopic examination. Preliminary data suggest that quantities of hematoporphyrin as small as 5 picograms can be detected on the surface of tumors by this method.

Bronchoscopy↗