Anatomy of the thoracic duct: an endosonographic study.
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Biomedical subjects
Publications and source records attributed to E Meroni.
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Cytogenetic analysis was performed on 23 samples from non-neoplastic ureters. Clonal chromosome abnormalities were found in eight. They were: loss of Y chromosome, as a single abnormality (five cases) or associated with trisomy 10 and 20 (one case) or with trisomy 2 (one case); and duplication of Y chromosome (one case). Different numerical and structural sporadic abnormalities were found in nine cases. Immunohistochemical analysis and direct observation using the inverted microscope showed that the cells were mainly of the fibroblastic type. FISH analysis with chromosome 7 alpha-satellite probes failed to detect the presence of trisomy 7 in three epithelial cases tested.
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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.
Cytogenetic studies of benign prostatic hyperplasia (BHP) are scarce. We analyzed primary cell cultures obtained from biopsies of prostatic tissues from 10 patients (mean age: 60.7 years) with histologic diagnosis of BHP to compare the eventual chromosome changes with those reported in prostatic adenocarcinoma. Clonal chromosome abnormalities were noted in five of the 10 cases, with loss of Y chromosome in all. In one case, a clonal t(1;20) was observed with a -Y clone. Different numerical and structural sporadic abnormalities were evident in eight. Chromosome 1 was the chromosome most frequently involved in sporadic rearrangements. We concluded that -Y is a frequent nonrandom chromosome abnormality in BHP in this sample of patients. Immunohistochemical studies showed that loss of Y occurs in fibroblasts and not in epithelial cells; therefore, this anomaly is not related to cancer development.
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.
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.
A sample of 52 spontaneous blighted ovum abortions (BO) was examined cytogenetically and compared with a sample of abortions with echographic evidence of the embryo (AE). Abnormal karyotypes were 67% in the BO sample and 53% in the AE sample, a non significant difference. In the BO abortions trisomies were 74% of the abnormal karyotypes but 35% in the AE abortion, and the 45,X karyotype was absent among the BO but was found in 10 cases of AE. The prevalence of trisomies 16 and 22 in the BO abortions indicates that genes on these chromosome may be responsible for the early arrest of embryonic development.
We analyzed the correlations between chromosome abnormalities and clinical and histopathologic characteristics in 77 cases of renal cell carcinoma (RCC). Chromosome changes such as +5,+7,+8,+10,+18,+X,+Y, and -Y have been excluded from the analysis because they also occur in nonneoplastic kidney tissue and cytogenetic analysis indicates that these anomalies are not involved in tumor progression. The most frequent specific chromosome abnormalities in this sample were 3p rearrangements, trisomy 17, and hyperdiploidy and were not related to tumor stage or grade or to development of distant metastases.
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.
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).
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.
Pancreatic pseudocysts can be treated by endoscopic procedures. We report a case in which a naso-gastric tube, endoscopically placed through a cysto-gastrostomy, permitted the successful drainage of a large pancreatic pseudocyst without any recurrence.
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.
Submucosal neoplasms can be found in the esophagus and stomach during radiologic or endoscopic examination; histological diagnosis, however, is not significant in many cases because sampling is difficult. Endoscopic biopsies usually do not allow to obtain tissue from the submucosal layer nor other techniques prove to be reliable enough. 23 patients, aged between 21 and 76 were studied over a period of 5 years; in 1 male large gastric folds were observed. Of the 22 patients affected by benign submucosal neoplasms, 2 underwent surgical operation; no significant samples were obtained in any of the 11 cases in which biopsy forceps had been used. In the remaining patients an electrosurgical snare for polypectomy was used; this technique proved to be successful in 77.8% of cases. It is often shown to be also a therapeutic method when polypoid neoplasms are found.
Trisomy 7, trisomy 10 and loss of the Y chromosome have been found by some authors in presumptive normal parts of human kidneys. We describe cytogenetic findings in short-term cultures from 58 biopsies obtained from non-neoplastic and neoplastic (renal cell carcinoma, RCC) tissues from the same kidney, the same types of tissues from independent kidneys, and tissue from kidneys without neoplasia. The results indicate the following. Non-neoplastic tissue from kidneys involved in RCC have (in mosaics) trisomies 5, 7, 10, 18 and loss of the Y as non-random clonal changes. They are not the result of local metastasis but are also found in kidneys with non-tumoral chronic pathologies and should thus not be considered specific for RCC. They are neither culturing artefacts nor a general phenomenon found in cultured normal solid tissues, but are acquired abnormalities, possibly related to various reactive cellular states in the tissues that are histologically normal.
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