Biomedical subjects
Publications and source records attributed to F Varoli.
The authors report on the results obtained using vital staining in fiberoptic bronchoscopic investigations. Vital staining is performed during normal fiberoptic bronchoscopic investigations under local anesthesia. The method has proved very sensitive for cancerous and precancerous lesions of the bronchial mucosa.
Multiple-dose pharmacokinetics of ceftriaxone were investigated in 7 patients with bronchopneumonia using an intramuscular regimen of 1 g given every 24 h for 7 days. Serum, sputum, and urine samples were collected serially following the first dose (day 1) and last dose (day 7). Mean peak serum concentrations of ceftriaxone occurred at 2 h on both days and were 67.8 and 75.1 micrograms/ml, respectively, on day 1 and day 7. Ceftriaxone had a half-life of 6.9 h on day 1 and 7.4 h on day 7. The half-life of ceftriaxone in sputum was 5.9 and 6.6 h, respectively, on days 1 and 7. Approximately 50% of the dose of ceftriaxone was recovered in the urine within 24 h on day 1, 60% on day 7. Tissue distribution of ceftriaxone was determined in 103 patients following intramuscular administration of a single 1-gram dose at different times up to 24 h prior to surgery. High concentrations of ceftriaxone were found in lung, tonsil, middle ear mucosa, and nasal mucosa, and therapeutic levels of ceftriaxone persisted for 24 h after administration.
Seventy-three patients who underwent thoracic surgery were randomly selected for intraoperative intercostal nerve block using phenol (32 block and 41 control subjects). The patients were divided into three groups: pneumonectomies, lobectomies and explorative thoracotomies and evaluated by pain level, respiratory function parameters (VT, IRV, ERV, VC) and blood-gas analysis, both six and 24 hrs after surgery. The patients who had intraoperative nerve block using phenol enjoyed a more comfortable postoperative period. In particular, respiratory parameters were statistically better.
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A long-term retrospective study was carried out on 1,514 cases of lung cancer to assess whether the disease presents substantial differences in young as compared to older patients. Clinical, epidemiologic, surgical, and survival data were evaluated in all cases. A young group under 45 years of age was studied separately and compared with the remaining older patients. In contrast with the literature, our results showed no percentage increase or variation in the male/female ratio of lung cancer in the young group. No significant difference was found regarding clinical picture, operability, histotype, and prognosis.
Patients with chronic bronchitis were treated orally with either amoxicillin (500 mg) alone or in combination with carbocysteine (150 mg), thrice daily for five days, in order to assess whether the combination allows higher antibiotic levels to be obtained in bronchial mucus than those obtained from amoxicillin alone. Serum and mucus levels were determined for each patient at first and fifth day of the two drug regimens. The levels of amoxicillin in the lung tissue collected in patients undergoing pulmonary surgery were also determined after a single oral dose of amoxicillin (1 g) or of amoxicillin (1 g) plus carbocysteine (300 mg). In the bronchial secretions, at the same plasma concentrations, amoxicillin levels were statistically higher after administration of combined substances. These findings indicate the presence of a pharmacokinetic synergism between these compounds, which allows amoxicillin to penetrate more easily through the hemato-bronchial barrier. The association of amoxicillin and carbocysteine, determining an increase of the quantitative levels of antibiotic in the bronchial secretion (also if it is purulent), performs a sterilizing action in a short time with significant therapeutic advantages.
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Primary intrapulmonary neurogenic tumours are extremely rare. In a series of 1664 patients with pulmonary neoplasms observed during 1967-80 only four such tumours were identified (0.2%). All four patients underwent surgical excision. The histological diagnosis was benign neurilemmoma in three cases and malignant schwannoma in the fourth. The patients with neurilemmoma are alive and well four to 12 years after surgery, but the patient with malignant schwannoma died from metastatic spread of the tumour four months after surgery. No association with von Recklinghausen's disease was observed. Macroscopic and microscopic features generally lead to a correct diagnosis in benign types, but the histological diagnosis of malignant schwannoma may present some difficulties and requires the establishment of a definite origin in a nervous structure, identification of benign neurofibroma in different areas of the same tumour, and a high density of cells with appreciable pleomorphism, with mitosis and atypia. Benign tumours carry a good prognosis with little tendency to recur, but malignant schwannoma has a high invasive tendency and is associated with a low survival rate.
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99 pulmonary resections for benign tumors were performed during the period 1967-1978. 4 patients showed bronchial papilloma. Solitary papilloma of the bronchus is one of the rarest benign tumors; the differences of multiple papillomatosis and inflammatory polyp are stressed. Malignant change was observed in 3 of the 4 cases. The 4 patients presented a 2- to 5-year history of hemoptysis episodes and radiographic aspects characterized by intermittent atelectasis. Radical surgery is the only satisfactory therapy; endoscopic removal of the neoplasm is often incomplete and unsatisfactory.
150 patients with lung cancer have been studied from the immunological point of view: the two years that elapsed between the study and processing of the data permitted an evaluation of the prognosis in terms of immunology also. This study has been carried out in vivo by means of skin tests (BCG, PPD, Candida, Varidase, CCB, Mumps, BNCB) and in vitro with lymphocyte blastization in the presence of PHA and dependent antibody cytotoxicity. Serum factors which can interfere with lymphocyte cytotoxicity have also been studied. Peri- and intra-tumour lymphocyte infiltration and the lymph node activation stage have been analyzed in patients who underwent surgery. A real depression of the cell mediated immunity observed in the negative response to skin tests has been found. The study of in vitro parameters showed a deficient blast response in 86% of the cases examined, decreased cytotoxicity in 62% and the presence of inhibiting serum factors in 53%. No correlation was observed between positivity to skin tests, normal response to PHA, normal concentration of inhibiting serum factors on the one hand and survival on the other. The only finding which seems to be correlated with survival is lymphocyte infiltration; its peri- and intrastromal presence on the neoplasia may be associated with a significantly better prognosis.
The Authors report on a case of pure lipoma of the bronchus, one of the rarest of benign lung diseases. The article discusses the aetiopathogenesis of the lesion, still a source of debate among the various scholars, and its symptoms, which do not differ from those of other benign endobronchial lung diseases.
An additional case of acute colonic pseudo-obstruction (Ogilvie's syndrome) is reported. Conservative management was successful. Etiology of this syndrome is still uncertain. The aim of the treatment is to stop natural evolution to ischemia or perforation. Medical therapy, colonoscopic decompression and surgery are employed following prognostic criteria (age, cecal diameter, therapeutical delay). Mortality rate remains high, especially if complications occur. Colonoscopic decompression is a safe and efficacious first line of treatment when cecum is less than diameter 12 cm. Surgery is mandatory when perforation or ischemia are suspected and colonoscopy failed or is contraindicated.
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An in-depth retrospective statistical analysis was performed on 150 consecutive cases of adenocarcinoma of the lung. One-hundred and twenty-eight patients (85%) underwent pulmonary resection; 15 (10%) had an explorative thoracotomy and 7 (5%) were considered inoperable. At the time of operation, 72 patients were classified as Stage I, 18 as Stage II and 50 as Stage III. Factors analyzed included age, sex, surgical treatment, staging, immunologic monitoring and survival. When compared with other histotypes of our series a statistically significant difference was found in the male: female ratio (p less than 0.05), surgical resectability (p less than 0.05), frequency of Stage I, and immunologic status evaluated by studies of delayed hypersensitivity skin tests, lymphocyte blastogenesis, antibody dependent cellular cytotoxicity (ADCC), blocking serum factors and intrastromal peritumoral lymphocyte infiltration. There were no significant differences due to age, cigarette smoking, mediastinal lymph node involvement, except for small oat-cell carcinoma or previous pulmonary diseases. In all stages, the five-year survival rate was lower for patients affected with adenocarcinoma than for those affected with other histological types, except small oat-cell carcinoma.
Major pulmonary resections are generally performed through long thoracotomies which cause important functional and cosmetic sequelae. The progress in videoendoscopic surgery has allowed the authors to perform 31 pulmonary resections (28 lobectomies, 1 segmentectomy and 2 pneumonectomies) by thoracoscopic approach. Seven patients had benign pulmonary disease, 3 patients had pulmonary metastases and 21 cases suffered from a primary lung cancer TNM stage I. In all cases of malignancy hilar lymphadenectomy was performed. No major postoperative complications were observed. Functional and cosmetic results were always excellent.