Biomedical subjects
L Luciani
Publications and source records attributed to L Luciani.
[Endoscopic findings after gastric surgery: suture stitches protruding into the anastomotic lumen].
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[Role of direct transcutaneous puncture cytology in the diagnosis of adrenal metastases of urological cancers].
The authors present their technique for the demonstration of adrenal metastases of urological cancers by direct percutaneous aspiration biopsy of the adrenal glands under ultrasound or CT control. Aspiration cytology appears to be a safe and reliable technique. The authors were surprised by the frequency of these metastases as, out of the 11 adrenal aspirations, cytology confirmed the diagnosis of metastasis in 9 cases.
[Gleason's system and pelvic lymphadenectomy in the pretherapeutic evaluation of cancer of the prostate. Apropos of 85 cases].
Accuracy of staging of prostatic cancer is related to invasive procedures since imaging methods do not allow a reliable knowledge of the nodal status. Unfortunately lymphadenectomy is adversely affected by morbidity and mortality, therefore alternative methods should be elaborated. Post-lymphographic aspiration cytology seems to be worthwhile, having proved to be a reliable, accurate, safe procedure which can provide useful information in the management of patients with prostatic cancer. Nevertheless uncertainty exists upon the clinical significance of negative cytologic findings. In this connection correlation between grading and aspiration cytology can constitute a further improvement. In our experience the Gleason grading system has shown to be the most reliable and reproducible. 85 patients classified according to the Gleason's system, underwent staging lymphadenectomy and no nodal metastases were present when the Gleason score was lower than 5. In 50 cases even aspiration cytology was accomplished before surgery. No false positive cytologic findings were seen on histologic verification. Two false negative results were obtained in patients with Gleason score higher than 5. In conclusion we believe that when prostatic cancer shows a Gleason score lower than 5 and the lymph node aspiration cytology is negative no staging lymphadenectomy should be performed. On the contrary in cases with Gleason sum from 5 to 10 negative nodal cytologic findings are inconclusive, nevertheless this rate of patients is low and the necessity of surgical staging can be really reduced.
Correlation between serum aluminum concentration and signs of encephalopathy in a large population of patients dialyzed with aluminum-free fluids.
The role of persistently high serum aluminum levels (sAl) in the pathogenesis of dialysis encephalopathy (DE) was evaluated in two groups selected from 170 patients dialyzed with low Al fluids. Group 1 (G1) consisted of 24 patients showing two or more sAl below 50 micrograms/l and group 2 (G2) consisted of 27 patients with sAl above 100 micrograms/l in at least 2 of 3 determinations. The two groups did not show any significant difference for age, sex, education or duration of the dialysis treatment. All G1 patients were treated by hemodialysis. In G2, 24 patients underwent hemodialysis and 3 were on continuous ambulatory peritoneal dialysis (CAPD). We evaluated body loads of Al in 25 of 27 G2 patients with the desferrioxamine (DFO) infusion test. All 51 patients underwent a neurological examination and a waking EEG. Intelligence was assessed by Raven's Progressive Matrices 47 test in 19 of the G1 patients and in 20 of the G2 patients; short-term memory was measured by digit span and by word span and long-term memory by a short story in 10 G1 patients and 17 G2 patients. We diagnosed DE only in the presence of the typical EEG changes, with or without manifest clinical symptoms. DE was diagnosed in none of the G1 patients and in 8 of the G2 patients (0 vs 29.6%, chi 2 = 6.34; p less than 0.025). Five of the patients with DE showed both clinical and EEG signs, while the remaining three showed only EEG signs.(ABSTRACT TRUNCATED AT 250 WORDS)
The role of aspiration cytology in the management of ureteral obstruction in patients with known cancer.
In patients with known cancer, especially in cases of genitourinary cancer, thickening of the ureteral wall secondary to irradiation, chemotherapy, or surgery may make the diagnosis of metastasis, recurrence or persistence of malignancy very difficult. Since it is impossible to determine by radiologic imaging methods, whether the stricture is benign or malignant in nature, exploratory laparotomy with direct tissue biopsy remains the only procedure for an accurate diagnosis of the cause of the obstruction. As such surgery carries a significant level of morbidity, nonaggressive diagnostic techniques should be considered. The authors investigated the usefulness of aspiration biopsy cytology under fluoroscopic guidance in establishing the true nature of ureteral stenosis in 15 patients with known primary malignancy, who had previously been treated with surgery, radiotherapy, or chemotherapy. The etiology of the primary malignancies were uterine cervix (six), bladder (two), prostate (two), uterine corpus (two), pancreas (one), stomach (one), and rectum (one). Thirteen patients had metastatic ureteral involvement. There were no false-positive or false negative cytologic findings, therefore diagnostic accuracy was 100%. In the authors' experience the success of aspiration biopsy cytology depends on the skill and experience of the physician performing the procedure. The results of this study and review of the literature demonstrate that aspiration biopsy cytology is an accurate, minimally invasive means for correct cytologic diagnosis of ureteral strictures which can complicate cancer, without resorting to more aggressive diagnostic procedures.
Penile cancer. Aspiration biopsy cytology for staging.
Appropriate management and prognosis of patients with penile carcinoma depends on an accurate knowledge of the regional node status. The usefulness of clinical and radiologic examinations in detecting the nodal spread of the disease is limited by the high rates of false-positive and false-negative results. On the other hand, routine or prophylactic lymphadenectomy is associated with 30% to 50% of the major morbidity and 3% of the mortality rate, so that caution is advisable for its use in patients with disease-free nodes. Even bilateral sentinel lymph node biopsy, as proposed by Cabanas, does not warrant an adequate selection of patients candidates to surgical treatment. The role of aspiration biopsy cytology in the management of penile carcinoma was evaluated in a study of 29 cases from the authors' institutions. Aspiration under fluoroscopic or computed tomographic guidance was performed using a 22-23-gauge Chiba needle. The accuracy of aspiration biopsy cytology in identifying the true stage of the disease was 100%. On histologic control, only one node contained malignant cells that were not detected by aspiration biopsy cytology, but this finding did not alter the stage of the patient. Positive cytology is conclusive of Stage III disease and, in this case, a curative lymphadenectomy may be attempted. Negative aspirations do not warrant the absence of metastatic nodal involvement as can be seen in two patients in this series. In such cases, however, a policy of "wait and watch" may be adopted, with repeated aspiration biopsies or surgical biopsy of the sentinel node area.
The value of aspiration cytology in the definitive staging of bladder carcinoma.
Aspiration cytology is a simple, accurate and minimally invasive procedure in staging urological neoplasms. Percutaneous fluoroscopy-guided fine needle aspiration biopsy of 99 lymph nodes was performed in 30 patients with bladder carcinoma and 62 lymph node chains were evaluated. Aspiration biopsy is more accurate and specific than lymphography in the pre-operative staging of the neoplasm and represents a useful diagnostic procedure for the staging of bladder carcinoma.
Adenomatoid tumor of the epididymis: immunohistochemical study of 8 cases.
The immunohistochemical characteristics of 8 adenomatoid tumors of the epididymis are reported. Using the peroxidase antiperoxidase technique and the avidin-biotin complex method, antibodies against carcinoembryonic antigen, factor-VIII-related antigen and keratin were tested. In agreement with previous findings strong cytoplasmic staining for keratin was seen in all the tumors, whereas the factor-VIII-related antigen and carcinoembryonic antigen were absent. These results suggest a mesothelial origin of the adenomatoid tumor.
Renal cell carcinoma. An immunohistochemical study. Preliminary report on 20 cases.
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[Octanol-water partition coefficient of different bismuth salts].
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[Value of percutaneous sclerotherapy in the treatment of varicocele. Technic and results].
Since December 1983, percutaneous transvenous retrograde sclerotherapy of the internal spermatic vein was performed successfully, without complications in 37 patients. The administration of the sclerosing agent through a coaxially balloon catheter specifically inserted into the spermatic vein caused therapeutic hardening. The effectiveness of the treatment was endorsed by subsequent checks by clinical and radiological examinations.
Hormone steroid receptor variation after tamoxifen administration in endometrial adenocarcinoma from postmenopausal patients.
Cytoplasmic and nuclear variations of estrogen (ER) and progesterone receptors (PgR) induced by tamoxifen (TAM) treatment were investigated in 38 postmenopausal women with endometrial carcinoma. The treatment consisted of a daily oral administration of 40 mg for 7 days. Tumor samples from each patient were withdrawn before TAM administration under hysteroscopy and at the time of hysterectomy. Cytoplasmic and nuclear receptors were respectively determined by the dextran-coated charcoal assay and the hydroxylapatite technique. In the cytoplasmic fraction no significant change in mean ER value was observed, but a statistically significant increase in PgR was found (P less than 0.001). Conversely, in the nuclear fraction PgR did not vary, but a significant increase in ER content (P less than 0.001) was observed. PgR, analyzed by sucrose density gradient after TAM, showed the same sedimentation property (9 S) as the preexisting receptor, but with a single peak profile, indicating a lower heterogeneity. Our data support the hypothesis that the mechanism of PgR synthesis is induced by the ER-TAM complex and suggest the possibility of increasing the PgR content in these patients for sequential endocrine therapy.
Urine cytology in the detection of renal adenocarcinoma.
Whereas urine cytology has proved to be of considerable diagnostic value for nonpapillary urothelial carcinoma, carcinoma in situ, and high-grade urothelial tumors, controversy has arisen over the accuracy of cytology in the diagnosis of renal neoplasms. To establish the reliability of urine cytology as a detection technique, 436 urine specimens from 59 patients with histologically proven renal adenocarcinoma were examined. Malignant cells in urinary sediment were found in 121 (27.75%) specimens from 31 (52.54%) patients. Seven of 20 (35%) patients with Stage I tumor showed neoplastic cells in 16 (16.5%) of 97 urinary samples. Positive cytologic features were found in 36.9% of 84 urinary specimens from 7 (50%) of 14 patients with tumors smaller than 5 cm. Using only imaging methods, the renal neoplasm was diagnosed in 58 (98.3%) cases. Urine cytology is, therefore, of little value in the diagnostic evaluation of known renal masses and in the detection of early-stage disease. In the current series there was not a single case with positive cytologic findings in which radiology did not reveal the tumor. The cytologic examination of the urinary sediment is unreliable in the diagnosis of radiologically unresolved cases of renal neoplasms. In 15 patients (44%) who had cancer cells in the urine the neoplasm had not invaded the renal pelvis. In 36% of patients with negative urine cytologic findings the renal pelvis was involved by renal adenocarcinoma. In the current study the desquamation of neoplastic cells in the urinary stream did not depend on tumor invasion of the renal pelvis. Based on the assumption that the primary objective of a screening procedure is to achieve an adequate sensitivity for early detection of disease, the results led the authors to conclude that the use of urine cytology as a possible screening test of renal adenocarcinoma is futile. Factors in the current study that diminished the practical value of cytologic examination of urinary sediment included the large number of specimens without malignant cells and the insensitivity of the procedure in diagnosing early renal adenocarcinoma of limited extent. Although this is the largest series reported, the number of cases considered was limited and further detailed studies are mandatory to definitively clarify the value of urine cytology in detecting renal adenocarcinoma.
Aspiration cytology in the staging of urologic cancer.
Knowledge of the status of the pelvic lymph nodes is vital for accurate staging and adequate treatment of patients with urologic cancer. Noninvasive techniques for assessing the lymphatic spread of urologic neoplasms have proved to be of limited value. Bipedal lymphangiography and percutaneous fine needle aspiration cytology under fluoroscopic guidance were performed for staging purposes in 71 patients with clinically localized bladder, prostatic and penile cancer from 257 nodal chains. The overall diagnostic accuracy was 93% and the correct aspiration of 186 lymph nodes was surgically confirmed. There were 11 (6%) false-negative biopsy results and no false-positive diagnoses. Aspiration cytology is a safe, well tolerated, accurate, and rapid method of determining the presence of metastatic disease in lymphangiographically visualized pelvic nodes. In the management of prostatic carcinoma, positive cytologic results are diagnostic of nodal metastatic involvement and spare the patients unnecessary surgical staging. Negative cytologic findings may be considered diagnostic of localized disease in the patients with well differentiated prostatic carcinoma (2-4 Gleason's sum). Since most surgeons are reluctant to perform a staging lymphadenectomy in the management of invasive bladder carcinoma, aspiration cytology can provide accurate staging, thus permitting an appropriate treatment plan. In patients with carcinoma of the penis, a positive aspirate permits an early and even curative lymphadenectomy in cases with clinically negative but pathologically positive nodes.
Experience with modified Chiba needle in staging of genitourinary tumors.
The features of a new needle used in the percutaneous pelvic node fine-needle aspiration biopsy in 56 patients with urologic neoplasms are described. The side openings on either side of the needle walls and the bevel angle lowered to 15 degrees provide excellent penetration and aspiration ability. Representative specimens were obtained from all patients, and the accuracy of aspiration biopsy results in determining true stage of disease was 94.64 per cent. These data provided sufficient evidence of the efficiency of our needle to recommend it for use in TNM classifications of urologic tumors.
Regional node aspiration cytology in staging penile cancer.
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Aspiration cytology of simultaneous bilateral adrenal metastases from renal cell carcinoma. A case report and review of the literature.
We report the computerized tomography and ultrasound-guided aspiration cytology results in the first case of renal cell carcinoma with bilateral adrenal involvement. The adrenal metastases were evident clinically 6 years after radical nephrectomy and were treated successfully by an operation. Aspiration cytology under computerized tomographic and sonographic guidance is an excellent procedure to evaluate enlarged adrenal glands in patients with renal cell carcinoma or other malignant neoplasms.