Biomedical subjects
Publications and source records attributed to M Firpo.
Carcinoma of the collecting ducts, or Bellini carcinoma, is a rare renal tumour and, unlike most renal cell carcinomas, it derives from distal tubules. It displays highly aggressive behaviour and has a poor prognosis. In this study, the authors present three cases which they observed over the past three years.
BACKGROUND: Surgery remains the only effective treatment for renal carcinoma. According the current surgical procedure, both the neoplastic kidney with its perirenal tissue and the Gerota fascia with adrenal gland must be removed. In the last years, the utility of routine adrenalectomy for kidney cancer surgery has been questioned and some authors now recommend this procedure just in selected cases. METHODS: In order to provide a contribution to this debate, 350 cases of nephrectomy after renal carcinoma have been reviewed. In all, 185 adrenalectomy have been performed and neoplastic involvement of adrenal gland has been identified just in 9 cases (4.9%), suggesting a rarity of tumor progression to adrenal gland at the time of surgery. RESULTS: Moreover, neoplastic involvement of adrenal gland has been shown in just 3 cases at preoperatively CT scan. CONCLUSIONS: The conclusion is drawn that adrenal gland may be retained in surgery for radical nephrectomy after renal carcinoma. Adrenalectomy may be recommended in doubtful cases, especially in upper pole localization and in large tumours.
The generation of blood cells, haematopoiesis, in the mouse embryo begins with the development of primitive nucleated erythroid cells in the yolk sac followed by the appearance of precursors for multiple definitive haematopoietic lineages. The later developing lineages arise from multipotential stem cells, but the relationship of primitive erythroid cells to these other haematopoietic populations is unknown. Using an in vitro embryonic stem (ES) cell differentiation system, we show that primitive erythrocytes and other haematopoietic lineages arise from a common multipotential precursor that develops within embryoid bodies generated from differentiated ES cells. In response to vascular endothelial growth factor and c-kit ligand these precursors give rise to colonies containing immature cells (blasts) expressing marker genes characteristic of haematopoietic precursors. Many blast colonies also expressed betaH1 and beta major globins but not Brachyury, a mesodermal marker. Kinetic analysis demonstrated that the blast colony-forming cells represent a transient population, preceding the establishment of the primitive erythroid and other lineage-restricted precursors. This precursor population may represent the earliest stage of embryonic haematopoietic commitment.
This report describes a patient with combined immune deficiency associated with congenital neutropenia (CID/CN) and reports a partial characterization of his hematopoietic abnormalities. The CID/CN syndrome described is characterized by neutropenia and by deficiencies in B-lymphoid and T-lymphoid cell number and function. Red cell and platelet counts were normal. In vitro assays indicate that the myeloid lineage was developmentally arrested at the level of the committed monocyte/granulocyte progenitor (CFU-GM), while precursors to the CFU-GM progenitor were normal. In vitro studies showed that the defect in myeloid development was not corrected with G-CSF or GM-CSF. However, combinations of cytokines present in conditioned media from the T-cell lines MO or C5MJ, or defined multiple cytokine combinations containing IL-1, IL-3, GM-CSF, kit ligand, IL-6, and IL-9, restored myelopoiesis in-vitro. In contrast, C5MJ-conditioned media did not correct deficiencies in immune function in the patient's lymphocytes and accessory cells. No abnormalities in the production of G-CSF, GM-CSF, M-CSF, or IL-1 from the patient could be identified to account for the defects in myelopoiesis orimmune function.
Eleven cases of renal angiomyolipoma are reported. In all cases a correct preoperative diagnosis was made, using standards x-radiography, ultrasonography and computerized tomography. Small size AML do not generally require any surgery, while surgical procedures for larger AML vary depending on the size, associated diseases, other complicating factors. As a general rule, surgical treatment should be as conservative as possible.
The persistence or onset of hyperparathyroidism following kidney transplant is characterized by an incidence ranging from 2.6 to 70% according to the various statistics available. In a total of 462 kidney transplants performed in our department, hyperparathyroidism was detected in 9 patients. Surgery took the form of parathyroidectomy 8/8 plus autograft in 3 cases, parathyroidectomy 3/4 in 2 cases, 7/8 in 2 cases, and 4/8 in 1 case. Serum calcium values returned to normal in all patients after the operation.
The authors report the results of a clinical study of the use of cyclosporin A plus low-dose steroids in a consecutive series of 55 kidney transplants with follow-up ranging from 6 to 20 months. The clinical results (rejects, immunosuppressant side effects, 12-month survival of transplant and patient) are compared with those of a similar group of patients on "traditional" therapy (azathioprine plus high-dose steroids). The results of the study confirm the efficacy of cyclosporin A in preventing and controlling acute reject crises in the course of allogenic transplant, though many of the problematic issues related its clinico-therapeutic management remain open questions.
Primary retroperitoneal tumors (PRT) constitute about 0.02 per cent of all tumors examined in the Department of Pathology of our hospital. We report 3 cases of malignant PRT - yolk-sac tumour, vascular leiomyosarcoma and extraskeletal chondrosarcoma - selected for their histological rarity and clinical features. Recent techniques available for the diagnosis of these neoplasms and surgical treatment are discussed. The role of radio-chemotherapy is also dealt with.
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