Biomedical subjects

Pasquale Spinelli

Publications and source records attributed to Pasquale Spinelli.

6 recordsLinked to original sources

PubMed2006

Operative colonoscopy in cancer patients.

Gastrointestinal endoscopy has experienced tremendous developments in technology and equipment over the past decades. It is not only a diagnostic tool, but it also allows some interventional treatments in benign and malignant digestive diseases. Operative colonoscopy has been used to perform curative treatment of various kinds of polyps, flat and carpet-like adenomas and early colorectal carcinomas. Endoscopic palliative treatment strategies, such as the placement of self-expandable metal stents (SEMS), laser ablation, photodynamic therapy (PDT), argon plasma coagulation (APC), electrocoagulation, and injection therapy, have been proved to effectively alleviate advanced colorectal cancer (CRC) associated symptoms and maintain or improve the quality of the patient's remaining life.

Colonoscopy↗

PubMed2003

Predictors of metachronous colorectal neoplasms in sporadic adenoma patients.

Our objective was to assess the overall risk of subsequent colorectal neoplasms (cancer or adenoma) in relation with the various characteristics of the index lesion in a cohort of patients who underwent endoscopic polypectomies of colorectal adenomas. A total of 1086 patients with adenomas of the large bowel were reported between 1979 and 1999 at the National Cancer Institute of Milan during a screening program for colorectal carcinoma. Data on patients who had colonoscopic examinations and treatments were collected prospectively. The relation between colorectal cancer (CRC) and adenoma features was assessed by computing the hazard ratio (HR) values and corresponding confidence intervals (95% CI) according to Cox proportional hazard models. Of the 1086 eligible patients (487 females, 579 males), 736 had single adenomas (67.7%) and 350 had multiple adenomas (32.3%). Histologic examination revealed 772 cases of tubular adenoma (73%), 205 cases of tubulovillous adenoma and 80 cases of villous adenoma (7.5%). Severe dysplasia was found in 3.3% of the cases. During the 11393 person-years of follow-up, with an average time of surveillance of 10.5 years, colorectal carcinomas developed in 10 patients (0.8%) and a new adenoma in 323 patients (29%). Multivariate analysis showed that male gender (HR 1.6; 95% CI 1.3-2.0), multiple polyps (HR 1.6; 95% CI 1.3-2.0), polyps larger than 2 cm (HR 1.5; 95% CI 1.1-2.1), tubulovillous and villous histology (HR 1.3; 95% CI 1.0-1.6 and HR 1.8; 95% CI 1.2-2.6, respectively) at index polypectomy were statistically significant risk factors for developing metachronous adenomatous polyps. The standardized incidence rates (SIR) for CRC was 0.52 (95% CI 0.25-0.95). The SIR was increased in subjects with severe dysplasia (2.8; 95% CI 0.34-1.02). Some features of large bowel adenomas are strongly correlated with an increased risk of metachronous adenomas and colorectal cancer. However, the endoscopic polypectomy is able to reduce by 50% the incidence of CRC in patients with large bowel adenomas.

Adenoma↗

PubMed2003

Human leukocyte antigen class II genes and Helicobacter pylori infection: does genotype overwhelm environmental exposure?

OBJECTIVE: We investigated associations between human leukocyte antigen class II genes, environmental exposures, and Helicobacter pylori infection. METHODS: Sixty-eight subjects with histologically confirmed H. pylori and intestinal metaplasia (cases) and 70 healthy subjects without H. pylori (controls) matched for age, sex, and year of birth were included in this study. All patients answered a detailed questionnaire designed to collect sociodemographic characteristics, smoking, alcohol drinking, and dietary habits. Human leukocyte antigen class II genes were typed with genomic DNA. The cytotoxins CagA and VacA were investigated with serology. Odds ratios and corresponding 95% confidence intervals were estimated from multivariate conditional logistic regression. Multiple correspondence analysis was used to represent the interrelationships of a multiple contingency table. RESULTS: Human leukocyte antigen DRB1, DQA1, and DQB1 genotypes were not significantly associated with H. pylori infection and intestinal metaplasia. No significant association with blood group or Lewis antigen system was found. However, multiple correspondence analysis clearly associated H. pylori with environmental exposure: the control group largely consumed olive oil, fresh fruits, and vegetables and histories of never or formerly smoking and the case group (those positive for H. pylori and metaplasia) largely consumed eggs, meat and butter and had histories of smoking cigarettes. CONCLUSIONS: These findings suggested that H. pylori infection is not influenced by a genetic compound and confirmed the relevance of environmental exposure.

Adult↗

PubMed2002

Preoperative chemoradiation in patients with resectable rectal cancer: results on tumor response.

BACKGROUND: There is no consensus about the role of preoperative radiotherapy (RT) and chemotherapy (CT) in patients with resectable cancer of the distal rectum. This study analyzed the local clinical and pathologic response in patients receiving preoperative RT/CT for rectal cancer. METHODS: Thirty-two consecutive patients with a palpable adenocarcinoma of the rectum received preoperative RT (45 Gy in 25 fractions over 5 weeks) plus continuous chemotherapy with doxifluridine and leucovorin or 5-fluorouracil by continuous intravenous infusion during RT. Surgery was performed 8 weeks later. The Wilcoxon and chi(2) tests were used for data analysis. RESULTS: Twelve patients had mild gastrointestinal toxicity, only one of whom required interruption of therapy. The tumor shrank to 57.8% of its original size, and at the echoendoscopy (u) there was a 58.7% decrease of the maximum diameter (P <.001). Downstaging from uT3 and uT2 to <uT3 and <uT2, respectively, occurred in 41.6% of patients (P =.0020). Total and major regression of the tumor at the histopathologic examination occurred in 12.5% and 50% of patients. CONCLUSIONS: Local response to preoperative RT/CT was highly satisfactory and allowed conservative surgery in 81% of patients. Optimization of the combined therapy could achieve even better results.

Adenocarcinoma↗

PubMed2002

Molecular changes track recurrence and progression of bronchial precancerous lesions.

Diagnosis of lung cancer is reached when the disease had grown to advanced stages in its natural history. Thus, novel molecular markers for early detection and risk assessment are needed. Here we performed a longitudinal study of 20 morphological lesions occurred in the bronchial tree of high-risk patients. The lesions were subjected to LIFE (laser-induced fluorescence endoscopy) bronchoscopy and molecular follow-up over a 4 year period. The presence and the persistence of specific genetic alterations were correlated with recurrence or progression of the disease on follow-up. Molecular lesions considered as highly predictive of invasion could be prospectively used as diagnostic markers of high risk for lung cancer in exposed patients.

Acid Anhydride Hydrolases↗

PubMedDate not supplied

Barrett's esophagus: ablative endoscopic techniques.

Barrett's esophagus consists of a precancerous condition in which the progression from dysplasia to adenocarcinoma is now well documented. The management of patients affected by Barrett's esophagus is still debatable, in particular for the risk of surgical treatment in the presence of small precancerous lesions or early adenocarcinoma. Furthermore, quality of life after surgical resection is often poor. Endoscopy is the main diagnostic and follow-up procedure in Barrett's esophagus: it allows the detection and treatment of severe dysplasia and invasive esophageal adenocarcinoma. Endoscopic treatment also produces reduction or disappearance of intestinal metaplasia. In these cases, the aim of the treatment is to prevent dysplastic changes. Moreover, the ideal endoscopic treatment should be safe, easy to perform and cost effective. Thermal (electrocoagulation, laser, argon-plasma coagulation), photochemical (photodynamic therapy) or ablative (endoscopic mucosal resection) procedures have been proposed alone or in combination, with the aim to completely eradicate dysplastic lesions or early adenocarcinoma as an alternative to surgical treatment. Endoscopic removal of the lesions is followed by restoration of normal epithelium. Some questions about patient selection, prevention of recurrence and best endoscopic treatment still remain unanswered.

Adenocarcinoma↗