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Small cell lung cancer is generally staged as a localized or diffuse disease due to its great invasiveness and quick spread. The authors investigated the advantages of a more accurate staging by TNM system applied to small cell lung cancer. Sixteen patients (12 males and 4 females, mean age 54 years, max 66, min 48) were submitted to a treatment protocol consisting of 6 cycles of chemotherapy over an 18-month period. All patients underwent CT before and after the third and sixth cycles. Disease evolution was evaluated by means of the TNM system; relative to the N parameter, the American Thoracic Society criteria were followed. After completion of the third chemotherapy cycle, CT demonstrated reduction in T in 7/16 cases, while in the extant patients T was unchanged. N decreased too in 7 patients and remained unchanged in the others. CT examinations at the end of the whole treatment protocol demonstrated no changes in T. As for N, CT showed evolution from N0 to N2 in one case and from N3 to N0 in another one, while no changes were observed in the extant patients. The M parameter was constantly negative in all cases. Our results demonstrate that this approach to small cell lung cancer permits a more accurate characterization of the disease, thus making it easier to monitor the positive/negative response to treatment and allowing the latter to be personalized.

Primary venous insufficiency is a pathologic condition characterized by reflux in the deep venous system not secondary to phlebothrombosis. The authors compare the diagnostic capabilities of duplex and Doppler US in the evaluation of this condition. At present, Doppler US has a more widespread use than the duplex method. Both lower limbs were examined in 46 patients known to be affected with mono/bilateral primary venous insufficiency thanks to previous retrograde phlebography. Ten patients with different phlebopathies and 10 healthy volunteers were also studied as a control group, duplex US had 92% sensitivity and 90% specificity, while Doppler had 86% and 75%, respectively. Duplex US appeared to be more accurate than Doppler in locating and quantifying the reflux. Finally, the authors draw attention to the segmentary reflux phenomenon they observed in asymptomatic patients and suggest the possibility of recognizing the preclinic stage of this condition by duplex US, which is a non-invasive and relatively inexpensive method. The latter could become, thanks to its intrinsic characteristics, the method of choice for monitoring.

The authors evaluated the long-term results of sclerosing therapy as an alternative to surgery by means of high-resolution US and Doppler dynamic fluximetry (duplex system). Seventy patients (53 females and 17 males) were examined, all of whom fulfilled the clinical criteria of recovery and efficacy of sclerosing therapy. Average follow up was 20 months (range: 6-26). The results, compared with duplex findings before sclerosing therapy, demonstrated: a) persistence of reflux and absence of US signs of sclerosis (9/70 patients); b) evident sclerosis with persistent residual lumen and reflux of variable entity at the thigh (33/70) cases; c) incomplete sclerosis sparing the crosse, with physiological flow and disappearance of reflux (8/70 patients); d) nearly complete sclerosis with vasal lumen obliteration (20/70 cases). No changes were observed in the deep venous system after sclerosing therapy. The authors stress the advantages of the duplex system they employed as an instrumental support to clinics for a complete monitoring of sclerosing therapy.

The authors analyze the results obtained by means of Doppler US, duplex examination and venography in the preoperative evaluation of venous vascular anatomy and flow dynamics in the popliteal fossa for short saphenous vein surgery. As a whole, 50 legs were examined in 34 patients who subsequently underwent surgery. The confluence of the short saphenous vein in the deep system proved to be very variable. Doppler results were compared with contrastographic ones: Doppler US had 10% accuracy in locating the confluence of the short saphenous vein and the figure rose to 62% with a +/- 2 cm tolerance. Duplex US had 30% and 98%, respectively. The latter always correctly demonstrated the reflux, while Doppler US in 5 cases (10%) ascribed gastrocnemius vein incompetence (4 cases) and Giacomini vein incompetence (1 case) to the short saphenous vein. The above findings demonstrate the total reliability of duplex US versus Doppler US and venography in recognizing the anatomic confluence and in allowing the fluximetric evaluation in a noninvasive, riskless and inexpensive way.