Search

We report a rare case of diffuse malignant pleural mesothelioma synchronous with a localized adenocarcinoma of lung in a 68-year old man with a suspicious history of asbestos exposure. Computed tomography revealed a sub-pleural mass in the lower lobe and an irregular dense area of medium lobe of right lung with thickening of pleura encasing the lung parenchyma and homolateral pleural effusion 1 cm thick. The patient underwent surgery and a right medium and lower lobectomy was performed. Upon frozen sections, intraoperative diagnosis was adenocarcinoma with a poorly differentiated component of lung infiltrating the pleura. The postoperative histological definitive diagnosis with an important contribution of immunostaining was synchronous pulmonary adenocarcinoma and pleural diffuse malignant epithelioid mesothelioma.

Background: The influence of physiological and methodological factors on recordings of brainstem auditory evoked potentials (BAEPs) is greater in children than in adults., Objective: To collect and evaluate BAEP data in normal children, and measure intra- and inter-laboratory variability., Methods: Seven hundred and fifty unselected BAEP recordings were collected and evaluated from children ranging from neonates to 14-year-olds by eight laboratories in Italy., Results: In newborns, three laboratories showed satisfactory concordance; wave I was more broadly distributed than wave V and IPL I-V. The evaluation of pooled BAEP data from the older children showed that laboratories with age-matched data gave overlapping results; those with unmatched-age data differed significantly. The sound intensities of the laboratories did not significantly affect absolute BAEP latencies or IPLs. Females had shorter latencies than males; the difference was not significant. A single exponential regression model was an adequate but not the best predictor of normal data., Conclusions: The pooled data were consistent with the physiological maturation of the brainstem acoustic pathway. The BAEPs was reliably normalised using the natural logarithm of age. The differences between Centres were related to sample size, measurement accuracy, and inclusion and selection criteria., Significance: The creation of multicentre common database from an unmatched data collection is feasible and reliable enough for clinical diagnosis and multicentre clinical research.

Background: Carboplatin-containing regimens are sometimes preferred for patients with advanced non-small cell lung cancer., Methods: Eighty-three patients with stage III-IV non-small cell lung cancer received 3 to 4 cycles of carboplatin AUC 5 on day 2 and gemcitabine 1250 mg/m2 on days 1 and 8 every 21 days., Results: The overall response rate was 43.4%. Results obtained from elderly and non-elderly groups were compared using the logrank method. Median overall survival and progression-free survival were 11 and 7 months, respectively (12 and 7 months, non-elderly group; 6.5 and 5 months, elderly group, P = 0.28 and 0.25 respectively). Grade 3-4 toxicity included neutropenia, thrombocytopenia, anemia, nausea/vomiting, and diarrhea. Incidences of grade 3-4 toxicity were similar for elderly and non-elderly patients., Conclusions: Data confirm that carboplatin-gemcitabine is an active and well-tolerated regimen in advanced non-small cell lung cancer and could be investigated in elderly patients.

Purpose: To assess the advantages of the 2001 ILAE proposed diagnostic scheme for classification of newborns with epileptic seizures over the 1989 ILAE classification., Method: Clinical features, seizure semiology and duration, neurological evaluation, ictal and interictal EEG, brain imaging and outcome at the end of the neonatal period (44 weeks post-conceptional age) of 94 newborns with EEG confirmed seizures were analyzed. The 2001 ILAE classification was applied where possible., Results: Twenty patients died before the end of the neonatal period. In the remaining patients, applying axis 3, we classified 54 newborns as having epileptic seizures that do not require a diagnosis of epilepsy; 14 as symptomatic partial epilepsy; 5 within the neonatal epileptic syndromes and one as benign neonatal seizures (NS). Axis 4 in all newborns provided a valuable tool in order to better define the individual patient., Conclusions: Compared to the 1989 ILAE classification, which allowed a syndromic diagnosis in only 6/94 patients, the remaining being classified as Epilepsies and Syndromes undetermined whether focal or generalized, the 2001 ILAE diagnostic scheme, applied at the end of the neonatal period, offers a variety of approaches to classification, allowing an early distinction between epilepsy and single or isolated clusters of seizures, with therapeutic and prognostic implications.

Aim: Since 1997 a newborn hearing screening programme has been implemented by the U.O. Neurologia-Neurofisiopatologia and Dipartimento di Neonatologia of the Istituti Clinici di Perfezionamento ICP in Milan for both babies with no risk and those at risk of hearing impairment. This programme was named the Milan Project., Methods: The protocol for no-risk babies consisted of three stages: in the first two stages, newborns were tested with transient click-evoked otoacoustic emissions (TEOAE), in the third one with conventional auditory brainstem responses (ABR). The first TEOAE test was performed by 36 h of age, before discharge, the second one after 15-30 d in case of referral, and the third one, by ABR, for those babies who failed the second TEOAE stage. Newborns at audiological risk were submitted to conventional ABR before the third month of corrected age. Some of this latter population was also submitted to the TEOAE test. The entire tested population (no-risk babies and newborns at audiological risk) consisted of 19 777 babies: 19 290 without risk ("no risk") and 487 at risk ("at risk")., Results: During the course of the Milan Project, hearing impairment (ABR threshold equal to or greater than 40 dB nHL) was identified in 63 newborns (19 from the no-risk and 44 from the at-risk population), with a prevalence of 0.32%. Bilateral hearing impairment (BHI) was found in 33 newborns (10 from the no-risk and 23 from the at-risk population), corresponding to 0.17%. Among infants with bilateral hearing impairment, 30.3% had no risk factors. The prevalence of hearing impairment was determined on days 15-30 after birth., Conclusions: The results show that the implementation of a hospital-based, universal neonatal hearing screening programme for babies with and without audiological risk is feasible and effective. The effectiveness of the programme has increased as a function of the years since its inception, with a strong decrease in the referral rate. Further improvement is obtained if the TEOAE measurements are repeated in cases of referral scoring before discharge.

The present phase III trial was carried out to verify whether a kinetic recruitment induced by low doses of diethylstilbestrol (DES) could increase the killing efficacy of chemotherapy in patients with locally advanced breast cancer. One-hundred and seventeen untreated patients with locally advanced breast cancer (stage IIIA/IIIB) were randomized to receive 3 courses of primary chemotherapy consisting of cyclophosphamide (600 mg/m2 i.v.), doxorubicin (50 mg/m2 i.v.) and fluorouracil (600 mg/m2 i.v.) (CAF) on day 1, or DES-CAF (DES, 1 mg orally days 1-3, CAF on day 4). The courses were repeated every 3 weeks. The patients who achieved an objective response were submitted to mastectomy followed by 3 courses of CAF alternated with 3 courses of CMF (cyclophosphamide, 600 mg/m2 i.v.; methotrexate, 40 mg/m2 i.v.; fluorouracil, 600 mg/m2 i.v.), with or without DES. The two treatment arms were well balanced in terms of clinical and pathologic features. There was no significant difference in response rates to induction chemotherapy between the two treatment arms (objective response rate, 63.3% for CAF and 56.1% for DES-CAF). Median overall survival was 49 and 47 months and median progression-free survival was 24 and 21 months for CAF and DES-CAF patients, respectively. Toxicity was not significantly different in the two groups, with the exception of leukopenia: DES chemotherapy was significantly more myelotoxic than the standard treatment, which resulted in a significant reduction in the actual dose intensity. In spite of the attractive experimental evidence, we conclude that so far there is no clinical advantage in the combination of estrogen and chemotherapy. Further research is needed to investigate different schedules of chemotherapy and hormones, or to test the possibility of combining various mitogens.

Pattern reversal visual evoked potentials were recorded in 71 children with different types of migraine (e.g. migraine with aura, migraine without aura) or tension-type headache and in 19 controls (mean age of both groups 9 years). P100 latencies were comparable in all three groups.

In this multicentre trial tramadol and buprenorphine were compared for the treatment of neoplastic pain no longer responsive to non-steroidal antiinflammatory drugs. A total of 131 adults (86 M, 45F) were treated with tramadol (one 100-mg slow-release tablet every 8-12 h), or buprenorphine (one sublingual 0.2-mg tablet every 6-8 h). The trial was to continue for up to six months. Most patients started treatment with 2-3 tablets/day in both groups, and the mean treatment period was 58 days for tramadol and 51 for buprenorphine. Almost all dose changes needed were made in the first fortnight in both treatment groups, and the largest number of patients dropped out because of inadequate pain relief or progression of the underlying disease. The results achieved in the first two weeks persisted throughout the rest of the trial, and the investigator's assessments on each patient's clinical chart corresponded closely with those that patients made in their own daily diaries. In the four hours after the first dose both drugs virtually halved the severity of pain (measured using a visual analogue scale), and this relief lasted throughout treatment. By the end of the first week the proportion of patients with strong/unbearable pain in the tramadol group had fallen significantly (from 98.4% to 48.1%, p < 0.05), as compared to a drop from 92% to 66.7% for buprenorphine. The quality of sleep also tended to improve in the tramadol group, with the proportion of patients enjoying good or deep sleep rising from 37% to 50%, as compared to 33% to 40-44% with buprenorphine. Karnofsky's and Spitzer's indices reflecting the quality of life did not change in the tramadol group; in the buprenorphine group the Karnofsky index dropped slightly after a fortnight (p < 0.05 between treatments). In the first two months of the trial the number of patients with no/moderate pain rose continuously in the tramadol group (71% and 80% after one and two months); the rise was less marked in the buprenorphine group (number of patients with mild/moderate pain, 45% and 65%). In both the short term and in the longer term, it was found that the levels of efficacy and acceptability were always significantly better in the tramadol group than in the buprenorphine group. General and biological safety in both drugs was good. The most typical side-effects were those characteristic of opioids (nausea and/or vomiting, drowsiness). Adverse reactions were reported in 17 patients taking tramadol (25%) and in 16 taking buprenorphine (26%). There were six drop-outs in the first group (9%) and seven in the second (11%). Serious symptoms arose more frequently in the buprenorphine group (19% cf. 10%). No signs of dependence or tolerance were noted.

Aims and Background: In vitro and in vivo studies have shown that lonidamine potentiates the cytotoxic effect of anthracyclines in simultaneous and sequential combination. On the basis of such evidence, we evaluated the activity and toxicity of a combination of epirubicin plus lonidamine in advanced breast cancer., Methods: Between January 1991 and November 1993, 33 patients with advanced breast cancer, age < 75 years and PS < 2, were treated with epirubicin (75 mg/m2 i.v. on day 1, every 3 weeks), plus lonidamine (450 mg/day orally from day 1 continuously until disease progression)., Results: Thirty patients were evaluable for response: 4 achieved complete response (13%) and 8 partial response (27%) (total response rate = 40%), 6 (20%) had stabilization of disease, and 12 (40%) progression of disease. The median duration of response was 10 months (range, 4-24+ months). This scheme was tolerated, with a mild additional toxicity related to lonidamine: only WHO grade III myalgia in 1 patient (3%) and epigastralgia in 3 patients (9%)., Conclusions: Although some patients seem to have benefited from the combination at the dose levels of the drug used in the study, the therapeutic advantages of addition of lonidamine remain unclear.

The aim of the present study was to evaluate the clinical, morphological and functional results obtained in a group of patients previously submitted to Traverso-Longmire pylorus-preserving duodeno-pancreatectomy (PPDP). The study was performed as a clinical, endoscopic, radioisotopic and electro-manometric evaluation. An analysis of the results allowed us to conclude that: 1) most patients show good clinical features, and this becomes more evident as post-operative time progresses; 2) bile reflux gastritis is an infrequent event; 3) gastric emptying times in patients overlap those seen in control subjects, and progressive normalization occurs postoperatively. The best clinical results coexist with normal gastric emptying times; 4) gastrojejunal interdigestive motor activity shows a reduction in phase 3 and a relative increase in phase 2. We argue that the motor activity of the upper gastrointestinal tract can restore, from a functional point of view, the new anatomical situation. On the basis of the good clinical and functional results, pyloric preservation seems to be the most physiological procedure for the restoration of alimentary continuity following duodenopancreatic resection.

In line with data reported in the literature, the authors consider that the careful protection of the tracheal suture with abundant vital tissue is of fundamental importance in the prevention of complications in tracheal resective-reconstructive surgery. This procedure in fact reduces the risk of necrosis and subsequent fistulization of tracheal tissue and prevents decubitus of the suture on the innominate arterial wall, avoiding possible ulceration with fistulization and tracheal hemorrhage.

The authors illustrate the current possibilities and limitations of a leading-edge technique, thoracoscopic surgery, made possible by the enormous technical progress which has led to the creation of specific visual and surgical instruments. On the strength of their personal experience, they list the different diseases which may be treated using video thoracoscopic surgery.

Twenty patients undergoing lung resections were randomized into two groups: group 1 (n = 10) received mini-tracheotomy postoperatively and group 2 (n = 10) were control patients. The two groups were similarly matched in pulmonary functions (FEV1 < 1.8 1), performance status and surgical procedures (major pulmonary resections). All patients were monitored by serial chest X-ray examinations, arterial blood gases, clinical assessment and response to chest physiotherapy. Postoperative pulmonary complications of atelectasis/bronchopneumonia developed in 1 patient in group A and 4 patients in group B. Two patients of this last group required mini-tracheotomy to treat the pneumonia. The mean overall duration of mini-tracheotomy was 6.3 days. Five patients presented minor temporary symptoms related to mini-tracheotomy, including voice changes, discomfort and stridor. No long term morbidity was observed. We concluded that the use of mini-tracheotomy is safe and effective in decreasing postoperative respiratory morbidity in high risk patients.

Human neutrophils (5 x 10(4) incubated on fibronectin precoated wells released 2.83 +/- .25 nmoles of superoxide (0(2)-) (x +/- 1 SEM, n = 15) in response to 5.9 nM (100 ng/ml) Tumor Necrosis Factor Alpha (TNF). On the contrary, the 0(2)- production induced by interleukin-8 (IL-8) (doses ranging from 0.1 nM to 1 microM) was comparable to that of "resting" cells (< .6 nmoles/5 x 10(4) cells). IL-8 (100 nM) did not affect the TNF-dependent 0(2)- production when added with TNF at the beginning of the assay, but reduced it by approximately 80% when added with TNF on neutrophils previously incubated for 1 hour on fibronectin. As compared with IL-8, N-formyl-methionyl-leucyl-phenylalanine (FMLP, 100 nM) failed to suppress the TNF-triggering of the oxidative burst in neutrophils plated on fibronectin. The data suggest that the interaction of neutrophils with fibronectin uncovers the capacity of IL-8 to limit the cell response to TNF, without affecting the response to the combination of FMLP and TNF. Thus, although the chemotactic factors IL-8 and FMLP share the capacity of triggering the oxidative burst of neutrophils incubated in suspension, only IL-8 has the potential to down-regulate the responsiveness of fibronectin-adherent cells to TNF.

Surgical resection is the only curative procedure for the treatment of the cancer of the pancreatic head: this paper describes the precise indications for surgery. These are: tumour size (diameter less than 4 cm), no metastases in the extra regional lymph nodes, no arterial invasion or involvement of the portal vein of more than 1.2 cm in length or its bilateral narrowing. The authors point out that only the complete removal of the retropancreatic tissue allows control of local recurrence and metastasis. They examine different resective procedures, concluding, on the basis of the literature and their own experience, that R2 subtotal pancreatoduodenectomy leads to a curative resection because of the removal of the foci of micrometastasis, a better control of local recurrence and, perhaps, a longer survival. They discuss the problem of the use of pyloro preserving pancreatic duodenectomy (PPDP) for exocrine tumours of the pancreas and conclude that it is correct to perform such an operation even for the treatment of these tumours if the local extension of the neoplasm allows it. Finally, the authors underline the need to use other adjuvant therapies to improve results: these however, are very often, quite limited.

DVT is a very frequent complication of general surgery. Heparin and, more recently, LMWHs can successfully prevent post surgical thromboembolism. One thousand one hundred and twenty-two patients (533 males and 589 females; mean age 62.2 +/- 11.4 yrs) were enrolled in a multicentre controlled study, to evaluate the efficacy and safety of enoxaparin in comparison to calcium heparin in the prevention of deep venous thrombosis (DVT) following general surgery. Patients assigned to the enoxaparin and the calcium heparin groups received 1 daily dose of 20 mg (2000 I.U.) and 2 daily doses of 0.2 ml (5000 I.U.), respectively starting 2 hours before the operation. Both drugs were given by subcutaneous route. A Doppler or Duplex Scan diagnosis of DVT was made in 3 (0.5%) patients in the enoxaparin group (2 cases during treatment and 1 patient at the end of treatment) and in 6 (1.1%) patients in the calcium heparin group (5 cases during treatment and 1, bilateral, after the end of treatment). Pulmonary embolism (PE) was ascertained by angiography in 1 patient (0.18%) in the enoxaparin group and in 2 patients (0.36%) in the calcium heparin one. Hemorrhagic complications occurred in 29 patients (5.2%) in the enoxaparin group and in 34 (6.1%) in the calcium heparin group. Haematomas located in the injection site were reported in 16.1% and 25.3% in the enoxaparin and calcium heparin groups respectively (p = 0.0001). Local pain in the injection site at the 5th day of treatment was reported in 8.4% and 16.6% in the enoxaparin and calcium heparin groups respectively (p = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

A sixteen-years-old boy with a brain-stem neoplasia inducing coma was treated with chemotherapeutic agents. It resulted in dramatic clinical and instrumental improvement; radiologic findings were evaluated, showing decreasing dimension of intracranial mass. Brain-stem auditory evoked potentials were highly sensitive. We think that chemotherapy can be considered among the options a physician can offer to such a patient explaining informed consensus.

The superoxide (O2) production by phagocytes (neutrophils plus monocytes) and the lactoferrin release by neutrophils were measured in normal volunteers before and after the oral administration of the anti-inflammatory drug nimesulide. The chemotactic factor N-formylmethionyl-leucyl-phenylalanine (FMLP) and opsonized zymosan particles (OPZ) were used as activating stimuli. The oral administration of nimesulide lowered the phagocyte ability to generate O2- in response to both FMLP (percent inhibition = 67.62) and OPZ (percent inhibition = 36.75). The lactoferrin release by neutrophils was unaffected, proving that the drug does not affect the exocytosis of specific granules. The results provide direct evidence that the oral administration of nimesulide efficiently reduces the oxidative potential of phagocytes, particularly neutrophils, without interfering with mechanisms related to exocytosis of specific granules and involved in the amplification of the cell responses to inflammatory mediators.

The glycoprotein alpha 1-proteinase inhibitor is the specific inhibitor of neutrophil elastase, a major tissue-damaging protease. When incubated with activated neutrophils, alpha 1-proteinase inhibitor lost its pancreatic porcine elastase inhibitory capacity and became incapable of forming a sodium dodecyl sulphate-stable complex with pancreatic porcine elastase. Inhibitors and scavengers of neutrophil-derived reactive oxygen species outlined the crucial role of hypochlorous acid in the alpha 1-proteinase inhibitor inactivation. Moreover, the drug 5-aminosalicylic acid prevented the inactivation of alpha 1-proteinase inhibitor by neutrophils in a dose-dependent manner. Finally, when the capacity of 5-aminosalicylic acid to rescue alpha 1-proteinase inhibitor from the neutrophil-derived attack was plotted as a function of the 5-aminosalicylic acid ability to scavenge neutrophil-derived hypochlorous acid, a positive linear relationship was found. Thus, our results provide a direct evidence that 5-aminosalicylic acid is able to prevent the oxidative inactivation of alpha 1-proteinase inhibitor by neutrophils. Therefore, we suggest that the drug has the potential to limit the elastase-mediated damage of colonic connective tissue by creating a microenvironment of active alpha 1-proteinase inhibitor around the neutrophils.

The anti-inflammatory drug ibuprofen was found to inhibit neutrophil aggregation and chemotaxis, triggered by the chemotactic factor N-formyl-methionyl-leucyl-phenylalanine (FMLP). The drug did not modify the surface expression of the glycoprotein CD11b-CD18, required for both aggregation and chemotaxis. Consistent with this finding, ibuprofen did not affect the release of lactoferrin from secondary granules which contain CD11b-CD18 molecules in their membranes. As the drug failed to interfere with the neutrophil oxidant production and primary granule release, the results suggest that it acts primarily at the initial steps of the neutrophil response during inflammation, i.e. the cell recruitment at inflamed tissue sites. Moreover, the data prove that adhesion-dependent neutrophil responses required cell processes independent of CD11b-CD18 but controlled, at least in part, by ibuprofen-inhibitable pathways.

In the present study we have investigated the effect of six antibiotics (penicillin G, ceftazidime, cephotaxime, cephoperazon, ampicillin and piperacillin) on the neutrophil cytolytic activity by using a system constituted of phorbol-12-myristate-13-acetate-triggered neutrophils and 51Cr-labelled lymphoblastoid Daudi target cells. The results demonstrate that five of these drugs (ceftazidime, cephotaxime, cephoperazon, ampicillin and piperacillin) are capable of inhibiting the neutrophil cytolytic activity by inactivating the hypochlorous acid (HOCl) generated extracellularly by the myeloperoxidase pathway and crucial to the target cell lysis. Penicillin G had no effect on neutrophil-mediated cytolysis. Thus, these data demonstrate that ceftazidime, cephotaxime, cephoperazon, ampicillin and piperacillin lower the neutrophil-mediated target cell damage by a HOCl-scavenging mechanism, suggesting a possible cytoprotective role for these drugs during infections.

Between 1971 and 1986 11 patients suffering from pulmonary aspergilloma were seen in the thoracic surgery service at Genova-Sampierdarena Hospital. Nine patients underwent thoracotomy. Lobectomy was the most frequent operation. Complications occurred in 3 patients (33%). There were no recurrent symptoms in any of them over a mean follow-up of 4 years. The remaining two patients were treated by instillation of antifungal agents into the aspergilloma cavity. There was no systemic toxicity and in one patient the mycetoma resolved. The authors conclude that pulmonary resection can provide effective long-term treatment, while intracavity infusion of antifungal agent can be a successful nonoperative method in critically ill patients.

This study is based on the analysis of the survival data in patients with N2 disease reported by Martini, Pearson, Shields et al. Many factors appear to influence survival of this group of patients. We made a retrospective analysis of a series of 91 patients with N2 disease between January 1980 and March 1985. Sixty-nine patients (71.5%) presented clinically N2 disease; 44 patients (63.7%) were treated with complete resection and postoperative irradiation, the actuarial five year survival was 11%. Twenty-two patients (24.2%) were discovered to have N2 disease at thoracotomy. Twenty-one patients underwent resection and the actuarial five year survival was 29%. We conclude that surgery can be effective in a highly selective group of patients.

The results of this work, carried out to extend the limited information at present available on the genotoxic potential of chloramphenicol (CAP), indicate that in millimolar concentrations this antibacterial agent produced a minimal amount of DNA fragmentation in both V79 cells and metabolically competent rat hepatocytes. Moreover, a level of DNA-repair synthesis indicative of a weak but positive response was detected in primary cultures of liver cells obtained from 2 of 3 human donors, and a borderline degree of repair was present in those prepared from rats. The promutagenic character of CAP-induced DNA lesions was confirmed by a low but significant increase in the frequency of 6-thioguanine-resistant clones of V79 cells, which, however, was absent when the exposure was done in the presence of co-cultured rat hepatocytes. Finally, oral administration to rats of 1/2 LD50 CAP did not increase the incidence of either micronucleated polychromatic erythrocytes or micronucleated hepatocytes. Taken as a whole these findings suggest that CAP should be considered a compound intrinsically capable of producing a very weak genotoxic effect, but only at concentrations about 25 times higher than those occurring in patients treated with maximal therapeutic dosages.

Pancreatoduodenectomy is the most used resective operation in the treatment of cephalopancreatic pathology; nevertheless it is a severely demolitive operation, especially if performed according to the traditional technique. It can induce early as well as late complications in a high percentage of cases. A number of technical improvements have been proposed so far in order to reduce or avoid such complications; duodenopancreatectomy with gastric and pyloric preservation (PPDP) is the most representative one. The Authors analyze technical and functional features of PPDP in 22 patients operated on; results are compared with the traditional technique. In conclusion, among all the techniques proposed, PPDP assures the best improvement in the quality of life of these patients.

A new formulation of megestrol acetate, a semisynthetic oral progestin used in the hormonal treatment of breast cancer, allows the administration of 160 mg of the drug in a single daily dose. Sixty-nine postmenopausal patients with advanced breast cancer have been treated with this regimen: five patients received megestrol acetate as first-line treatment of their metastatic disease, while all the others had been previously treated with one or more regimens of chemotherapy and/or hormone therapy. The median duration of the treatment for evaluable patients was 3 months (range 1-13+). Among 65 evaluable patients 2 complete responses and 12 partial responses (objective response rate 21.5%; 95% confidence limits 12.31%-33.49%) were observed. Median duration of response was 7 months (range 2-12+). Responses were observed both in visceral and in non-visceral sites of disease. Twenty-nine patients obtained a stabilization of disease (44.7%), and twenty-two progressed (33.8%). Median duration of stabilization was 4 months (range 3-13+). Median survival for all patients from the start of megestrol acetate was 9 months (range 1-22+). The most common side effect of therapy was weight gain, occurring in 36% of patients. Megestrol acetate on a single-daily-dose schedule can be considered as an interesting hormonal treatment for advanced breast cancer, especially in the clinical instance of patients who, after having obtained a remission or stabilization of disease with tamoxifen, need further palliative treatment.

Twenty patients with migraine with visual aura, aged 19 to 55 years (2 men and 18 women) were studied by the method of Visual Evoked Potentials (VEP). The control group consisted of an equal number of healthy subjects, comparable for age and sex. The most important finding in our study is that migraine patients with visual prodromata have a significantly longer P100 latency than the subjects of control group. These modifications of the VEP-PR could indicate, as other investigators have pointed out, that there are some special metabolic conditions and abnormalities of neuromediators during and between attacks.

Efficacy of automatic staplers in broncho-pulmonary surgery was evaluated in a series of 316 consecutive patients. The results confirm that utilization of staplers has drastically reduced the incidence of post-resection bronchial fistulae; moreover on parenchymal tissue such instruments guarantee excellent haemostasis and air tightness. On the contrary, indications for their use on pulmonary vessels seem to be very limited.

Retinoids have shown a tumor growth inhibition and a synergistic activity with hormonal manipulations in human breast cancer cell lines and rat mammary carcinoma. To investigate the potential usefulness of this synergistic activity in human breast cancer, 33 postmenopausal patients with advanced disease were treated with the combination of tamoxifen (10 mg p.o. three times a day) and retinyl acetate (300,000 IU p.o. daily). Out of 31 evaluable patients, 3 achieved complete response, 9 partial response (overall response rate: 38.5%, 95% confidence interval = 21%-56%) and 16 (52%) showed no change. The median duration of response was 11.5 months (range: 3-19+ months), while the 2-year overall survival rate for the entire group of patients was 63%. Toxicity was generally mild, hot flushes, nausea (and/or vomiting), headache and cutaneous itching being the most frequent side-effects. Only 1 patient discontinued treatment for severe toxicity. These preliminary results suggest that the combination of tamoxifen and high-dose retinyl acetate is a safe and effective regimen for breast cancer patients. However, the study design does not allow us to establish whether the very low rate of early disease progression we observed might be related to a possible synergistic effect between retinoids and antiestrogens or rather to the quite indolent disease of the patients who have been selected for entry into this trial.

The authors present their experience with 39 cases of pre and postoperative percutaneous transhepatic cholangioscopy (PTCS), listing the indications and advantages of this new tool for the study of the biliary tract and the therapy of several pathological conditions that would otherwise be untreatable.

Bile samples from patients suffering from cholestasis were tested. Cholesterol, phospholipids, and bile acids (cholic, lithocholic, deoxycholic, chenodeoxycholic) were measured and the methods for the gas-chromatographic determination of cholesterol and major bile acids as well as for the colorimetric determination of phosphorus in phospholipids of human bile are described in extenso. Bile samplings were first carried out on the day the drainage tube was positioned and were repeated every 5 days for four times. Between the first and the last sampling, 1250 mg of phosphatidylcholine was intravenously administered to each patient daily. The aim of the experiment was to evaluate the possible variations in the bile constituents occurring over the specified time.

24 patients with a median of 3 prior chemotherapy regimens were treated in our department with cisplatin 20 mg/m2 (with pre- and posthydration) and 5-fluorouracil 200 mg/m2 i.v. on day 1-5, every three weeks. 23 patients are evaluable; one had early death. 4 patients (17%) achieved a partial response, 8 had stable disease, and 11 progressed. Toxicity observed was moderate and no renal toxicity was noted. This study therefore shows tolerable toxicity but limited usefulness of adding cisplatin to 5-fluorouracil according to this schedule in these highly pretreated patients.

Antiblastic chemotherapy was combined with two aspecific immune stimuli, Levamisole Corynebacterium parvum, in 48 and 55 neoplastic patients respectively. C. parvum was found to be more easy to handle, particularly since Levamisole, albeit compensated by absolute lymphocytosis in many cases. In addition, C. parvum proved more effective in patients with lung and oro-pharyngeal neoplasias, whereas Levamisole appeared to be of greater use in breast cancer. Both stimuli led to improved coenaesthesia and performance status by comparison with a control group. It can thus be asserted that aspecific immunotherapy should have a place in the multidisciplinary approach currently sought.

55 patients with various types of malignant neoplasias at different stages were given DNCB skin tests in the Oncological Department of the S. Paolo Hospital in Savona. Lymphocyte blastisation was evaluated both before and after the skin test. In about 75% of the patients it was observed that DNCB sensitisation increased lymphocyte blastisation capacity independently of the level of reaction to the skin test, the type of neoplasia or the patients' age. Indeed increased blatisation was more noticeable in non-responsive DNCB. The hypothesis is advanced that DNCB has the capacity indirectly to stimulate blastisation by unknown mechanisms.

The results obtained with a three-fold association of drugs (VCR, 5Fu, MeCCNU) in the treatment of 68 patients suffering from advanced carcinoma of the gastroenteric system followed up over an approximately four year period at the Savona Oncology Centre are reported. The percentage of positive responses (CR + PR) was 75% for carcinoma of the colon-rectum and 44.4% for stomach cancer. The results obtained in intestinal carcinoma proved more satisfactory than those reported in the literature. This could be attributed to the contemporaneous use of Corynebacterium parvum which boosts the immunitary state and so enhances the defences of the host organism, making it more sensitive to polychemotherapy. In the light of this hypothesis, stress is laid on the need to use an immunochemotherapy approach for the treatment of advanced carcinoma of the gastroenteric apparatus.

Forty patients with various neoplasias and radiological and scintigraphic evidence of multiple osteolytic lesions were studied between March 1979 and December 1981 at the Savona Oncology Service. All of them were treated with chemo and/or hormone therapy, plus 100 UMRC salmon calcitonin a day for 20 days a month until a clinical improvement was observed. The parameters for evaluation were: radiography and scintigraphy of the skeletal segment involved, blood calcium, alkaline phosphatase, intensity of pain, and restriction of function. An assessment was made before and after calcitonin management. Blood calcium fell in all cases even in the range of those initially normal. Alkaline phosphatase decreased in 83.3% and pain disappeared or was less severe in 87.50%. Good results were also observed with regard to restriction of function. Good recalcification of some osteolytic lesions was noted in 7 cases (17.5%). Calcitonin thus proved effective in the correction or prevention of damage caused by hypercalcaemia, and was particularly useful in the reduction of pain and functional damage. Its analgesic effect often appeared at an early stage.

110 patients observed over a three-year period suffering from cancer of the breast, digestive apparatus, lung and urogenital apparatus, and submitted simultaneouly to the DNCB skin test and to radioimmunological measurement of CEA have been studied. Confirming what has already been reported, the epicutaneous findings and laboratory results show there is an almost constant correlation between marked reactivity to DNCB and normal CEA titre and that, on the contrary, ml response to immune stimulation is often matched by a pathological CEA value. It is maintained that this type of cross investigation may be important for prognosis as the basis for initial assessment of the probable clinical course of the disease and the response of the patient to immunochemotherapeutic treatment.

Thirty-three patients were given cholangiojejunoanastomoses: 13 for benign postoperative stenoses of the biliary tract (BT) with or without lithiasis; five for massive intra and extra-hepatic lithiasis; 15 for malignant stenoses on the upper third of the biliary ways. The 15 patients in Group A were given a muco-mucosal anastomosis and the 18 in Group B extramucosal anastomosis after excision of the excess mucosa on the jejunotomy. In both groups an interrupted suture using fine, slow-absorption thread was employed. Three patients (two from Group A and one from Group B) were excluded from the study due to postoperative filtration of the anastomosis. Transhepatic cholangioscopic monitoring of the healing process on the 15th, 20th, 30th and 40th day showed that while both types of anastomosis were equally secure, the extramucosal suture after excision of excess mucosa produced wider anastomoses and is therefore advisable in all cases of bilioenteric anastomosis (BEA) but especially when the biliary ways are narrow or tendentially thin-walled.

Authors personal experience during ten years in surgery Oddi's sphincter is reported. Indications and technique of papillosphincteroplasty and wirsungsphincteroplasty are described; results obtained in 504 surgical treatment of PSP (combined with WSP in 121 cases) are referred; failures and complications are described and estimated; long-term results are reported and methods used for their evaluation illustrated. Authors conclude with a favourable Judgement on PSP and WSP, since on the basis of investigations and indications described, they are the surgical treatment of choice in biliary and pancreatic pathology.

308 mammary needle aspirations for suspected clinical forms of mammary cystitis were performed between 1971 and 1980 at the Savona Oncological Centre. The evacuated cystic cavity was always treated with a concentrated Lugol solution, the sclerosing and modifying properties of which foster wall adherence and prevent relapses. Non relapses were observed at 2 years' distance in the 194 patients checked. Relapses were observed in 11 patients only and in 20 cases the cytological examination was positive, revealing atypical cells. It is felt that this technique, which poses no risk to the patient could be a valid routine treatment for mammary cyst.