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Neoplastic recurrence is the most common cause of death after surgery for esophageal cancer. The Authors review the therapeutic options evaluating in terms of palliation of dysphagia and complication and mortality rates. Prognostic factors and mechanisms determining the recurrence are also reviewed. A strategy for a rational approach in the management of recurrent esophageal cancer emerges from both the literature and their own experience. Notwithstanding the small life span of these patients, the treatment of esophageal obstruction is mandatory. The therapeutic options that be considered are: palliative resection, surgical bypass, laser therapy, intubation, radiotherapy. The site of obstruction, the presence of metastasis, the general status can lead to the optimal choice. In terms of palliation of dysphagia the surgical approach seems to obtain the best results, even if high complication and mortality rates have been reported. Bypass is the second surgical choice when applicable. The other non-surgical modalities have been administered in large series of patients with good results. Combination therapies can obtain better results.

Cells from a group of 185 patients suffering from malignant tumours (160 non-small-cell lung carcinoma, 13 small-cell lung carcinoma, and 12 non-epithelial tumours) and 6 with benign lung tumours were studied by flow cytometry in order to detect the prognostic value of DNA content. A total of 144 (90%) non-small-cell lung carcinomas (NSCLC) and 8 (62%) small-cell lung carcinomas (SCLC) exhibited aneuploidy. Furthermore 52% (83 patients) NSCLC, 24% (3 patients) SCLC and 50% (6 patients) non-epithelial tumours demonstrated multiclonality. Benign cases showed diploid DNA content. For actuarial survival analysis using the Bergesson and Gage method and the Greenwood variance, 142 patients were selected. Statistical comparisons were made by the use of the t-test for unpaired data between fixed times. No correlation was observed between ploidy and stage, histological grading or treatment modality. A statistically significantly better survival was observed after 12, 18 and 24 months of follow-up for diploid and monoclonal (with the exclusion of hypo- and hypertetraploid) patients. Thus, flow-cytometric DNA analysis may be useful in prognostic assessment of human lung tumours.

The cases of 42 patients with malignant ascites treated with a peritoneal venous shunt over a 5-year period are reviewed to establish the incidence of surgical and postsurgical complications. Although the yield of malignant cells found in the peripheral blood was increased after shunting, no new hematogenous metastases were observed after the operation. No evidence of disseminated intravascular coagulation was observed after shunt placement. While the shunt effectively relieved the discomfort due to abdominal distention and respiratory impairment, no restoration of cutaneous hypersensitivity was observed in the nine patients who were anergic prior to surgery. The median survival of patients with breast and gynecological cancer, after surgery, was significantly longer than the survival of patients with primary gastrointestinal neoplasma. In conclusion, peritoneal venous shunt appears to be an effective and safe method to improve the quality of life of patients with malignant ascites.

The classification of bronchogenic carcinoma as a function of the prognosis is still an open field. The evaluation of stage, by use of the TNM system, and histologic cell type is not sufficient to guarantee a correct prognosis. The growth rate of the neoplasm is another important parameter. We propose a classification that takes into account the stage (S), histologic cell type (M), immune status (I) and the growth rate of the primary tumor (G): S.M.I.G. We studied 90 lung cancer patients according to the S.M.I.G. classification and we observed that their prognoses were directly correlated with their S.M.I.G. scores (the higher the score, the higher the 10-month mortality rate). The mortality rates within the first 10 months of follow-up were respectively 0%, 0%, 36.36%, 68%, 90.9% for the 5 groups obtained by S.M.I.G. The difference is statistically significant (P less than 0.0075) and there is a linear correlation between the mortality rate and the score assigned to each group (R = 0.943; P less than 0.05). The S.M.I.G. classification can predict the prognosis more efficiently than the usual classification (TNM) and histological cell type.

Serum values of retinol, carotenoids, tocopherol and ascorbic acid were assayed in healthy adult females (Group A: 20 cases) and in subjects with fibrocistic mastopathy (Group B: 20 cases), benign breast neoplasms, as fibroadenomas and intraductal papillomas (Group C: 18 cases), and breast carcinoma in situ (Group D: 36 cases). Retinol and carotenoids were evaluated by spectrophotometry using trifluoroacetic acid. Tocopherol was determined by a colorimetric method involving the reduction of Fe to Fe++ by tocopherol with the formation of a red complex of the Fe++ with alpha, alpha'-dipirydyl. Ascorbic acid was estimated by a colorimetric method after derivatization with 2,4-dinitrophenylhydrazine. Our results point out that there is a highly significant decrease (p less than 0.001) of average retinol serum levels in all three patient groups as compared with group A, whereas carotenoids resulted decreased but not significantly. Tocopherol was found to be significantly lower only in groups B (p less than 0.05) and D (p less than 0.01), ascorbic acid in groups B (p less than 0.01) C (p less than 0.05) and D (p less than 0.001).