A randomized trial of misoprostol versus extra-amniotic sodium chloride infusion with oxytocin for induction of labor.

OBJECTIVE: Our purpose was to compare the efficacy and safety of misoprostol and extra-amniotic sodium chloride infusion with oxytocin for induction of labor. STUDY DESIGN: This randomized trial compared two methods of labor induction in women requiring cervical ripening. One hundred twenty-three women undergoing labor induction with a Bishop score < or =5 were randomly selected to receive either misoprostol, 50 microg intravaginally every 4 hours, or extra-amniotic sodium chloride infusion. The primary outcome variable was the time interval from induction to vaginal delivery. RESULTS: Sixty-one women received extra-amniotic sodium chloride infusion and 62 women received misoprostol. The mean time interval from the start of induction to vaginal delivery was 15.0 +/- 5.0 hours and 16.5 +/- 7.2 hours for the extra-amniotic infusion and misoprostol groups, respectively (P, not significant). The cesarean delivery rate was not significantly different between the 2 groups (32.8% for the extra-amniotic infusion group; 19.4% for the misoprostol group). Maternal and neonatal outcomes were similar between the 2 groups. CONCLUSIONS: Both methods of induction are equally efficacious and result in similar maternal and neonatal outcomes.

Absence of regular alpha2(I) collagen chains in colon carcinoma biopsy fragments.

The extracellular matrix (ECM) is known to play an active role in numerous biological processes such as differentiation, apoptosis and cancer. Extensive alterations of epithelial basement membranes and of interstitial ECM are known to occur during the progression of most invasive carcinomas. Collagen, which represents the major component of the interstitial ECM, is primarily involved in the stromal changes at the site of tumor cell invasion. We have previously described the occurrence in breast and colon cancer ECM of an oncofetal form of collagen, characterized by an acidic chain distinct from those of type I and III collagen. In the present paper, we bring evidence that alpha2(I) collagen chains in colon cancer tissues expressing the acidic chains, are either overmodified or absent, both as protein and as regular mRNA transcripts. The results obtained strongly suggest that: i) the disorganisation of the collagen architecture and the phenomenon of fibril dispersion, which accompanies the lysis of basement membrane, is not only due to the enzymatic degradation of the collagen fibres, but presumably also to changes of the collagen molecules deposited in the stroma; ii) the neosynthesis of collagen occurring at tumor-host interface is deeply deregulated, and therefore to be considered the result of altered collagen gene expression correlated with the tumor progression, rather than as a mere defensive reaction of the host cells.

Weekly levofolinic acid and 5-fluorouracil plus hydroxyurea in metastatic gastrointestinal adenocarcinomas.

There were 42 patients with advanced gastrointestinal carcinomas (GA) enrolled in the study. In the Phase I part of the study we identified the MTD of 5-fluorouracil (5FU) in combination with levofolinic acid 100 mg/m2 per week intravenously plus hydroxyurea 1 g/m2 per week given by mouth in 3 refracted doses starting 6 hours after 5FU was administered. This treatment was given weekly for 6 consecutive weeks followed by a 15-day rest period. We were not able to increase 5FU weekly dosage above 700 mg/m2 due to the occurrence of grade 3-4 gastrointestinal toxicity. Thus 5FU was employed at 600 mg/m2 per week for the Phase II part of the study. Among 20 evaluable patients with measurable metastatic colorectal cancer, 1 patient had CR of 6.0+ months and 7 patients had PR with a mean duration of 6.2+ months, for an overall response rate of 40%. Four patients (20%) showed stable disease, and 8 patients progressed. The mean survival of the whole group was 5+ months (range: 3.0-12.8). This treatment was very well tolerated by most patients, with grade 3 diarrhea in 10% of cases and grade 3 vomiting in 20% of patients. Hydroxyurea (HU), employed at this dosage, seems not to increase 5FU/FA-related toxicity. This regimen is quite active in the management of advanced colorectal carcinoma, and may be safely given on an out-patient basis. A Phase III randomized trial may be established if HU improves results achievable with the 5FU-FA combination.

[Aneurysm of the subrenal aorta. Comments on 25 cases seen]. / L'aneurisma dell'aorta sottorenale. Considerazioni su 25 casi osservati.

The authors report their experience in the diagnosis and treatment of subrenal aortic aneurysms. The incidence of the abdominal aortic aneurysms, in aged population, is increasing, linked, in 95% of cases, to atherosclerotic disease. The diagnosis is essentially clinical with help of various examination techniques, that provide an accurate preoperative morphological assessment, like direct X-ray of the abdomen, echography, angio computerized axial tomography and arteriography. The moment for operating aneurysms of the subrenal aorta is discussed. The rate of operative deaths following elective replacement of abdominal aortic aneurysms is less than 4% and it increase to 40-80% in emergency replacement for rupture. Rupture remains a catastrophic life-threatening complication for cardiovascular, respiratory and renal failure, in spite of improved surgical techniques and postoperative intensive care.

[Costo-clavicular outlet syndrome]. / Le sindromi del défilé costo-clavicolare.

Syndromes caused by the compression of the neurovascular bundle are not a rare pathology, though their exact frequency cannot be assessed. Neurovascular bundle in the upper limbs may be compressed at the costo-clavicular space, interscalene triangle or at the insertion of the minor pectoralis muscle into the coracoid process. More than 90% of patients present neurological symptoms and 10% also have vascular problems. Diagnosis depends on a careful clinical and instrumental study of the patients. Arteriography, phlebography and Doppler tests were of value in the diagnostic approach, showing the compression of the subclavian artery and vein using the arm abduction manoeuvre. Electromyography is of value in differential diagnosis of the carpal tunnel syndrome showing the entity and site of nerve compression. The best form of surgical treatment is resection of the first rib according to Roos, using an extrapleural and transaxillary route.