Locally advanced non-small cell lung cancer: role of induction chemotherapy in resectable N2 disease.

Patients with resectable stage IIIA-N2 non-small cell lung cancer should receive induction chemotherapy before surgery. The aim is to early control systemic disease, eventually cure the mediastinal tumor spread and improve patients' survival. A recent metanalysis of randomized trials with second-generation platinum-based combinations has reinforced the evidence concerning the benefit of induction chemotherapy followed by surgery versus surgery alone in resectable disease. Moreover a large number of phase II trials have explored the activity and feasibility of platinum-based combinations with third-generation drugs in the same setting. Still opened questions to address with current clinical research are the eventual role of radiotherapy as induction treatment, the impact of definite chemoradiation versus induction treatment followed by surgical resection on local control and survival and finally the non-easy choice between neo-adjuvant and adjuvant chemotherapy.

A three-week schedule of gemcitabine-cisplatin in advanced non-small-cell lung cancer with two different cisplatin dose levels: a phase II randomized trial.

BACKGROUND: To explore a new schedule of gemcitabine-cisplatin (GP) combination therapy using two different cisplatin doses in patients with advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: From May to December 1997, 92 chemonaive patients entered the study and 88 (28 with locally advanced and 60 with disseminated NSCLC) were evaluable for response and toxicity (45 in arm A and 43 in arm B). Patients were randomly assigned to arm A or arm B. Gemcitabine 1000 mg/m2 was given on days 1-8 plus cisplatin 100 mg/m2 in arm A and cisplatin 70 mg/m2 in arm B on day 2 of every 21-day cycle. RESULTS: The overall response rates in arms A and B were 42% (95% confidence interval (CI): 27.8%-56.7%) and 47% (95% CI: 31.6%-61.5%), respectively. Median duration of response was 9.7 months (range 1.8 to 30.9 months; 13.1 and 9.5 months for arm A and B, respectively), and median survival was 12 months (range 0.2 to 31.1 months; 15.4 and 11.5 months for arm A and B, respectively). Major WHO grade 3-4 toxicities in arm A vs. arm B included: thrombocytopenia (23% vs. 17% of courses), leukopenia (15%, vs. 4% of courses), anemia (7% vs. 6% of courses), and nausea-vomiting (20% vs. 7% of patients). Grade 1-2 nephrotoxicity occurred in 20% of patients in arm A and in 7% of patients in arm B, with one grade 4 episode in arm A. Six patients discontinued treatment because of toxicities, 5 in arm A and I in arm B. CONCLUSIONS: Results of this trial indicate that both schedules are feasible and active, with a milder toxicity in the arm with the lower cisplatin dose.

Structural alterations in erythrocytes from patients with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is characterized by inflammation of deep lung and pulmonary hypoxemia. In order to investigate if the clinical manifestations of this disease can be correlated to specific alterations in red blood cell (RBC) morphology, the erythrocytes from 12 COPD patients and 12 control subjects were obtained and examined by scanning electron microscopy (SEM), fluorescence microscopy and electron paramagnetic resonance (EPR) spectroscopy. The results demonstrate that the RBCs from COPD patients are greatly altered with respect to control erythrocytes. Specifically, SEM analysis revealed important shape changes while light fluorescence microscopy demonstrated microfilament network (actin and spectrin) redistribution. Finally, EPR spectroscopy, using the paramagnetic spin label 5-nitroxystearate, revealed an increase in membrane order (rigidity) in the erythrocytes of COPD patients with respect to controls. When taken together and when compared to the morphological variations present in the RBCs of other ill patients (i.e., diabetics), the data presented in this report seem to suggest that changes in erythrocyte shape and rheological properties play a key role in RBC dysfunction in the course of COPD.

Inorganic particles in bronchoalveolar lavage fluids from nonoccupationally exposed subjects.

This study comprised 30 patients who had not been exposed occupationally to dusts, but for whom a diagnosis of suspected pulmonary carcinoma had been made. Bronchoalveolar lavage fluids from these patients were analyzed by transmission electron microscopy and by energy-dispersive x-ray microanalysis in an effort to study the mineral particulate present in the alveolar region. Particles of silica, silicates, oxides, sulphates, and metal alloys were detected in various percentages in each subject. The smoking habits of two groups of patients that were defined by their bronchoalveolar lavage particulate concentrations (i.e., lower or higher than the median of the distribution) differed significantly.

[Heart rhythm changes in patients with chronic obstructive bronchopneumopathies: effects of different methylxanthine drugs]. / Alterazioni del ritmo cardiaco in pazienti con broncopneumopatia cronica ostruttiva: effetto di differenti farmaci metilxantinici.

The present study was designed to assess effectiveness and safety and the proarrhythmic effects of two methylxanthine derivatives, doxofylline and aminophylline, in the management of chronic obstructive pulmonary disease associated with cardiac rhythm disturbances. Fourteen patients of both sexes (9 male, 5 female) with a mean age of 54 (range 43 to 66 years) with concomitant chronic obstructive pulmonary disease and high incidence of ventricular (VPB) and/or supraventricular (SVPB) premature beats were selected. The study was performed in a double-blind randomized cross-over trial. Following a proper wash-out period, in each phase patients were administered intravenously 400 mg b.i.d. of doxofylline or 480 mg of aminophylline b.i.d. (rate of infusion: 60 min) according to the cross-over design. A 24-hour Holter monitoring was carried out before the onset of the treatments and at the end of each venous infusion of methylxanthines. Spirometry for measurement of forced expiratory volume in one second and clinical parameters were also evaluated. Parametric variables were evaluated by analysis of variance. Kruskal-Wallis test was used to estimate non parametric variables. A p value less than 0.05 was considered statistically significant. We observed a significant reduction in the occurrence of VPB/24 h (p less than 0.05 vs basal value) and in the total number of beats (p less than 0.01 vs basal value and p less than 0.05 vs aminophylline) after doxofylline administration, whereas no changes from baseline in the incidence of premature beats and in the mean 24-hour heart rate were reported after aminophylline.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of the effects of pneumogenic hypoxemia on the nervous tissue by the determination of the critical flicker fusion frequency of the central retina]. / Valutazione degli effetti della ipossiemia pneumogena sul tessuro nervoso mediante determinazione della frequenza critica di fusione centrale retinica.

Considering the eye an extroflection of the brain it is possible to detect a decrease of nervous tissues efficiency during hypoxia through a deficit of eye function. The authors studied a highly specialized retinal function that is extremely sensitive to low values of PaO2: the so called "critical flicker fusion frequency". The authors tested 14 patients with respiratory disorders and PaO2 levels between 36.5 and 67.1 mmHg. All patients showed impairment of this function.

[Use of psychological evaluation in orthodontics]. / Utilità della valutazione psicologica in ortognatodonzia.

The Authors have checked the behavioural and psychological differences between co-operate e not co-operate patients emploing three psychodiagnostic tests in diagnostic phase. While in order to appraise the standard of patient's compliance during the terapeutical phase, the Authors have planed a variable of co-operation list.

Plasma carcinoembryonic antigen and tissue polypeptide antigen levels in lung cancer: correlation with cell types and stage.

This investigation was carried out to evaluate the plasma CEA and TPA levels in normal subjects and in 140 patients with lung cancer: 116 patients with nonsmall cell lung cancer (NSCLC) and 24 patients with small cell carcinoma (SCLC). The CEA and TPA levels were determined simultaneously by radioimmunoassay. The cutoff limit of CEA was found to be 17 U/SORIN, and the cutoff of TPA was 99 U/L. TPA has shown a sensitivity almost twice that of CEA. The relationship between the mean values of CEA and TPA and the stages of NSCLC was statistically significant (P less than 0.01), whereas only the mean values of TPA significantly (P less than 0.05) correlated with extensive and limited disease in SCLC. The determinations of combined CEA and TPA levels (CEA X TPA) (P less than 0.001) correlated significantly with the stage of disease in patients with NSCLC; conversely, the use of CEA X TPA did not correlate with the stage of SCLC.