[Correlation between surgical intervention, adjuvant therapy, and long-term survival in patients operated on for breast neoplasia]. / Correlazione tra intervento chirurgico, terapie adiuvanti e sopravvivenza a distanza in pazienti operate per neoplasia mammaria.

INTRODUCTION: Breast cancer is the most frequent cancer among female sex, above all in rich countries where it occurs ten times more than the others. The most incidence of breast cancer is in female over 45 yrs and over 70 yrs with a plateau during menopause. So it is really very uncommon before 30 yrs. It is well known that breast cancer is related to several risk factors: these have always to be well evaluated before any treatment, especially in surgery. In the last years we can see an improvement of techniques to make diagnosis of breast cancer. Also surgery has improved in that way, so it can ensure better results to patients than before, also from the esthetical point of view. There are lot of discussions on which is the best surgical treatment to do, if lymphoadenectomy of the armpit is always required and if it has to be considered only as a prognostic element or also a therapeutical one. It is also important to plan radio, chemio and hormonal therapy, well chosen on the base of histological exams, and of the grading made either before either during surgery. Last studies moreover evaluate the specificity, the importance and the prognostic value of searching the so called "sentinel lymph node" who is always the first one to be interested in a metastatic process. STUDY AND DISCUSSION: Through a random and retrospective study among all our female patients (Department of Surgical Science in Rome University "La Sapienza") who had surgery for breast cancer in the last ten years (approving all the hystological exams) we have related the kind of surgical treatments to overall survival, to the therapies, and to any possible local recurrence of disease. We analyzed 270 female patients (age between 19 and 83). We considered all surgical treatments used in breast cancer: from the "simple" quadrantectomy up to radical mastectomy with the association of lymphoadenectomy of the armpit (both armpits in case of recurrence to disease). All these patients had then their own therapy (radio, chemo or hormonal one, it depended on each case) and follow up of the length of at least five years. The overall survival was of 82.2%. From these study we made important considerations about all the factors involved in breast cancer. The first step is to consider always all of these to have a well surgical approach, and to get the best compliance and performance from patients in order to have at distance the best results.

Occupational exposure to cadmium and lung function.

A total of 69 male subjects occupationally exposed to cadmium fumes in a factory producing silver-cadmium-copper alloys for brazing, were subjected to lung function tests, including ventilation (FVC and FEV1), residual volume (RV) and alveolar-capillary diffusion capacity (TLCO and KCO). For each subject, the cumulative exposure to cadmium was calculated as the product of the number of years in the job and the average atmospheric concentration of cadmium (expressed in micrograms/m3) encountered each year. Cadmium-exposed subjects had moderately higher mean values of RV (+ 8%) as compared with the control group; the increase was greater (+ 10%) in the subgroup of workers with greater cumulative exposure to cadmium. No significant differences were observed in FVC, FEV1, TLCO and KCO.