Influence of light and flow on taxon composition and photosynthesis of marine phototrophic biofilm in photobioreactors.

In this study, marine biofilms were cultured in a flow-lane, semi-continuous photobioreactor at different irradiances and flows to evaluate their combined effect on biofilms' phototrophic composition and photosynthetic activity. Taxon richness, evaluated by different microscopy techniques, including transmission and scanning electron microscopy, resulted to be heavily reduced from source communities to mature cultures. The strongest decrease was observed for diatoms, which were overcome by cyanobacteria and green algae over time. Photosynthetic performance was investigated by pulse amplitude modulated fluorescence. Irradiance was the main driver of data distribution of the photosynthetic parameters rel.ETRmax and Ik, while flow rate affected α and ΔF/Fm'. The combination of irradiance and flow rate affected ΔF/Fm' reflecting the photosynthetic performance of the most relatively abundant taxa. Higher ΔF/Fm' was attained when cyanobacteria and green algae were dominating, whilst lower ΔF/Fm' when diatoms occurred in the initial phase of biofilm development.

Non-small-cell lung cancer: detection of mediastinal lymph node metastases by endoscopic ultrasound and CT.

In this prospective study endoscopic ultrasound (EUS) and computed tomography (CT) were evaluated to compare diagnostic accuracy of the two methods. They were performed for nodal staging in selected patients admitted to our institution for non-small-cell lung cancer (NSCLC). From February 1992 to July 1993, 45 patients were recruited for the study when N3 and N2 nodal involvement were excluded on standard chest X-ray. All the patients completed EUS and CT exams for staging before treatment. The results of sensitivity, specificity and accuracy were obtained in 30 patients who underwent surgical treatment with macroscopically radical resection of T and N, which allowed a complete surgical and histological comparison of CT and EUS findings. On a per-patient basis CT results were: sensitivity 63.6%, specificity 78.9% and accuracy of 73.3%; on a nodal station basis sensitivity, specificity and accuracy were 70.0%, 85.1% and 81.6%, respectively. The EUS evaluation showed, on a per-patient basis, values of sensitivity 45.5%, specificity 57.9% and overall diagnostic accuracy of 53.3%. On a nodal station basis the results were 50.0%, 86.6% and 78.2%, respectively. The results obtained in the 30 patients when both techniques were taken in association regarding sensitivity (90.9%), specificity (73.7%) and accuracy (80.0%) on a per-patient basis suggest that the association of EUS and CT offers the best approach for preoperative staging of NSCLC.

[The radiodiagnosis of bone metastases from melanoma]. / Contributo alla radiodiagnostica delle metastasi ossee da melanoma.

The records of 3,795 cases of malignant melanoma treated at the INT (Milan) from 1975 to 1992 were reviewed. Histologic confirmation was obtained in all cases. Thirty-one patients (0.82%) with solitary or multiple skeletal metastases were identified. The review of conventional films, tomograms, CT, MR and bone scintigraphy images enabled us to detect 120 single bone lesions. The X-ray features were divided into two groups according to typical and atypical skeletal lesions. Typical bone metastases are osteolytic (87.5%), with medullary origin (91.6%), and they cannot be distinguished from other osteolytic metastases on the basis of imaging criteria alone. Lesion growth causes cortical erosion and destruction (46.6%), pathologic fractures (22.5%) and soft tissue involvement (12.5%). Lytic areas usually have ill-defined margins. Clear-cut outline is an uncommon finding. Atypical skeletal metastases exhibit a mixed osteolytic-osteoblastic pattern (10%), which is hardly ever completely osteoblastic (2.5%). Other unusual metastatic patterns include intense trabecular rarefaction with no detectable single lesion (3.3%), the presence of a well-defined sclerotic rim and periosteal reaction (12.5%). Atypical growth may cause extensive cortical destruction and periosteal production resembling osteogenic osteosarcoma. The various imaging methods show that conventional radiology has relatively poor sensitivity because of anatomical reasons, while MRI is the most sensitive method to detect skeletal localizations. Treatment changes the radiologic patterns of the lesions: recalcification, sclerotic rim, periosteal reaction are common response patterns. Finally, in spite of the above limitations, conventional radiology remains the method of choice to assess lesion evolution during the follow-up.

Conventional radiographic follow-up in the irradiated lung.

AIMS: To highlight the different changes induced in lung tissues by various forms of radiotherapy (RT) according to tumor site and type. METHODS: A retrospective analysis of the roentgenographic evaluation of and long-term follow-up data on 2375 patients who received RT for various intrathoracic and extrathoracic tumors at the National Cancer Institute of Milan. RESULTS: The iconographic patterns of post-RT changes, grouped by site and type of tumor and RT procedure and described in detail, afford deeper insight into a little-known area of lung pathology. CONCLUSIONS: These descriptions of common and uncommon patterns of the irradiated lung as they appear on conventional chest roentgenograms enable the radiologist and radiotherapist to assess exactly the response of tumor and lung tissues and to plan the most appropriate clinical follow-up.

Radiobiologic and pathologic characteristics of the irradiated lung and roentgenographic aspects.

AIMS: Experimental radiobiologic factors help to better understand and interpret the development of radiographic alterations in lung tissues due to radiant treatments. In this paper the authors summarize the radiologic factors and technical bases about radiotherapy of the lung. METHODS: The conventional radiologic iconography has been examined in a large series of patients (n = 2151) with iatrogenic pulmonary lesions determined by various types of antineoplastic radiant treatments at the Istituto Nazionale Tumori of Milan. RESULTS: A radiologic control and a long follow-up is essential to assess the successive phases of postactinic lesions due to "passive" irradiation therapy for any type of non-endothoracic tumor as well as those due to "necessary" lung radiotherapy for endothoracic neoplasms. CONCLUSIONS: A strict relation has been found between the aspects in conventional radiologic iconography and the corresponding lesions in the irradiated lung.

Adrenal gland metastasis in osteogenic osteosarcoma. A radiological case report.

Adrenal gland metastases from osteogenic sarcoma are rare and an unusual pattern of relapse. The recognition of solitary metastases, particularly when located in uncommon sites is very important for subsequent treatment. The authors describe the radiological features of an adrenal metastases from osteogenic sarcoma.

[Current role of conventional tomography in the staging of pulmonary neoplasms. Reflections based on the comparison of tomography-magnetic resonance in 81 cases]. / Ruolo attuale della tomografia tradizionale nella stadiazione delle neoplasie polmonari. Riflessioni sulla base del confronto tomografia-risonanza magnetica in 81 casi.

The preoperative conventional tomographic and Magnetic Resonance images were reviewed of 81 patients affected with bronchogenic carcinoma; all patients underwent surgery 1986 to 1988. Radiological findings were compared with surgical and pathological results to evaluate the actual role of conventional tomography in the staging of bronchogenic carcinoma. MR Imaging proved to be more useful in the evaluation of mediastinal and hilar lymph nodes. As for mediastinal node status, conventional tomography had 23.5% sensitivity, 90.6% specificity, and 76.5% overall accuracy; MR Imaging had 82.3% sensitivity, 84.4% specificity, and 84% overall accuracy. As for hilar adenopathies, tomographic sensitivity, specificity and overall accuracy were 53.3%, 72.5%, and 65.4% versus 50%, 82.3% and 70.4% with MR Imaging. Tomography was slightly superior in identifying the primary tumor (97.5% versus 92.6% for MR), as well as in the demonstration of central bronchial involvement (100% for conventional tomography versus 50% for MR Imaging). Conventional tomography is useful as a complementary technique to MR Imaging in the preoperative staging of bronchogenic carcinoma when information on central bronchial involvement is needed.

Pilot study with cisplatin, ifosfamide, and etoposide in advanced non-small-cell lung carcinoma.

Twenty-five patients with advanced non-small-cell lung carcinoma (NSCLC) were treated with a multidrug regimen (CIV) consisting of ifosfamide (IFX), cisplatin (CDDP), and etoposide (VP-16). Twenty-four patients were evaluable for response. An objective response was detected in eight cases (33%), including one case with complete tumor response. Median duration of response was 31 weeks, and median overall survival 46 weeks, with no significant difference between responders and nonresponders. Myelosuppression and gastrointestinal side effects represented the main toxic manifestations; a toxic death and an ischemic cardiac episode were also observed. CIV seems a moderately effective regimen in NSCLC, but unlikely to provide an advantage over the widely employed two-drug combination of CDDP and VP-16.

[Radiodiagnosis of thymomas]. / Contributo alla radiodiagnostica dei timomi.

On the ground of the clinical experience gained on thymomas observed during the last decade and controlled by histopathology at the National Cancer Institute of Milan, the authors report and describe the typical morphology of the above neoplasms, which were studied with both the conventional and the most advanced imaging procedures. First of all, the authors point out the common problems of differential diagnosis with other lesions in the anterior mediastinum, with a special emphasis on lymphomas. Attention is also drawn to both the diagnostic and therapeutic value of conventional radiotomographic procedures combined with CT and MRI: in particular, the former can provide an extremely valuable diagnostic support to fine needle biopsy. In the authors' opinion, explorative surgery--e.g. mediastinal endoscopy-is immediately advisable when an unquestionable diagnosis is not reached even after a most rational combination of the different imaging procedures.

[Somatic sequelae induced by radiotherapy in bone segments in adults]. / Sequele somatiche da radioterapia in corrispondenza dei segmenti scheletrici dell'adulto.

The authors, on the basis of reports found in literature and of a personal series, discuss the radiological aspects, the differential diagnosis, the main factors that lead to bone sequelae, and the possible contributory causes and complications. The radiological aspects is characterized by the association of sclerotic and atrophic changes, with a prevalence of the latter in the involvement of the mandible and the cranial bones. Among the main factors there are the radiation dose and its chronological distribution. In fact, the higher the values of the nominal standard dose (NSD), the higher the incidence of such alterations and the more difficult to carry out the efficacy of their treatment. These alterations are found almost exclusively after treatment with administration, in terms of NSD, of more than 1352 rets. Among the contributory causes there are all the factors that may change the physiological condition of the bony tissue. The most common complications are fractures and septic osteitis, the last particularly frequent in the mandible. These alterations and mainly fractures may be solved even spontaneously, even if rather late, so that conservative treatments are indicated. After osteitis it is usually possible to avoid pseudoarthrosis. In cases irradiated with higher doses, osteotomy is often necessary sometime followed by poor results.

Growth rate of primary breast cancer and prognosis: observations on a 3- to 7-year follow-up in 180 breast cancers.

The disease-free probabilities after 3 to 7 years of follow-up of 180 breast cancers of known doubling times were studied to assess the prognostic significance and clinical implications of the growth characteristics of primary breast cancer. Fast-growing tumours, N+ greater than 3, showed a prognosis significantly worse (P less than 0.01) than that of slow-growing tumours of the same class; no significant differences were found among N- or N+ (1-3) fast-, intermediate- and slow-growing tumours. Highly significant differences were found among fast- and intermediate-growing tumours with different degrees of lymph node involvement (respectively P less than 0.0001 and P less than 0.001), with the worst prognosis for N+ greater than 3 tumours. In contrast, no significant differences were found among slow-growing tumours of the different N classes. When the Cox model was applied, the relationship between lymph node involvement and doubling time was significant, as was the interaction term. It is suggested that growth rate and metastatic potential are not the same in primary breast cancers, and their relation should be investigated.

Systematic use of the clinical-mammographic-cytologic triplet for the early diagnosis of mammary carcinoma.

Of about 8500 women with a minimum age of 30 years who had a breast examination at our Outpatient Clinic from April 1982 to March 1983, we found in 286 cases a clinically evident carcinoma, and in 534 cases an apparently benign or suspect solid lump. All 534 of these cases were subjected to the triplet clinical, mammographic and cytologic diagnostic investigation by needle aspiration within 1 to 4 days. The clinical judgment was based on a method of scoring of the characters of 9 physical features (Clinical Diagnostic Index) in use at our Institute. The results of the examinations were grouped into 5 categories: 1) certain benignancy or negativity of the examination; 2) probable benignancy (excluding the cytologic examination); 3) probable malignancy; 4) certain malignancy; 5) nonevaluability of the examination (excluding the clinical examination). Except for 80 cases with collectively negative examinations which were clearly or completely regressed at the control within 2 months, all the others were subjected to surgery. On the basis of the histologic examination (or if regression occurred), 284 of the 534 lumps examined were found to be benign or nontumoral, whereas the other 250 (47%) were carcinomas. Of the latter, 57% were not more than 20 mm in size, whereas in 67.6% there was no microscopic evidence of axillary metastases. Sensitivity of the clinical, mammographic and cytologic examinations was 0.79, 0.76 and 0.72, respectively; specificity 0.71, 0.75 and 0.94, respectively, and the predictive value for malignancy of the positive response of the three examinations 0.71, 0.75 and 0.93, respectively. The use of the diagnostic triplet demonstrated an overall sensitivity of 0.95, specificity of 0.59, and a predictive value for malignancy of 0.98 and 0.93 for benignancy. These results confirm the usefulness of the systematic use of the diagnostic triplet in solid breast lumps of over thirty aged women for the early detection of cancer.

The growth rate in the interpretation of the natural history of lung cancer.

The relationship between growth rate, expressed as doubling time (DT), of 110 lung cancers from randomly collected patients and patient age, sex, histological type, symptoms, smoking habits, size and lymph node involvement was studied. Median DT values of epidermoid carcinomas and adenocarcinomas were superimposable (98 and 99 days, respectively), but 15% of adenocarcinomas had a DT of more than one year. Significant correlations were found with sex (slower growth rate in females) and symptoms (faster growth in symptomatic patients), but only for adenocarcinomas. The number of cigarettes smoked did not seem to affect the growth rate of lung cancers. There was no correlation between growth rate and tumor size or lymph node involvement.

[Radiographic semeiotics of bone metastasis in thyroid carcinoma]. / Semeiotica radiografica delle metastasi ossee da carcinoma tiroideo.

It's well-known that thyroid malignant cancer often metastatizes to skeletal structures. Analysing a wide casuistry of the National Cancer Institute of Milan, we thought right not only consider most common iconographic findings of these bone metastases, but rarest too. Therefore, we studied many radiological symptoms: osteolysis and its shape; extension in the next soft tissues; absence of the periosteal reaction; some resemblances with other primitive cancer or secondary too and dysplasic focus; the changes after therapy usually give a not univocal interpretation of the pictures regarding these peculiar alterations.

[Radiodiagnosis of radiation-treated lung cancer]. / Radiodiagnostica del cancro polmonare irradiato.

Consultation of an exhaustive iconographic casuistry concerning more of one thousand of primitive lung cancer, irradiated by high energies in the National Cancer Institute of Milan, has given in the opportunity of observing some changes induced by radiotherapy both on neoplastic focus and on health tissue near it. In the first instance we observed marked regressions both progressive and complete. In the second instance we saw structural characteristic reactions that can be classified in the, so called, "radiation pneumonia". In the first stage, these are characterized by hyperemia and exudate, liable to complete regression. In the following stages, we observed fibrous evolution which, in a second time, went in to a fixed stage of sclerosis. This produces, in most cases, a "print" of the irradiation fields. Here we present some representative iconographic examples.

[Role of teletermography in the diagnosis of primary tumors of soft tissues and bones]. / Il ruolo della teletermografia nella diagnosi dei tumori primitivi delle parti molli e dello scheletro.

The thermographic behaviour of bone and soft tissue tumors (168 malignant), submitted to this examination from 1971 to 1981, has been retrospectively analyzed and statistically evaluated. In the group of malignant neoplasms, thermography reached a good sensitivity (81.5%), a little better (but not significantly) in soft tissue tumors. Mainly three pathological features have been analyzed: histological type, size and site of neoplastic masses. None of them appears to be related with the result of thermographic examination. The authors emphasize (also from a possible prognostic point of view) the peculiar behaviour of Ewing's sarcoma, whose tendency to uniform distribution through the different thermographic classes cannot be currently explained.

Accuracy of breast cancer diagnosis by physical, radiologic and cytologic combined examinations.

Physical examination, mammography and fine-needle aspiration cytology were performed in 1498 consecutive cases with a solitary solid lump of the female breast. The intent was to verify the validity of this diagnostic triplet in the accuracy of the preoperative diagnosis of breast cancer. Clinically sure cancers were excluded from the study. The collected data were evaluated in terms of sensitivity, specificity and predictivity of any procedure alone or in combination. In 1138 cases confirmed by histology (514 carcinomas and 669 benign or non-neoplastic lesions), the physical examination and mammography were very sensitive (respectively 96% and 84%) but with a high rate of false-positive reports (respectively 20% and 18%). The cytologic diagnosis was less sensitive (65%), mostly due to many inadequate smears, but highly specific (93%) and predictive for malignancy (99%) when the cytologic report was frankly positive. Any single procedure improved the overall sensitivity, and taken together this triplet appears to be the most effective noninvasive diagnostic combination that provides in a short time with minimal cost and discomfort, a diagnosis of certain malignancy in about 50% of carcinomas with a predictivity close to 100%, when cytology detected malignancy.