[Sentinel node in the surgical treatment of the breast cancer. Technique and clinical experience]. / Il linfonodo sentinella nel trattamento chururgico del carcinoma del mammella. Principi di tecnica ed esperienza clinica.

AIM: It is very important to confirm the reliability of the sentinel node (SN) technique in breast cancer surgery, since it can avoid useless traumas, wide mutilations, prolongation of the operation. The aim of the study is to give a contribution to evaluate the real value of SN as regards axillary lymph nodes, in breast cancer, in order to limit axillary lymphadenectomy (AL). METHODS: The search of LS was made in 42 patients (using Patent Blue alone in 5 cases, with radioisotope in 25 cases and with both techniques in 12 cases); their mean age was 62 years and they were suffering from not multicentric infiltrating carcinoma of the breast, with a diameter less than the 2.5 cm and no evidence of axillary gland at clinical examination. All the patients underwent histologic examination of SN and AL was carried out, whatever was the histologic result of SN. RESULTS: Lymphoscintigraphy identified the SN in 96% of the cases (1 case with no identification in a patient with a previous excisional biopsy), with the Patent Blue in 80% of the cases and with the combined technique in 100% of the cases. The average number of SN obtained was 3 and the number of removed lymph nodes in AL was 25. The metastasization of SN was verified in 10 cases, in 3 of them the SN turned out to be the only one interested by metastasis. In 1 case the intraoperative examination was negative and the postoperative one was positive. The percentage of false-negative was 5% (1 case with lymphoscintigraphy and 1 case with Patent Blue). These findings show that in about 70% of the patients AL could be avoided since axillary lymph nodes were without metastases. The predictive role of SN, particularly with lymphoscintigraphy, proved to be reliable with a very reduced number of false-negative. CONCLUSIONS: In our opinion, the SN technique can be considered reliable but it could be used in routine practice when all false-positive can be avoided, since even if not very numerous they represent the principal obstacle to its application.

Prostaglandin E1 versus lumbar sympathectomy in the treatment of peripheral arterial occlusive disease: randomised study of 86 patients.

BACKGROUND AND AIM: The aim of this study was to compare the effects of a pharmacological and a surgical vasodilatatory therapy in the treatment of chronic arterial diseases of the lower limbs. METHODS AND RESULTS: After giving their informed consent, 40 patients were randomised to receive a slow (approximately 2-hour) infusion of 40 microg of prostaglandin E1 twice daily for 28 days (group A), and 46 were randomised to undergo lumbar sympathectomy, including the second and third ganglion. Twenty-four (60%) of the patients in group A experienced complete remission, seven (17.5%) were partial responders, and nine (22.5%) failed to respond. Of the 46 patients in group B, 29 (63%) experienced complete remission, seven (15.2%) were partial responders, and 10 (21.7%) failed to respond. CONCLUSIONS: Broadly similar results were obtained with the two types of treatment, both of which are indicated mainly in Fontaine stages IIB and III (non-advanced), particularly when revascularising therapy is impossible or excessively risky. The two strategies can be advantageously combined with direct revascularisation surgery and may therefore constitute a first-line approach favouring subsequent therapy.

Alteration of haemostasis in non-metastatic gastric cancer.

BACKGROUND: Cancer is one of the most common acquired causes of venous thromboembolism. AIM: To evaluate haemostasis disorders in patients with non-metastatic gastric cancer. PATIENTS AND METHODS: We studied 11 patients with non-metastatic gastric cancer (9 males and 2 females, median age 54 years) and 20 healthy subjects (15 males and 5 females, median age 48 years) control. We measured prothrombin time, activated partial thromboplastin time, coagulation time, clot lysis time, fibrinogen, clotting factors (II, VII, VIII, IX, X), C protein, S protein, AT III, activated protein C resistance, prothrombin 1+2 fragment, tissue plasminogen activator and D-Dimer in all subjects. RESULTS: Fibrinogen plasma levels were significantly higher in patients with non-metastatic gastric cancer than in control group (505+/-24 mg/dl vs 336+/-30 mg/dl, p<0.001). We also found a significant increase in prothrombin 1+2 fragment plasma concentration compared with controls (3.8+/-0.6 nM vs 0.83+/-0.09 nM, p<0.001). Plasma D-dimer levels were 20-fold higher in patients with non-metastatic gastric cancer compared with controls (9.57+/-0.4 ng/dl vs 0.4+/-0.05 ng/dl, p<0.001). Also tissue plasminogen activator was significantly higher in gastric cancer patients than in controls (20.8+/-2.32 ng/ml vs 9.1+/-1.37 ng/ml, p<0.01). Finally clot lysis time was significantly accelerated in gastric cancer patients compared with control subjects (81+/-37 min vs 233+/-74 min, p<0.01). CONCLUSIONS: Patients with non-metastatic gastric cancer are at risk for thrombotic events due to the combined increase in fibrinogen plasma levels and thrombin formation.

[Thymopentin and immune response in patients with cancer]. / Timopentina e risposta immunitaria nel paziente neoplastico.

The results of an experimental study using thymopentin (Timunox) on cancer patients are reported. The drug was administered to 25 patients with cancers of the digestive tract in the form of subcutaneous injections of a vial of the product on alternate days for 36 days. All patients treated revealed a good immune response as indicated by assays of total lymphocytes, T4 lymphocytes the T4/T8 ratio and skin tests, apart from their excellent postoperative recovery. Timunox is therefore considered effective in improving the immune competence of cancer patients.