[A case of pulmonary artery sarcoma and review of the literature]. / Un caso di angiosarcoma polmonare e revisione della letteratura.

Pulmonary artery sarcoma (PAS) is a highly malignant tumor that originates in the pulmonary artery. This disease has a poor prognosis. Early diagnosis followed by radical surgical resection constitutes the only chance of survival for patients. However, owing to the rare and nonspecific clinical manifesta-tions and imaging findings, PAS is frequently misdiagnosed as various pulmonary thromboembolic diseases. We report the case of a 49-year-old woman who presented to our emergency department for dyspnea, hemoptysis, cough, and asthenia. A diagnosis of pulmonary thromboembolism was initially postulated. However, the rapid clinical progression of the disease, characterized by multiorgan involvement, together with the persistence of pulmonary filling defects despite appropriate anticoagulation therapy, induced to a late diagnosis of metastasized PAS. The peculiarity of our case consists of two main factors: the first is the atypical clinical presentation characterized by severe neurological impairment that finally led to patient's death; the second is the histopathological aspect of the lesion with a prevalent histiocytic cell component that is described in the literature as the less frequent pathological variant of this tumor.

[Role and interactions of the cardiologist in a regional institutional project of primary prevention]. / Ruolo ed interazioni del cardiologo in un progetto istituzionale regionale di prevenzione primaria.

BACKGROUND: Evidence is available in support of the policies for a population-wide approach to shifting risk factor distribution; on the other side, setting up enduring projects of primary prevention is difficult, as well as gathering the right experts. METHODS: In 1999 the Piedmont Region's Administration set up a multi-year intervention with the aim at reducing risk factors and increasing protective factors of oncologic and cardiovascular diseases in the general population, particularly in disadvantage groups. The cardiologists played a primary role by supporting the project of evidence-based guidelines, producing bibliographic reviews and spreading coronary risk maps. A main group of trainers was set up in each Local Health Service to promote a system of counseling lifestyles, with the central reference of the general practitioner activity. As a second step, a mass-media campaign has been set up using health advertisements on newspapers, television, public transports, notice-boards on the following subjects: nutrition, hypertension, tobacco, physical activity, stress; warehouses, food markets, trains and squares were involved. Moreover, a newsletter review has been published since January 2000, to produce basic models, most effective interventions and recommendations for their implementation. RESULTS: A new care for the primary prevention and counseling arguments as well as the need for continuous training to promote preventive actions were shown to general practitioners. A system to identify the best channels, communication ways and the most effective messages for healthy lifestyles was settled. A model of monitoring risk factor changes and protective behaviors in the population, describing social differences, was established to better plan and assess effective interventions. CONCLUSIONS: After more than half a century of productive public health science, there is an urgent need that Government Administrations steer their health policies towards determinants of health and create the best conditions to make citizens to improve their lifestyle.