[Atypical radiological images in Pneumocystis carinii infection in HIV-positive patients]. / Considerazioni sui quadri radiologici atipici nell'infezione da Pneumocystis carinii nei pazienti HIV positivi.

To assess the prevalence of atypical PCP patterns in AIDS patients, the chest films of 300 patients with clinical and laboratory diagnosis of PCP were reviewed. We considered as atypical patterns the finding of an asymmetric lesion, the involvement of apical regions, pleural effusion, hilar and/or mediastinal lymphadenopathy, parenchymal nodules and pneumatoceles. In some patients more than one of these patterns was found. Atypical patterns were observed in 32% of cases and consisted of: unilateral involvement in 11% of cases, apical involvement in 6%, pleural effusion in 9%, hilar and/or mediastinal lymph nodes in 4%, parenchymal nodules in 6% and finally pneumatocele in 12% of cases.

Present status of treatment for invasive cervical carcinoma.

The results are presented of a retrospective clinical study carried out on 341 patients affected with cancer of the uterine cervix, with lymphography in the pretreatment diagnostic work-up, treated in our Institute from January 1961 to December 1976. The clinical classification of the patients studied was: 157 cases in Stage I (46.0%), 95 cases in Stage II (27.9%), and 89 cases in Stages III and IV (26.1%). During the period considered, the therapeutic approach for carcinoma of the cervix was practically constant and in line with the therapeutic policy most frequently followed for these neoplasms. For the early stages (9/341 patients or 27.6%) preference was given to a radical surgery and postoperative radiotherapy combination; for borderline cases and "bulky" and "barrel-shaped" lesions, radiotherapy usually preceded surgical treatment to enlarge its indications and improve its results (36/341 patients or 10.5%). The cases that were more developed locally or that presented contraindications to surgery received radiological treatment alone (211/341 patients or 61.9%). Radiotherapy treatment consisted of radium therapy performed with a single application of 226Ra conventional sources, followed by percutaneous irradiation with 60Co-teletherapy in the more developed cases and/or in the presence of lymph node metastases. All the patients were submitted to diagnostic lymphography at the onset of the treatment and 92 (26.9%) had lymph node metastases. In the framework of this clinical review, the 5-year disease-free survival from onset of the treatment varied from 88.2% for the cases at Stage Ib occult, 72.5% for the cases at Stage Ib, 63.8% for the Stage II cases, to 40.5% for the cases at Stage III and IV. The presence of a pathologic report at lymphography makes a considerable difference in terms of disease-free, long-term survival after treatment

The value of radiotherapy in the treatment of vaginal carcinoma.

Herein we report the retrospective survey of 48 consecutive unselected cases of vaginal carcinoma, mainly treated with radiotherapy in our Institute from 1959 to 1970. In this series irradiation was delivered almost always with a single and continuous application of sources of radium 226. Radiumtherapy treatment varied according to the extension in surface of the neoplasm, the clinical stage and especially the vaginal step involvement, considering the length of the organ. Despite the very good immediate response, failures of treatment locally or in paravaginal and pelvic areas were frequently observed, and success of the treatment after a brief follow-up was poor. The actuarial survival was 41.6% and 33.3% at 3 and 5 years, respectively. Stage I cases showed at the follow-up better therapeutic results (48.6% survival at 5 years) than stage II and III cases (28.3%). The poorest results were observed in neoplasms extended to the whole vagina, and all these patients died within 4 years of the beginning of treatment. This report stresses that radiotherapy of vaginal carcinomas demands individualization and a properly planned therapeutic program that combines external irradiation with renewed techniques of low dose rate and continuous irradiation with radioactive sources.

Clinical results of lymphography in cancer of the uterine cervix. A retrospective study of 542 consecutive, unselected patients.

From 1961 to 1976, 542 patients were evaluated with foot lymphography for cancer of the cervix at the Istituto Nationale Tumori of Milan. A group of 341 patients had lymphangiography as part of the initial diagnostic work-up. The overall incidence of positive examinations was 25% (9% stage I, 29% stage II, 46% stage III, 50% stage IV). In the 115 patients who had pelvic surgery the overall diagnostic accuracy of lymphography was 88%, with 2 false positive and 12 false negative reports. A second group of 90 patients was evaluated in the follow-up without clinical evidence of disease, and the incidence of metastases was 17%. Finally, group of 111 patients was studied for recurrence, and in this group the incidence of metastases was 51%. As regards site of involvement, the external iliac chains were involved in 93 to 96% of the cases, the common iliac in 34 to 79%, and the para-aortic in 17 to 36% in the different clinical conditions. The highest incidence of para-aortic metastases was found in the clinically initial stages (I and II) and in the recurrences. The lymphographic involvement of the retroperitoneal nodes was usually limited to a single region (41%) or two regions (37%). Only in 22% of the positive cases was a diffuse involvement of the retroperitoneal node chains evident.