[The prevention of DVT after general surgical interventions for cancer pathology]. / Profilassi delle TVP dopo interventi di chirurgia generale per patologie oncologiche.

The efficacy of postoperative DVT prophylaxis of defibrotide and heparin calcium was evaluated in a group of 47 patients undergoing general surgery for oncological pathologies. A sub-group (24 patients) received defibrotide treatment, 400 mg b.i.d. i.m.; the second subgroup (23 patients) was treated with heparin calcium, 5000 IU b.i.d. s.c., from the day before operation until the 7th postoperative day. No postoperative thrombotic symptoms were observed in either group of patients.

[Idiopathic myelofibrosis associated with an IgM-secreting immunocytoma]. / Mielofibrosi idiopatica associata ad immunocitoma IgM secernente.

A case of idiopathic myelofibrosis developing in conjunction with IgM secreting immunocytoma is described. The possible pathogenetic implications of the association between myeloproliferative and lymphoproliferative disorders are discussed.

Kappa light chain gene rearrangement in a T-cell lymphoma.

Forty-three patients were studied to determine whether light chain gene rearrangements may occur in hematopoietic cells not pertaining to the B-lineage. In only one patient, affected by T-cell lymphoblastic lymphoma, one kappa light chain allele was rearranged. Neither at the protein level nor at the RNA level the rearranged gene was expressed. These data confirm that, although rarely, kappa light chain gene rearrangements may occur in neoplastic T-cells. Furthermore, as in our patient Ig heavy chain genes retained a germline configuration, the present data demonstrate that kappa light chain gene rearrangements may occur regardless of Ig heavy chain gene arrangement.

Hodgkin's disease prognosis: a directly predictive equation.

586 patients with Hodgkin's disease diagnosed between 1970 and 1979 were staged and treated in the same way. Multivariate analysis was used to delineate the prognostic roles of several clinical features at diagnosis. A multiple regression analysis was applied to an exponential model for survival-time distribution, which proved to fit the data accurately. Several clinical characteristics were studied and those that could singly discriminate survival significantly were chosen as predictive variables for the multiple regression. These were: sex, age, stage, histological subtype, presence of constitutional symptoms, mediastinal mass, and erythrocyte sedimentation rate (ESR), and haemoglobin and serum albumin concentrations. ESR, stage, histological subtype, and age proved to be the best prognostic factors, while sex and albumin had minor value. The presence of symptoms, mediastinal bulk, and haemoglobin were not so important. A linear equation for the six variables was derived to calculate the estimated median survival time for any given patient. This equation was validated on an external group of 179 similar patients.

Reevaluation of prognostic significance of symptoms in Hodgkin's disease.

The prognostic value--at diagnosis--of fever, sweating and weight loss, which enter the Ann Arbor B category, and of pruritus, whose influence on survival is still debated, were systematically reevaluated in 635 patients with Hodgkin's disease, observed between 1972 and 1982. By means of multivariate analysis an intrinsic, more negative prognostic value was demonstrated for each of the following symptoms: fever over 38 degrees C, weight loss more than 10% of body weight in the 6 months before admission, and severe pruritus, which is defined as being generalized, causing multiple excoriations and resisting local and systemic antipruritics. Patients with the mild counterparts of these symptoms, as well as sweats, were found to have a survival rate quite comparable with that of fully asymptomatic patients. A rearrangement of the Ann Arbor B constitutional symptoms which would replace sweats with severe pruritus might be more correct and more suitable for better selecting the patients who require more aggressive therapy.

Serum albumin in Hodgkin's disease.

Serum albumin levels were measured by electrophoresis in 552 evaluable patients with Hodgkin's disease. Determinations were made on all patients at onset, on 224 after induction therapy and on 78 in relapse after remissions of variable length. At onset a discrete hypoalbuminemia was evident, inversely related to stage and more marked in symptomatic cases and elder patients. Little or no differences in albumin levels were found with relation to histologic subtypes, sex and presence of weight loss or hepatic damage. Posttherapeutic normalization of serum albumin occurred only after achievement of complete remission and failed after partial remission, while a new clear decrease became evident in relapse. On the basis of 799 albumin measurements during active disease and in remission, the albumin/alpha 2-globulin ratio demonstrated a clear and useful clinical advantage over either albumin or alpha 2-globulin fractions alone as indicator of active disease and relapse. If defective synthesis is the most accepted mechanism for hypoalbuminemia in Hodgkin's disease, these results suggest a casual factor somehow related to the tumoral mass.

New clinical criteria for the assessment of liver involvement in Hodgkin's disease.

The hepatic involvement in Hodgkin's disease, histologically verified in 133 patients who underwent laparotomy or laparoscopy, proved to be singly related to the following clinical findings: result of the liver isotopic scan, liver and/or spleen enlargement, serum albumin less than or equal to 3.5 g/dl, GOT and/or GPT greater than or equal to 20 mU/ml, serum alkaline phosphatase (SAP) greater than or equal to 210 mU/ml, BSP retention at 45 min greater than or equal to 6.5% and ESR greater than or equal to 51 mm at 1 hr. Such clinical findings were jointly evaluated and further selected by means of a logistic discriminant analysis, and the simplest function with the best discriminant ability between involved and non-involved liver was made by liver scan, spleen enlargement, BSP retention and GOT (89.5% of correct diagnoses). Since the Ann Arbor clinical criteria for liver involvement showed correct diagnoses in 69-80% of the cases, more reliable criteria can be proposed. So, liver involvement is highly probably (a) when three or more of the five variables indicated above are abnormal, or (b) when a markedly abnormal liver scan is associated with alteration of at least one of the other four parameters: otherwise liver will be non-involved.

Tonsillectomy: a prognostic factor in Hodgkin's disease?

The clinical features and course of Hodgkin's disease (HD) were investigated in 160 previously tonsillectomized patients and compared with 375 nontonsillectomized ones. In both groups, sex, social class, histologic type, stage and symptoms were almost identically distributed. Tonsillectomized patients showed a higher incidence of initial cervical forms (p less than 0.05) and more frequently developed the disease under 35 years of age (p less than 0.001), thus also reflecting the different policies of the otolaryngologists in the past few decades. Moreover, the tonsillectomized patients enjoyed a significantly better survival (p approximately equal to 0.01) than the nontonsillectomized ones. Adjusted survival curves for age and site of initial involvement proved that the favorable prognostic value of tonsillectomy was not due to the altered distribution of these 2 factors in the 2 groups; in addition, an earlier diagnosis in tonsillectomized patients could be excluded. The favorable effect of tonsillectomy in HD patients might be related specifically to the reduced portion of immunologically reacting oropharyngeal lymphoid tissue remaining after tonsillectomy. A decreased output of the specific immune-complexes, which are responsible for the disease, according to Vianna's theory, might be hypothesized in tonsillectomized patients.

Lymphoid blastic crisis at the onset of chronic granulocytic leukemia: report of two cases.

Two patients with a typical hematologic pattern of acute lymphatic leukemia were brought into complete remission by treatment. A few weeks later they developed a typical peripheral and bone marrow pattern of chronic granulocytic leukemia, with Philadelphia chromosome and very low leukocyte alkaline phosphatase. These cases, along with other findings recently reported in the literature, support the possibility of a previously unrecognized relationship between lymphoblastic cell populations and chronic granulocytic leukemia.