More information, more choice: an Italian database for oncology patients.

BACKGROUND: In recent years there has been a proliferation of cancer information available for patients in the Italian language. However, quantity without validation and organization is by no means synonymous with providing good information and a good service. Furthermore, the lack of coordination and cooperation between the various information-providing initiatives results in uncontrolled waste. MATERIALS AND METHODS: To impose order on the vast ocean of cancer information in Italian, and to provide patients with a reliable and comprehensive tool, the Azalea Project was developed whereby a database of information for patients was created. Paper-based and electronic information is validated and stored so that patients can search and retrieve it. Validation is by means of a grid drawn up by the project team with reference to international standards. RESULTS: The nucleus of the database constructed by the Centro di Riferimento Oncologico (Oncology Referral Centre), Aviano, was extended using the wide experience of the Italian Cancer Institutes within the Italian Alliance Against Cancer. The website is at http://www.azaleaweb.it CONCLUSIONS: Meetings and courses specially designed for the project enabled evaluation grids to be created and permitted a fruitful interchange of skills and experience from a variety of professional information providers united in the common aim of providing patients with a service that meets their needs and puts them in control at a difficult time in their lives.

Electronic biomedical journals: how they appear and what they offer.

This study, prompted by a number of articles presaging the imminent demise of biomedical journals due to the rise of their electronic spread, analysed 54 Web sites of the journals included in the Oncology section of the Science Citation Index, Journal Citation Reports (1994) and the sites of 10 other leading digitised biomedical journals. The aim was to determine quantitative and qualitative differences in terms of information content existing between the two media. The analysis confirmed that there are limits to the information contained in the scientific journals currently on the Internet and upholds the authors' conclusion that, in the oncology field, the printed journal will continue to have an important role for most individual users for some time.

Sustaining Oncology Studies--SOS: information and support for training, research and exploitation in cancer and related biomedical disciplines.

This paper outlines the development of the Sustaining Oncology Studies Information Resources (SOS Europe), a multimedia World Wide Web (WWW) prototype providing support to experimental and clinical cancer researchers, general practitioners, industry personnel, and university students in the field of oncology in Europe and Italy. The system utilizes applications developed for the WWW and is designed in the most easily understandable approaches possible. The prototype now structures oncology-related information available on the Internet and also places resources maintained locally at users' disposal. The system utilizes a WWW browser as a design platform and HTML to build its Home and subpages and to create hyperlinks to internal and external resources.

Fotemustine (S 10036) in the intra-arterial treatment of liver metastasis from malignant melanoma. A phase II Study.

Fotemustine is a new nitrosourea which has shown some efficacy on disseminated malignant melanoma (DMM) (24.2% response rate (RR) among 153 patients in a Phase II trial) but little activity on hepatic metastasis (8.8% RR). In order to improve those poor results, hepatic intra-arterial infusion (HIAI) of fotemustine was performed. After two years, thirteen patients, all in good general condition, were evaluable. Seven were pretreated and six had extrahepatic metastasis on entry into the study. All patients had a surgically implanted intra-arterial catheter. The induction cycle consisted of 100 mg/m2/week for 3-4 weeks, followed by 5 weeks rest and maintenance therapy of 100 mg/m2 every 3 weeks for stabilized or responding patients. Two complete responses (CR) (72+ and 145+ weeks) and six partial responses (PR) (7-18.5 weeks) were observed. The hepatic RR reached 61.5%. A RR of 42.8% was registered on preexisting EHM (one CR and one PR on cerebral lesions). Nevertheless, this treatment is limited by the high progression rate of 46.1% in extrahepatic disease. Toxicity was mainly hematologic (grade III-IV), comprising 36% neutropenia and 15% thrombopenia. Hepatic intra-arterial infusion of fotemustine is efficient therapy for liver metastases of DMM, but combination schedules (IV + HIA) are warranted.

[AIDS in Africa]. / AIDS in Africa.

While AIDS (Acquired Immunodeficiency Syndrome) certainly represents a worldwide health problem, the attention of many researchers and epidemiologists, besides the WHO itself, has recently focused on Africa for the following reasons: 1) The etiologic agent of AIDS, the Human Immunodeficiency Virus (HIV) (previously named HTLV-III or LAV) is likely to have originated in Africa. Solid evidence has been accumulated that antibodies against HIV were present in African sera collected in the early 1960s. In the same period widespread infection by viruses strictly related to HIV has been documented in primates living in tropical Africa. A second type of HIV (now named HIV-2 and previously known as HTLV-IV or LAV-2) which is responsible for a milder AIDS-related disease, has been subsequently identified in West African inhabitants with its own simian correlate. Although epidemiological evidence for the presence of AIDS in Africa in these early periods is scanty, sporadic cases have retrospectively been identified. 2) Up to 1986, AIDS epidemiology in Africa has been hampered by inconsistency of demographic data, inadequacy of public health services and difficulty of obtaining the necessary laboratory evidence. The few data available (Zaire, Rwanda), suggests an annual incidence in 1983 of 170-800 per million, comparable to higher U.S. and European rates. There is no evidence, however, that African epidemy precedes that of the U.S., for which there is no explanation at present. On the other hand, recent data indicate an alarming acceleration of the African epidemy, that spreads well beyond the risk groups which have been recognized in Western countries. 3) Prevalent infection routes in Africa are not entirely overlapping with Western countries'. Rather than homosexual intercourse (U.S.) and syringe sharing by drug abusers (Italy), most African cases seem to be transmitted by heterosexual promiscuous contacts and, to a lesser extent, by blood derivates and recycled syringes. Insects and tribal rituals have been also suspected as vehicles of infection in Africa; widespread prostitution and inadequate health facilities certainly are. As a consequence, transplacental infection appear much more common than in the West. 4) Clinical aspects of AIDS progression in Africa appear linked to the different spectrum of opportunistic agents present on the continent and to the general hygienic and social conditions prevailing among its people. Rather than generalized lymphoadenopathies and Pneumocystes Carini pneumonia, diarrhoea and extreme weight loss ("Slim disease") represent the most common clinical pattern.

PIP: In regard to AIDS, attention has focused on Africa for the following reasons: 1) Solid evidence indicates that antibodies against HIV were present in African sera collected in the early 1960s. 2) Up to 1986, AIDS epidemiology was hampered by inconsistent demographic data, inadequate public health services, and scanty laboratory evidence. 3) Prevalent infection routes in Africa are not entirely overlapping with Western countries. 4) Clinical aspects of AIDS progression in Africa appear linked to the different opportunistic agents and to the prevailing hygienic and social conditions. In 1983, in Rwanda and Zaire, the annual incidence of HIV infection ranged from 17 to 800/million and 170/ million, respectively. In the first five months of 1985, the range of annual incidence in Africa was 50-1000/million. In Zaire, the male-female infection ratio was 1:1.2 and the average age of infected people was 33.6 years. Seropositivity ranged from 1% to 15%. The distribution of African AIDS is characterized by heterosexual transmission, transmission via contaminated syringes, blood transfusion, and maternal-fetal transmission. Lack of condom use among prostitutes and multiple partners are the main routes of heterosexual transmission. Other routes are high risk sexual practices as well as traditional and tribal rituals (clitoridectomy/female genital mutilation). Perinatal infection results from maternal-fetal transmission but also from blood transfusion and the use of unsterilized syringes. In 1986, in Zaire, among 2384 hospital workers, significantly more seropositivity occurred in a group who had had injections in the previous three years. A 1986 study also hinted at the possible role of insects in HIV infection. The major symptoms of AIDS in an African context, in addition to the usual depletion of CD4 lymphocytes, include diarrhea and weight loss, candida, cryptococcus, cytomegalovirus, cryptosporidium, and herpes simplex. Only 14% of AIDS patients in Africa have pneumonia carinii as compared with 63% of AIDS patients in Europe. The concomitant infection with both HIV and tuberculosis is particularly high in Africa.