[Radiotherapy of limited pulmonary microcytoma in current clinical practice]. / La radioterapia del microcitoma polmonare "limitato" nella pratica clinica corrente.

The use of thoracic irradiation in the treatment of "limited disease" small-cell lung cancer yields better local control and survival rates than chemotherapy alone, according to meta-analysis studies of randomized clinical trials. Outside experimental studies, however, the role radiotherapy can currently play in the management of this type of cancer is difficult to assess because treatment modalities and patient selection criteria differ greatly. We report on the treatment outcome obtained in the Radiotherapy Department of the University of Siena in a series of 86 patients with small-cell lung cancer consecutively referred, January 1986 to January 1992; after a thorough staging, 46 of them were diagnosed as having a "limited disease". A "sequential" chemo-radiotherapy combination was used: irradiation was delivered after the completion of the initial drug treatment. Twenty-four patients (52.5%) achieved a complete and 22 (47.5%) a partial objective remission after chemotherapy, with acceptable early toxicity rates and severity. Twenty-eight of them received irradiation according to the following selection criteria: objective remission after chemotherapy (19 of 24 complete responders, excluding those with initial pleural effusion or worsening medical status during chemotherapy) and initial large tumor bulk (9 of 22 patients in partial remission). The overall treatment outcome rate (median survival: 18 months, 2-year survival: 28%) is in agreement with that of similar previous studies; toxicity rates are also similar (2% of treatment-related deaths). Survival analysis, according to "performance status" score, chemotherapy schedule and the achievement of complete remission with the initial drug management, exhibited significant differences only relative to the latter parameter. Many recent clinical trials suggest that combined chemo-radiotherapy could improve these results: toxicity is however reported as heavy, with this approach. Some guidelines are here considered, which could make this combination reliable also for current clinical use.

Breast-conserving treatment of early breast cancer. Results in a common clinical trial.

Results of large prospective trials, often based on selected series and optimal treatment techniques, indicate that breast conserving therapy is appropriate for most patients with early breast cancer. Questions remain regarding the therapeutic outcome in common practice. We report on a series of 206 consecutive, unselected patients treated with current radiotherapy procedures. The Kaplan-Meier evaluation showed 5- and 8-year survival rates (93%, 91%), distant disease-free survival rates (87%, 85%) and local relapse-free survival rates (90%, 88%) that were comparable to those of the conservative arms in reported randomised trials and to the data from retrospective studies reported by authoritative institutions. However, subanalysis according to prognostic factors such as menopausal status, age and axillary nodal status was of limited value, due to the small number of cases.

[Echographic diagnosis of hip dysplasia in neonates. Reflections on two years' work at our ultrasonography center]. / Diagnosi ecografica nella displasia dell'anca nel neonato. Considerazioni su due anni di lavoro nel nostro centro di ecografia.

The paper evaluates the role of ultrasound examinations of the hip joint in neonates by comparing the results of a one-year screening study (non-selected group) with the findings in a selected group of neonates with a high risk of hip dysplasia. The introduction to the paper contains a general discussion of the clinical aspects of hip dysplasia and describes the main anatomical findings using echography.

Effects of ticlopidine on blood fibrinogen and blood viscosity in peripheral atherosclerotic disease.

Ten patients with peripheral atherosclerotic disease(PAD) treated with 750 mg/d of 5-(2-chlorophenylmethyl)-4,5,6,7-tetrahydrothieno (3,5-c-pyridine) hydrochloride (ticlopidine, Tiklid) were studied for three months. As control was studied a similar group of patients treated with a traditional vasodilator (nicotinate). The aim of our study was to evaluate the effect of ticlopidine both on the clinical evolution of the disease and on rheologic, coagulative and platelet parameters. A progressive increase of maximal walking distance was noted during the three months of therapy with ticlopidine and limited to the first 30 days of treatment with nicotinate. The fibrinogen levels resulted significantly lowered during 90 days of treatment with ticlopidine, while that was not evident in the nicotinate group. There was also a slight improvement of blood viscosity in the ticlopidine group (not evident in the nicotinate group), but it was not statistically significant. No further modifications of investigated data were found in the two groups of patients. The clinical benefit of ticlopidine in PAD without adverse reactions can be confirmed at least at the dosage of 750 mg/d instead of the usual dose of 500 mg/d. A direct or indirect action of ticlopidine on plasma fibrinogen is suggested. This observation may supply new clues for the understanding of the mechanism of action of this drug.

Platelet-specific proteins in patients with transient ischemic attacks. (Effects of anti-platelet drugs).

Levels of beta-thromboglobulin and platelet factor 4 in 46 patients with transient ischemic attacks and the influence of treatment with dipyridamole or aspirin plus dipyridamole were evaluated. Patients not receiving therapy showed levels of beta-thromboglobulin significantly higher than controls. However, patients taking only dipyridamole showed values of beta-thromboglobulin significantly lower than untreated patients or those taking aspirin plus dipyridamole. No significant difference was observed with regard to platelet factor 4 between the patients.