[Cardiac pacemaker and radiotherapy: a growing association. Report of a clinical case]. / Pacemaker cardiaco e terapia radiante: un'associazione in crescita. Descrizione di un caso clinico.

Cardiac pacing is increasingly common. In 1986, in the USA there were more than 500,000 pacemaker-implanted patients and at least 100,000 new pacemaker implants were performed, for a total of 3,000 pacemakers for million inhabitants. The increment in cardiac pacing is due to: a fall in cardiovascular mortality; increased elderly population, in which bradyarrhythmias are frequent; and the introduction of implantable cardioverter defibrillators (ICD). In 1992, in Italy, there were 30,500 deaths due to lung tumours and 10,900 deaths for breast malignancies. Both malignancies are more common in patients older than 65. Lung and breast cancer therapy involves the use of surgery, radiation, or chemotherapy, and often a combination of two or all three. In particular 40% of cancers are managed with radiotherapy. It is therefore likely that cancer patients may require radiotherapy at sites (lung, breast) where a pacemaker is implanted. The authors describe the finding on a chest radiogram of a one centimeter nodular mass at the right superior lobe almost completely hidden by the pacemaker. The modalities to proceed to radiotherapy, without damaging the sensitive pacemaker, are discussed.

[Italian clinical cardiology research at the international level. Statistical data from the period 1983-1993]. / Osservazioni sulla ricerca clinica cardiologica italiana di livello internazionale. Dati statistici per il periodo 1983-1993.

Recent studies show that, among advanced countries, the rank of cardiological research finds Italy last for number of scientific publications and for gross expenditure on research and development. To assess more thoroughly the characteristics of Italian clinical cardiological research we examined, over the period 1983-1993, all original articles published by five important international cardiology journals (Circulation, American Heart Journal, American Journal of Cardiology, Journal of the American College of Cardiology and European Heart Journal). During the mentioned period the Italian contribution (743 articles over a total of 16375, mean prevalence of 4.5%) has increased from 3% in 1983-1985 to 5.8% in 1991-1993 (p < 0.0001). Taking into account that research often results from the joint-work of different centers, the 743 articles derived from 1056 contributions from just over 120 centers. Of these contributions 57% were from universities, 23% from hospitals, 19% from research institutes, and 1% from private foundations. The cooperation with foreign countries has steadily increased, particularly with the USA (45%) and with the European nations (42%). Within the first three names, the contribution of female Authors has increased from 7% in 1983-1985 to 16% in 1991-1993 (p = 0.0001). The mean prevalence of female Authors as last name was 4% and did not change with time. As to geographic distribution, 57% of the scientific publications comes from the North, 28% from the Centre, and 15% from the South. After adjusting these data for population size, the percentages were respectively 40, 46, and 14%. An index of productivity (the ratio between the number of scientific contributions from universities and research institutes and their funding) was highest in the North. The Italian scientific contribution to international cardiological research is not satisfactory, although it is significantly increasing; yet, this trend might worsen due to the shortage of funding. The collected data outline that in the three main national geographic areas, the distribution of funds and scientific productivity are markedly unbalanced.