Breed differences in behavioural response to challenging situations in kittens.

In a previous experiment, the behaviour of Oriental/Siamese/Abyssinian (OSA) kittens was compared with that of Norwegian Forest kittens (NFO) in a repeated Open Field Test (OFT), and significant differences emerged. To further investigate such variations, we analyzed kittens' responses to a potentially threatening object (TO) during the OFT. It was a metal spring enveloped in a cotton case suddenly bouncing out of the cylinder after the first 6 min of OFT exposure, and the test lasted 6 more minutes. From the 4th to the 10th week of age, during each test, the response of 43 OSA kittens and 39 NFO kittens to the TO was analyzed. Heart rate (HR) before and after the test was recorded. Behaviours were recorded and analyzed by focal animal sampling. Behavioural modifications recorded after TO exposure confirmed our suggestions on slow limbic system development in NFO kittens, as previously suggested by poor habituation and poor memory retention of repeated OFT exposure. The evident avoiding response to the TO confirmed the adoption in NFO kittens of an active-coping strategy towards challenge, as indicated also by their high scores for exploration and escape attempts. Otherwise, poor TO influence on exploration observed in OSA kittens suggested the adoption of a passive coping strategy, as previously shown by low levels of exploration and intra-session reduction in the number of vocalizations. Nevertheless, some of the behaviours observed, and the evidence of emotional tachycardia in OSA kittens, suggested also that the low level of activity recorded could have been due to a low arousability predisposition in this breed. The perception of a poorly arousing potential in the experimental setting might have influenced the perception of danger and the behaviour adopted in OSA kittens.

Breed differences in behavioural development in kittens.

Differences in behaviour of pure breed cats have been suggested but not wholly investigated. Oriental/Siamese/Abyssinian (OSA) kittens (n=43) were weekly compared with Norwegian Forest (NFO) kittens (n=39) from the 4th to the 10th week of age in a repeated Open Field Test (OFT) paradigm. Heart rate (HR) and rectal temperature (RT) before and after the test, and behavioural responses during the OFT were recorded. Behaviours registered were analysed by focal animal sampling. Significant breed differences were found; cats of the northern zones (NFO) seem to develop earlier thermoregulatory abilities. Precocious opening of eyes, higher locomotion scores and longer time spent standing, observed in OSA kittens may indicate an earlier neurological development. Inter breed differences recorded for exploration and locomotion seem to indicate coping style divergences: in the OFT challenging situation OSA kittens presented higher emotional tachycardia and performed more passively, with a faster decline in exploration and locomotion scores. NFO kittens exerted a more active behaviour as they spent more time exploring the arena and in escape attempts. Notwithstanding OSA and NFO cat selection was mainly aimed to improve divergent morphological traits, some different behavioural and physiological traits seem to have been maintained or co-selected within each breed.

Gemcitabine as single agent therapy in advanced non small cell lung cancer and quality of life in the elderly.

BACKGROUND: The aim of this study is to test the efficacy of gemcitabine as single agent therapy in advanced non-small cell lung cancer in the elderly by the evaluation of the clinical response, the survival increase and the quality of life. METHODS: Nineteen patients (age >65 years) with a PS >2, bearing an advanced non-small cell lung cancer (IIIb-IV) not treated with chemotherapy before, were charged between December 1996 and December 1998. Sixteen patients were treated with gemcitabine at the dose of 1000 mg/mq 1-8-15 every 28 days. CT scan, X-rays and skeletal scintigraphy were used in the evaluation of the therapeutic response. The toxicity was estimated by following WHO indexes. The quality of life and the modification of the specific symptoms were estimated by particular tests (Spitzer Index, IADL, EORTC-LC13). RESULTS: One complete response (6%), 4 partial responses (25%), 7 cases of illness stabilization (43%), 4 cases of illness progression, were shown. One year of survival was found in 43% of cases with a 14 week of therapeutic response and a global survival ratio of 12.4 weeks. Only 2 cases (12.5) of medium grade G3-leucopenia were found. All patients improved their quality of life (IADL and Spitzer indexes) with reduction of symptoms, (EORTC-LC13) and increase of self-agin and relationships. CONCLUSIONS: The effectiveness of gemcitabine as single agent therapy as not yet been tested due to the scanty number of patients, nevertheless it must be considered in relation to the improvement of the patient s quality of life.

[Combined treatment of thymoma. State of the art and our experience]. / Trattamento integrato del timoma. Stato dell'arte e nostra esperienza.

Thymoma is the most common neoplasm of the anterior mediastinum and is frequently associated with paraneoplastic syndromes. Surgery is the first therapeutic option, but in advanced disease a multidisciplinary approach is feasible, because of chemosensitivity and radiosensitivity of the disease. The natural history of thymoma after surgery points to local recurrence. Adjuvant radiotherapy seems to improve local control and survival. Chemotherapy based on cisplatin plus anthracyclines could be performed in advanced and metastatic disease. The optimal sequence of chemotherapy, radiation therapy and surgery is yet to be defined. In our experience, primary chemotherapy seems to give best results in advanced thymoma with good tolerability.

[Role of rectal exploration, suprapubic and transrectal prostatic ultrasonography, and PSA in the diagnosis and follow-up of prostatic carcinoma]. / Il ruolo dell'esplorazione rettale, dell'ecografia prostatica sovrapubica e transrettale e del PSA nella diagnosi e follow-up del carcinoma prostatico.

BACKGROUND AND AIM: The aim of this study was to evaluate the advantages and limits of the various examinations, namely rectal exploration, suprapubic and transrectal scan and PSA, used in the diagnosis and follow-up of prostatic carcinoma. METHODS: The study was carried out in 21 cases of histologically confirmed prostatic carcinoma in patients aged between 57 and 82 years old (mean age: 69.5) referred to the authors' attention between January 1990 and August 1993. RESULTS: With regard to the diagnosis, rectal exploration showed a sensitivity of 80.9%, suprapubic scan 95.2%, transrectal scan and PSA 100%. During the follow-up, patients were divided into operated (9) and non-operated (12) groups. Of the 9 patients undergoing radical prostatectomy, 5 showed residual locoregional disease; of the other 4 who had undergone a complete removal of the gland, one subsequently reported local recidivation. In those patients with residual disease, rectal exploration showed a postoperative sensitivity of 20%, nil sensitivity in the case of local recidivation and 100% specificity in successfully operated patients. Suprapubic scan showed a sensitivity of 60% in patients with residual disease, nil sensitivity in the case of local recidivation and 100% specificity in successfully operated patients. Transrectal scan and PSA revealed 100% sensitivity and specificity in all cases. These patients who were not operated owing to the presence of metastases at the time of diagnosis were divided into those who responded to hormone and chemotherapy (3 total responses, 6 partial responses) and patients who did not respond to this type of treatment (3 non-responders). In the cases of total response, all the tests used obtained 100% specificity. Serum levels of PSA were higher than the threshold value owing to the persistence of metastases. In the cases of partial response to treatment, rectal exploration revealed 50% sensitivity, suprapubic scan 83%, and transrectal scan and PSA 100%. Sensitivity to the four methods used was 100% in all non-responders. CONCLUSIONS: From the results obtained it can be affirmed that the diagnosis of prostate pathology should start with rectal exploration and in the event that this method suggests the probable benignity of the lesion, the diagnostic process should conclude with a suprapubic scan. If rectal examination or suprapubic scan reveal a suspected malignancy, it is essential to perform a transrectal scan or PSA assay which has a high level of sensitivity and specificity for values over 10 ng/ml. During follow-up the only tests which show a high level of sensitivity are transrectal scan and PSA, whereas suprapubic scan and rectal exploration are not reliable in view of the high percentage of false negatives observed. The follow-up of those patients who were not operated and responded totally or partially to treatment must be carried out exclusively using transrectal scan and PSA assay. Suprapubic scan enables the evolution of the neoplasia to be followed over time in those patients who did not respond to treatment.

[Role of the oncologist in prevention, diagnosis and treatment of neoplasms]. / Il ruolo dell'oncologo medico nella prevenzione, diagnosi e cura della patologia neoplastica.

Oncological pathology represents a topic of particular interest and importance owing to both its rising frequency (151,690 deaths in Italy in 1992) and the continuous progress made in the diagnostic and therapeutic field. The steady growth of this pathology has led to the need to identify a new professional figure: the cancer physician capable of bringing together all the skills required to optimise the diagnosis and treatment of oncological patients. As it is now universally accepted in theory, but not always put into practice, the treatment of oncological pathologies calls for a multidisciplinary approach. The optimal treatment is based on the integration of the roles of all the various specialists: oncologist, surgeon, radiotherapist and expert in pain therapy. In this therapeutic strategy, the cancer physician should manage the starting phase of the disease and subsequently should manage its course together with the surgeon and radiotherapist, returning in the terminal phase to sole management of the cancer patient with the help of other qualified professional figures. In short, the authors feel that it is not exaggerated to state that the cancer physician plays a central role in resolving the needs posed by the problem of cancer, needs which may take the form of diagnosis, therapy and care.

[Prognostic significance of desmoplasia in breast carcinoma. A preliminary clinical study]. / Significato prognostico della desmoplasia nel carcinoma della mammella. Studio clinico preliminare.

This study carried on 61 patients with breast cancer confirmed the biological assumption of a higher malignancy in tumors with strong desmoplastic reaction. Patients in stage II A, II B and III presenting a marked desmoplastic reaction have a shorter DFS (disease free survival). Therefore, desmoplastic reaction may be considered a marker of local malignancy and metastatic process.

[Out-of-the-hospital care for terminal cancer patients. Clinical and organizational features. Our experience]. / Assistenza extraospedaliera al paziente oncologico terminale. Aspetti clinico-organizzativi. Nostra esperienza.

Home care for terminal oncological patients is, in Italy and in many other highly developed countries, a rapidly expanding part of the health system. At the time of writing it would appear to be the most valid response to the mounting economic and social demands of the population. The present paper has two purposes: 1) to propose an integrated home care operating model for the cancer patient that comprises various operating stages: a) recruitment of patients on the basis of the seriousness of the cancer, life expectancy and socioeconomic conditions of the family; b) interdisciplinary planning of a personalized care project; c) implementation of an integrated care programme at the home of the patient; d) periodic control of the project team; e) periodic professional courses for health personnel; 2) to illustrate our specific clinical expertise in the sector, in 16 months of activity (October 94-February 96) during which we handled on a home basis 27 cancer patients at an advanced stage of the disease; specifically, we describe the main internal-oncological and palliative type problems encountered during the home care period; 3) finally, to highlight in terms of cost/benefit ratio the economic advantages of home compared to the traditional hospitalization care model.

Adjuvant treatment for breast cancer in the elderly.

Eighty one patients with breast cancer stages I, II and III (T3a) were given adjuvant treatment with tamoxifen (Nolvadex), chemotherapy, or both. Most patients had estrogen and progesterone receptors measurement. Twenty one (63.6%) patients of the tamoxifen group were node positive, all 25 (100%) of the chemotherapy plus tamoxifen group and 13 (56.5%) of the chemotherapy alone group. Tamoxifen was administered for at least 3 years. Disease free survival and overall survival were substantially similar after treatment with tamoxifen or chemotherapy plus tamoxifen. Side effects were more numerous and severe in patients given chemotherapy. In receptor positive elderly breast cancer patients tamoxifen represents an excellent adjuvant therapy independently of disease stage. Chemotherapy should be reserved for subjects at high risk of recurrence in controlled clinical trials.

Serum ostase in the follow-up of breast cancer patients.

The present study was carried out on 152 patients divided into three groups: A) 73 underwent radical surgery for breast carcinoma without signs of metastases; B) 31 patients with radiologic and scintigraphic evidence of bone metastases originating from malignant mammary neoplasia (14 with only one and 17 with two or more localizations); C) 48 affected by simple mammary cysts. No patients had a previous history of primary or secondary bone pathologies or renal, hepatic or endocrine ones. Besides this, no patient took drugs influencing the metabolic turnover of the bony tissue in the three months preceding the study. After surgery all patients underwent standard clinical and laboratory follow-up, the latter including, every 3 months, the evaluation of serum CA 15.3, CA 27.29 MCA, and ostase. The ostase cut-off, obtained by the statistical elaboration of the serum values of the 48 patients with benign mammary cysts and the 73 disease free patients, was 17 microg./L. The mean concentration in the three groups and two subgroups was: 13.76 microg./L (patients without metastases), 31.84 (patients with metastases), 18.4 (limited bony metastases), 40.04 (diffused bony metastases) and 5.36 (mammary cists). The diagnostic sensitivity of ostase proved superior to that of CA 15.3 (84% vs 75%) except when considering the subgroup with limited metastases (71.4% vs 72.7%), while the specificity was similar (around 78%). CA 27.29 and MCA were not useful as markers of metastasis. In a longitudinal-perspective study it was possible periodically to test these markers in 13 patients, at first, disease free and then with signs of bone progression evidence by skeletal scintigraphy. In 11 of these patients ostase and CA 15.3 showed increased values, an average 136 and 131 days respectively, before instrumental evidence of progression. None of the 13 patients, at the time of bone progression diagnosis, showed clinical, laboratory or instrumental signs of disease in other organs. The precocity of the serum increase of ostase could have a triple role: 1) accomplishment of a closer follow-up in patients at "high risk" of bone disease; 2) aid in the interpretation "in a neoplastic sense" of an "uncertain image of hypercaptation"; 3) accomplishment of a supporting or specific oncology treatment at an earlier stage which may be of some advantage as regards quality of life.

[Prognostic factors in operated breast carcinoma]. / Fattori prognostici del carcinoma mammario operato.

The traditional prognostic factors (tumour size, lymph node involvement, receptor status) have now been shown to have limits in terms of prognostic definition. These limits may be partially overcome when parameters exist to determine the extent of tumour biological aggression and the patient's degree of immune response. It is important to clarify these links because they may lead to more precise indications regarding the prognosis and choice of therapy, above all in cases of breast cancer operated with no lymph node involvement. Breast carcinoma is often surrounded by inflammatory cells showing host and tumour interaction. The aim of this study was to evaluate the prognostic value of lymphocyte infiltration in operated breast cancer. The degree of lymphocyte infiltration observed in 56 breast cancer patients was compared with other prognostic factors (tumour size, lymph node status, histological variants, necrotic areas and desmoplastic reaction). This preliminary study allowed the authors to examine the degree of peritumoral lymphocyte density as an important predictive index of overall survival in patients with breast cancer and N-.

Skeletal alkaline phosphatase as a serum marker of bone metastases in the follow-up of patients with breast cancer.

Immunoradiometric determination of the bone isoenzyme of alkaline phosphatase with a method provided by Hybritech Inc., San Diego CA (USA) was carried out in 145 female patients, 97 of whom with radically operated breast cancer and 48 with benign mammary cysts, in order to evaluate the correlation of serum levels with the metabolic process of bone rearrangement in patients with bone metastases. This study shows that skeletal ALP, having high specificity (86.48%) and sensitivity (78.6%) for early progression (the average anticipation time compared to scintigraphic detection was 101 days) could represent a valid marker for bone metastases in association with mucinous markers in the follow-up of patients operated for breast cancer. In addition, dynamic serum determination of skeletal ALP could be a valid help in monitoring the efficacy of therapy in patients with bone progression.

[Clinical evaluation of the efficacy of the combined determination of serum markers CEA, CA 19.9, CA 72.4 as indexes of gastro-intestinal tract neoplasms]. / Valutazione clinica dell'efficacia dell'associazione dei markers sierici CEA, CA 19.9, CA 72.4 come indici di neoplasia del tratto gastro-intestinale.

The aim of our study was to evaluate the usefulness of the tumor markers CA 72.4, CEA and CA 19.9 in the monitoring of gastrointestinal carcinomas. Our experience demonstrated the usefulness of the determination of CA 72.4 in the follow up of patients with gastrointestinal neoplasms.