[Quadrantectomy and tumorectomy followed by radiotherapy in early tumors of the breast]. / Quadrantectomia e tumorectomia seguita da radioterapia nei tumori iniziali della mammella.

The authors examined 235 patients with early breast cancer treated by radiotherapy after conservative surgery during a 10-year period (1974-1984). Disease-free survival and incidence of local recurrences, in agreement with the data reported in literature, did not differ from those of patients with early breast cancer treated with radical surgery. As for local recurrences in the breast only (7/235), a slightly significant difference was observed in favor of quadrantectomy (3/62 for tumorectomy versus 4/173 for quadrantectomy). On the contrary, a significant difference was observed in the breast recurrence rate of premenopausal (5/7) and postmenopausal women (2/7). Complications occurred in 7.2% of the cases. Satisfactory esthetic results were generally obtained, with 78% good and excellent results. Doses greater than 50 Gy to the whole breast and irradiation of the axilla both worsened the esthetic results and increased complication rate. Chemotherapy does not worsen the esthetic results, while that is often the case when the removed volume is excessive in comparison to the whole breast volume.

Osmotic and nonosmotic control of vasopressin release in the elderly: effect of metoclopramide.

The study was undertaken to define the relationships between the arginine vasopressin (AVP) response to a pressure-volume stimulus (upright posture test), an osmolar challenge, and metoclopramide injection (20 mg, iv) in normal young and elderly subjects. Besides confirming previous findings of increased AVP responsiveness to osmolar challenge and reduced AVP responsiveness to upright posture in the elderly, we found that metoclopramide stimulated AVP release in both young [from 1.09 +/- 0.05 (mean +/- SD) to 1.77 +/- 0.05 pmol/L; P less than 0.05] and elderly subjects (from 1.54 +/- 0.18 to 4.73 +/- 1.82 pmol/L; P less than 0.01). The response was much greater in the elderly (P less than 0.01). The AVP responses to upright posture and metoclopramide were inversely correlated (r = -0.77; P less than 0.01), suggesting that the elderly have increased sensitivity to stimuli, such as metoclopramide, to counteract their reduced sensitivity to baroreceptor stimulation of AVP release.