[Evaluation of myopia in a group of people working with video terminals: first results]. / Valutazione della miopia in un gruppo di lavoratori addetti al videoterminale: primi risultati.

UNLABELLED: Since the 70's the occupational use of electronic systems equipped with visual display terminals (VDTs) became wide-spread also in Italy. Some longitudinal studies on large samples of VDT workers found no significant changes of myopia (M) with regard to years and daily hours spent working at a VDT. OBJECTIVE: To evaluate the prevalence and the time course of M in 209 VDT workers employed in the service sector. MATERIALS AND METHODS: After obtaining workers' informed consent their work, social, family and personal medical histories were collected. Myopia was defined as need of >0.25 D negative spherical correction. Average daily hours duringfollow-up and overall years spent working at a VDT were calculated as exposure indexes. RESULTS: The mean baseline age was 39.2 years (SD: 8.7, min-max: 22-62) and the mean education was 14 years (SD: 2.2). The mean follow-up period was 5.5 (3-9) years. The prevalence of M was 45.5% at the start and 49.8% at the end of the study. It was higher in workers with >13 years of education and in those < 40 year-old. A slight but significant increase of the degree of M (dioptres) occurred during the follow-up. The change in the degree of M was not different between the classes of VDT exposure (< or = 4 and >4 daily hours; < or =15 and >15 years spent), of education and of age at the end of follow-up. DISCUSSION: The high mean educational level can partly explain the higher prevalence of M detected in the workers on study with respect to the one described elsewhere on VDT workers and general population. The progression of the M seems not to be related to the professional and personal variables analyzed, but to depend on the natural evolution of M. Further studies are needed to confirm these preliminary data in larger groups of VDT workers.

Paclitaxel, vinorelbine and 5-fluorouracil in breast cancer patients pretreated with adjuvant anthracyclines.

We investigated the activity and toxicity of a combination of vinorelbine (VNB), paclitaxel (PTX) and 5-fluorouracil (5-FU) continuous infusion administered as first-line chemotherapy in metastatic breast cancer patients pretreated with adjuvant anthracyclines. A total of 61 patients received a regimen consisting of VNB 25 mg m(-2) on days 1 and 15, PTX 60 mg m(-2) on days 1, 8 and 15 and continuous infusion of 5-FU at 200 mg m(-2) every day. Cycles were repeated every 28 days. Disease response was evaluated by both RECIST and World Health Organization (WHO) criteria. Objective responses were recorded in 39 of 61 patients (64.0%) assessed by WHO and in 36 of 50 patients (72.0%) assessable by RECIST criteria. Complete remission occurred in 15 (24.6%) and 14 patients (28.0%), respectively. The median time to progression and overall survival of entire population was 10.6 and 27.3 months, respectively, and median duration of complete response was 14.8 months. The dose-limiting toxicity was myelosuppression (leucopenia grade 3/4 in 52.5% of patients). Grade 3/4 nonhaematologic toxicities included mucositis/diarrhoea in 13.1%, skin in 3.3% and cardiac in 1.6% of patients. Grade 2/3 neurotoxicity was observed in five patients (7.2%). The VNB, PTX and 5-FU continuous infusion combination regimen was active and manageable. Complete responses were frequent and durable.

[Biologic therapy and epithelial ovarian cancer]. / La terapia biologica nel tumore epiteliale dell'ovaio.

The identification of new molecular prognostic and predictive factors for ovarian cancer may contribute in deciding individual therapeutic strategies; on the other hand, there has been growing interest in new biologic therapies to correct molecular or genic lesions of neoplastic cells (genic therapy), or to activate the specific immune response (immunological therapy). Chemotherapy collateral toxic effects, as myelotoxicity, should be reduced through transfection of genes that modulate drug resistance in stem cells. The data at present available suggest then the potential role of these new treatments, are more specific and less toxic than current therapies; however, other biological-molecular studies are required to obtain the clinical applications of the results: Aim of this study is to provide a review of the most interesting data in ovarian cancer biologic therapy.

Pathologic features of endometrial carcinoma in elderly women.

It has been estimated that more than two-thirds of cancers occur in people over 65 years of age: endometrial cancer (EC) is the most common gynaecologic cancer in the U.S. and represents the fourth most common malignancy in women. Some authors have reported that EC in elderly women was more aggressive, histologically less-differentiated and often non-endometrioid when compared with EC in the younger population. The purpose of this retrospective study is to evaluate the pathologic features of EC in women 70 years old or over compared with those of younger patients. Between 1987 and 1997, 174 patients with EC were surgically treated: 52 women were 70 years old or over. Two-thirds of both groups had surgical Stage I tumors: 54% of surgical Stage I tumors in the elderly had myometrial invasion more than 50% compared with 32% in the younger group (p<0.01). On the whole 37% of elderly patients had Stage IC tumors compared with 21% in younger women (p<0.01). Seventy-five percent of elderly women had Grade 2 or 3 tumors compared with 55% of younger patients (p<0.005). The majority of EC was endometrioid in both groups: 8% of elderly patients had clear-cell carcinomas compared with 4% of younger women (p not significant). No elderly patients showed nodal metastasis (0 out of 10): 9% of younger women had pelvic or para-aortic metastasis. The median follow-up was 78 months. The overall survival in the elderly and in the younger group was 80% and 93%, respectively (p<0.01): in elderly women overall survival significantly varied according to histotype and depth of myometrial invasion in Stage I tumors. In conclusion patients 70 years old or over have a high probability of surgical Stage I EC but a significantly higher probability of deep myometrial invasion and less-differentiated tumors than younger women: the prognosis w as good but poorer than for younger patients.

Magnetic resonance imaging of temporomandibular disorders: classification, prevalence and interpretation of disc displacement and deformation.

AIM: To analyse the prevalence of disc displacements and deformations from MRI of symptomatic temporomandibular disorders (TMD). METHODS: The study was conducted retrospectively on 192 joints of 98 patients (67 females, 31 males, mean age 29 years), who had undergone bilateral MRI (except for four who had unilateral) in the sagittal (both open and closed mouth) and coronal (closed mouth only) planes. These displacements were subdivided into static (complete anterior and posterior, partial anterolateral and anteromedial, sideways lateral and medial, anterolateral and anteromedial rotational) and dynamic (with reduction, without reduction, with incomplete reduction; non-determinable). Disc deformations were subdivided into: enlargement of the posterior band, reversed biconcave shape, biplanar (flattened) and biconvex shape. RESULTS: Eighty per cent of patients had bilateral displacement, 15% unilateral and 5% a normally positioned disc. Complete anterior displacement was the commonest and sideways the rarest. Reduction was present in 58% of disc displacements, no reduction in 26%, incomplete reduction in 4%, while in the remaining 12%, it could not be determined. Rotational displacement was the most likely to feature reduction and sideways the least. Temporomandibular joints with no reduction were closely correlated with bone lesions. The most frequent deformation was biplanar and the rarest enlargement of the posterior band. CONCLUSIONS: There was a high prevalence of displacements and deformations. While they do not appear to be significant in inducing pain, they can predispose to the onset of osteoarthrosis.

Epidoxorubicin and paclitaxel as primary chemotherapy for T > 3 cm and T4 breast cancer patients.

UNLABELLED: The Anthracyclines/Taxanes combination is often used in adjuvant and advanced breast cancer. PURPOSE: To evaluate the toxicity and pathological response of sequential epidoxorubicin/paclitaxel combination as primary chemotherapy for T > 3 cm and T4 breast cancer patients. PATIENTS AND METHODS: Forty-eight patients with T2 > 3 cm, T3 and T4 breast tumours were treated with Epidoxorubicin (90 mg/m2, i.v.) on day one and paclitaxel (200 mg/m2 over 3 hours) on day 2 every 21 days for four courses. After the fourth cycle the patients underwent modified radical mastectomy or quadrantectomy plus axillary lymph node dissection followed by six courses of intravenous CMF regimen (days 1 and 8, every 4 weeks). Radiotherapy was given to patients undergoing conservative surgery or with T4 cancers. Tamoxifen was administered in ER or PgR positive patients. RESULTS: Out of the 48 patients enrolled into this trial, 43 were evaluable for toxicity and pathological response. Primary chemotherapy with epidoxorubicin and paclitaxel was well tolerated: no heart toxicity was observed during primary chemotherapy and follow-up. Primary toxicity consisted of myalgia, grade 1 neuropathy and grade 3 alopecia. Disappearance of invasive tumours in the breast with node negative was observed in 11.6% of patients: pathological partial response was shown in 56% of patients. On the whole major pathological response was achieved in 67% of our series: in the remaining 33% we found a stable disease or a size reduction less than 50%. No progressive disease was observed. Conservative surgery was performed in 64.5% of T2 and T3 tumours. CONCLUSION: These preliminary data showed that the epidoxorubicin/paclitaxel combination was safe and effective as primary chemotherapy for patients with T > 3 cm and T4 breast cancer patients.

Cervical cerclage for the treatment of patients with placenta previa.

Over a ten year period, placenta previa occurred in 103 instances among 12,965 deliveries. In six of these, cervical cerclage was undertaken to prevent severe bleeding while prolonging pregnancy between the 24th and the 30th weeks of gestation, according to the McDonald technique. We performed cesarean section delivery in all cases. The medium prolongation of the pregnancy was of 8.2 weeks and the foetus weighed from 1,820 to 3,360 g. No complications due to fetal respiratory distress were observed. No patients needed transfusions. Postpartum and the puerperium were regular. These results support the use of cervical cerclage for the treatment of patients with symptomatic placenta previa early in gestation.

Endometrial carcinoma in women 45 years of age or younger.

Adenocarcinoma of the endometrium in patients 45 years or age of younger accounts for 21% of all endometrial neoplasms diagnosed. The clinical and pathological findings in 17 cases of endometrial adenocarcinoma patients aged 45 years or younger treated between January 1976 and December 1992 in Department B of the Gynecologic and Obstetric Institute, University of Torino, Italy are reported. The patients age ranged from 31 to 45 years, with a median age of 39.3 years. Thirteen of the 17 neoplasms (76.4%) were stage IB (FIGO 1988), two (11.7%) stage IIB, one (5.8%) IIIC and one IVA. Histologically all patients had endometrial adenocarcinoma, eight were well-differentiated tumors (G1), six were moderately-differentiated tumors (G2) and three poorly-differentiated tumors (G3). Three of the patients treated from 1976 to 1979 received post-operative administration of 17-hydroxiprogesterone-19-norcapronate (500 mg i.m. weekly for one year) and 14 of the patients treated from 1980 to 1992 received, according to neoadjuvant hormonal protocols, Medroxiprogesterone acetate (MPA) 1,000 mg daily per os for 90 days and 500 mg per os for one year. The aim of this paper is to draw attention to the existence of this neoplasm in an unexpected age range.

Reduced IL-2 level concentration in patients with breast cancer as a possible risk factor for relapse.

Reduced interleukin 2 (IL-2) production has been described as one of the most frequent immune dysfunctions observed at relapse in patients with disseminated solid neoplasms. It was seen that patients treated for breast cancer (NED-no evidence of disease- at check-up) have a relapse percentage of 4.7% if the IL-2 plasmatic level is normal while the relapse percentage increased to 33.3% if it is low after a 10-12 month follow-up. This link between low IL-2 and the host immune response is a new prognostic indicator and one not strictly related to the tumour itself.

Management of patients with intrauterine fetal death.

Fetal death incidence is 5-10 per 1,000 births. About 25% of the women who carry a dead fetus for more than 4 weeks will show significant alterations in their coagulation system. The treatment for a patient with endouterine fetal death depends on when the pregnancy is terminated, based on the ecographic fetus age. There were 15,070 births from January 1983 to December 1994 in Department B of the Institute of Obstetrics and Gynecology, University of Torino. We took into consideration the cases ofintrauterine fetal death between the 26th and 40th week before labour. This study is based on a cohort of 57 cases of intrauterine fetal demise from the 24th to the 40th week of pregnancy before spontaneous labour.

Microinvasive carcinoma of the uterine cervix. Diagnostic and therapeutic dilemma.

Squamous microcarcinomas of the uterine cervix represent a focus of controversy regarding a useful clinical definition. The confusion of terminology and numerous pathological definitions have led to a great variety of surgical treatments from the cone to the radical hysterectomy, with pelvic adenectomy. This report analyses retrospectively 133 cases of Stage IA cervical cancers which have been followed up for 10-240 months. The purpose of this work is to seek a uniform therapeutical approach to cervical microcarcinoma with the review of International Literature.

Two cases of ovarian cysts in postmenopausal patients under antiestrogen treatment.

In 20% of premenopausal breast cancer women on Tamoxifen (TAM) treatment there is an ovarian enlargement: in literature one case of acutely cystic ovaries is described. We observed 2 cases of acutely cystic ovaries in postmenopausal women surgically treated during a long-term adjuvant therapy with TAM.

Leiomyomas in patients receiving Tamoxifen.

In literature there have been only 8 cases of unavoidable laparotomy due to uterine leiomyomas performed in patients with breast cancer on Tamoxifen (TAM). Our article describes two cases of rapidly growing leiomyomas in patients treated with TAM: one of these underwent abdominal hysterectomy while the second stopped taking TAM and began therapy with Triptorelin. This therapeutical alternative could be a useful choice.

Endometrial carcinoma in breast cancer patients treated with tamoxifen. Two case report and review of the literature.

Recent reports suggest an increased incidence of endometrial cancer in breast cancer patients under long-term adjuvant tamoxifen (TAM) treatment. The Authors describe two cases of endometrial adenocarcinoma among 80 post-menopausal patients affected with breast cancer and treated with TAM.

Advanced primary squamous carcinoma of the vagina treated with carboplatinum (JM 8). A case report.

Primary cancer of the vagina is one of the rarest malignant neoplasms: radiotherapy is the most frequently used treatment and local recurrences remain a constant problem. We describe a case of invasive squamous carcinoma of the vagina submitted to neoadjuvant therapy with carboplatinum. Pathological findings after surgery were completely negative for cancer.

Biochemical aspects of the hormonal therapy of endometrial adenocarcinoma.

This paper reports an investigation of the mechanism involved in the response of endometrial adenocarcinoma to MPA. The following protocol was used for a period of 8 years: 1 g/day MPA per os for 30 days and 60 days after surgery, following by 500 mg/day for 1 year. Adenocarcinoma glycolytic activity, G-6-P cycle, polyamine concentration, and the activity of ornithine decarboxylase (ODC), i.e. the first enzyme in polyamine synthesis, were compared before and after the 30/day treatment. The modifications induced by MPA are discussed and related to the pathological picture in an attempt to determine the characteristics of responding tumors.

Treatment failure in cervical cancer: high risk factors of relapse.

Actuarial survival in 178 patients treated with radical surgery and lymphadenectomy from 1977 to 1987 have been evaluated. The survival rate at 60 months in the 124p N0 patients was 95%; in the 57 p N1 patients was 20.2%. The survival in patients with only 1 or 2 metastatic lymph nodes was 39.7%, while it was 13.1% with 3 or more lymph nodes involved. Survival rate related to lymph nodal metastatic level was 36%, 32%, 17% respectively when the first, second and third levels were involved. We demonstrated a statistically significant relation between survival and external thirds, CLS, vaginal, parametrial invasion. A multifactorial analysis also showed the remarkable significance of the simultaneous negativity of vaginal, CLS, external third invasion (survival rate 98.4%). When the positivity of the external invasion was associated with simultaneous negativity of vaginal and CLS invasion the survival rate was 79.4%. The survival rate in patients with positive vaginal and external third invasion was 26%. This showed the decisive importance of vaginal invasion in cervical cancer survival.

Lymph nodal metastases and pathological patterns in cervical cancer: a critical review.

We analyzed 8 pathological factors in order to recognize which of them are statistically significant in worsening the stage of cervical cancer. Three factors (external third invasion, CLS, parametrial invasion) are highly significant (p less than 0.001) as regards lymphatic metastases, while no one statistical relation has been found among grading or histotype and cervical canal invasion. Comparing the 8 pathologic factors among themselves, we have observed that parametrium, corpus and CLS are highly related to external third (p less than 0.001); in the same way corpus is related to cervical canal and parametrium to CLS (p less than 0.001).