[Neonatal group B Streptococcus infection: an integrated approach (of clinical pathologists, gynecologists, midwives, pediatricians-neonatologists) of the functional area of Cuneo (Italy)]. / Infezione neonatale da Streptococco B: un approccio multidisciplinare integrato (di laboratoristi, ginecologi, ostetriche e pediatri-neonatologi) del Quadrante di Cuneo.

The frequency of early-onset neonatal sepsis without prophylaxis is 1-5/1.000 live births. Since year '70 the most frequent causative microorganism is the group B Streptococcus (S. agalactiae, GBS), followed by Escherichia coli. The mortality rate is now reduced to 4% due to the improvement of neonatal intensive care. In the USA, the incidence of GBS early-onset neonatal sepsis has been markedly reduced by the application of the guidelines released by the Centers for Disease Control (CDC). This strategy, however, is not effective on occurrence of late-onset neonatal group B streptococcal disease. In Italy, the application of CDC guidelines is not customary, and different, often complex, protocols of obstetrical-neonatological integrated approach are applied. The frequency of infectious risk has made the GBS a paramount problem for the neonatologist, even for the legal responsibility issues resulting from the multiplicity of possible options. To reach the best level of protection of the newborn against early-onset GBS infection, the working group of providers of prenatal, obstetric, and neonatal care of the functional area of Cuneo issued an integrated protocol, in order to perform the GBS screening with the optimal culture method suggested by CDC guidelines in the highest possible number of pregnant women, and to standardize the obstetrical and neonatal management.

Avm (adriamycin, vinblastine, methotrexate) neoadjuvant chemotherapy in advanced or inflammatory carcinoma of the breast.

Thirty-eight consecutive patients with locally advanced (stage IIIb/IVa-c) or inflammatory breast cancer (stage IVd) underwent neoadjuvant chemotherapy in our department between 1978-1990. All patients in this phase II study, received from three to five courses of neoadjuvant AVM regimen (Adriamycin, Vincristine, Methotrexate). Complete or partial response (CR+PR) was observed in 94.6% of this group of patients after the completion of therapy (chemotherapy + surgery + consolidation therapy) and in 97.3% at the completion of neoadjuvant chemotherapy alone. The overall 5-year median survival was 31.86% with a median disease-free time of 13 months. Only one patient showed progression of disease before surgery and was excluded from the study. The annual incidence of relapse in this study was 35% and the first metastatic event was observed locally in 1/4 of the patients examined. Low to moderate toxicity observed was reversible and easily controlled. We conclude that AVM neoadjuvant chemotherapy is a well tollerated regimen with long term clinical response in locally advanced breast cancer patients.

Breast self examination survey carried out at a cancer prevention center serving a province.

Screening programs for early diagnosis of breast cancer and particularly, for its prevention are not feasible at present, because when the neoplastic mass becomes clinically observable it has already been quietly evoluting for many years. Besides the clinical examination, the self examination of the breast (B.S.E.) is therefore the only way to detect breast cancer at the earliest possible clinical stage. This study aimed at evaluating the average knowledge of this method among 2530 women who came to the centre for prevention and early diagnosis of tumours at the U.S.L. 61 Savigliano over the first half of 1981. We examined the relationship existing between some parameters and the B.S.E. as well as the reason why some women, though knowing about the S.E. do not perform it. We finally give some indications for a correct education to the B.S.E.

[Echographic examinations in 246 cases of voluntary interruption of pregnancy]. / Indagine ecografica in 246 casi di I.V.G.

PIP: 246 women underwent legal induced abortion between June 1978 and December 1979 at the Hospital "SS. Annunziata" in Savigliano, Italy. Echography was used prior to the operation to determine exactly the duration of pregnancy and to gather indications on the intervention and on its possible difficulties. 4% of patients were 18 years of age, and 14% were 24 years of age. 67% came from other provinces, 53% were housewives, 77% were married, and 41% had elementary school education. Only 15.8% had been referred by private physicians. Reasons for requesting abortion were family reasons (56.5%), social reasons (16.6%) and economic reasons (11.3%); only 1.2% of requests were for fear of fetal malformations. 25.8% of abortions were done at the 10th week of gestation; 24.8% of women were nulliparous and, of these, 11.4% had had a previous abortion; 57.7% were multiparous, and, of these, 28.8% had had a previous abortion. 91% of operations were done through vacuum aspiration and 7.5% by aspiration and curettage. Echographic exploration prior to the operation revealed 2 phases of rapid growth of the fetus, up to the 8th week and from the 10th to the 13th week.^ieng

Could follow-up different modalities play a role in asymptomatic cervical cancer relapses diagnosis? An Italian multicenter retrospective analysis.

OBJECTIVE: The aim of this study was to evaluate how much clinical surveillance performed by follow-up scheduled appointments may correctly identify asymptomatic recurrences and describe the pattern of relapse detected by procedures. METHODS: The records of 327 consecutive women with recurrent cervical cancer treated from 1980 to 2005 were retrospectively collected in 8 Italian Institutions. Primary disease and recurrence data were picked up: diagnosis, type of treatment, FIGO stage, tumour grade, histology, clinical lesion size, number of localizations and site of relapse, presence of symptoms and primary method of detection, the type of treatment of recurrence and follow-up data, such as appointment date, clinical status and procedure performed. A multivariate analysis was carried out using the Cox proportional hazards regression model. Survival curves were calculated using the Kaplan-Meier technique. Survival differences were evaluated by the log-rank test. RESULTS: Sixty-seven out of 327 patients (20.5%) had a local recurrence on vaginal vault, 120 (36.7%) in central pelvis, 31 (9.5%) in pelvic wall, 16 cases (4.9%) in lymph nodes. Seventy-nine patients (24.2%) showed a distant relapse while 14 (4.3%) developed both a distant and local relapse. Among patients with distant relapses 39 (49.4%) had lung metastasis, 41 (51.9%) an hepatic recurrence, 4 (5.1%) a bone relapse. Among distant sites 32 out of 79 patients (40.5%) had single relapse and 46 (58.2%) had multiple localizations. The site of relapse influenced survival since patients with vaginal vault recurrences lived significantly longer than patients with recurrences in other sites. Ninety-seven (29.7%) patients were symptomatic and anticipated the scheduled visit, 66 (20.2%) reported their symptoms during the follow-up visit and 164 (50.1%) were asymptomatic and the diagnostic path was introduced by a planned visit or exam. Between asymptomatic patients the first procedure was clinical visit for 85 patients out of 164 patients (51.8%), imaging for 60 patients (36.6%), both clinical visit and imaging for 14 (8.5%) and cytology for 5 (3%, Pap smear test). The median OS of symptomatic patients was 37 months versus 109 months of asymptomatic patients (Log rank, p=0.00001). The median survival since recurrence was 9 months for symptomatic patients and median was not reached for asymptomatic patients (p<0.0001). The median disease-free interval was 24 months for asymptomatic patients vs. 36 months for symptomatic patients (p=0.03). CONCLUSIONS: Our study helps demonstrate the great need of prospective cost-effectiveness studies which are lacking at the present time.