Carotid dissection with and without ischemic events: local symptoms and cerebral artery findings.

OBJECTIVE: To study whether spontaneous dissections of the cervical internal carotid artery dissection (ICAD) with and without ischemia of the brain or retina differ in the prevalence of vascular risk factors, local neurologic signs and symptoms, and stenoses and occlusions of the cerebral arteries. METHODS: The authors prospectively studied 181 consecutive patients with 200 ICAD. Diagnosis was based on ultrasonography and MRI or catheter angiography. Vascular risk factors, presenting local (headache, neck pain, Horner syndrome, pulsatile tinnitus, cranial nerve palsy on the side of the ICAD) and ischemic signs and symptoms, and ultrasonographic findings in the carotid and basal cerebral arteries were evaluated. RESULTS: ICAD with ischemic events (n = 145) had a higher prevalence of hypercholesterolemia (p < 0.05), >80% stenoses and occlusions of the ICA (p < 0.0001), and intracranial obstructions (p < 0.001). ICAD without ischemic events (n = 55) had a higher prevalence of Horner syndrome (p < 0.001), cranial nerve palsy (p < 0.01), and normal ICA findings (p < 0.0001). CONCLUSIONS: These data suggest that ICAD causing high-grade stenosis and occlusion are more likely to lead to intracranial obstructions and cerebral or retinal ischemic events. Conversely, ICAD without luminal narrowing cause more local signs and symptoms.

Cancer mortality among relatives of children with soft-tissue sarcoma: a national survey in Italy.

Information was obtained on the living status or cause of death of 2223 close relatives of 195 children with soft-tissue sarcomas (STS) diagnosed under age 15. Three-hundred nine relatives had died, from all causes, before STS diagnosis in the index child. The expected figure estimated from age- and sex-specific mortality rates in Italy was 293.3. Cancer was reported as cause of death in 76 relatives (75.1 expected). Seven grandmothers, 2 aunts, 1 uncle and 0 mothers died from breast cancer vs. 4.6, 0.9, 0.0 and 0.2 expected. Three siblings died from cancer (0.2 expected, P less than 0.01), i.e. STS, ependymoma and non-Hodgkin lymphoma. These results confirm and expand previous observations that STS in children are associated with other cancers, particularly childhood and breast cancer, in members of the same family.

Time trends in survival of children with acute lymphocytic leukemia in Piedmont, Italy: a report from the Population-Based Cancer Registry.

AIMS AND BACKGROUND: The Childhood Cancer Registry of Piedmont (RTI) periodically updates the life status of each registered child. Given its size, the RTI is the major (albeit geographically limited) Italian source of population-based survival rates of cancer in children. The present report describes time trends in survival of children with acute lymphocytic leukemia (ALL). METHODS: During 1970-87, 429 residents in Piedmont aged 0-14 were diagnosed as having ALL: they have been followed up until 1991. RESULTS: Five-year survival rates increased from 21% to 72% for children diagnosed ALL respectively in 1970-72 and 1985-87. Major improvements occurred up to the mid-seventies and again between cases diagnosed in the early and late eighties. Improvement in survival was statistically significant for children belonging to classes comprised between 2 and 10 years of age at diagnosis. Period of diagnosis was unrelated to probability of survival among the 13 cases diagnosed ALL at age 0. Survival was unrelated to sex, even in the early seventies and even after consideration of children dying more than 5 years after diagnosis. Between 1976-81 and 1982-87, an improvement in survival was found in all categories of WBC count at diagnosis: the ratio between the two estimates was somewhat higher for children with more than 50,000 WBC/mm3 at diagnosis than for other children. CONCLUSIONS: Present data are compared with those resulting from other population-based series: this exercise can be useful for an overall evaluation of delivery of cancer therapy at the population basis.

Mortality of parents of children with cancer: a population-based study in Turin, Italy.

AIMS AND BACKGROUND: A cohort study was conducted in order to measure cause-specific mortality among parents of children recorded in the Childhood Cancer Registry of Piedmont. It is the first study carried out on the subject in southern Europe. METHODS AND STUDY DESIGN: The study comprised the 740 children resident in Turin and in whom a cancer had been diagnosed in the period 1967-1991. Nominal data were obtained for 723 fathers and 733 mothers. At the end of the follow-up in 1995, 645 fathers were alive, 68 dead and 10 untraceable. Corresponding figures for mothers were 700, 28 and 5. Cause of death was known for 91 of 96 parents. RESULTS: The period of observation of parents started on the birth of the index child, however mortality analyses were restricted to the period after 1965 because of limited availability of local reference rates. Total mortality was lower than expected among fathers (66 observed deaths vs 88.2 expected, P <0.05) and mothers (28 vs 31.4). Fathers showed deficits (not statistically significant) of lung neoplasms (4 vs 9.9), cardiovascular diseases (18 vs 27.1) and hepatic cirrhosis (2 vs 6.6). No statistically significant variations in mortality were observed with time from diagnosis or according to life status of the children. No cancer deaths occurred among the mothers of sarcoma cases whereas 1.9 were expected. CONCLUSIONS: The data do not indicate any increase in mortality from cancer or other causes end, on the contrary, show a reduction in mortality which was more evident for the causes related to life style.

Physical impairment and social life goals among adult long-term survivors of childhood cancer: a population-based study from the childhood cancer registry of Piedmont, Italy.

AIMS AND BACKGROUND: The study describes the health status and the attainment of life goals in the adult survivors of childhood cancer recorded at the Childhood Cancer Registry of Piedmont. METHODS AND STUDY DESIGN: A postal questionnaire was sent to the general practitioner of the 690 cases born before 1976 and alive in 1991 after at least 5 years from diagnosis. The answer was received for 485 (72.9%) included in the analyses. Items in the questionnaire were: sequelae related to cancer and its treatment, health-related quality of life (according to Bloom's criteria), educational level attained, and employment status. RESULTS: Vital and marital status were obtained for all 690 cases at the offices of the town of residence. No medical condition was reported for 309 cases (63.7%). The overall proportion with a high school or university education was compared to corresponding figures for Piedmont in 1991, adjusted by age, and was as high as in the general population. Similar results are observed for occupation. Patients of both genders were married less than expected. Patients with leukemia (112 cases), non-Hodgkin's lymphoma (34) or Hodgkin's lymphoma (52) were reported to have the highest quality of life. In contrast, patients with tumors of the central nervous system (151) had the highest frequency of sequelae and the lowest score for health-related quality of life. They-also presented the lowest educational achievement, the lowest proportion of employment and, among males, the lowest frequency of marriage. CONCLUSIONS: Our study shows a good social adjustment of adult survivors from childhood cancer, with the exception of central nervous system tumors. From the methodologic point of view, the present study shows the feasibility of surveillance surveys on health-related quality of life with the contribution of general practitioners.

Results of a multicenter retrospective study on pediatric brain tumors in Italy.

This retrospective study was undertaken to evaluate the clinical characteristics, course and treatment of children (0-14 years of age) diagnosed with a primary CNS tumor during the period 1976-1982 in Italy. Four hundred and sixty-two patients (263 males and 199 females) were followed by 18 various neurosurgical and pediatric oncology centers. The histologic types most frequently reported were: medulloblastoma (23%), astrocytoma (16%), ependymoma (11%) and spongioblastoma (11%). Of the 388 patients who underwent surgery, radical excision was reported in 42%, partial excision in 32%, biopsy only in 6%, and unqualified surgery in 4%; 19% had no surgery. Radiotherapy and chemotherapy combined were administered in 61% of the 143 patients followed at pediatric oncology centers; 19% received radiotherapy alone, 3% chemotherapy alone, and 17% neither treatment. Forty-six percent of the patients were reported alive, 40% dead, and 14% lost to follow-up. Performance status was identified for 62 patients. The investigation revealed marked differences in the therapeutic treatment administered, thus precluding valid data analysis. This emphasizes the need to coordinate efforts among the institutions and the disciplines involved in the treatment of this form of childhood cancer.

Neurofibromatosis and malignant childhood cancers: a survey in Italy, 1970-83.

Neural tumors, Wilms' tumor, rhabdomyosarcoma and several types of leukemia have been previously described in association with neurofibromatosis (NF). In a nation-wide collection of cases in Italy, 15 children (0-14 years of age) with NF and cancer or leukemia were identified; 13 of them had been diagnosed with cancer between 1976-83. The expected number of children with cancer and NF in 1976-83 was 4.48. The distribution of tumor types was different from that found in the general population, with a higher proportion of tumors of neural crest origin as well as soft tissue sarcomas. In 7/15 the family history was positive for NF; in 5/7 the individuals affected included the mother and/or a maternal relative.

[Pediatric Tumor Registry of Piedmont. Descriptive epidemiology of malignant tumors in children in Piedmont, 1976-1994]. / Il Registro dei Tumori Infantili del Piemonte. Epidemiologia descrittiva dei tumori maligni in età pediatrica in Piemonte, 1967-1994.

Since 1967, the Childhood Cancer Registry of Piedmont measures cancer incidence and lethality among children aged 0-14 residents in the Region. Two thousand seven hundred twenty cases were recorded in the period 1967-94. Males were 55.4%. The highest frequency was observed in the age class 0-4 including 41.3% of cases. The most frequent malignancies were: Acute Lymphocytic Leukemias, CNS Tumours and Lymphomas. Incidence rates showed limited variation, both for total neoplasm and for the largest diagnostic categories. On the contrary, lethality decreased markedly: rate (per million children years) was 77.2 in 1967-69 and 59.4 in 1988-94. This trend as more evident for acute leukemias and CNS tumours. Better diagnostic techniques, anticancer and support therapies are the likely explanation for the improved prognosis. Prevalence increased, as a consequence of improved survival and curability: in the Province of Torino it increased from 62 cases per 100,000 children (age 0-14) in 1980 to 98 cases in 1994.

Elevada frecuencia de enfermedad tiroidea funcional en embarazadas chilenas sin antecedentes de patología tiroidea utilizando el estándar de TSH internacional / Frequency of subclinical thyroid problems among women during the first trimester of pregnancy

Background: Thyroid hormones play an important role in fetal neural and cognitive development. Therefore thyroid abnormalities should be detected and treated early during pregnancy. Aim: To assess the frequency and risk factors for functional thyroid disorders during the first trimester of pregnancy. Material and Methods: A blood sample was obtained from women during their first trimester of pregnancy, consulting in a prenatal care facility. Women with known thyroid diseases were excluded from the study. Thyroid stimulating hormone (TSH), total thyroxine (T4) and free thyroxine (fT4) were measured by electrochemoluminiscence. Antithyroid peroxidase antibodies (anti TPO) were measured by enzyme immunoassay. Results: Five hundred and ten women aged 25.7 ± 6.6 years were assessed. The frequency of clinical hypothyroidism was 0.6%, subclinical hypothyroidism 35.3% and clinical hyperthyroidism 1%. Five percent of women with hypothyroidism and 3.5% of euthyroid women had positive anti TPO antibodies. There was no association between the frequency of thyroid diseases and risk factors for thyroid diseases. Conclusions: There is a high frequency of subclinical thyroid diseases among women consulting in this prenatal care clinic.

[Carotid stenosis: epidemiology and symptomatology (see comment)]. / Karotisstenose: Epidemiologie und Symptomatologie.

Risk factors for atherosclerotic carotid stenoses are smoking, arterial hypertension, diabetes mellitus and hypercholesterolaemia. Atherosclerotic carotid artery disease is a risk factor for the development of coronary artery disease (CAD), and in older men the risk of CAD-related death is five times higher than the risk of death related to ischaemic stroke. The prevalence of > 50% carotid stenoses in population-based studies in 6-11% for older men and 5-7% in older women. Diagnosis and differential diagnosis of ischaemia-related ophthalmologic and neurological deficits in the territory of the carotid artery are discussed.

[Transient ischemic attacks and prolonged reversible ischemic neurologic deficit. Diagnosis, differential diagnosis and treatment]. / Transiente ischämische Attacke und prolongiertes reversibles ischämisches neurologisches Defizit. Diagnose, Differentialdiagnose und Behandlung.

Cerebral and ocular ischemic events are classified according to their duration and localisation in transient (< 24 hours) or permanent (> or = 24 hours) cerebral (transient ischemic attack (TIA), cerebral infarct) and ocular (amaurosis fugax, retinal infarct) deficits. The terms "Prolonged Reversible Ischemic Neurological Deficit" (PRIND, > or = 24 hours to < or = 7 days) and "Reversible Ischemic Neurological Deficit" (RIND, > or = 24 hours to < or = 3 days) are no longer used. The differential diagnosis of TIAs and ischemic strokes is discussed. Ischemic strokes are an emergency and should be referred within five hours at the latest to a centre, which offers around the clock acute therapies such as fibrinolysis and an organised stroke management. Secondary stroke prevention after TIA or stroke encompasses the treatment of vascular risk factors, carotid endarterectomy, anticoagulation in the presence of cardiac embolism (target international normalised ratio, 2.5; range 2.0-3.0) and the administration of platelet inhibitors. Carotid endarterectomy is indicated, when luminal narrowing is at least 70%, and not indicated when it is less than 50%. The benefit of endarterectomy in 50-69% stenoses decreases, and individual predictors of the operation risk are useful for choosing the appropriate treatment. Patients without indication for carotid endarterectomy or oral anticoagulation are treated with platelet inhibitors. We use the combination dipyridamole-aspirin as first choice drug, because it has been shown to be superior to aspirin and dipyridamole alone. In the presence of adverse effects or contraindications for dipyridamole we prescribe aspirin (100-300 mg daily). We administer clopidogrel (75 mg daily) if dipyridamole and aspirin are not indicated, have caused adverse effects, or did not prevent ocular or cerebral ischemic events.

Childhood Cancer Registry of the Province of Torino: survival patterns since 1967 and update of incidence rates.

During 1967-1981, the population-based Childhood (ages 0-14 years) Cancer Registry of the Province of Torino has recorded 1057 resident children with incident cancer. The life status of each child has been ascertained as of December 31, 1983. Sex- and age-specific incidence rates have been stable throughout the period. Annual mortality rates (per million) from leukemias (all types) decreased from 34.0 in 1967-69 to 19.4 in 1979-81. Correspondingly, the survival percentage cumulative of leukemic children at 3 years after diagnosis increased from 16 for children diagnosed in 1967-69 to 57 for those diagnosed in 1979-81. For other cancer types, no increases or debatable decreases in mortality rates and increases in survival rates were recognized.

Heterotrophic bacterial populations in the mineral waters of thermal springs in Spain.

The microbiological quality and heterotrophic bacterial populations of 26 thermal mineral water springs in Spain were studied. In most of the springs the number of viable aerobes was less than 10(3) cfu ml-1 and the number of sporulated bacteria less than 10(2) cfu ml-1. No significant differences were found in the counts obtained with Plate Count Agar (PCA) and PCA diluted 1:10 and incubated at 22 degrees, 37 degrees and 45 degrees C. Total coliforms were found in 14 springs, faecal streptococci in three, spores of sulphite-reducing Clostridium and Pseudomonas aeruginosa in seven. Neither Escherichia coli nor Staphylococcus aureus were found. A total of 665 strains were isolated and 85.4% of these identified; 329 were Gram-positive and 239 were Gram-negative. The genera most prevalent present in the springs were Pseudomonas (in 92.3%), Bacillus (65.4%), Enterobacter, Micrococcus and Staphylococcus (50%), Acinetobacter (42.3%), Arthrobacter (38.4%), Clostridium (27%) and Xanthomonas (23%). Gram-negative bacteria predominated in the mesothermal springs and Gram-positive bacteria in the hyper- and hypothermal springs. The most common Gram-negative rod species isolated were Ps. fluorescens, Ps. aeruginosa, Ps. putida, Ent. agglomerans, Ent. sakazakii, Ac. calcoaceticus and Ent. amnigenus.

Resistance to the antimicrobial agents of bacteria isolated from non-sterile pharmaceuticals.

The in vitro antimicrobial resistance of 391 bacterial strains isolated from 389 samples of oral and topical medicaments was examined. The numbers of strains isolated (and percentage of samples that present them) were: 234 Bacillus (32.1%), 79 Staphylococcus (13.6%), 46 Micrococcus (11.3%), nine Pseudomonas (1.5%), eight Acinetobacter (1.5%), five Enterococcus (1.2%), three Alcaligenes (0.8%), two Escherichia and Enterobacter (0.5%), one each Providencia, Serratia and Streptococcus (0.2%). Gram-positive bacteria were isolated from topical and oral medicaments and Gram-negative rods were detected only in topical medicaments. The 97.4% of Bacillus strains were resistant to lincomycin and B. cereus was resistant to beta-lactam and trimethoprim-sulphamethoxazole. Staphylococcus spp. showed a high percentage of resistant strains to ampicillin (51.8%), tetracycline (40.5%) and trimethoprim-sulphamethoxazole (48.1%). Staphylococcus epidermidis had the highest number of multiresistant strains. The 23.9% of Micrococcus strains were resistant to colistin. Enterococcus and Streptococcus strains showed multiresistance to penicillin G, aminoglycosides and erythromycin. The 61.5% of Gram-negative rod strains showed multiresistance to beta-lactam antibiotics and erythromycin; Pseudomonas spp. were the most resistant.

Childhood cancer registry of the Province of Torino, Italy. Survival, incidence, and mortality over 20 years.

Incident childhood cancers in the Province of Torino, Italy (population aged 0 to 14 years averaging 0.5 million) have been registered since 1967. Four population-based exhaustive surveys have been done to collect cases diagnosed during the periods 1967 to 1969, 1970 to 1975, 1976 to 1981, and 1982 to 1986. For each registered child, vital status on June 30, 1988 was assessed. This article reports incidence, mortality, and survival rates over a 20-year period. A statistically significant trend toward an increased incidence of soft tissue sarcomas was identified. Statistically insignificant trends included an increased incidence of brain tumors (probably reflecting improved diagnostic procedures) and a decreased incidence of thyroid tumors. Incidence rates of leukemias in the first year of life tended to decrease. As expected, survival rates of some childhood cancers dramatically improved throughout the 20-year period; this occurred in leukemias, brain tumors, soft tissue sarcomas, and renal tumors. Survival rates are compared with observations in comparable population-based series.

Numerical taxonomy of Bacillus isolated from orally administered drugs.

Numerical taxonomy procedures were used to study 118 strains of Bacillus isolated from non-sterile drugs prepared for oral administration. Similarities between pairs of strains were calculated by the simple matching coefficient of Sokal and Michener (SSM). Each strain was tested for 60 unit characters and three clusters were defined. The strains in each cluster presented a similarity level of at least 60%. Cluster A comprised the strains identified as Bacillus cereus (SSM = 93.13%), cluster B contained three subgroups corresponding to the species B. pumilus, B. subtilis and B. licheniformis (SSM = 84.35%) and cluster C also included three subgroups that belonged to the species B. firmus, B. lentus and B. badius (SSM = 80.14%). The most discriminating tests were selected to differentiate the clusters from the subgroups. The feature with the highest discriminating power between clusters A and B was the lack of acid production from arabinose and mannitol. The Voges-Proskauer, methyl red tests and sensitivity to polymyxin B clearly distinguished cluster A from C. The Voges-Proskauer test and acid production from arabinose were the best to differentiate between B and C. Bacillus pumilus and B. subtilis differed in starch hydrolysis and B. licheniformis in growing anaerobically. To discriminate B. firmus from B. lentus the most important tests were the acid production from glucose and sucrose; intermediate strains were found. Bacillus badius was differentiated from B. firmus by 10 tests, and from B. lentus by the production of urease.

Characterization of Bacillus cereus strains isolated from drugs and evaluation of their toxins.

The microbial contamination of 68 samples of topical and 324 samples of oral medicaments has been studied. The most common group of contaminants was members of the genus Bacillus (34.4%). Because of the pathogenic significance of B. cereus, 39 strains were characterized by morphology and biochemical properties. All except three showed most of the characteristics of the type strain. They were highly resistant to lincomycin, polymyxin B and penicillin G-cephalosporin and were susceptible to streptomycin, erythromycin and chloramphenicol. Enterotoxin, phospholipase C and haemolysin production were also studied: 33 strains gave a positive vascular permeability reaction, four of them causing necrosis, and 24 showed positive mouse lethal tests. All the strains had phospholipase activity. The majority also exhibited differing degrees of haemolysis. Permeability factor was related to mouse lethality and haemolytic activity. Phospholipase C was not related to any of the above activities.

Carotid dissection with permanent and transient occlusion or severe stenosis: Long-term outcome.

OBJECTIVE: To compare the rate of ischemic events and intracranial hemorrhage in the long-term follow-up of patients with persistent and transient severe stenosis or occlusion of the internal carotid artery (ICA) due to spontaneous dissection (ICAD). METHODS: One hundred and sixty-one consecutive patients with unilateral ICAD causing severe stenosis or occlusion were examined clinically and by ultrasound 1 year after symptom onset. Forty-six cases with persistent and 46 age- and latency-matched cases with transient (recanalization complete or less than 50% stenosis) severe stenosis or occlusion of the ICA were enrolled. Nine patients with surgical, endovascular, or fibrinolytic therapy for ICAD or associated stroke were excluded. Antithrombotic therapy was given at the discretion of the treating physician. Clinical follow-ups were done annually. RESULTS: Antithrombotic therapy and follow-up were similar in patients with permanent (6.2 +/- 3.4 years) and transient (7.2 +/- 4.3 years) severe stenosis or occlusion of the ICA. Cases with permanent carotid stenosis or occlusion showed annual rates of 0.7% for ipsilateral carotid territory stroke and of 1.4% for any stroke. Cases with transient carotid stenosis or occlusion showed annual rates of 0.3% for ipsilateral carotid territory stroke and of 0.6% for any stroke. CONCLUSIONS: This study suggests that ICAD has a benign long-term prognosis with low rates of ipsilateral carotid territory and any stroke and that the stroke rate in ICAD is not related to the persistence of severe carotid stenosis or occlusion. These results question the rationale of surgical or catheter-based revascularization in patients with ICAD.

Survival trends of childhood cancer diagnosed during 1970-1994 in Piedmont, Italy: a report from the Childhood Cancer Registry.

BACKGROUND: The Childhood Cancer Registry of Piedmont (CCRP) started its activity in 1967. It is population based and covers the Piedmont Region (population 4,500,000; NW Italy). This article reports on time trends in survival after a childhood cancer diagnosed during 1970-1994. PROCEDURE: During 1970-1994, 2,329 incident cases were registered at CCRP on the basis of histological and/or clinical information, excluding 30 cases reported only by death certificate. Histological or hematological diagnosis was available for 2,067 cases. Vital status was assessed through the offices of the town of residence. At the end of follow-up, 1,202 cases were alive, 1,084 dead and 43 were not traceable. Survival was measured for the major diagnostic groups using both univariate and multivariate statistics. RESULTS: The 5-yr survival rate for acute lymphoblastic leukemia (ALL) improved regularly from 24.7% in 1970-1974 to 81.1% in 1990-1994, for acute nonlymphoblastic leukemia (ANLL) from 0% to 38.1%, for non-Hodgkin lymphoma (NHL) from 25.2% to 67.7%, for tumors of the central nervous system (CNS) (all types) from 33.4% to 75.9% and for Ewing tumor from 0% to 90%. Focusing on survival by period of diagnosis, the highest 5-year survival rate was observed for children diagnosed during 1985-1989 for medulloblastoma, neuroblastoma (NB), retinoblastoma, Wilms tumor, osteosarcoma, and rhabdomyosarcoma and for children diagnosed in 1990-1994 for the remaining sites. The trend over time was statistically significant for ALL, ANLL, NHL, CNS tumors, NB, and osteosarcoma as well as for all malignancies together. CONCLUSIONS: Population-based survival studies are useful complements to clinical studies. Survival results in the present study are similar to those presented for other European countries and the United States. For most types of neoplasm (except CNS) survival probability appears to stabilize 5-10 years after diagnosis.

Incidence of second primary malignancies after a malignant tumor in childhood: a population-based survey in Piedmont (Italy).

We have studied the frequency of second primary malignancies (SPM) among the 2,328 children registered in 1967-1969 at the Childhood Cancer Registry of Piedmont, the largest population-based childhood cancer registry in Southern Europe. Since the population of Piedmont is not served by a conventional cancer registry covering all ages, SPMs were identified through a number of ad hoc surveys within a variety of sources. Eighteen SPM (all histologically diagnosed) were observed after a thorough survey conducted in the ontological departments in Piedmont and after a postal questionnaire addressed to general practitioners. Death certificates were also examined. The crude incidence rate was 116.5 per 100,000 person-years. Risk was higher among children whose first malignancy was diagnosed more recently (SIR = 9.8 for diagnoses in 1983-1989 vs. 4.5 for diagnoses in 1967-1974). The same tendency was confirmed in analyses restricted to children in whom leukemia was diagnosed as the first cancer. Clinical data regarding the treatment of the first malignancy were available for 16 children out of 18: 15 had received chemotherapy and 12 radiotherapy (9 SPM originated in the irradiation field). The interest of measuring the risk of SPM on a population basis (and not only in clinical series) and the advantage of close cooperation between epidemiologists and clinical oncologists are underlined.