[Pemetrexed monotherapy in previously treated patients with advanced non small cell lung cancer; differences by histology. Our experience]. / Monoterapia con pemetrexed in pazienti pretrattati affetti da carcinoma polmonare non a piccole cellule in fase avanzata: impatto dell'istologia. Nostra esperienza.

Emerging data suggest pemetrexed is active in patients with adenocarcinoma of lung compared to those with squamous cell carcinoma. We retrospectively reviewed advanced non small cell lung cancer (NSCLC) patients previously treated, analysing efficacy on histologic characteristics. From January 2007 to December 2010, 25 patients with stage IIIB or IV NSCLC (17 with adenocarcinoma and 8 with squamous cell carcinoma), who had previously failed on platinum-based chemotherapy, received pemetrexed 500 mg/mq every 3 weeks until disease progression or unacceptable toxicities. Analysing the histologic subgroups we observed 1 (5.9%) complete response, partial response in 5 patients (29.4%), stable disease in 6 (35.3%), progression disease in 5 (29.4%) in adenocarcinoma group compared to 4 (50%) stable disease and 4 (50%) progression disease in squamous cell carcinoma group. Median progression free survival was 8 months (range 3-22) for adenocarcinoma patients and 4 months (range 2-6) for squamous cell patients. According to data of the literature, also our small retrospective study conducted on unselected patients confirms the difference of pemetrexed efficacy by histology type, with better results in patients with adenocarcinoma lung cancer.

Long-term survival of metastatic melanoma to the ileum with evidence of primary cutaneous disease after 15 years of follow-up: a case report.

The small bowel is the most common site of gastrointestinal metastasis from cutaneous melanoma. Malignant melanoma has a poor prognosis, especially if distant metastases appear. Although rare primary melanoma of the small bowel has been described, more frequently these lesions originate from unknown cutaneous melanoma. Here we report the case of a 58-year-old man with a diagnosis of melanoma of the ileum without evidence of primary cutaneous disease. After 15 years, during the clinical and radiological follow-up, a cutaneous melanoma in the left parietal side of the scalp, probably corresponding to the primary lesion with abdominal node metastasis, was diagnosed. After 6 months of chemotherapy with fotemustine, the patient showed a complete response. At present, he is still alive 18 years after the diagnosis of intestinal metastasis.

Compliance with the Surgical Safety Checklist Results of an Audit in a Teaching Hospital in Italy.

AIM: We carried out an audit to verify compliance to Surgical Safety Checklist (SSC), as we have become aware that compliance across different teams and by individual surgeons has not been optimal. MATERIAL OF STUDY: 100 SSC records from October-December 2014 and 100 from March-June 2015 were inspected to verify correct . 44 surgeons and 34 scrub nurses were asked to complete a questionnaire to know surgeons' compliance to the different stages of the Checklist and the compliance of each surgical team. 100% of scrub nurse and 73.7% of surgeons completed the questionnaire. RESULTS: All Checklist records were correctly filled out but we could verify that while nurses have a strong commitment to the SSC, the Checklist's implementation is not being actively supported by all surgical team members. DISCUSSION: Many surgeons showed limited awareness of not collaborating during SSC procedure and admitted delegating the responsibility for answering questions to other members of their team. A number of them fell into contradiction answering to various parts of the questionnaire. Consistent with the literature, at our hospital there is a gap between quality of Checklist paper records and correct use of this safety tool. CONCLUSIONS: Thanks to the data we have collected we will improve the way the SSC is used and promote change in the behavior of surgeons. Eighteen surgeons (40.9%) expressed willingness to be involved in a work group to revise the SSC and we hope that their commitment to safety and quality will increase. KEY WORDS: Surgical Safety Checklist, Surgeons commitment.

Gastric stump lymphoma five years after distal gastrectomy.

We report the case of a 77-year-old man who developed low grade B cell non-Hodgkin's lymphoma of the gastric stump 5 years after undergoing a distal gastrectomy for benign gastric ulcer. Lymphoma occurring in the post-operative stomach would appear to be very rare, with only 14 previously recorded cases. The median period of lymphoma onset after ulcer surgery is about 20 years (range 9-43 years) and gastric remnants of lymphoma are generally diagnosed in low stage, when surgery is possible and makes the prognosis good. The clinical case presented herein is quite different from the others. The patient developed lymphoma within 5 years of the ulcer surgery, thus, earlier than generally reported in literature; he presented with massive regional and extra-regional nodes involvement and liver metastases and he poorly responded to antiblastic chemotherapy. The pathogenetic role of Helicobacter pylori (HP) infection and the possibility of malignant lymphoma developing in the gastric stump are discussed.

Breast cancer metastatic to the choroid in a male patient: case report.

Choroidal metastases have been observed in about 8% of patients with metastatic breast cancer, even if their true incidence is likely to be higher, as they are not routinely investigated in the absence of symptoms. Radiotherapy is the treatment of choice for symptom palliation. The prognosis is traditionally poor, with a reported average survival of one year. Here we describe the third case reported in the literature of a metastatic tumor to the choroid from a male breast carcinoma.