Infantile cerebellar thrombosis: a case of lupus anticoagulants?

Lupus Anticoagulants (LA) pathology is a disease frequently associated with venous and/or arterial thrombosis. The authors describe a 6 year-old boy complaining cephalea and emesis, followed by lethargy, in whom antiphospholipids antibodies were detected. Brain magnetic resonance scans showed lesions of the cerebellum. The characteristics of LA disease are discussed.

[Radiotherapy in the treatment of Merkel cell tumors]. / La radioterapia nel trattamento dei merkelomi.

Merkel cell carcinomas are very rare (80 cases up to 1986) and very malignant; they have been known for 20 years only as "trabecular carcinomas". They do not rise from neural crests, and therefore are not apudomas, but from a staminal cell of the skin with neuroendocrine evolution. Merkel cell carcinomas must be distinguished from undifferentiated carcinomas of the skin, lymphomas, and oat cell carcinomas. Eight patients (46 to 86 years old) are presented, 4 males and 4 females, with 1 gluteal (the younger female patient), 3 head and 4 limb localizations of Merkel cell carcinoma. Radiotherapy was carried out after surgery in 7 patients and after biopsy in 1; local recurrences were already present in 3 cases, and lymph node metastases in 5; tumor doses were 36-65 Gy, administered with different techniques, i.e. roentgen therapy, telecobalt therapy, 192Ir curietherapy. Chemotherapy was used in 2 metastatic patients only. Four patients are alive and free of disease and 4 are dead; 3 of the living patients have been followed 3-26 months. The high risk of radiation damage (1 necrosis, 2 giant edemas, 1 severe fibrosis) recommends that large fields and high single and/or total radiation doses be avoided. In conclusion, surgery is diagnostic but not curative on account of the high risk of recurrence; radiotherapy is important because Merkel cell carcinomas are very radiosensitive. Due to easy lymphatic spread of this type of cancer, radiotherapy must include the regional lymph nodes (dose: 40-50 Gy). The role of chemotherapy is still to be assessed but many antiblastic drugs are effective.

Limited small cell lung cancer of the lung treated with combination chemotherapy and radiotherapy: a retrospective analysis.

We assessed the outcome in 65 patients with limited small cell lung cancer (SCLC) treated from 1980 through 1989 with combination chemotherapy and chest and cranial irradiation. Of the 65 patients, 32.3% (21/65) achieved a complete remission (CR) prior to radiation therapy; six additional cases achieved a CR after radiotherapy with an improvement of 10% in the incidence of CR. In our group, 8 patients were alive and free of disease at 30 months (12.3%). We think that a combination of local thoracic irradiation in SCLC limited disease plus chemotherapy yields more CR and improves survival, especially in the group of patients who obtained the CR after initial induction chemotherapy.

The evaluation of effect of radiotherapy on T and B lymphocytes with standard methods and monoclonal antibodies: results at 30 months.

We examined and evaluated the immunologic status of 15 patients suffering from neoplastic, not ematologic, diseases, who underwent external beam radiation therapy. We determined the total lymphocyte count, the percentage of E and EAC rosettes, surface membrane immunoglobulins, the lymphocyte reactivity to PWM and PHA, and T-lymphocyte subpopulations by means of monoclonal antibodies (OKT3-OKT4-OKT8). Besides we evaluated the percentage of LEU7 and OKM1 cells and lymphocytes response to MLR. Blastogenesis tests (PHA and MLR), after 18 months, were performed with and without monocytes. We found out that the amount of T and B lymphocyte subpopulations, which was extremely variable during and after radiotherapy, gradually returned to initial value. After 30 months, the functional impairment seems to be almost completely recovered. At 18 months from the beginning of radiation treatment, the mixed lymphocyte reaction was normal. The presence of monocytes doesn't change either MLR or PHA responses. LEU7+ cells are normal, while OKM1+ cells increased.

[Evaluation of the immune function of patients undergoing radiotherapy: results after 18 months]. / Valutazione dell'assetto immunitario di pazienti sottoposti a radioterapia: risultati a 18 mesi.

The effects of radiotherapy on subset lymphocyte populations of 15 neoplastic patients were studied. The initial impairment of lymphocyte functions, was restored after eighteen months to 78% of initial values. The numerical equilibrium of T and B subpopulations was completely reinstated.

The mid-term effects of radiotherapy on T and B lymphocytes: an evaluation of cellular immunity with standard methods and monoclonal antibodies.

The mid-term effects of radiotherapy on T and B peripheral lymphocytes of 15 patients treated for various malignancies were evaluated. All patients had a significant impairment of lymphocyte functions, as measured by blastogenesis after stimulation with phytohemagglutinin and pokeweed mitogen. Such impairment lasted for 1 year after the completion of radiotherapy, when numerical variability of T and B subpopulations, observed during and after radiation treatment, was restored to initial values.

Clinical relevance of bone marrow biopsy in staging and follow-up of breast cancer.

Bone marrow biopsies by Jamshidi needle were performed in 106 breast cancer female patients. Sixty-four of them were in follow-up after mastectomy, and neoplastic involvement of marrow was found in 21 patients (32.8%). Among the 42 women undergoing staging before mastectomy, the incidence of marrow involvement was 11.9% (5 women, all with radiographic positivity). Of the 37 women, either in follow-up or in the staging phase, with bone metastases detected by roentgenographic and isotopic examination, the bone biopsy was positive in 23 (62.1%), and 7 histologically had micrometastases. Three women, without any radiographic or isotopic sign of metastases, had positive biopsies. A good correlation was found between the hydroxyproline:creatinine ratio and neoplastic involvement of bone marrow.

[Hydroxyprolinuria and bone metastases of breast cancer]. / Idrossiprolinuria e metastasi ossee da carcinoma della mammella.

The urinary excretion of Hydroxyproline (OH-P), evaluated as OH-P/creatinine ratio, has been examined in the follow up of 142 breast cancer patients. The mean value obtained in the women with bone lytic lesions, prior to treatment, was 5.3 +/- 1.9 (min. 3, max. 9), whereas in the women without bone metastases it was 1.7 +/- 0.5 (min. 0.6, max. 3), similar to the control group. The patients affected by osteoplastic lesions had a normal OH-P/creatinine ratio. The highest values of OH-P/creatinine ratio were found in women with bone marrow infiltration, ascertained by bone needle biopsy. In the group of patients with bone lytic metastases, a good correlation between changes of OH-P/creatinine ratio and response to hormonal or chemotherapeutic treatment has been observed. Therefore the OH-P/creatinine ratio could be effectively useful, with other clinical parameters, in the follow up of breast cancer patients.