Attitudes and thoughts of medical practitioners towards their profession in the era of financial crisis in Greece.

INTRODUCTION: The financial crisis which started in Greece about 10 years ago has affected the income of citizens, their quality of life, as well as social and occupational relationships. Aim of the present study was to assess the attitudes towards working conditions and personal life and to explore quality of life, as well as disorders in physical condition, sleep, mood and their predictors, among doctors working or being trained in a tertiary hospital of NE Greece. METHODS: Included were 133 medical students and doctors of all ranks (61.7% males) practicing medicine in a university tertiary hospital in Greece. All of them answered a 31-item questionnaire regarding their working conditions, and personal life, daytime activities and sleeping habits. RESULTS: In general, the majority reported dissatisfaction with the work environment, the salary and they rated their quality of life worse than that of the general population. Weekly workload exceeded 60 hours for the majority. No difference between sexes was revealed, with the exception of use of energy drinks which was more prevalent in males (70.7% vs. 51%, p = 0.022). Comparison between ranks revealed that medical students performed better in everyday activities and socialization, although prevalence of reported fatigue was higher in them. Finally, it was demonstrated that surgeons used more frequently medication to achieve sleep promotion (80.4% vs. 36%, p < 0.001) and daily energy (78.4% vs. 44%, p < 0.001). CONCLUSIONS: An overall dissatisfaction regarding workload, salary and quality of life is recorded among doctors of a tertiary hospital in Greece, with different coping strategies among subgroups.

Association of occupational exposures and work characteristics with the occurrence of gastrointestinal disorders.

BACKGROUND: Work is a daily activity with various conditions, exposures, and habits that may affect health either positively or negatively. Aim of this study was to investigate the relationship between occupational factors and conditions, and the occurrence of gastrointestinal disorders. METHODS: We enrolled in this study a sample of 891 consecutive individuals, who were examined by standard colonoscopy and gastroscopy and interviewed regarding their working conditions and exposures. Consecutively, data were statistically analyzed to explore possible associations. RESULTS: Peptic ulcer diagnosis was associated with reports of muscle pain/headache [odds ratio (OR): 3.656, 95 % confidence interval (95% CI): 1.898-7.043], with working in shifts (OR: 2.463, 95% CI: 1.058-5.731), and with the presence of occupational stress (OR: 2.283, 95% CI: 1.162-4.486). Gastritis was associated with muscle pain/headache (OR: 2.258, 95% CI: 1.096-4.652), shift work (OR: 3.535, 95% CI: 1.345-9.29), occupational stress (OR: 2.182, 95% CI: 1.072-4.444), and sedentary work (OR 0.275 lower risk 95% CI: 0.113-0.671). Ulcerative colitis was associated with muscle pain/headache (OR: 6.211, 95% CI: 2.162-17.840) and occupational stress (OR: 6.418, 95% CI: 2.243-18.361), while Crohn's disease diagnosis with muscle pain/headache (OR: 3.554, 95% CI: 1.628-7.759), frequent ordering food at work (OR: 4.928, 95% CI: 2.3-10.559), occupational stress (OR: 3.023, 95% CI: 1.413-6.469), work with intense physical activity (OR: 0.665 lower risk, 95% CI: 0.252-0.758). Colon cancer diagnosis was associated with frequent ordering food at work (OR: 2.739, 95% CI: 1.268-5.916) and occupational stress (OR: 3.175, 95% CI: 1.384-7.286), while stomach cancer diagnosis with ordering food at work (OR: 2.794, 95% CI: 1.154-6.763) and exposure to dust (OR: 5.650, 95% CI: 1.551-20.582). Finally, presence of polyps was associated with ordering food at work (OR: 2.154, 95% CI: 1.135-4.091), and constipation with ordering food at work (OR: 2.869, 95% CI: 1.451-5.672), occupational stress (OR: 2.112, 95% CI: 1.097-4.066), and occupational noise (OR: 0.248, 95% CI: 0.084-0.737). CONCLUSION: The incidence of the gastrointestinal diseases is affected by occupational exposures and related lifestyle habits. HIPPOKRATIA 2017, 21(2): 74-79.

Correlation of age at natural menopause with occupational status and other epidemiologic factors in women from Prefecture of Kavala, Greece.

AIM: Aim of this study was to explore possible associations between the timing of natural menopause and occupational status and other determinant epidemiologic factors among women living in the Prefecture of Kavala, a region of North-East Greece. METHODS: The sample of the study comprised of 827 naturally menopausal women, who consented to participate in this questionnaire-based interview study between 2011 and 2016. The study population was recruited from women who were hospitalized or visited the outpatient clinics of the General Hospital of Kavala and women working in the public sector services and private companies in the Prefecture of Kavala. RESULTS: The mean age of the sample at natural menopause was 49.1 years; 12.2 % had early menopause, and 4.5 % were diagnosed with premature ovarian failure. For the majority of enrolled women (80.5 %) menopause occurred between 45-54 years, and for the rest (2.8 %) after 54 years of age. In univariate analysis, a statistically significant correlation was found between age at menopause and occupational status, year of birth, mother's age at menopause, age at menarche, and high levels of chronic stress. Multiple regression analysis revealed that occupational status, year of birth and mother's natural menopausal age could predict age at menopause. CONCLUSION: Socioeconomic, demographic and familial variables appear to be associated with age at natural menopause in a representative sample of women in the Prefecture of Kavala, Greece. HIPPOKRATIA 2017, 21(1): 32-37.

Estimating life expectancy of the population in Cyprus with the use of life tables.

AIM: The aim of this study was to investigate the life expectancy of the Cypriot population between 1986 and 2012. MATERIAL AND METHODS: We used the data reported in the annual editions of the Statistical Service of Cyprus and constructed life tables of the Cypriot population between 1986 and 2012. RESULTS: For both genders, and for males and females separately, in the year 1986 life expectancy accounted 74.47, 72.2, and 76.76 years respectively, while in 2012 values increased to about 81.28, 79.02, and 83.50 years respectively. The longitudinal trend of life expectancy is to increase over the calendar years. The largest increase in life expectancy occurred at birth and was approximately seven years for both males and females. Until the age of 55, this gain was approximately six years of life. From age 60 to 65 years, the gain was about five years of life, and in the oldest age groups, the gain was four years of life. The values corresponding to male were lower compared to those corresponding to females, with the exception of the age 0 (at birth). CONCLUSIONS: A significant increase in life expectancy of the Cypriot population was noted in the period 1986-2012, which was more obvious at younger ages and in females. Hippokratia 2016, 20(2): 99-103.

Work-related respiratory symptoms and airway disease in hairdressers.

BACKGROUND: Hairdressers are occupationally exposed to a number of agents in their workplace that result in respiratory symptoms and changes in pulmonary function. OBJECTIVE: To evaluate associations between occupational exposure and respiratory function and reported symptoms in a group of hairdressers compared to a control group. METHODS: A questionnaire on respiratory symptoms and workplace characteristics was completed by 94 hairdressers and 39 age- and sex-matched controls. Spirometry and exhaled nitric oxide (FeNO) measurements were also performed. RESULTS: Hairdressers reported more severe dyspnea (p=0.03) and eye (p=0.001) and throat (p=0.007) irritation, compared to the control group, at the workplace; no differences were noted at home. Lower FEV1/FVC (p<0.001) and higher FeNO values (p=0.012) were observed in hairdressers. A larger working area and presence of window ventilation were associated with better pulmonary function. CONCLUSION: Worsening of symptoms and pulmonary function at workplace, and alleviating the symptoms at home, indicate that they may be related to occupational exposure.

Mean Platelet Volume and Platelet Distribution Width in non-diabetic subjects with obstructive sleep apnoea syndrome: new indices of severity?

UNLABELLED: To evaluate Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) in non-diabetic subjects, according to obstructive sleep apnoea syndrome (OSAS) severity and the associations of these indices with anthropometric characteristics and parameters of breathing function during sleep. MATERIALS AND METHODS: We included 610 non-diabetic subjects with suspected OSAS, evaluated by polysomnography. According to their apnoea-hypopnoea index (AHI), patients were divided into Group A (n=148) with AHI<5/h; Group B (n=121) with AHI: 5-14.9/h; Group C (n=85) with AHI: 15-29.9/h and Group D (n=256) with AHI ≥ 30/h. MPV and PDW were measured using an automated blood cell counter. RESULTS: MPV was significantly higher in group D (mean value 12.1 ± 1.3 fl) than in groups A (9.8 ± 1.1 fl), B (9.8 ± 1.6 fl), and C (11.5 ± 1.3 fl) (p<0.001). The same pattern was observed in PDW values (15.9 ± 2.2 fl for group D and 13.2 ± 2.2 fl for group A, 14.1 ± 2.8 fl for group B, and 15 ± 2.2 fl for group C, p<0.001). Significant correlations were seen between MPV and AHI (p<0.001), average pulse oxygen saturation (SpO(2)) (p<0.001), minimum SpO(2) (p<0.001) and percent of the total sleep time with SpO(2) lower than 90% (t<90%) (p<0.001) during sleep, Arousal Index (p<0.001) and Epworth sleepiness scale (ESS) (p=0.028). Similarly, PDW was correlated with AHI (p<0.001), average SpO(2) (p=0.001), minimum SpO(2) (p<0.001), t<90% (p=0.002), and Arousal Index (p<0.001). CONCLUSIONS: MPV and PDW are higher in non-diabetic patients with severe OSAS and are correlated with different parameters of breathing function during sleep.

Occupational accidents in Greek Armed Forces in Evros County.

AIM: The purpose of this study was to investigate risk factors for occupational accidents and the relationship between perceived and actual risk of occupational accidents in Greek soldiers. METHOD: A case-control study was conducted of military personnel in Evros county in Greece. Cases (n = 250) were defined as enlisted personnel having had an accident at work and the control series (n = 300) comprised of a simple random sample, stratified by age from the army population. RESULTS: Conscripted soldiers (OR = 3.8, 2.21 to 6.58, p < 0.001) and professional soldiers (OR = 2.2, 1.28-3.75, p = 0.004) had higher frequency of occurrence of accidents in comparison to army officers. The degree of risk perception due to electrical hazards (OR = 2.8, 1.81-4.18, p < 0.001), lighting (OR = 2.6, 1.74-3.97, p < 0.001), falls (OR = 2.9, 1.61-5.13, p < 0.001) and inadequate safety signs (OR = 3.3, 1.99-5.49, p < 0.001) were associated with increased occurrence of accident. Regression analysis demonstrated a significant relationship between the accident and the age, time of service in the present unit, specialty, level of education, years of service and the overall military training. CONCLUSION: This study highlights the increased likelihood of occupational accidents among military personnel with lower rank and lower level of education, less working experience (fewer years of service) and less military training (conscripted and professional soldiers). The existence of occupational accidents in the workplace, civilian or military, creates the need for the adoption of policies for the protection of workers and the organization of occupational preventive services.

Community-acquired pneumonia due to Legionella pneumophila, the utility of PCR, and a review of the antibiotics used.

INTRODUCTION: There are at least 40 types of Legionella bacteria, half of which are capable of producing disease in humans. The Legionella pneumophila bacterium, the root cause of Legionnaires' disease, causes 90% of legionellosis cases. CASE PRESENTATION: We describe the case of a 60-year-old woman with a history of diabetes mellitus and arterial hypertension who was admitted to our hospital with fever and symptoms of respiratory infection, diarrhea, and acute renal failure. We used real-time polymerase chain reaction (PCR) to detect L. pneumophila DNA in peripheral blood and serum samples and urine antigen from a patient with pneumonia. Legionella DNA was detected in all two sample species when first collected. CONCLUSION: Since Legionella is a cause of 2% to 15% of all community-acquired pneumonias that require hospitalization, legionellosis should be taken into account in an atypical pulmonary infection and not be forgotten. Moreover, real-time PCR should be considered a useful diagnostic method.

Occupational health and safety of personnel handling chemotherapeutic agents in Greek hospitals.

The expansion of chemotherapy raised concerns about the health and safety of hospital personnel. Very little is known about the conditions of handling of chemotherapeutic agents by healthcare workers in Greece and possible adverse effects related to their safety practices, as well as the safety policies adopted by the Greek hospitals. A self-evaluation questionnaire was completed by 353 healthcare workers involved with the use of chemotherapeutic drugs in 24 Greek hospitals and the answers were statistically analysed. The majority of the healthcare workers are aware of the dangers of their work, although they had received limited training and medical surveillance. A significant percentage of them does not use personal protective equipment or use it inadequately. The safety design of their workplace is rather poor. Different health problems have been experienced, deriving from the respiratory, central nervous system, reproductive, gastrointestinal and musculoskeletal system. The improvement of safety training and procedures as well as medical surveillance seems to be a vital priority of hospital administration in Greece, in order to comply with the European guidelines and for the prevention of occupational diseases and environmental pollution.

Distinct distribution of corticotropin releasing factor receptors in human breast cancer.

The hypothalamic neuropeptide corticotropin releasing factor (CRF) has been found in several types of human cancer, where its biological role is not clarified. In experimental models of breast cancer CRF has been shown to exert anti-proliferative and other actions. Aim of the present study was to describe the expression of the two types of CRF receptors CRF(1) and CRF(2) in human breast tumors. Receptor expression was studied in breast biopsies from patients diagnosed for primary breast adenocarcinoma, obtained from the tumor and the adjacent benign tissue. Gene expression levels were evaluated by real-time PCR following reverse transcription of total RNA extracts. CRF(1) transcripts were found in 23.1% of benign and in 23.1% of malignant biopsies. CRF(2(a)) was found in 22.2% of benign and 36.0% of malignant biopsies. Transcript levels of both receptors did not differ significantly between cancer and benign biopsies from the same tumor. No correlation was found between CRF receptor expression and patient histo/clinicopathological characteristics. Histological mapping using immunohistochemistry revealed positive CRF(1) immunostaining in the cancerous implants and breast ducts, whereas CRF(2) immunoreactivity was localized mainly in the perineural invasions. In conclusion, both CRF receptors were found in breast cancer and the respective benign adjacent tissue. The two CRF receptor proteins presented distinct distribution and subcellular localization, pointing into differing biological roles. CRF receptors could serve as targets of endogenous ligands expressed in the tumor microenvironment, regulating cancer growth.

Substantial underreporting of tuberculosis in West Greece: implications for local and national surveillance.

In order to estimate the reliability of the officially reported national tuberculosis (TB) incidence rates we performed a retrospective review of data collected in regional and national public health framework. TB notifications for the period 2000-2003 were obtained from two major hospitals and three relevant Public Health Departments (PHDs) in the region of West Greece, and subsequently compared with the data reported to the Hellenic Centre for Diseases Control (KEELPNO). During the four-year study period a total of 161 cases of TB were reported to the PHDs in West Greece; 70% of these cases were reported to the KEELPNO. Furthermore only 72 (38.7%) out of the 186 cases of TB identified in the two hospitals were notified to the PHDs. Assuming that the degree of undernotification observed for the two hospitals is the same throughout the region, we estimated that the case detection rate was 14 cases per 100,000 persons per year, i.e. 3.7 times higher than the rate officially reported for the period 2000-2003. Male predominance (2.1, male/female ratio) and an increased incidence in the elders (older than 60 years) and adolescents (10-14 years old) were also evident. The study demonstrated a substantial underestimation of TB burden in West Greece. In the face of the massive influx of immigrants and refugees coming from regions with high TB incidence and the increase of the number of drug-resistant cases a reliable and complete notification of TB is crucial in the planning of programs and development of appropriate control policies.

Serum alkaline phosphatase isoenzyme activities in canine malignant mammary neoplasms with and without osseous transformation.

BACKGROUND: Increased serum activity of total alkaline phosphatase (TALP) has been found in dogs with mammary neoplasms, especially malignant mixed tumors. We hypothesized that the bone isoenzyme of alkaline phosphatase (BALP), a specific indicator of osteoblastic activity and bone formation, may contribute to increased TALP in dogs with mammary neoplasms with osseous transformation. OBJECTIVE: The purpose of this study was to compare serum TALP, BALP, and other ALP isoenzyme activities in dogs with mammary malignant neoplasms with and without osseous transformation. METHODS: Twenty-one female dogs with malignant mammary neoplasms were compared with 21 clinically healthy, age-matched female control dogs. Physical, clinicopathologic (including preprandial and postprandial serum bile acids, ACTH stimulation, and low-dose dexamethasone suppression tests), radiographic, and ultrasonographic examinations were performed on all dogs with tumors to assess coexisting conditions. On the basis of histologic examination of excised tumors, dogs were further classified as having epithelial (n = 11) or mesenchymal/mixed (epithelial-mesenchymal) (n = 10) neoplasms, the latter of which had histologic and radiologic evidence of bone formation. Serum TALP, BALP, liver alkaline phosphatase (LALP), and corticosteroid-induced alkaline phosphatase (CALP) activities were measured using biochemical methods. RESULTS: Dogs with malignant mammary tumors had significantly higher (P < .05) median serum TALP (170 U/L), BALP (59 U/L), LALP (49 U/L), and CALP (24 U/L) activities, compared with control dogs (81, 32, 37, and 5 U/L, respectively). Significantly higher activities of BALP and LALP were found in dogs with epithelial neoplasms; whereas, only CALP activity was higher in dogs with mesenchymal/mixed neoplasms. There was no significant difference in TALP or isoenzyme activitities between epithelial and mesenchymal/mixed groups. CONCLUSION: BALP activity is increased in some dogs with malignant mammary tumors but does not account for the increase in TALP in dogs with neoplasms that have osseous transformation.

Histological grading and prognosis in dogs with mammary carcinomas: application of a human grading method.

The human "Elston and Ellis grading method" was used in dogs with mammary carcinoma to examine its relation to prognosis in this species, based on a 2-year follow-up period. Of the 85 cases examined, 27(31.8%) had well-differentiated (grade I), 28 (32.9%) had moderately differentiated (grade II) and 30 (35.3%) had poorly differentiated (grade III) carcinomas. Two years after mastectomy, significant differences in survival between cases with different tumour grade were found; thus, survival was worse in dogs with grade III carcinomas than in those with grade II (P<0.05) or grade I (P<0.001) tumours. However, in dogs with simple carcinomas which had a less favourable prognosis than that of other carcinomas (P<0.001), there was no significant difference in survival between grade II and grade III cases (P=0.878), both having a very poor prognosis. Undifferentiated (grade III) carcinoma cases had a 21-fold increased risk of death as compared with differentiated (grade I and II) carcinoma cases. An increased risk (about 10-fold) was also associated with undifferentiated simple carcinomas as compared with differentiated ones. The predictive value of histological grade was not influenced by tumour size or age of the dog at mastectomy; nodal metastasis, however, worsened the prognosis (P<0.001). Routine use of this human grading method would help the clinician to make a more accurate prognosis in the interests of post-surgical management in dogs with mammary carcinomas.

Correlation of serum alkaline phosphatase activity with the healing process of long bone fractures in dogs.

BACKGROUND: Bone healing is monitored mainly by physical and serial radiologic examinations of the fracture site. However, it is sometimes difficult to distinguish a delayed union from a nonunion, and advanced imaging techniques may not be available. Serum biochemical markers of bone formation, such as alkaline phosphatase (ALP) activity, may be clinically useful in evaluating the progress of healing. OBJECTIVE: The purpose of this study was to correlate serial values of serum ALP activity with the process of fracture healing in dogs and to assess its potential as a postsurgical prognostic indicator. METHODS: Changes in serum ALP activity were studied in 83 dogs with closed long bone diaphyseal fractures treated surgically. Physical and radiologic examinations of the fracture site and determination of serum ALP activity and calcium (Ca) and phosphate (P) concentrations were performed on admission (day 0); postoperatively on days 10, 20, and 30; and subsequently on a monthly basis until bone union was completed or signs of nonunion were evident. The dogs were allocated into 3 groups with respect to the fracture healing progress as documented by physical and serial radiologic examination. RESULTS: Group A dogs (n=35) developed a medium-sized callus that led to bone union within 2 months. Group B dogs (n=36) had a hypertrophic callus and delayed union, within 3-5 months. Group C dogs (n=12) had slow progress in fracture healing, with minimal callus formation during a 2-month period. Changes in mean serum ALP activity followed the same pattern in groups A and B, reaching a maximum level on day 10. Group A values returned to normal within 2 months, at which point bone union was complete, whereas group B values remained increased and returned to normal within 3-5 months, thus correlating with delayed union. In Group C, mean serum ALP activities showed no significant changes during the 2-month follow-up period, consistent with failure of bone union (nonunion). Serum P and Ca changes followed a proportional and inverse pattern to ALP changes, respectively. CONCLUSION: Serial determination of serum ALP activity during fracture healing could be an additional tool in predicting fractures at risk of developing a nonunion, helping the clinician to choose the appropriate intervention.

Serum leptin values in relation to bone density and growth hormone-insulin like growth factors axis in healthy men.

A novel action of leptin on bone formation has recently been described in animals. However, in humans, studies provide data, that, are less conclusive. So far, few studies investigated the leptin-bone density association in males. Moreover, it has been suggested that GH, IGF-1 and IGFBP-3 may be major players in the hormonal or paracrine pathways that regulate bone cell metabolism. Also, leptin has been shown to modulate the GH/IGF pathway. The aim of this study was to clarify further this issue by investigating (a) the influence of serum levels of leptin, GH, IGF-1 and IGFBP-3 on bone mass in various skeletal sites and, (b), the relationship between leptin and the GH/IGF axis. 363 healthy individuals were investigated. BMD and serum leptin, GH, IGF-1 and IGFBP-3 serum levels were assessed. Our results indicate that 11% of healthy males had bone density with T scores

Occupational injuries in Greece (1938-1955): history of medicine and descriptive epidemiology.

AIM: To describe the longitudinal trends in the rates of total and fatal occupational accidents in Greece during 1938-1955. MATERIAL AND METHODS: Information on occupational injuries have been provided from the yearly reports of the Organization of Social Insurances (1938-1955) and on population data from the tables of National Statistic Agency. Bio-statistical analysis was performed by the use of SPSS software and Stat-Calc of Epi Info. RESULTS: The evolution of the longitudinal trend of occupational accidents has revealed a biphasic character, with a decreasing trend during 1938-1945 and an increasing trend during 1946-1955. The phenomenon was obvious in both sexes and in all age groups. On the contrary fatal occupational injuries increased across the period 1938-1945 and subsequently decreased. These temporal trends can be interpreted on the light of the important reduction in the level of economic activity during the second world war and the subsequent gradual recovery in the post war period. CONCLUSION: The biphasic characteristics of the occupational accidents longitudinal trend seems to be influenced by historical factors. Important lessons were learnt from the period of war. The decrease of the rate of total occupational accidents does not necessary reflect a satisfactory level of safety at work. The level of the economic activity, the efficiency of the registration and prevention agencies play a role. In addition, the rate of fatal injuries has a critical role in benchmarking national occupational health performance.

Methylenetetrahydrofolate reductase polymorphism C677T is not associated to the risk of cervical dysplasia.

The aim of the study was to explore a possible association between methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and cervical neoplasia. A total of 229 women were subjected to cytologic and colposcopic evaluation. Ninety-one of them were found to be normal, and served as the control group, while the other 138 of them had present or past histologically proven cervical pathology (patients group). All patients and controls were investigated for the MTHFR C677T polymorphism. Statistical analysis between the groups of cases with cervical intraepithelial neoplasia or invasive cervical cancer and the control group did not reveal any statistically significant difference in the frequency of the MTHFR C677T polymorphism.

A Phase II study of docetaxel and carboplatin in the treatment of non-small cell lung cancer.

We investigated the efficacy of docetaxel (D) in combination with carboplatin (C) in the treatment of non-small cell lung cancer (NSCLC) patients. Since 1996, 123 with inoperable NSCLC were enrolled in the study; 120 (108 males, 12 females; mean age 58.0+/-8.3 years) were evaluated. Of those, 46 patients had squamous carcinoma, 44 adenocarcinoma, 11 large cell carcinoma and 19 undifferentiated tumours. Eligibility criteria included, documented inoperable NSCLC, WHO performance status (PS) 0-1, age up to 70 years, and normal renal and hepatic function. A total of 622 cycles of chemotherapy (CHT) (median 7 (95% CI 6.2-7.47), courses per patient) were administered. Each cycle consisted of 100 mg/m(2) of docetaxel in a 2-h infusion with C at a dose of area under the curve (AUC) of 6 on day 1. This regimen was repeated every 28 days up to eight cycles. Of the patients, five (4%) achieved complete response, 49 (40%) partial response, 47 (39%) had stable disease and 19 (15%) had progressive disease. The median survival was 12 months for all patients, 12 for the four patients with stage IIb disease, 18 for the patients with stage IIIa disease, 20 for the 29 patients with stage IIIb disease, and 11 for the 65 stage IV patients. The median time to progression was 8 months (90 patients). Toxicity was, grade 3/4 neutropenia, 18 patients (15%); grade 3/4 anaemia, 6 patients (5%); and tolerable peripheral neuropathy, 16 patients (13.3%). Responders received radiotherapy (total dose, 50 Gy in 4 weeks) between the 6th and 8th cycle. Among responders with initial stage IIIb disease, 7 (5%) underwent surgical resection. Patients with early progression of the disease received the same dose of radiotherapy between 2nd and 3rd cycle. The study is ongoing, and six patients (5%) are still alive (after 3 years). Preliminary results indicate that the D/C combination is very active in the treatment of NSCLC with tolerable toxicity. It appears that this drug combination is also good as neoadjuvant therapy in inoperable NSCLC patients.

Adjuvant post-operative chemotherapy in bitches with mammary cancer.

The survival time in a group of eight bitches with malignant mammary tumours given adjuvant post-operative chemotherapy was compared with survival in another group of eight bitches with mammary cancer which were treated by surgical excision alone. The same surgical procedure was used in both groups. All bitches had stage III disease according to the World Health Organization clinical staging system. Histologically, 10 of the bitches had complex carcinomas (carcinomatous mixed tumours), the remaining six bitches had carcinosarcomas. The chemotherapeutic protocol used was a combination of 5-fluorouracil (150 mg/m2 of body surface area) and cyclophosphamide (100 mg/m2) given on the same day, intravenously, every week for four consecutive weeks. Chemotherapy was started one week post-surgery. Selected haematological parameters (packed cell volume, white blood cell count, platelet count and differential white blood cell count) and serum biochemical parameters (alanine aminotransferase, alkaline phosphatase, blood urea nitrogen and creatinine) were measured before and during chemotherapy. Survival analysis indicated that the chemotherapeutic regimen had a positive influence on the disease-free interval and the survival time of the eight bitches (P < 0.05). Although leucocyte numbers were significantly decreased (P < 0.001) during chemotherapy, the mean leucocyte counts remained within normal limits. Temporary leukopenia was noted only in one bitch. Packed cell volume and alkaline phosphatase increased significantly (P < 0.05) but within normal limits. Creatinine was also increased significantly (P < 0.01) but the mean creatinine concentrations were within normal limits, although in half of the bitches the concentrations occasionally rose above normal.