Our experience in the treatment of rheumatoid knee by arthroscopic synovectomy.

The authors present the results obtained in the treatment of rheumatoid knee by arthroscopic synovectomy. A total of 29 knees operated on in 25 patients after a mean follow-up of 38 months based on the Laurin evaluation scale were re-examined. There was significant improvement for pain, synovitis, and overall function (mean values pre- and postoperative 2.07 vs 0.98; 2.14 vs 0.84, 2.37 vs 1.26, respectively); there were no, substantial variations in joint movement (2.47 vs 2.58). By dividing the patients into the 4 Larsen radiographic classes, the worst results were observed in patients in classes 3 and 4. In this series of patients complications of significance were not observed. Thus, we consider arthroscopic synovectomy to be the treatment of choice for rheumatoid knee because of the intrinsic advantages of minimum disease rate, rapid functional recovery, with expectations of results inversely proportional to the stage of progression of the disease.

Accelerated neoadjuvant chemotherapy of non-small cell lung cancer (NSCLC).

Thirty patients with marginally resectable stage IIIA or stage IIIB NSCLC were treated with cisplatin (80 mg/ m(2)/i.v./dl), ifosfamide (4,000 mg/m(2)/i.v./dl) and vinorelbine (30 mg/m(2)/i.v./dl) plus G-CSF 300 mu g/s.c. on days 7-12 every 14 days for three cycles before surgery. In 26 evaluable patients, the radiographically assessed response rate to chemotherapy was 77% (8% complete). Three septic deaths (10%) occurred in spite of G-CSF and 1 patient refused to continue after the first cycle. Thoracothomy was performed in 23 patients including 19 complete resections. At 15 months median follow-up (range 10-22+), 11/19 (57%) completely resected patients relapsed. The overall median time to treatment failure was 11 months (range 0-17). Actuarial survival probability at 12, 18 and 24 months are 56%, 43% and 36%, respectively. In conclusion, the combination of cisplatin, ifosfamide and vinorelbine in full doses at a 14 day interval (accelerated chemotherapy) was very effective in neoadjuvant NSCLC setting. Nevertheless, relevant toxicity was demonstrated with a 10% death rate probably due to the overlapping toxicity of chemotherapy cycles, suggesting the need for a more intense supportive care or longer interval between cycles.

Antitetanus immunity in a sample of adult population from the Siena area (Italy).

1045 subjects (427 males and 618 females) from the Siena area, aged 20-85, were screened for tetanus antitoxin by the means of a passive haemogglutination assay. 32% of subjects was found protected against tetanus (antitoxin titre greater than or equal to 0.1 I.U./ml), 34.7% resulted partially protected (titre greater than or equal to 0.01 - less than 0.1 I.U./ml), and 33.3% was found unprotected (titre less than 0.01 I.U./ml). The protection rate was higher among males (44.9%) than among females (23%) and showed a definite age-related decrease. Within each age group, the protection rate was higher among males. The lowest protection rate (3.2%) was observed among females aged 70 or more. Analysis of the protection rate according to the individuals' occupation showed the highest value (44.9%) among workmen and the lowest (12.1%) among housewives. The anamnestic criterion was found exceedingly unreliable to assess the individual's immune status. Results, which are consistent with present tetanus italian epidemiology, are discussed for their implications relating to a possible improvement of current antitenus immunization policy.