The preservation of minor pectoralis muscle in axillary dissection for breast cancer: functional and cosmetic evaluation.

We have evaluated, in two groups of 50 patients each submitted to axillary dissection for breast cancer (10 mastectomies and 90 conservative procedures), the advantage of the preservation of the minor pectoralis muscle. This muscle was preserved in one group and removed in the other. Whereas in the immediate postoperative period complications (shoulder pain, functional impairment, quantity or duration of serum drainage from the axilla) were the same in the two groups, at longer follow-up (more than 6 months after surgery) the patients whose pectoralis minor muscle was preserved showed a reduction in the incidence of partial atrophy and fibrosis of the pectoralis major muscle. Patients treated with conservation of the pectoralis minor muscle showed this atrophy in 6% of cases vs 54% observed in the other patients. This fact may be related to disruption of the pectoral nerves, which are in close contact with the pectoralis minor during their course from the brachial plexus to the pectoralis major muscle.

Liver hemodynamic flow balance by image-directed Doppler ultrasound evaluation in normal subjects.

Image-directed Doppler ultrasonography of main hepatic vessels (hepatic artery, portal vein, hepatic veins, and inferior vena cava (IVC)] was performed in 22 healthy volunteers, 20 years to 65 years of age. For each vessel an estimate was made of the diameter, velocity time interval (VTI), volume blood flow in relation to heart rate (stroke volume in L/min/beat), and body size (blood flow index in L/min/m2 body surface area). Moreover, a hemodynamic hepatic balance to define a range of values in normal population was described. The summation of flow of hepatic veins and IVC flow, just over renal veins, (= IVC subhepatic flow) was significantly correlated with the IVC flow rate before entrance into the atrium (R2 = 0.90). Hepatic artery flux plus portal vein flux plus subhepatic vein flux was also related to IVC flux before right atrium entrance (R2 = 0.92). This study confirms the utility and efficiency of Doppler ultrasonography in understanding liver flow hemodynamic balance.

Preliminary evaluation of myocardial toxicity of 4'-deoxydoxorubicin: experimental and clinical results.

4'-deoxydoxorubicin (4'-deoxy-DXR), a new doxorubicin (DXR) analogue with interesting antineoplastic activity, was tested for its cardiotoxicity in guinea pigs and humans. In experiments on isolated guinea pig heart, which is considered a highly predictive model of acute anthracycline cardiotoxicity in humans, 4'-deoxy-DXR was found to be significantly less cardiotoxic than DXR. This effect was correlated with a lower degree of inhibition of the fast-exchanging calcium compartment and of the low affinity sarcolemmal calcium-binding sites. The preliminary study on 4'-deoxy-DXR in humans was conducted on 117 patients affected by advanced malignancies resistant to conventional chemotherapy. The drug was administered by bolus i.v. injection in doses ranging from 10 to 40 mg/m2 in the phase I study and in doses of 35 mg/m2 in the phase II study, which is still ongoing. Cardiologic evaluation consisted of recording of EKG, left ventricular systolic time intervals (STI), echocardiography and radionuclide ejection fraction. Preliminary data indicated a lower percentage of EKG abnormalities in comparison not only with DXR but also with other anthracycline analogues. Analysis of STI recorded 1 h after different doses of 4'-deoxy-DXR failed to show the dose-dependent effect on left ventricular function which has been described for DXR, thus confirming the lower acute cardiotoxic effect. Functional parameters serially measured to evaluate chronic cardiotoxicity in 15 patients who received more than 200 mg/m2 were not significantly different from basal values.

Possible enhancement of the cardiotoxicity of doxorubicin when combined with mitomycin C.

Forty-six patients with recurrent metastatic breast cancer were treated with a combination chemotherapy including doxorubicin and mitomycin C. Myocardial contractility was monitored by means of echocardiography. During therapy there was a progressive deterioration of myocardial function, and this phenomenon was found to be linearly correlated to the cumulative dose of doxorubicin. Six patients (13.8%) developed congestive heart failure during therapy; it occurred after the median cumulative dose of 322 mg/m2 (range 135-472). Possible risk factors of cardiomyopathy could be identified in only two patients. These results suggest that mitomycin C could enhance the cardiotoxicity of doxorubicin.

Relationship between pulmonary function tests and morphologic changes in the lung in bleomycin-treated patients.

The transfer factor of the lung for carbon monoxide (TLCO) and the respiratory response to moderate exercise were determined in 16 patients with pulmonary metastasis pretreated with bleomycin who underwent pulmonary partial resection. The results of pulmonary function tests were related to histologic findings. No significant correlation was found between pulmonary morphologic changes and the TLCO: this questions the usefulness of TLCO as a predictive method for detecting subclinical bleomycin pulmonary toxicity. No significant correlation was found between morphologic findings and cumulative dose of bleomycin: this confirms the limit of a dose limitation strategy. In contrast, evaluation of pulmonary response to exercise seemed to improve the sensitivity of monitoring such patients for clinical evidence of latent pulmonary toxicity; however, it seems that critical morphologic changes must occur before pulmonary performance begins to deteriorate.

Preliminary echocardiographic and polygraphic evaluation of cardiac toxicity of 4'-epi-doxorubicin.

Data recorded by ECG, poly ECG, and echocardiography in 101 cancer patients treated with 4'-epi-doxorubicin are reported and compared with those previously obtained in a comparable group of 78 patients treated with doxorubicin. 4'-Epi-doxorubicin was administered by i.v. route in doses ranging from 50 to 90 mg/m2 in a three-weekly regimen; the maximum cumulative dose was 630 mg/m2. The results obtained demonstrate that this new antitumor anthracycline develops a lower acute cardiotoxic effect and suggest that 4'-epi-doxorubicin is endowed with a reduced chronic cardiotoxicity as compared to doxorubicin.