Usefulness of breast self-examination for an early detection of breast cancer results of a study on 500 breast cancer patients and 652 controls.

The knowledge and practice of breast self-examination (BSE) was investigated among 500 women with operable breast tumors between 35 and 64 years of age (all successively operated) and 652 healthy women, matched with the previous group for 5-year age groups from 35 to 54 years. Only 39.9% of breast cancer women and 34.5% of the controls practiced BSE, starting from 45 years, and it is used less frequency by the women with a poor education and those in a lower economic bracket. Among the 500 breast cancer patients, those who practiced the self-examination had a higher number of tumors with a diameter no greater than 2 cm and a lower number with a diameter larger than 4 cm. In addition, in this group the percentage of unaffected axillary lymph nodes (N-) was 58.8% compared to 48.8% for the group that did not practice self-examination, and the percentage of the cases with more than 3 metastatic lymph nodes (N+ greater than 3) was 20.0% in the first group and 27.3% of the second one. These differences were statistically significant. The correlation between tumor diameter and the histologic lymph node stage is equally evident, since there is a progressive reduction in N- cases and a contemporary progressive increase in N+ (greater than 3) cases with increasing breast tumor diameter. Therefore, we can infer that the lack of practice of BSE causes a diagnostic and therapeutic delay, which is responsible for aggravation of the prognosis.

[Occupational exposure to hepatitis B virus in personnel of the S.S. Trinità Hospital in Borgomanero]. / Esposizione professionale al virus dell'epatite B (H.B.V.) del personale ospedaliero "S.S. Trinità" di Borgomanero.

369 workers at the S.S. Trinità Hospital, Borgomanero - Health Unit 54 were screened for H.B.V. H.B.V. markers were found in 49.9% of whom 28% presented a profile of immunization, 1.9% were found to be chronic carriers of HBsAg, 18.1% were only positive for anti-HBc and 1.9% presented a doubtful serum profile that will require further study. Women and senior staff (in terms of both age and seniority of service) were most often affected. In view of the high rate of H.B.V. infection, preventive vaccination is though necessary to protect the workers' health.

[Essential thrombocythemia. Clinical case report]. / La trombocitemia essenziale. Contributo clinico-pratico.

Essential thrombocythemia is a rare form of proliferative myelopathy and should not be confused with secondary thrombocythemia. In view of the frequency with which an increased platelet count is recorded with the automatic hemochromogen recorder, the fundamental parameters necessary for an accurate diagnosis are summarised on the basis of a typical clinical case observed for two years.

[Proposal for a program in the early diagnosis of breast cancer]. / Proposta per un programma di diagnosi precoce del carcinoma della mammella.

Systematic examination of the breasts of women admitted to a medical ward for apparently non-breast-related pathologies revealed 22 cases of isolated nodules (2.06%) of which 9 (40.9%) were carcinomatous. It is pointed out that while mass screenings are impossibly expensive careful periodic clinical examination by the G.P. is sufficient to identify a good percentage of potentially curable neoplasias.

[Syndrome of clinical pseudohypoglycemia]. / Sindrome della pseudoipoglicemia clinica.

Four cases of coma, clinically typed as hypoglycaemic but without low blood sugar levels are presented. The clinical picture was rapidly normalised by immediate infusion with hypertonic glucosate. A tentative pathogenetic hypothesis is proposed and the Yager and Young "non-hypoglycaemia" syndrome is once more discussed.

[Angioimmunoblastic lymphoadenopathy with dysproteinemia. A doubtful clinical case]. / Linfoadenopatia angioimmunoblastica con disproteinemia. Un caso clinico dubbio.

After a brief description of the clinical and laboratory picture of angioimmunoblastic lymphadenopathy with Dysproteinaemia (AILD), the case of a 49 year old woman is described. The woman died of haematemesis and with a clinical picture that originated 14 years earlier with Sjogren's syndrome that developed with modest systemic lymphadenopathy, splenohepatomegaly, autoimmune anaemia (Coombs direct positive). Histological examination of the parotid, certain lymph glands, the liver and the spleen suggested a diagnosis of proliferative lymphopathy that might have been either AIDL or low malignity NH lymphoma. The rarity of the syndrome and the clinical difficulties of accurate diagnosis are discussed.

[Behavior of blood composition in chronic liver diseases]. / Comportamento della crasi ematica in epatopazienti cronici.

On the basis of data from hospitalised patients with chronic liver pathology, the relationship between the type and severity of the disease and the nature and extent of changes in blood composition was studied. It is concluded that a direct relationship exists between liver pathology and haemopathy which can be attributed to various aetiopathogenetic factors. The severity of the liver pathology is the main factor, independently of its aetiology.

[Primary extra-lymph node localization of non-Hodgkin's lymphoma. Considerations on a clinical case]. / Localizzazioni primitive extralinfonodali del linfoma non Hodgkin. Considerazioni su di un caso clinico.

The location on first diagnosis of a non-Hodgkin lymphoma (NH lymphoma) in the respiratory structures (bronchi, pleura, pulmonary parenchyma) is rather rare (2-4%) in the absence of mediastinic and/or hilar adenopathy. In any event diagnosis is extremely difficult, often impossible even with the aid of a properly conducted biopsy since the biopsy does not provide suitable material. The case is presented of a 72 year old woman with intermittent hyperpyrexia and multiple alveolar masses, the aetiology of which was only identified 8 months after the onset of the symptoms with the appearance of latero-cervical lymphadenopathy where biopsy revealed the presence of an N.H. lymphoma that was highly malignant but otherwise unspecificable.

[Hepatic cirrhosis caused by alcohol: normalization of the functional parameters after prolonged abstinence]. / Cirrosi epatica da alcool: normalizzazione dei parametri di funzionalità dopo prolungata astensione.

It has often been noted that total abstention from alcohol will lead to the normalisation of modest liver lesions. For this reason the possibility of regression of more severe lesions was studied. To this end five patients with clinically diagnosed cirrhosis of the liver (bioptically confirmed in 2 cases) were followed up for a minimum of 1 and a maximum of 5 years, demonstrating the total reversibility of clinical and laboratory signs after total abstention for an average 15 months.

[Para-albuminemia and alloalbuminemia: 1st case report of a VR/VR B genetic variant in the Novara area]. / Paraalbuminemia e alloalbuminemia. Prima osservazione nel novarese della variante genetica VR/VR B.

The 12th case of alloalbuminaemia in Piedmont, and the 1st in the Novara area, coded NO/PN, are reported. Although alloalbuminaemia is at present purely a clinically asymptomatic scientific curiosity, future investigations could link it to other genetic marks with consequent practical advantages. It is also important to distinguish this form from acquired para-albuminaemia, often the only sign of pancreatic fistulisation.

[Determination of fibrinogen-fibrin degradation factors in neoplasms]. / Determinazione dei fattori di degradazione fibrinogeno-fibrina (FDP) in corso di neoplasie.

Disseminated intravascular coagulation (DIC) and Primary Fibrinolysis (PF) are frequently reported in the literature as occurring in a wide variety of tumours whether subjected to chemotherapy or not and triggering a thrombohemorrhagic mechanism that is often fatal. It was therefore decided to assess the extent of the Fibrinogen-Fibrin Degradation Products (FDP) in a group of cancer patients in order to identify the primary, asymptomatic clinical expressions of these syndromes with a view to ascertaining the possibility of preventing more severe forms. The data confirm the presence of circulating FDP in a small percentage of the patients (26.9%) especially those with solid tumours metastasising to the liver. The involvement of that organ is therefore considered decisive for the onset of DIC and PF.

[Reactions caused by Hymenoptera: a first aid problem]. / Reazioni da imenotteri: un problema di pronto soccorso.

The incidence of reactions to insect bites both local (erythema, pemphigus, oedema, itching) and systemic (urticaria, angioedema, anaphylactic shock) in Borgomanero (NO) National Health Clinic 54 was assessed. The high incidence of medical treatments for this pathology encountered reflects the fact that in the summer and in a rural area a great many people are exposed to this type of emergency. The importance of careful diagnosis (anamnesis, skin allergy tests, RAST is emphasised as a means of identifying cases at allergic risk and providing the appropriate immunotherapy.

Parity and breast cancer: confirmed evidence of an effect on age at diagnosis.

An evaluation is made of the hypothesis of Woods et al. (1) that the number of full-term pregnancies constitutes a factor of growth acceleration in breast cancer. Our results confirm, at least in part, the effect of parity on age at diagnosis of breast cancer. Patients with two or more children were significantly younger at the time of diagnosis than were those with none or one child. Age at first birth and duration of lactation do not seem to be, in this analysis, confounding factors for the observed association.

A comparative assessment of psychological and psychosocial characteristics of cancer patients and their caregivers.

We recruited 50 cancer patients and their caregivers with the aim of extending our knowledge of emotional, personality and psychosocial variables, and comparing their reciprocal experience of the disease. The patients and caregivers were administered four of the questionnaires included in the Cognitive Behavioral Assessment 2.0, the Family Strain Questionnaire and the Satisfaction with Life Scale. The patients were characterised by significantly greater emotional disturbances than their caregivers, who were emotionally stable and had a relatively low level of perceived strain despite their high level of hostility and state anxiety. The intra-scale correlations highlighted the fact that the perception of distress depends on neuroticism and the presence of anxiety and depression (which are themselves known to be connected with neuroticism). The everyday life of the caregivers seemed to be characterised by restricted social relationships and interests; a relatively large proportion also declared that they had practical problems related to disease management, economics and some embarrassing and stigmatic aspects of the disease itself.

Combined modality treatment with a weekly brief chemotherapy (ACOP-B) followed by locoregional radiotherapy in localized-stage intermediate- to high-grade non-Hodgkin's lymphoma.

BACKGROUND: A cooperative study was undertaken to evaluate the efficacy and toxicity of a very brief course of chemotherapy followed by locoregional radiotherapy in patients with localized-stage intermediate- to high-grade non-Hodgkin's lymphoma (NHL). PATIENTS AND METHOD: From January 1988 to November 1994, 84 patients with localized stages IA and IIA intermediate- to high-grade NHL underwent a combined modality treatment. All patients underwent a six-week chemotherapy regimen, ACOP-B (doxorubicin 50 mg/sqm and cyclophosphamide 350 mg/sqm on weeks 1, 3, 5; vincristine 1.4 mg/sqm and bleomycin 10 mg/sqm on weeks 2, 4, 6; prednisone 50 mg p.o. daily throughout the first two weeks and thereafter every other day), followed by locoregional radiotherapy (36 Gy). RESULTS: The median age was 58 years, with 35% older than 65 years; 52 patients had stage I and 32 stage II; 39 patients had extranodal +/- nodal involvement, and 4 had testicular involvement. Treatment was well tolerated, with only 38% suffering from mild mucositis and no toxic deaths. Seventy-nine patients achieved CR after ACOP-B and 83 at the end of the program. With a median follow-up of four years, relapse-free survival was 79% with 15 relapses (93% disseminated). Two patients with testis lymphoma had CNS relapses. Overall survival was 90% at four years. CONCLUSION: This combined program is effective and probably curative in localized stage intermediate- to high-grade NHL, with low toxicity, also in elderly people. Patients with NHL of the testis, as primary site, require CNS prophylaxis due to the high likelihood of CNS relapse.