Non small cell lung cancer treatment with carboplatin and vindesine: a phase II study.

A phase II trial aiming to verify the effectiveness of a regimen including carboplatin and vindesine was performed. From November 1989 to September 1990, nineteen patients with advanced small cell lung cancer entered this study. Polychemotherapy treatment included: carboplatin 400 mg/sm, on day 1 and vindesine 3 mg/sm, on days 1 and 15, repeated every 4 weeks, as an outpatient regimen. Observed toxicity was mild; myelodepression, and nausea and vomiting were the main adverse events. No objective response was obtained; 14 no changes in the disease and 4 progressions were detected. The low objective response rate observed in this study is strongly influenced by a set of unfavourable prognostic factors. The median overall survival time [32 weeks] is comparable with the results of other studies.

Efficacy and safety of short intravenous amiodarone in supraventricular tachyarrhythmias.

The safety and efficacy of short intravenous therapy with amiodarone were evaluated in 44 patients (24 males, 20 females), aged 21-84 years, with supraventricular tachyarrhythmias newly arisen in less than 24 hours. The study group consisted of 15 patients with paroxysmal supraventricular tachycardia, 8 patients with atrial flutter and 21 patients with atrial fibrillation. They were treated with a single infusion of amiodarone up to 2 hours after the restoration of a stable sinus rhythm, or up to a maximum dose of 2400 mg in 24 hours. Our study shows that 88.6% of all supraventricular tachyarrhythmias reverts to sinus rhythm in less than 24 hours: 100% of paroxysmal supraventricular tachycardia, 75% of atrial flutter, and 85.7% of atrial fibrillation. Intravenously administered amiodarone proves to take effect rapidly (0.5 to 22 hours). The plasma amiodarone concentrations at sinus rhythm restoration showed a wide range (405-3800 ng/ml). Piecewise analysis suggested that the probability of sinus rhythm was 14.4-fold greater in paroxysmal supraventricular tachycardia. No linear statistical relationship was detectable between the log-dose-body mass index and log-QTc. Total amiodarone dose and left atrial volume are inversely correlated with a statistically significant difference. The toxicity in our short intravenous course with amiodarone was not relevant. We conclude that short high-dose intravenous amiodarone shows efficacy and safety in all newly occurring supraventricular tachyarrhythmias.

[Radiological mass screening in pulmonary cancer. Is it useful in improving the prognosis?]. / L'esame radiologico di massa nel carcinoma polmonare. E utile per migliorare la prognosi?

The diagnostic usefulness and practical possibilities of mass X-ray screening in lung cancer is examined. On the basis of the literature and personal experience, the conclusion is cautiously pessimistic, in agreement with what has recently been stated by Lemoine, Corda and others.

[Fiber bronchoscopy in the diagnosis of bronchopulmonary tumors. Evaluation of the diagnostic efficacy of a cyto-histologic protocol in an ambulatory center]. / La fibrobroncoscopia nella diagnosi del tumore broncopolmonare. Valutazione della resa diagnostica di un protocollo cito-istologico presso un centro ambulatoriale.

An examination was made of the series of 439 lung tumours diagnosed ambulatorially at the Turin Social Health Dispensary to assess the diagnostic return from several techniques (cytology of the sputum, bronchial aspirate and brushing; histology on a biopsy specimen) used singly or in combination. It was also sought to determine the increase in sensitivity obtained by adding technique to each one other, and to establish the overall sensitivity of the protocol. It was found that biopsy was the most sensitive technique (91% in tumours visible by fibrobronchoscopy). The single cytological techniques displayed a lower sensitivity than in the literature, and there was no significant difference among them. The most sensitive combination was brushing + sputum (89.2%), while the sensitivity of the protocol as a whole was much the same as that reported in the literature. In the case of fibrobronchoscopically visible lesions, multiple biopsies (preferably 3) may be sufficient, whereas combination of the three cytological techniques is necessary to ensure acceptable sensitivity with regard to invisible lesions.

[The acute treatment of supraventricular tachycardia with endovenous amiodarone]. / Trattamento acuto delle tachicardie sopraventricolari con amiodarone endovena.

In the present study we evaluated 35 patients of both sexes, aged 21-84, with newly occurring supraventricular tachyarrhythmias, 19 atrial fibrillation (AF), 6 atrial flutter (FL) and 10 paroxysmal supraventricular tachycardias (PSVT). They were treated with a single amiodarone infusion up to two hours after the restoration of a stable sinus rhythm or to a maximus dose of 2,400 mg (in 24 hours). Plasma amiodarone concentration and QTc were measured at the restoration of sinus rhythm and twelve hours after the amiodarone withdrawal. Amiodarone infusion restored a stable sinus rhythm in all 10 patients of the PSVT group (100%), in 5 of the FL group (83%) and in 16 of the AF group (84%). The average dose needed to stop PSVT was lesser than for AF and FL (M + SE: 473.3 +/- 36.88 vs 1842.1 + 259.6 vs 1548.8 +/- 345.5 mg; p less than 0.001). The average plasma amiodarone concentration at the restoration of sinus rhythm was 2450.4 +/- 175.9 SE ng/ml in all the tachyarrhythmias as a whole without any statistically significant difference among PSVT, FL and AF. Moreover no correlation exists between plasma amiodarone concentrations and the amount of amiodarone infused. QTc showed a statistically significant transient lengthening at the restoration of sinus rhythm, but not twelve hours after amiodarone withdrawal. In conclusion, a single dose of amiodarone is effective and safe in all newly occurring supraventricular tachyarrhythmias, without any important side effect and with a high therapeutic index in pharmacologic cardioversion as alternative treatment to cardioversion.

The oxygen affinity of normal human whole blood measured by double tonometry. II. pH-depending Bohr effect and DPG.

Following another preliminary work on the whole blood oxygen affinity, the Authors have found in this occasion normal values of the pH-depending Bohr effect in healthy subjects of both sexes and different age. Furthermore, the Hb decreasing causes in these cases also a P50 increasing which is mediated by raised DPG levels. However, while in the anemias this effect is constant, many exceptions have been found in physiological conditions. Since these ones have been mainly detected at the maximal DPG levels, the phosphate could modify the affinity not only as allosteric effector, but also by acting on pH and related equilibria as non diffusible free anion. These interferences are difficult to be calculated and often could disturb notably a correct use of the common mathematical model which describes the oxygenation.

[Critical course of a case of idiopathic pulmonary fibrosis]. / Evoluzione critica in un caso di fibrosi polmonare idiopatica.

The authors present a case of idiopathic pulmonary fibrosis with an unusual onset in the form of acute interstitial pneumonia. On being admitted to hospital the 53-year-old woman presented an altered breathing pattern which initially required oxygen therapy using Venturi's oxygen mask followed by sedation and mechanical ventilation with appropriate FiO2 to guarantee adequate pO2 and arterial saturation. For diagnostic purposes bronchiolar and alveolar lavage was immediately performed together with transbronchial biopsy during the course of fibrobronchoscopy. The results of these tests revealed a syndrome of interstitial pneumonia and widespread alveolar lesion with an enhanced lymphocyte population. Antibac-terial and immunosuppressive therapy (6-methylprednisolone and cyclophosphamide) commenced on the basis of these tests caused a temporary improvement in blood-gas parameters and parenchymal thickening. But in spite of treatment the patient's cardiocirculatory and respiratory conditions deteriorated, causing death. This case report raises a number of different questions regarding both diagnosis and treatment. With regard to diagnosis it is worth underlining the absence of hyaline membrane, pathognomonic of widespread alveolar lesions, in biopsies removed while the patient was still alive. With regard to treatment, in addition to specific antibiotic and immunosuppressive therapy, the authors consider that surfactants might be of some help given that widespread alveolar damage can be attributed to pulmonary fibrosis.

The whole blood oxygen affinity in normal human newborns: II) P50, n value and related parameters.

The cord blood from 82 normal newborns (48 males and 34 females) has been extensively investigated, to check p50, cooperativity and related parameters. The most important results are the following: Neonatal p50 is slightly above 20 torr, in good agreement with the literature data, but this value refers to the p50 "CO-free" (T50); otherwise, the original p50 is slightly less than 22 torr, a value which is not indicative enough, because neonatal blood contains a consistent excess of Hb-CO. Either this CO-excess and the low p50 value seem to be mainly depending on the low binding capacity of Hb-F with DPG, even if further studies are still necessary at regard. The empirical factor correcting adult p50 to T50 is -0.27, a value which must be increased to -0.36 for neonatal blood. Multiple gas analyses of the samples indicate that oxygen transport is a very complicate equilibrium involving pH, CO2, bicarbonate balance and other factors. A complete statistical analysis of the data has been carried out and the main result indicates that oxygen assumption favours CO2 releasing and vice versa, a phenomenon already well known and globally called "Bohr effect".