Epirubicin versus mitoxantrone in combination chemotherapy for metastatic breast cancer.

As valid therapeutic alternatives to adriamycin, with a more favourable safety profile, epirubicin (E) and novantrone (N) were compared in combination with fluorouracil (F) and cyclophosphamide (C) in a prospective randomized clinical trial as first-line treatment for metastatic breast cancer (mbc). 158 women with mbc were randomly allocated to receive FEC or FNC regimen; the dosage in mg/m2 was as follows: 500 for C and F, 75 for E and 10 for N. All drugs were administered iv.

[Abdominal propriospinal myoclonus of unknown etiology].

We report the case of a 77-year-old woman with a two-year history of abdominal non rhythmic myoclonus. Neurological examination was normal. Bursts of myoclonic activity were recorded from the rectus abdominis muscle and then from the external oblique muscle after a delay of 40 ms.

[Psychological, behavioral and occupational status changes after an aortocoronary bypass intervention].

BACKGROUND. Studies on the quality of life after coronary artery by-pass grafting (CABG) have yielded discordant results. Several studies have described psychological and social improvements while others have reported a lack of change in behavioural risk factors and return to work.

[Medium- and long-term effects of various treatment schedules with nasal S-calcitonin spray].

188 patients with high-turnover type post-menopausal osteoporosis were treated for 18 months with 4 different treatment regimens of S-calcitonin nasal spray. For a total of 18 months group 1 was given 100 IU/day, continuously; group 2, 100 IU/day daily for 30 days every other month ("ciclically"); group 3, 200 IU/day continuously, and group 4, 200 IU/day, ciclically. To monitor the effects of treatment, MOC of L2-L4, as well as serum osteocalcin and urinary hydroxyproline: creatinine levels were measured, on initiation of therapy, then at 9, 12 and 18 months, and finally at 6 and 12 months after completion of therapy.

[A computerized endurance test: efficacy of pelvic floor rehabilitation treatment in patients with stress incontinence].

In the present study the authors wanted to transfer rigorous methods of study, already in use in other sectors (sports, medicine, isokinetic work, etc.) of the validity of interventions made and their effectiveness, into an "emerging" field, that of perineal rehabilitation. 15 female patients, aged between 35 and 45, affected by stress incontinence underwent a baseline clinico-instrumental evaluation of the perineal floor including a computerized test of endurance.

Reproducibility of Doppler indices of left ventricular systolic and diastolic function in patients with severe chronic heart failure.

Doppler ultrasound has been utilized to evaluate cardiac output and left ventricular filling pressure in patients with various cardiac diseases. This method would be particularly useful for non-invasive haemodynamic monitoring in patients with severe chronic heart failure. However, few data exist on the reproducibility of Doppler indices in this population.

Drinking habits and occupational exposure to xenobiotics: a review.

The evaluation of health status of workers exposed to a variety of chemicals is usually performed by means of several laboratory indices. Our aim is to review literature data in order to evaluate the influence of some lifestyle characteristics (alcohol intake) on these parameters. Since alcohol intake is responsible for a modification of some laboratory parameters in healthy workers, the medical surveillance of workers exposed to chemicals should include a careful evaluation of alcohol intake.

[Toxicity of chemical elements].

A survey is presented of the most important facets of toxicity due to chemical elements as well as of the mechanisms through which it may be triggered. In particular, a detailed discussion is made on the characteristics shown by arsenic, cadmium, chromium, lead, mercury, barium and beryllium, with specific reference to the influence exerted by physiological, environmental and life-style factors.

[Assessment of factors causing pre-analytic variabililty].

Preanalytical variability can affect the results of trace element determinations. Even using sensitive and reliable analytical methods, the analysis of a contaminated specimen can only lead to erroneous results. Analyte contents in a sample can be altered during collection, storage and pretreatment, including simple dilution.

Activation of ANP synthesis during congestive heart failure in rats treated with monocrotaline.

We studied plasma concentration, content, and mRNA for atrial natriuretic peptide (ANP-mRNA) in heart chambers of monocrotaline-treated rats. Three distinct groups emerged: group 1, with moderate congestive heart failure (CHF; pleural effusion < 1 ml; no peritoneal effusion); group 2, with severe CHF (pleural and peritoneal effusion > 1 ml); and group 3, with right hypertrophy and no CHF. Group 1 and 2 rats had right atrial and ventricular hypertrophy, raised plasma ANP (from 16.

[Determination of low levels of urinary trans,trans-muconic acid].

A method is described which allows determination of urinary t,t-muconic acid (MA) by means of HPLC with UV detection even at micrograms/l concentrations. The clean-up procedure of samples involves the use of strong anionic-exchange cartridges (SAX) for solid phase extraction (SPE). In order to improve the reproducibility of the retention time of MA (CV < 1%) and to obtain an adequate separation of MA from interferents, a high performance reverse-phase column (250 x 4.

Hemidiaphragm dysfunction due to megacolon: functional recovery after colectomy.

We describe an uncommon case of hemidiaphragm dysfunction in a man with megacolon. The patient complained of exertional dyspnoea associated with a restrictive ventilatory impairment, a reduction in respiratory muscle force, and a left hemidiaphragm elevation on roentgenogram. During maximal inspiratory manoeuvre, the electromyograph (EMG) showed an abnormal pattern in the time of recruitment of the left hemidiaphragm, associated with a rapid decline in force.

Evaluation of occupational exposure to benzene by urinalysis.

Urinary phenol determinations have traditionally been used to monitor high levels of occupational benzene exposure. However, urinary phenol cannot be used to monitor low-level exposures. New biological indexes for exposure to low levels of benzene are thus needed.

Stem cell factor and interleukin-6, alone or in combination with granulocyte colony-stimulating factor, do not affect the growth of solid tumor cell lines.

Hematopoietic growth factors (HGFs) are glycoproteins that control hemopoiesis. They have potential usefulness in a range of clinical conditions including the treatment of patients with myelosuppression induced by chemotherapy. Among HGFs, Stem Cell Factor (SCF) and Interleukin 6 (IL-6) are attracting interest for their capacity to stimulate early hematopoietic progenitors.

Professional figures in intermediate intensive units.

In Italy, respiratory intermediate intensive care units (IICUs) are not yet considered as autonomous hospital departments. The IICU of the Rehabilitation Department of the Medical Centre of Gussago (12 monitored beds) provides care for respiratory and cardiac patients. Ventilatory assistance and noninvasive modalities both in treatment and monitoring suggest a multidisciplinary approach to the patient.

Weaning and outcome from mechanical ventilation.

Weaning means the ability of a patient to breath spontaneously after mechanical ventilation. In chronic obstructive pulmonary disease (COPD) patients, inability to tolerate discontinuation of mechanical ventilation is reported to have an incidence of 25-60%. It is, therefore, important to employ simple parameters able to predict weaning success, since, in the case of failure, the validation of predictive indices of weaning may also contribute to the decision of whether or not these patients should eventually enter a programme of home ventilation.

Ventilation techniques: invasive versus noninvasive.

Conventional medical treatment of COPD patients with acute respiratory failure (ARF) was associated with an overall mortality ranging 12-29%. When conservative treatment fails, ARF is usually managed by means of mechanical ventilation (MV) via an endotracheal tube (ET) or tracheostomy. Mortality of COPD patients with ARF treated with invasive MV ranged 21-54%.

Location and architectural structure of IICU.

When an Intermediate Intensive Care Unit (IICU) is planned, three groups of professionals are usually involved: the managers of the hospital, the architects and the staff. Although several aspects and problems related with the building of IICUs are considered in the specialized literature, lack of communication and discussion of the appropriate issues at the appropriate time is the origin of several errors during the planning and building of IICUs. Standards of IICU for respiratory departments have been proposed by the Working Group "Rehabilitation and Intensive Care" of the Italian Hospital Pneumologist Society.

[Assessment of the autonomic nervous system after infarction and its prognostic significance].

Recently there has been increased interest in the analysis of heart rate variability (HRV) and baroreflex sensitivity (BRS) for postinfarction risk stratification. HRV and BRS are decreased in patients following myocardial infarction and both a reduced HRV and a depressed BRS identify a subgroup at higher risk of cardiac mortality and arrhythmic events. In a large trial of post-myocardial infarction patients the relative risk of mortality was 5.

Decreased heart rate variability in patients with chronic obstructive pulmonary disease.

To evaluate possible autonomic nervous system (ANS) dysfunction in patients with chronic obstructive pulmonary disease (COPD) in the absence of any hypoxic neuronal damage, we studied 31 patients with COPD patients aged 31 to 68 years (55 +/- 10) and 32 age-matched healthy subjects (control). Respiratory function in the patients was as follows: FEV1 = 52 +/- 8 percent; PaO2 = 71 +/- 14 mm Hg; and PaCO2 = 40 +/- 10 mm Hg. The ANS was assessed by heart rate variability (HRV) in the time domain (SD of mean RR interval) and frequency domain (autoregressive spectral analysis recognizing low [LF] and high [HF] frequency components, vagal and sympathetic related, respectively).

Extraction and assay of creatine phosphate, purine, and pyridine nucleotides in cardiac tissue by reversed-phase high-performance liquid chromatography.

The levels of creatine phosphate, purine, and pyridine nucleotides in tissues provide important information on energetic and oxidative cellular states. Nevertheless, technical, theoretical, and methodological difficulties in extraction and quantification procedures have so far limited our understanding of the exact role that these substances play in metabolic processes which take place in cells. The objective of our study was to find an easy and rapid method for extracting, separating, and quantifying creatine phosphate, purine, and pyridine nucleotides in solid tissues.