The treatment of pulmonary metastases in osteosarcoma. Preliminary observations on 30 cases

Thirty cases of pulmonary metastases in osteosarcoma are analysed from the point of view of evaluating the indications for localised excision, and also to report the results obtained. This group is compared with 42 analogous cases in which the metastases were not treated surgically. The results of pulmonary surgery is shown to be effective in the multidisciplinary treatment of osteosarcoma with pulmonary metastases.

[A thymus extract (thymomodulin) in the prevention of childhood asthma]

41 children aged 2-12 years affected with bronchial asthma, have been treated orally with a thymus extract for three months (sep.-oct.-nov. 1980); a further period of treatment has been repeated during the month of March 1981. The following immunologic tests have been performed before therapy, 2 months after therapy withdrawal and 12 months after the second therapeutical discontinuance: plasmatic immunoglobulins (P. Ig), C3-C4 complement's factors, E-rosette forming cells (both active and total), surface immunoglobulins (IgS), PHA lymphocyte stimulation. Periodic anamnestic and clinical controls of patients revealed a significant reduction of asthmatic attacks during the months of observation, in comparison with the crises remarked in the same period of the previous year (the mean number of crises per child being 6 and 0.7 respectively before and after treatment, P less than 0.001). The immunologic tests, despite the clinical results, did not show significant modifications at the 1st control. Nevertheless the control carried out 12 months after the second therapeutical withdrawal demonstrated: IgG and IgM plasmatic levels significantly increased (1097 +/- 63 vs 906 +/- 45 and 122 +/- 10 vs 104 +/- 10 respectively, P less than 0.02) while IgE, C3-C4 plasmatic levels significantly decreased (232 +/- 57 vs 396 +/- 71, 132 +/- 6 vs 162 +/- 7, 22 +/- 2 vs 30 +/- 2 respectively, P less than 0.005). No side effects have been seen in all the patients treated.

[Correlation between plasma IgE and IgA in infant nephrosis and nephrotic syndrome]

A study on IgE - IgA plasmatic level has been carried out in the acute phase and in remission of minimal changes nephrosis (MCN) and in glomerulonephritis with nephrotic syndrome (NS). The results obtained are the following: 1) Mean values of Ig classes were impaired in comparison with the normal values of children of the same age, both in MCN and in NS. 2) IgE were increased, particularly in children over 6 years in the MCN acute phase; the values decreased within normal after the remission was achieved. 3) IgA, on the contrary, were decreased in the subjects over 6 years, in the MCN acute phase. 4) No significant correlation was found between the two Ig classes. 5) The modifications of the Ig plasmatic level during the remission, after corticosteroid therapy was characterized by IgE reduction; IgA were only slightly, but not significantly, decreased in the same phase.

Transolecranal dislocations

The authors report the results obtained in the treatment of twenty-four cases of transolecranal dislocation (anterior dislocation of the elbow accompanied by fracture of the olecranon). Follow up examinations were performed after one to eight years. Discussion of the types of dislocation is followed by a description of the operations necessary to reduce and stabilise the individual lesions. In the light of the results obtained the authors still consider it advisable for the elbow to be immobilised in plaster for three weeks to allow the capsulo-ligamentous lesions caused by the dislocation to cicatrize.

[Diagnostic and therapeutic problems in lupus nephritis]

A review of the SLE in the paediatric age in performed to underline the peculiarity of the disease in children: age, frequency, symptomatology, renal histology, clinical course, therapy and correlated side effects are reported according to literature data. The A.A. describe six cases of lupus nephritis, observed in the last few years, which confirm the diagnostic difficulties and the wide variety in the evolution of the disease. A favourable course of the disease was obtained in three cases, with corticosteroid and immuno-depressive treatment (used in association and/or alternatively); a fourth case developed some therapeutic complications among which an avascular bilateral bone necrosis, leucopenia, alopecia and herpes zoster. In two cases the SLE led to chronic renal failure owing to many relapses of the disease, enhanced by therapeutic break or dosage reduction. A careful surveillance of these patients is of fundamental importance in the management of the disease in order to obtain the longer survival and the lesser side effects.

[Asymptomatic microhematuria]

Microscopic haematuria is an urinary finding more and more frequently observed in routine analysis in childhood; the diagnostic problems, most of which unresolved, are yet the principal questions of concern. We have studied 123 patients during five years from 1975 to 1980, and followed them for 1-8 years (mean 4 years). Our experience allowed us to consider "normal" or without remarkable pathologic significance a urinary finding less than or equal to 5.000 RBC/m' at the Addis count. Such findings were pointed out in 55 cases (44%); 27 patients (22%) had 5-10.000 RBC/m', 34 cases (27,6%) presented 10-50.000 RBC/m' and 7 cases (5,7%) had more then 50.000 RBC/m'. The familiar background, the clinical, biological and immunological data, the roentgenographic investigations and the renal biopsy carried out in the 4 groups of patients, led us to the following conclusions: 1) 26% of the 123 cases had a "unexplained;; microscopic haematuria with complete lack of anamnestic data, symptomatology and with normal biological findings. 2) in 65,8% of the cases it was possible to discover frequent upper respiratory tract infections (and allergy in 5,6% of them). 3) in 26% of the patients we discovered a previous or actual genito-urinary (10,5% and 15,5% respectively) infection: 9,4% of 96 urography demonstrated a variable degree of nephro-urological abnormalities. 4) 23 children (18,7%) was selected for renal biopsy, primarily by the hypocomplementemia and positive anti-DNA ab. test, and secondly by elevated degree of microhematuria. The histological and immunohistochemical studies demonstrated the presence of mesangial proliferation glomerulonephritis with IgG-IgA-C3 deposits in 7 cases (30% of the cases biopsied and 5,6% of the total), 69,6% of the cases had only minimal charges with negative immunofluorescence. 5) A mean follow-up of 4 years in two groups of patients (less than or greater than 6 years of age) has demonstrated that microscopic haematuria remains unchanged in 18-19% of both groups. A more marked improvement or normalization has been documented in the children more than 6 years aged (p less than 0,001) while a worsening has been observed in the children less than 6 years aged (p less than 0,005), with a statistically significant difference between the two groups considered.

[Study of factors affecting the renin-angiotensin-aldosterone system in the premature infant]

Renin-angiotensin-aldosterone system (RAA), Na-K dietary intake and Na-K urinary excretion in 36 premature babies have been investigated. The plasmatic renin activity (PRA) and plasmatic aldosterone level (P-aldo) resulted significantly increased in comparison with children previously studied, 20 days - 23 months old (p less than 0,01). P-aldo demonstrated, in premature babies, a negative correlation with Na-K intake and urinary excretion (p less than 0,001 and less than 0,01 respectively); in the groups nourished with maternal milk or "adapted" formulae P-aldo mean value was significantly more elevated than in the group nourished with formulae "unadapted" (p less than 0,01). A different Na dietary intake seems to be the most important factor influencing P-aldo level also in premature babies. No correlation between PRA - electrolyte excretion was found in any group. The main factor influencing PRA seems to be the age of infants as well as, probably, other hemodynamic mechanisms.

[Is it possible to improve the prognosis of congenital nephrosis?]

Two cases of congenital nephrotic syndrome (C.N.S.) with a prolonged survival are related. The AA. outline some clinical and immunological features which are already known but not currently employed to therapeutic ends. Probably due to metabolic disorders, the biological and clinical hypothyroidism is a prominent problem which worsens either poor skeleton maturation or neurological development of these patients; adequate doses of thyroid hormone produced a marked increase of the muscular tone, skeleton maturation and neuropsychological development in both patients. Periodic plasma administration (2-3 times monthly) during the first year of life, and a great care to avoid all extra-family contacts and infections in the same period, resulted to be the prevalent reason of the prolonged survival of these children (the plasma acting as a source of proteins and immunoglobulins). The immunologic assessment demonstrated in both children as marked depression of T-cells number and function, besides a hypogammaglobulinemia. This aspect of the immunocompetent system is similar in C.N.S. and nephrotic syndrome of the aged children and perhaps could approach the pathogenesis of the two diseases. The cases related demonstrate that a better assistance is possible and necessary in order to obtain the longest survival of these patients and therefore the best results in dialitic treatment and in transplantation programs.

[Medical and dietetic management of congenital and inherited nephropathies (author's transl)]

The management of the congenital and inherited nephropathies is, still today, almost exclusively symptomatic. The authors relate the most important drugs and the dose used for the principal complications of these nephropathies: hypertension, hypo-dysprotidoemia, oedema, anemia, metabolic acidosis, polyuria, hypoevolutism, recurrent urinary infections. Particular care must be taken in order to provide an adequate caloric-protein allowance principally when the renal insufficiency is reached.