Spontaneous echo-contrast as an in vivo indicator of rheological imbalance in dilatative cardiomyopathy

The aim of this study was to evaluate coagulative and hemorheologic assessment in patients with dilatative cardiomyopathy with or without spontaneous echo contrast (SEC). We studied 45 patients, 35 males and 10 females (mean age 72.1 +/- 9.2). We measured whole blood viscosity, plasmatic fibrinogen, prothrombin time (PT), activated partial thromboplastin time (aPTT), D-dimer and red cell morphology with Zipursky-Forconi method. Transthoracic and transesophageal echocardiography was performed in all patients to evaluate the presence of SEC in left atrium. We divided all the patients into two groups: the 1st group of 20 patients with SEC and Atrial Fibrillation (AF) in 80% of cases, and the 2nd group of 25 patients without SEC and AF in 31%. Our results show that in patients with SEC there is a statistically significant increase of whole blood viscosity and plasma fibrinogen in comparison with patients without SEC. Red cell morphology in all patients demonstrates a reversed EMI. D-Dimer, was out of the normal range in about 1/3 of the patients in both groups. An analysis of our results points out that in patients with SEC and AF, with a major risk factor for cardioembolic stroke, we have alterations of hemorheologic assessment with an increase of whole blood viscosity and fibrinogen that seems to be caused by an increase of red cells aggregability favoured by fibrinogen. Our conclusions are that SEC in patients with dilatative cardiomyopathy and AF is an important in vivo indicator of hemorheologic imbalance and an important marker for cardioembolic risk stroke evaluation.

Long-term survival of atypical bronchial carcinoids with liver metastases, treated with octreotide

OBJECTIVE

To demonstrate that liver metastases by radically resected atypical carcinoids of the lung can be effectively treated by new somatostatin analogs.

METHODS

Between January 1977 and December 1999, 126 patients affected by bronchial carcinoids were submitted to a radical resection of the lung. Seven of them (5.5%) presented liver metastases 27, 22, 14, 18, 16, 12 and 9 months after surgery: carcinoid syndrome (CS) was ever present. 111In-DTPA-pentetreotide scintigraphy (Octreoscan) and ultrasound guided biopsy were performed in all cases, and the presence of somatostatin receptors sst2 was demonstrated by polymerase chain reaction (PCR) method.

RESULTS

Five patients refused the proposed chemotherapy, and liver alcoholization was not feasible. Octreotide was administered at the dose of 1500 microg/daily subcutaneously. CS was controlled and also high urinary 5-hydroxyindoleacetic acid values returned to normal after a median of 7 days (range 4-10 days) of medical treatment. No important side effects were registered, and a good quality of life was observed. The patients are alive and well at 51, 36, 24, 24, 23, 19, and 16 months after the diagnosis of the metastases, respectively. In two cases ultrasounds revealed the reduction and in one case the complete resolution of the liver lesion.

CONCLUSIONS

Octreotide is effective in controlling symptoms of CS of patients with liver metastases of resected atypical bronchial carcinoid. The efficacy of the drug is due to the presence of sst2 somatostatin receptors in the pathologic tissue, as demonstrated by PCR method. The positivity to Octreoscan depends on the presence of the same receptors. Octreoscan may be used in the follow-up of these neuroendocrine neoplasms of the lung. A positivity to Octreoscan is predictive for an effective therapy with octreotide.

Stage I non-small cell lung carcinoma: really an early stage?

OBJECTIVE

We review our results on surgical treatment of patients with stage I non-small cell lung carcinoma and we attempted to clarify the prognostic significance of some surgical--pathologic variables.

METHODS

From 1993 to 1999, 667 patients received curative lung resection and complete hilar and mediastinal lymphadenectomy for non-small cell lung cancer. Of these, there were 436 Stage I disease (65%), of whom 144 T1N0 and 292 T2N0. No patients had pre- or postoperative radio- or chemotherapy. Prognostic significance of the following independent variables was tested using univariate (log-rank) and multivariate (Cox proportional-hazards) analysis: type of resection (sublobar vs lobectomy vs pneumonectomy), histology (squamous cell vs adenocarcinoma), tumour size (<or=3cm vs >3cm), histologic vascular invasion, visceral pleura involvement, positive bronchial resection margin, general T status.

RESULTS

Overall 5-year survival was 63%. In both univariate and multivariate survival analysis, significant prognostic factors were histology (adenocarcinoma 65% vs squamous cell carcinoma 51%), tumour size (<or=3cm 67% vs >3cm 46%), and the presence of negative resection margin. Five-year survival by general T status was 66% in T1N0 vs 55% in T2N0 disease (P=0.19).

CONCLUSIONS

Despite advances in early diagnosis and surgical technique, 5-year survival of stage I non-small cell lung carcinoma remains low as compared to survival of other solid organ neoplasm. Tumour size <or=3cm, adenocarcinoma histologic type and negative bronchial resection margins were associated with a more favourable outcome in our patient population. More effective multimodality treatments are needed to increase survival rates.

Bronchial carcinoid tumors: surgical management and long-term outcome

OBJECTIVE

We sought to determine the variables influencing long-term survival of patients treated for bronchial carcinoid tumors.

METHODS

A retrospective, mono-institutional review of patients subjected to surgical treatment since 1977 was conducted.

RESULTS

Over 22 years, 126 patients with a final histologic diagnosis of bronchial carcinoid tumors were assessed for surgery. The group comprised 72 men (57%) and 54 women (43%) with a mean age at presentation of 47 +/- 16 years (range 11-77 years). Symptoms were present in 65 (53%) patients. Operations included lobectomy or bilobectomy in 88 (with 4 bronchoplastic procedures), pneumonectomy in 15, segmentectomy in 3, wedge resection in 16, and bronchial sleeve resection in 3 patients. One patient (0.7%) died in the perioperative period. Eighty-two patients (65%) had typical and 44 (35%) had atypical carcinoid tumors. Postoperative staging was complete for 113 of 126 patients (13 patients did not undergo lymphadenectomy): 90 patients had stage I disease, 6 had stage II, 15 had stage III, and 2 had stage IV disease. A typical subtype was stage I in 70 and more advanced (II-IV) in 5, whereas an atypical subtype was stage I in 20 and more advanced in 18 (P <.05). Mean follow-up was 99 +/- 73 months (range 6-282 months) during which 19 (15%) patients died (12 of recurrent disease). Recurrent tumor developed in 4 (5.5%) of 72 patients affected by typical subtypes and 8 (19.5%) of 41 by atypical subtypes with complete follow-up. Overall survival at 15 years was 74%; survival related to histologic type and nodal status at 15 years was significant (P <.05).

CONCLUSIONS

Biologic behavior and prognosis for bronchial carcinoid tumors are better than for other lung cancers. Surgical treatment requires radical excision and lymph node sampling. Survival and long-term outcome are significantly related to the histologic type, nodal status, and pathologic stage.

Value of splanchnic Doppler ultrasound in the diagnosis of portal hypertension

The accuracy of various Doppler parameters of portal circulation in the diagnosis of relevant portal hypertension (presence of gastroesophageal varices) was prospectively validated. The following parameters were compared in 51 patients with chronic liver disease (40 with cirrhosis and 11 with chronic hepatitis): portal vein flow velocity and congestion index, hepatic and splenic arteries resistance indexes (RI), modified liver vascular index (portal flow velocity/hepatic artery RI) and portal hypertension index, a new index calculated as: [(hepatic artery RI x 0.69) x (splenic artery RI x 0.87)]/portal vein flow velocity. Highest accuracy was achieved by the splenic artery RI and the portal hypertension index (both around 75%) at cut-offs, respectively, of 0.60 and 12 cm/s(-1), which appeared to be, therefore, the most favorable parameters for the clinical practice. Their use may limit the need for endoscopy to search for varices.

Influence of liver fibrosis on hepatic artery Doppler resistance index in chronic hepatitis of viral origin

BACKGROUND

Hepatic arterial Doppler sonography is increasingly being used in liver diagnostics. The determinants of the elevation of hepatic artery impedance indexes in chronic liver disease, however, have still not been fully clarified. The aim of the present study was to investigate the relationship between histological alterations and liver circulation in chronic hepatitis.

METHODS

Hepatic artery resistance index and portal flow velocity were measured using Doppler sonography in 47 patients with chronic hepatitis of viral origin diagnosed at histopathology. The patients were divided into two groups, those with mild and those with severe alterations, in accordance with the various histological parameters of the Knodell scoring system.

RESULTS

Hepatic artery resistance index and age were higher in patients with more severe liver fibrosis (respectively 0.638 +/- 0.084 and 39.0 +/- 10.9 (years) in mild fibrosis versus 0.687 +/- 0.060 and 49.4 +/- 14.4 (years) in severe fibrosis; P < 0.05 for both), whereas no difference between the two groups was found for the other histological features (degeneration, inflammation and necrosis), nor for portal flow velocity.

CONCLUSIONS

The increase in hepatic artery resistance index appears to be influenced by the extent of fibrous tissue deposition in the liver, determined by chronic inflammation and repair and, secondly, by ageing.

Intra- and post-dialytic platelet activation and PDGF-AB release: cellulose diacetate vs polysulfone membranes

BACKGROUND

During haemodialysis the blood-membrane contact causes a release of platelet granule content, which contains platelet-derived growth factor AB (PDGF-AB). In view of the potential role of this in altering biocompatibility during haemodialysis, we evaluated the intra- and post-dialytic changes in PDGF-AB serum levels during haemodialysis sessions performed with cellulose diacetate (CDA) and polysulfone (PS) membranes respectively.

METHODS

PDGF-AB, platelet factor 4 (PF4), beta thromboglobulin (betaTG), and mean platelet volume (MPV) levels were determined in 30 patients, each of whom underwent six dialysis sessions: three with a CDA and three with a PS membrane. Blood samples were taken at times 0, 15, 30, 120, 180, and 240 min during dialysis and at 1, 4, and 20 h after the end of the session. Statistical analysis was performed using a one-way ANOVA and Student's t test.

RESULTS

PDGF-AB at 15 min was increased to +41+/-9% with CDA vs +20+/-5% with PS (P<0.001) from the T0 values, and at 120 min it was +19+/-8% with CDA vs -25+/-9% with PS (P<0.001) from T0 levels. At 240 min it was +95+/-14% with CDA vs +49+/-15% with PS (P<0.001) from the T0 values, returning to basal only 20 h after the end of the session. betaTG at 15 min was +60+/-8% for CDA vs +24+/-7.5% for PS (P<0.001) from the T0 values. PF4 showed a similar trend to betaTG. MPV at 30 min from the start of dialysis was 7.4+/-0.3 fl with CDA and 8+/-0.3 fl with PS (P<0.001), and at 240 min MPV was 7.9+/-0.3 fl with CDA and 8.4+/-0.3 fl with PS (P<0.001).

CONCLUSIONS

Platelet activation and platelet release reactions are lower with PS than with CDA membranes. PDGF-AB, released during and after dialysis, represents a clear biocompatibility marker. Its slow return to basal values and its action on vascular cells make it a potential risk factor for atherosclerosis in uraemic patients.

[Treatment according to "evidence-based medicine" of aged-related exudative age-related macular degeneration (laser photocoagulation and photodynamic therapy)]

INTRODUCTION

Age related macular degeneration (AMD) is actually the leading cause of severe visual acuity loss in people over 65 in the Western World. Most of the visual loss is due to choroidal neovascularization (CNV).

METHODS

Review of the literature.

RESULTS

For more then 10 years laser photocoagulation was the only proven treatment for selected cases of AMD according to the evidence based medicine criteria. In 1999 photodynamic therapy was proven to be efficient for the treatment of predominantly classic subfoveal CNV.

CONCLUSION

Laser photocoagulation and photodynamic therapy constitute therefore the only evidence based medicine treatment available for CNV in AMD.

[Value of indocyanine green angiography in detection of central serous chorioretinopathy]

INTRODUCTION

Central serous chorioretinopathy (CSC) is a relatively common and self-limited disease affecting more commonly young adult males who are likely to have a type A personality. The aim of our study was to analyze indocyanine green (ICG) angiographic findings in CSC and correlate them with the biomicroscopical and Fluoresceine angiography (FA) findings in the affected and non affected eyes.

PATIENTS AND METHODS

Our study included 19 consecutive patients, that were affected by CSC. The mean age of the patients was 44 years (range 35-50 years). In thirteen patients, in one eye typical acute lesions were observed, and in six patients presented chorioretinal inactive lesions. Angiographic ICG and FA findings of both eyes were compared.

RESULTS

In 13 eyes (68%) presenting with the active form of CSC a classic focal leak with a smokestack phenomenon was seen in FA. The leaking point was identified in both FA and ICG, in 9 out of 13 eyes (70%). Surrounding the FA leaking point, an hyperfluorescent plaque in ICG was associated in 12 out of 13 (92%) eyes with active lesions. In 8 out of 13 (62%) controlateral eyes of this group, hyperfluorescent plaques in ICG were also observed. All eyes with inactive FA lesions (6 out of 6), expressed an hyperfluorescent plaque in ICG.

DISCUSSION

ICG hyperfluorescence appears in the affected and the fellow eyes in areas where no clinical or FA signs of active disease were present. The persistence of abnormal ICG findings in all the cases of inactive disease suggest that CSC could be not a recurrent but a chronic disease.

Nocturnal activity in the cathemeral red-fronted lemur (Eulemur fulvus rufus), with observations during a lunar eclipse

Several ecological and physiological factors have been suggested to structure circadian activity in cathemeral primates, i.e., those that are regularly active both day and night, but their relative importance remains controversial. We studied the nocturnal activity of a group of cathemeral redfronted lemurs (Eulemur fulvus rufus) in Kirindy Forest in Western Madagascar to examine its relationship with one environmental factor, ambient light levels, in detail. To this end, nightly travel distances and moon luminosity were determined between March and June 1996. During this transitional period between the wet and dry seasons these red-fronted lemurs were regularly active at night, and traveled significantly larger distances during full-moon nights compared to new-moon nights. The importance of ambient luminosity for nocturnal activity was highlighted by observations during a total lunar eclipse (i.e., during a full-moon night), which caused abrupt cessation of the animal's activity. Our results support the hypothesis that nocturnal activity of these cathemeral lemurs is regulated also by changes in ambient light levels.

[Idiopathic giant retinal tears: treatment with vitrectomy and temporary silicone oil tamponade]

PURPOSE

Vitrectomy with intraoperative use of perfluorocarbon liquids facilitates the treatment of giant retinal tears and permits the reattachment of the retina. This surgical technique maximizes the anatomic results with decreasing of failures and complications associated with the extraocular surgical approach.

MATERIAL

and

METHODS

Fourteen patients were operated on for idiopathic giant retinal tears without proliferative vitreoretinopathy. All patients underwent pars plana vitrectomy, unfolding of the giant retinal tears by perfluoro-n-octane, endophotocoagulation, cryoapplication and temporary silicone oil tamponade (ablation after 2 months). Visual acuity, anterior segment examination and fundus examination with a contact lens were performed preoperatively, followed by a control one week later, as well as monthly for 6 months and after that every 3 months postoperatively.

RESULTS

Visual acuity at the end of the follow-up (mean 22 months) was increased by 3 lines or more in all cases but one. Postoperatively the retina was reattached in all of the cases. A recurrence of localized retinal detachment secondary to a focal proliferative vitreoretinopathy was observed in one case. Cataract formation (80% of the cases) and epiretinal macular membranes (50% of the cases) were the most frequent complications.

CONCLUSION

The treatment of idiopathic giant retinal tears with vitrectomy and temporary silicone oil tamponade maximizes the functional results and permits the definitive reattachment of the retina in detriment of the classic complications of vitrectomy.

[Pseudophakic retinal detachment: treatment by vitrectomy and scleral buckling. Pilot study]

INTRODUCTION

Localization of retinal tears generating a pseudophakic retinal detachment (RD) is not always possible; subsequently, segmental indentation by external compression often causes a residual RD. Vitrectomy enables a detailed view of the peripheral part of the retina and better detection of small size retinal breaks. Our pilot survey report anatomic and functional results of a surgical treatment of pseudophakic RD, associating vitrectomy and scleral buckling.

MATERIAL AND METHODS

Twenty three consecutive pseudophakic eyes showing an RD were operated on with scleral buckling, vitrectomy, internal subretinal fluid drainage, endolaser and fluid-air exchange by SF(6) 20%. Preoperative findings, intraoperative and postoperative complications, and final results were analyzed.

RESULTS

The retina was successfully reattached with a single operation in 21 eyes (92%). One eye presented a recurrence of RD due to a preexisting retinal tear. PVR was observed in one case with the recurrence of the RD. In both cases, a second operation achieved the retinal reattachment. After surgery, visual acuity improved on an average of 3 lines. The most frequently occurring complication was a transitory hypertony in 6 cases (26%).

CONCLUSION

Surgical treatment of the pseudophakic RD, combining vitrectomy and scleral buckling shows very good anatomic and functional results; it seems to offer the advantage of a better localization of peripheral retina tears, which enables a recovery with a lower recurrence rate than by extra-ocular surgery only.

Frontal nonconvulsive status epilepticus associated with high-dose tiagabine therapy in a child with familial bilateral perisylvian polymicrogyria

PURPOSE

Antiepileptic drugs are known to exacerbate absence and myoclonic seizures, especially in patients with idiopathic generalized epilepsies. Exacerbation of nonconvulsive generalized seizures in patients with partial epilepsy is less common. Recently, however, a number of cases of putative generalized nonconvulsive status epilepticus (NCSE) or NCSE without further specification have been reported in patients with chronic partial epilepsy treated with the gamma-aminobutyric acid reuptake inhibitor tiagabine. Although complex partial status epilepticus during tiagabine therapy has also been reported, possible precipitation of NCSE specifically associated with frontal lobe discharges does not appear to have been recognized. In this communication, we describe the case of a boy with familial bilateral perisylvian polymicrogyria who developed frontal NCSE after being stabilized on high-dose tiagabine

METHODS

A 12-year-old boy with familial bilateral perisylvian polymicrogyria, mental retardation, and refractory partial seizures was administered tiagabine in addition to sodium valproate. The tiagabine dosage was increased gradually up to 10 mg t.i.d. (1 mg/kg per day), resulting in complete seizure control.

RESULTS

After 1 week on maintenance treatment, seizures were completely controlled, but the child developed hypoactivity, decreased reactivity, and affective detachment. An EEG recording revealed subcontinuous sharp-wave discharges with irregular runs of atypical spike-wave complexes over the anterior regions of both hemispheres, consistent with a diagnosis of frontal NCSE. A reduction in tiagabine dosage to 15 mg/day led to complete regression of the behavioral and affective changes and to disappearance of the subcontinuous EEG discharges.

CONCLUSIONS

Although tiagabine-induced NCSE has been described previously, particularly in patients with preexisting spike-wave abnormalities, this is the first report that identifies its potential role in the precipitation of frontal NCSE.

Vitrectomy for traction macular edema

PURPOSE

Traction macular edema may develop through contraction of macular epiretinal membranes (ERM), or due to persistent vitreomacular traction during the evolution of vitreomacular traction syndrome (VMS). The purpose of this retrospective study was to determine the effect of vitreous surgery and the release of the vitreomacular traction or the removal of epiretinal membranes, on the evolution of traction induced macular edema.

MATERIAL AND METHODS

Fourteen eyes from 14 patients presenting with idiopathic or secondary epiretinal membranes, and 11 eyes from 10 patients presenting with vitreomacular traction syndrome, underwent vitrectomy for reduced vision and cystoid macular edema, identified by slit-lamp examination and fluorescein angiography. No coexistent ocular conditions that might have caused macular traction were present. History, preoperative eye examination, operative findings, postoperative course and final examination as well as pre- and postoperative fluorescein angiography were reviewed.

RESULTS

In the ERM group, cystoid macular edema disappeared in all cases during the postoperative period and the mean visual acuity (VA) at the end of the follow-up (0.48 +/- 0.23) significantly increased compared to the preoperative one (0.29 +/- 0.2) (p=0.004). In the group of patients suffering from VMS, the posterior vitreous traction on the macula was released and macular edema disappeared in all cases but one. The mean v.a. at the end of the follow-up (0.42 +/- 0.24) significantly increased compared to the preoperative one (0.18 +/- 0.1) (p=0.01). Complications included intraoperative small petechias and postoperative progressive nuclear sclerosis, retinal detachment and retinal pigment epitheliopathy.

CONCLUSIONS

Cystoid macular edema may develop secondary to vitreomacular traction syndrome or epiretinal membrane contraction. Vitrectomy is effective in releasing macular traction which, in turn, may induce a decrease of the macular edema with improvement of visual acuity.

TGF-beta1, TGF-beta receptor II and ED-A fibronectin expression in myofibroblast of vitreoretinopathy

PURPOSE

Formation of scarlike epiretinal membranes (ERMs) constitutes potentially the end stage of evolution of proliferative vitreoretinopathy (PVR) and proliferative diabetic retinopathy (PDR). Among various cellular populations, ERMs contain cells with contractile features typical of myofibroblasts. The current study was conducted to investigate the presence of transforming growth factor (TGF)-beta1, TGF-beta receptor II (RII) and ED-A fibronectin (FN), the main inducers of myofibroblastic differentiation in ERMs in PDR and PVR.

METHODS

Samples of ERM were obtained from 23 patients during microsurgery for PVR or PDR. Electron microscopy, immunohistochemistry, and confocal microscopy with antibodies recognizing beta-smooth muscle (SM) actin, desmin, TGF-beta1, TGF-beta receptors I and II, and ED-A FN were performed.

RESULTS

alpha-SM actin was detected in all ERMs, whereas desmin was present in 50% of the cases. ED-A FN was expressed in all ERMs in close relation with alpha-SM actin-positive myofibroblasts. In addition, TGF-beta1 and TGF-beta R II were always present, TGF-beta RII being expressed in both alpha-SM actin-positive and negative fibroblastic cells.

CONCLUSIONS

Myofibroblast accumulation is a key event in ERM-associated traction retinal detachment occurring during PVR and PDR. The current results suggest that the presence of alpha-SM actin-positive myofibroblasts is probably dependent on the concomitant neoexpression of TGF-beta1, TGF-beta RII, and ED-A FN. The results furnish new data on the mechanism of alpha-SM actin stimulation in fibroblasts in a human pathologic setting.

Macular epiretinal membranes

Epiretinal membranes (ERM) are a common finding in older patients. Although they may be associated with numerous clinical conditions, most epiretinal membranes occur in the absence of ocular pathology. Patients symptoms range from asymptotic to complaints of severe vision loss and metamorphopsia. Epiretinal membranes are commonly classified according to their density, to the severity of retinal distortion and to associated biomicroscopic changes. Pars plana vitrectomy has been found to be effective in removing ERM from the macula, improving the visual acuity and decreasing metamorphopsia. Both idiopathic and secondary ERMs do well after surgery, although secondary ERMs showed a greater amount of improvement than idiopathic ones. Complications are frequent including accelerated postoperative nuclear sclerosis, retinal breaks and RD, macular edema, RPE and, occasionally, macular hole and hypotony. However only RD involving the macula have a worsening prognosis on final outcome.

A preliminary study of photodynamic therapy using verteporfin for choroidal neovascularization in pathologic myopia, ocular histoplasmosis syndrome, angioid streaks, and idiopathic causes

OBJECTIVE

To evaluate short-term safety and the effects on visual acuity and fluorescein angiography of single or multiple sessions of photodynamic therapy with verteporfin for choroidal neovascularization (CNV) not related to age-related macular degeneration (AMD), including pathologic myopia, the ocular histoplasmosis syndrome, angioid streaks, and idiopathic causes.

DESIGN

A nonrandomized, multicenter, open-label, dose-escalation phase 1 and 2 clinical trial.

SETTING

Four ophthalmic centers in Europe and North America providing retinal care.

PARTICIPANTS

Thirteen patients with subfoveal CNV due to pathologic myopia, the ocular histoplasmosis syndrome, angioid streaks, or idiopathic causes.

METHODS

Standardized protocol refraction, visual acuity testing, ophthalmic examinations, color photographs, and fluorescein angiograms were used to evaluate the results of photodynamic therapy treatments with verteporfin. Follow-up ranged from 12 weeks for patients who were treated once to 43 weeks for patients who were treated up to 4 times.

RESULTS

Verteporfin therapy was well tolerated in patients with CNV not related to AMD. No deterioration in visual acuity was observed; most patients gained at least 1 line of vision. Reduction in the size of leakage area from classic CNV was noted in all patients as early as 1 week after verteporfin therapy, with complete absence of leakage from classic CNV in almost half of the patients. Improvement in visual acuity after verteporfin therapy was greatest (+6, +8, and +9 lines) in 3 patients with relatively poor initial visual acuity (between 20/200 and 20/800). Up to 4 treatments were found to have short-term safety even with retreatment intervals as short as 4 weeks.

CONCLUSIONS

Treatment of CNV not related to AMD with verteporfin therapy achieves short-term cessation of fluorescein leakage from CNV in a small number of patients without loss of vision. Further randomized clinical trials including a larger number of patients are under way to confirm whether verteporfin therapy is beneficial for subfoveal CNV not related to AMD.

Atypical bronchial carcinoids. Review of 46 patients

BACKGROUND

The purpose of this study was to assess the behaviour of atypical carcinoids operated at our Department in the period 1977-1998 and to review the last 19 cases according to Capella's classification (1994), indicating the most adequate surgical approach.

METHODS

On the basis of anatomo-pathological characteristics, we have reviewed surgical treatment and outcome in 46 patients, submitted in the last 22 years to surgical resection for neuroendocrine neoplasms.

RESULTS

5-year survival is 77.2%; 10-year survival is 53.2%. Lymph node metastases are also important for survival, but less than the histotype. The review of our last six years' series, according to Capella's classification, of 19 patients affected by so-called atypical carcinoids revealed that: 5 were well differentiated neuroendocrine tumors (WDNT), 12 were well differentiated neuroendocrine carcinomas (WDNC), 2 were small cell neuroendocrine carcinomas (SCLC). The 5-year overall survival of our cases is 78%, for the WDNT 100%, for WDNC 81.2%. Of the 2 patients with SCLC, one survived 2 months; the other is still alive 5 months after surgery.

CONCLUSIONS

The authors conclude that 5-year and 10-year survival are strongly related to the histological type of neuroendocrine neoplasm and to the presence of lymph node metastases. Capella's anatomo-pathological classification helps to give a more accurate prognosis for survival in so-called "atypical carcinoids". If the neoplasm is malignant, the authors recommend radical resection, if possible.