[Quality assurance of mammography in the province of Trent]

In 1991, a second program for quality control in mammography was carried out in the Physics Department of the Trento Hospital. All the six mammographic centers around Trento entered the study and 9 mammographic units were thus considered. Two main types of measurements were obtained: a) determination of the physical variables affecting radiologic system optimization; b) evaluation of image quality and average breast dose, according to DQM program criteria. The film variables, mean gradients and base plus fog level, the half-value layer (HVL) and the entrance exposure free in air were scored as acceptable in all cases. The average breast dose was calculated on the basis of literature data, given the entrance exposure free in air, the HVL and the focus-skin distance values. All the mammographic units but one were scored as "D" (acceptable) on the average breast dose curve, which is defined by the national average value obtained during phase II of the DQM program. This Quality Control program allowed all mammographic units to be optimized and also emphasized the need for periodical quality controls.

Fat absorption and gastroenteric pH profile in postsurgical pancreatic insufficiency: role of the association of H2-receptor antagonists with pancreatic enzymes

The complete control of steatorrhea in post-surgical exocrine pancreatic insufficiency is difficult. The aim of this study was to evaluate the effect of the association of ranitidine with pancrelipase om fecal fat excretion in patients who had undergone a pancreatoduodenectomy with suppression of the exocrine pancreatic secretion by Neoprene injection. Ten patients were studied 1 year after surgery. Steatorrhea was measured as an integrated test of 3-day stools, while patients were kept on a diet of 100 g lipid/day, with their usual enzyme supplementation therapy (16,050 USP units of lipase/meal). A basal 24-h gastroenteric pH profile was also obtained. In the following month, patients had ranitidine (150 mg twice a day) in addition to pancrelipase. Then steatorrhea and gastroenteric pH were reassessed. Mean fecal fat was 26.9 (SD 13.7) g/day without ranitidine and 30.5 (SD 13.9) g/day during combined treatment. Body weight and nutritional parameters did not show any significant variation after ranitidine administration. Even in the absence of ranitidine, postprandial gastroenteric pH values were always > 4; the H2-receptor antagonist only reduced fasting gastric acidity. In conclusion, the gastroenteric pH and fecal fat determinations showed that ranitidine is not useful in patients with total postsurgical exocrine pancreatic insufficiency.

Diagnostic performance: a comparative study of the leukocyte differential count on four automated haematology analysers

The diagnostic performance of the haematology analysers, Technicon H1, Sysmex NE 8000, Coulter STKS and Sequoia Cell Dyn 3000 was determined by comparing their results for automated differential counting with the result obtained for 400 cells by the manual microscopic method. These comparative studies were performed on a group of adults, containing both normal individuals (n = 150) and those affected by various pathologies (n = 113). The number of morphologically false negatives is low for all the systems (from 1.8% for the Cell Dyn 3000 to 6.2% for the NE 8000), while the number of distributionally false negatives was slightly higher (from 4.4% for the Cell Dyn 3000 to 7% for the H1 and NE 8000). The morphological flags, though useful for improving the diagnostic performance of the instruments, show a rather modest sensitivity when taken individually: immature granulocytes/bands from 71% for the STKS to 43% for the NE 8000; blasts from 66.6% for the H1 to 53.3% for the STKS, atypical lymphocytes from 59% for the H1 to 13.6% for the NE 8000; erythroblasts from 42.8% for the STKS to 7% for the NE 8000.

Dose-response effects of oral loxiglumide on postprandial gall-bladder emptying in man

The effect of two different single oral doses of loxiglumide (CR 1505, CAS 107097-80-3) on gall-bladder emptying induced by a 550-cal standard mixed meal in 6 healthy volunteers was studied. Following placebo, the maximal gall-bladder emptying occurred about 90 min after the meal (minimal residual gall-bladder volume 27.4% of basal volume). Loxiglumide 400 or 800 mg dose-dependently inhibited the physiologica gall-bladder emptying. Loxiglumide plasma levels dose-dependently increased. The inhibition of gall-bladder emptying and the kinetic of loxiglumide plasma levels were temporally related. The results of the present study confirm that oral loxiglumide is a potent orally active cholecystokinin (CCK) antagonist in man and that CCK is the major physiological mediator of gallbladder emptying in response to meal.

Evaluation of four automated hematology analyzers. A comparative study of differential counts (imprecision and inaccuracy)

The authors evaluated the performance of four modern, commercially available hematology analyzers for imprecision and inaccuracy in determining the leukocyte differential count. The evaluation was performed according to International Committee for Standardization in Haematology protocols and the National Committee for Clinical Laboratory Standards H20-T standard, using the same group of patients simultaneously. Imprecision was very low among all the analyzers for neutrophils and lymphocytes (coefficient of variation maximum = 4.12%), whereas for the other leukocyte populations it tended to increase as their presence percentage decreased. The imprecision of the analyzers was still lower than that of the microscopic method. The correlation with the manual 800 cell count (inaccuracy) was good for neutrophils, lymphocytes, and eosinophils (r = 0.974 to 0.888), less so for monocytes (r = 0.757 to 0.490), whereas it was poor for basophils (r = 0.532 to 0.078).

[Radiotherapy, radiotherapy combined with surgery, radiotherapy combined with chemotherapy in the treatment of carcinoma of the pyriform sinus. A retrospective study]

A rectrospective analysis was performed of the results of 104 consecutive patients with carcinoma of the pyriform sinus, who underwent radiation therapy. Thirty-four patients underwent radical surgery and postoperative radiation therapy (group 1); 36 patients received radical radiation therapy alone (group 2); neoadjuvant chemotherapy was administered prior to full-dose radiation to 20 patients (group 3); 14 patients received palliative radiation therapy (group 4). Loco-regional control and survival rates at 5 years were 60.4% and 34.3% in group 1, 23.8% and 23.8% in group 2, 17.5% and 23.8% in group 3; no patients in group 4 survived at 5 years. Patients in group 1 experienced significantly better survival and local control than those in groups 2 and 3. No differences were observed between groups 2 and 3. Loco-regional recurrence was the main cause of failure in group 2 (69.4%) and 3 (70.0%). In group 1, 20.3% of cases developed distant metastases. Overall 5-year survival rate was 23.7%, confirming the poor prognosis of this disease. These results provide further support to the need of improving prevention and early diagnosis to improve both results and outcome in patients with carcinoma of the pyriform sinus.

Moxibustion and breech presentation: preliminary results

Moxibustion at the Zhiyin acupuncture point (67 B) is an ancient method of obtaining the version of abnormal presentation of the fetus during the last three months of pregnancy. The authors reviewed the Chinese references on this subject and stressed the importance of parity and gestational age in testing the efficacy of this therapy. Preliminary results are described and compared with those reported in Chinese articles. Success rates in version by moxibustion versus spontaneous version are also compared.

[Radical radiation therapy of carcinoma of the rhinopharynx: analysis of 80 cases]

From 1976 to 1987, 98 patients affected with nasopharyngeal carcinoma were observed at the Oncology Center, Trento, Italy. Eighty of them were treated with radical radiation therapy (average total dose: 6432 Gy, range: 5500-7400 Gy) on primary tumor and positive neck nodes. The clinically negative neck received 5000 Gy. Each dose ranged from 180 to 250 Gy. Fifty-nine patients were treated with the split-course technique with an interval of about 15 days after receiving 4000 cGy. The patients were 60 males and 20 females, their age ranging 17-81 years (mean: 57 years). Histology diagnosed squamous cell carcinoma in 15 cases and undifferentiated carcinoma in 65 cases. All patients were staged according to TNM (UICC, 1978) criteria. Ten patients were stage I/II. Complete local control was obtained in 81.3% of cases. Actuarial global survival at 10 years was 52%, actuarial relapse-free survival was 49%. Mean follow-up is 33 months (range: 4-122 months). Squamous cell carcinoma at histology and advanced nodal involvement (N2-N3) were negative prognostic factors. Six patients had a relapse in the nasopharynx and 5 in the neck; the incidence of distant failures was 20%. The most frequent mid-/long-term side-effect was xerostomia.

[Intraoperative radiotherapy with electrons: construction of facilities and dosimetry]

The technical complexity of intraoperative radiotherapy (IORT) requires modification of the standard physical and dosimetric methods used in external electron beam therapy. At the Radiotherapy Department of Ospedale S. Chiara in Trento a number of technical innovations have been developed, including an electron beam applicators system and related devices. Ionometric and film dosimetry have been used to obtain relative dose distributions of clinical electron beams in phantoms.

Effect of loxiglumide on gallbladder contractile response to cerulein and food in humans

The present study investigated the effect of loxiglumide, a new selective cholecystokinin-receptor antagonist, on the gallbladder contractile responses to caerulein and to food in humans. In 6 healthy men, the gallbladder emptying driven by intravenous infusion of stepwise increasing doses of cerulein (10-80 ng/kg . h) and that induced by a 550-cal standard meal were monitored by ultrasonography. In both sets of experiments, the effect of loxiglumide was tested at various infusional rates against a control infusion of saline. An infusional rate of 2.5 mg/kg . h of loxiglumide abolished the gallbladder response even to maximal doses of cerulein, whereas a rate of 1.0 mg/kg . h counteracted the cholecystokinetic activity of cerulein up to the dose of 20 ng/kg . h. In postprandial experiments, the cholecystokinin antagonist dose-dependently inhibited the physiologic gallbladder contraction. The maximal gallbladder emptying, which always occurred 85 min after the meal, was 71.1% +/- 3.3% of basal volume in control studies, 39.2% +/- 1.8% during infusion of 2.5 mg/kg . h of loxiglumide, and 17.3% +/- 5.9% when 5.0 mg/kg . h were infused. A dose of 7.5 mg/kg . h of loxiglumide was able to prevent any postprandial emptying of the gallbladder. The present study shows that a selective cholecystokinin receptorial blockade competitively antagonizes cerulein-induced gallbladder contraction and dose-dependently inhibits postprandial gallbladder emptying.

Comparative study of two neoadjuvant protocols (VBM and DDP-BLM) combined with radiation therapy in advanced head and neck cancer

Forty-five patients with epidermoid cancer of the head and neck were either treated with cisplatin and bleomycin (DDP-BLM) or with vincristine, bleomycin and methotrexate (VBM) as neoadjuvant chemotherapy before radical radiation therapy (XRT). Chemotherapy with DDP-BLM provided a tumoral response of 80% [20% complete response (CR), 60% partial response (PR)]; VBM showed a response of 60% (12% CR, 48% PR). At the end of XRT-program (65 Gy total dose, 2-2.5 Gy dose per fraction, 5 times a week) complete response rates were similar in VBM-pretreated group (52.5%) and DDP-BLM pretreated group (50%). Analysis of survival shows no significant difference between the two inductive schemes: 8% vs 7.5% at 72 months. Our study suggests an increased initial response rate but no advantage in survival with combined therapy in comparison with standard XRT: long-term benefits were not apparent in these two groups of patients.

Skeletal scintigraphy and physical examination in the staging of early breast cancer

The significance of skeletal scintigraphy in staging of early breast cancer is still controversial. The results of bone scanning with 99Tcm diphosphonate and clinical examination in 204 patients with stage I-II breast cancer are reported. Bone scans were positive in 28 cases. However, only one was true positive as confirmed by x-ray examination and/or biopsy, with a detection rate of 0.5%. Physical examination had a detection rate similar to bone scan, but with superior specificity. In our experience bone scan cannot be recommended as a routine staging test in early breast cancer.

A new catheter for peritoneal dialysis (two years of experience with Valli catheter)

The authors analyze the experience of more than 2 yrs of peritoneal dialysis with a new type of catheter. The catheter proposed allows higher flow rates and the maximum outflow of fluid even if malpositioned. The possibility of migration of the catheter is also reduced. The main new feature of this catheter consists in a perforated silastic balloon which protects the distal end of a standard Tenckhoff catheter.

Pancreatic endocrine response to the first feed in term newborn infants

Blood glucose, insulin, C-peptide and glucagon were evaluated in 36 newborn term infants at birth, and before and 60 min after the first feed during the first day of life. Under basal conditions glycaemia diminished during the first day of life and glucagon increased, while insulin and C-peptide did not show any variation. The C-peptide: insulin molar ratio was higher in the newborn than in adults because of the longer half-life of C-peptide, probably due to reduced renal function in the neonatal period. The subjects were divided into two groups: 18 newborn infants were given a feed of commercially available milk powder reconstituted in water at 10% (5 ml/kg); the other 18 were given a feed of 5 ml/kg 10% glucose solution. In each group 6 were given the first feed after a fast of 6 h, 6 after a fast of 12 h and 6 after a fast of 24 h from birth. After the first feed with milk, the average increase of glycaemia was 19.83 mg%, of insulin 6.06 muU/ml, and of C-peptide 1.88 ng/ml. After the first feed with glucose the average increase of glycaemia was 13.59 mg%, of insulin 2.46 muU/ml, and of C-peptide 0.59 ng/ml. Glucagon did not show significant changes after the first feed.