Disorders of candidacidal activity and other neutrophil functions in three cases of chronic candidiasis

Three unrelated cases of recurrent and untreatable candidiasis have been followed for about one year. A persistent in vitro defect of neutrophil candidacidal activity characterized the three cases, while other neutrophil functions were shown to be only transiently impaired during the period of observation. None of the three cases could be identified with previously described granulocytopathies.     

Evaluation of the appropriateness of hospital use: the case of IRCCS Ospedale Maggiore di Milano,Italy

In 1999 an Italian version of the AEP was applied to some units of the IRCCS Ospedale Maggiore di Milano and a modified AEP version was used to evaluate the day hospital activity. The main aims of the study were: to establish the appropriateness of the utilisation of beds and of day hospital activity and to calculate the costing of the misuse of hospital resources. 267 admission days were evaluated and 31.5% were not appropriated; whereas of 3,248 days of stay 37% were found not appropriated. The day hospital activity was evaluated through 300 record referred to 570 days of treatment and 13% of them were not appropriated. The cost of the 1,201 not appropriated hospital days was over 351.000. The not appropriated level of hospital utilisation in the IRCCS Ospedale Maggiore di Milano is similar to what is reported in national and international literature. Our study highlights some limits in the application of the AEP protocol at high specialised hospital units.     

Influence of triphasic oral contraceptives on blood rheology and hemostatic and metabolic patterns in young women. Results of a three-year study.

Long-term (three-year) variations in clinical, hemorheologic, hemostatic and blood lipid parameters were evaluated in 20 young healthy women taking a triphasic oral contraceptive. Body weight, arterial blood pressure, whole blood, plasma and serum viscosity, erythrocyte deformability, fibrinogen, fibronectin, alpha-2 macroglobulin, Von Willebrand factor antigen, triglycerides, nonesterified fatty acids, total and low density lipoprotein cholesterol, very low density lipoprotein, low density lipoprotein and apolipoprotein B levels remained unchanged throughout the study. However, high density lipoprotein cholesterol, high density lipoprotein and apolipoprotein A1 serum concentrations increased significantly during treatment. Long-term use of the triphasic oral contraceptive does not seem to adversely affect the blood rheology pattern or vascular endothelium function, which are the main factors responsible for the development of thromboembolic complications.     

Prognostic value of pathological patterns of lymph node positivity in squamous cell carcinoma of the vulva Stage III and IVA FIGO

Lymph node positivity in invasive squamous cell vulvar cancer implies a severe decrease in survival rates. Pathological lymph node positivity covers a wide range of metastatization patterns. In the present investigation the nodal positivity of 53 patients affected by Stage III and IVA invasive vulvar squamous cell carcinoma has been carefully evaluated and correlated with survival. Number, size of the metastasis inside the node, intracapsular or extracapsular site of the metastasis, and immune response of the positive nodes were considered. Cancer-related survival has been obtained for the whole study group (53 cases), for the patients with monolateral node positivity (36 cases), and for the patients showing only one positive node (19 cases). The diameter and the site of the metastasis were significantly correlated with survival in all three groups studied. Patients showing an intracapsular positivity or a size of metastasis less than 5 mm had a 5-year cancer-related survival of almost 90%, while patients showing a metastasis larger than 15 mm or an extracapsular site had a 20% survival. The results demonstrate that patients affected by invasive squamous cell vulvar cancer with positive nodes can be divided into two groups with a significantly different survival according to the histopathological pattern of lymph node invasion.     

Long-term outcome for patients with non-metastatic Ewing's sarcoma treated with adjuvant and neoadjuvant chemotherapies. 402 patients treated at Rizzoli between 1972 and 1992

We evaluated the long-term results obtained in 402 patients with non-metastatic Ewing's sarcoma (ES) of the bone treated in a single institution with adjuvant and neoadjuvant chemotherapies between 1972 and 1992. Multivariate analyses showed male gender, age older than 14 years, high serum lactate dehydrogenase (LDH) level, axial location of the tumour, use of radiotherapy alone as a local treatment, and poor histological response to chemotherapy, to be independent, adverse prognostic factors for event-free survival (EFS). At a mean follow-up of about 18 years (10-30 years), 177 patients (44.0%) remained continuously free of disease, 2 died of doxorubicin-induced cardiotoxicity and 8 developed a second neoplasm (5 died, and 3 are alive and free of disease). 215 patients relapsed with metastases and/or local recurrence: 14 are alive and free of disease, 1 is alive with uncontrolled disease, and 200 died. The overall survival (OS) at real follow-ups of 5-, 10-, 15- and 20-years was 57.2, 49.3, 44.9 and 38.4%, respectively. We conclude that since local or systemic relapses, treatment-complications and second malignancies are more common after 5 years or more from the beginning of treatment; a long-term follow-up is mandatory for patients with ES.