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Biomedical subjects

D Bartoli

Publications and source records attributed to D Bartoli.

At least 19 recordsLinked to original sources

Response of primary breast cancer to tamoxifen alone in elderly women.

The authors report on a consecutive series of 62 evaluable, elderly (age greater than 69 years) women with primary operable breast cancer treated only with tamoxifen. The treatment schedule was 160 mg on day 1 followed by a daily maintenance dose of 20 mg. Compliance to treatment was excellent, and subjective side effects were minimal. The best response achieved after at least 6 months of treatment was complete in 7, partial in 22 and minor in 3, whereas stable disease or progression was observed in 28 and 2 patients, respectively. The response rate decreased and progressions increased with time. At 6, 12, 24, 36 and 48 months of treatment, the complete + partial response rates were 30.6%, 45%, 45.6%, 38.7% and 25% and the progressive disease rates 4.8%, 19.6%, 34.8%, 45.2% and 66.6%, respectively. These results do not confirm some previous reports of a high response to tamoxifen. This difference is only partially explained by the use of mammography, which is more sensitive than palpation, to assess tumor size and treatment response. The present study does not support primary hormone therapy as a current alternative to surgery, which should be the standard treatment in otherwise healthy elderly patients with operable breast cancer.

Aged

[The Guillain-Barré syndrome. The clinico-electrophysiological correlations].

The authors refer about clinico-electrophysiological correlations in children with Guillain-Barré syndrome (GBS). The dates confirm the diagnostic and prognostic value of electrodiagnostic studies in GBS, so that the authors suggest an electrodiagnostic protocol. According to the authors, independently of the extent of electrophysiological abnormalities, young age has a favourable influence on the restoration of conduction abnormalities and on the evolution of damage to peripheral neurones.

Adolescent

Risk of breast cancer subsequent to proven gross cystic disease.

3809 women in whom breast cysts were aspirated were followed up to evaluate the observed/expected ratio of subsequent breast cancer. Breast cancer at cyst aspiration was excluded by physical examination and mammography. The first year of follow-up was censored to avoid a prevalence screening effect. Subsequent breast cancers were found either directly or by means of a cancer registry which also provided the expected age and residence specific incidence rates. The number of expected cancers was assessed in person-years (15,915 in the total series). The observed/expected subsequent breast cancer ratio was 1.77 (34/19.15; 95% confidence interval 1.23-2.48, P less than 0.05). The presence of gross cysts was associated with a moderately though significantly increased risk of subsequent breast cancer. Increased surveillance in such patients is not justified.

Adolescent

Referral policy and positive predictive value of call for surgical biopsy in the Florence Breast Cancer Screening Program.

The authors evaluate the referral rates and the predictive value (PV) of call for diagnostic work up or biopsy in a population based breast cancer screening program in the 1979-1986 period. The presence of mammographic abnormalities either benign or suspicious proved to be the only reliable referral criterion (recall rate = 7.9%, recall PV = 3.8%, biopsy call PV = 39%). When mammography was normal the presence of breast complaints other than pain or of a radiologically dense breast were aspecific referral criteria, and since the latter was abandoned, (a) referral rates dropped especially in younger women, (b) referral or biopsy PV improved, whereas (c) cancer detection rate was almost unaffected. Younger age was associated with higher referral rates and with lower PV of both referral or biopsy. Whenever comparison with previous examination was possible, mammography accuracy was higher; this explains the decrease in referral rates and the increased predictivity observed at further rounds with respect to first screening round.

Adult

Ring chromosome 16: a new case.

A 46,XX,r(16) "de novo" karyotype is reported in a 4 7/12-year-old girl. In spite of the mild cranio-facial dysmorphism without visceral malformations in r(16) patients, the proband's phenotype is similar to the other four previous case reports. This could support the hypothesis of a specific "r(16) syndrome".

Abnormalities, Multiple

[Monosomy 7qter: 2 new cases of chromosomal pathology with aspecific disorders of pre- and post-natal development].

Many cases of 7q deletion associated with mental retardation and multiple malformations have been described, nevertheless it is quite different to recognize common features among these infants. In this paper the cases of two female infants with uncommon facial features and 7q deletion are described. We also try to recognize the phenotypic features of this chromosomal disorder.

Chromosome Aberrations

Tumor size and prognosis of breast cancer with negative axillary nodes.

A report on 1877 consecutive node negative (N-) breast cancer cases is presented in which the prognostic value of the main clinico-pathologic features is evaluated. Tumor size (and UICC-TNM T category) and lobular infiltrating histologic type were significantly associated with a more favorable prognosis whereas no association was found for patient age, tumor site and number of examined axillary nodes. However tumor size (and T category) is not a very accurate prognostic predictor (71% of all recurrences observed occurred in cases with tumor diameter of more than 20 mm, which represented 58% of the total series), although its efficiency seems almost as good as that of other more recent prognostic predictors such as estrogen receptor content or labeling index. None of the prognostic predictors currently available, including tumor size, seems sufficiently specific and they do not allow for a reliable selection of high risk N-patients for adjuvant treatment.

Adult

[Pain in Guillain-Barré syndrome].

The clinical features of pain were analysed in 31 children with Guillain-Barré Syndrome. Pain may be considered characteristic of childhood GBS. Pain, various painful sensations and dysaesthesias must be emphasised in the early diagnosis of GBS. An attempt was made to identify the meanings of early pain (preceding or accompanying the onset of weakness), late pain, mild or severe sensory symptoms or signs and the role played by triggering or perpetuating factors. Only the application of a diagnosis-therapeutic protocol for childhood GBS, that pays particular attention to the problem, will suggest satisfactory answers to research.

Child

An attempt to increase compliance to cervical cancer screening through general practitioners.

The authors report the results of a campaign aimed at increasing compliance to cervical cancer screening by promoting general practitioners' (GPs) cooperation. Different types of intervention were tested, namely mailing lists of non responders to the GP, visiting the GP at the office, or both. No active intervention was made in a sample of GPs who served as a control group. Overall 288 GPs assisting 75,853 women aged 25 to 59 were enrolled in the study. Compliance before and after the campaign was studied and the association between compliance and different variables such as age, residence and type of intervention was tested by univariate and multivariate analysis. The proportion of previous non responders who performed a Pap test after the campaign was 6.7%, the response being dependent on age (25-29 = 11.5%, 30-39 = 8.8%, 40-49 = 6.5%, 50-59 = 4.2%) and place of residence (urban = 7.2%, suburban = 5.9%, rural = 4.0%). Compliance was better in the case of the active campaign (list mailing = 8.3%, visit = 7.0%, list + visit = 7.2%) with respect to controls (2.9%) although no significant differences were detected between different types of active intervention. Compliance to cervical cancer screening may be increased by promoting GPs cooperation but the benefit is limited. Mailing lists of non responders was found the most cost effective policy in this study.

Adult

Fine needle aspiration cytology and breast cancer diagnosis.

The authors report on 315 histologically confirmed consecutive breast cancer (BC) cases undergoing fine needle aspiration cytology (FNAC). Inadequate smears were infrequent (7%), particularly when reaspiration of inadequate cases was employed (1-2%). FNAC suspected BC in 81% of the total or 88% of adequate smears. Univariate and multivariate (Cox's model) analyses showed no correlation between inadequacy or suspect/positive FNAC rate and patient age, T category or histologic type. Differences in the inadequacy and suspect/positive rate were recorded among 30 operators (surgeons, oncologists, radiologists) performing the sampling, but the average results were consistent with literature reports. FNAC was found to be a useful diagnostic tool for BC diagnosis, and proper training of the highest number of operators is recommended to allow the widest diffusion of this diagnostic technique.

Adult