Evaluation of Cytokeratin 19 Serum Fragments (Cyfra 21–1) in Patients with Lung Cancer: Results of a Multicenter Trial

Recently, a new immunometric assay (Cyfra 21–1) was developed to measure serum concentrations of a soluble fragment of cytokeratin subunit 19. With this method, supplied by Boehringer Mannheim (EIA Test Cyfra 21–1), an Italian multicenter trial was performed in patients with lung cancer. Cyfra 21–1 serum levels were determined in 568 normal subjects (blood donors), 607 patients with non-malignant diseases (491 respiratory diseases) and 730 patients with malignancies. In the latter group 584 had lung cancer. All these 584 patients had pathologically confirmed disease; 314 were epidermoid tumors, 166 adenocarcinomas, 88 small cell cancers and 16 large cell cancers.

In the 568 healthy blood donors the mean Cyfra 21–1 value was 0.91 ng/ml (SD 0.47 ng/ml; range 0.05–2.90 ng/ml). A threshold of 1.9 ng/ml was chosen as the upper limit of normality. High levels of Cyfra21–1 were observed in patients with chronic hepatitis (positivity rate: 17/51–33.3%) and with pancreatitis (positivity rate 5/16 - 31.3%). In 114 out of 491 (23.2%) patients with respiratory diseases Cyfra 21–1 showed values greater than 1.9 ng/ml. The overall sensitivity (all stages) of Cyfra 21–1 in lung cancer was 65.6% (383/584). When the histology was considered the highest positivity rates were found in patients with squamous cell tumors (226/314; 72%) followed by adenocarcinomas (105/166; 63%). In patients with SCLC the global sensitivity was 52.3% (46/88). Higher sensitivity of Cyfra 21–1 was observed from stage I to stage IV (53.9% vs 85.7%; Chisquare: p < 0.01). When comparing patients in whom curative resections were possible (up to stage IIIa) with patients suffering from inoperable tumors, a significant difference in Cyfra 21–1 positivies was found (59% vs 81.5%; Chi square p < 0.01).

Vascular Thoracic Outlet Syndrome staging and treatment

Thoracic Outlet Syndrome (TOS) is a well known lesion. Sophisticated imaging techniques can clearly highlight any anatomical damage and a wide range of therapeutic choices are available. It would seem obvious that any given patient should obtain the same treatment irrespective of the medical institution he contacts, but this is not the case. Instead each specialist may recommend different treatments: physiatrist, neurologist, surgeons (thoracic, vascular, neuro, orthopedic). Everyone preserves his specific language and there is no univocal treatment plan consensus for this complex syndrome. Evidently, the correct staging of TOS is still an unresolved question. In order to solve this problem, we collected all clinical and instrumental aspects of the syndrome into a clear, precise classification. Similar to TNM staging of malignant diseases, we used a grouping model based on the three mainly involved anatomical structures: N (= Nerves; brachial plexus and sympathetic fibers), A (= Artery; subclavian-axillary), V (= Vein; subclavian-axillary). We named it the NAV staging of TOS. A retrospective examination of our case records confirmed a valid and useful correlation between the proposed NAV staging and the therapeutic procedures that were actually applied. It is now essential to perform a multi-centre study to extend the validity of our staging.

Extrapleural bullectomy or lung volume reduction: air tight surgery for emphysema without strip-patch

Air leaks after stapled lung resections for emphysema remain the most common postoperative complication. Staple line reinforcement, alone or in association with a parietal pleural tent, is recognised as an effective technique for decreasing the occurrence of air leaks after pulmonary wedge resection. Several materials have been employed for reinforcement, most of them prosthetic and costly. We use the parietal pleural tent covering the pulmonary targets to be excised, as a reinforcement on which the staple is fired (2 LVRS and 6 bullectomy procedures). Air tightness and obliteration of intrapleural space are simultaneously achieved. We named our technique: Extrapleural Bullectomy (EB) or Extrapleural Lung Volume Reduction (ELVR), according to the indication of the operation. No mortality nor significative morbidity, particularly prolonged postoperative air leak, were observed. At the follow-up (3 to 12 months) no pneumothorax or residual spaces have occurred.

Autoaggregation and adhesion ability in a Bifidobacterium suis strain

On the basis of autoaggregation ability, two different phenotypes (Agg+ and Agg-) were selected from a strain (BSu895) of Bifidobacterium suis. The relationship between autoaggregation and adhesion of bacteria to intestinal tissue was investigated by observing the adhesivity of the two phenotypic variants to ileum and colon tissue pieces collected from six new-born piglets. The results suggest that there is a good relationship between autoaggregation and adhesion as variant Agg+ (autoaggregating) has a stronger adhesion ability than Agg- (non-autoaggregating).

Epidermal growth factor receptor in lung malignancies. Comparison between cancer and normal tissue

Epidermal growth factor receptors (EGFr) were measured using a radioligand binding assay, in membrane preparations from 51 human non-small cell lung cancers and in normal tissue of the same patients. The binding characteristics of EGFr were similar in tumour and normal lung membranes (range of dissociation constant of high affinity sites: 0.1-0.6 nM). However, the concentrations in tumours (median, 16.4 fmol mg-1 of protein; range, 1.5-176) were significantly higher than in normal tissues (median, 7.4 fmol mg-1 of protein; range, 1.9-13.4). The receptor levels in normal tissue were normally distributed. It was therefore possible to define a normal/pathologic cut-off level (12.9 fmol mg-1 of protein). In 57% of cases EGFr in cancer was higher than the cut-off. No relationships were found between receptor concentrations and positivity rates of EGFr and histology, stage, lymph node positivity and pT. A trend for a direct relation between receptor positivity and grading was found.

[Dieulafoy's exulceratio simplex: a rare cause of digestive bleeding]

Among the various, uncommon sources of digestive bleeding due to vascular malformation, Dieulafoy's disease--a peculiar clinical and histological entity--usually causes the most pronounced hemorrhage. A case admitted to our hospital for massive bleeding requiring emergency surgery is presented. The most qualified pathogenetic hypotheses and the importance of diagnostic accuracy before operation are emphasized and stress is laid on therapeutic endoscopy on the basis of literature data.