Esophageal reconstruction by colon interposition.
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Biomedical subjects
Publications and source records attributed to N Martini.
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Using two systems which routinely record information about the management of psychiatric disorders in the community (a drug prescription monitoring system and a psychiatric case register), a parallel study was conducted in South Verona on antidepressant prescriptions written by general practitioners (GPs) and on contacts for affective disorders with specialized psychiatric services, in 1983 and 1984. The extent of patient contact for affective disorders was approximately ten times greater at the GP level (in one year about 150 antidepressant prescriptions per 1000 adult inhabitants) than at the out-patient/community psychiatric service level. Similarly, the extent of patient contact at the latter level was approximately ten times greater than at the in-patient level. Patients with a diagnosis of affective disorder accounted for about 20% of the total number of patients contacting the specialized services in one year. The proportions of patients admitted to hospital, among those in contact with these services and assigned a diagnosis of depressive neurosis or a diagnosis of affective psychosis, were 34 and 33% (in 1983 and 1984) and 49 and 50% (in 1983 and 1984), respectively. There was a clear correspondence between monthly fluctuations in the extent of care for affective disorders provided at the two levels in 1984, but not in 1983.
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Lung cancer is the most common cause of death from cancer for both males and females in the United States. Left untreated, most patients die within one year of diagnosis with a median survival of less than six months. Surgery remains the most effective method for controlling the primary tumor in most cases. This article reviews the role of surgical treatment for the various stages of lung cancer.
Thirty-eight patients with small cell carcinoma and no prior therapy were treated with a combination chemotherapy program including 60 mg/m2 of cis-dichlorodiammineplatinum(II) (cis-platinum) iv on Days 1 and 22 and 120 mg/m2 of VP-16-213 iv on Days 4, 6, 8, 25, 27, and 29. This was followed by 1000 mg/m2 of cyclophosphamide, 40 mg/m2 of Adriamycin, and 1.4 mg/m2 of vincristine, all given iv on Days 42, 63, 84, and 105. The program was then recycled, with cis-platinum and VP-16-213 beginning on Day 126 and the regimen repeated as above. All patients received prophylactic whole-brain radiation (usually at a dose of 3000 rads in ten fractions) between Days 42 and 63. The projected duration of treatment is 18 months in the absence of relapse. In 21 patients with limited disease, the complete response rate was 52% (5.75+--15.25+ months) and the partial remission rate was 48% (2.25--10.5 months). The extensive-disease group showed a complete remission rate of 41% (4.75--11+ months) and a partial remission rate of 47% (3.75--11.5+ months). Response to therapy with cis-platinum and VP-16-213 was very rapid and invariably maximal by the end of the 6-week induction period. Survival for the limited-disease group appears encouraging but followup time is insufficient. Toxicity included nausea and vomiting, myelosuppression, alopecia, and renal insufficiency which was dose-limiting in two patients. The cis-platinum and VP-16-213 combination is clearly an active induction regimen in small cell carcinoma of the lung, but whether it will play a role in increasing long-term survival rates remains to be seen.
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