Background and Objectives: Chemotherapy and radiotherapy have been investigated in several studies about their role in primary (neoadjuvant) treatment before surgery in breast cancer. We proposed a pilot study to evaluate a primary scheme of alternate radio‐chemotherapy in the treatment of operable (T2‐ small T3) breast cancer. Methods 14 patients were recruited. Cyclophosphamide, methotrexate, and 5‐fluorouracil (CMF) were administered on days 1 and 8, every 4 wk, for two cycles. Radiotherapy was administered during the 3rd and 4th wk (5 d/wk) after the beginning of chemotherapy. The patients were operated on within 2–4 wk. All the patients received four additional cycles of chemotherapy within 1 mo after surgery. Results We observed: 1 (8.3%) complete remission (CR), 8 (66.7%) partial remission (PR), 3 (25%) stationary disease (SD); no progressive disease was observed. Modified radical mastectomy was performed on 7 patients (58.3%). Conservative surgery was performed on 5 cases (41.7%). No major complications were observed. No patient has shown local or distant recurrence. Conclusions This study shows the feasibility of a primary chemo‐radiotherapy treatment for breast cancer. But to evaluate the impact of this therapy on overall survival and recurrence risk and its possible introduction in clinical practice, we need larger series and longer follow‐up. J. Surg. Oncol. 1998;68:48–50. © 1998 Wiley‐Liss, Inc.

Background:The avascular region of the fibrous body between the mitral and aortic valves, named mitral-aortic intervalvular fibrosa (MAIVF), is often involved in the periaortic diffusion of infective endocarditis (IE), resulting in abscess or pseudoaneurysm formation. The early recognition of these life-threatening complications is of crucial importance, as urgent surgical correction is necessary. In the first stages of the abscess formation, the only sign is an increased thickness of the MAIVF. To the best of our knowledge, normal transesophageal echocardiography (TEE) examination reference values for MAIVF thickness has not yet been established. The aim of the study was to define the normal ranges of MAIVF thickness in a population of healthy adults who underwent a TEE examination.Materials and Methods:A population of consecutive adult patients who underwent a TEE examination was enrolled in the study. Measurement was performed in short-axis (SAX) and long-axis (LAX) views. Mean-2 standard deviations (mean-2SDs) and 5%, 10%, 90%, and 95% confidence intervals were evaluated. A comparison with MAIVF thickness in patients affected by aortic IE complicated by abscess formation was performed, and receiver operating characteristic (ROC) curves were constructed to achieve the optimal cutoff value of normality.Results:A total of 477 consecutive Caucasian adult patients were enrolled (mean age: 69 years, range: 27–93 years). Mean-2SD MAIVF measurement in SAX view was 0.325 cm (95% confidence interval [CI]: 0.319–0.330 cm) and in LAX view was 0.340 cm (95% CI: 0.334–0.346 cm). Computed tomography–MAIVF mean measurement (±2SD) was 0.237 cm (95% CI: 0.110–0.340 cm). ROC curves showed that a cutoff SAX value measurement of 0.552 (area under the curve [AUC]: 95.2%) had a sensibility of 88.2% and a specificity of 92.4%; a LAX measurement value of 0.623 (AUC: 93.3%) had a sensibility of 82.7% and a specificity of 85.7%. The multivariate analysis showed no significant correlation between MAIVF thickness, age, and sex.Conclusion:In healthy patients, MAIVF thickness should not exceed 0.600 cm. Above these values, the suspicion of a periaortic abscess formation should be raised. MAIVF increased thickness may be an early sign of perivalvular diffusion requiring an urgent endocarditis team evaluation.

In an attempt to study the orienting of attention in reasoning, we developed a set of propositional reasoning tasks structurally similar to Posner's (1980) spatial cueing paradigm, widely used to study the orienting of attention in perceptual tasks. We cued the representation in working memory of a reasoning premise, observing whether inferences drawn using that premise or a different, uncued one were facilitated, hindered, or unaffected. The results of Experiments 1a, 1b, 1c, and 1d, using semantically (1a-1c) or statistically (1d) informative cues, showed a robust, long-lasting facilitation for drawing inferences from the cued rule. In Experiment 2, using uninformative cues, inferences from the cued rule were facilitated with a short stimulus onset asynchrony (SOA), whereas they were delayed when the SOA was longer, an effect that is similar to the "inhibition of return" (IOR) in perceptual tasks. Experiment 3 used uninformative cues, three different SOAs, and inferential rules with disjunctive antecedents, replicating the IOR-like effect with the long SOAs and, at the short SOA, finding evidence of a gradient-like behaviour of the facilitation effect. Our findings show qualitative similarities to some effects typically observed in the orienting of visual attention, although the tasks did not involve spatial orienting.

Background/Aims: The surgical treatment of duodenogastric reflux (DGR), resistant to medical therapy, in patients with intact stomach is difficult to standardize. The aim of this study is to present our experience on 5 patients, all cholecystectomized, with severe DGR disease treated surgically. Methods: Out of a group of 223 patients suffering from nonulcerous dispeptic pathology presenting to our department, we selected 5 patients suffering from alkaline reflux gastritis in intact stomach. The diagnosis of primary DGR was made using Wilson’s criteria. The surgical procedure adopted consisted of a truncal vagotomy, antrectomy, and a Roux-en-Y gastrojejunostomy. Results: No perioperative mortality was observed. Twelve months after surgery all patients expressed satisfaction with the result of the operation and complained of no severe disturbances. A sense of postprandial fullness with a sense of pain in the left shoulder persisted in one case only, requiring the consumption of small and frequent meals. Radiological examination of the upper gastrointestinal tract of these patients showed notably delayed emptying of the gastric stump, while the endoscopic picture was completely normal. Conclusion: The antrectomy and Roux-en-Y gastrojejunostomy is a better known operation, easily executed, and has the advantage that it can be performed on patients previously operated on for gastric resection and therefore suffering from secondary reflux. It also has the advantage of removing the gastric antrum where mucous atrophy is more frequent and is susceptible to neoplastic degeneration. However, at the present time the choice between different types of operation depends exclusively on the personal conviction and experience of the surgeon.