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The paper reports a number of cases of uncommon metastasis confirmed by histological tests in surgical biopsies; following a brief discussion of the literature on this topic and in particular on the basis of an earlier study by one of the authors, the paper affirms that metastasis is related to general and local biological factors, that the diffusion of neoplastic cells is an early and generalised phenomenon opposed by organic defence mechanisms, and that the concept of uncommon metastasis should be revised, without resorting to fixed anatomical references, according to a general "impregnation" of tumour cells.

The Authors report about one surgical case of pulmonary carcinosarcoma recently observed. The literature is reviewed and the histogenesis of this rare affection is discussed.

Autotransfusion carried out in 100 patients undergoing chest surgery is discussed. The Authors emphasize the need to determine a protocol in transfusion procedures for thoracic surgery and stress the importance of using haemocomponents in lieu of whole blood, taking into consideration transfusional risks.

The results of microbiological research carried out on haematological patients admitted to the same ward are reported. The pathogenic flora observed consisted mainly of gram-negative germs (60%). Pseudomonas infections represented the most important problem because of their frequency and the consequent clinical problems. The in vitro sensitivity of 306 strains of gram-negative germs to 11 different antibiotics has been analysed. Amikacin proved to be easily the most effective antibiotic against isolated pathogens.

The effectiveness and tolerability of defibrotide in the prevention of post-surgery deep vein thrombosis (DVT) were compared with those of heparin in a multicentric randomized controlled study. One hundred-eight-four both sexes patients submitted to thoracic surgery were randomly allocated to defibrotide (400 mg b.i.d. by IV route, n = 94) or to calcium heparin (5000 I.U. t.i.d. s.c., n = 90); both treatments were started the day before the operation and withdrawn when patients were allowed to stand up (i.e., after 7 days). No patients developed DVT in the defibrotide group, while a single case of DVT was detected in the heparin group; furthermore, a more prominent bleeding was observed in the latter, in the early post-operative period (normal bleeding: 2nd day: defibrotide 70/92 pts, heparin 53/90 pts, p less than 0.02; 3rd day: defibrotide 87/92 pts, heparin 76/90 pts, p less than 0.05, chi 2 test), while the healing rate of surgical wounds was similar in the two groups. No relevant modifications in laboratory parameters were seen throughout the observation period. Thus, these preliminary data suggest that defibrotide is at least as effective as heparin in the prevention of post-thoracic surgery DVT and that the former drug has a possibly better tolerability profile, due to a lesser tendency to bleeding.

The folic acid plasma level in 12 out of 13 children with thalassemia major was lower than 3 ng/ml. This deficiency is not due to intestinal malabsorption. Folate deficiency should then be provoked by an increased allowance due to the compensatory erythropoiesis and to the lack of. Folic acid level less then 3 ng/ml in 24% and not more then 6 ng/ml in 50% of thalassemic heterozygotic children has been found. Therefore the necessity of folic acid treatment in thalassemic children with a low blood transfusional therapy and in beta-thalassemic heterozygotic children has been recommended.

We present a case of severe pneumonia by Mycoplasma pneumoniae, whose clinical course was complicated by immunodepression, hepatitis and deep venous thrombosis. Treatment with pepsin-treated human immunoglobulins was unsuccessful, whereas prompt recovery was obtained by infusion of human immunoglobulins treated at pH 4.

The radiological features of invasive pulmonary aspergillosis, observed in 20 patients with hematologic malignancies, are reported. From the analyses of the initial signs and their modifications in the course of the disease it was possible to identify some aspects strongly suggestive of the mycotic nature of the pulmonary lesions. Rounded pneumonia and hemorrhagic infarction often complicated by cavitation with or without intracavitary nodule are the most suggestive aspects, and the latter carry good prognostic significance.