Disclosure of a diagnosis of cancer to patients is a major problem among physicians in Italy. The aim of the study was to assess physicians' attitudes to and opinions about disclosure. A convenience sample of 675 physicians in Udine (North Italy) completed a ten-item questionnaire. About 45% indicated that, in principle, patients should always be informed of the diagnosis, but only 25% reported that they always disclosed the diagnosis in practice. Physicians with a surgical specialization employed in general hospitals endorsed disclosure of the diagnosis more frequently than GPs and older physicians. One third of the responding physicians persist in the belief that the patients never want to know the truth. Hospital doctors considered the hospital, rather than the patient's home, was the most appropriate place to inform the patients. The opposite result was found among GPs. Almost all the physicians endorsed the involve-

SUMMARY The use of the chelating agent diethylenetriamine penta-acetic acid (DTPA) for measuring body storage iron was investigated in patients with iron excess whose stores could be determined by venesection.Iron excretion after DTPA bore a close semi-logarithmic relationship to body iron stores when these were increased. The excretion of DTPA-bound 59Fe was similarly related to the size of the stores, indicating that the increased iron excretion produced by DTPA in iron overload states reflects both increased tissue iron available for chelation and greater stability of the iron-chelate complex. Evidence was obtained that injected 59Fe-DTPA could be used as a marker for chelated tissue iron enabling the DTPA-chelatable body iron pool to be calculated.There was a highly significant correlation between DTPA-chelatable iron and body storage iron. The regression intercept approximated to the origin, implying a specific relation between the DTPA effect and storage iron. The SE of the mean estimate for storage iron on DTPAchelatable iron was 0.25 g (5.6 %).Mean storage iron values of 392 mg for males and 243 mg for females were predicted from the findings in control subjects.

SUMMARY The effect of desferrioxamine is examined in more than 100 patients with liver disease, including haemochromatosis, using the differential ferrioxamine test.The procedure gives a reasonably accurate estimate of the size of the iron stores, as determined by multiple venesection, in patients with idiopathic haemochromatosis. Since desferrioxamine is not specific for storage iron, unequivocally abnormal results are not obtained unless the iron load exceeds about 2.3 g.In other forms of liver disease the effect of desferrioxamine is generally increased compared with that in controls. The results show no correlation with the serum iron level or the degree of hepatic siderosis. High values are usual in the presence ofjaundice and overlap the range found in untreated haemochromatosis, adding to other evidence that desferrioxamine can derive iron from a hyperchelatable source unrelated to the stores.It is concluded that in liver diseases other than haemochromatosis the results of the test do not reliably reflect body storage iron content.

From February 1983 to January 1985, 497 patients with advanced breast cancer were randomly allocated to receive either epirubicin or doxorubicin in the following combination chemotherapy regimen: fluorouracil (5-FU) 500 mg/m2 intravenous (IV) on days 1 and 8; epirubicin or doxorubicin 50 mg/m2 IV on day 1; cyclophosphamide 500 mg/m2 IV on day 1 (FEC or FAC). Cycles were repeated every 21 days until progression or to cumulative doses of 700 mg/m2 for epirubicin and 550 mg/m2 for doxorubicin. Dose reductions were applied according to the standard criteria. Activity was evaluated in 443 patients (222 in the FEC arm and 221 in the FAC arm). The two experimental groups were comparable in age, performance status, menopausal status, histology, previous treatments, and site of the disease. The overall response rate (complete response and partial response [CR + PR]) was not significantly different: 53.6% for FEC and 56.5% for FAC. The median time to progression was 273 days for FEC and 314 days for FAC; the median survival time was 591 and 613 days, respectively. Leukopenia, anemia, nausea, and vomiting were significantly lower in patients treated with FEC. As for cardiotoxicity, four cases of congestive heart failure (CHF) were recorded among patients treated with FAC while only one was observed in the FEC group. These results indicate that epirubicin in a combination chemotherapy regimen is as active as doxorubicin and is significantly less toxic.

SummaryAntigenic material related to the fibrin stabilizing factor (Factor XIII-FSF) has been found in all the examined patients with congenital deficiency, albeit in reduced amount.Recently, Bohn et al. (1973) and Israels et al. (1973) showed that plasma Factor- XIII is composed by two subunits, A (or a) and S (or b); the former active protein, the latter probably FSF-binding protein.Using specific anti-S and anti-A antisera the Authors found, in a case of congenital deficiency of factor XIII, absence of subunit A. Subunit S presented abnormal behaviour as demonstrated by means of quantitative immunoelectrophoresis according to Laurell.