[Epidemiologic study of chronic hepatitis in relation to heptatis B virus infections (author's transl)]

In order to evaluate the role of hepatitis B virus (HBV) in the etiology of chronic liver diseases, paired sera of 143 patients with biopsy-documented chronic hepatitis were tested for HBsAg and anti-HBs by radioimmunoassay method. HBsAg was detected in 67.3% of patients with a preceding verified eipsode of acute hepatitis, and in 26.7% of patients with a cryptogenic form of chronic hepatitis. HBsAg was not found in any of patients with alcoholic chronic hepatitis and in only two of 18 patients with other forms of chronic liver disease. No significant difference in the incidence of anti-HBs was observed in all groups of patients. According to previous studies our results confirm the higher prevalence of HBV infection in etiology of chronic persistent and aggressive hepatitis and indicate that this prevalence may be observed especially in Middle and South Italy. The presence of HBsAg in the serum of 37.2% of our patients with cirrhosis compared with 9% of reported cases in North Italy suggest that HBV plays an important role in the etiology of cirrhosis of the liver in our area.

[Behavior and clinical significance of the eAg/ anti-e system in carriers of HBsAg]

An investigation has been carried out in 315 patients with acute and chronic HBsAg positive and negative hepatitis in order to study the relationship between a new recently identified antigen/antibody system designed eAg/anti-e and HBV pathology. eAg was detected in sera of 37,8% patients with acute hepatitis who recovered normally and of 65% patients with acute protracted hepatitis and circulating HBSAg. eAg was not found in the serum of any of 52 cases of acute HBsAg negative hepatitis. Prevalence of eAg positivity was also demonstrated especially in patients with more severe forms of chronic hepatitis. Anti-e was not found in any of 20 patients with acute protracted hepatitis, but in 40% of subjects with acute hepatitis who recovered, in 54,5% of asymptomatic HBsAg carriers and in 30% of patients with chronic persistent hepatitis. Our results confirm the specific association between eAg/anti-e system and hepatitis B infection and indicate that eAg determinant is associated with continuing activity and chronicity of hepatitic process. In contrast, anti-e is correlated with normal recovery of acute hepatitis, but it may be indicative also of asymptomatic carriage of HBsAg and of non-progressive liver disease.

Mortality from Esophageal Cancer in Piedmont, Italy

Piedmont is located at the borderline between Italy (where mortality from esophageal cancer is relatively low) and France and Switzerland (where it is relatively high). Therefore, it seemed of interest to investigate the mortality from this cancer in Piedmont. Age-adjusted yearly mortality rates for 1965–1969 were 4.3 and 0.8 per 100,000 for males and females, respectively. Rates were very similar in the town of Torino, in the 23 suburbs of the first belt, in the nonmetropolitan areas of the province of Torino, and in the other 5 provinces of Piedmont. In both sexes, the rates did not differ from those observed in Italy during 1966–1967, whereas rates for males were lower than the national rates for France and Switzerland (14.0 and 8.5/100,000/year, respectively). Rates for males were also lower than in the adjacent French departments of Savoie, Haute-Savoie, and Isère (where in 1967–1968 they ranged between 9 and 16). Mortality rates from esophageal cancer in the town of Torino were constant from 1951–1971. During the same period, mortality from laryngeal cancer in men doubled. This suggests that although some etiological agents (alcohol consumption and tobacco smoking) are common to esophageal and laryngeal cancer, the interplay between these 2 factors as well as that with other carcinogens is different for the 2 types of cancer.

Prevention of Meningeal CNS Involvement as a Factor Influencing the Duration of Complete Remission and Survival in Childhood Acute Lymphoblastic Leukemia

The influence on the duration of CR and survival of 2 modalities (MTX + hydrocortisone IT, with and without TCT) for the prevention of meningeal CNS involvement was assessed in 24 children with acute lymphoblastic leukemia. Of the 9 subjects who received MTX and hydrocortisone only, 42 % were still in CR 33 months after its attainment, as opposed to 75 % of the 15 who also received TCT. Survival at 33 months after diagnosis was 89 % and 82 % in the 2 groups. The results are compared with those obtained in an earlier series of 14 children who received no prophylactic treatment. Here CR at 45 months was 25 % and survival 46 %. Eight subjects died, as opposed to 3 (1 in CR) in the present series.

[Wilms' tumor. Our clinical experience]

The survival of children with Wilms' tumour is evaluated in 11 males and 12 females treated between 1967 and 1975 in the light of the clinical stage, age at diagnosis, and sex. The subjects were aged from 4 months to 6 years. Six were in stage I, 4 in stage II, 4 in stage III, 7 in stage IV, and 2 in stage V. Survival in stage I was 100% at 36 months and gradually decreased with the stage. Patients aged less than 2 years presented a survival of 50% two years after diagnosis, compared to 24% in those over 2 years old. Sex appears to be irrelevant to prognosis.

Trimethoprim-sulphamethoxazole in the treatment of cholera. Comparison with tetracycline and chloramphenicol

67 of the bacteriologically proved adult acute cholera patients have been examined in order to evaluate the efficacy of TM-SMX in comparison with tetracycline and chloramphenicol in the eradication of Vibrio cholerae from stools. Our results demonstrated that all three drugs sterilized the stools of all patients within 3 days with the exception of one case of TM-SMX's group, which had negative culture stools after 4 days. On the basis of our experience it can be emphasized that TM-SMX can support chloramphenicol and tetracycline in the antibacterial treatment of cholera with the advantage that the drug is efficacious with daily administrations.

A bioptic study of gastrointestinal mucosa in cholera patients during an epidemic in southern Italy

A histological biopsy study of gastric and jejunal mucosa of eight acute cholera patients during an epidemic in Southern Italy was carried out. The study demonstrated in all patients an intact epithelial lining of gastric and jejunal mucosa, a moderate degenerative process of enterocytes, presence of inflammatory lesions manifested by edema, vascular congestion, mononuclear cell infiltrate of lamina propria, and discharge of goblet-cells mucus. These changes reverted to normal in a few days. The authors emphasize that, contrary to cholera patients of Asiatic areas in whom an underlying chronic spruelike enteropathy is very common, the histological picture observed in Western patients may be considered more specific since Vibrio cholerae acts upon a normal intestinal mucosa.

[Treatment of cholera in the adult. Studies during recent epidemics in Apulia]

A rapid and adequate intravenous infusions of saline and alkali in correcting hypovolemic shock, alectrolyte abnormalities, acidosis and renal failure, is the choice treatment in the majority of acute cholera patients. On the basis of the knowledge of chemical composition of the gastrointestinal fluids loss and the definition of exact mechanism of metabolic features observed in acute cholera patients, it has been possible, in the last ten years, to develop and utilize in a large numbers of patients, a more exact and adequate treatment consisting of replacement of water and electrolytes depletion with saline and alkali of the same ionic composition of fluids lost through the gastrointestinal tract. The isotonic saline and isotonic sodium lactare regimen in a 2:1 ratio has been employed in the treatment of our adult acute cholera patients. Hypotensive patients received a rapid fluids infusion of 2-4 liters within the first 4-6 hours immediately after admission. Later on the quantity of intravenous fluids replacement was regulated on the basis of blood electrolytes pattern, blood pressure, diuresis and patient's hydratation. With this regimen of treatment we observed electrolytes and acid-basic abnormalities in only 25% of our patients. The peritoneal dialysis was applied in three of these patients with irreversible renal failure. Antibiotic therapy, that assume a secondary role in the treatment of cholera patients, was carried out in each case: in 19 cases were given 1 gram every 12 hours i.m. of chloramphenicol succinate; 14 cases received mg 500 of tetracycline orally every six hours; 34 cases received two tablets of trimethoprim-sulphamethoxazole every 12 hours (mg 240 of TM and g 1,6 of SMZ total dose). Except one case of TM-SMZ group who had stool culture positive for Vibrio on 4th day of therapy, in each other patients the stool cultures were sterilized in a period of 24-72 hours of antibiotic treatment.

[Renal complications of Asiatic cholera]

Seventy cases of cholera were admitted to Hospital during 1973 cholera epidemic; 49 showed the symptoms of renal failure, 19 of whom with anuria. Acute renal failure is caused from hypertonic or isotonic dehydration, metabolic acidosis and potassium depletion. Clinically the pattern of a tubulo-interstitial nephritis can be found; a short oliguric or anuric phase followed by a poliuric phase lasting about 10 days. The glomerular function usually cames back to normal in 20 days time. As for the therapy, 16 of the above mentioned 19 anuric patients received a conservative treatment only; 3 patients with preexisting chronic nephropathy required peritoneal dialysis. Only one patient died and one patient with lupic nephropathy was put on chronic haemodialysis treatment. Concluding: 17 patients out of 19 completely recovered their renal function.

Gastric abnormalities in cholera: epidemiological and clinical considerations

The anatomofunctional status of the stomach was studied in cholera patients during the outbreak in Bari, Italy, in 1973. Of a total of 70 patients examined, 24 were found to have undergone gastric resection for ulcer in the past. Stomach secretions induced by fasting and histamine stimulation were studied in 30 patients, the majority of whom showed achlorhydria and other disturbances of gastric secretion. These abnormalities not only predisposed the patients to cholera infection but shortened the incubation period. The clinical course and severity of the disease were also related to the degree of gastric damage, the most serious cases occurring in gastrectomized patients.