DNA content in human colon cancer and non-neoplastic adjacent mucosa

DNA content was determined by flow cytometry in a series of 51 paired fresh tissue samples of primary colorectal carcinomas and the respective non-neoplastic adjacent mucosa in order to assess the relationship between DNA ploidy and the most commonly used prognostic factors. Aneuploidy was observed in 70.6% of the tumors and more than one aneuploid peak was present in 3.9%. Aneuploid tumor frequency was higher in left (93.3%) and right colon (64.7%) cancers than in rectal carcinomas (60.0%), and multiple aneuploid clones were detected more frequently in men than in women and in patients with advanced disease (Dukes stage D). Non-neoplastic mucosa adjacent to aneuploid tumors showed aneuploidy in 4 out of 51 samples (7.8%). The mucosa adjacent to diploid cancers had only diploid characteristics. Polidy did not correlate with histological abnormalities.

These findings suggest that DNA content as determined by flow cytometry needs further study with adequate follow-up to evaluate possible correlations with relapse-free and overall survival. Furthermore the aneuploidy of non-neoplastic mucosa provides evidence for a field defect in mucosa adjacent to colorectal cancer and supports the concept that this alteration may be of influence on carcinogenesis.

[Hospital admission of subjects with chronic obstructive bronchopulmonary disease (COPD) and air pollution in the city of Parma (Italy). A preliminary analysis]

A study was conducted in subjects admitted to hospital for chronic obstructive bronchopulmonary disease (COPD) in the city of Parma (Italy). The aim was to evaluate changes in patients' percent vital capacity (VC), forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), as a function of changing degrees of atmospheric pollution as measured by PM10, NO2 and O3 concentrations in the outside air. Study results revealed an association between PM10 concentrations and hospital admissions for COPD. Statistically significant differences were found between PM10 concentrations measured three-four days before admission and in days not followed by admission to hospital. Regression analysis between PM10 concentrations at 24, 48, 72, and 96 hours before admission and respiratory function showed a significant association between FVC% and FEV1% and PM10 concentrations at 96 hours. The relative risk was calculated to be 1.016 (95% confidence intervals: 1.001-1.032), which corresponds to a 1.6% increased risk of admission to hospital for COPD for each unit increase in PM10 concentration in the outside air.

[Microbiological aspects of pool water]

It is well known that there is an elevated risk of diffusion of pathogenic micro-organisms in swimming pools. Preventive measures aimed at protecting the health of swimmers are complex because of the variety of micro-organisms involved, the different ways in which these can be transmitted and the involvement of both aquatic and environmental factors. In industrialised countries, the circulation of many pathogens which were common in the past has progressively decreased in recent years; in contrast, infections caused by emerging pathogens such as Pseudomonas, atypical mycobacteria, Aeromonas, Legionella, Cryptosporidium, Norwalk virus, adenovirus and rotavirus have increased in frequency. Such infections affect not only the gastrointestinal tract but also other body sites, in particular the skin, conjunctiva, respiratory tract and auditory apparatus. Opportunistic pathogens capable of causing potentially serious infections in debilitated and immunocompromised subjects may also be involved. It is clearly necessary, therefore, that preventive interventions and effective monitoring programs, regarding both pool water and environmental quality, be implemented in all swimming facilities.

Investigation on virucidal activity of chlorine dioxide. experimental data on feline calicivirus, HAV and Coxsackie B5

INTRODUCTION

The aim of this study was to evaluate the efficacy of ClO2 with regard to viruses which show a particular resistance to oxidizing agent such as HAV and Norwalk and Norwalk-like viruses, and which play an important role in the epidemiology of viral foodborne diseases. In the food industry, disinfection of processing systems and equipment is a very important instrument to prevent secondary contamination and to guarantee food safety. Among disinfectants, chlorine dioxide (ClO2) presents a good efficacy at wide range of pH values, its action is rapid and generates few reaction byproducts if compared to hypoclorite. Experimental studies have highlighted that ClO2 shows a good bactericidal activity and it is also active towards viruses. Furthermore, the low concentrations and low contact times required to obtain microbial load reduction are favourable elements for the application of this compound in the industrial sanitizing practices.

METHODS

As it is impossible to cultivate the Norwalk virus in vitro, we tested the resistance of Feline calicivirus (F9 strain) vs. ClO2, in comparison with HAV (strain HM-175) and Coxsackie B5. Chlorine dioxide was used at concentrations ranging from 0.2 to 0.8 mg/l in water solution, at pH 7 and at +20 degrees C. Viral suspensions were added to disinfecting solution and, at pre-set times, were sampled to undergo to titration after blocking the disinfectant action with thiosulphate 0.05 M. On the basis of the data obtained, for each virus and in relation to different concentrations, mean reduction times were calculated for 99%, 99.9% and 99.99% using the regression analysis model.

RESULTS

As regards Feline calicivirus, at a concentration of 0.8 mg/l of ClO2, we obtained the complete elimination of the viral titre in 2 min while 30 min were required at concentrations of 0.2 mg/l. Coxsackie B5 showed a similar behaviour, being completely inactivated in 4 min with 0.4 mg/l of ClO2 and after 30 min at a concentration of 0.2 mg/l. Inactivation was quicker for HAV, which was eliminated after only 30 sec at a concentration of 0.8 mg/l and after 5 min at 0.4 mg/l.

CONCLUSION

Our data show that for complete inactivation of HAV and Feline calicivirus, concentrations > or = 0.6 mg/l are required. This observation is true for Coxsackie B5 too, but this virus has shown a good sensitivity at all concentration tested according to regression analysis results. For Feline calicivirus and HAV, at low concentrations of disinfectant, prolonged contact times were needed to obtain a 99.99% reduction of viral titres (about 16 and 20 minutes respectively).

[Exposure to organic halogen compounds in drinking water of 9 Italian regions: exposure to chlorites, chlorates, thrihalomethanes, trichloroethylene and tetrachloroethylene]

This study investigated the exposure to organohalogens compounds in drinking water from 9 Italian towns (Udine, Genova, Parma, Modena, Siena, Roma, L'Aquila, Napoli and Catania). Overall, 1199 samples collected from 72 waterworks were analyzed. THMs, trichloroethylene and tetrachloroethylene were evaluated using the head-space gas chromatographic technique (detection limit of 0.01 microg/l; chlorite and chlorate analysis was performed by ion chromatography (detection limit of 20 microg/l). THMs were evidenced in 925 samples (77%) (median value: 1.12 micro/l; range: 0.01-54 mciro/l) and 7 were higher than the THMs Italian limit of 30 microg/l. Chlorite and chlorate levels were higher than the detection limit in 45% for chlorite and in 34% for chlorate samples; median values were 221 microg/l and 76 microg/l, respectively. Chlorite values were higher than the chlorite Italian limit (700 microg/l) in 35 samples (8.7%). Trichloroethylene and tetrachloroethylene were measured in 29% and 44% of the investigated samples and showed values lower than the Italian limit (highest levels of 6 microg/l and 9 microg/l, respectively). The low levels detected of THMs, trichloroethylene and tetrachloroethylene have no potentials effects on human health, whereas, the levels of chlorite and chlorates should be further evaluated and their potential effects for the populations using these drinking waters, better understood.

[Integrate cell culture--PCR (ICC/PCR) in viruses researches in environmental and food samples. Note I]

We carried out an experimental work integrating cell-culture and PCR to follow the HAV replication, to verify the PCR positiveness times and to confirm infectious viral particles presence. In tests HAV strain H59-175 was used. We proceeded to an initial valuation of the lowest viral concentration detectable by PCR. With viral titres between 10(5)-10(7) PFU/ml, the highest positive dilution resulted 10(-4)-10(-5). Then the 1 log lower dilution was inoculated in cell culture. At fixed times we proceeded to take surnatant and lisate samples for PCR test. After cell culture integration, positiveness was obtained in 72-120 hours against the 10-18 days necessary for CPE appearance.

Study on inactivation kinetics of hepatitis A virus and enteroviruses with peracetic acid and chlorine. New ICC/PCR method to assess disinfection effectiveness

The virucidal activity of chlorine-compounds was studied using hepatitis A virus (HAV) and Poliovirus 2 and comparing the disinfectant efficiency of peracetic acid. HAV presented a higher resistance to HClO than Poliovirus did. With ClO2 the inactivation times of HAV were markedly shorter. A comparison between these data and those resulting from the kinetics with peracetic acid (PA) showed that PA is less effective than chlorine. As a preliminary to future research, the PCR-test integrated with cell-cultures was experimentally introduced for a quick evaluation of the HAV-infectiveness, with the aim of possible application in the field of disinfection and of viruses-isolation from environmental and food samples.

A fluorescence-based method for the detection of adhesive properties of lactic acid bacteria to Caco-2 cells

AIMS

The ability of probiotic micro-organisms to adhere to the intestinal surface is regarded as a substantial advantage in terms of bacteria persistence in the gastrointestinal tract. The aim of the present study was the development of a method based on fluorescent staining of bacteria and subsequent spectrofluorimetric detection to quantify the adhesion of several strains of Lactobacillus and Bifidobacterium to Caco-2 cells.

METHODS AND RESULTS

Lactic acid bacteria strains were subjected to fluorescent staining using the viable probe carboxyfluorescein diacetate and subsequently incubated on Caco-2 monolayers. The adhesion of the micro-organisms was determined by spectrofluorimetry following the lysis of the attached bacterial cells and expressed as adhesion percentage. The values obtained for the micro-organisms tested ranged from 4% for Bifidobacterium infantis Bi1 to 10% for a Bifidobacterium mixture containing three different strains.

CONCLUSIONS

In the present study we successfully applied fluorescent labelling and fluorimetric detection to investigate the adhesive properties of some Lactobacillus and Bifidobacterium strains and a Bifidobacterium mixture to Caco-2 cells.

SIGNIFICANCE AND IMPACT OF THE STUDY

The results proved that fluorescent labelling is suitable for adhesion studies and provides a reliable and safer alternative to radioactive labelling.

[Air pollution and mortality and hospital admission for respiratory disease in Parma on 1992-2001 period]

A study into the effects of atmospheric pollution on the health of people living in the city of Parma (population 170,000) shows motor vehicle traffic of average density and light industrial activities that have little impact on air pollution. General mortality and hospitalisation for all causes and for DRG specific were considered as sanitary events. The day values of the total PT, PM10, SO2 and NO2, CO and benzene were analysed. In addition, atmospheric conditions and outbreaks of flu were considered. The study results for the period 1992-2001 show quite moderate pollution levels with the sole exception of PM10 that shows average values often higher than 40 microg/l. An analysis of the associations between mortality and climatic parameters shows the role of temperature with RR equal to 1.0064 (CI95% 1.0046-1.0082) and epidemics of influenza with RR 1.042 (CI95% 1.0219-1.0671). As regards the pollution parameters, the total PT and SO2 turned out to be related to increases in mortality of respectively 0.6% for 100 microg/m3 of PT and 1.72% for 50 microg/m3 of SO2 while the NO2 turned out to be related to an increase in hospitalisations of 1.9% for 10 microg/m3 of NO2.

[Presence of disinfection by-products (DBPs) and other halogenated compounds in drinking water samples collected in the areas of Modena and Parma]

The Authors report data about the presence of Disinfection By-Products (DBPs) and other halogenated compounds in drinking water samples collected in the areas of Modena and Parma (20 water supplies). Trihalomethanes, chlorite and chlorate (only in water samples treated with chlorine dioxide), and halogenated compounds were investigated. On the whole, trihalomethanes were evidenced in the 85% of the samples (n. 285) at low levels, while chlorite and chlorate were present in the 67% and 63% of the treated samples with chlorine dioxide (257 samples). Chlorite mean and median values were 225.70 microg/l and 136.75 microg/l respectively, ranging from 20 to 2000 microg/l. Chlorate concentrations were lower than chlorite: the mean value was 102.93 mg/l, while median level was 50 microg/l (range: 20-1500 microg/l). The high concentrations of chlorite and the wide range of values within each municipality plant in Modena and Parma suggest to investigate further in order to evaluate the human exposure in drinking water thoroughly.

[Comparative study on HAV and Poliovirus 2 inactivation cinetics with peracetic acid]

Hepatitis A virus and Poliovirus 2 inactivation tests were carried out using three peracetic acid concentrations (160, 320 and 640 mg/l) at different pH condition and at +20 degrees C temperature. HAV HM-175 strain was grown in FRhK4 cells and titrated in PFU (plaque technique) and the Poliovirus 2 strain was grown in monkey kidney cells RC-37 and titred in TCID50. The viral titration reduction was determined in the space of an hour with the disinfectant contact at 10-15 minutes intervals. The results obtained with the hepatitis A virus have shown a good linear trend between viral titration and contact time at the highest concentrations without any particular pH influence. The complete viral activity absence was achieved after 30-60 minutes of contact at 640 mg/l concentration. As regards Poliovirus 2 a good linear trend was highlighted between titrations and times at all the concentrations in shorter times at pH acid. The complete viral activity absence was obtained with 640 mg/l concentration after 30 minutes at pH acid. The HAV seems to own a higher resistance than Poliovirus 2 and Poliovirus 1 too.

Biological markers in non-small cell lung cancer. Retrospective study of 10 year follow-up after surgery

BACKGROUND

The biological markers in non-small cell lung cancer (NSCLC) have been widely studied and encouraging results have shown that products of some oncogenes and other molecular markers can predict the aggressiveness of the disease and the outcome of the patients.

METHODS

To verify the reliability of these prognostic markers we have studied retrospectively the expression of c-erbB-2 and 67Ki (growth regulation), p53 (cell cycle regulation and apoptosis), bcl-2 (apoptosis) and CD31 and CD34 (angiogenesis) in 78 patients operated on for NSCLC with curative intent between January 1987 and December 1988 and followed up for 10 years. For the determination of the biological markers we have used the ABC (Avidin-Biotin-Peroxidase complex) immunohistochemical method. The Cox regression model was used for the univariate and multivariate analysis.

RESULTS

Nineteen patients (24%) were alive after 10 years and 59 (76%) died. The univariate analysis of the relationship between the 10-year survival and the expression of the markers was significant only for p53 (p=0.0097). Stratifying the patients according to the 3 histological subtypes (squamous cell carcinoma, adenocarcinoma and large cell undifferentiated carcinoma) the correlation between markers and survival pointed out that the only significant one was p53 (p=0.0459) in adenocarcinoma. In the same way considering the stages p53 was significant in stage IIIa (p=0.0357). The multivariate analysis emphasized that p53 was the only significant marker with respect to the 10-year survival (p=0.0091). Examining the histological groups significant was only p53 in adenocarcinoma (p=0.0192) and in large cell undifferentiated carcinomas (p=0.0290). This marker is also significant in pathological stage II (p=0.0271) and IIIa (p=0.0402). Apart from histology and staging the 10-year survival was 33% for p53 negative versus 10% for p53 positive. In patients with adenocarcinoma the 10-year survival was 40% for p53 negative and 6% for p53 positive.

CONCLUSIONS

In conclusion our results emphasize the importance of p53 as a prognostic factor in 10-year survival in patients with adenocarcinoma and in stage II and IIIa.

Simultaneous repair of bilateral inguinal hernias: a prospective, randomized study of open, tension-free versus laparoscopic approach

No randomized trial exists that specifically addresses the issue of laparoscopic bilateral inguinal hernia repair. The purpose of the present prospective, randomized, controlled, clinical study was to assess short- and long-term results when comparing simultaneous bilateral hernia repair by an open, tension-free anterior approach with laparoscopic "bikini mesh" posterior repair. Forty-three low-risk male patients with bilateral primary inguinal hernia were randomly assigned to undergo either laparoscopic preperitoneal "bikini mesh" hernia repair (TAPP) or open Lichtenstein hernioplasty. There was no difference in operating time between the two groups. The mean cost of laparoscopic hernioplasty was higher (P < 0.001). The intensity of postoperative pain was greater in the open hernia repair group at 24 hours, 48 hours, and 7 days after surgery (P < 0.001), with a greater consumption of pain medication among these patients (P < 0.05). The median time to return to work was 30 days for the open hernia repair group and 16 days for the laparoscopic "bikini mesh" repair group (P < 0.05). Only 1 asymptomatic recurrence (4.3%) was discovered in the open group. The laparoscopic approach to bilateral hernia with "bikini mesh" appears to be preferable to the open Lichtenstein tension-free hernioplasty in terms of the postoperative quality of life and interruption of occupational activity.

Mini-laparoscopic cholecystectomy vs laparoscopic cholecystectomy

BACKGROUND

We set out to assess the safety and efficacy of mini-laparoscopic cholecystectomy (MLC) in uncomplicated situations.

METHODS

MLC was performed on 30 consecutive selected patients (< 60 years old, ASA I-II, uncomplicated cholecystectomy) with one 12-mm and three 3-mm ports. The total operating time, conversion rate, degree of postoperative pain, duration of postoperative hospital stay, complications, and cosmetic results were all reviewed and compared with 30 cases of consecutive conventional laparoscopic cholecystectomy (LC).

RESULTS

None of the patients in either group required conversion to open cholecystectomy. No complications were observed. The operating time and duration of hospital stay were similar in both groups. The level of postoperative pain was lower in the MLC group (p < 0.001). More patients in the MLC group expressed satisfaction with the cosmetic result (p < 0.05).

CONCLUSIONS

MLC was shown to be feasible in uncomplicated situations. Furthermore, it was associated with less pain and produced better cosmetic results than conventional LC. Randomized studies are still needed to confirm these findings.

Pre- and postsurgical psycho-emotional aspects of the orthognathic surgery patient

The current study represents an attempt to examine psychologic changes, emotional impact, expectations, and satisfaction in patients before and after orthognathic surgery. Levels of presurgical anxiety, postsurgical depression, body concept, and all the important changes in physiologic functions were measured by 4 questionnaires, which were self-administered before and after surgery. The results of this study suggest that surgery does, in fact, produce improvements in self-esteem and body image (patient's evaluation of his or her facial attractiveness) and in mastication and speech, and therefore in their lifestyle. All patients experienced a medium to high level of presurgical anxiety, but no major problems after surgery.

Does laparoscopic cholecystectomy worsen the prognosis of unsuspected gallbladder cancer?

BACKGROUND

Several reports claim that there is a risk that laparoscopic cholecystectomy (LC) might worsen the prognosis of unsuspected gallbladder cancer.

HYPOTHESIS

Several factors rather than LC could influence prognosis.

METHODS

A retrospective clinicopathologic study was performed on 20 patients, 9 patients (3 men and 6 women, aged from 36 to 75 years [mean age, 62.3 years]) undergoing LC and 11 patients (2 men and 9 women, aged from 53 to 91 years [mean age, 65.3 years]) undergoing open cholecystectomy (OC), with postoperatively diagnosed gallbladder cancer. The correlation was evaluated between cumulative survival rates and the following 7 prognostic factors: age, sex, histopathological grade, pathologic stage, occurrence of bile spillage, type of cholecystectomy (LC or OC), and additional surgical treatments.

RESULTS

Seven patients (87%) after LC and 9 patients (82%) after OC had cancer recurrence: the difference is of no statistical significance (P =.9). There were no recurrences of cancer in the abdominal wall after either LC or OC. Survival rate was statistically correlated to tumor stage (P =.007) and to the occurrence of bile spillage (P =.002). Survival rate did not change according to whether the operation was carried out using LC or OC (P =.60).

CONCLUSION

These results would seem to lend support to the opinion that LC does not worsen the prognosis for unsuspected gallbladder cancer.

Asymptomatic bile duct stones: selection criteria for intravenous cholangiography and/or endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy

OBJECTIVE

Routine use of endoscopic retrograde cholangiography (ERC) and/or intravenous cholangiography (IVC) or magnetic resonance cholangiopancreatography (MRCP) before laparoscopic cholecystectomy (LC) is not cost-effective. The objective of this study was to determine precise and easily applicable criteria to select patients who should undergo IVC, MRCP and/or ERC before LC.

DESIGN AND METHODS

Prospectively collected data from 74 consecutive patients who were diagnosed with asymptomatic common bile duct stones (CBDS) before undergoing LC, were compared with data from 74 matched controls without CBDS. Using the chi2 test, those variables were identified which were significantly related to the presence of CBDS. These were inserted into a logistic multiple regression model and, by means of conditional regression analysis, each variable was assigned a score from -2 to +4 proportional to the odds ratio. By adding up the scores obtained, a classification was made as to high, medium and low CBDS risk.

RESULTS

As a result, 51 patients were found to be low-risk cases, 53 medium-risk and 44 high-risk. Assuming no further assessment of the bile duct needed to be carried out in low-risk patients, an IVC or MRCP in those at medium risk and an ERC in those at high risk, a calculation was made of the positive predictive value and the sensitivity of the system proposed. The positive predictive value and the sensitivity of the procedure were calculated as being greater than 90%.

CONCLUSIONS

This predictive system for the risk of CBDS allows the selective use of ERC, IVC and MRCP to ensure a high yield and improve cost-effectiveness. A controlled prospective study will verify these results.

Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy

BACKGROUND

Postoperative shoulder-tip pain occurs frequently following laparoscopic cholecystectomy. The aim of this randomized clinical trial was to evaluate the efficacy of a low-pressure carbon dioxide pneumoperitoneum during laparoscopic surgery in reducing the incidence of postoperative shoulder-tip pain.

METHODS

Ninety consecutive patients undergoing laparoscopic cholecystectomy were randomized prospectively into low-pressure (group A) and normal-pressure (group B) laparoscopic cholecystectomy groups. Patients in group A (n = 46) underwent laparoscopic cholecystectomy with 9 mmHg carbon dioxide pneumoperitoneum during most of the operation, and those in group B (n = 44) had laparoscopic cholecystectomy with 13 mmHg pneumoperitoneum. Shoulder-tip pain was recorded on a visual analogue pain scale 1, 3, 6, 12, 24 and 48 h after operation.

RESULTS

The low-pressure pneumoperitoneum did not increase the duration of surgery. There were no significant intraoperative or postoperative complications in either group. Fourteen patients (32 per cent) in group B and five (11 per cent) in group A complained of shoulder pain (P<0.05). Mean shoulder-tip pain scores at 12 and 24 h and postoperative analgesia requirements were also significantly lower in the low-pressure laparoscopic cholecystectomy group (P<0.001).

CONCLUSION

A carbon dioxide pneumoperitoneum pressure lower than that usually utilized to perform laparoscopic surgery reduces both the frequency and intensity of shoulder-tip pain following laparoscopic cholecystectomy.

Adenocarcinoma of the colon and rectum: some reflections on the immediate and long-term results of surgery

Colorectal cancer continues to be a major public health problem in western countries. Although some studies have reported an improvement in disease-free and overall survival, few of the diagnostic and therapeutic procedures proposed have found unanimous consent. We report some reflections on both the immediate and the long-term results of colorectal cancer surgery on the basis of our experience, represented by 1164 patients with histologically proven colorectal carcinoma, admitted to the Institute of General Surgery of Parma University between 1976 and 1993 and operated on by the same surgical team, in order to provide data for scientific discussion. A curative resection was possible in 67.9% of the cases. Our experience shows that many colorectal cancer patients will be cured with aggressive surgery, although, in recent years, adjuvant therapy for colorectal cancer has advanced considerably. Statistical analyses reveal that an unfavourable prognosis is correlated with variables indicative of advanced disease. Concerning the problem of local recurrences, our results demonstrate that surgery is the only therapeutic option providing tangible results, and that intense follow-up leads to a greater number of resections carried out for local recurrence and to improved 5-year survival. Comparison of studies and scientific discussions can prove useful, above all regarding secondary prevention and, in particular, the identification of patients at risk who should undergo screening for early diagnosis and early surgical treatment.

Risk factors of local recurrence of colorectal cancer: a multivariate study

BACKGROUND/AIMS

Duke's staging is still the most widely used parameter in the estimation of risk for local recurrence in patients with colorectal neoplasia. The aim of this study is to identify biological determinants that may be of use in segregating patients with similarly staged tumors into groups with different risk of local recurrence.

METHODOLOGY

Ninety-eight patients who had undergone curative resection for colorectal cancer between 1989 and 1991 were prospectively studied. Statistical analysis of clinical and pathologic variables was carried out using a Cox multivariate proportional hazard model.

RESULTS

Dukes stage and DNA ploidy were the only significantly predictive variables for local recurrence. In particular, the factors increasing local recurrence risk were seen to be the presence of lymph node metastases and aneuploid status. In the absence of both of these negative prognostic factors the risk of local recurrence is practically nil, in the presence of just one it reaches 16% and in the presence of both it rises to over 40%.

CONCLUSIONS

The results of this study indicate that the presence of an aneuploid tumor with positive lymph nodes places patients at a higher risk of local recurrence, and calls for post-operative adjuvant therapy and intensive follow-up.

Reduced postoperative morbidity after elective laparoscopic cholecystectomy: stratified matched case-control study

To answer the question whether laparoscopic cholecystectomy (LC) or open cholecystectomy (OC) is safer in terms of complications and to what extent the "learning curve" influences the frequency of complications after LC, we conducted a matched case-control study. First, 200 patients undergoing LC (LC group A), and two groups of 200 patients undergoing LC at two different periods of the learning curve (LC groups B and C) were matched, taking into account sex, age, anesthesiologic risk, and surgical difficulties. We evaluated the frequency and grade of postoperative complications of these patients and of the last 200 patients undergoing OC before the introduction of LC, retrospectively matched with the LC groups. The total rate of complications in the OC group was 16.0% compared with 5.5% in the LC groups (p < 0.003); the difference was particularly significant for complications classified as grade I, in female patients, those younger than 70, those with low anesthesiologic risk (ASA), and those after cholecystectomy without surgical difficulties. Matched case-control analysis revealed that the complication rate in the LC group significantly decreases with experience (P < 0.01). We conclude that LC is today the treatment of choice for symptomatic cholelithiasis and is replacing OC as the gold standard against which new therapies should be compared.

Prognostic value of ploidy, cell proliferation kinetics, and conventional clinicopathologic criteria in patients with colorectal carcinoma: a prospective study

PURPOSE

The aim of this study was to obtain additional biologic determinants that may be of use in segregating into subgroups with different prognosis patients with similarly staged colorectal cancers.

METHODS

Between 1989 and 1991, a prospective study of prognostic factors has been performed in a group of 98 consecutive, unselected patients who underwent curative resections for primary untreated large bowel carcinoma. The fate of all patients is known at three years after operation. Clinical and pathologic data were recorded at the time of presentation and operation, and patients have been the subjects of regular follow-up. Tumor DNA content was determined by flow cytometry, and cell proliferative activity was determined by autoradiography with tritiated thymidine labeling index (LI).

RESULTS

Univariate analysis revealed that the most important predictors of survival (P < 0.001) were the presence of positive lymph nodes, the presence of preoperative complications, Dukes stage, and LI. The multivariate analysis showed that Dukes stage (P < 0.002) and LI (P < 0.0001) were the only factors significantly related to survival. Disease-free survival was influenced significantly by Dukes stage (P < 0.001), LI, according to the classification in the two groups of high and low proliferative activity, respectively, (P < 0.0001), LI, calculated as a continuous variable (P < 0.0002), and the presence of lymph node metastases (P < 0.003). Outcome (favorable/unfavorable) was influenced significantly by Dukes stage (P < 0.0001) and LI (P < 0.0001). Concordance for each patient between Dukes stage and outcome was 73.1 percent and between LI, calculated as a continuous variable, and outcome was 74.1 percent. If, on the other hand, Dukes stage and LI are used together, concordance with outcome reaches 89.2 percent.

CONCLUSION

We can conclude that, from a practical point of view, LI is an essential factor that must be combined with pathologic variables for a better prediction of patient outcome.

Prevention of colorectal cancer. Role of association between gallstones and colorectal cancer

A significant association was found between colorectal cancer, especially of the right colon, and concomitant gallstones. This was noted especially in female patients and in those over the age of 65. The existence of such an association is of advantage in terms of secondary prevention of colorectal cancer. The possible screening methods are discussed for those gallstone patients at risk.

Gallstones and risk of colonic cancer: a matched case-control study

The aim of the research was to verify the existence of an association between neoplasms in the colon and cholelithiasis, treated surgically or non-surgically. The case-control study was carried out on 109 patients operated on for cancer of the colon, and on 109 control patients operated on for benign pathology. Matching was carried out according to sex, age, region of origin and dietary habits of the patients. Results showed a significant association of cancer of the colon with concomitant cholelithiasis (odds ratio = 2.42) but not with previous cholecystectomy. This correlation was more evident in female patients (odds ratio = 3.2), over 65 years of age (odds ratio = 3.6), with neoplasms in the right colon (odds ratio = 5). Observations suggest cholecystectomy has a protective role as regards an increased risk of cancer of the colon in cholelithiasic patients. A confirmation of this association might also be beneficial in terms of early diagnosis of cancer of the colon, thereby allowing identification of a large population of risk patients to be submitted to monitored screening.

[Acute respiratory syndromes caused by viruses in a pediatric department. Clinical and epidemiological studies of a series of cases admitted in the period from February to May, 1979]

In the period between February and May 1979, in concomitance with a sharp increase in admittance to the pediatric Division of the Parma General Hospital for acute respiratory infections, we carried out a virologic and serologic investigation on hospitalized children aged 21 days-12 years. The investigation was carried out on 137 patients with respiratory diseases: 33 with bronchiolitis, which occurred mainly (32/33) between February and March in children that were prevalently (30/33) in the first year of life; 27 with upper respiratory tract infections; 54 with mid respiratory tract infections; 23 with pneumonia. Forty-eight controls (without respiratory infections) were also investigated. In the months of February and March there was a high circulation of respiratory syncytial virus (RSV): throughout the entire period there was a lower incidence of Adenovirus infections and more uniformly distributed.

[Virological research in acute respiratory diseases in 1976--1977 (author's transl)]

From October 1976 to June 1977 virological researches have been carried out on 5 subjects with influenza, on 302 children hospitalized in pediatric departments for respiratory illness and 94 children hospitalized in the same departments for other (non respiratory) diseases. The incidence of influenza was moderate and restricted to small epidemic episodes in school and preschool children. The isolated viruses resulted of A type, substantially similar to the prototype strains appeared from 1972 to 1975. Among children hospitalized for respiratory diseases Adenoviruses (6.8%) and, with decreasing frequency, Enteroviruses, paraifluenza viruses and RS have been also isolated. The incidence of isolation of RS virus is significantly related to bronchopneumonia cases in infants under on year of age. The incidence of significant increases of FC antibodies against influenza (A and B) viruses, RS and Myc. pneumoniae in children with bronchitis and broncho-pneumonia is also considerable. The drawing of pharyngeal swabs at different intervals from the entry to the hospital has shown that the shedding of respiratory viruses is generally very short and that hospital cross-infections may occur.

[Research on the quality of the Po River and its tributaries in the region of Cremona-Casalmaggiore mountain. III. 1972-1973]

The analises of water samples collected during the second research period, year 1972-73, in the tract of the river Po from Cremona to Casalmaggiore partly confirmed the results obtained in the first period (1971-72). However we have to consider that during this second research year the hydrological conditions of the river Po have been very similar to the average ones of the last 30-40 years. The fact is particularly important and it permitted us to better value all those parameters which feel the effects of the flow variations. Also in this second period the different parameters didn't present significative variations upstream and downstream Cremona and at Casalmaggiore except the turbid load as happened in 1971-72 period. As far as the water qualities are concerned no significative differences have been registered between the two paeriods; in fact the most part of the physioco-chemical parameters keep suitable levels for fish life and drinking purposes; meanwhile, except some particular situations, the microbiological indexes exceed the limits for bathing waters fixed by the W.Q.C. and by the Italian Ministry of Health.

[Studies on the quality of water of the right side tributaries of the Po River; Trebbia and Nure, in 1971-1973]

In the period 1971-73 samplings were taken out monthly at the mouths of the two right side tributaries of the river Po, Trebbia and Nure. The aim of the research was to value the water quality, the polluted load conveyed to the river Po and to compare the real load with the one estimated on the basis of inhabitants and the basin area. Both the water courses are torrent-like rivers with highflow values in the winter and low flow values in the summer (July and August). There are no important industries in the basins studied and the high polluted effluents, mainly domestic and agricultural discharges, are placed in the plain tracts of the rivers at few kilometers from the mouths. As far as the water quality of both rivers is concerned, most of the chemical parameters maintain suitable levels for fish life and drinking purposes; on the contrary the microniological indexes exceed the limits for bathing fixed by the Italian Ministry of Health by 100 E.coli 100/ml. and by 1000 total coliforms 100/ml. in about 90 and 70-80% of samplings. The comparison between real and calculated loads has shown a good agreement for BOD and chloride in Trebbia and for BOD and phosphates in Nure.

[Researches on the water quality of the river Po and its tributaries between Cremona and Casalmaggiore. I. materials and methods (author's transl)]

During 1971 a research program about the status of pollution of the river Po and its tributaries was started by six Institutes of Hygiene altogether (Turin, Pavia, Milan, Parma, Modena and Ferrara Universities) with the Institute for Water Research of C.N.R. and Hydrographic Office of Magistracy of the Po. The role of the Parma University Hygiene Institute was to study the water qualities of the river Po between Cremona and Casalmaggiore and of two right side tributaries, Arda-Ongina and Taro. The hydrogeographical characteristics of the examined reach are reported in the present note, with special reference to the hydrological conditions, basin area, inhabitants and industrial typology. The sampling stations were placed upstream and downstream Cremona town, near Casalmaggiore and at the mouth of Arda-Ongina and Taro. Moreover the methods, for chemical and bacteriological analysis are reported.

[Studies on the water quality of the river Po and its tributaries between Monte Cremona and Casalmaggiore. II. Period 1971-2]

The results relating to the research carried out on the river Po upstream and downstream Cremona town, at Casalmaggiore and at the mouths of the right side tributaries Arda-Ongina and Taro in the period 1971-72 are reported in the present note. The samplings took place once every month and on the same day flow measurements were effected by the Magistracy of the river Po in the five stations. The results of this first series of sampling have shown a good stability of the water quality of the river Po, in the different seasons and in the different hydrological conditions. No significative differences were poi nted out for the most part of the determined parameters between the stations upstream and downstream Cremona and Casalmaggiore, except the turbid load (turbidity, suspended matter at 105 degrees C, setteable solids) which presented at Casalmaggiore an average value absolutely higher than the calculated one which was achieved considering concentrations and river flow at Cremona and at the mouths of Arda-Ongina and Taro. With few exceptions the water quality keeps a good level for fish life and its actual pollution degree let us think it possible to improve the situation in a short time. Only microbiological parameters are excepted, as they exceed the proposed limits for recreation and bathing uses (W.Q.C.).