Similarities in the surnames of island and continental populations of the north-western Mediterranean area.

This paper compares the structures of the surnames of 75 municipal populations living in six north-western Mediterranean regions. Its purpose is to unravel the relations between the local populations in Corsica and Sardinia and the links between these populations and those living in the Italian and French continental territory. On the basis of the matrix of similarity of surnames, some topological representations have been drafted showing the above-mentioned relations between populations under the light of their geographical position, their recent history and studies of genetic analysis. Corsica has an eterogeneous surname structure and evident similarity of the north with Tuscany and some centres of continental France. When only the populations of Sardinia were taken into consideration, it emerged that they differ among each other in relation to their geographical position and their history; when, instead, they were considered in relation to other populations outside the island, it was possible to observe that they form a highly different cluster. This study also identified many differences in the analysed geographical areas of Sardinia. In the minor islands - Elba, Giglio, Capraia - the structure of the surnames has a Tuscan origin as well as some similarity with other geographically distant areas, as in the case of the island of Giglio, if compared with some communities of Liguria.

Reducing colorectal cancer mortality by repeated faecal occult blood test: a nested case-control study.

Randomised trials have shown the efficacy of faecal occult blood testing (FOBT) in reducing colorectal cancer mortality, but observational studies are needed to monitor such efficacy in population programmes. We conducted a nested case-control study on a cohort of 21,879 subjects who participated in a colorectal screening programme from 1978 to 1995, undergoing at least one FOBT test. 95 fatal cases of colorectal cancer were eligible for the study. For each fatal case, 5 non-fatal matched controls were randomly selected from the cohort. FOBT screening history was less common among cases than controls. The odds ratio of colorectal cancer mortality among 'attenders' (defined as those who underwent a second FOBT within 2 years of study entry) with respect to 'non-attenders' was 0.64 (95% confidence interval 0.36-1.15). We also computed odds ratios defining exposure as one or more tests in the detectable preclinical period, hypothesising various lengths for the latter, which, however, yielded an efficacy estimate biased towards the null. A strong inverse relationship was observed between mortality and the number of tests, but this phenomenon is interpretable as 'healthy screenee bias'. The results suggest that the potential efficacy in preventing colorectal cancer mortality through annual FOBT screening may be of the order of one third.

Conservative management of esophageal leaks by transluminal endoscopic drainage of the mediastinum or pleural space.

BACKGROUND: The management of postoperative leaks into the mediastinum or pleural cavities after esophageal surgery yields unsatisfactory results. A recently described method, drainage of the mediastinum or pleural cavity through suture line defects, has been used in our department with eight patients. METHODS: A suction tube was advanced over an endoscopically placed guide wire into the abscess from inside the esophagus, and gentle aspiration was used to remove saliva and secretions. Intravenous antibiotics and total parenteral nutrition were also given. RESULTS: The sepsis was rapidly controlled, and the abscess cavity progressively collapsed in all cases. Seven patients recovered and were discharged 34 to 61 days after operation; one died of concomitant complications. CONCLUSIONS: This method seems promising for the management of intrathoracic esophageal leaks.

Determinants of Helicobacter pylori seroprevalence among Italian blood donors.

BACKGROUND/AIM: Helicobacter pylori is a worldwide infection. It is estimated that approximately 50% of the general population is affected, but this percentage varies considerably between countries. To investigate the prevalence of H. pylori infection, a cross-sectional epidemiological study, based on the serological determination of the IgG antibodies against H. pylori, was carried out in healthy Italian blood donors by using a commercially available kit. METHODS: From March 1995 to March 1997, a total of 2598 consecutive volunteer blood donors were tested for the presence of antibodies against H. pylori. All patients answered a detailed questionnaire which collected sociodemographic characteristics, and smoking, alcohol drinking and dietary habits. Test-positive subjects with gastrointestinal symptoms underwent endoscopy, with biopsies taken for histological diagnosis. RESULTS: The global prevalence of H. pylori infection in our study was 1161/2598 (45%). It was directly correlated with age (67% in subjects aged > or = 50 years). The prevalence of H. pylori infection was higher in men (46.4%) than women (38.4%), and more frequent in patients with a low educational level, in the lower quintile of height and in the upper quintile of body mass index (BMI). No significant association with smoking and alcohol drinking was found. Inverse associations were found with elevated consumption of milk (chi-square for trend 5.49, P < 0.05), but not other examined food groups. Multivariate analysis selected sex, age, BMI and educational level as the variables independently related to H. pylori infection. CONCLUSION: This study confirms relatively high prevalence of H. pylori seropositivity among Italian healthy adults and points to sex, age, BMI and sociocultural class as persisting determinant features of H. pylori infection.

First-line chemotherapy with intraperitoneal cisplatin and intravenous cyclophosphamide in ovarian carcinoma. A preliminary report.

Between August 1982 and October 1986, the feasibility and activity of five cycles of intraperitoneal (i.p.) cisplatin (CDDP) (90 mg/m2 in 6 h dwelling) and i.v. cyclophosphamide (600 mg/m2) were studied in 24 previously untreated patients with ovarian carcinoma having small or no residual disease after cytoreductive surgery. Six patients (25%) had local complications requiring catheter removal before the end of therapy. Fifteen of the 21 patients (71%) evaluable for activity achieved or maintained a pathologic complete remission. The median disease-free survival was 29+ months (range 18-58+ months). Three patients with tumor progression (two patients previously without evidence of disease, and one patient with minimal residual disease), and three partial responders were documented by laparotomy at the end of therapy. Two patients who achieved pathologic complete response relapsed at 20 and 36 months. All treatment failures (eight cases, 38%) occurred in the peritoneal cavity. Since patients were selected for having the most favorable tumor characteristics to benefit from i.p. treatment, our findings may cast some doubt on the actual contribution of i.p. CDDP at a dose of 90 mg/m2 in the treatment of patients with ovarian carcinoma and small residual disease in the peritoneal cavity.

Radiologic diagnosis of invasive carcinoma on adenomatous polyps of the colon.

The radiographic appearance at double contrast enema of 33 cases of invasive cancer on adenomatous polyps (AP) of the colon is reviewed. The radiologic diagnosis of malignancy was prospectively made in 54.5% of the cases. In 45.5% of the cases, malignancy was not suspected at the time of examination. The endoscopic appearance of these lesions was identical to that seen on the barium study. There are no radiologic criteria able to entirely rule out the possibility of a carcinomatous transformation of an AP. However, the radiologic features of malignancy (indentation of the intestinal wall and/or irregular outline of the surface of the polyp) have to be considered quite reliable.

Treatment of malignant polyps.

From 1975 to 1993, at the Division of Diagnostics and Endoscopic Surgery of the Istituto Nazionale Tumori in Milan, 191 malignant adenomas of colon-rectum have been endoscopically removed. On the basis of histopathologic criteria, endoscopic treatment has been judged adequate in 102 cases (53%), not adequate in 44 (23%), doubtfully adequate in 45 (24%). In 84 patients (44%) endoscopic polypectomy has been followed by surgical resection of the involved intestinal tract, 107 patients (56%) have been treated only by endoscopy. Results have been evaluated on the basis of surgical specimen, clinical follow-up and survival, showing that criteria we have adopted for the adequacy of the endoscopic treatment have a high negative predictive value (96%) and a low positive predictive value (32%). Actuarial survival of patients treated only endoscopically is 97% at 5 years and 95% at 10 years.

Laparoscopy in staging and restaging of 95 patients with ovarian carcinoma.

The merits of laparoscopy with inspection of diaphragmatic leaves were studied in 95 patients with ovarian carcinoma. Laparoscopy was positive in 19 out of 27 new cases, 11 out of 47 patients previously treated and in apparent complete remission, and 12 out of 21 patients previously treated and with the disease. Thirty-one out of 95 patients were shown to have diaphragmatic metastases alone and/or associated with other localizations of disease. In 5 out of 27 new cases the stage was modified after laparoscopy. The histologic-endoscopic correlation was correct in 28/36 positive cases (78%) and in 31/32 negative cases (97%). In conclusionall patients with ovarian carcinoma should be subjected to laparoscopy as staging and restaging before undergoing laparotomy.

Endoscopic treatment of postradiation strictures.

BACKGROUND: Esophageal stricture is a rare complication of radiotherapy: reports on its incidence and management are therefore anecdotal. METHODS: From January 1978 to September 1992, 44 patients presenting with an esophageal stricture related to a previous radiation treatment were endoscopically dilated at the Endoscopy Division of the Istituto Nazionale Tumori of Milan. RESULTS: Esophageal recanalization was obtained in 95% of the patients treated, and in 79% of these normal eating habits were restored. No strict correlation was observed between radiation dose and severity of the stricture, or time elapsed between first treatment and endoscopic dilation. CONCLUSIONS: In our experience, endoscopic dilation was a safe effective procedure and represented an effective palliative tool in dysphagic patients with esophageal strictures due to previous local radiotherapy.

Laparoscopy combined with peritoneal cytology in staging and restaging ovarian carcinoma.

The merits of laparoscopy, with inspection of the diaphragmatic leaves, and of peritoneal cytology (free fluid or washing) in staging and restaging were studied in 153 patients with ovarian carcinoma. Of 153 patients examined, 83 were new cases, 34 were restaging in patients without clinical and/or radiological signs of disease, and 36 in patients with evident disease. The conversion rate for diaphragmatic metastases alone was 6%. Information about the spread of disease (diaphragmatic metastases) was obtained in 33 new cases (39.7%). In pretreated patients, laparoscopy was positive in 4 of 34 NED restaging and in 24 of 36 ED restaging. The conversion rate for peritoneal cytology was 6.6%, but information about the cellular intraperitoneal spread of the disease was obtained in 31 new cases (37.8%). In pretreated patients, peritoneal cytology was positive in 4 of 34 NED restaging and in 13 of 36 ED restaging.

Risk of colorectal cancer following colonoscopic polypectomy.

AIMS AND BACKGROUND: To follow a cohort of patients who had undergone polypectomies in order to assess the overall risk of subsequent colorectal cancer in relation with various adenomas characteristics. METHODS: A total of 1,063 patients with adenomatous polyps of the large intestine were treated between 1979 and 1996 at the National Cancer Institute of Milan, during a screening program for colorectal carcinoma. Data on patients who had undergone colonoscopies were collected prospectively. The relation between colorectal cancer and adenomas characteristics was assessed by computing the hazard ratio (HR) values and corresponding confidence intervals (95% CI), according to Cox. RESULTS: Of the 1,063 patients who met the eligibility requirements, 672 had single adenomas (63.2%) and 391 had multiple adenomas (36.8%). Histological examination revealed 743 cases of tubular adenoma, 196 cases of tubulo-villous adenoma, and 96 cases of villous adenoma. High-grade dysplasia was found in 3.1% of the cases. During the 8,906 persons/year of follow-up, adenocarcinomas of the large bowel developed in 11 patients. Several adenomas' characteristics at index polypectomy were significant predictors of colorectal cancer occurrence. In univariate analysis the risk of colon cancer was significantly related with multiple adenomas (HR 4.2, 95% CI 1.1-6.5), high-grade dysplasia adenomas (HR 10.0, 95% CI 2.6-38.1) and with adenomas larger than 2 cm (HR 5.0, 95% CI 1.2-20.4). A multivariate stepwise procedure confirmed that the presence of multiple adenomas and presence of high-grade dysplasia are the most important predictors of carcinomas. Hazard ratios for colorectal cancer occurrence, from multivariate Cox's model, were 5.1 (95% CI 1.2-19.9) for multiple compared to single adenomas, and 13.0 (95% CI 3.6-50.7) for adenomas with high-grade dysplasia compared to those with low-grade dysplasia. CONCLUSIONS: High-grade dysplasia, number and size of adenomas were confirmed as the major cancer predictors. Based on this conclusion, a subgroup of patients, who may benefit from intensive surveillance colonoscopy, can be identifiable.

Accuracy of the double contrast enema in evaluation of the abdominal diffusion of ovarian carcinoma.

The results of 103 double contrast enemas in 72 patients with ovarian carcinoma (stage III and IV) were compared with laparoscopic and/or laparotomic findings at comparable times. The evaluation of the validity of radiology in detecting the presence of abdominal disease showed an 84% overall accuracy, 75% specificity and 86% sensitivity. The accuracy in detecting signs of adhesion and parietal infiltration of the large bowel was 76.3%, due to the limited size of most of the lesions. Forty-seven of the 72 patients underwent a double contrast enema and laparoscopy during presurgical staging: accuracy in detecting lesions was the same for both examinations (80.4%). When double contrast enema and laparoscopy were used together in the evaluation of abdominal extension of the disease, the diagnostic accuracy rose to 93.6%.

Immunohistochemical reactivity of a monoclonal antibody prepared against human ovarian carcinoma on normal and pathological female genital tissues.

The reactivity profile of the monoclonal antibody (MAb) MOv18, raised against a poorly differentiated ovarian carcinoma specimen, was studied on normal tissues and tumors from the female reproductive system and on the kidney, which like the oviducts, vagina and uterus, also derives from the intermediate mesoderm. The obtained results indicate that MOv18 recognizes an epitope present on the normal epithelium of the oviducts, on 14-week old fetal kidney and, focally, on proximal and distal tubules of normal adult kidney. A strong reactivity was found on ovarian carcinomas, on invasive squamous carcinomas of the cervix and on endometrial carcinomas and hyperplasias. The antigen recognized by MOv18 (CaMOv18) therefore seems to be an epithelial cell marker associated with intermediate mesoderm differentiation, which can be derepressed during the neoplastic transformation of the ovary and the uterus.

Evaluation of quality of life in patients with malignant dysphagia.

BACKGROUND: In the last 10 years of clinical research there has been increasing interest in the evaluation of quality of life. Several generic and specific instruments have been developed for this purpose. EORTC QLQ C-30 is a cancer-specific questionnaire translated into various languages and validated in several European countries including Italy, where the impact of malignant disease on different areas of quality of life is poorly documented. METHODS: The EORTC QLQ C-30 was administered to 109 patients referred to the endoscopy division of the Istituto Nazionale Tumori, Milan, for endoscopic palliative treatment of malignant dysphagia to test its characteristics in terms of acceptability and clinical validity. RESULTS: In this group of patients the impact of advanced esophageal cancer was highly evident for Emotional and Physical Functioning, Fatigue and Global QoL scales. Dysphagia is a serious problem for many patients; there is a correlation between grade of dysphagia and four QoL dimensions. CONCLUSIONS: QoL assessment is an important tool to evaluate the adequate management of patients with esophageal cancer. The EORTC QLQ-C30 questionnaire proved to be valid and reliable also in this population.

MOv18 monoclonal antibody in diagnostic applications: capability to recognize the histotype of the original tumor.

Cells from 52 ascitic fluids and 28 abdominopelvic cavity washings, obtained from 46 ovarian cancer patients, 17 patients bearing malignancies of non ovarian sites and 17 patients with non-malignant ovarian diseases, were tested using 2 methods: traditional cytology and monoclonal antibody immunofluorescence. The immunologic test using the MOv18 MAb, raised against ovarian carcinoma, revealed immunoreactive cells in 83% of the 36 cytologically positive fluids and in one of the 8 negative fluids from ovarian carcinoma patients and in 18% of the 17 fluids from patients with non-malignant ovarian disease. Forty six cytologically positive ascitic fluids from malignant patients were analyzed in order to evaluate the ability of this MAb to identify the histotype of metastatic cells. Ninety-three percent (26/28) of the effusions from nonmucinous ovarian carcinomas contained MOv18-positive cells, whereas no reactive cells were found in cytologically malignant fluids from patients with ovarian tumors of other oncotypes or with carcinomas of non-ovarian origin. The MOv18 reagent, used as an adjuvant in cytological analysis, can help in the identification of the histotype of metastatic cells of unknown origin.

Endoscopic treatment of gastric carcinoids.

Carcinoids are the most common endocrine tumours, and arise from a multipotential primitive stem cell; the gastric location represents 2% of all carcinoids. From 1979 to 1992 at the Endoscopy Division of Istituto Nazionale Tumori, Milan, 2 patients suffering from single gastric carcinoid were endoscopically treated by electro-resection. No complication occurred during the treatment; 2 year- and 5-year-follow-up was performed in these patients, and no recurrence are observed. Surgical treatment represents the therapy of choice for gastric carcinoids, but endoscopic resection can represent an alternative in selected cases (lesions less than 1 cm or carcinoids with multicentric growth). Endoscopy can be used also in patients at high surgical risk.

Endoscopic treatment of polyps in the resected stomach.

Between 1974 and 1992, at the Department of Diagnostic and Surgical Endoscopy of Istituto Nazionale Tumori, in Milan, 27 patients with resected stomach and suffering from epithelial polyps of the gastric stump (10 lesions) and/or anastomosis (25 lesions), were endoscopically treated using electroresection (13 cases), electrocoagulation (2 cases), combined methods (electroresection plus Nd:YAG photocoagulation) (1 case) and biopsy forceps (19 cases). Complications occurred in 4 cases and consisted of hemorrhage. Seven patients developed 15 recurrences. Endoscopic treatment of polyps in patients with resected stomach is a safe and effective treatment, considering the low rate of complication.

Prevention and treatment of complications after endoscopic prostheses placement in tumors of the upper gastrointestinal tract.

Endoscopic intubation is a popular palliative method to resolve immediately malignant dysphagia. However, the complication rate is still high. Between 1978 and 1993, at the Division of Diagnostic and Surgical Endoscopy of Istituto Nazionale Tumori in Milan, 305 patients suffering from malignant dysphagia, were endoscopically treated by insertion of an endoprosthesis. We report the analysis of data regarding our complication rate, compared with the literature, and our experience in preventing managing complications related to this endoscopic procedure.

Endoscopic treatment of malignant dysphagia.

Palliative endoscopic treatment of dysphagia in patients with inoperable oesophageal cancer includes: dilation, Nd:YAG laser photocoagulation and intubation, used alone or in combination. Such procedures are usually performed on an outpatient basis and are associated with a low rate of morbidity and mortality. From 1978 to 1988, 476 patients (401 males, 75 females) were treated at the Endoscopy division of the National Cancer Institute of Milan for inoperable primary or recurrent malignancies of the oesophagus or cardia or for extra-oesophageal neoplasms causing dysphagia. Dilation was used in 172 cases, Nd:YAG laser photocoagulation in 90, prosthesis insertion in 72, dilation and laser in 97, and prosthesis and laser in 45. Functional improvement was reported in 75% of patients after dilation, in 89% after laser treatment, in 80% after intubation, in 80% after dilation and photocoagulation, and in 89% after laser and intubation. The median duration of dysphagia-free interval was 4 weeks in dilated patients, 6-8 weeks in photocoagulated patients and 20 weeks intubate patients. Overall median survival was 6.2 months. The complication rate was: 1.4% in dilation treatment, 1.4% in laser photocoagulation, and 8.8% in prosthesis intubation. Mortality related to endoscopic treatment was 2.1% (10/476 patients). Relief of dysphagia is one of the most important goals of palliative treatment in patients with inoperable oesophageal neoplasms. Moreover, endoscopic palliation improves the quality of life in the patients, with a low complication rate.

[Endoscopic polypectomy of the stomach]. / Polipectomia endoscopica nello stomaco.

Until 1970 endoscopy of the digestive tract was the only diagnostic method available. After this date, the introduction of endoscopic polypectomy enabled patients affected by these lesions to be treated, and at the same time considerably reduced their length of stay in hospital. The paper reports the results of 346 gastric polypectomies performed in 187 patients from 1974 to the present.