[Intrahepatic cholangiocarcinoma: case report]. / Colangiocarcinoma intraepatico: case report.

The primitive tumors of the liver are relatively rare in the Western countries (around the 0.7% of all the neoplasms) while they present more elevated incidence in Africa and in the South Asian East. While the hepatocellular carcinoma rises up in the 50-70% of the cases in livers cirrosis, this correlation is not valid for the form of carcinoma to departure from the learned intra and extra biliar. The etiology of the intrahepatic colangiocarcinoma (CC) stays unknown. They have stayed observe, on the other hand, of the conditions sometimes correlated to the development of the CC (Carolí morbs, ulcerative colitis, asbestosis). The CC usually rises up from the epithelial cells of surface that delimit the biliary ducts, although different studies suggest that these tumors can also originate from the learned smaller biliary ducts, from the hepatic cysts of the policistic illness and from the complexes of von Meyenburg. The low incidence of the CC, the clinical atypical debut, the not facility of a precise diagnosis have aroused our interest so that the present job wants to be a modest scientific contribution to this type of pathology.

Prevalence of tuberculous infection among students in Naples.

The aim of this study was to estimate the prevalence of tuberculous (TB) infection in Naples, Italy. The target population was defined as pupils aged 6, 9 and 13 yrs, studying in state and private schools in Naples. A stratified cluster sampling design was used. The stratification criteria were: age (6, 9, 13 yrs); type of school (state or private); and district within the town. Prevalence of TB infection was assessed through a tuberculin Tyne test. Some individual risk factors of tuberculous infection were also investigated by means of a simple questionnaire given to pupils' parents. Among observers reproducibility of test reading was also evaluated. An overall prevalence of TB infection of 5.7% (95% confidence interval (95% CI) 4.6-6.8) was observed in the 1,597 sampled subjects. Skin-test positivity was highly variable with age, ranging from 2.8 (95% CI 1.0-4.6) at 6 yrs to 9.4% (95% CI 7.1-11.7) at 13 yrs. In 458 children (28.7%) response was blindly assessed by three independent observers. Reproducibility of tuberculin skin-test reading was good, with an overall kappa value of 0.718. Only parents' drug abuse was found to be significantly associated with infection. This is the first study to evaluate the prevalence of tuberculous infection in Naples.

Asthma and bronchial reactivity: a contribution from multivariate analysis.

This study was performed on 508 young male candidates on the military pilot course of the Air Force Academy. Observations of the following parameters were made: immunoglobulin E (IgE) level, skin sensitivity test (prick test) to most common continuous and seasonal allergens, and results of nonspecific bronchial provocation tests with methacholine. The analysis strategy that has been developed consists of two techniques, "multiple correspondence analysis (MCA)" and "automatic classification". The correlation between the categories of the characters evaluated are: degree of high skin reactivity in relation to high IgE levels, hyperreactivity to low methacholine dose (noticed mainly in subjects allergic to continuous antigens), low degree of skin reactivity (both to continuous and seasonal antigens and found in relation to a low methacholine dose) and medium and low IgE levels. The cluster analysis defined three different classes of subjects: 1) 51.97% of the total observed subjects. 68.82% of those subjects that showed IgE levels above 7300 and a high reactivity to low methacholine dose; 2) 15.94% of subjects with a severe allergy to pollens; and 3) 32.09% of subjects with IgE levels lower than 900, low bronchial reactivity and no allergic component for either seasonal or continuous antigens. The use of multivariate statistical techniques in this field of pathophysiology has allowed a confirmative-explorative study of allergic phenomena in relation to several characters, and the determination of classes of subjects characterized by well-defined categories.

Clinical and functional outcome after restorative proctocolectomy.

Restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) has been carried out on 88 patients since 1982. Three different pouch designs (J, S and W) were used. Ten pouches had to be removed. Detailed analysis was performed on 61 patients (J = 23, S = 15, W = 23) whose pouches had been functioning for at least 6 months. There was no significant difference in surgical complications before or after ileostomy closure between pouch designs but the hospital stay was greater after construction of an S pouch (P less than 0.05). There were no significant differences in stool frequency, degree of continence or urgency between the three types. Twelve patients with J pouches required antidiarrhoeal medication compared with only one with S and five with W pouches. Only seven patients with S pouches could defaecate spontaneously compared with 22 with W pouches and all patients with J pouches (P less than 0.001). Twenty-five of 29 patients who had preservation of the anal transition zone had perfect continence compared with 23 of 32 with a mucosal proctectomy (P = n.s.). Pouchitis occurred in 13 patients, all of whom had ulcerative colitis. In a subgroup of 23 patients, pouch evacuation was assessed scintigraphically. There was no difference in pouch capacity or total volume evacuated, but spontaneous evacuation was better in J and W pouches compared with S pouches.