Colorectal cancer screening in LHU4 Chiavarese, Italy: ethical, methodological and outcome evaluations at the end of the first round.

UNLABELLED: INTRODUCTION. The screening programmes are very challenging from the ethical perspective, and their impact in terms of morbidity and mortality make secondary colorectal cancer prevention a valuable public health intervention. METHODS: The target population people aged 50-69 years receive an invitation card with a test-tube for the fecal occult blood test (FOBT) and an immunochemical test is used for fecal occult blood. Subjects positive to FOBT are invited to perform a gastroenterologic examination and a full colonoscopy. RESULTS: In the firt round of screening, 100% of the target population has been invited with an adhesion rate of 41.3%. A total of 1739 FOBT-positive subjects have been invited to the second level of the screening. 1429 of them have performed the gastroenterologic examination (83.9%). To date 956 full colonoscopies have been completed and the rate of subjects affected by carcinoma, malignant polyp and advanced adenoma has been equal to 23.5%. DISCUSSION: Thanks to the reminders already sent, an increasing compliance has been registered with an increased rate of subjects with a low schooling that have performed a FOBT test. With the aim to optimize all the operative aspects of the screening programme it is already ongoing a set of meetings between health workers of Local Health Unit 4 and General Practioners.

[A case of voluminous gastric fibroleiomyoma. Diagnostic problems]. / Su un caso di voluminoso fibroleiomioma gastrico. Problemi diagnostici.

The Authors present a case of gastric fibroleiomyoma characterized by its remarkable size (at least in this anatomic site) and, this notwithstanding, by the fact that, of all instrumental investigations, only abdominal echotomography supported the clinic relief of a neoplastic "mass" situated in the left hypochondriac region. Echotomography quite exactly, though not specifically, informed the Authors on the localization and conformation of the neoplasm, and on its not-infiltrating tendency and not belonging to parenchymal organs. The Authors therefore consider echotomography a determinant investigation for the surgeon willing to perform an explorative laparotomy, being in front of an abdominal "mass" of doubtful provenance.

[Comparison of quandrantectomy and Halsted's radial mastectomy. Personal cases]. / Confronto fra la quadrantectomia e la mastectomia radicale secondo Halsted. Casistica personale.

The authors review all the breast diseases and tumours observed from 1972 through 1979 at the Division of Surgery, Hospital of Rapallo. On the basis of personal experience they discuss the possibility that, in the treatment of early breast cancer, a relatively conservative surgery (i.e. quadrantectomy), followed by postoperative radiotherapy and adjuvant chemotherapy in the N+ cases, give no worse results than standard radical mastectomy, in preventing local relapses and distant metastases, and therefore in conditioning both free-of-disease interval and survival of the patients, as many Authors in these last years have well shown either for quadrantectomy or other conservative procedures. This retrospective study particularly evaluates the results of 12 quadrantectomies performed in Stage I and II, compared to 8 Halsted radical mastectomies in the same Stages: all patients in the two groups survive free of disease (follow-up for the quadrantectomies from 6 to 41 months). Furthermore 4 cases of Stage III breast cancer are presented, 2 treated with Halsted procedure: in the first case the death occurred at 19 months, after the development of distant metastases, while in the second local relapses have been observed at 11 and 30 months; 2 patients were treated with quadrantectomy, as they didn't accepted a radical procedure: both survive free of disease at 17 and 23 months respectively.