[The relationships between the general practitioner and the oncological radiotherapist. A preliminary study by telephone interviews]. / I rapporti tra medico generico e radioterapista oncologo. Studio preliminare attraverso interviste telefoniche.

PURPOSE: We addressed the issue of the relationship between the general practitioner (GP) and the radiotherapist to improve the quality of care of cancer patients. MATERIAL AND METHODS: The study consisted in evaluating medical requests and phone interviews, with a questionnaire with yes/no and multiple choice answers to the following 5 questions: 1) Do you think a cancer diagnosis is always a hopeless death sentence? 2) Is it professionally rewarding to cure a cancer patient? 3) Are you satisfied with your relationship, as a general practitioner, with oncologic reference centers? 4) Is it more wearing for a general practitioner to manage a cancer than a noncancer patient? 5) Would you answer a questionnaire about the relationship between the general practitioner, the cancer patient and the oncologist? We evaluated 1590 medical requests and made 401 phone interviews; 255 colleagues (70%) answered the questionnaire. RESULTS: Medical requests were correctly and completely formulated by GPs in 45% of cases. A cancer diagnosis was not considered a hopeless death sentence in 90.9% of cases and 76% of GPs considered it professionally rewarding to cure a cancer patient. 75.6% of GPs considered it more wearing to manage a cancer than a noncancer patient, and female GPs felt this more strongly than their male counterparts. Irrespective of gender, GPs over 50 years of age tend to consider cancer a hopeless and fatal disease. The relationship with oncologic centers was considered satisfactory in 86.2% of cases. However, since cancer patients need greater medical care, GPs would like a closer cooperation with oncologists. DISCUSSION AND CONCLUSIONS: The great interest GPs took in this study encourages further investigation through a more in depth questionnaire designed with the help of GPs themselves and interested statisticians.

[Therapeutic and prophylactic role of mesalazine (5-ASA) in symptomatic diverticular disease of the large intestine. 4 year follow-up results]. / Ruolo terapeutico e profilattico della mesalazina (5-ASA) nella malattia diverticolare sintomatica del crasso. Risultati a 4 anni di follow-up.

In order to evaluate the efficacy and tolerability of mesalazine (5-ASA) in the prophylaxis of symptomatic relapses, of major complications and of microhemorrhagic phenomena in diverticular disease of the large intestine (MDC), prospective clinical study was conducted on patients with light-moderate symptomatic MDC under treatment with sulbactam-ampicillin 1.5 g/12 h i.m. and rifaximine 400 mg/12 h per os for 7 days. Follow-up period of 5 years with seriated checkups and laboratory and instrumentation controls. End points are represented by the relapse on inflammation and/or by the occurrence of major complications. On enrollment, 166 patients were randomized to receive mesalazine (Pentacol tablets--SOFAR S.p.A.) 400 mg b.i.d. per os for 8 weeks (81 patients; group M) or no supplementary treatment (85 patients; group C). After 4 years of follow-up, 44 patients dropped out of the study (9 because of major complications, 3 for massive hemorrhage, and 32 drop outs). Symptomatic relapses occurred in 51 patients (12 M; 39 C), while minor diverticular hemorrhages occurred in 43 patients (12 M; 31 C), with an estimated probability of remaining free respectively from symptomatic relapse (p=0.00005) and from microhemorrhagic phenomena (p=0.001) decisively in favor of the group treated with mesalazine. The duration of abdominal pain due to diverticolitis was also shorter in patients of group M (p=0.0002), while the incidence of major complications and side effects was comparable in the two groups. In conclusion, supplementary treatment with mesalazine in patients affected with MDC--at a follow-up limited to 48 months--proved to be well tolerated and effective in reducing the frequency of symptomatic relapses and microhemorrhagic phenomena and in reducing the duration of abdominal pain.

Note: identification of Lactobacillus delbrueckii subspecies bulgaricus and subspecies lactis dairy isolates by amplified rDNA restriction analysis.

Amplification and restriction analysis of the 16S rRNA gene (PCR-ARDRA) was used to identify Lactobacillus delbrueckii dairy isolates and to assign them to its three subspecies (delbrueckii, lactis and bulgaricus). PCR-ARDRA allowed confirmation of predictions from the DNA database regarding the restriction mapping of the 16S sequence to be verified in practice. PCR-ARDRA was shown to be a reliable and rapid method for identifying Lact. delbrueckii isolates at the subspecies level and for differentiating this species from Lact. helveticus and Lact. acidophilus.

Genotypic heterogeneity among Lactobacillus helveticus strains isolated from natural cheese starters.

A total of 23 strains of Lactobacillus helveticus isolated from natural whey starter cultures for Italian hard cheeses and three reference strains were characterized by plasmid profiling, ribotyping and random amplified polymorphic DNA (RAPD) fingerprinting. The data showed an interesting strain heterogeneity in natural cheese starters, that seemed not only strain-dependent, but also related to the source of isolates. Nineteen of the strains tested harboured extrachromosomal elements, whilst 11 different plasmid profiles were detected. Ribotyping with a variety of restriction enzymes differentiated 11 strains and in a few cases, RAPD fingerprinting allowed differentiation amongst strains that were not distinguished by the other two techniques.

[Efficacy of low dose mesalazine (5-ASA) in the treatment of acute inflammation and prevention of complications in patients with symptomatic diverticular disease. Preliminary results]. / Efficacia della mesalazina (5-ASA) a basse dosi nel trattamento della flogosi acuta e nella prevenzione delle complicanze in pazienti con malattia diverticolare sintomatica. Risultati preliminari.

MATERIALS AND METHODS: To assess the efficacy of mesalazine in treating acute diverticulitis and preventing diverticular disease (DD) complication. 166 patients with symptomatic DD were randomly assigned to receive mesalazine Pentacol (400 mg b.i.d., orally; M group) or no additional treatment (controls; C group). RESULTS: After a 12 months follow-up, 26 patients experienced a symptomatic relapse (8%M vs 27% C, p=0.003), with a higher rate in C group for the patients with a history of previous diverticulitis (p=0.006) and independently of the diverticular site (sigmoid p=0.041; colon and sigmoid p=0.044). Minor diverticular haemorrhages were less frequent in M group (p=0.016), with a significant difference only for the patients with sigmoid diverticula (p=0.023); abdominal pain persisted for a shorter time in the treated group (p=0.0015). CONCLUSIONS: No significant difference was found between the two groups for the incidence of DD major complications.

Transcobalamin II: a marker for macrophage/histiocyte proliferation.

Increased blood levels of (apo-)transcobalamin II have been observed in several clinical conditions, but persistent inability to find a common denominator for this plasma protein aberration has hampered its introduction as a clinically useful laboratory parameter. Because several observations suggested a relationship between reticuloendothelial cell activity and transcobalamin II, the finding of an extreme transcobalamin II elevation in a patient with malignant histiocytosis was taken seriously. Of 14 consecutive patients with proliferative histiocytosis (8 malignant, 6 reactive), all revealed marked to extreme elevations of transcobalamin II. Macrophage/histiocyte origin of this protein is supported by a close parallelism to increased serum angiotensin-converting enzyme activity. Comparative pre- and postoperative measurements of transcobalamin II and angiotensin-converting enzyme in four patients with histiocytic proliferation who underwent splenectomy, an intervention that led to immediate reduction of the macrophage/histiocyte cell pool, revealed a parallel and impressive drop of both parameters, further corroborating the histiocytic origin of transcobalamin II. It is suggested that transcobalamin II determination provides useful information on activity and size of the macrophage/histiocyte system, and supplements measurements of the traditional acute phase reactants (e.g., C-reactive protein, red blood cell sedimentation rate).