[The psychological characteristics of dyspepsia. A controlled study with gastroscopic follow-up]. / Caratteristiche psicologiche della dispepsia. Studio controllato con follow-up gastroscopico.

It's known that some psychologic factors could be implicated in dyspepsia. Therefore, the psychologic aspects of 38 dyspeptic patients (17 males, 21 females, aged 18-65 years), who underwent digestive endoscopy, were evaluated by means of Rorschach and MMPI test. Patients with previous peptic ulcer history, with chronic ethanol or NSAID intake, operated on digestive tract and patients with behavioural problems were excluded. The results of psychological tests enhanced two main groups: anxiety patterns (17 patients--49%) and normal patterns (21 patients--55%). Endoscopic and histological findings moreover showed: "anxious" group--12 patients with chronic gastritis (HP+ 50%), 5 patients with normal endoscopy; "normal" group--16 patients with chronic gastritis (HP+ 87.5%), 5 patients with normal endoscopy. This study suggests that in about 50% of dyspeptic patients anxious pattern is present. Moreover chronic gastritis is more frequently associated to Helicobacter pylori in non-anxious patients.

Prevalence of cholelithiasis in alcoholic and genetic haemochromatotic cirrhosis.

The prevalence of cholelithiasis and possible related factors was evaluated in 350 consecutive patients with alcoholic cirrhosis (218 cases, 174 male and 44 female, mean age 58 +/- 9 years) or genetic haemochromatotic cirrhosis (132 cases, 115 male and 17 female, mean age 53 +/- 10 years). At enrollment patients with alcoholic cirrhosis were significantly older than those with genetic haemochromatotic cirrhosis (P < 0.01), and their clinical status was more severe (Child's class B/C in 99 alcoholic cirrhosis cases versus 27 genetic haemochromatotic cirrhosis cases, P < 0.01). The overall frequency of cholelithiasis was 31% (67 cases) in the alcoholic cirrhosis group and 30% (40 cases) in the genetic haemochromatotic cirrhosis group, without differences according to gender, classes of age (< or = 49, 50-59, > or = 60 years), or HBsAg positivity in either group. In addition, in the genetic haemochromatotic cirrhosis group the presence of diabetes (45 cases), alcohol misuse (38 cases) and beta-thalassemia trait (13 cases) did not influence the prevalence of cholelithiasis. Body mass index, serum cholesterol and triglycerides, and the severity of the underlying liver disease (Child's class) did not distinguish patients with or without cholelithiasis. In conclusion, the frequency of cholelithiasis was high in both alcoholic cirrhosis and genetic haemochromatotic cirrhosis, and was three times higher than that reported in controls from the general population of the same area.

[The effect of colloidal bismuth and its combination with amoxicillin on the elimination of Helicobacter pylori in patients with a duodenal ulcer and chronic antral gastritis]. / Effetto del bismuto colloidale e dell'associazione con amoxicillina sull'eradicazione dell'Helicobacter pylori in pazienti con ulcera duodenale e gastrite cronica antrale.

Although the aetiopathogenetic role of Helicobacter Pylori (HP) in duodenal ulcer and in chronic gastritis seems now well defined, we have not yet standardized therapeutic schedules to achieve disappearance of HP. This study was aimed at evaluating the efficacy of two different therapeutic schedules, colloidal bismuth alone [CB(1200 mg/day)], vs. association with amoxicillin [CB+A(3 g/day)] for six weeks, to clear HP from antral specimens in a cohort of dyspeptic patients. 49 consecutive patients (23 females, 26 males, mean age 47 years, range 22-69) with HP in gastric specimens, 30 suffering from chronic antral gastritis (CG) and 19 affected by duodenal ulcer (DU) were treated with CB (37 pts) or with CB+A (12 pts). DU patients were given also H2-blockers. These latter patients were all healed at the endoscopic control performed after therapy. 4 out of 13 DU patients (31%) treated with CB were found HP free. In 4 out of 6 DU patients (66%) treated with CB+A, HP was no more detectable. As for CG patients, 12 out of 24 (50%) were free from HP at control when treated with CB, while only 2 out of 6 (33%) when CB+A was administered. This study suggests that colloidal bismuth is more effective when administered associated with amoxicillin, but this concerns only DU patients. No relation between endoscopic healing of UD and HP presence was found.

Cholelithiasis in cirrhosis: analysis of 500 cases.

The prevalence of cholelithiasis (gallstones or previous cholecystectomy) was evaluated in a series of 500 cirrhotic patients from Northern Italy (329 males and 171 females, mean age 58 +/- 11 (SD) yr and 61 +/- 10 yr, respectively). Cirrhosis was related to chronic alcohol abuse in 180 cases, non-A non-B (NANB) hepatitis in 160, hepatitis B virus (HBV) in 94 (including 38 with concomitant alcohol abuse), idiopathic hemochromatosis in 44, and miscellaneous causes in the remaining 22 (including 15 with primary biliary cirrhosis). One hundred and sixteen patients (23.2%) had gallstones, and 31 others (6.2%) had previously undergone cholecystectomy, with an overall prevalence of cholelithiasis of 29.4%. The frequency was similar in both sexes (91/329 males, 27.7% vs. 56/171 females, 32.7%; p = NS), showed a slight increase with age, and differed significantly according to etiology (p less than 0.05), with the highest prevalence in the miscellaneous group and the alcoholics (36.4% and 33.3%, respectively). No significant difference was found in the prevalence of cholelithiasis according to Child's A, B, or C class.

Prevalence of HIV infection in 646 heroin addicts and outcome of HIV-related conditions in the 266 followed up.

In a series of 646 heroin addicts anti-HIV was detected in 428 (66.2%) and HBsAg in 53 (8.2%). Forty-eight (90.5%) of the latter had concomitant chronic HDV infection. Markers of past HBV infection were found in 481 (74.4%). The prevalence of anti-HIV was significantly higher in the 534 subjects with HBV markers than in the other 112 without markers (69.8% versus 49.1%, p less than 0.001). Of the 266 anti-HIV positive subjects followed for 3-48 months (median 12), nine progressed from no disease to persistent generalized lymphadenopathy (PGL), 52 from PGL to AIDS-related complex (ARC) or AIDS (30 and 22 cases respectively), and six from ARC to AIDS. Baseline T4 + cell count was significantly lower and reduction during follow-up significantly greater in heroin addicts with disease progression than in those without.

Validation of a screening questionnaire for alcoholism (MAST) in an Italian sample.

One hundred fifty subjects (75 index cases and 75 controls) completed the Italian version of the Michigan Alcoholism Screening Test (MAST). Using Relative Operating Characteristic (ROC) analysis, the 5/6 cut-off point was found to be the best as for discriminating between "cases" and "non-cases" in terms of balance between sensitivity (96%) and specificity (89%). The positive predictive value, the negative predictive value, and the overall misclassification rate were 90%, 95%, and 7% respectively. Using item by item assessment of discriminating capacity, we developed a brief ten item Italian version (2/3 cut-off point). This discriminated between alcoholics and non-alcoholics as well as the longer version, and is thus superior in situations where a brief evaluation is necessary.