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Background: Colorectal cancer (CRC) is a major cause of mortality in Italy. Although prevention of CRC is possible, its cost-effectiveness when applied to the Italian population is unknown. Recently, computerized tomographic colonography (CTC) has been proposed for CRC screening., Aim: To compare the efficacy and cost-effectiveness of CTC screening in a simulated Italian population with those of colonoscopy and flexible sigmoidoscopy (FS)., Methods: The cost-effectiveness of different screening strategies was compared using a Markov process computer model, in which in a hypothetical population of 100,000 50 year-olds were investigated by CTC, colonoscopy or FS every decade. Outcomes were projected to the Italian national level., Results: CRC incidence reduction was calculated at 40.9%, 38.2%, and 31.8% with colonoscopy, CTC and FS, respectively. As compared to no screening, all screening programs were shown to be cost-saving, allowing a saving of 11 Euro, 17 Euro, and 48 Euro per person with colonoscopy, FS and CTC, respectively. FS appeared to be less cost-effective than CTC, whilst colonoscopy appeared to be an expensive option as compared to CTC. Undiscounted national expenditure was calculated to be 1,042,489,512 Euro, 1,093,268,285 Euro, and 1,198,783,428 Euro for FS, CTC and colonoscopy, respectively, as compared to 695,818,078 Euro without screening., Conclusion: CRC screening is cost-saving in Italy, irrespective of the technique applied. CTC appeared to be more cost-effective than FS, and it may also become a valid alternative to colonoscopy.

Background: To avoid multiple surgeries in stenosing Crohn's disease, pneumatic endoscopic dilatation has been introduced. The present study evaluated the long-term clinical outcome in Crohn's disease patients after endoscopic dilatation for ileal or neoileal strictures., Patients and Methods: All Crohn's disease patients who underwent pneumatic dilatation of ileal or ileo-colonic strictures between January 1988 and December 2001 were invited to return for a clinical check-up in June 2002. Clinical, endoscopic and radiological reports were reviewed. Symptomatic relief from sub-occlusive symptoms without requiring surgery was considered as a positive outcome, whereas the requirement of surgery was regarded as an unfavourable outcome. Possible predictors of favourable outcome were analysed., Results: Endoscopic dilatation was technically successful in 34/43 (79%) Crohn's disease patients, with a mean number of dilatations per patient of 3 +/- 3.13. During a mean follow-up of 63.7 +/- 44.6 months, a positive long-term outcome was observed in 18 (52.9%) patients, whereas surgery was necessary in the remaining 16 cases. The risk of surgery was distinctly higher within 2 years post-dilatation than in the next 2 years (26.4% versus 8.3%, respectively; P = 0.078). No clear clinical, endoscopic or radiological predictive factors for a successful outcome were identified., Conclusions: Endoscopic pneumatic dilatation is an effective and safe procedure to be applied to patients with stenosing Crohn's disease, offering a very long-term benefit in a sub-group of patients.

Serum mitochondrial and total aspartate aminotransferase activity was quantified by a characterized immunochemical method in 126 subjects, 44 healthy controls and 82 chronic alcoholics (51 outpatients and 31 monitored through 15 days). The monitored alcoholics were divided into actual abstinents (n = 21) and drinkers (n = 10) by blood ethanol concentration performed daily. The aims of the present study were: (a) to compare the diagnostic diagnostic usefulness of the mitochondrial isoenzyme and the mitochondrial/total aspartate aminotransferase ratio to detect problematic drinkers; (b) to evaluate the suitability of these indices to monitor abstinence, a difficulty not yet solved in the clinical management of alcoholics. The results demonstrated the mitochondrial isoenzyme to be more suitable to discriminate between controls and alcoholics (Kruskal and Wallis ANOVA, Bonferroni test, P < 10(-5) and mostly between actual drinkers and other alcoholics (P < 0.041). So acute alcohol consumption may be a significant, suggestive and until now inadequately examined factor in evaluating the suitability of mAST as a marker. The results, showing that mAST peaks quickly appear in the presence of a new alcohol intake, should indicate mAST as a possible marker of acute alcohol intake useful in checking self-claimed abstinence.

The relative accuracy and precision of the Coulter S Counter have been evaluated in comparison with manual hemiglobincyanide determination according to the recommendations of the International Committee for Standardization in Hematology. Some improvements in the manual procedure, such as centrifugation of hemiglobincyanide solutions and the use of the detergent Triton X-100, were also tested. The Coulter S Counter generally gives higher precision in comparison with the manual method. Nevertheles, Coulter S determinations are systematically lower due to both constant and proportional errors. The available data ranged between hemoglobin values of 11.5 and 18.5%, giving differences of 0-8% between hemoglobin values determined by the Coulter S Counter and the hemiglobincyanide method.

Pb-blood levels of 801 adult non-occupationally exposed subjects from Rome are reported. The investigation was carried out according to EEC Directive No. 77/312 with acceptable quality control of analytical data. A mean Pb-blood level of 173 micrograms/l (198 micrograms/l for males and 150 micrograms/l for females) was found; good correlations were found between Pb-blood levels and age, sex and smoking habits but no correlation was found in relation to drinking habits, residence and other variables which were examined. In the present survey all the three EEC reference levels were observed.

Serum bone GLA protein (BGP) was measured by radioimmunoassay in 42 patients (age, 47.5 +/- 16.6 years; serum creatinine, 4.32 +/- 1.9 mg/dl) with predialysis chronic renal failure (CRF). Nineteen patients were studied within a short period of time, while 23 were followed with repeated measurements of serum BGP, creatinine, iPTH, and alkaline phosphatase (AP) for a mean period of 17.1 +/- 8.1 months. Eleven of these patients were treated with 1,25(OH)2D3 for a mean of 16.8 +/- 6.4 months. In 23 patients at various stages of CRF, a transiliac bone biopsy was performed for histomorphometric evaluation. In the untreated patients, serum BGP was higher than normal and showed a positive correlation with creatinine levels (P less than 0.001). Serum BGP was also positively correlated with iPTH, AP, serum phosphate, active resorption surface, active osteoblastic surface, osteoid surface, and volume. During treatment with 1,25(OH)2D3, BGP, iPTH, and AP were significantly lower than in the untreated patients. The reduction in iPTH and BGP was proportional, while BGP and AP no longer correlated. Repeated measurements of BGP during the long-term follow-up showed a progressive rise in the untreated patients and a downward course of BGP levels during treatment. In conclusion, serum BGP increases progressively in CRF, rising with advancing renal damage in close correlation with iPTH, AP, and the severity of renal osteodystrophy. Treatment with 1,25(OH)2D3 causes a parallel decline in BGP and iPTH levels and dissociation between BGP and AP can be observed. Compared to AP, BGP seems to be a more reliable index of secondary hyperparathyroidism and potentially more useful in the long-term monitoring of treatment with 1,25(OH)2D3.

We studied the inorganic particulate contained in the lung parenchyma of 10 subjects (5 males and 5 females) resident in an urban area and not occupationally exposed to dusts. A total of 17 mineral types were identified, along with 16 metal elements in the form of oxides and sulfides. Approximately 70% of the minerals were made up of phyllosilicates, in particular clay, mica, and talc; three metal elements, Fe, Al, and Ti, accounted for more than 75% of the recovered oxide particles. The mean concentration of the observed inorganic particles was approximately 1.8 X 10(5) pp/mg dry tissue. No significant differences were observed in terms of total particulate concentration in the various areas of the lungs and between the right and left lung. Instead we observed a larger concentration of fibrous particles in the upper lobes. The analysis of the data made it possible to determine the presence of a high degree of correlation between the concentrations of silicates and the concentrations of metal oxides and sulfides, implying the existence of a ubiquitous environmental source of these mineral particles. The frequent observation of tremolite fibers is remarkable. This finding, confirmed elsewhere, indicates that the magnitude of the sources of these fibers in the environment, constituted by contaminated talc dusts, has been underestimated until today.

An interlaboratory study in which the insulin contents of five plasma samples were estimated in 36 italian laboratories was coordinated by the Istituto Superiore di Sanità (National Institute of Health) and the Consiglio Nazionale delle Ricerche (National Research Council). A rather large between-laboratory variability resulted, though the ranking of samples according to their insulin concentrations was practically the same. A significant dependence of estimates on the method used was established. The analysis of data, aimed at defining the possible reasons of the assay variability, is reported and discussed.