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Objective To compare the results from an initial negative human papillomavirus (HPV) test with re-screening after 3 years in women attending two HPV-based screening programmes. Design Population-based cohort study. Setting Two cervical service screening programmes in Italy. Population Women aged 25–64 years invited to screening from April 2009 to October 2015. Methods Eligible women were invited to undergo an HPV test. Those with a negative HPV test went on to the next screening round 3 years later. Cytology triage was performed for HPV+ (HPV by Hybrid Capture 2) samples, with immediate colposcopy (if abnormal) and HPV re-testing 1 year later (if negative). Main outcome measures Participation rate, positivity at HPV and at triage, referral rate to colposcopy, positive predictive value for cervical intraepithelial neoplasia grade 2+ (CIN2+) at colposcopy, and detection rate for CIN2+. Results We present the results from 48 751 women at the first screening and 22 000 women at re-screening 3 years later. The response rate was slightly higher at the second screening (74.5 versus 72.1% at the first screening; referral rate, RR 1.11; 95% confidence interval, 95% CI, 1.07–1.14). Compared with the first screening, we observed a significant reduction at the second screening in terms of HPV positivity (RR 0.55, 95% CI 0.51–0.60), referral rate to colposcopy (RR 0.47, 95% CI 0.41–0.53), CIN2+ detection rate (RR 0.24, 95% CI 0.13–0.39), and positive predictive value (PPV) for CIN2+ at colposcopy (RR 0.51, 95% CI 0.29–0.87). Conclusions The very low frequency of disease and inadequate PPV at colposcopy indicate that a 3-year interval after a negative HPV test is too short. Tweetable abstract Three years after a negative HPV the frequency of cervical disease is so low that re-screening is inefficient.

Platelet-derived growth factor receptor (PDGFR) signaling plays an important role in the fundamental biological activities of many cells that compose musculoskeletal tissues. However, little is known about the role of PDGFR signaling during tendon growth and remodeling in adult animals. Using the hindlimb synergist ablation model of tendon growth, our objectives were to determine the role of PDGFR signaling in the adaptation of tendons subjected to a mechanical growth stimulus, as well as to investigate the biological mechanisms behind this response. We demonstrate that both PDGFRs, PDGFRα and PDGFRβ, are expressed in tendon fibroblasts and that the inhibition of PDGFR signaling suppresses the normal growth of tendon tissue in response to mechanical growth cues due to defects in fibroblast proliferation and migration. We also identify membrane type-1 matrix metalloproteinase (MT1-MMP) as an essential proteinase for the migration of tendon fibroblasts through their extracellular matrix. Furthermore, we report that MT1-MMP translation is regulated by phosphoinositide 3-kinase/Akt signaling, while ERK1/2 controls posttranslational trafficking of MT1-MMP to the plasma membrane of tendon fibroblasts. Taken together, these findings demonstrate that PDGFR signaling is necessary for postnatal tendon growth and remodeling and that MT1-MMP is a critical mediator of tendon fibroblast migration and a potential target for the treatment of tendon injuries and diseases.

Mucormycosis are a group of infections that affect principally immunocompromised host and have a high mortality. Liposomal amphotericin B is the first-line treatment with combined surgical removal of the infectious focus. We report the case of 67-year-old man with idiopathic granulocytic aplasia and a cutaneous lesion caused by Rhizopus arrhizus treated with isavuconazole. Its safety profile and spectrum of activity make it an important therapeutic option. Keywords: Mucormycosis, Cutaneous, Immunocompromised, Isavuconazole

Aims To review prevalence and significance of urinary tract (UTI) and genital infections (GI) in diabetes and the effects of sodium glucose cotransporter 2 (SGLT-2) inhibitors on these complications. Data synthesis The prevalence of asymptomatic bacteriuria (ASB) is 2–3 times higher in diabetic than in non-diabetic women. The treatment of ASB has no impact on the development of UTIs and/or a decline in renal function. Therefore, there is no indication for screening for and/or treatment of ASB. The incidence of UTI is higher and frequently complicated in diabetic patients, particularly in those with longer duration of disease and of older age. There is no consistent evidence of an association between A1c levels, glycosuria and the risk of ASB and/or UTIs. Diabetes is a known risk factor for Candida colonization and GI , and a poor glycemic control is associated with a higher risk. While patients treated with SGLT-2 inhibitors may have a non-significant increased risk of UTI, they have a clearly increased risk of GI; most of these infections are mild, easy to treat, and the rate of recurrence is low. Conclusion Diabetic patients are at high risk of UTIs and of GI. Only GI are associated with poor glycemic control. Although patients treated with SGLT-2 inhibitors have an increased 3–5 fold risk of GI, proper medical education can reduce this risk.

To investigate the prevalence of undernutrition, risk of malnutrition and obesity in the Italian gastroenterological population.The Italian Hospital Gastroenterology Association conducted an observational, cross-sectional multicenter study. Weight, weight loss, and body mass index were evaluated. Undernutrition was defined as unintentional weight loss10% in the last three-six months. Values of Malnutrition Universal Screening Tool (MUST)2, NRS-20023, and Mini Nutritional Assessment (MNA) from 17 to 25 identified risk of malnutrition in outpatients, inpatients and elderly patients, respectively. A body mass index ≥ 30 indicated obesity. Gastrointestinal pathologies were categorized into acute, chronic and neoplastic diseases.A total of 513 patients participated in the study. The prevalence of undernutrition was 4.6% in outpatients and 19.6% in inpatients. Moreover, undernutrition was present in 4.3% of the gastrointestinal patients with chronic disease, 11.0% of those with acute disease, and 17.6% of those with cancer. The risk of malnutrition increased progressively and significantly in chronic, acute and neoplastic gastrointestinal diseases in inpatients and the elderly population. Logistical regression analysis confirmed that cancer was a risk factor for undernutrition (OR = 2.7; 95%CI: 1.2-6.44, P = 0.02). Obesity and overweight were more frequent in outpatients.More than 63% of outpatients and 80% of inpatients in gastroenterological centers suffered from significant changes in body composition and required specific nutritional competence and treatment.

Introduction. Periodic limb movements during sleep (PLMs) is common in the elderly. When quality-of-life drops due to sleep disturbances, we speak about periodic limb movement disorder during sleep (PLMD). Another similar disorder, restless legs syndrome (RLS), is considered to be related to diabetes; RLS and PLMDs are genetically related. Our aim was to detect PLMDs in a population of diabetic patients and identify them as possible hallmarks of these autonomic disorders. Material and Methods. We selected 41 type-2 diabetics with no sleep comorbidity, and compared them with 38 healthy matched volunteers. All participants underwent the Epworth Sleepiness Scale (ESS) and polysomnography (PSG). A periodic limb movement (PLM) index >5, that is, the higher number of PLMs/sleep hour for the entire night, was considered as abnormal. Results. Diabetics showed lower sleep efficiency than controls on the ESS, lower proportions of REM and non-REM sleep, and higher arousal and PLM indexes, as assessed through PSG. PLMDs were diagnosed in 13 of 41 diabetic patients (31%); the latter showed lower sleep efficiency, lower non-REM slow-wave sleep, and increased arousal and PLM indexes. Conclusion. The relationship between PLMs-related sleep fragmentation and endocrine carbohydrate metabolism regulation might be casual or genetically determined. This deserves further investigations.

Objective Peritoneal dialysis (PD) patients have equivalent or slightly better kidney transplant outcomes when compared to hemodialysis (HD) patients. However, given the risk for postoperative infection, we sought to determine the risk factors for PD catheter-associated infections for patients who do not have the PD catheter removed at the time of engraftment. Methods Demographic and outcomes data were collected from 313 sequential PD patients who underwent kidney transplant from 2000 to 2015. Risk factors for postoperative peritonitis were analyzed using logistical regression. Results Of 329 patients with PD catheters at transplant, 16 PD catheters were removed at engraftment. Of the remaining 313 patients, 8.9% suffered post-transplant peritonitis. On univariate analysis, patients with peritonitis were significantly more likely to have used the PD catheter or HD within 6 weeks after transplant. Multivariate analysis had similar findings, with increased risk for those using the PD catheter after transplant, with a trend for those who underwent HD only within 6 weeks of transplant. Conclusion These results suggest that delayed graft function requiring any type of dialysis is associated with increased post-transplant peritonitis risk.

The aim of this study was to describe the clinical presentation and predictors of death in a HIV population hospitalized in Ouagadougou, Burkina Faso. Baseline demographics, viro-immunological status, clinical presentations, and outcome have been analyzed by univariate analysis and a multivariate model. A total of 1,071 hospitalizations of HIV-positive patients was recorded between 1 January, 2004 and 31 August, 2006, the majority of whom were female (64.1%). The baseline CD4 cell count/μl was higher in the female patients than in the male ones (166.1 vs 110.9). Gastroenteric symptoms were the first cause of hospitalization (61.7%). The crude mortality rate was higher in males than females (38% vs 25.3%). Baseline World Health Organization clinical stage IV (OR 9.22), neurological syndrome (OR 3.04) or wasting syndrome at admission (OR 2.9), positive malaria film (OR 2.17), and an older age independently predicted death. Weight at admission > 40 kg and a higher platelet count at admission were independently associated with a better outcome. Females are admitted to hospital earlier than males, probably as an indirect result of the Prevention of Mother-to-Child Transmission (PMTCT) public health initiative. An active search of HIV status in other members of the family (PMTCT-plus) may result in the detection of asymptomatic HIV-infected patients as well. A Plasmodium falciparum-positive smear during admission significantly impacted on outcome as well as low platelet count.

On the basis of historical studies, hepatitis delta virus (HDV) infection is considered uncommon in the United Kingdom (UK) and mainly confined to intravenous drug users. In order to assess the current prevalence of HDV co-infection in patients with chronic hepatitis B (HBV), a retrospective analysis was performed of 962 consecutive HBV-infected adult patients referred to King's College Hospital between January 1st 2000 and March 31st 2006. The 82 subjects positive for HDV antibody (8.5%) had a similar age to those without HDV (median 36 years, interquartile range 30-47, vs. 35 years, 29-43). Excluding non-UK residents, the prevalence of HDV Antibody was 7.1%. Most HDV-infected subjects were born in regions where HDV is endemic, for example, Southern or Eastern Europe (28.1%), Africa (26.8%) or Middle-East (7.3%). Forty one (50%) were considered to have acquired HDV infection via intra-familial transmission but intravenous drug use was still a common route of transmission (24.4%). Comparing HBV/HDV co-infected to HBV mono-infected patients, a higher proportion were hepatitis C antibody positive (25.6% versus 3.8%; odds ratio 8.89, 95% confidence interval 4.4-17.9; P < 0.00001) and more had cirrhosis (26.8% vs. 12.9%; odds ratio 2.64, 95% confidence interval 1.55-4.49; P < 0.0001) but, despite this, the risk of hepatocellular carcinoma was similar (odds ratio 1.34, 95% confidence interval 0.62-2.91). Although HDV infection is reportedly declining in some endemic regions, our data demonstrate a high prevalence in South London. HDV co-infection is associated with increased morbidity and patients with HBV should be tested for HDV infection.

Hepatitis G virus (HGV) is a flavivirus that can cause acute hepatitis and persistent infection but its role in chronic liver disease or primary liver cancer is unproven. In this study we have examined the prevalence of HGV RNA in the serum of patients with hepatitis C virus (HCV) infection and in patients with cryptogenic chronic liver disease, including non-alcoholic steatohepatitis (NASH), and in patients with HCV-related hepatocellular carcinoma (HCC) and HCC arising in patients with cryptogenic liver disease. One-hundred and thirty patients who were positive for antibody to HCV (anti-HCV), 54 patients with cryptogenic chronic liver disease (including 17 patients with NASH) and 46 patients with hepatitis C-related (n=27) or cryptogenic liver disease-related HCC (n=19) were studied. HGV RNA was detected using nested reverse transcriptase–polymerase chain reaction (RT–PCR) and was found in 16.1% of patients with HCV infection. HGV RNA was not detected in any patient with cryptogenic liver disease. In patients with HCC, 7/34 samples were positive for HGV RNA and six out of seven HGV-positive subjects also had HCV infection. Only one patient with HCC in cryptogenic liver disease was positive for HGV RNA. Hence, cryptogenic liver disease in the UK is not caused by HGV/GBVc infection. It seems unlikely that HGV plays a significant role in hepatocarcinogenesis.

The protein encoded by the p53 tumour suppressor gene plays an important part in the regulation of cell growth. Abnormalities of this gene represent one of the most common genetic changes in the development of human cancers. This study investigated the expression of p53 protein in cholangiocarcinoma arising in association with primary sclerosing cholangitis (PSC). Of the 14 patients with cholangiocarcinoma studied, 13 had underlying PSC. The expression of p53 protein was detected immunohistochemically in paraffin wax embedded liver specimens, after microwave pretreatment. The expression of p53 protein was shown in the cholangiocarcinoma tissue of 11 of 14 (78.5%) patients. In five of 10 patients, the accumulation of p53 protein highlighted the presence of neoplastic cells in biliary tissue separate from the main tumour. These cells were mainly located in the septal bile ducts or in the accessory glands, or both, but occasionally also in large portal areas at the periphery of nerves and lymphatics, and in one case in the mucosa of an extrahepatic bile duct. No p53 protein was detectable in liver tissue obtained at the time of transplantation in 15 patients with PSC but not cholangiocarcinoma. These results show that cholangiocarcinoma development in PSC is commonly associated with abnormalities of p53 and that these occur at a late stage in the development of the malignant process. Staining for p53 protein could represent an additional criterion for the diagnosis of cholangiocarcinoma development in patients with PSC.

Background Home Parenteral Nutrition is a therapeutic option to improve quality of life in chronic intestinal failure. Aims To describe frequency of complications both in cancer and non-cancer patients. Methods This study was performed on 270 adult patients (52% with cancer, 48% without cancer) followed for a total of 371 years of treatment. Mean duration of therapy was 191±181 for cancer and 830±1168 days/patient for non-cancer. The treatment was administered by a competent, dedicated provider. Patients received our prescribed “all-in-one admixtures” at their homes. Results Catheter-related complications/1000-days-catheter was 1.40; mechanical complications were comparable in cancer (0.82) and non-cancer (0.91) patients while a statistically significant difference was observed between cancer (0.71) and non-cancer (0.46) patients for sepsis. Bacterial infections were more frequent in non-cancer, mycotic infections primarily affected cancer patients. In our experience 49% of the patients were readmitted, with a low incidence rate of 0.89/1000 days-catheter. The incidence of hepatobiliary complications in our population was 65%. The degree of liver damage was related to short bowel syndrome and to length of treatment. Conclusions This study indicated that cancer patients are more vulnerable to CVC-related infections during Home Parenteral Nutrition and that a safer Home Parenteral Nutrition protocol should be adopted in order to contain CVC-related complications.

Histological assessment of patients with chronic hepatitis C infection is no longer performed routinely; consequently, a simple test is needed to identify patients with significant hepatic fibrosis.Data were collected, retrospectively, on 923 consecutive patients undergoing percutaneous liver biopsy for chronic hepatitis C at King's College Hospital between 1 January 2000 and 30 June 2006; 602 patients were accepted to form the training set and a further 105 patients to form the validation set.On liver biopsy, 132 (22%) had cirrhosis (Ishak F5-6) in the training set and 19 (18%) in the validation set. Factors found by multivariate analysis to be associated with fibrosis in the training set were used to construct the King's Score: age x aspartate aminotransferase x international normalized ratio / platelets. Area under receiver operating characteristic curves for predicting cirrhosis and significant fibrosis (F3-6) were 0.91 and 0.79, respectively. A King's Score of greater than or equal to 16.7 predicted cirrhosis in 34% of patients (odds ratio 36.2, 95% confidence interval, 22.0-59.6; P0.0001) with sensitivity 86%, specificity 80% and a high negative predictive value of 96%; a score greater than or equal to 12.3 predicted F3-6 (odds ratio 33.9, 95% confidence interval, 15.2-34.4; P0.001). The validation set confirmed the utility of this index, area under receiver operating characteristic curves 0.94 and 0.89 for cirrhosis and F3-6, respectively.The King's Score is a simple and accurate index for predicting cirrhosis in chronic hepatitis C. Patients with a score of less than 16.7 have a low risk of cirrhosis.

Controlled trials of sclerotherapy for the prevention of the first variceal hemorrhage in cirrhotics have given conflicting results. In the present study, 106 cirrhotics were randomized to sclerotherapy (55 patients) or control group (51 patients). Admission criteria were no history of previous variceal bleeding and the presence of high-risk varices, i.e., a variceal score less than or equal to 0 according to Beppu et al. Sclerotherapy sessions were performed at time zero, 7 days, 30 days, and then monthly until eradication. Follow-up endoscopies were performed at 6-month intervals thereafter. Control patients underwent repeat endoscopy at 6-month intervals. Bleeding episodes were treated by sclerotherapy in both groups, whenever possible. Mean follow-up was 24 months. Analysis of the results was performed by the intention-to-treat method. Variceal bleeding occurred in 19 sclerotherapy patients (34.5%) and in 17 controls (35.4%, P = NS). Overall mortality was 34.5% in sclerotherapy patients and 50% in controls (P = NS). Seven of the 19 sclerotherapy patients (36.8%) and 11 of the 17 controls (64.7%) who bled died of hemorrhage (P less than 0.05, log-linear model). It is concluded that prophylactic sclerotherapy does not reduce the incidence of first variceal bleeding in cirrhotics. However, there seems to be a trend toward a lower bleeding-related mortality in sclerotherapy patients than in controls.

International audience; Serotonin (5-HT) is a regulator of morphogenetic activities during early brain development and neurogenesis, including cell proliferation, migration, differentiation, and synaptogenesis. The 5-HT transporter (5-HTT, SLC6A4) mediates high-affinity reuptake of 5-HT into presynaptic terminals and thereby fine-tunes serotonergic neurotransmission. Inactivation of the 5-HTT gene in mice reduces 5-HT clearance resulting in persistently increased concentrations of synaptic 5-HT. In the present study, we investigated the effects of elevated 5-HT levels on adult neurogenesis in the hippocampus of 5-HTT deficient mice, including stem cell proliferation, survival, and differentiation. Using an in vivo approach, we showed an increase in proliferative capacity of hippocampal adult neural stem cells in aged 5-HTT knockout mice (approximately 14.5 months) compared to wildtype controls. In contrast, in vivo and additional in vitro analyses of younger adult 5-HTT knockout mice (approximately 7 weeks and approximately 3.0 months) did not reveal significant changes in proliferation of neural stem cells or survival of newborn cells. We showed that the cellular fate of newly generated cells in 5-HTT knockout mice is not different with respect to the total number and percentage of neurons or glial cells from wildtype controls. Our findings indicate that elevated synaptic 5-HT concentration throughout early development and later life of 5-HTT deficient mice does not induce adult neurogenesis in adult mice, but that elevated 5-HT levels in aged mice influence stem cell proliferation.

We studied pulmonary function in 22 patients affected by in-transit metastases from cutaneous melanoma and metastases from soft tissue sarcoma of the limbs who were treated with isolation perfusion in extracorporeal circulation with rTNF alpha at doses ranging from 0.5 to 4 mg/m2 in mild hyperthermia. Seventeen patients suffered from respiratory insufficiency which required assisted ventilation (7 mechanical ventilation for 1 day, 8 for 2 days and 2 patients on synchronized intermittent mandatory ventilation). Spirometric parameters recorded 7 to 15 days after treatment did not change from baseline values; in contrast, lung transfer factor for carbon monoxide significantly declined in a dose dependent fashion. These data confirm that rTNF alpha administered by isolation perfusion technique induces pulmonary side effects. Further studies are required to better define time course and reversibility of impairment in pulmonary function.

A case of human immunodeficiency virus (HIV)-associated lymphocytic interstitial pneumonia is described, in which improvement occurred soon after starting antiviral therapy. A 20-y-old black female with HIV infection (CD4+ count 228 x 10(6) cells and plasma viral load 379,670 copies/ml) showed radiological signs of reticulonodular infiltrates of the lungs and pulmonary functional tests indicative of a severe restrictive syndrome. Bronchoalveolar and blood cultures yielded no organism and transbronchial biopsy disclosed findings consistent with lymphocytic interstitial pneumonia. After 4 weeks on triple HIV combination therapy, she was well and respiratory tests had normalized. Six months later, a computed tomographic scan of the chest showed only residual alterations. Despite a good sirological response to treatment, no significant immune recovery occurred over a 2 y follow-up.

“Urologist” was developed to run a Department of Urology. A local area network (LAN), one server and five stations, connects the single functional units of the Department (O.R.; I.C.U.; wards; Spinal Unit and Patient services). A Patient Identification Card integrates both clinical and organisational data. A multidisciplinary group, consisting of medical and non-medical specialists, was necessary to develop this system.

OBJECTIVE: To define the prevalence of interstitial lung fibrosis in systemic sclerosis (SSc) and its relationship with the different clinical forms of disease and ANA specificities. METHODS: Fifty patients with SSc were submitted to pulmonary high resolution computed tomography (HRCT). Lung abnormalities were evaluated according to Warrick's score that considers both the severity and the extent of fibrotic lesions. RESULTS: Pulmonary HRCT abnormalities were observed in 84% of SSc patients. Ground glass aspects (60%), irregular pleural margins (56%) and septal/subpleural lines (68%) were the most common lesions. The distribution of these abnormalities favoured the posterior basilar segments of both lungs. HRCT findings were significantly more frequent in males and in patients with the cutaneous diffuse form of SSc and with the specific antibody anti-Scl70. CONCLUSIONS: HRCT is a very useful method for the diagnosis of interstitial lung fibrosis in SSc. Warrick's score permits to quantify the HRCT findings and to evaluate their relationship with the disease clinical forms and ANA specificities.

Background Objectives To evaluate hypersomnolence in patients affected by fibromyalgia syndrome. Methods Thirty consecutive patients affected by fibromyalgia syndrome (FMS) (28 F) underwent a general sleep questionnaire, the Epsworth sleepiness scale (ESS), formal polysomnography, and lung function tests. Results Patients complaining of daytime hypersomnolence had a higher number of tender points (15 ± 2 vs 12 ± 1, p FMS patients who referred daytime somnolence slept significantly less efficiently than the FMS with no day time somnolence (p Conclusion The occurrence of daytime hypersomnolence in FMS patients, is linked to a greater severity of fibromyalgia symptoms and to a more severe polisomnographic alterations.

The association of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), defined overlap syndrome by Flenley, is frequent. Aims of the present study were to assess the frequency of overlap syndrome in 168 consecutive OSA patients, and to evaluate the functional pulmonary hemodynamic, and polysomnographic consequences of this association by comparing Overlap patients with OSA patients.From the results of the pulmonary and polysomnographic investigation, patients were classified as OSA patients (group 1), having an apneas/hypopneas index (AH/I)15/hr, and Overlap patients (group 2), i. e. OSA patients with an obstructive spirographic pattern (FEV160%, FEV1/FVC65%, RV130%, RV/TLC140% of predicted value) not reversible after beta2 agonist inhalation. Group 1 consisted of 135 Patients (115 males, 20 females, age 56+/-10 yr, BMI 32+/-6 Kg/m(2)); the group 2 included 33 patients (30 males, 3 females, age 56+/-11 yr., BMI 34 +/- 6 Kg/m(2)).The OSA and Overlap patients were similar in most respects: age, BMI, clinical characteristic. In awake Overlap patients had lower PaO(2), higher PaCO(2) and Ppa (p0.001), and an obstructive spirographic pattern, as compared to OSA patients. During sleep the overlap group had a higher AH/I and a lower mean SaO(2) (p0.05), a reduction of the sleep efficency (p0.05), and a reduction in the duration of 1NREM and REM sleep stage (p0.05), as compared to group 1.In conclusion, an associated COPD is observed in more than 19% of OSA patients. Overlap patients are at increased risk of developing pulmonary hypertension and show a poorer quality of sleep as compared with OSA patients. The possibility of developing cor pulmonale should be given particular attention in the diagnosis and follow-up of Overlap patients.

Fifteen patients with cirrhosis underwent orthotopic liver transplantation for small hepatocellular carcinoma (HCC) and 12 patients with cirrhosis underwent hepatic resection for similar HCC. All tumours were of the non-fibrolamellar variant. The majority of the patients in the transplant group had Child's grade B or C cirrhosis. Median follow-up was 37 months with a minimum of 18 months. Eleven of 12 patients in the resection group had Child's grade A cirrhosis. Median follow-up was 29 months with a minimum of 16 months. Actuarial survival rates at 1 and 3 years for the transplanted patients were 80 and 63 per cent and all were tumour free. Tumour recurrence rate was 15 per cent. The overall 1- and 3-year tumour-free survival rates for patients in the resection group were 61 and 33 percent. Tumour recurrence rate was 45 percent. The results show orthotopic liver transplantation to be an important surgical option in cirrhotic patients with small HCC, particularly in those with moderate to severe hepatic decompensation.

Background/Aims: Recurrence of hepatocellular carcinoma (HCC) after orthotopic liver transplantation (OLT) depends on tumor size and number; the accuracy of radiology in detecting HCC is uncertain. This study compared tumor size at radiological and pathological examination in 30 patients with HCC who underwent OLT. Methods: Pre-OLT radiology included ultrasonography (US), computerized tomography (CT), and hepatic angiography (HA). Sensitivity of radiology was calculated by comparison with pathology. Results: Radiology missed HCC in two patients but showed five with small ( 4 cm) lesions. Multicentricity was shown in 15 cases at radiological examination and 24 at pathological examination, including one incidental and 4 of 5 radiologically small HCC. Mean tumor bulk was 3.4, 74, 338, and 1375 cm 3 , respectively, in patients with incidental, small, large, and multicentric HCC at radiology. Sensitivities of US, CT, and HA in detection of HCC (and multicentricity) were 80% (16.6%), 86.6% (58.3%), and 90% (58.3%). No recurrence was found in patients with incidental or small HCC, even when multicentric. Conclusions: US, CT, and HA identified patients with small or large tumor bulk, but sensitivity in detecting satellites was poor; their finding in patients with radiologically small or incidental tumors does not affect outcome. The failure of US, CT, and HA to detect satellites must be considered in patients undergoing partial hepatectomy for HCC.

remission. Twenty-four of 41 (58.5%) patients needed for systemic steroids, 13/41 (31.7%) for immunosuppressive agents, 8/41 (19.5%) for biological agents and 3/41 (7.3%) required surgery. If we consider smoking status at the discontinuation of the drug, overall in 41 patients who have stopped AZA with at least one year of follow-up after withdrawal, 17/41 (41.5%) were current smokers, 18/41 (43.9%) never smokers and 6/41 (14.5%) former smokers. If we consider among these patients those who maintained remission at 1 year after withdrawal of AZA number of current smoker was greater (5/7 current smokers vs. 1/7 never smoker). This result is consistent with very recent data from literature, which suggest current smoking as a factor delaying relapse after AZA discontinuation (2). Conclusions: Our retrospective study confirms a high frequency of relapse after azathioprine discontinuation, whatever the reason and the timing of discontinuation itself. References: 1.Treton X, Bouhnik Y, Mary JY, et al. Azathioprine withdrawal in patients with Crohn’s disease maintained on prolonged remission: a high risk of relapse. Clin Gastroenterol Hepatol 2009;7:80.5. 2.Sokol H, Seksik P, NionLarmurier I, et al. Current smoking, not duration of remission, delays Crohn’s disease relapse following azathioprine withdrawal. Inflamm Bowel Dis 2009; in press (PMID: 19462422). # G. Inflammatory bowel diseases 2. Ulcerative colitis and Crohn’s disease diagnosis/therapy

A 62-year-old man with a history of chronic hepatitis B cirrhosis presented with deteriorating liver function. The serum α fetoprotein (AFP) level was 253 kU/l (normal upper limit

The Italian Cooperative Group on AIDSTumors (GICAT) is collecting data on the epidemiological and clinical features of Kaposi's sarcoma (KS) in Italy, a country where intravenous drug users (IVDUs) comprise the largest group affected by AIDS. As of December 31st 1989, among 5317 cases of CDC-defined AIDS reported to the National Registry of AIDS, there were 419 (8%) cases of KS. Twenty-five percent of all of the homosexual men with CDC-defined AIDS had KS, while only 3% of the IVDU patients with CDC-defined AIDS had KS. The first case of KS was observed in 1982, 2 cases in 1983, 7 cases in 1984, 17 cases in 1985, 55 cases in 1986, 89 cases in 1987, 120 cases in 1988 and 128 cases in 1989. Of the 226 cases of KS reported to GICAT, 60% were in homosexual men, 21% in IVDUs, and 9% in heterosexuals. An increased number of KS has been observed since 1982, although the number of new cases in the past year seems to have been stable, possibly due to the usual delay in notification. There is, however, an actual decrease of the percentage of KS among AIDS patients, from 18% in 1984 to 6% in 1989. Almost half of the patients had had a diagnosis of AIDS prior to the appearance of KS, but in 25% of the patients KS was the first AIDS manifestation. Almost all patients had skin involvement either alone or in association with other sites, whereas very few patients had only lymph node involvement. Only treatment with alpha-2 interferon was able to obtain complete remission in 9% of evaluable patients.(ABSTRACT TRUNCATED AT 250 WORDS)

The increased incidence of malignancies associated with AIDS has been the subject of several reports in the North American literature: besides Kaposi’s sarcoma and other tumours, such as squamous carcinoma of the tongue and cloacogenic carcinoma of the anorectum [1–22], malignant lymphomas have been demonstrated to be one of the major problems among the neoplastic complications of AIDS [12–24]. According to the North American experience, non-Hodgkin’s lymphomas in patients with AIDS or AIDS-related clinical conditions present at an advanced stage in which lesions are concentrated in extranodal and often unusual locations, notably the CNS. Disease confined to the lymph nodes is uncommon. These lymphomas are predominantly high-grade B-cell neoplasms classified as immunoblastic and Burkitt’s-like lymphomas. A variety of severe opportunistic infections and Kaposi’s sarcoma affect these patients. At the same time, the association with AIDS is strengthened by the regular demonstration of reversed ratios of helper (T4+) and suppressor (T8+) lymphocytes in the peripheral blood and by the presence of antibodies to human immune deficiency virus (HIV) [22]. The prognosis is dismal: response to chemotherapy does not positively affect median survival. Mortality rates analysed by histological grade are higher than the currently reported rates for comparable patient populations [18].

Many factors influence the survival of patients with hepatocellular carcinoma, quite apart from treatment, the most important being the size of the tumor at the time of diagnosis and the severity of the underlying cirrhosis.1 Small hepatocellular carcinomas have relatively long tumor-doubling times, as compared with large, symptomatic hepatocellular carcinomas. In a recent study, the three-year survival rate among 260 patients with well-compensated cirrhosis and hepatocellular carcinomas 5 cm or less in diameter was 79 percent with surgical treatment and 26 percent without treatment; among 131 patients with more advanced liver disease, the comparable rates were 40 percent and 13 . . .