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Objective: The aim of the study was to verify the usefulness of helical CT angiography for diagnosis of gastrointestinal hemorrhage of obscure origin., Subjects and Methods: Eighteen consecutive patients underwent catheterization of the abdominal aorta followed by helical CT angiography before and after intraarterial injections of a contrast medium. Helical CT angiography revealed the site of hemorrhage as an extravasation of contrast medium resulting in a hyperdense area in the intestinal lumen. All patients then underwent conventional angiography that was selective for the 13 patients in whom helical CT angiography was positive and standard for the remaining five patients with negative helical CT angiograms., Results: Helical CT angiography revealed the site of hemorrhage in 13 (72%) of 18 patients. Diagnosis of bleeding site was confirmed, and the cause was established at surgery in 11 of these 13 patients. The site of bleeding for the remaining two patients was confirmed by angiography as angiodysplasia of the jejunum (n = 1) and of the colon (n = 1). Of the five patients with negative helical CT angiograms, location of bleeding was revealed by conventional angiography in two patients; one of the remaining three patients underwent exploratory laparotomy; and bleeding ceased in the remaining two patients, who were treated without surgery. Conventional angiography was negative for two of the 13 patients in whom helical CT angiography was positive., Conclusion: Despite our limited experience, helical CT angiography proved to be an easier and faster technique than conventional angiography for localizing gastrointestinal bleeding of obscure origin and useful as a guide for subsequent selective conventional angiography.

Objective: To estimate the extent of the HIV/AIDS epidemic among Italian women and to assess its impact on mortality. Further, to assess the incidence of AIDS and the main characteristics of women affected by AIDS: with particular attention to those aged 25-34 years, and to identify differences in these characteristics compared with men infected with AIDS., Methods: Incidence data were derived from the Italian National Register of AIDS Cases (RAIDS). The most recent complete data refer to cases diagnosed to the end of 1994. Mortality data were collected from the Italian mortality database, which is held by the Italian National Census Bureau (ISTAT) and processed by the Laboratory of Epidemiology and Biostatistics at the National Institute of Health of Italy (Istituto Superiore di Sanitá; ISS). The most recent mortality data refer to 1992, but projections were made to obtain mortality data up to 1994. All the rates were standardized by age and sex., Results: A total of 26 957 cases of AIDS, 21 441 men (79.5%) and 5516 women (20.5%), diagnosed before the end of 1994 were reported to RAIDS. The majority of cases and deaths occurred in individuals aged 25-34 years. The incidence of AIDS among women increased from 2.1 per 100 000 in 1987 to 17.2 per 100 000 in 1994. The sex ratio (men:women) fell from 5.2 in 1987 to 2.9 in 1994. In 1992, AIDS was the second most common cause of death (slightly behind cancer and ahead of traffic accidents) in Italy, but was the most common cause in three regions of northern Italy (Liguria, Lombardia and Emilia)., Conclusions: Although the AIDS epidemic in the past has predominantly affected young men, AIDS is now rapidly becoming a major health problem for young women in Italy. Moreover, as these women are at reproductive age, this may have important consequences in terms of increased morbidity and mortality among children.

Some 5-20% of gastrointestinal (GI) bleeding cases are of obscure origin because bleeding is difficult to diagnose or locate with conventional imaging methods. The authors suggest arterial spiral CT (ASCT) of the abdomen as an original tool to study GI bleeding of obscure origin. This diagnostic method consists of two subsequent phases: first, after abdominal aorta catheterization, the catheter is positioned in the celiac artery; then, CT of the abdomen is performed before and after intra-arterial contrast agent injection. In 6 of 10 patients with GI bleeding of obscure origin, ASCT depicted small high-intensity areas in the intestinal lumen, which indicate a source of bleeding. The site of bleeding was studied only with topographic criteria according to scanning planes, and the morphological features of the intestinal segments were investigated. All patients were submitted to surgery: when ASCT identified a bleeding site, angiography was limited to the involved arterial district. Angiography alone could locate the source of bleeding in 5 patients; angiography and ASCT were in agreement in 4 patients. The combined techniques located the source of bleeding in 7/10 patients and the nature of bleeding was diagnosed in 3/10 patients (angiodysplasia). Even though their experience is limited, the authors believe that ASCT can be useful in locating GI bleeding of obscure origin, as well as in guiding subsequent selective angiography.

The objective of this study is to describe the impact of AIDS on the mortality of young adult (aged 25 to 44 years) in Italy, at both the national and regional level. We analyzed the official mortality data for Italy: the most recent data available being from 1990. General mortality trends show that while mortality among young women is still decreasing (i.e. from a standardized rate of 83.8 per 100,000 in 1980 to 68.4 in 1990), mortality among young men began to rise in the mid-1980s, after a steady decrease over many years. Among the 25-34 year olds, however, this reversal in trend is more marked, notwithstanding a decrease or stabilization in most major causes of death. In fact it coincides with the appearance and spread of AIDS in Italy, which has affected young men in particular. (The peak age group for AIDS deaths is the 25-34 year olds). Mortality data from 1990 reveal that AIDS is the fourth leading cause of death in Italy among men between the ages of 25 and 44 years. Among 25-34 year-old men, however, AIDS is the second leading cause of death, after road accidents. AIDS also contributes greatly to the general mortality in individual regions, both among 25-44 year-old men (Lombardy, Liguria, Lazio, Emilia-Romagna, Tuscany), and especially among 25-34 year-old men (Lombardy, Liguria, Lazio, Sardinia, where it is the number one cause of death, Emilia-Romagna, Tuscany, and Veneto, where it is the number two cause of death).

Background: Few risk functions for the prediction of coronary heart disease mortality have been produced in Italy. This study used a large population sample to evaluate the effect of major risk factors on coronary mortality., Methods: Coronary deaths in 45 cohorts of men (n = 31317, aged 30-69 years) were studied and related to selected cardiovascular risk factors., Results: After 6 years, 1089 men had died, of whom 239 were coronary fatalities. Univariate and multivariate (Cox model) analyses conducted on each age group (30-39, 40-49, 50-59, and 60-69 years) showed a positive association between coronary deaths and systolic blood pressure, serum cholesterol level and cigarette smoking, with few exceptions. A multiple logistic model was produced for men aged 35-57 years, assessing the role of age, serum cholesterol, cigarettes smoked per day and diastolic instead of systolic blood pressure, using the same endpoint as that employed in a similar model published from the analysis of MRFIT primary screenees in the USA to facilitate valid comparison. The coefficients in the present study were similar to those in the US cohort: no statistically significant differences could be detected when comparing the pairs of coefficients., Conclusion: Coefficients relating cholesterol, blood pressure and cigarette smoking to coronary mortality in Italian men are similar to those in American men from the same age groups.

We report a case of thrombotic thrombocytopenic purpura evaluated by MR. Multiple hyperintense foci on the T2-weighted images, observed principally in the brain stem and in the region of the basal nuclei, and neurologic signs disappeared after 15 days of therapy.

To investigate the relationships between the mammographic aspects (according to Broberg), proliferative activity and hormone receptor status, we studied 165 patients subjected to radical mastectomy for operable breast cancer. The highest percentage of estrogen receptor-positive cases was observed in mammograph class I (p < 0.02) while classes III and V were highest in progesterone receptor-positive cases. Proliferative activity (111 cases) was significantly lower in class I and IV with respect to all other classes (p < 0.03 and p < 0.01, respectively). This study suggests that certain mammographic signs can be related to the biological characteristics of breast cancer.

Using the official mortality data, collected by ISTAT, and the data of the Italian Register of AIDS cases, in Istituto Superiore di Sanità, three arguments have been developed: 1) Study of causes according to which ISTAT could classify deaths from AIDS: the leading cause appears to be "Deficit of Cell Immunity" (I.C.D. 279.1). 2) Study of the under-estimation of official data with respect to those of the specific system. Under-estimation decreased over the years, reaching 20% in 1987 and 6% in 1988. 3) Analysis of the general mortality trend in all of Italy and in particular metropolitan areas, with a high concentration of cases, such as Rome and Milan; there is evidence of a possible influence of AIDS deaths on mortality of young age classes particularly notable among single males.

In 1987, in Italy, 27,106 men and 4,159 women died from lung cancer or larynx cancer. Taking into consideration the smoking habits of the Italian population and the relative risks for pulmonary cancer, of smokers and ex-smokers versus nerve smokers, we estimate that 87% of deaths can be attributed to smoking. We know from previous studies that quitting smoking results in the reduction of the risk elapsed since quitting and that this reduction depends on the time and on the quantity of tobacco previously smoked before the cessation. We estimated the reduction in the number of deaths due to respiratory cancer if part of the population were to quit smoking. In males aged 35-74 years after 12 years, there would be 3,604 fewer deaths if 10% quit smoking and 11,915 fewer deaths if 100% quit smoking.

As for the pathologic conditions of neck lymph nodes, the clinician needs to know if the involved node is reactive, phlogistic, or neoplastic in nature. If accurate tumor staging is required, imaging techniques play a fundamental role. Our study was aimed at assessing the actual role of MR imaging in the evaluation of neck lymph node involvement. The study was performed using an MR Max Plus by General Electrics operating with an 0.5 T superconductive magnet. We employed gradient-echo (GE) pulse sequences with TR 500, TE 15 ms and 90 degrees flip angle for T1-weighted images, and with TR 500, TE 30 ms and 25-30 degrees flip angles for T2-weighted images; for Pd-T2-weighted images, TR was 520, TE 30 ms, and flip angles were 40-45 degrees. The results were correlated with histopathologic findings obtained at biopsy. The advantages of GE sequences were: 1) whole neck imaging--thus saving time, and reducing radiation dose and contrast media; 2) optimal anatomical and topographic evaluation of the lesion; 3) imaging of the longitudinal diameter of the node; 4) higher sensitivity for lymph node tissue modifications; 5) imaging of necrosis, hemorrhage, and/or fibrosis. GE sequences were especially useful for accurate tumor staging, in the follow-up, and to verify response to therapy. However, even though MR imaging has proven to have high sensitivity, its specificity was similar to that of contrast-enhanced CT. Further studies with the use of paramagnetic contrast media are needed to solve these problems.

The diagnosis of spine metastasis is a problem of great interest which leaves many questions unanswered. In this field MR imaging plays a fundamental role, as the only technique able to directly demonstrate the changes in bone marrow tissue, bound to tumoral activity. The introduction of gradient-echo (GE) sequences has helped reduce examination time. Moreover, with the accurate choice of pulse-sequence parameters (TR, TE, flip angle) additional information is acquired which is not yielded by conventional spin-echo (SE) sequences. Our study was aimed at evaluating MR sensitivity in the different stages of bone metastatic evolution. The comparative adequacy was evaluated of combined bone scintigraphy and conventional radiology versus MR imaging in 62 patients with vertebral metastases. Time interval between bone scan and/or radiological study and MR exam ranged from 10 days to 8 months. SE and GE T1-weighted images, and SE and GE T2-weighted images on the sagittal plane were employed, and axial images; coronal images were rarely acquired. Metastases were demonstrated by MR imaging at 122 vertebral levels, versus 88 true positives of combined scintigraphy and conventional radiology. Scintigraphic false-positives were observed at 15 vertebral levels, versus 9 with radiography. GE sequences were superior to SE ones in detecting vertebral morphologic lesions and bone marrow involvement thanks to their improved resolution and sensitivity. Moreover, GE sequences demonstrated tumoral bone marrow spread and persistent tumoral activity in the follow-up of spine metastases. Our results point to GE sequences as those of choice because of their higher resolution and sensitivity, which also allow response to treatment to be evaluated.

To verify the relationship of mammographic (Mx) patterns of breast cancer to hormone receptor content (ER, PgR) we studied 129 women (59% in postmenopause; average age 55) in the last 3 years. All women had operable breast cancer and were submitted to mammography before surgery. The tumors were classified, according to Mx characteristics, in 5 classes (Broberg, 1983). ER and PgR contents (cut-off for positivity: 10 fmol/mg prot cyt) were analyzed in all patients by means of DCC method. The percentage of ER+ cases was significantly higher in class I than in all other Mx classes (85% vs 57%; p = 0.02), whereas it was lowest in class IV (51% vs 70%; p = 0.03). The percentage of PgR+ cases was significantly different only in class I with respect to class IV (70% vs 41%; p = 0.002). As for ER and PgR mean tumor content, no statistically significant difference was observed between the 5 classes. When the 2 receptors were simultaneously considered the percentage of ER+ PgR+ cases was higher in class I than in all the extant classes (p = 0.01), and the percentage of ER- PgR- was higher in class IV than in the extant ones (p = 0.02). In selected subgroups of patients, Mx classification of breast cancer can help the physician predict the hormone receptor tumor status with sufficient reliability.

Liver cirrhosis is considered as a double etiology disease, being its incidence and mortality associated either to alcohol consumption or to a previous viral hepatitis infection of type "B" or "neither A nor B". A two components mathematical model is here used to estimate the proportion of liver cirrhosis mortality attributable to alcohol consumption and the proportion from hepatitis. The model has been fitted to mortality data of the 95 Italian provinces in 5 periods of three years each from 1969 to 1983. In 1981-83, the first-component (interpretable as due to alcohol) is estimated to account for 31% in males and 28% in females of total mortality from liver cirrhosis. Estimates are given also for large geographical areas, regions and provinces.

The multiple logistic function (MLF) was applied for the estimation of coronary heart disease (CHD) - "hard criteria" in 5 years as a function of several risk factors in two rural Italian areas belonging to the "Seven Countries Study". CHD was estimated with solutions including 4, 5 and 11 factors respectively. Only serum cholesterol showed a statistically significant contribution; but other factors, like age and physical activity, very likely contributed to a better discrimination between "cases" and "non-cases". By increasing the number of factors the discrimination tends to improve anyway. In the solution with 11 factors, 46% of the observed cases was found in the upper 10% of the estimated risk probabilities; 57% in the upper 20%; while no cases were found in the lowest 20% of the same rank probability list. For practical purposes of selecting high risk individuals for preventive action, a simple 5 factor solution, including age, systolic blood pressure, serum cholesterol, consumption of cigarettes and physical activity is suggested.

European cohorts of the Seven Countries Study have been analyzed in order to examine relationships between the observed incidence of coronary heart disease (CHD) in the second 5-year period of the follow-up and the major risk factors and their spontaneous changes in the first 5 years. The analysis, using the Multiple Logistic Function (MLF) model, shows that changes of systolic blood pressure and smoking habits were significant factors associated with CHD incidence, whereas changes of cholesterol and body mass index were not.

Examinations of 'healthy' men in Helsinki and in rural west and east Finland in 1956 included estimation of total cholesterol and that in the HDL and beta fractions separated by electrophoresis. Vital status to the end of 1980 has been ascertained for all but eight of the 526 men aged 35-61 and for all but two of 261 men aged 30-34 at entry. Among the men aged 35-61, in 24 years 155 died, 63 from coronary heart disease; among the men aged 30-34, 36 died, 16 from coronary heart disease. All causes and coronary death rates were highest in east Finland where HDL cholesterol was also highest. Coronary death rates were not related to HDL cholesterol in east or west Finland but 16 men dead from coronary heart disease in Helsinki tended to have low HDL values. Consideration of five other entry characteristics did not change the picture with regard to HDL-mortality relationships. Solution of the multiple logistic equation using all those variables found the probability of 24-year coronary death was not significantly related to HDL but was significantly related, positively, to the non-HDL cholesterol concentration. HDL and total cholesterol mean values for men of the same age in the same area of Finland, with lipoprotein separation by the new recommended methods, agree closely with the means recorded in 1956. These 24-year findings are not necessarily in conflict with reports in the literature on an inverse relationship between coronary heart disease incidence and HDL cholesterol based on much shorter periods of follow-up and few data on mortality.

Some risk functions are presented linking serum cholesterol to the development of coronary heart disease. They are produced from epidemiological studies on Italian population samples made of men aged 40-59 at entry and followed up to 20 years. The purpose is to provide a simple tool for the estimation of the expected risk and of that depending on changes of the risk factor.

In the Roman Project of Coronary Heart Disease Prevention two different techniques were employed for the identification of individuals at high coronary risk within the treatment groups of the Project. The "risk score" is a simple additive system developed by the working groups of WHO, while the "multiple logistic function" is a complex mathematical model of multivariate analysis. Both of them consider 5 risk factors (age, systolic blood pressure, serum cholesterol, smoking habits and physical activity at work) and are applied for the identification of individuals belonging to the upper 20% of a risk rank list. The two techniques apparently provide similar predictive performances when applied to epidemiological prospective material collected in other studies where the morbid events are already known. When employed in the study population groups they identify, as high risk individuals, different subgroups of population, which overlap only partially. On the basis of theoretical and practical considerations, it has been decided to employ both techniques and to extend, as a consequence, the proportion of high risk individual, eligible for individual treatment, from 20% to about 30% of the total.

The hypotheses of reversibility of risk and of prevention of increasing risk represent the theoretical basis for any attempt to prevent coronary heart disease. After the impressive but inconclusive trials of the first generation, conducted principally in the sixties and on single risk factors, the second-generation trials, begun in the seventies and focused mainly on multifactor intervention, are now producing preliminary results. Although many problems remain unresolved and many questions are as yet unanswered, several results indicate the feasibility of mass intervention aimed at changing the risk-factor levels and suggest an association of such action with a measurable reduction in the incidence of coronary heart disease.

A descriptive analysis of the features of mortality from cirrhosis in Italy suggests that it is made up of two components which are characterized by different age trends. On the basis of this hypothesis, a model has been postulated and applied to the data for the 94 Italian provinces in order to identify the two components. When considering alcoholic drinking data, it appears that only one of these components is associated with the consumption of alcohol, both for men and for women. In this way an estimate can be made of the proportion of mortality in Italy which can be linked to alcohol consumption. For males, this is 40.4% (47.1% for the North, 29.7% for Central Italy, and 33% for the South/Islands). For females, the average is 24.6% (36.6% for the North, 16.2% for Central Italy, and 12.3% for the South/Islands). In absolute terms, these figures represent approx 5000 of the 13,000 deaths per year among males and around 1200 of the 5000 deaths from cirrhosis among females.