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Segmental liver resection is generally considered the treatment of choice for small HCC in cirrhotic livers. Although in selected patients with small encapsulated nodules and low alpha-fetoprotein levels long-term survival can be expected after resection [4], Western experience is still limited and follow-up studies too short so that the data presently available cannot be considered satisfactory [3].

Etiologically-oriented epidemiologic studies on cancer of the nasal cavities and paranasal sinuses have been carried out since the beginning of the century. These studies showed that several chemical agents (chromates, nickel compounds, isopropylic alcohol, and mustard gas), and two occupational exposures (wood dust in the furniture industry and exposure to leather in shoe factories) were causally associated with nasal cancer. An increased risk has also been associated with several occupations (i.e. metalworker, textile worker, construction worker, and farmer) even in the apparent absence of causal agents. The first reports of an increased risk of nasal cancer in woodworkers and leather workers in Italy date back to 1980. Subsequent studies have provided estimates of the relative risk, ranging from 3.0 to 11.0 among woodworkers and from 8.1 to 47.1 among leatherworkers. Increased risks have been associated to the metal industry (relative risk ranging from 3.1 to 5.9), the textile industry (ranging from 2.9 to 17.0), the mining and construction industry (ranging from 2.3 to 5.3), and the agricultural industry (ranging from 1.9 to 3.3); all of these estimates are time- and place-specific. Moreover, the estimates are not reliable because of the small sample size, resulting from the low occurrence of the disease. The etiologic fraction for the population, taking into account both verified and suspected carcinogenic exposures, ranges between 50% and 65% in males. Relatively few cases of nasal cancer (all of them occurring in woodworkers) have been notified for workman's compensation; woodworkers with nasal cancer have received monetary compensation in Italy since 1988. Nasal cancer is an often fatal but largely preventable disease. Several verified and suspected occupational exposures are associated with this neoplasm. The reduction of dust and fumes in the air of the above mentioned work environments is recommended for reducing the occurrence of this disease.

Segmental liver resection is generally considered the treatment of choice for small HCC in cirrhotic livers. Although in selected patients with small encapsulated nodules and low alpha-fetoprotein levels long-term survival can be expected after resection, Western experience is still limited, and follow-up studies too short so that the data presently available cannot be considered satisfactory. The true value of alcoholization as a possible alternative therapy in these patients is still to be ascertained. When using these treatment modalities, the major problem is the high tumour recurrence within the liver. Three main reasons could explain these clinical observations: 1. inadequate resection of the original tumor; 2. unrecognized multifocal HCC; 3. newly generated tumours in the remnant cirrhotic parenchyma. The rationale for liver transplantation is the oncological accuracy of the ablation of the liver, and the possibility of a simultaneous cure of the associated cirrhosis. In our programme of liver transplantation, begun in 1985, we accepted as an indication small HCC in cirrhotic livers. We present here our initial experience with 19 cases.

A collaborative study has been performed in order to detect cases of pleural mesothelioma diagnosed or treated in Italy in the years 1984-88. Cases have been notified to ISS by 88 centres (clinics of thoracic surgery and respiratory diseases, oncologic centres, institutes of pathology), active in 14 Italian regions. Altogether, 575 cases (415 males and 160 females) have been included in the study. Information on occupation and/or on non occupational exposure to asbestos was available for 65% of the subjects, and the occurrence of definite or possible exposure to asbestos was estimated for 58% of them.

To the Editor: Hepatitis G virus (HGV), a newly discovered hepatotropic flavivirus1 that can induce persistent infection, has been associated with acute and chronic liver disease.2,3 There are only...

A polycentric mortality study was performed in five Italian harbours: Savona, Marina di Carrara, Livorno, Civitavecchia, and Ravenna. The cohort included active and retired workers (longshoremen), who had been employed between 1960 and 1981. Causes of death were ascertained from death certificates; expected numbers of deaths were generated from age, sex, calendar year, and cause-specific national mortality rates. A low overall mortality was found, which is in agreement with procedures of health selection, typical of physically demanding jobs; an excess of lung cancer was, however, found in four out of five harbours.

A cohort mortality study of 5000 vinyl chloride manufacturers is ongoing in 9 Italian plants. They represent the entire workforce of those ever employed in the production of the monomer and its polymerization. The objectives of the study are to investigate the mortality of the exposed population and to clear up the carcinogenic spectrum of vinyl chloride. This article gives the results for 3 out of 9 plants, Rosignano, Ferrara and Ravenna, which represent about 25% of the total cohort. The expected deaths have been calculated using the mortality rates of the Italian population. For the deceased persons information from the death certificates were used in the analysis of mortality; additional clinical and pathological data were collected (best pathological evidence, b.p.e.). In Ferrara a statistically significant excess for all malignant tumors and lung cancer was detected. In Rosignano and Ravenna the number of observed deaths were small and therefore no comments can be made on cancer mortality. The cohort study is ongoing in the 6 remaining cohorts and the future analysis will consider duration and level of exposure and latency.

Preliminary data of a kindred with multiple endocrine neoplasia type IIa (MEN IIa) are presented. The study concerns 20 subjects belonging to 4 generations. The first is a man, previously adrenalectomized for pheochromocytoma, suffering from thyroid node with high serum calcitonin (CT) and normal tests for parathyroid function, who underwent total thyroidectomy, removal of a grossly enlarged parathyroid and subsequent autotransplantation, because the other glands seemed to be macroscopically uninvolved. In 4 further patients total thyroidectomy and removal of the parathyroid glands with autotransplantation were performed. In all patients, despite biochemical tests had disclosed parathyroid hyperfunction in only one, one or more enlarged parathyroid glands were found, subsequently diagnosed as adenomatous or with focal areas of "chief-cell" hyperplasia. In 3 out of 4 patients, a single test among those performed to detect the presence of a pheochromocytoma was positive. However, because of the lack of a clear correlation among data from biochemistry, stimulation tests and morphological investigations, adrenalectomy has not been performed. Nevertheless these patients will be closely followed up, in order to promptly state when andrenalectomy has to be performed.

Thirty-two patients with hepatocellular carcinoma (HCC) occurring in individuals with cirrhosis had a potentially curative surgical procedure. Twenty-two had segmental hepatic resections (HR), and 10 underwent orthotopic liver transplantation (OLTx). The diagnosis of hepatic malignancy was established in each case preoperatively, and each case was studied intraoperatively by means of sonography. Postoperatively each surgical specimen was examined pathologically with attention to the possibility of intrahepatic tumor spread. Twenty-three of the 32 patients had single small HCC lesion (

Escherichia coli strains B and K12 could grow in very limiting conditions of divalent cation deficiency. Growth curves showed a long lag period of about 30 h, followed by an exponential phase bringing the bacterial concentration to about 10(7) ml-1, with a 24 min doubling time, while the growth curves of control cultures were characterized by short lag periods, maximum populations of about 10(9) ml-1 and an 18 min doubling time. The DNA/protein ratio in bacteria grown in deficient medium was 0.48 compared with 0.21 for control bacteria. Significant differences were found in the ultrastructure of the two types of bacteria. Freeze-etched control cells showed the typical appearance with the protoplasmic fracture face of the cytoplasmic membrane (PFC) having a random distribution of intramembranous particles. Bacteria growing in deficient medium in exponential phase presented several particle-free areas on the PFC. At the beginning of the stationary phase, the particle-free zones became larger and crystalline structures were formed. These structural modifications, which increased with culture age, were never observed in bacteria grown in control medium. Optical diffraction analysis of the crystalline structures in freeze-etched cells revealed regular periodic arrays with a rhomboid repeating unit approximately 7.6 x 5.4 nm in dimension and an angle between the axes of about 73 degrees. Negative staining of isolated membranes of bacteria grown in deficient medium showed a more complex organization of the crystalline arrays, each unit being clearly composed of subunits.

A research study was carried out at a pyrite mine in Niccioleta, southern Tuscany, during the period 1980-1983 to investigate the possible effects of gaseous and particulate pollutants on the respiratory function of mine workers. The study was undertaken to fill the gap in recent scientific information in this field and also collect data which could be used for future planning of epidemiological and environmental controls at the mine. For the most exposed underground workers a dust exposure of 1.04 mg/m3 of inhalable dust and 0.60 mg/m3 of respirable dust was found. The average quartz content was less than 1.5% in both types of dust. Median exposures of the most exposed risk group were 6.0 ppm for carbon monoxide (CO), 0.22 ppm for nitrogen dioxide (NO2), 0.09 ppm for sulfur dioxide (SO2). The health effects of gaseous and particulate pollutants were studied by comparing the respiratory symptoms and lung function data of the miners with those of a reference group. A significantly increased prevalence of simple chronic bronchitis was found among underground miners when compared to the reference group. This condition was not associated with functional impairment of obstructive nature. Chest x-rays revealed 14 cases of p type pneumoconiosis.

The mortality experience of 1392 lead-zinc-silver miners (Gorno, Northern Italy) employed in the period 1/1/1950-31/12/1980 and followed-up to 31/12/1986 was examined. Two separate estimates of the radon exposure level are available: 0.60 and 0.36 working levels respectively. The silica exposure level was not assessed. Vital status was ascertained for 95.6% of the cohort members and their mortality was compared with expected deaths based on national rates. Significant excess mortality from esophageal cancer, stomach cancer, lung cancer, respiratory tuberculosis, respiratory diseases and deaths from external causes was found among underground miners. Surface workers show significantly increased mortality from liver and bile ducts cancer, hepatic cirrhosis, respiratory tuberculosis and respiratory diseases. Based on the 16.4 excess lung cancer cases among underground miners and their cumulative radon exposure, an attributable risk estimate ranging from 9.78 and 16.31 cases per million person-years and WLM (Working Level Month) was calculated.

Twenty-eight frozen renal biopsy specimens with a marked mononuclear cell interstitial infiltrate (MCI) were analyzed with monoclonal antibodies and a biotin-avidin peroxidase technique to define the surface phenotype distribution of the infiltrating cells. Twelve cases were diagnosed as tubulointerstitial nephritis of acute and chronic presentation, of unknown cause in 5 cases or secondary to multiple myeloma or drug reactions. Sixteen cases occurred in primary and secondary glomerulonephritis, 3 cases being associated with lymphoproliferative disorders. The results showed a remarkable heterogeneity of the MCI composition, even in cases with similar clinical and pathological findings. Namely, the T cells accounted for the majority of the infiltrating cells in most cases but a variable predominance of the T cell subsets Leu3 and Leu2 was observed. B cells and monocytes were also prominent in some cases. Such differences in the MCI composition may indicate the activation of different mechanisms of tissue damage, or a different phase of the renal disease. In the three cases of glomerulonephritis associated with lymphoproliferative disorders, the malignant origin of the MCI was demonstrated in one case, while in the remaining cases it was excluded.

We are presenting a series of 23 patients with Cushing disease selected from a larger study in which the ectopic production of ACTH (paraneoplastic or tumoral), adrenal adenoma or carcinoma were discarded. Sixteen were female and seven male. Diagnosis was fundamentally realized by clinical manifestations derived from hypercortisolism (obesity, muscular atrophy, diabetes, osteoporosis or polyglubulia). The polytomography demonstrated a deformed sella in 19 patients. Endocrine exams showed an alteration in rhythm of Cortisol and elevated levels of urinary metabolites. Others exams, Liddle Test, Metopirona Test, or stimulation of exogenic ACTH did not always permit diagnosis of pituitary adenoma. Plasmatic dosage of ACTH is the best test although results did not always agree with clinical manifestations. In each case we performed clinical treatment in preparation for surgery and later selective removal of adenoma or total pituitary ablation by transphenoidal approach. Of 21 patients, we found an adenoma during surgery in 15; the other 6 on whom we performed a total hypophysectomy, the pathological study showed an adenoma in 5 and a hyperemic gland with thick capillaries in 1. Another type of treatment was used on 2 due to their age. Nine patients were given post-operative radiotherapy. We conclude that microsurgery by transphenoidal approach offers the best possibilities for patients with Cushing disease.

300 patients underwent kidney transplantation. Uretero-neocystostomy was performed by means of the Politano-Leadbetter technique in the first 185 patients and direct ureterovesical anastomosis in the other 115 patients. Immunosuppression included conventional therapy (steroids, antilymphocyte globulins, azathioprine) and the association cyclosporine A and steroids. Retrospective analysis on these 300 patients indicates that the improved 1 year graft survival rate (85% vs 64%) we observed in the latest years has depended to the same extent, on improved surgical technique and on advent of cyclosporine A in our therapeutic protocols. Cyclosporine A at low starting doses immediately adjusted on whole blood trough levels (200-400 ng/ml) proved to be superior to other therapeutic schedules reported in this study (1-year graft survival rate: 94% vs 84%-73%). Direct ureterovesical anastomosis was characterized by a net reduction of urologic complications (2.5% vs 9.7%).