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In the last two decades the life expectancy of patients with cystic fibrosis (CF) has improved enormously: it is now estimated at around 30 years, but some patients reach an older age and one third of all patients with CF currently reach adulthood. Once considered a pediatric disease, CF now is a disease of adults too. As a consequence, internists must be highly knowledgeable about all the clinical patterns of this multifarious disease, must be better qualified to recognize its complications and must be highly trained to treat them. This review is dedicated to internists and general practitioners and not to the specialists in the research and clinical field of CF, until now only pediatricians; it briefly summarizes the medical history of CF and the current knowledge at the molecular, genetic and clinical levels about this disease; it reports up-to-date epidemiological data and it illustrates the clinical patterns which are more frequently encountered in adult patients. The true target of this review is to stimulate a greater interest and participation in this clinical field by adult caregivers, as a development of a medical care system for adults with CF is now crucial. Therefore, a growing number of internists will be increasingly involved in providing care for patients with this disorder.

The prevalence of comorbidities in patients dismissed from hospitals has already been investigated to obtain economical, administrative and epidemiological information, or for health insurance-related problems. Originally designed for billing purposes, administrative data could be the basis for clinical research as well, although the clinical element has somehow been disregarded till now. The aim of this research is (i) to study the prevalence, and (ii) to evaluate the clinical relevance of comorbidities in patients dismissed from a Department of Internal Medicine. In a recent series of 1605 patients (since the Diagnosis-Related Groups-DRG-based hospital financing system has come into common use in Italy) comorbidities have been observed in 92.65% of the cases, while the percentage of comorbidities was rated as 71.97% in a previous series of 2551 patients dismissed from the same Department before the introduction of the DRG system. In the recent series, the prevalence of a single comorbid condition and of two and of three comorbid conditions was 19.50, 32.89 and 47.61%, respectively. In any case, the so-called comorbid conditions were active diseases requiring medical investigation and therapy. They included hypertensive heart disease, ischemic heart disease and angina, arrhythmias, peripheral vascular diseases, chronic bronchitis, chronic hepatitis, liver cirrhosis, diabetes, metabolic disorders, etc. In conclusion, patients referred to a Department of Internal Medicine have a high severity of illness due not only to the gravity of the primary diagnosis but also to the number and seriousness of comorbid conditions. For these patients more hospital resources and a high level of professional skill are required.

A 70-year-old woman was admitted to the hospital because of a 5-year history of weight loss, weakness, anemia, osteomalacia, pathologic fractures and pain responding only to narcotic analgesics. A diagnosis of celiac disease was made on the basis of pathologic xylose absorption test results, studies confirming the presence of antigliadin and antiendomysial antibodies, and jejunal biopsy evidencing shortened or absent villi. The detection of unusual cases of celiac disease without diarrhea is on the increase. The only observable symptoms of this pathology may be osteomalacia or persistent iron deficiency anemia despite oral iron therapy.

The Authors describe and discuss the biological bases and fundamental clinical principles for proper and rational anti-tumor chemotherapy. The effectiveness of chemotherapy depends essentially on the following factors: 1) kinetic phase of the neoplastic cells, 2) penetration of the drugs within the tumor mass, 3) segregation of tumor cells in pharmacological sanctuaries, 4) presence of drug-resistant cell phenotypes. It follows that proper chemotherapy must: 1) begin early, when the tumor is small and the number of drug-resistant cells and cells in G0 is small, 2) involve the simultaneous use of several drugs acting on cells in different phases of replication without overlapping toxicity and cross-resistance, 3) be utilized at high drug dosages and at optimum time intervals between one cycle and another so that the greatest number of neoplastic cells can be destroyed as soon as possible in order to prevent regrowth of the tumor and development of drug-resistant cell strains.

The ability of history taking to predict endoscopically verified pathology of the upper gastrointestinal tract was evaluated in a group of 1000 patients submitted to esophagogastroduodenoscopy (EGDS). The presence of one or more of the following symptoms at the time of EGDS or 4 weeks previously, was considered: epigastric pain, dysphagia, dyspepsia, gastrointestinal bleeding, pyrosis, anorexia and/or weight loss, nausea and/or vomiting. The results of this elaboration showed that the presence of recent symptomatology does not allow differentiation of patients with endoscopically verified pathology from those without it. The presence of an "at risk history" consisting of one or more of the following factors was also evaluated: smoking 10 cigarettes per day, drinking 100 g alcohol per day, previous diagnosis of upper gastrointestinal tract pathology, gastrointestinal-irritating therapy. Data analysis showed notable importance of the presence of an "at risk history"; in fact, when compared with subjects without this type of history, "at risk" patients were twice as likely to have a pathological condition diagnosed. Thus, when protocols for endoscopic examination are established the history of the patient and his lifestyle must be taken into consideration.

Serial chromosome and biochemical studies were carried out in 11 subjects before and during initial occupational exposure to moderate quantities of lead fumes in a storage battery plant. The rate of abnormal metaphases, mostly with chromatid and one-break chromosome aberrations, was approximately doubled after one month of work; it further increased after two months of work; remained in this range up to seven months of exposure; and then tended to decrease somewhat. Blood lead levels increased progressively in the first few months, then reached a steady state. Urinary lead and coproporphyrin levels increased sharply after one month of work, while urinary delta-aminolevulinic acid (ALA) levels increased moderately. The ALA dehydratase (ALAD) activity of red blood cells (RBCs) was reduced to almost 50% of the initial values after one month, decreased further in subsequent months, and remained decreased through the remainder of the study.

A variant form of acute promyelocytic leukemia has been recently described, characterized by a particular morphological picture associated with severe disseminated intravascular coagulation, with hyperleukocytosis at onset in most cases, and often a rapidly fatal outcome. Reviewing our case series of the past 3 years, we have identified 2 cases which presented with this typical clinical and hematological picture, in which diagnoses have been made retrospectively. The possibility of diagnosing this variant at onset even only on the basis of cytomorphology is discussed as well as the advisability of studying a new therapeutic approach for cases of this type in a attempt to improve its otherwise very unfavorable prognosis.

The prevalence of the symptom pyrosis was investigated in 700 cases subjected to gastroduodenoscopy. The incidence of pyrosis was considered in relation to sex, age, "vices" (consumption of coffee, alcohol, cigarettes), character traits, family and pathological medical histories and the diagnosis formed during endoscopy. The incidence of pyrosis proved to be identical for both sexes and slightly higher in the first decades of life. There was no correlation between familial gastroduodenal or intestinal diseases and pyrosis. There seems to be no connection between cigarette smoking and alcohol consumption (assessed quantitatively) and a higher incidence of pyrosis; the consumption of coffee, however, does appear to increase the incidence of pyrosis. When interpreting these data, it should be remembered that many subjects may have modified their habits as a result of pyrosis. The incidence of pyrosis was always found in cases of oesophagitis, current bulbar ulcers, the initial stage of gastric tumours (not advanced cases) and, although with less certainty, in pyloric stenosis and duodenitis. A low incidence was recorded for cases of hypotrophic gastropathies, and cicatricial gastric or duodenal ulcers, for males with oesophageal varices or with a history of chronic hepatopathies. To conclude, pyrosis does not seem to show any characteristics of specificity or sensitivity.

700 cases subjected to endoscopic examination were investigated to find the relationship between dyspepsia and personal characteristics, lifestyle, family and pathological history and formulated diagnosis. Dyspepsia is taken to represent: epigastric heaviness following meals, prolonged and difficult digestion accompanied by the sensation of slow gastric emptying and fullness. Dyspepsia occurs with equal frequency in both series and is more common during the first decades of life. Dyspepsia is not affected by whether or not the patient lives in the town or the country, smokes, drinks significant amounts of alcohol or coffee. Neither a family history of gastroduodenal or intestinal complaints or gall bladder stones or chronic liver diseases have many bearing on dyspepsia. An attempt to connect endoscopic diagnosis with dyspepsia had no positive result. Dyspepsia was observed with the same frequency in subjects free from upper digestive tract diseases, subjects with organic disease and subjects with functional diseases.

Despite increasingly sophisticated techniques, improvements in the correlation between laboratory findings and tumor response to endocrine therapy have not been obtained by hormone receptor studies. A possible explanation is that present knowledge of the mechanisms of the endocrine stimulus is incomplete. Some aspects of the present model, (elevated conjugated steroid levels, multiplicity of the plasma proteins capable of binding hormones, pulsatility of the plasma protein bond and of the receptor system for steroids), are still unclear and thus are not used in diagnosis. By evaluating these factors it will probably be possible to correlate better laboratory data with clinical findings.

In the endocrinologic study of dysplastic and neoplastic pathologies of hormone-dependent organs we propose the determination not only of the plasma levels of the "total" hormone but also those of the free hormone as well as the plasma/hormone binding capacity and the kinetics of the plasma/steroid interaction.