Cytological and histological diagnosis of lung cancer in Sardinia and Italy in the 1990s.

BACKGROUND: Up to 30-50% of all lung cancer cases remain without cyto-histological characterisation. The aim of our study was to evaluate retrospectively the proportion of histological and/or cytological diagnosis in patients with lung cancer in Sardinia. METHODS: Data was gathered by consulting the hospital registers and case notes of individual patients released from hospital with a diagnosis of Lung Cancer at all medical centres throughout Sardinia. In gathering patients' data, we focused our attention on cytological and histological procedures through which allowed the lung cancer was diagnosed. Cancer Registries data was utilised to compare our data with national and Sassari province data. RESULTS: From 1991 to 1996 there was a total of 3146 lung cancer patients registered in Sardinia. 1902 patients (60.5%) had a histological diagnosis, 142 patients (4.5%) a cytological diagnosis while in 1102 patients (35%) the diagnosis was performed without any pathological validation. CONCLUSIONS: Our study has shown that lung cancer diagnosis is supported by pathological verification in 65% of cases while in remaining 35% of patients the diagnosis is based only on clinical and radiological reports. In Italy data from Cancer Registries report the percentage of cytohistological diagnosis to be 70% with the percentage of cytological diagnosis being higher than in Sardinia.

Epidemiology of lung cancer in Sardinia, Italy, from 1980 to 1996.

SETTING: Bronchial carcinoma is the most common cause of death among all malignant tumours. Despite a progressive increase, many Italian regions--ours included--do not have a Regional Cancer Registry. OBJECTIVE: To assess lung cancer incidence and mortality rates in Sardinia during the period 1980-1996. METHODS: Data were gathered by consulting hospital registers and the case notes of individual patients released from hospital with a diagnosis of bronchial carcinoma at all Sardinian medical centres between 1980 and 1996. RESULTS: A total of 7734 patients with lung cancer were registered in Sardinia between 1980 and 1996. Data showed a steady increase in lung cancer incidence rates over the years (from 22.3/100000 in 1980 to 34.5 in 1996). The same increase was evident in mortality rates (from 25.7/100000 in 1980 to 42.9 in 1996). The increase in mortality rates was higher in women (+146%) than in men (+59.5%). CONCLUSIONS: Results show a slow but steady increase in lung cancer incidence and mortality rates in Sardinia. The high number of smokers among lung cancer patients seems to indicate that anti-smoking campaigns need to be more effective in Sardinia.

The impact of climate and traffic-related NO2 on the prevalence of asthma and allergic rhinitis in Italy.

BACKGROUND: Environmental factors are likely to be involved in explaining the wide geographical variation in asthma and atopic diseases that has been documented in many recent epidemiological studies. AIM: To evaluate to what extent climate and outdoor NO2 pollution can explain the geographical variation in the prevalence of asthma and allergic rhinitis, and to estimate the relative risk for exposure to different levels of these two factors. METHODS: The impact of climate and long-term exposure to nitrogen dioxide (NO2) pollution on asthma and allergic rhinitis was assessed in a cross-sectional study, carried out during 1998 to 2000 on young adults aged 20 to 44 years (n = 18 873), living in 13 areas from two different Italian climatic regions (subcontinental and Mediterranean). RESULTS: Mediterranean areas had a significantly higher prevalence of asthma-like symptoms (P < 0.001), higher annual mean temperature (16.2 degrees C vs. 12.9 degrees C), lower temperature range (16.0 C degrees vs. 22.1 degrees C) and lower NO2 levels (31.46 microg/m3 vs. 57.99 microg/m3) than subcontinental ones. Mediterranean climate was associated with an increased risk of wheeze (OR = 1.23; 95% CI 1.13 to 1.35), tightness in the chest (OR = 1.21; 95% CI 1.11 to 1.33), shortness of breath (OR = 1.21; 95% CI 1.08 to 1.36) and asthma attacks (OR = 1.19; 95% CI 1.07 to 1.31). After adjusting for climate, an increase of 18.3 microg/m3 in NO2 levels moderately increased the risk of asthma attacks (OR = 1.13; 95% CI 0.98 to 1.32), tightness in the chest (OR = 1.11; 95% CI 0.98 to 1.26) and wheeze (OR = 1.11; 95% CI 0.96 to 1.28). When the levels of outdoor NO2 exposure rose, the prevalence of allergic rhinitis increased significantly in the Mediterranean region (OR = 1.38; 95% CI 1.12 to 1.69), but not in the subcontinental one (OR = 1.03; 95% CI 0.83 to 1.28). CONCLUSION: Our results show that the prevalence of asthma increases when annual mean temperature increases and temperature range decreases. Furthermore, climate interacts with NO2 outdoor exposure, increasing the risk for allergic rhinitis in people exposed to high stable temperatures. A long-term role for the effect of traffic pollution on asthma is also suggested.

Epidemiology of tuberculosis in Sardinia: a comparison of two data-gathering methods.

SETTING: A complete surveillance system for tuberculosis should be able to guarantee constant updating of incidence and provide useful data on a variety of problems related to tuberculosis such as drug resistance, co-infection with the human immunodeficiency virus (HIV), the geographic origin of patients, and mycobacterial species. OBJECTIVE AND DESIGN: To assess the completeness of the surveillance system currently operating in Sardinia, cases seen by all medical centres between 1987 and 1995 were compared with those notified to Sardinian Public Health Services for the same period. RESULTS: Each year, on average 39% of cases seen in Sardinia are notified; 646 (40%) of the 1591 patients notified during the study period were never seen by regional medical centres. An analysis of the results shows that from 1992 the decline recorded in incidence rates in previous years ceased: 1992 (26/100,000), 1993 (25/100,000), 1994 (28/100,000), and 1995 (24/100,000). CONCLUSIONS: The current surveillance system in Sardinia is inadequate for performing an accurate epidemiological survey of the disease. Epidemiological analysis based solely on notification can provide neither reliable incidence rates nor useful information concerning many aspects of tuberculosis.

Microbiological diagnosis of tuberculosis: a comparison of old and new methods.

The aim of our study was to evaluate the diagnostic value of various methods widely used in microbiological diagnosis of tuberculosis: direct smear examination for acid-fast bacilli, cultural identification in Lowestein-Jensen (L-J) medium, the radiometric BACTEC 460 system, and Polymerase Chain Reaction (PCR). Three hundred and ninety-three clinical samples of sputum (375), gastric aspirate (3), pleural fluid (12) and urine (3) were taken from 125 patients hospitalized at our Institute for suspected pulmonary tuberculosis, between January 1995 and June 1997. On completion of diagnosis, 35 were found to be affected by active tuberculosis (30 pulmonary, 4 pleural and 1 urinary) and 90 by other non-tubercular diseases (pneumonia, lung cancer, non-tubercular pleural effusion, etc.). In our study, direct smear examination for acid-smear bacilli gave diagnostic value results of 88% and positive predictive value of 91.67%. Cultural identification in L-J and BACTEC 460 TB radiometric system media resulted in diagnostic values of 96.80% and 94.40%, respectively, and positive predictive values of 100% for both of them. Finally, One-Tube Nested-PCR, a variant which uses specific primers for the IS6110 insertion sequence specific for Mycobacterium tuberculosis, gave us 88.80% (91.43% sensitivity and 87.78% specificity) diagnostic value results, and 74.42% (11 false-positives) positive predictive value. On the basis of our results, we can affirm that PCR is a good method for microbiological diagnosis of tuberculosis, given its high sensitivity and specificity and unparalleled rapidity. However, the high number of false-positives that we found suggests that results obtained should be confirmed with BACTEC, which considerably reduces the time required for identification, and makes it possible to carry out an antibiotic assay rapidly.

Detection of Mycobacterium tuberculosis by PCR analysis of urine and other clinical samples from AIDS and non-HIV-infected patients.

A number of different clinical specimens, such as sputum, cerebrospinal fluid and blood, have been reported to be good substrates for the detection of Mycobacterium tuberculosis by PCR assay. We wanted to search for the presence of mycobacteria in other body fluids, such as urine. Urine samples and other samples obtained from AIDS patients and non HIV-infected patients were analysed by PCR. The results were compared with those obtained using conventional methods (Bactec 460 TB and AFB (acid fast bacilli strain)). We analysed 412 urine samples and 210 different other samples (sputum and cerebrospinal fluid) obtained from AIDS patients by PCR; almost identical levels of PCR-positive (14-17%) results were observed in all samples analysed. The results were then compared with those obtained with the Bactec 460 TB and AFB. PCR, Bactec 460 TB and acid fast stain were also used to analyse 190 urine samples and 230 other samples from non-HIV infected patients in the consumption ward of Sassari Hospital. The number of urine samples positive by PCR (6.3%) and Bactec 460 TB (2.1%) was half that obtained from samples taken from the AIDS patients. As expected, an increase in the number of positive sputum samples was observed with all methods. The results indicate that PCR analysis of urine samples represents a valid alternative for fast and sensitive detection of M. tuberculosis. This method can be routinely used in the clinical laboratory, especially in HIV-infected patients.

Etiology and therapy of community-acquired pneumonia.

The Authors report the data of a retrospective study performed on 520 patients admitted to the Institute of Respiratory Diseases, University of Sassari, Italy, for community acquired pneumonia (CAP) from 1980 to 1995. The aim of this study was to investigate: the frequency of risk factors and their impact on severity of pneumonia; the frequency of pathogens and their correlation with the severity of the illness; antibiotic treatments. One or more risk factors were found in 86% of patients, while 14% had none. In 286 patients (55%) no etiological diagnosis was possible, while in 234 patients (45%) the pathogen was identified. Of the latter, 73% suffered from pneumonia caused by Gram-negative bacilli, 24% by Gram-positive organisms, 0.8% by Mycoplasma pneumoniae and 1.7% by respiratory viruses and endemic fungi. The mortality rate found was 2.69%. In this study, pneumonia caused by Gram-negative bacilli showed a plurilobar and often bilateral involvement, frequent resistance to the most common antibiotics, which required longer hospitalization (> 30 days). The high prevalence of pneumonia caused by Gram-negative bacilli can be explained by the presence in most of the patients, of serious and numerous risk factors.

Etiology and risk factors of adult pneumonia.

The authors point out the remarkable importance that pneumonia has today among infectious diseases, and survey the main risk factors and etiological agents both of the forms acquired in the community and in the hospital, also considering the data from the international literature. The authors stress the high incidence of gram-positive microorganisms, among which Streptococcus pneumoniae is the most widespread in the forms acquired in the community, and the absolute prevalence of the gram-negatives in the nosocomial forms and, among the gram-positives, the pre-eminence of Staphylococcus aureus; these are "difficult" bacterial species, whose prevalence has been determined mainly by induced selective pressure through the inadequate use of antibiotics. The authors also point out the principal factors that favor the onset of pneumonia; they are connected to the host and to the environment; their combination with the infectious agent causes the infective event.

Once-daily tobramycin therapy in lower respiratory tract infections.

In a multicenter Italian study of 104 adult patients with severe bacterial lower respiratory tract infections, the safety and efficacy of a regimen of high dose, once-daily tobramycin alone or in combination with antipseudomonas betalactams was assessed. The overall bacteriological response was an elimination of the original pathogen in 70% of the patients while the overall clinical response mirrored the bacteriological results with a successful clinical outcome in 78% of patients. Adverse experiences were, in general, few and mild without oto- or nephrotoxicity. The once-daily, high dose regimen of tobramycin proved to be a safe and efficacious therapy for severe lower respiratory tract infections in adult patients.

Flurithromycin ethylsuccinate in the treatment of lower respiratory tract bacterial infections.

Efficacy and tolerability of flurithromycin ethylsuccinate were evaluated in lower respiratory tract infections. One hundred and ten patients (38 women, 72 men; age range 18-87 years) were treated with on 375 mg tablet 12-hourly for a mean duration of 8.7 days. One hundred and five patients were evaluable for efficacy. Overall clinical cure rate was 62.9%; improvement was recorded in 19% of patients for a total satisfactory clinical response rate of 81.9%. Sputum production decreased in most patients, being absent after treatment in 47% (only one patient was negative at baseline); sputum was purulent or mucopurulent in 80% of subjects before and in 20% after treatment. Bacteriological evaluation was possible in 72 patients: pathogen eradication was achieved in 80.2% of cases. Eight patients out of 110 reported adverse reactions, mainly gastrointestinal; in one case treatment had to be discontinued. These results demonstrate that flurithromycin ethylsuccinate is safe and effective in the treatment of lower respiratory tract infections.

Serodiagnosis and follow up of patients with pulmonary tuberculosis by enzyme-linked immunosorbent assay.

A new ELISA assay based on antigen A60 from M. bovis BCG was used to quantitate specific anti-mycobacterial antibodies in 250 sera from 133 subjects: 90 tuberculosis cases and 43 controls. Controls were all negative, suggesting the specificity of this assay. In subjects with secondary pulmonary tuberculosis, a correlation was observed between the anti-mycobacterial antibody titer and culture positivity. In fact, positive ELISA assays were found in 88.8% of patients with positive cultures for M. tuberculosis and in 45% of culture-negative tuberculosis patients under therapy. According to our results the A60 ELISA assay is useful in monitoring the efficacy of anti-mycobacterial drugs. In pulmonary tuberculosis cases with positive cultures for M. tuberculosis higher levels of specific anti-mycobacterial IgGs were found after therapy.

Pefloxacin in lower respiratory tract infections.

To determine the efficacy and safety of pefloxacin in the treatment of lower respiratory tract infections, a multicentre trial involving four departments of respiratory diseases was performed. One hundred and eight patients were admitted to the study: most of them were affected with exacerbations of chronic bronchitis or with pneumonia complicating lung cancer. Isolation and identification of responsible microorganisms from bronchial secretions was possible in 78 patients. Seven patients were withdrawn, one for worsening of the underlying disease and six for early side-effects. Thus, of 108 patients recruited, 101 completed the course of therapy (pefloxacin 400 mg bd for 5-14 days) and could be submitted to final evaluation. Of these 43 (42.6%) were cured and 48 (47.5%) showed improvement. Eradication of responsible microorganisms was achieved in 70 (90.9%) of 77 patients microbiologically evaluated. Side-effects of moderate severity were observed in 12 patients (gastrointestinal disturbances in 11 and dyspnoea in one); these did not necessitate discontinuation of therapy.

[Cefotetan in the therapy of respiratory infections. Multicenter research]. / Il cefotetan nella terapia delle infezioni respiratorie. Ricerca multicentrica.

In a controlled multicenter trial 291 patients have been treated with cefotetan. They suffered from acute or chronic exacerbated bronchopulmonary disorders. In 110 patients it was possible to identify the etiological agent: enterobacteria (62), non-fermentative gram-negative bacilli (10), Haemophilus influenzae (8), Branhamella catarrhalis (1), Streptococcus pneumoniae (19), Staphylococcus aureus (12), Streptococcus pyogenes (4). In the exacerbations of chronic bronchitis (203), cefotetan was generally administered at the dose of 1 g/12 h i.m., whereas it was administered at the dose of 2 g/12 h i.v. in acute infection. The mean duration of therapy was 8.8 days. Positive clinical results were obtained in 251 patients (86.2%) with eradication of the pathogen initially isolated in 90.5% of cases. Cefotetan showed good local and general tolerance. The results obtained confirm those of studies concerning limited numbers of patients and show the efficacy of cefotetan both in acute and chronic pathologies, also in patients with serious involvement of their general conditions (concomitant pathologies, high mean age).

Multicentre clinical and bacteriological study of sulbenicillin in patients with bronchopulmonary infection.

In view of the pharmacodynamic and therapeutic properties of a broad-spectrum semisynthetic penicillin recently introduced in Italy, namely sulbenicillin, the authors conducted a multicentre clinical and bacteriological trial of the drug administered by intramuscular or intravenous injection in daily doses of 4, 6 or 8 g given in two or three administrations daily to a group of 66 patients with acute bronchopulmonary infection, mainly exacerbation of chronic infection, hospitalized in four Pneumology Centres of Sardinia. The authors assessed clinical, radiological, microbiological, and biohumoral parameters before and after treatment to provide a basis for assessing test product effectiveness and tolerability. On the strength of their findings, the authors concluded that the clinical and bacteriological activity of sulbenicillin was satisfactory and its local and general tolerability was excellent. The assembled findings indicate that the new antibiotic molecule can be used to advantage in the treatment of nontubercular bronchopulmonary infections, including severe or otherwise "difficult" cases, providing that the drug is administered at adequate dosages and for sufficiently long treatment periods.

A multi-centre trial comparing a sulfamethopyrazine/trimethoprim combination with co-trimoxazole in respiratory tract infections.

A double-blind, multi-centre trial was carried out in 72 patients with acute or chronic infections of the lower respiratory tract to compare the efficacy and tolerance of a sulfamethopyrazine (200 mg)/trimethoprim (250 mg) combination with that of the established combination co-trimoxazole (400 mg sulphamethoxazole plus 80 mg trimethoprim). Patients received treatment for 10 days either with 2 capsules of co-trimoxazole twice daily or in the newer combination group with 2 capsules on Day 1 but then only 1 capsule daily for the remainder of the treatment period. The results of clinical, bacteriological and functional tests showed an excellent or good response in over 90% of patients in each group. There was no statistically significant difference in effectiveness of treatment with the once-daily sulfamethopyrazine/trimethoprim regime compared with co-trimoxazole given twice daily, and both treatments were well tolerated, with only a few mild side-effects, mainly gastro-intestinal ones, being reported.