Epidemiology of hepatocellular carcinoma in a province of northern Italy: prevalence of the risk factors and incidence in the population.

AIMS: Epidemiologic studies on hepatocellular carcinoma (HCC) in limited geographic areas of Italy are rare, and most of them derive from autopsies. We retrospectively analyzed the prevalence of risk factors (sex, age, HBsAg, alcoholism, cirrhosis) in 137 HCC diagnosed between 1980 and 1989 in a single centre of northern Italy (Bergamo). RESULTS AND CONCLUSIONS: One hundred and nine of the HCC (79.6%) occurred in men (M:F = 3.9:1); 35.8% were HBsAg+ and 41.4% had histories of alcoholism. There were significant differences between men and women as regards prevalence of HBsAg+ (40.4% vs 17.9%; p = 0.046) and alcoholism (47.6% vs 17.9%, p = 0.008). The mean age of the patients was 63.6 years (range, 40-82), with significant differences between men and women (62.4 +/- 08 vs 68.2 +/- 1.4, p = 0.001), between HCC/HBsAg+ and HCC/HBsAg- (59.1 +/- 1.1 vs 66.1 +/- 0.8, p = 0.00001) and between alcoholics and nonalcoholics (61.6 +/- 1.1 vs 64.8 +/- 0.9; p = 0.03). Liver cirrhosis was associated with HCC in 104/122 cases (data not available for 15 patients) without differences in distribution of sex, age, HBsAg+ or alcoholism between HCC with cirrhosis and HCC without cirrhosis. Incidence was calculated for the surrounding territory of the hospital center (10 towns, districts 5 and 6, USSL 30). Fifty-four cases of HCC were found in this area over the 10-year period, in according with a mean standardized incidence rate (Lombardy population 1971) of 11.7/100,000 inhabitants/year (c.i. 95%, 1.49-21.86).

The spontaneous bacterial peritonitis in cirrhotic patients. To a new gold standard.

Of 282 consecutive ascites prospectively collected in 54 months, Spontaneous Bacterial Peritonitis (SBP) was diagnosed in 8.5% of the cases, "probable" SBP in 31.1%, Bacteriascites (BA) in 3.5% and Sterile Ascites (SA) (negative ascitic fluid culture with PMN less than 250/mm3) in 74.8%. Escherichia Coli (41.6%) and Staphylococcus Epidermidis (60%) were the most frequent pathogens isolated in patients with SBP and BA, respectively. With regards to in-hospital mortality, 18% of patients with BA and 50% with SBP died; the mortality seemed to be related to the degree of hepatic and renal damage, to a higher peripheral and ascitic WBC concentration and to a lower pH of ascitic fluid (FA). When the comparative analysis was applied to the four groups of ascites, a different distribution of clinical signs and biohumoral parameters appeared. As a matter of fact, abdominal pain, fever and rebound tenderness resulted significantly more frequent in SBP and "probable" SBP. Furthermore, the mean values of peripheral and ascitic WBC concentration, of serum creatinine and of ALT were statistically higher in SBP and "probable" SBP than in SA and BA groups. The strict relationship, both symptomatologic and biochemical, between SA and BA on the one hand and between "probable" SBP and SBP on the other, prompted us to conclude that "probable" SBP and SBP represent different patterns of the same disease. Therefore, the subclassification in the four groups outlined above would not be in accordance with the clinical practice and could give rise to the physician's confusion and uncertainty.

[Autonomic neuropathy in reduced glucose tolerance]. / La neuropatia autonomica nella ridotta tolleranza glucidica.

33 subjects belonging to I.G.T. class according to N.D.D.G. criteria and controlled in our ambulatory, have been studied for the response to the tests usually employed for the investigation of parasympathetic and sympathetic cardiovascular innervation. We have found pathological values for the SL1 test and borderline values for SL2 and LS tests; on the contrary all the other tests presented normal values. The Authors conclude that signs of deterioration of cardiac and vascular innervation, especially regarding the parasympathetic nervous system, can be present also in the subjects showing a small glucose metabolism alteration. This subclinical alterations do not depend on factors which can interfere with the responses to the tests (as age, boyd weight, sex and presence or absence of diabetic familiarity) but on glucose metabolism alteration. Hence also the subjects with I.G.T. have to be considered as a at risk population, like the neuropathic diabetics.