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Biomedical subjects

D Giorgi

Publications and source records attributed to D Giorgi.

At least 91 records · Page 5Linked to original sources
PubMed1995

Measurement of the costs in two mammographic screening programmes in the province of Florence, Italy.

OBJECTIVES: To estimate and to compare the cost per woman examined and per breast cancer detected in two mammographic screening programmes in the province of Florence. SETTING: Two ongoing, population based, mammographic screening programmes in the province of Florence. The first (district project) was started in the seventies in a rural area, whereas the second (city project) was started in the city at the end of 1990. METHODS: All relevant resources consumed by the programmes (costs) were listed and measured. The costs are related to 1993. The unit cost for each phase (recruitment, screening, assessment) of the screening process was estimated by dividing the total cost of the phase by the number of women examined. The cost per cancer detected was obtained by dividing the total cost of the programme by the number of cancers detected at screening. RESULTS: The costs per woman examined were $38.1 and $41.1 in the district and city programmes respectively. The cost per breast cancer detected was $7424 in the district programme and $5180 in the city programme. Staff accounted for more than 50% of the total cost. The unit cost in the screening phase was higher in the district programme, whereas it was lower in the assessment phase. CONCLUSIONS: Our results are consistent with, although slightly lower than, published estimates of the cost per woman screened. Important parameters for determining the efficiency of a mammographic screening programme are the compliance rate and the recall rate.

Breast Neoplasms↗
PubMed1995

[Evaluation of the costs of mammographic screening program in the city of Florence].

This paper investigated differential direct costs determined by the difference between implementation of mammographic screening program for breast cancer detection in the city of Florence (PFD) and the "absence" of the PFD. The involved resources have been identified, quantified and evaluated. The results of the I round (1991/92) of the PFD involve the following different phases: invitations, mass screening, diagnostic assessment. Differential net costs aumonted to 780 million for total cost, and to 53,000 per screened woman. The PFD invited 27,325 women per year; at the I round, the PFD registered an attendance rate of 53.9% and a recall rate of 4.3%, with a total cost of about one thousand million and a cost per screened woman of about L. 64,000. Instead, economic results of alternative "absence" of screening registered a total cost of 170 million and a cost per screened woman of about L. 100,000. Costs for detected cancer amount about to 8.2 million for PFD and 5.7 million for "absence" of the Program. Sensitivity analysis has been performed texting the fundamental parameters of the PFD: attendance rate, recall rate and life time average of the investiments. The sensitivity analysis, performed on the PFD, registered a variation of total cost from 859 million to 1,216 million and a variation of the total cost per woman screened from L. 43,500 to L. 80,000. Sensitivity analysis results highlighted the fundamental role played by women's attendance and by the percentage of women recalled for diagnostic assessment.

Breast Neoplasms↗
PubMed1995

[Intraoperative histological study of nonpalpable lesions of the breast].

The intraoperative frozen section technique has proven to be valid and accurate in the diagnosis of palpable breast lesions, while its use in non-palpable lesions of the breast has been recently discussed. In order to estimate the accuracy of frozen section technique in non-palpable breast lesions we reviewed our series of 672 cases of non-palpable lesions examined intraoperatively between January 1977 and December 1991. Frozen section diagnoses were compared with diagnoses obtained at review of the permanent paraffin sections. A review of the mammographic pattern of each lesion was also carried out. Frozen section diagnosis was replaced by permanent paraffin sections in 22 cases (3.3%). Benign or malignant (in situ and invasive carcinomas) frozen section diagnoses were accurate in 623 of 650 cases (95.8%). Frozen section diagnosis was modified on the basis of permanent sections in 27 cases (4.2%), with 3 false positives and 24 false negatives. Sensitivity and specificity of frozen section technique were 91.7% and 99.2%, respectively. Comparing frozen section and definitive diagnosis according to the mammographic pattern, sensitivity was lower in patients with microcalcifications as the only alteration (88.8%) compared with patients with opacities (94.9%). On the basis of our results the frozen section technique in non-palpable breast lesions is to be considered a valid and reliable diagnostic procedure, particularly in lesions detectable at mammography as an opacity and identifiable on gross examination of the surgical specimen.

Adult↗
PubMed1994

Population-based breast cancer survival. Mammographic screening activities in central Italy.

BACKGROUND: The aim of this study was to evaluate the effect on 5-year survival of patients with invasive breast cancer relative to demographic and clinical variables (age, residence, and disease diffusion) and to early diagnostic procedures performed in the area. METHODS: The observed (Kaplan-Meier method) and relative 5-year survival in 1263 patients with invasive breast cancer in the Province of Florence, Italy, between 1985-1986 (source: Tuscany Cancer Registry) are presented. The results were compared with those of other European areas and of the Surveillance, Epidemiology, and End Results Program. The Cox model is used to evaluate the effects of age at diagnosis (5-year age groups), disease diffusion (localized, regional, distant, unspecified), residence (Municipality of Florence, screening area, other municipalities), and source of diagnosis (Center for the Study and Prevention of Cancer, hospitals) on observed survival. RESULTS: Observed 5-year survival was 68.4% (Kaplan-Meier method) and relative 5-year survival was 75.4%. Relative survival for patients younger than age 35 at diagnosis was high (82.3%); it decreased slowly from 80.5% in the group of patients 35-44 years of age, to 74.0% in those 65-74 years of age, and steeply decreased to 68.1% in those 75 years of age and older. Relative 5-year survival in Florence was lower only than that observed in Switzerland (Geneva) and in the USA (whites). Five-year prognosis was worse in women 70 years of age or older, in advanced stages, in residents of municipalities not involved in the screening program, and in cases diagnosed in hospitals. The gain in survival may be explained partially by lead-time effect and by length bias due to early diagnosis both in self-referred women and in screening-detected cases. In these cases, though, the better prognosis, although attenuated, persisted after adjustment by disease diffusion. CONCLUSIONS: The results suggest that the early diagnosis of breast cancer in self-referred women affects prognosis, at least concerning 5-year survival. Moreover, although lead-time effect and length bias cannot be excluded in this study, screening by personal invitation may reduce the disadvantage in the survival of patients with breast cancer often observed in rural areas.

Adult↗
PubMed1994

Application of bacterial artificial chromosomes to the generation of contiguous physical maps: a pilot study of human ryanodine receptor gene (RYR1) region.

In order to increase the rate of generation of a contiguous human chromosome 19 physical map, we have investigated the advantages of using a bacterial artificial chromosome (BAC) library in comparison with other systems. This cloning system, recently described, can faithfully propagate DNA fragments greater than 300 kb in size. We have screened a total human genomic BAC library with a complex cosmid probe, specific for the ryanodine receptor gene (RYR1) located at 19q13.1. One 150-kb BAC was positive for the ryanodine receptor probe. The ryanodine receptor BAC hybridized to a 150-kb overlapping set of nine chromosome 19-specific cosmids at the 3' terminus of the RYR1 gene as well as two established cosmid contigs which can be linked to the same physical region. The hybridization of the BAC to a 150-kb set of chromosome 19 cosmids suggests that this BAC is nonchimeric in structure.

Calcium Channels↗
PubMed1994

Breast cancer early diagnosis experience in Florence: can a self referral policy achieve the results of service screening?

STUDY OBJECTIVE: To assess the impact of a breast clinic on a specific target population and evaluate early diagnosis performance indicators for breast cancer in the presence of a self referral policy. DESIGN: Women living in Florence between 1980 and 1989 who had undergone mammography at a self referral breast clinic were studied. Main outcome measures were the use of mammography in relation to age, symptoms, and the interval between two subsequent tests, and early diagnosis performance indicators were the detection rate (DR), the prevalence/incidence ratio, and the proportion of early detected cancers. Performance indicators were compared with those from formal screening programmes. SETTING: Florence, Italy. PATIENTS: All mammograms performed at the clinic from 1980-89 in 40-69 year old women living in Florence were examined (n = 42,226). Records included the date of birth and of the examination, the reason for testing (asymptomatic/presence of pain/presence of symptoms other than pain), and the TNM classification for breast cancer cases. MAIN RESULTS: The total number of mammograms performed per annum increased by 70% over the decade, but much of this was routine repeat mammography (54.1% in 1989). Rates of first examinations in asymptomatic women increased in the second half of the decade from 17 per 1000 in 1985 to 31 per 1000 in 1989. Mammographic coverage decreased with increasing age from 12.6% in 40-49 year olds to 6.0% in 60-69 years old. Performance indicators of the activity in asymptomatic women were comparable with those expected in service screening. The proportion of not advanced cancers detected in asymptomatic women was 62.3% with a DR of 5.3 per 1000, and the average prevalence/incidence ratio was 2.9. CONCLUSIONS: High quality mammography performed in a breast clinic in self referred asymptomatic women can achieve as good results as a formal invitation screening service. Only a few of these women will benefit, but those who do are likely to be younger (40-49 year old women).

Adult↗
PubMed1994

Assessment of lesions detected at mammographic screening: performance at first or repeat screening in the Florence programme.

OBJECTIVE: To evaluate the assessment criteria and the results achieved in the detection of breast lesions at mammographic screening. SETTING: Review of cases assessed in the last screening round of Florence city (FC--first screening round: 29,522 subjects) and Florence district (FD --repeat screening round: 13,268 subjects) programmes. METHODS: Referral and biopsy rates, predictive values, and prevalence of cancers detected by screening were determined, as well as the frequency of the diagnostic procedures used at assessment, and their contribution to the final diagnosis according to the mammographic appearance of the suspected lesion. Assessment costs were estimated. RESULTS: Referral rate (FC 4.2%; FD 1.8%), referral positive predictive value (FC 18.7%; FD 28.3%), surgical biopsy rate (FC 0.96%; FD 0.6%), benign/malignant biopsy ratio (FC 0.20; FD 0.13), and prevalence of cancers detected by screening (FC 0.78%; FD 0.5%) were all within the European Community (EC) recommended standards for screening performance. The benign biopsy rate was considerably lower than that of recommended standards. The cost for each subject assessed was 179,000 Italian lire at the first and 116,000 lire at repeat screening. The cost for each subject screened that was attributable to assessment was 7600 lire at the first or 2100 lire at repeat screening. CONCLUSIONS: Limited referral rates and costs were achieved and the proportion of cancers detected by screening was high. The number of referrals was further reduced at repeat screening, and assessment had a limited impact on total screening costs. Detail or magnification mammography, palpation, sonography, and fine needle aspiration cytology all contributed to the final diagnosis and should be immediately available at the assessment clinic. The observed benign biopsy rate was particularly low and suggests that EC recommended standards should be modified.

Aged↗
PubMed1993

A gene homologous to the reg gene is expressed in the human pancreas.

We have determined the nucleotide sequence of regl a human genomic DNA fragment homologous to the reg gene which is expressed in the exocrine pancreas and regenerating islets. Sequence comparisons of reg and regl suggested similar exon-intron organisation. Based on this assumption, specific oligonucleotides for regl exons were used to demonstrate expression of the regl gene in pancreas and liver. The proteins encoded by reg and regl comprise 166 amino acids and differ by 22 amino acids only.

Amino Acid Sequence↗
PubMed1993

First results of a mammographic screening program in two municipalities of Massa-Carrara Province (Italy).

AIMS AND BACKGROUND: A mammographic screening for breast cancer was started in 1989 in two municipalities of Massa-Carrara province. This paper describes the results of the first two years and evaluates the quality of the program via early indicators. METHODS: We calculated the attendance rate at first screening, the proportion of women recalled for further examinations (recall rate), the ratio between benign lesions and carcinomas detected by screening, the staging of the screen detected cancers and the ratio between detection rate and expected incidence (P/I ratio). RESULTS: Out of 14826 invited women 10407 (70.2%) attended the first screening; 266 (2.6%) of them were referred for further investigations but only 63 (0.6%) required surgical biopsy. A histological confirmed malignancy was found in 39 women corresponding to a detection rate of 3.7/1000. According to pTNM classification 89.1% of all cancers were either Tis or in stage T1; and in two third of the cases there was no nodes involvement. CONCLUSION: The results achieved so far, evaluated via early indicators, show a good start of the program.

Adult↗
PubMed1993

A cosmid and yeast artificial chromosome contig containing the complete ryanodine receptor (RYR1) gene.

The ryanodine receptor (RYR1) gene is responsible for some forms of malignant hyperthermia and has been localized to 19q13.1. Central core disease is a genetic myopathy that is genetically linked to RYR1. We have identified an overlapping set of cosmid and YAC clones that spans more than 800 kb and includes the RYR1 gene (approximately 205 kb). Cosmids from this region were identified by screening three chromosome 19 cosmid libraries (11-fold coverage) with six subclones representing the entire RYR1 cDNA. Genomic sequences from positive cosmids were then used as probes to identify additional cosmids. A minimally overlapping set of 23 cosmids was assembled into two contigs on the basis of restriction fragment analysis and hybridization data. Three YAC clones were isolated by screening a human YAC library with selected cosmid inserts. Overlaps among these YACs and the cosmid contigs were determined by hybridizing YAC Alu-PCR products to cosmid DNAs. The YACs bridged the gap between the cosmid contigs and extended the contig on both sides. Fluorescence in situ hybridization experiments positioned the RYR1 contig between GPI, MAG, and D19S191 on the proximal side and D19S190, CYP2A, CYP2F, SNRPA, BCKDHA, and other markers on the distal side. The 800-kb contig of cloned reagents will facilitate the detailed characterization of the RYR1 gene and other loci that may be closely related to central core disease.

Animals↗
PubMed1993

Human regeneration protein/lithostathine genes map to chromosome 2p12.

The pancreatic stone protein (lithostathine) secreted by the exocrine pancreas is an inhibitor of CaCO3 crystal growth. This protein, which is also present in endocrine pancreas, has also been called the regeneration protein (reg). Here we report the mapping of the REG gene to chromosome 2 using the polymerase chain reaction for the specific amplification of human reg sequences in rodent/human somatic cell hybrid DNA. A regional assignment has been made by in situ hybridization to metaphase chromosomes using two different fluorescently labelled genomic probes corresponding to the REG gene and a related gene REGL. Both probes hybridized to chromosome 2p12 suggesting the tandem organization of these genes.

Animals↗
PubMed1991

Rat pancreatic stone protein messenger RNA. Abundant expression in mature exocrine cells, regulation by food content, and sequence identity with the endocrine reg transcript.

We used a cDNA encoding the human pancreatic stone protein (PSP-S), the secretory inhibitor of CaCO3 crystal growth, as a probe for cloning rat PSP-S messenger RNA. Overlapping clones gave a mRNA sequence of 783 nucleotides encoding a preprotein of 165 amino acids including a prepeptide of 21 amino acids. Rat and human PSP-S showed 70% identity, and the mature proteins had the same length. PSP-S mRNA concentration was measured in the pancreas of rats adapted to diets containing 15, 25, or 70% protein. Compared with the 15% protein diet, concentration increased 3 and 12 times with the diets with 25 and 70% protein, respectively, which is 3 times higher than for serine proteases. A complete sequence identity was observed between the rat PSP-S transcript and the reg mRNA described by Terazono et al. (Terazono, K., Yamamoto, H., Takasawa, S., Shiga, K., Yonemura, Y., Tochino, Y., and Okamoto, H. (1988) J. Biol. Chem. 263, 2111-2114), which is expressed in regenerating pancreatic islets but not in mature islets. A specific role of the reg protein in islet regeneration was suggested. We found that PSP-S (reg) mRNA concentration was indeed increased in isolated regenerating islets. Yet, a transient increase was also observed in exocrine tissue during the initial phase of regeneration following pancreatectomy or acute pancreatitis, suggesting increased expression during cell dedifferentiation. It is concluded that, in mature pancreas, expression of the reg/PSP-S gene occurs primarily in acinar cells. The gene product, which encodes a secretory protein inhibiting CaCO3 crystal growth in juice, is unlikely to play a specific role in islet regeneration.

Amino Acid Sequence↗
PubMed1989

Secretory pancreatic stone protein messenger RNA. Nucleotide sequence and expression in chronic calcifying pancreatitis.

The pancreatic stone protein and its secretory form (PSP-S) are inhibitors of CaCO3 crystal growth, possibly involved in the stabilization of pancreatic juice. We have established the structure of PSP-S mRNA and monitored its expression in chronic calcifying pancreatitis (CCP). A cDNA encoding pre-PSP-S has been cloned from a human pancreatic cDNA library. Its nucleotide sequence revealed that it comprised all but the 5' end of PSP-S mRNA, which was obtained by sequencing the first exon of the PSP-S gene. The complete mRNA sequence is 775 nucleotides long, including 5'- and 3'- noncoding regions of 80 and 197 nucleotides, respectively, attached to a poly(A) tail of approximately 125 nucleotides. It encodes a preprotein of 166 amino acids, including a prepeptide of 22 amino acids. No overall sequence homology was found between PSP-S and other pancreatic proteins. Some homology with several serine proteases was observed in the COOH-terminal region, however. The mRNA levels of PSP-S, trypsinogen, chymotrypsinogen, and colipase in CCP and control pancreas were compared. PSP-S mRNA was three times lower in CCP than in control, whereas the others were not altered. It was concluded that PSP-S gene expression is specifically reduced in CCP patients.

Adolescent↗
PubMed1988

Cancer mortality in migrant populations within Italy.

Italian death certification rates from all causes of death, all diseases of the circulatory system, all neoplasms, and cancers of the upper digestive and respiratory tract, stomach, intestines, lung and breast in middle age (45-64 years) were analyzed according to selected geographic areas of birth and residence at death. For total cancer mortality and most neoplasms considered, the rates in middle age were closer to those of place of birth than to those of area of residence, although this pattern was more evident for some sites (e.g., mouth or pharynx, esophagus, larynx, stomach or bladder) than for others (e.g., intestines or breast). In most cases, migration had an adverse effect on cancer rates, and the lowest mortality was reported among stable populations (i.e., those with the same area of birth and death). These findings are discussed in relation to the major migration fluxes within Italy during the current century. Moreover, these analyses give information on the quality of Italian cancer death certification, since the observation that area of birth is often a more important determinant of cancer rates than area of residence provides indirect evidence that cancer death certification in various Italian geographic areas is satisfactorily reliable and consistent.

Adult↗
PubMed1987

Effect of cholinergic agonists and antagonists on gallbladder volume in fasting man.

The effect of direct cholinergic stimulation and blockade on gallbladder volume, determined by real-time ultrasonography (RUS), was evaluated in twenty normal, fasting subjects. Eleven subjects received atropine sulphate or placebo and 9 subjects a series of 3 injection of prostigmine, bethanechol or placebo, randomly assigned, at intervals of 24 h. RUS was performed under basal conditions after fasting for 12 h and every 5 min after drug injection up to 45 min in the atropine study and up to 60 min after prostigmine and bethanechol. There was no significant variation from fasting gallbladder volume after placebo in either group. After atropine sulphate gallbladder volume at first decreased and then significantly increased. With bethanechol and prostigmine, the volume fell significantly to a trough after 30 to 35 min, and then it returned to the basal value within 60 min. It is suggested that cholinergic mediation is involved in maintaining fasting tone in the gallbladder and that cholinergic stimulation causes contraction of the gallbladder by a direct effect.

Adult↗