Increase in incidence of invasive cervical cancer.
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Adult↗
Biomedical subjects
M Zappa
Publications and source records attributed to M Zappa.
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↗
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↗
[Comparison between 2 techniques of screening for prostatic carcinoma. Rectal exploration and transrectal ultrasonography vs. prostate specific antigen].
We report the results of two pilot studies for the early detection of prostatic carcinoma in resident men aged 60-75 years, using combined digital rectal examination (DRE) and transrectal ultrasonography (TRUS) versus prostate-specific antigen (PSA; cutoff: 4 ng/ml) as screening tests. Both screening protocols exhibited high cancer detection rates (DRE + TRUS = 1.82%, PSA = 1.67%), with a high prevalence/incidence ratio (observed/expected ratio: DRE-TRUS = 13.8:1, PSA = 11.3:1) and a diagnostic anticipation of about 6-7 years. Stage (DRE + TRUS: A = 0%, B = 69%, C-D = 31%; PSA:A = 14%, B = 77%, C-D = 9%) and grading distribution (no case with Gleason score < 5) suggests that most screen-detected cancers were clinically assessable but the extent of overdiagnosis of latent carcinomas cannot be estimated. Both screening protocols proved to be cost-effective (biopsy rate: DRE + TRUS = 2.7%, PSA = 2.8%; cost per screened subject: DRE + TRUS = L. 33,750, PSA = L. 30,400; cost per cancer detected: DRE + TRUS = L. 1,854,000, PSA = L. 1,817,500) but screening by PSA was much better accepted (attendance rate: DRE + TRUS = 33.7%, PSA = 66.9%), which makes it the screening test of choice for controlled studies on screening efficacy. This study allows no definitive conclusions to be drawn on screening efficacy but confirms only that screening is feasible at a reasonable cost and yields high diagnostic anticipation. Whether this benefits the screened population is currently debated and needs to be confirmed by controlled studies. Screening may have upsetting negative outcomes such as overdiagnosis, overtreatment, increased treatment-related mortality rates and worsened quality of life, and there is no evidence supporting the recommendation of screening as a routine practice.
Aged↗
Prognostic value of proliferating cell nuclear antigen in lymph node-negative breast cancer patients.
BACKGROUND: The prognostic value of proliferating cell nuclear antigen (PCNA) has been demonstrated in recent studies of human tumors including breast cancer. METHODS: PCNA immunoreactivity was assessed retrospectively in a consecutive series of 173 lymph node-negative primary breast cancer cases. The PCNA grade was determined according to estimated quartiles of nuclear immunostaining, and its association to disease-free and overall survival was studied. RESULTS: PCNA grade was associated significantly with nuclear grade. On univariate analysis, PCNA grade was associated significantly with both 5-year relapse-free survival rate (Grades 1-2 = 78%; Grades 3-4 = 52%; P = 0.0117) and overall survival. On multivariate analysis, T category and PCNA were associated independently and significantly with both relapse-free and overall survival. Nevertheless, the magnitude of the association of PCNA grade to prognosis was low (relative risk of recurrence in patients with PCNA Grades 3-4 versus Grades 1-2 = 2.13), and only 24% of all relapses or 28.8% of all cancer deaths observed at 5 years occurred in patients with PCNA Grades 3-4. CONCLUSIONS: The predictive value of the relationship of PCNA grade to prognosis was too low to be of value as an independent prognostic indicator.
Adult↗
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↗
A prospective study of the value of mammographic patterns as indicators of breast cancer risk in a screening experience.
The association between mammographic parenchymal patterns and the risk of subsequent breast cancer was studied in a cohort of 17,911 women aged 40-70 years, enrolled in a mammographic screening program. The cohort was prospectively followed-up for 5 years after blind attribution of mammographic pattern. Incident cancers, either screen- or interval-detected, were monitored through the screening program and by the local cancer registry. Multivariate analysis adjusting for the confounding effect of age, demonstrated an independent and significant association between mammographic patterns and breast cancer risk. The relative risk of subsequent breast cancer, assumed to be 1 for N1 pattern, was 2.39 (1.0-5.7) for P1, 4.02 (1.7-9.3) for P2, and 5.01 (1.9-13.3) for DY category, respectively. The relative risk of P2-DY with respect to N1-P1 categories was 2.09 (1.4-3.1). A diagnostic delay, possibly due to the 'masking effect' of a radiologically dense breast, was evident for P2-DY with respect to N1-P1 cancers (proportion of Stage I cancers = 42% vs. 69%). These results suggest the adoption of a shorter rescreening interval in P2-DY subjects.
Adult↗
Biomechanical factors in abdominal aortic aneurysm rupture.
Hitherto the size of abdominal aortic aneurysms (AAA) has been considered the most important factor in determining the risk of rupture. For this reason most interest has been devoted to physical, echographic and tomographic analyses of the shape of AAA. However, it is known that rupture can also occur in small AAA. Other factors must be considered to have an important role in the natural history of aneurysms. The aim of this study was to characterise the mechanical stress in the wall of an AAA due to pressure in the presence of atherosclerosis, intraluminal thrombus and anatomical restraints. The Finite Elements Method (FEM) was used to determine wall stress distribution. Due to the simplicity of the AAA structure an axisymmetric model has been built. The results of the structural analysis confirms that maximum stress increases with diameter. These effects may be reduced by the presence of intraluminal thrombus, which in the models reduces maximum stress by up to 30%; however this is not the case for dissecting thrombus. On the other hand atherosclerotic plaques cause stress concentration and a significant increase in maximum wall stress. The risk of rupture can increase by about 200%. Finally the investigation shows the FEM is a versatile tool for studying the mechanics of vascular structures. It enables the influence of various parameters on wall stress to be quantified in diagnostic settings, and so could be useful for predicting the rupture of AAA, although at present such predictions are limited by data leakage and by the approximations used in the model.
Aged↗
Occupation and cancers of the lung and bladder: a case-control study in Bombay.
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Case-Control Studies↗
Lung cancer among textile workers in the Prato area of Italy.
The association between lung cancer and occupational exposure in the textile industry was investigated in a population-based case-referent study conducted in the Prato area of the province of Florence (Italy) where there is a concentration of textile factories. A complete response to a postal questionnaire was obtained for 207 cases (85.1%) and 440 referents (76.1%). Those who had ever worked in the textile industry had an odds ratio (OR) of 1.45 [95% confidence interval (95% CI) 1.0-2.1]; when nine different textile job titles were considered, an increased OR was observed only for rag sorters (OR 2.2, 95% CI 1.3-3.8) and weavers (OR 1.7, 95% CI 1.1-2.7). Analysis by different "time windows" showed an OR of 3.0 (95% CI 1.6-5.8) for rag sorters at work in the 1950s and an OR of 2.8 (95% CI 1.5-5.0) for weavers at work in the 1970s. This result supports the suggestion of two different carcinogenic exposures in the Prato textile industry (asbestos and mineral oils).
Animals↗
[Clinico-echographic screening in the early diagnosis of prostatic carcinoma. Preliminary results of a feasibility study of a randomized trial].
The preliminary results of a feasibility study of a randomized trial for the early detection of prostate carcinoma are reported. 4,229 healthy men aged 60-75 years were invited to undergo digital rectal examination (DRE) and transrectal ultrasonography (TRUS); 1,284 of them responded and were thus examined. Subjects with suspicious findings at DRE and/or TRUS underwent transperineal US-guided biopsy and prostate-specific antigen (PSA) determination. Subjects with equivocal findings were controlled after 6 months with DRE, TRUS and PSA. The screening program was rather simple (examination time < 10') and cost was limited (cost x subject = US $25). So far, 27 biopsies (2.1%) have been performed. Eighteen cancers have been detected (1.41%), the prevalence/expected incidence ratio being 10.6:1. Stage at diagnosis was B1 in 12, B2 in 3, C in 2 and D in one case, respectively. Cancer had been suspected at DRE in 12, at TRUS in 17 and at PSA (cutoff = 4 micrograms/ml) in 15 of 18 cases, respectively. This study provides evidence that screening for prostate cancer is feasible at a moderate cost and diagnostic anticipation is relevant. A prospective randomized trial is needed to assess whether early detection has any impact at all on mortality. When designing such a study, the effect of compliance, which was low in our experience, on the statistical power should be carefully evaluated. The possibility of pre-screening with PSA, which is much more accepted and might improve attendance rates, should also be evaluated by specific studies.
Aged↗
The association between abdominal aortic aneurysms and chronic leg ischaemia. Prevalence in 125 consecutive patients.
A study was carried out to see if in patients with atherosclerotic lesions of the lower limbs the percentage of abdominal aneurysms is higher than in the general population. One hundred twenty five consecutive patients were studied in two different hospitals and compared with a control group. In the two groups with peripheral vascular diseases the patients had a prevalence of aneurysms of 12%, while in the control group the prevalence was of 3%. All patients were operated on successfully except two of them who are now in follow up with regular ultrasound assessment, one with an aortic aneurysm of 3.2 cm and the other with an aortic diameter of 4 cm and moderate liver failure.
Aged↗
Pleural malignant mesothelioma in Tuscany, Italy (1970-1988): II. Identification of occupational exposure to asbestos.
Following the finding of an unexpected cluster of mesotheliomas in textile workers, a surveillance system of malignant mesotheliomas was implemented in the region of Tuscany, Italy. This article reports on the investigation of 124 cases of mesothelioma diagnosed and reviewed by the Institutes of Morbid Anatomy and Histopathology at the Universities of Florence, Pisa, and Siena between 1970 and 1988. A complete occupational and asbestos exposure history was assessed through a semi-structured questionnaire directly administered to resident cases of Tuscany or, if deceased, to their closest living relatives, for a total of 100 interviews. The hypothesis of past occupational asbestos exposure was verified and documented. Seventy-two cases have been classified as occupationally exposed to asbestos; four were classified in the category of "possible domestic" exposure to asbestos. For two others, the role of other risk factors was stressed, and for 22 cases, either no asbestos exposure was found or the available data were not adequate to define it. The present study allowed identification of some unknown or scarcely known occupational asbestos exposures in the study area.
Adult↗
[Personal observations on surgical therapy of pulmonary metastases of renal carcinoma].
Renal cancer has an high incidence of metastasizing and its metastases are just a little responsive to chemo and radiotherapy. Because of this, thoracic surgeons began to have experiences on surgical resections of lung metastases from renal cancer. Pulmonary metastases can be isolated or multiple and may appear at the same time of renal cancer discovery or after it, and they generally have a very slow evolution. Authors report their own 15 years old experience on lung metastases from renal cancer resections.
Carcinoma, Renal Cell↗
[Importance of Staphylococcus epidermidis in the bacterial colonization of abdominal drains in surgical patients].
Bacterial adherence to biomaterials as an element of clinical relevance is a well-known factor in the pathogenesis of sepsis. Drainages, intravascular catheters, surgical prostheses and other devices are susceptible to bacterial colonization with clinical consequences. In the last few years attention has been paid to coagulase-negative Staphylococcus (S. epidermidis), mainly to some strains able to produce a highly adhesive polysaccharide substance, called glycocalix or slime. This promotes adherence either interbacterial either between bacteria and biologic tissues or synthetic materials acting as a pathogenetic factor in sepsis being able to increase bacterial resistance to phagocytes and antibiotics. Bacterial contamination of 40 abdominal drainage tubes in patients operated in elective and in emergency surgery for various pathology has been evaluated. Sonication of the tip of the drainage was utilized in order to promote the detachment of adherent colonies and its effectiveness was compared to that of microcentrifugation. Culture of 25 drainages (62.5%) showed no bacterial contamination; 7 drainages (17.5%) have proved to be colonized by S. epidermidis, in 4 cases the isolated strains were also methicillin-resistant, 2 of which slime-producing. Out of the 7 drainages colonized by S. epidermidis, 4 were removed from patients operated in emergency: none of the isolated strains was slime-producing. Six drainages (15%) were colonized by Gram+ bacteria (S. fecalis, P-sensible cocci, rods), 1 (2.5%) by E. coli and 1 (2.5%) by P. aeruginosa, S. epidermidis appears to be the chief contaminant of abdominal drainages, especially in emergency surgery; slime production has always been observed in methicillin-resistant strains: this confirms the hypothesis that slime production is typical of specialized, virulent strains.(ABSTRACT TRUNCATED AT 250 WORDS)
Abdomen↗
Further evidence of an excess of risk of pleural malignant mesothelioma in textile workers in Prato (Italy).
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Asbestos↗
[Heterotopia of the gastric fundus wall in bilobate gallbladder associated with dilatation of the main bile duct. Description of a case].
On the basis of a recent case of fundic gastric heterotopia in the gallbladder, the principal, possible embryogenetic hypotheses of the malformation are described and discussed. The possibility that acid secretion of the gastric glands contained in the ectopic fundic mucosa determined part of the symptomatological and clinical picture accompanying signs of lithiasic cholecystopathy is also evaluated.
Adult↗
[Screening and follow-up of patients with arteriopathies of the lower limbs using the test proposed by Laing].
The Authors tested a standard exercise suggested by Laing in 1980 for the screening and the follow-up of patients with atherosclerotic lesions of the arteries of the lower limbs. Were included in this study 44 patients with monolateral symptoms and was studied the asymptomatic limb. The results were compared with the ones obtained by the traditional exercise proposed by Strandness and with the ones of a control group studied with the two tests. The excellent correlation of the data gives us the opportunity to reaffirm the utility of the Laing's standard exercise in the clinical investigation of potentially arteriopathic patients.
Aged↗