The clinical outcome of cirrhotic patients with hepatocellular carcinoma (HCC) depends both on the residual liver function and tumor characteristics. However, the relative prognostic weight of these variables is not well defined. The aims of this study were to verify the value of known prognostic factors and to devise a prognostic index more sensitive than the commonly used Okuda stage. A retrospective analysis of the cases of HCC diagnosed at 16 Italian institutions from 1990 to 1992 was performed. Overall survival was the only end point used in the analysis. The Cox model, stratified by locoregional treatment, was used for multivariate analyses. The final model was derived from 10 randomly chosen training samples, and the prognostic validity of the Cancer of the Liver Italian Program (CLIP) score was assessed on the corresponding testing samples. Four hundred thirty‐five cases of HCC were collected. As of January 1997, 313 patients (72%) were deceased. Overall median survival was 20 months. At multivariate analysis, independent predictive factors of survival were Child‐Pugh stage, tumor morphology, α‐fetoprotein (AFP), and portal vein thrombosis. A simple scoring system (CLIP score) was thus produced, assigning linear scores (0/1/2) to the covariates. Compared with Okuda stage, the CLIP score, structured as a six‐category tool, has a greater discriminant ability, revealing a class of patients with an impressively more favorable prognosis and another class with a relatively shorter life expectancy. The CLIP score is a new prognostic system that accounts for both liver function and tumor characteristics. It is easy to calculate and appears to give more precise information than the Okuda stage.

OBJECTIVE:To determine behavioural, dietary and other common factors associated with new cases of gallstones, diagnosed by ultrasonography, in a prospective cohort study conducted in southern Italy.SUBJECTS AND METHODS:Between May 1985 and June 1986, systematic sampling from the electoral register of Castellana, a small town in southern Italy, yielded 2472 subjects who had had their gallbladder checked for gallstones by ultrasonography. Between May 1992 and June 1993, 1962 out of the 2235 (87.7%) subjects without gallstones at baseline agreed to a further ultrasound examination. At the first survey a standardized questionnaire was administered, inquiring about medical history, diet, cigarette smoking and other behavioural characteristics. Height and weight were also measured, and blood levels of glucose, cholesterol, HDL-cholesterol and triglycerides were determined by standard methods. The same variables were measured at the second survey. The diagnosis of gallstones was made with the same echograph by echographists working in the same department. Multiple logistic regression was used to determine which factors measured at the first survey were associated with the incident cases of gallstones.RESULTS:One hundred and four subjects had developed gallstones, an incidence of 9.7 per 1000 persons per year. Age, body mass index (BMI), weight change, a history of diabetes, constipation (shown by use of laxatives), cigarette smoking, years of schooling, consumption of fried foods and excessive oil, and pregnancy in females, were positively associated with the incidence of gallstones. Consumption of wine, coffee, fish and wholemeal bread was inversely associated. Sex, family history of cholelithiasis, use of oral contraceptives and serum lipids were not independent risk factors for gallstones.CONCLUSION:The results of this study confirm many gallstone-associated factors reported in previous cross-sectional and case-control studies, as well as in other cohort studies based on the clinical diagnosis of gallstones, such as BMI, ageing and wine consumption. Furthermore, use of laxatives, considered a proxy of constipation, appears to be another important independent risk factor for gallstones.

Objective: To describe the prevalence and incidence of gallstones in a population sample from a typical Mediterranean area.Subjects and methods: A sample of 3500 subjects (2000 men and 1500 women, aged 30-69 years) was selected by systematic sampling from the electoral register of Castellana, a small town in southern Italy. Between May 1985 and June 1986, 2472 (70.6%) subjects (1429 men and 1043 women) had their gall bladders checked for gallstones by ultrasonography. Between May 1992 and June 1993, 1962 (87.7%) of the subjects without gallstones (1162 men and 800 women) agreed to be re-examined by ultrasonography.Results: A total of 226 subjects (92 men and 134 women) had gallstones, a prevalence rate of 9.2% (6.5 and 12.9% in men and women, respectively). On re-examination, 104 subjects (55 men and 49 women) had developed gallstones; an incidence rate of 7.9 per 1000 person-years (7.1 and 9.1 per 1000 person-years in men and women, respectively). Prevalence and incidence increased with age in both sexes but were higher in women than in men at all ages.Conclusions: This study suggests that the population of Castellana has a high incidence of cholelithiasis compared with populations studied in central and northern Italy and northern Europe.

Transcatheter arterial chemoembolisation (TACE) using antiblastic agents in association with occlusion of tumour-feeding arteries seems currently to be the most suitable treatment for unresectable hepatocellular carcinomas (HCC) larger than 3 cm in diameter. From July 1989 to January 1991, 21 patients with HCC and a previous history of liver cirrhosis were treated by TACE. The drugs used were doxorubicin and mitomycin C mixed with Lipiodol UF. The arterial occlusion was obtained using Gelfoam or Spongostan particles; in 16 patients it was limited to tumour-feeding arteries to avoid diffuse parenchymal liver damage, while in 5 patients either the main right or left hepatic artery was embolised. Three patients were excluded from the study after TACE because of too short a follow-up; 4/18 died within 3–9 months and 14/18 are still alive with follow-up ranging from 3 to 19 months. A tumour size reduction of more than 50% was observed in 9 patients (50%), with a median survival of 9.8 months. Transient and well-controlled side effects (fever, abdominal pain, nausea and vomiting) were related to the post-embolisation syndrome and could be reduced by using a superselective occlusion procedure.

The paper reports a case of Meckel's bleeding diverticulum which was diagnosed preoperatively using a selective arteriography of the superior mesenteric artery. The infrequent use of this instrumental test may be due to the small number of examples reported in the literature. In conclusion, the Authors underline that selective arteriography can be used with good results even in cases with hemorrhagic complications during the remission phase.

Four-hundred eighty-five patients underwent US examination; 183 of them had gastric cancer, 239 colorectal cancer, 38 pancreatic cancer, 11 esophageal cancer, and 14 had gastric lymphoma. All patients underwent surgery. In 95 cases fine-needle biopsy under US guidance was performed. Lymphadenopathies were classified by the criteria proposed by Yoshinaka et al., type I: poorly-defined borders, diffuse internal echoes; type II: well-defined borders, diffuse internal echoes; type III: well-defined borders, notchings, strong internal echoes. Twenty/twenty-nine type I, 66/98 type II, and 39/43 type III adenopathies were found to be neoplasm-positive. Of 73 patients with adenopathy from gastric cancer, 9 were type I, 42 were type II, and 22 were type III (183 patients examined); of 9 patients with adenopathy from esophageal cancer, 7 were type II and 2 were type III (11 patients examined); of 48 patients with adenopathy from colorectal cancer, 5 were type I, 28 were type II, and 15 were type III (239 patients examined); of 29 patients with adenopathy from pancreatic cancer, 7 were type I, 18 were type II, and 4 were type III (38 patients examined); finally, of 11 patients with adenopathy from gastric lymphoma, 8 were type I, and 3 were type II (14 patients examined). The relationship between US and pathology was possible from a statistical point of view only. Type I lymphadenopathies seem to suggest lymphomatous involvement, whereas type III ones suggest metastatic involvement. US is a valid approach method, which must be supported by other investigation techniques--e.g., CT and lymphography--in order to avoid high false-negative percentages.

The authors report the results of the lymphographic examinations performed on 123 patients affected with melanoma of the limbs. The patients were divided into 2 groups according to the different clinical stages; they all had pathologic confirmation. The following lymphographic parameters were considered: sensitivity, specificity, efficacy and positive/negative predictive value. The results obtained in the first group of patients (clinical stage: I) demonstrated lymphography to have low sensitivity, specificity and efficacy in the staging of melanomas (37%, 50% and 45%, respectively). On the contrary, lymphography could be trusted in the study of stage II melanomas thanks to its high sensitivity. As for stage III, the methodology had a clinical indication only in the follow-up of melanomas treated with radiochemotherapy.

The authors described a case of left subclavian artery stenosis, treated by percutaneous transluminal angioplasty (PTA), in a patient with subclavian steal and arm claudication. The excellent technical and immediate clinical success justify this case report in consideration to the severe subocclusive lesion. The Authors present the clinical and technical aspects of subclavian artery PTA.

Journal of Clinical UltrasoundVolume 12, Issue 5 p. 286-288 Case Report Ultrasonic findings in whipple's disease Domenico Brindicci MD, Domenico Brindicci MD Department of Radiology, University of Bari, School of Medicine, Policlinico, Bari, ItalySearch for more papers by this authorAscanio Mossa MD, Ascanio Mossa MD Department of Radiology, University of Bari, School of Medicine, Policlinico, Bari, ItalySearch for more papers by this authorOttavio Albano MD, Corresponding Author Ottavio Albano MD Department of Internal Medicine, University of Bari, School of Medicine, Policlinico, Bari, ItalyDepartment of Internal Medicine, Clinica Medica I, University of Bari, Policlinico, P.zza G. Cesare 11, 70124, Bari, ItalySearch for more papers by this authorVito Carrieri MD, Vito Carrieri MD Department of Internal Medicine, University of Bari, School of Medicine, Policlinico, Bari, ItalySearch for more papers by this authorVincenzo Vinciguerra MD, Vincenzo Vinciguerra MD Department of Internal Medicine, University of Bari, School of Medicine, Policlinico, Bari, ItalySearch for more papers by this authorOnofrio Cecere MD, Onofrio Cecere MD Department of Internal Medicine, University of Bari, School of Medicine, Policlinico, Bari, ItalySearch for more papers by this authorGiuseppe Palasciano MD, Giuseppe Palasciano MD Department of Internal Medicine, University of Bari, School of Medicine, Policlinico, Bari, ItalySearch for more papers by this author Domenico Brindicci MD, Domenico Brindicci MD Department of Radiology, University of Bari, School of Medicine, Policlinico, Bari, ItalySearch for more papers by this authorAscanio Mossa MD, Ascanio Mossa MD Department of Radiology, University of Bari, School of Medicine, Policlinico, Bari, ItalySearch for more papers by this authorOttavio Albano MD, Corresponding Author Ottavio Albano MD Department of Internal Medicine, University of Bari, School of Medicine, Policlinico, Bari, ItalyDepartment of Internal Medicine, Clinica Medica I, University of Bari, Policlinico, P.zza G. Cesare 11, 70124, Bari, ItalySearch for more papers by this authorVito Carrieri MD, Vito Carrieri MD Department of Internal Medicine, University of Bari, School of Medicine, Policlinico, Bari, ItalySearch for more papers by this authorVincenzo Vinciguerra MD, Vincenzo Vinciguerra MD Department of Internal Medicine, University of Bari, School of Medicine, Policlinico, Bari, ItalySearch for more papers by this authorOnofrio Cecere MD, Onofrio Cecere MD Department of Internal Medicine, University of Bari, School of Medicine, Policlinico, Bari, ItalySearch for more papers by this authorGiuseppe Palasciano MD, Giuseppe Palasciano MD Department of Internal Medicine, University of Bari, School of Medicine, Policlinico, Bari, ItalySearch for more papers by this author First published: June 1984 https://doi.org/10.1002/jcu.1870120511Citations: 8AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume12, Issue5June 1984Pages 286-288 RelatedInformation

34 patients suffering from renal tuberculosis of different degree were examined by ultrasound. The ultrasonographic aspects were compared with the urographic pictures. It was not possible to show by ultrasound the papillar erosions at the initial stage of the infection. In the advanced stage it was possible to evaluate the alterations of the excretory system and the parenchymal damage. The role of the method to study the tuberculous kidney, not visualized at urography, is essential. The typical aspect caused by the coarctated pelvis with dilated calyces allows nearly always to formulate a diagnosis. The achieved results make ultrasonography a very important investigation for the diagnosis and the prognosis of the renal tuberculous infection.