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In order to assess the interaction between alcohol intake, tobacco smoking and coffee consumption in determining the risk of liver cirrhosis we carried out a hospital-based case-control study involving 115 patients at their first diagnosis of cirrhosis and 167 control patients consecutively enrolled in the General Hospitals of the Province of L'Aquila (Central Italy). The mean life-time daily alcohol intake (as g ethanol consumed daily) was measured by direct patient interviews, whose reproducibility was > 0.80 and similar for cases and controls, as checked by interviewing the relatives of a sample of 50 cases and 73 controls. During the same patient's interview we also measured the mean consumption of coffee (daily number of cups of filtered coffee) and tobacco (life-time daily number of cigarettes smoked). A dose-effect relationship on the risk of cirrhosis was present both for alcohol intake--for which the risk was significantly increased above 100 g of daily intake--and for cigarette consumption. The latter did not however improve the goodness-of-fit of a logistic regression model including alcohol intake as covariate. By contrast, coffee consumption had a protective effect on the risk of cirrhosis and significantly improved the goodness-of-fit of such a model. Abstaining from coffee consumption determined both a significantly increased risk of cirrhosis, even for daily alcohol intake below 100 g, and a multiplicative effect with alcohol intake on this risk. In patients drinking > or = 101 g ethanol daily the relative risk increased from 5.5 (95% confidence interval: 1.4-22.0) for coffee consumers to 10.8 (95% confidence interval: 1.3-58.1) for coffee abstainers.(ABSTRACT TRUNCATED AT 250 WORDS)

From a practical point of view, it has been estimated that the combination of intestinal resection plus side-to-side or end-to-side anastomosis with oral 5-ASA treatment reduces by 64 percent the postoperative recurrence rate in CD at three years follow-up.

The aim of this study was to select the best approach for screening coeliac disease patients among populations with different grades of disease prevalence.

The heterogeneity in the results of observational studies that investigated the association between alcohol consumption and risk of liver cirrhosis was analysed by means of a meta-analysis that included 15 articles published from 1978 to 1997. Relative risks associated with low levels of alcohol intake (25 g/day) ranged from 1.5 [95% confidence interval (CI): 1.4-1.5] for a linear model fitting the results of the six studies performed in Mediterranean areas, to 3.6 (95% CI 3.1-4.3) for a quadratic model fitting the results of the nine studies performed in other areas. A strong indication of heterogeneity was observed when combining all studies. Quadratic term of alcohol intake, quality of the study and area in which the study was performed explained most of this heterogeneity. Efforts should be made to explain the strong heterogeneity in the trend estimates. Reproducible methods to collect relevant and valid information on alcohol intake should be developed and the role of drinking patterns and viral and nutritional factors in modifying the effect of alcohol on the risk of liver cirrhosis should be investigated.

The age-period-cohort analysis allows targeting of health care and prevention programmes based on future trends. Aetiological and prognostic factors act differently in Europe. A better understanding of the trends would require more detailed information on alcoholism treatment rates, alcohol habits, viral hepatitic infections and other factors involved in the aetiopathogenesis of the disease.

No abstract

BACKGROUNDThe activation of the clotting‐fibrinolytic system in cancer patients is common and represents an unfavorable clinical sign. D‐dimer (DD) is a sensitive marker of fibrinolysis.METHODSThe current study comprised 826 new lung carcinoma patients seen consecutively in a single institution over a 10‐year period (1992–2001). For each patient, 31 variables, including DD and survival duration, were available for analysis.RESULTSOnly weak relationships between DD and the other variables were found. The DD variable correlated best with the level of lactate dehydrogenase, performance status, tissue polypeptide antigen, stage of disease, and the number of metastases (rho = 0.33, −0.25, 0.18, 0.18, and 0.15, respectively). The D‐dimer distinguished patients with different prognoses. The median survival periods were 154 days (95% confidence interval [CI], 122–189 days) and 308 days (95% CI, 227–409 days; log rank statistic, 26.56; P < 0.01), respectively, for abnormally elevated and normal values. The difference was greater in patients with adenocarcinoma and in patients presenting with a less advanced disease, especially in patients with pathologic Stage Ia disease. The best multivariate survival model selected 10 significant covariates, including DD.CONCLUSIONSThe authors recommend measuring the plasma level of DD in all new lung carcinoma patients. This measurement may help to formulate individual prognoses and can be used to indicate adjuvant treatment for surgical patients. Cancer 2003;97:3044–52. © 2003 American Cancer Society.DOI 10.1002/cncr.11432