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Aim: Given the demographic shifts and needs of cost rationalization, it is of high priority to organize health care on the basis of ambulatory outpatients models. The aim of this study was to examine activity at the gastro-hepatology outpatients clinic of the Molinette Hospital. In this facility, the management is based on a work team organization that follows cohorts of patients with specific pathologies., Methods: All services, consultations and urea breath test (UBT) for the diagnosis of Helicobacter pylori infection, carried out from January 2003 to December 2006, were extrapolated from the computerized system. Consultations were divided into first examination and controls. Furthermore, the destination of the patients after each consultation was considered., Results: During the year 2003, 8 842 consultations and 4 071 UBT were carried out, in the year 2004, 11 342 consultations and 2 409 UBT, in the year 2005, 12 474 consultations and 2 510 UBT, in the year 2006, 12 249 consultations and 2 357 UBT. No further specialistic management was required for 25% of patients, while 2% had been hospitalized in the bed unit, 3% in the short hospitalization unit or the day-hospital. The remaining 70% were included in work teams or monitored thereafter. The comparison with consultations from 1994 shows an increase due to both first examination (+300%) and controls (+83%)., Conclusions: The burden of the requests from the population and primary care structures addressed to the outpatients clinic of gastro-hepatology is relevant. The activity of this facility leads to a low rate of hospitalization as well as of cost reduction.

A study was made of 20 patients with "resistant" obesity selected from a series of about 4000 observed between 1970 and 1976 in an assessment of the possible existence of features distinguishing such patients from those who respond to treatment and display a satisfactory decrease in weight. The group was marked by a higher incidence of familial obesity, earlier onset of overweight, and certain personality features (evaluated by psychometric tests). Their blood sugar and insulin curves, blood cholesterol and uric acid, adipose tissue cellularity, and blood pressure (LHAP) were similar to those in the general series. Whereas their blood triglyceride values were normal, however, those in the general series were up by 21%. It is therefore felt that the clinical tests used at present do not enable the "resistant" obese subject to be distinguished. "Resistant" obesity may well constitute a distinct nosological entity, but one that is only identifiable via the patient's response to treatment.

Unlabelled: 50 patients suffering from dysphagia and oesophageal stenosis were treated in the period 1975-77. Of these 31 had renutrition of longer than two weeks and are the subject of the present study. Three nutrition systems were employed: 1) total parenteral feeding (7 patients), 2) feeding by naso-gastric tube or gastric fistula (15 patients), 3) feeding per os with semiliquid foods (9 patients). The patients were suffering from benign cicatricial stenosis (5), tumours of the cardia (7), tumours of the oesophagus (19). Short-term survival, weight behaviour and the course of certain blood parameters (Hb, GR, cholesterol, albumin, total proteins) are reported., Conclusions: --in benign cicatricial stenosis and tumours of the cardia, a normal protein-caloric amount (2000-3500 KCal., 80-120 g/24 h of proteins) is sufficient to obtain weight increase and stabilization of blood examinations. The administration route is unimportant; --in malignant stenosis, 4000-6000 KCal. and 100-130 g of protein/24 h must be provided to obtain the same result. In patients treated with total parenteral nutrition the weight loss persists. The reason for this behaviour is not known; it is likely that enzymatic blocks exist in substrate utilization; --further study is needed to improve results obtained and to clarify the reasons for such behaviour.

The results of restructuring the meals service in Ivrea Hospital are reported. 7 diet-sheets with food prepared by the central kitchen composed: 2 of normal nutritional content (the first cooked with normal ingredients; the second using special recipes for the bed-ridden); one hypoprotein (50 g/24 hrs of protein), one hypoglycidic (145-170-210 g/24 hrs of glycides), 1 hyposodic (0.6-1.4 g of N/24 hrs), one semiliquid and one divided into 6 small meals. Special diets were needed for 0.5-6-12-2-0.1% of the patients. The amount of uneaten food fell (from 30% to 10%) and there was a real increase in calories (1390 leads into 1870 cals/24 hrs) and protein consumption (70-95 g/24 hrs). The cost remained the same (2079-2176 lire/per day/per capita).