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Introduction Colorectal cancer (CRC) is a leading cause of cancer mortality in the Veneto Region (North-east Italy). Population screening of adults between 50 and 75 for CRC was begun in 2002, and it became standard practice in all 21 local health units (LHU) of the region in 2008, 14 LHU provided in the program also follow-up colonoscopy and 7 LHU no. This study was carried out to evaluate the impact on surgery rates of CRC screening and follow-up programs. Method This is a retrospective cohort study on administrative data based on anonymous computerised database of Veneto Region hospital discharges between 2000 and 2015. All Veneto residents (in screening age) discharge records with principal diagnosis of CRC treated with surgery were included in the study. The number of patients studied rose approximately 18% reaching 1,547,097 for the last year (2015). The Standardised Hospitalisation Ratio (SHR) per five-year age group was calculated and expressed per 10 000 population. Results During the study period, 30 399 surgical procedures for colorectal cancer were performed (colon 63%, rectum 36%, secondary malignant neoplasm 1%) with a SHR of 139.1, higher in males (OR: 1.66; CI 95%: 1.62–1.7; p Conclusion Study findings confirmed that CRC screening was effective in reducing the number of oncological surgical oncology procedures particularly with regard to the distal colon and rectum. Data analysis showed that the screening seemed to accelerate reaching the peak rate in surgical procedures that took place in 2007. After that time point the number of operations began to fall as far as the distal colon was concerned (it fell by 37.3%). Finally data suggest that the real benefit in reduction of oncological surgery procedures is due to the first screening colonoscopy. Disclosure of Interest None Declared

A blood glucose (BG) fall after an oral glucose load has never been described previously at a population level. This study was aimed at looking for a plasma glucose trend after an oral glucose load for possible blood glucose fall if any, and for its impact on coronary mortality at a population level.In subjects from an unselected general population, BG and insulin were detected before and 1 and 2h after a 75-g oral glucose load for insulin sensitivity and β-cell function determination. Blood pressure, blood examinations and left ventricular mass were measured, and mortality was monitored for 18.8±7.7 years. According to discriminant analysis, the population was stratified into cluster 0 (1-h BGfasting BG; n=497) and cluster 1 (1-h BG ≥ fasting BG; n=1733). To avoid any interference of age and sex, statistical analysis was limited to two age-gender-matched cohorts of 490 subjects from each cluster (n=940). Subjects in cluster 0 showed significantly higher insulin sensitivity and β-cell function, lower visceral adiposity and lower blood pressure values. Adjusted coronary mortality was 8 times lower in cluster 0 than 1 (p0.001). The relative risk of belonging to cluster 1 was 5.40 (95% CI 2.22-13.1).It seems that two clusters exist in the general population with respect to their response to an oral glucose load, independent of age and gender. Subjects who respond with a BG decrease could represent a privileged sub-population, where insulin sensitivity and β-cell function are better, some risk factors are less prevalent, and coronary mortality is lower.

Background The involvement of IgE-mediated hypersensitivity reactions in the genesis of gastrointestinal symptoms after ingestion of foods containing wheat has been rarely reported. Objective To detect IgE specifically binding to wheat proteins in the sera of atopic and non-atopic patients suffering from gastrointestinal symptoms after ingestion of wheat and to evaluate the reliability of skin prick test and CAP in the diagnosis of food allergy to wheat. Methods The sera of patients (10 atopic and 10 non-atopic) previously diagnosed as suffering from irritable bowel syndrome and complaining of symptoms after wheat ingestion were analysed by immunoblotting for IgE binding to water/salt-soluble and insoluble wheat flour proteins. Results All the atopic patients and only one of the non-atopic patients were positive to wheat CAP. For the patients tested, skin prick test was positive for all the atopic patients and for only one of the non-atopic patients. However, immunoblotting experiments showed the presence of specific IgE to wheat proteins in all the patients. Ten out of 11 of the wheat CAP-positive patients had IgE binding to a soluble 16-kDa band, but the same band was recognized, in a slighter way, by only two out of nine of the wheat CAP-negative patients. Moreover, although almost all of the patients were negative in CAP testing with gluten, 19 out of 20 recognized protein bands belonging to the prolamin fraction. Conclusions For the atopic patients the positivity to skin prick test and CAP to wheat was in accordance with the immunoblotting results and a food allergy to wheat could be diagnosed. In these patients a major allergen was a 16-kDa band corresponding to members of the cereal alpha-amylase/trypsin inhibitors protein family, the major allergens involved in baker's asthma. In the non-atopic patients the positive immunoblotting results contrasted with the responses of the allergologic tests, indicating that the allergenic wheat protein preparations currently used are of limited value in detecting specific IgE to wheat and that the fraction of irritable bowel syndrome (IBS) patients with food allergy may be larger than believed.

Introduction NAFLD, which is increasingly and rapidly becoming the cause of liver disease in Western countries, is characterised by higher serum triglyceride and LDL levels, lower HDL levels, insulin resistance, and glucose intolerance, all crucial risk factors for the development of atherogenesis. The UK Prospective Diabetes Study (UKPDS risk engine v 2.0) and the Fatty liver index (FLI) are both validated prognostic scores for cardiovascular disease (CVD) risk and NAFLD in diabetic patients. Methods We retrospectively analysed 1902 patients attending our Diabetes Ambulatory in 2012–2013. The UKPDS risk engine and the FLI were calculated for each of these patient. Ninety-nine (19.2%) of these patients resulted at high CVD risk according to their UKPDS evaluation and underwent a complete CVD assessment (ergometric/ecostress test (EET), coronarography (CORO)). A two tailed t-test, Person’s Chi square test, and analysis of variance (ANOVA) were carried out. Results Sixty-six (59 M, mean age 68.1 y, mean disease duration 16.1 y, HbA1c > 7 prevalent) pts presented UKPDS positive/FLI > 60, 8/66 CORO+ (5 percutaneous transluminal coronary angiopathy-PTA, 3 cardiac bypass sugery-CABG, 1 peripheral transluminal angioplasty-PTA AAII) and 5 (4 M, mean age 68.6 y, mean duration disease 18.4 y, HbA1c > 7 prevalent) pts presented UKPDS positive/FLI 52 detected 9/14 pts positive at CORO with p 69/99) (100% > 14/14 CORO+) vs 81 pts FLI > 52 (EET negative 92.5% > 75/81) (64.2% > 9/14 CORO+). As expected, we found a significant association between CORO+ and FLI+ patients and microalbuminuria (p Conclusion Study results demonstrate that FLI can be used as a marker to predict CVD risk in patients with FLI > 52. The number of patients who undergo CVD screening with a low percentage of positivity can thus be reduced. An early and aggressive treatment and monitoring program can instead be begun for type 2 diabetic patients with FLI > 52 and a reasonable suspicion of NAFLD because this population has higher risk of developing CVD events with respect to patients with FLI Disclosure of Interest None Declared

Introduction Endoscopic submucosal dissection (ESD) is an advanced endoscopic technique. In Eastern countries the learning curve is begun with gastric GI lesions carried out under expert supervision and then goes on to address esophageal and colon lesions. As Early Gastric Cancer (EGC) is a rare disease in Western countries, expert guidance is not commonly available. Methods All the ESD performed in our Endoscopy Unit in Padua from February 2012 to December 2015 including 12,552 colonoscopies were recruited retrospectively in this study. We considered the learning curve of a single endoscopist who performed 10 ESD on in vivo animal models under expert supervision before starting on human subjects. All the dissections were performed using a Hybridknife needle and ERBEJET2 (ERBE®). ESD was performed if the neoplastic lesion was considered susceptible to ESD regardless to the size. T tests for unpaired data and Pearson’s chi-test were used for statistical analysis. Results 49 ESD were performed, 28 M(57%), mean age 63 yr. The breadown was: 29 rectum (59%), 12 sigmoid tract (24%), 2 trasverse colon (4%), 4 ascending colon (8%), 2 stomach (4%). The neoplastic lesions were: 36 laterally spreading tumours (73%), 5 polypoid lesions 0 Is (10%), 4 recurrent ton scars (8%), 4 polypoid lesions 0 Isp(10%). Mean polyp area was 17.6 cm 2 (range 1–70). Mean intervention time was 98 min (range 20–240). En-bloc dissection was successful in 34/49 (69%) and R0 was reached in 24/33 (72%). The histological features of the polyps were: 10 LGD (20%), 27 HGD (55%), 9 pT1 (18%), 3 pT2 (6%). The procedural complications that took place (14/49 = 28%) included: perforation during the procedure in 10/49 (20%), delayed bleeding in 3/49 (6%), rectal stenosis in 3/49 (6%). No deaths or surgical interventions followed the periprocedural complications. From the 12 th procedure onwards the surgical performance became acceptable 22/27 (81%) vs 3/12 (25%) (p th procedure onwards the surgical performance became good 17/19 (90%, p 2 (p=ns). Only 3 complications occurred after the 30 th procedure (p=ns). Conclusion Our findings demonstrate than an endoscopist can reach a satisfactory level of competence in ESD procedures by beginning training with in vivo animal models (at least 10 procedures) and then should go on to colo-rectal neoplasms (without size limits and no less than 12 procedures). Trainees have probably still not reached a learning curve plateau even after 40 procedures. Disclosure of Interest None Declared

Objective: To investigate the behaviour of serum tumour necrosis factor-alpha (TNF-alpha) during alpha-interferon (alpha-IFN) treatment in patients with chronic viral hepatitis. Design: The study included 31 patients with chronic active hepatitis: five positive for hepatitis B surface antigen (HBsAg) and hepatitis B early antigen (HBeAg), and six positive for HBsAg, anti-HBe and hepatitis B virus (HBV) DNA; the remaining 20 were anti-hepatitis C virus (HCV) positive. All patients received 3 million units recombinant-alpha-2b-interferon three times weekly and were followed up for at least 3 months. Serum samples were collected at 0 and 24 h, and on days 1 15, 30 and 90. Responders were those patients whose transaminase levels returned to normal during alpha-IFN treatment

Background and Aims. In Italy, per-capita consumption is low (6.9 lt in 2009), with an increase in binge drinking, but there are not results on treatment outcomes. This study aims to evaluate the efficacy of treatment of AUDs and alcohol abuse/dependence based on integrated social-health approach to individual needs. Material …

Antibodies to gangliosides and Purkinje cells have been reported in patients with celiac disease (CD) with neuropathy and ataxia, respectively. Whether these antibodies are pathogenic is not clear. The response of neurological symptoms and antibody titers to a gluten-free diet is still controversial. The objective of our study was to assess whether neurological manifestations in CD patients correlate with antibody titers and a gluten-free diet.Thirty-five CD patients (9 males, 26 females, mean age 37.1 +/- 12.6 yrs) were followed prospectively. At initial evaluation, 23 were on a gluten-free diet, 12 were not. At recruitment and during follow-up, patients underwent neurological and electrophysiological evaluation. IgG, IgM, and IgA anti-ganglioside antibodies were assayed by ELISA; anti-neuronal antibodies were assessed by immunohistochemistry and Western blot. Four patients, all males, had electrophysiological evidence of neuropathy; three had been on a gluten-free diet for several months, and one was newly diagnosed. One had reduced tendon reflexes; another complained of distal paresthesias. With regard to anti -ganglioside antibodies, three patients had a moderate increase in antibodies without symptoms or signs of neuropathy. No patients had ataxia or cerebellar dysfunction, although in four patients reactivity to neuronal antigens was found. In 17 patients, an electrophysiological follow-up (mean duration of follow-up, 9 months) showed no changes. In conclusion, the preliminary results of this prospective study indicate that neuropathy, usually subclinical, may accompany CD. Antibody titers do not seem to correlate with neurological symptoms/signs or diet. Ongoing follow-up will help confirm these data and clarify the role, if any, of antibodies in neurological involvement in CD.

O6.1 SEXUAL ORIENTATION AND DRUG OF CHOICE {#article-title-2} There has been some previous report on an association between sexual orientation and substance use, most studies reporting on elevated rates of illegal drug use among LGBs. Despite numerous assertions on supposed drugs of choice among gay/bisexual men (poppers, metamphetamines etc.), the hypothesis has, to our knowledge, not been specifically tested in a population study. Methods. Data from a representative sample of Swiss men (n = 5,387) approximately 20 years old were collected between August 2010 and November 2011. 167(2.8) reported to be gay/bisexual. Results. While no differences could be found regarding lifetime consumption of alcohol, tobacco and cannabis, gay/bisexual men had, compared to heterosexual participants, more often tried other illegal substances (heroin, cocaine, stimulants, hallucinogens etc.). No differences were found regarding the 12-month prevalence among the ever users, with the exception of poppers, which consumption gay/bisexual men had continued more often. Conclusion. Gay/bisexual men do not differ from heterosexual men regarding the trying out of drugs, but differed with regard to the maintenance of poppers consumption. # O6.2 SUSCEPTIBILITY OF AGE AND GENDER TO INTERMITTENT ALCOHOL ABUSE {#article-title-3} Intermittent alcohol abuse (binge drinking) may induce brain damage as well as cognitive impairment in adolescents. However it is unknown whether such alcohol abuse will also have such a devastating effect in adults as well as pre-adolescents engaged in under age drinking. In these present studies, an intermittent ethanol regimen (2or3g/kg, 3x/day for 2 days, followed by 5 days of abstinence for a total of three weeks) was administered to male and female pre-adolescent, adolescent and adult rats. Microdialysis studies identified significant changes in glutamate and arginine basal levels in the nucleus accumbens, NAc, of a) pre-adolescent male and females (glutamate increased; arginine decreased), b) adolescent male (glutamate decreased; arginine increased) and female (glutamate increased; arginine increased or decreased respectively for low and high ethanol dose) and, c) adult male (glutamate decreased; arginine increased) and female (glutamate increased; arginine decreased) rats after 3 weeks of the ethanol dosing regimen. In addition the concentrations of these two amino acids varied between the different groups. A further challenge with ethanol induced variable effects in the release of glutamate and arginine in each of these groups. Significant losses of hippocampal neuronal cells were evident in each of the groups, with the female adolescent rats showing the highest cell loss. These studies indicate that female adolescent rats are more susceptible to the toxic effects of binge drinking, while the male pre-adolescent, adolescent and adult rats appeared to be more resilient. # O6.3 HIGH EDUCATIONAL LEVELS AS PROTECTIVE FACTOR AGAINST DRUG AND ALCOHOL CONSUMPTION {#article-title-4} Background & Aims. Alcohol consumption is linked to social-cultural aspects in Northeast Italy. Precedently alcohol was consumed daily by all members of the family in Northern Italy (steady drinking). This study aimed to determine the prevalence of alcohol and drug consumption in drivers on weekend nights. Methods. As part of the government sponsored “Safe Roads” Program (November 2008 to September 2012) 3150 drivers were stopped in Padova (Italy) by law enforcement officials between midnight and 6. All underwent a preliminary alcohol test and if positive also a urine test for drugs. T test and multivariate analysis were used. Results. 1068 (909M-85% and 159F-15%; mean age 30.5 yr) drivers underwent the Breathalyzer test. 714 of 3150 (22.6%) were found positive (mean alcohol 0.77g/l; range 0-2.67). 242 of 1068 (22.6%) were also positive for drugs. Drug use was more frequent in those resulting positive to alcohol (23,6% vs 15,4%; p = 0.006209). The highest mean alcohol value (0.88g/l) was found between 4 and 5 am (p = 0.006509). Positivity rate for drugs and mean blood alcohol content resulted higher in subjects with lower educational levels (30,8%vs18,0%, p < 0,001 and 0,689g/l vs 1,027, p = 0,00782). At the multivariate analysis drug use is correlated with age, sex, scholar level and alcohol, instead positive test for alcohol is correlated only with scholar level and use of drugs. Conclusions. The prevalence of drugs and alcohol consumption on weekends is high. High educational levels may be protective against the use of drugs and binge drinking. # O6.4 AGE OF ONSET, PHYSICAL AND MENTAL HEALTH AND SOCIAL FUNCTIONING IN OLDER ALCOHOL-DEPENDENT INPATIENTS {#article-title-5} Background. Alcohol dependence is a severe and often chronic condition with a strong impact on physical and mental health and social functioning, especially in older patients. This study aims to determine whether older alcohol-dependent inpatients with early (age

O4.1 BRIEF MOTIVATIONAL INTERVENTION TO REDUCE ALCOHOL CONSUMPTION IN YOUNG PATIENTS IN A FRENCH EMERGENCY DEPARTMENT {#article-title-2} Background. Alcoholic intoxication (AI) in young people is an important problem in emergency departments (EDs). Aim - To establish the effectiveness of a Brief Motivational Intervention (BMI) in reducing alcohol consumption among young patients admitted in a French ED for AI. Methods. Two-group simple blind randomised controlled trial. From September 2011 to July 2012, patients aged 16 to 24 who tested positive for blood alcohol content of 0.5g/l or above were randomised, with stratification according to patient's age (16-17 or 18-24), between intervention (BMI performed by a psychologist in the ED setting followed by a phone booster session at one and two months) and controls (delivery only of an information leaflet and a list of addresses of services for alcohol misuse). The principal criteria used to assess the reduction of alcohol use at 3 months follow-up was the number of alcoholic drinks in the last week. Results. A total of 263 patients (controls 131, intervention group 132, mean age 20, men 72%) were randomized. Attrition accounted for 38% in controls and 43% in intervention group. Data analysis was conducted for a Poisson frequency distribution and showed no significant difference in effectiveness between the two conditions (OR 0.93 [0.64; 1.36]). All secondary outcomes were also not influenced by the intervention (including the number of AIs in the last month). Conclusions. This study did not detect a significant effect of Brief Motivational Intervention in reducing alcohol consumption after hospitalization for alcoholic intoxication in emergency department in young people. # O4.2 HARMFUL ALCOHOL CONSUMPTION IN HEALTH-WORKERS: RESULTS OF A SCREENING STUDY {#article-title-3} Background. In Italy national alcoholism risk prevention programs to assess number for year of accidents in health workplaces is actually in progress leaded by Health Minister and Regional administration. Particularly, prevention program acts consist in comprehensive informations for health workers and their co- workers, about prevention and identification of alcoholism related risks. Aims. To assess the rate of harmful alcohol consumption in a population of health workers in Padua. Materials and methods. Modified CAGE questionnaire was sent to 5590 health-workers in Padua. Anonymous questionnaires were collected in dedicated boxes. Results. 654/5590 (11.7%) subjects performed the test (M: 150, F: 504, mean age 42.9 yrs, range 28-65). The professional role was nurse in 300/654 (45,9%), physician 83 (12,7%), administrator 80 (12,2%), other 191 (29,2%). 57/654 (8.7%) had positive questionnaire for alcohol abuse or dependence: 33/57 (57,9%) had suspicion, 15 (26.3%) high probability and 9 (15.8%) were certainly alcohol abusers. 37/504 females (7,3%) and 20/150 males (13,3%) showed positive CAGE test. The professional role indicated positive test in 26/300 (8,7%) nurses, 9/83 (10,8%) physicians, 1180 (1,2%) administrator and 21/191 (11%) other professional roles. Conclusions. The number of tests performed is unsatisfactory, particularly among males and physicians. Our data suggest that harmful alcohol consumption is present in health-workers, more frequently in male sex. Physicians demonstrate an high prevalence of positive test. These data also suggests that the awarness of alcohol related problems doesn't reduce the probability of harmful consumption. A screening study can be useful to identify harmful alcohol users among the selective population of health-workers. # O4.3 BRIEF INTERVENTION IN PRIMARY HEALTH CARE FOR ALCOHOL USERS: AN EXPERIENCE IN PORTUGAL {#article-title-4} Introduction. The professionals of primary health care have a crucial role in screening individuals with risk consumption and harmful alcohol. The effectiveness of brief interventions in reducing alcohol consumption however, in Portugal its use is not yet widespread in particularly in primary care. Objective. to evaluate the effect of Brief Interventions in reducing excessive alcohol consumption on users accessing health center services, Coimbra, Portugal. Methods. A pre-trial, with a single group, and the assessment before the intervention (5 months). The sample included 45 patients (19 females, Mean= 48 age, SD = 15.199), enrolled in the Health Center Ansiao. We used a structured interview, using a questionnaire that included the AUDIT (Alcohol Use Disorders Identification Test), to evaluate the level of risk in relation to alcohol consumption. Interventions were made by previous protocol based on the level of risk identified, for data analysis resorting to the Wilcoxon test. Results. At baseline: 86.7% were at risk level I, 11.1% in the risk level II and 0% in the risk level III. In folow-up five months after the brief interventions, 95.6% were at risk level I, 2.2% in the risk level II and 0% in the risk level III. There was a positive effect on the progress of participants in respect to the levels of risk, with statistical significance (p = 0.046). Conclusions. Brief Interventions took effect in lowering and stabilizing the risk levels of alcohol consumption, reinforcing the importance of integration of Brief Interventions in Primary Health Care. # O4.4 UNIVERSAL SCHOOL-BASED PREVENTION INTERVENTION AND ALCOHOL USE {#article-title-5} Background. The Unplugged, a prevention intervention based on the Comprehensive Social Influence model, was implemented to reduce the risk of alcohol use in Czech adolescents. We investigated the effect of the Unplugged on the reduction of drunkenness. Methods. A randomized controlled prevention trial was conducted over 33 months. 1,874 6th-graders (mean age 11.82 years) completed the baseline testing. We compared self-reported drunkenness in control and intervention groups. Using logistic regression we study relationship between drunkenness and other variables such as gender, peer and parents effect, leisure time, ideas of hurting oneself, safe sex and school grades. Results. We find a significant effect of the Unplugged on the reduction of drunkenness. Male adolescents with unstructured leisure time activities and lower parents control report higher frequency of drunkenness. Idea of hurting oneself and unsafe sex is also associated with higher risk of getting drunk. Conclusion. We present evidence on the composition of risk profiles in adolescents who are engaged in high-risk alcohol consumption. Besides the intervention a screening tool should be used to identify adolescents who are eligible for complementary selective and/or indicated prevention interventions.

Colonic diverticular disease is a benign condition typical of the Western world, but it is not rare for even the 1st episode of diverticulitis to carry potentially fatal complications. The evolution of a peridiverticular process generally poses problems for medical treatment and exposes patients to repeated episodes of diverticulitis, making surgical treatment necessary in approximately 30% of symptomatic patients. One of the most worrying complications of diverticulosis is internal fistula. The most common types of fistula are colovesical and colovaginal, against which the uterus can act as an important protective factor. The symptoms and the clinical and instrumental management of patients with diverticular fistulas are much the same as for patients with episodes of acute diverticulitis. Staging of the disease (according to Hinchey) should be done promptly so that the necessary action can be taken prior to surgery, implementing total parenteral nutrition (TPN), nasogastric aspiration and broad-spectrum antibiotic treatment. The best surgical approach to adopt in patients with diverticulitis complicated by fistula is still not entirely clear, though the 3-step strategy is currently tending to be abandoned due to its high morbidity and mortality rates. There is a widespread conviction, however, that the 2-step strategy (Hartmann, or resection with protective stomy) and the 1-step alternative should be reserved, respectively, for patients in Hinchey stages 3, 4 and 1, 2 with a situation of attenuated local inflammation. The 1-step approach seems to be safe and effective. This report describes a case of colovaginal fistula in a patient with colonic diverticulosis who had recently undergone hysterectomy, but who, unlike such cases in the past, was treated in a single step using a laparoscopic technique.

Coeliac disease is an autoimmune enteropathy characterized by an enhanced permeability of the intestinal epithelial barrier. In epithelial cells paracellular permeability is regulated by intercellular tight junction. The cytoplasmic protein ZO-1 interacts directly with F-actin and plays a pivotal role in the structural and functional organization of tight junction. Aim. The aim of this study was to investigate the expression and localization of ZO-1 in the intestinal mucosa of coeliac patients. Patients and methods. Twenty patients with active coeliac disease, seven of whom underwent a repeat biopsy following a gluten-free diet and 27 control subjects, were studied. In all subjects, three biopsies were obtained from distal duodenum during upper gastrointestinal endoscopy. ZO-1 protein localization and levels were detected by immunofluorescence followed by confocal microscopy analysis and immunoblotting. ZO-1 mRNA expression was assessed by RT-PCR. F-actin distribution was also investigated. Results. In patients with active coeliac disease, both ZO-1 protein levels and mRNA were clearly reduced. Cytoskeletal organization was disrupted with F-actin staining concentrated at the subcortical and basal surface regions. Abnormalities in ZO-1 expression and actin organization were reversed after a gluten-free diet. Conclusions. In active coeliac disease, ZO-1 protein expression is downregulated at the transcriptional level in association with F-actin redistribution. These changes are completely reversed after a gluten-free diet and could contribute to the increased intestinal paracellular permeability observed in this disorder.

Recurrent aphthous stomatitis is a frequently occurring disorder which may be a clinical feature of systemic disease. For many other patients, it is a tedious problem often having no known cause. The aim of this study was to verify if immune responses to common foods and/or viruses are involved in the etiopathogenesis of recurrent aphthous stomatitis. Sixteen patients with this disorder were studied by measurement of immunoglobulin classes (IgG, IgA, IgM), blood lymphocyte subpopulations, blood circulating immune complexes, and complement fractions (C3 and C4). Intradermal skin tests for common food and inhalant allergens were performed in all cases. In 5 patients with positive skin tests, serum specific IgE were tested for the same allergens by radioallergosorbent test. Skin patch tests for dental material were performed in all cases. Oral mucosal biopsies and/or cytology samples were taken in 10 cases for histopathological evaluation and in situ hybridization for Papillomavirus, Cytomegalovirus, Herpes simplex virus I and II, Epstein Barr virus. In 13 patients, lymphocyte subpopulations were altered, with a reduced CD4/CD8 ratio. No other alterations of serum immunological parameters were observed. Skin patch tests for dental material were negative in all cases, while skin tests for food allergens were positive in 5 cases (not confirmed by radioallergosorbent test or food challenge tests). Virus antigen and DNA were not found in mucosal specimens, although one patient was positive for Epstein Barr virus DNA by in situ hybridization. An alteration of the CD4/CD8 ratio was demonstrated in most of the patients with recurrent aphthous stomatitis, although immune responses to food and/or dental material and/or common viruses did not seem to be involved in the etiopathogenesis of this disorder.

Interferon alpha has been reported to enhance autoantibody production and to increase the risk of autoimmunity particularly against thyroid tissue. We designed a study with the following aims: 1) to assess the incidence of organ- and non-organ-specific autoantibodies during Interferon treatment; 2) to evaluate whether these autoantibodies have any clinical relevance; 3) to establish whether the development of autoimmune disorders can be related to a genetic predisposition.A panel of 5 non-organ-specific and 6 organ-specific autoantibodies was evaluated in serum samples collected before treatment and then at 3 and 12 months in 47 patients enrolled in a treatment protocol with a 2b-recombinant Interferon (3 MU, 3 times a week for 12 months). In the second part of the study we explored genetic predisposition for autoimmune disorders in 31 patients by DNA-HLA class II typing using Restriction Fragment Length Polymorphism (RFPL).Non-organ-specific autoantibodies were absent in all patients before and after Interferon. During follow-up 6 patients showed an increment in thyroid microsomal antibody titres; 3 of these also developed thyroglobulin autoantibodies; 3 of the 6 patients developed persistent hypothyroidism; a fourth had a transient subclinical hypothyroidism and a fifth had a transient subclinical hyperthyroidism. Two patients with initial positivity for ICA and PCA maintained their reactivity during treatment without impairment of the respective target organs. Eight out of 39 initially negative patients developed one or more organ-specific autoantibodies during follow-up. One of these developed a persistent hypothyroidism, and another developed insulin-dependent diabetes. HLA-typing did not reveal any particular allele frequency in patients with thyroid antibody positivity as compared with those without autoantibodies and controls. Moreover, four of the 6 patients positive for islet-cell antibodies were carrying the non-Asp 57 allele which is considered a marker of a genetic predisposition for insulin-dependent diabetes.These findings suggest that, besides the thyroid gland, pancreatic beta-cells could be a target of autoimmunity during Interferon-treatment for chronic HCV hepatitis. A genetic predisposition may be important, though insufficient alone, in the development of Interferon-induced autoimmune phenomena.

Cord blood IgE levels have been studied as a possible marker of allergy in infants but few studies are available in our Region. The aim of this paper was to test IgE levels in cord blood of 60 consecutive newborns in a restricted area of Veneto, to correlate cord blood IgE levels with family history of allergy and to verify the risk of contamination from mother's blood.Cord blood was obtained from 60 consecutive newborns. Immunoglobulin levels (IgG, IgA, IgM, and IgE) were measured in cord blood of newborns and in serum of all mothers. Family history for allergy was previously investigated from the mothers.IgE were detectable in cord blood of 5 newborns but only 2 of them had positive family history for allergy which was pointed out in 11/60. In one of these cases the contamination of sample from mother's blood was postulated. IgG levels in newborn cord blood were higher than in mothers' blood and it was not related with IgE levels or other investigated factors.Only 6.6% of newborns in a restricted area of Veneto region have detectable IgE in cord blood whereas 18.3% of them have positive family history for allergy. Measurable levels of IgE in cord blood are not related with positive family history of allergy and are rarely influenced by mothers' blood contamination.

Gastric ectopias in the upper oesophagus and hypopharynx are relatively rare and often misinterpreted. They may become symptomatic due to the onset of a fistula involving adjacent structures in the neck. This case report describes a 20-year-old patient with swallowing difficulties and laterocervical pain, with a diagnosis of fistula of the pyriform sinus due to secernent gastric mucosal ectopia. The significance of this case lies in the fact that accurate aetiopathogenic study and careful differential diagnostic procedures enabled the proper identification of this rare upper oesophageal pathology, which is often misdiagnosed due to the technical difficulties involved in conventional endoscopy of the digestive tract.

CANCER INVADING THE SUBMUCOSAL LAYER: IS IT TIME TO CHANGE SURGICAL INDICATIONS FOR SCREENING COLONOSCOPIES? E. Rosa-Rizzotto ∗ ,1, M. Lo Mele2, D. Caroli 3 , E. Guido1, F. Ancona1, L. Peraro1, R. Cappellesso2 , S. Cocchio4 , V. Baldo4, M. Rugge2, F. De Lazzari 1 1Dpt of Medicine, Gastroenterology Unit, St Anthony Hospital, Padova, Italy; 2Department of Diagnostic, Medical Sciences and Special Therapies, Surgical Pathology and Cytopathology Unit, University of Padua, Padua, Padova, Italy; 3Dpt of Medicine, Chioggia Hospital, Venice, Italy; 4Dpt of Molecular Medicine, Laboratory of Public Health and Population Studies, University of Padua, Padova, Italy

Allergic mechanisms have been shown to induce gastric and intestinal damage in animal models. It has been demonstrated that people allergic to food may complain of gastrointestinal disorders. Furthermore food allergens can induce gastric mucosal damage in sensitized people. Little is known as regards allergic mechanisms underlying "peptic" ulcers although there are reports suggesting that some forms of gastric and duodenal ulcer may be caused by allergy. AIM. Of the study was to evidence if IgE specific to food and inhalants are localized in gastric and duodenal mucosa and if the in vitro incubation of gastric and duodenal biopsies with specific allergens, stimulate mast-cell mediators. MATERIALS AND METHODS. Twenty-one patients affected by gastric/duodenal ulcers (14 with high total IgE serum levels) and 16 controls were studied. All patients were submitted to upper digestive endoscopy and biopsies were taken from gastric fundus, body and antrum and duodenal bulb. Specific IgE to food and inhalant allergens were tested after homogenization of biopsies, using commercial kits. In 3 selected patients, 3 biopsies from gastric fundus and 3 from duodenal bulb were taken. After incubation of mucosal of mucosal biopsies with allergens (wheat, lactoalbumin, Parietaria J. pollen), the release of histamine and tryptase was measured. The release of Pepsinogen A was measured in the same conditions, as control. RESULTS. Specific IgE to food and inhalants allergens have been found in 164/586 tests (27.9%) of "peptic" ulcer patients and in 17/430 tests (4%) of controls. The duodenal bulb resulted the site in which most frequently IgE have been found. The release of histamine and tryptase has been stimulated only in 1/6 tests by incubation of biopsies with specific allergens in patients with specific IgE. PG-A release has been always stimulated by incubation of gastric biopsies, but not duodenal biopsies, with all tested allergens. DISCUSSION AND CONCLUSION. Specific IgE may be localized in gastric and duodenal mucosa of patients with "peptic" ulcer and/or food allergy. This event is linked to high total IgE serum levels and in a lesser extent, intestinal parasitosis, it is not strictly correlated with specific IgE in the serum and it regards both food and inhalant allergens. No relevant effects were observed after incubation of specific allergens with gastric or duodenal mucosa biopsies containing specific IgE. The possibility that higher allergens concentration stimulate mediator release from mast cells should be investigated. A defect of the gastric or duodenal epithelial barrier which permit a passage way for proteins with subsequent IgE production in the submucosa, appears to be the cause of localization of specific IgE in stomach and duodenum.

Results: We evaluated 118 subjects (55 M, 63 F), 71 (60.1%) 25–45 years old, 28 (23.7%) >45 years old, 16 (13.5%) 15–24 years old and 3 (82.5%) 20,000 in 4 (33.3%). Conclusions: The data of this pilot phase suggest a high prevalence of HBV infection in the immigrant population. The prevalence appears similar to that of country of birth. HBV-DNA quantification indicate that 50% of carriers have to be evaluated for treatment. On the basis of these data we confirm the utility of a screening programme for HBV in the immigrants.