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The "Policlinico A. Gemelli" in the context of ongoing change in the Italian Health Care Service, has developed a Strategic Plan for 1996-2000. In this context a major role is played by the reengineering project, divided into there sequential phases of implementation. The natural evolution of this project results in a department-oriented organization in order to complete and implement change.

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Phase 2 of reengineering project, the testing of solutions, was based on the definition of a Prototype, and the implementation of the Pilot phase. This gradual process has facilitated the organizational change and laid the foundations of subsequent extension phase. Ongoing initiatives concern the introduction of two new centers (wards and outpatient service) and the reorganization of ward and operating room activities.

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The identification of promoting factors of excellence improvement in radiology service management means to clearly assess how the different aspects of the service are managed. The key elements for intervention are sharply differentiated according to the service managerial level. The approach to continuous improvement should be a useful tool of assessment even when all its potentialities have been exhausted and new promoting factors are necessary to move to the subsequent stage.

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Planning and scheduling of radiologic exams represent one of the crucial aspects in the performance of Diagnostic Imaging service, whose optimal management should lead to optimal efficiency and exploitation of technological and professional resources. A Diagnostic Imaging service with agreed and scheduled exams for customers achieves a more adequate, precise planning of the activity with optimum productivity of radiology rooms and anticipated workload assessment.

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Radiology has a significant impact on all health care processes at the "Policlinico A. Gemelli". The performance of Radiology rooms was thus analyzed within the overall performance of health care processes (e.g. medical wards, emergency service, day hospital). In this context, in the assessment phase of the reengineering project the Radiology room productivity has been analyzed. From outcomes of this analysis it appears that there is a high potential for increasing the Radiology room productivity (except for TC and MRI rooms). It has been observed that a better ward/service communication, together with a better use and planning of Radiology rooms and resources would allow a more efficient performance of the service. The reengineering project has led to a reorganization of the communication between Radiology rooms and wards/day hospital, a better inpatient transfer system from wards to Radiology rooms and the planning of the requests for exams. At present, a team is working in order to introduce a medium term budget of exams for all the wards associated to the provision of care for those diseases for which patient admission can be planned based on available Radiology rooms.

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Several human myeloma cell populations were studied using a combination of cytochemical (Unna-Pappenheim and naphthol yellow staining, Feulgen reaction) and autoradiographical (uridine, leucine, thymidine uptake and actinomycin binding) techniques. Progressive differentiation of the myeloma population was associated with: 1. a loss of proliferative activity, 2. decreased transcriptional capacity, 3. decreased RNA and protein synthesis, 4. increased RNA and protein concentrations, 5. greater stability of the protein synthesis template. The existence of a pre-myelomatous compartment is suggested in the light of these results and those of previous kinetic studies in vivo.

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The evaluation of the kinetic characteristics of the blast population in AL, at the outset of the disease, establishes its growth rhythm and hence the degree of invasivity. Cases with a higher 3H-Tdr labelling index also display a higher growth fraction, birth and growth rates and a shorter generation time, in other words, greater cell growth potential and invasivity. The labelling index could thus represent an immediate guide to prognosis. Particularly when combined with other prognosis factors, it can be employed to divide AL into high and low growth and invasivity forms. A distinction of this kind can thus be made the basis of differentiated therapeutic programming, whereby more or less aggressive cytocidal drug associations and doses can be administered to improve the therapeutic index and the quality of life.

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A technique for evaluating membrane immunofluorescence and isotope (3H-Thymidine, 3H-Uridine, 3H-Leucine) labelling in the same cell is described in detail. The possible interference of autoradiographic labelling on the fluorescent staining have been considered and found not to alter the final preparations. The technique proved valid both in normal and in neoplastic cells irrespective of their origin (peripheral blood, bone marrow, lymph node). Its possible extensions are finally discussed.

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By using autoradiographic methods, we have studied the actinomycin-binding in nuclei of CLL's lymphocytes cultured, in presence of PHA, at varying cellular concentrations. Chromatin activation is earlier and greater in the most concentrated culture, which thus more closely resemble normal lymphocytes' cultures. This data supports the hypothesis that T cells in CLL have normal PHA-stimulability and that their apparently delayed response is due to dilution in a predominant B cell population.

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