Aggressive angiomyxoma of the vulva: expression of estroprogestinic receptors and follow-up.

PURPOSE OF INVESTIGATION: To analyze aggressive angiomyxoma hormone-dependency. METHOD: Estroprogestinic receptor expression was studied by immunohistochemistry in 5 patients with aggressive angiomyxoma of the vulva. RESULTS: The immunohistochemical results confirm the positivity of angiomyxoma for estrogen and progesterone receptors. CONCLUSIONS: We hypothesized that the concomitant factor favoring neoplastic growth is a different genetic substrate specific in the female sex. Analysis of the data regarding the distribution of angiomyxomas in different age groups has strengthened this hypothesis suggesting that this tumor is correlated with complete maturity, in all probability hormonal. However it cannot be excluded that the tumor begins to develop at an early age, but since it has a slow growth rate, the phenomenon is delayed and is related to hormonal stimulation.

Prevalence and incidence of schizophrenic disorders in Portogruaro. An Italian case register study.

The authors report a study of treated prevalence and incidence of schizophrenic and related functional psychoses in an area of northeastern Italy (Portogruaro), based on case-register data. Point, 1-year, and lifetime prevalence as well as incidence rates on the adult population for a broad ICD-9 diagnosis of schizophrenia are given. Data over an 8-year period show the incidence around .2/1000, point prevalence around 1.4, 1-year prevalence of 2.7, and lifetime prevalence around 5.2. The rates peak in the 45 to 64 age group on all measures of prevalence. The implications of these findings are discussed in the light of methodological issues in epidemiological studies of schizophrenia and comparisons are made with figures from other countries.

Urban-rural differences in the associations between social deprivation and psychiatric service utilization in schizophrenia and all diagnoses: a case-register study in Northern Italy.

Service utilization measures from the psychiatric case registers for urban South-Verona and rural Portogruaro in North East Italy for the period 1983-9 were used to identify associations with socio-demographic variables from the 1981 census in schizophrenia and related disorders as well as in all diagnoses. The patterns of service use were broadly similar, except that Portogruaro has significantly more community contacts, and has about twice the treated incidence and prevalence of schizophrenia. The census data showed that unmarried and unemployed people were more likely to live alone in the urban than in the rural area. In South-Verona the most strongly associated predictor variables, both for schizophrenia and all diagnoses, are: living alone, unemployment, percentage of the total population who are dependents and the percentage who are divorced, separated or widowed. In contrast, in Portogruaro there were no consistent associations between census and service use variables. Stepwise multiple regression models using three census predictor variables accounted for over 85% of the variance in South-Verona utilization rates. The results indicate that the strongly predictive associations previously described in England hold in urban South-Verona, but not in rural Portogruaro, and may be related to the effect of cities in clustering seriously disabled psychiatric patients in areas of low-cost housing where they live in relative social isolation.

Recent trends in mental health services in Italy: an analysis of national and local data.

This paper reviews trends in Italian mental health services after the implementation of the 1978 Mental Health Act. Data available at the national level on public and private inpatient services, community mental health centres, residential and day care facilities are presented and discussed. Findings from two case-register areas, where comprehensive community services according to the Mental Health Act have been implemented, are discussed. Public mental hospitals are no longer used for psychiatric treatment, except for a small number of long stay patients. General hospital psychiatric units are the only setting in the public sector where psychiatric patients can be admitted. In private mental hospitals, the number of residents has decreased, while admissions have remained stable. However, community services are unevenly distributed and residential facilities are generally lacking. Little is known about quality of care provided, although data from some pilot studies are encouraging. Stable admission rates to forensic mental hospitals suggest that the criminalization of mentally ill has not increased. The effect of changing patterns of mental health care on suicide rates are discussed.

Pelvic and mammary Burkitt-like lymphoma with simultaneous development of leukemia.

The authors report the case of a young nun who came to their attention because of the simultaneous development of mammary and pelvic lymphoblastic lymphoma and acute leukemia showing aspects typical of nonendemic Burkitt's lymphoma. The rapid tumoral growth and the equally rapid spontaneous cell lysis led to severe renal insufficiency and metabolic acidosis which were ultimately the cause of death. Given the rareness of the clinical situation and the diagnostic problems involved, the authors examined the literature dealing with this subject.

Proposed classification of vulvar disorders observed most frequently in a vulvar pathology surgery unit.

An adequate and unified classification of vulvar pathology has been difficult and continues to be a problem hard to solve, due to the difficulties in including different clinical aspects in various pathological classes. The causes of this uncertainty, as rather a multiplicity of view points, may be ascribed in particular to the extreme polymorphic nature of vulvar pathology. Our classification, in attempting to overcome arbitrary and absolute distinctions in such a polymorphic and variable field, adopts an etiological and anatomo-histological criterium which distinguishes vulvar pathology in: primary disorders, secondary disorders. It is evidently important to know and distinguish possible vulvar infections, in order to be able to identify those disorders which assume an oncogenous risk, while trying to overcome the problems of differential diagnosis.

Suicide and the Italian psychiatric reform: an appraisal of two data collection systems.

The reliability of Italian suicide data derived from returns made by the Police and Carabinieri was examined by comparing regional suicide data from that source with those based on medically certified cause of death for the years 1973-1980. Rates of medically certified suicide were found to be higher than those derived from the Police/Carabinieri returns, a difference which increased steadily over the years of study. The between-region within-year correlations (between the suicide rates derived from the two sources) were very high, but tended to decrease with time. The between-year within-region correlations were +0.700 or above for 12 of the 19 Italian regions and between +0.500 and +0.700 for a further 3. The correlation between the rates of suicide derived from the two sources was poor for the remaining 4 regions. A previous analysis of the influence on suicide of the Italian psychiatric reform used Police/Carabinieri data (Williams et al. 1986): this was repeated excluding data from these 4 regions, and the previous results were confirmed. Indeed, the negative correlation between suicide and the provision of general hospital psychiatric beds was stronger than that previously reported.

Psychiatric hospitalization in Italy before and after 1978.

The available information system in Italy does not allow to adequately evaluate the change in patterns of hospitalization that have taken place after the 1978 Mental Health Act came into force. There are huge differences among Northern and Southern Italy and inside these areas. On average, the reduction of public psychiatric hospitals activity had begun around 70's. People living in these hospitals at the census day January 1st were about 75,000 in the first years of the 70's, were 58,000 in 1977 and further decreased to 38,000 in 1981 (67.6 per 100,000 total population). This decrease was not counterbalanced either by private psychiatric hospitals, or by the newly opened Psychiatric Departments in general hospitals. Scant or no information is available on intermediate facilities, and on follow-up of discharged inpatients.

Hormonal changes and hair growth during treatment of hirsutism with cimetidine.

The effects on hair growth by treatment with cimetidine have been studied. This drug has been given orally to 4 women with simple hirsutism and 3 women with peptic ulcer as controls for a period of 9 months. Hair growth slowed down in all of the treated women but the results were not statistically significant. A significant decrease in urine 17-ketosteroids has been observed, while plasma levels of testosterone, 17-beta estradiol, progesterone, FSH, LH and prolactin, did not change substantially. It is concluded that, on the whole, cimetidine doses not seem to induce such results on hair growth as to claim a role in the treatment of hirsutism in other current regimes.

Vulvar lesions at risk. Prevention, clinical methodology and therapy.

In confronting the problem of prevention and early diagnosis of vulvar lesions at risk, the diagnostic methodology for their recognition and the therapeutic measures best taken are discussed. Through the use of routine, ambulatory screening tests, it is possible to detect and recognize those pathological situations which may evolve towards neoplasia. Among these, the vulvar dystrophies, some viral infections and sexually-transmitted diseases are particularly at risk. Patients with oncologic precedents are also at risk as well as patients receiving immunosuppressive therapy.

Topical testosterone propionate in the therapy of vulvar dystrophies.

187 patients with atrophic, hypertrophic and mixed vulvar dystrophy were treated with 2% testosterone propionate ointment from 18 months to 7 years. Symptoms, macroscopic, and histologic picture were evaluated before and during treatment. About 75% of the patients achieved good and excellent symptom relief. Treatment efficacy differentiates according to the type of dystrophy, and in relation to the lesion's extension and the duration of symptoms, which consist mostly of pruritus. Side effects from therapy were negligible.

Testosterone, 17 Ks, 17 beta E2 FSH-LH variations and hirsutism modifications during spironolactone therapy.

The research here reported concerns 9 hirsute women, four of them with PCO and five with idiopathic hirsutism, who underwent treatment with spironolactone. 4 non hirsute hypertensive cases served as control. For one year hair growth, testosterone, 17 Ks, estradiol and gonadotropins behaviours were studied in all of the patients. Results clearly show that the peripherical response (the hair) to the therapy is only just sufficient, and corresponds to a good reduction of the androgenic hormones in blood. However, there is also an LH gonadotropin secretion reduction which is statistically scarcely significant. If the therapeutic response of hair were good, fetal risk could be prevented with safe and contemporaneous contraception. However, since the response is scarcely sufficient, we do not think this therapy is more advisable than other ones.

Hormone receptors in dystrophic and neoplastic vulvar disease. Preliminary considerations.

Hormone receptor assays for testosterone, estrogens and androgens were performed on 53 biopsy specimens of vulva from 40 patients, consisting of 6 with normal tissue, 14 with atrophic type dystrophy, 13 with hypertrophic type dystrophy, and 20 with malignancy. Atrophic and hypertrophic forms showed a different receptor pattern; hypertrophic forms were characterized by consistently higher levels of progesterone receptors not correlated with estrogen receptors. Neoplastic tissue showed no significant changes in values compared to normal or dystrophic forms, but range of variability was high. The bond between neoplastic forms and hormone activity seems without doubt less important than in the corresponding endometrial and mammary forms. The study of dystrophic forms, instead, should be further explored with a larger number of cases.

Vulvar carcinoma: natural history.

On the basis of our clinical experience and a careful revision of the literature, we have attempted to identify the natural history of vulvar carcinoma by verifying the real evolutive possibility of these lesions, their possible genesis, the latent period between pre-invasive and invasive forms, and some events which seem to play a significant role in the onset of the invasive form in this period. These considerations indicate a new clinical and study approach to carcinoma in situ, which would thus become a pathology characterized by a more precise pathogenetic and evolutive individuality.

New trends for pain relief in gynaecologic oncology.

In pre-terminal and terminal gynaecological patients with persistent cancer pain, now it is possible to carry out some anthalgic methods associated or not to parenteral administration of non-narcotic or narcotic analgesic, i.e. intrathecal neurolytic injections and epidural narcotic administration. Many favourable results have been obtained by means of single or repeated 7% phenol in glycerine injections to patients with advanced but not terminal cancer affected by somatic and segmental pain or by perineal pain. In order to control more extensive pains, epidural injections of morphine in saline have been employed in preterminal patients. This method appears to be the best answer to many problems complained by the patients: pain, depression, malaise. As a matter of fact, low doses of epidural morphine induce both complete pain relief and sedation or slight drowsiness.

Plain films of the abdomen in term pregnancy.

Plain films of the abdomen taken during pregnancy at term from 1971 to 1981 at the Radiology Service of the Obstetric and Gynecological Clinic of the University of Padua are summarized and analysed. The average frequency of X-ray investigation is 0.5%, ranging from 0.06% (in 1980) to 2.11% (in 1977), compared to Carmichael's data which range from 11 to 30%. Indications have remained fairly constant over the years, in view of the very low incidence of this examination. The most significant finding is the greater incidence of fetal malformation in recent years, and is explained by a more efficacious program of pregnancy screening. X-ray examination may be still employed in some cases to obtain superior information regarding the best definition of gestational age, some fetal malformation, and in rare cases, hemolytic disease.