Burnout among therapists working with persons with autism after the 2009 earthquake in L'Aquila, Italy: a longitudinal comparative study.

The aim of this study was to follow up the occurrence of burnout in therapists of children and adolescents with autism experiencing the 2009 earthquake in L'Aquila, and to discuss implications for burnout prevention after disasters. A longitudinal study was carried out, measuring burnout outcomes according to the Maslach Burnout Inventory in 11 exposed and 53 unexposed therapists. Staff in the exposed group appeared to report significantly higher levels of emotional exhaustion after 1 and 2 years of follow-up than the unexposed staff. As to lack of personal accomplishment, the exposed groups shows increasingly lower scores with respect to the unexposed group, with personal accomplishment (PA) values falling from 41.0 [standard deviation (SD) 3.7] to 33.4 (SD 4.1) after 2 years, whereas PA values remain stable over time in the unexposed group. As to depersonalization, data show no significant difference between groups. Burnout occurrence is induced by the exceptional stressors related with natural disasters like earthquakes. Efforts are required to help mental health workers, including psychiatric nurses, to cope with the devastating situation determined by an earthquake. A periodical monitoring of mental health status is recommended in mental health works, especially with regard to help with post-traumatic stress disorder, coping with work and therapeutic relationships, family and social life and economic impact.

Detecting attention-deficit/hyperactivity disorder (ADHD) in adults with intellectual disability The use of Conners' Adult ADHD Rating Scales (CAARS).

There is an increasing interest in the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adulthood. It is also thought that ADHD is more prevalent in the field of intellectual disability (ID) than in the general population, but there are not many experimental studies. Since ADHD diagnosis in adults is more difficult, specific rating scales correlated to the main diagnostic systems have been created but have not been applied to people with ID. This work presents an application of an ADHD screening rating scale, the Conners' Adult ADHD Rating Scales (CAARS) screening version to 46 adults with ID. The resulting prevalence of "ADHD-positive" was 19.6%. These data are in accord with results reported in the general adult literature. Our data suggest that ID and attention disorders can co-occur. Therefore, not only can ADHD be a valid psychiatric diagnosis for a child with ID but for an adult with ID as well. The CAARS can be considered a useful clinical instrument to survey ADHD in ID.

Autism and intellectual disability: a study of prevalence on a sample of the Italian population.

BACKGROUND: In 1994, the American Association on Mental Retardation with the DSM-IV has come to a final definition of pervasive developmental disorders (PDD), in agreement with the ICD-10. Prevalence of PDD in the general population is 0.1-0.15% according to the DSM-IV. PDD are more frequent in people with severe intellectual disability (ID). There is a strict relationship between ID and autism: 40% of people with ID also present a PDD, on the other hand, nearly 70% of people with PDD also have ID. We believe that in Italy PDD are underestimated because there is no agreement about the classification system and diagnostic instruments. METHOD: Our aim is to assess the prevalence of PDD in the Italian population with ID. The Scale of Pervasive Developmental Disorder in Mentally Retarded Persons (PDD-MRS) seems to be a very good instrument for classifying and diagnosing PDD. RESULTS: The application of the PDD-MRS and a clinical review of every individual case on a sample of 166 Italian people with ID raised the prevalence of PDD in this population from 7.8% to 39.2%. CONCLUSIONS: The study confirms the relationship between ID and autism and suggests a new approach in the study of ID in order to elaborate a new integrated model for people with ID.

[Trans-anal resection of low rectal neoplasms]. / Exeresi transanale delle neoplasie del retto basso.

BACKGROUND: The rising incidence of colorectal neoplasms, and in particular those localised in the lower rectum is stressed and the therapeutic opportunities offered by the trans-anal resection technique are underlined. METHODS: The indispensable conditions for adopting a surgical approach are pointed out. These are identified as the size of the neoplasm, which should not exceed 4 cm, the fixity, site, the polypoid and non-ulcerated nature of the lesion, and the involvement of not more than 1/4 of the circumference of the bowel. Using these inclusion criteria, the authors operated on five patients in the 4th Division of General Surgery at G. Martino Polyclinic in Messina, using trans-anal resection of low rectal neoplasm. RESULTS: No hemorrhagic complications or lesions in the visceral wall occurred. All patients underwent a follow-up of up to 36 months and to date no patient has presented long-term metastasis; local recidivation was observed in one patient after 14 months and this was treated using the trans-anal method. CONCLUSIONS: The authors affirm that trans-anal resection may be regarded as the elective treatment of patients with neoplasms confined to the visceral wall and without dissemination; it is palliative in cases where the tumour is larger than 4 cm, with lymph node involvement. But even in this case, and in more advanced situations, this method allows mortality due to occlusive complications to be reduced and ensures a better quality of residual life.

[Carcinoma of the gastric stump]. / Il carcinoma del monocone gastrico.

After having emphasized that carcinoma of the gastric stump represents a "major" risk in patients undergoing gastric resection, the authors describe the physiopathology of the new anatomical and functional status of the gastroenteric apparatus and underline the probable etiopathogenetic stages attributable to carcinogenesis. They then describe the treatment of this neoplasia with a marked aggressive character and conclude with the affirmation that the surgeon's efforts must be focused on the correct execution of gastroresection and the follow-up of gastro-resected patients in order to allow the early identification of precancerous conditions and therefore the commencement rational oncological prophylaxis.

The psychopathological model of mental retardation: theoretical and therapeutic considerations.

Mental retardation has heterogenous elements including genetic-biological and environmental factors that occur in a complex relationship. One construction commonly utilized is the overlapping etiologies, pathogenesis, and symptomatology in a bio-psycho-social model framework. A new integrated bio-psycho-social model we call "universe line" provides the possibility of integrating data from different research areas, specially cognitive and psychopathologic indicators. However, further methodology to refine and experimentally verify that model need to be elaborated. Implications of this theoretical approach are discussed.

Psychopathology and mental retardation: an Italian epidemiological study using the PIMRA.

The incidence of psychopathology was studied in 176 adult patients with mental retardation through administration of the Psychopathology Instrument for Mentally Retarded Adults (PIMRA). Prevalence of answers relating to anxiety, tendency to live apart and body complaints in the group with mild mental retardation was documented. For people with severe intellectual impairments, mood disturbances with inconsistent behaviours was most prevalent. Implications of the findings are discussed.

Assessment of basic symptoms in schizophrenia, schizoaffective and bipolar disorders.

In order to evaluate the basic symptoms differences of schizophrenics, schizoaffectives and bipolar patients, a consecutive series of 72 outpatients participated in the study. According to DSM III-R criteria, 28 had a diagnosis of schizophrenia, 29 of bipolar disorder and 15 of schizoaffective disorder. The assessment of basic symptoms was performed using the Frankfurter Beschwerde-Fragebogen (FBF). Data obtained suggest that perception and thought disturbances are the most characteristic experiences of schizophrenic patients in comparison with bipolar patients. The FBF questionnaire did not highlight a characteristic basic symptoms profile of schizoaffective disorder, when compared with bipolar affective disorder and schizophrenia.

[Laparoscopic cholecystectomy: the complications]. / La colecistectomia per via laparoscopica: le complicanze.

The authors report their experience of 48 consecutive cases of colecystectomy performed using a videolaparoscopic technique. Laparoscopic surgery was not successful in only two patients in whom it was necessary to resort to laparotomy; bile duct injury occurred in one patient. On the basis of their experience the authors conclude by affirming that this videolaparoscopic technique may be applied to almost all patients requiring cholecystectomy since it offers considerable advantages over traditional techniques.

[Human IgG and adjuvant therapy in patients with colon-rectal cancer]. / IgG umane e terapia adiuvante in pazienti con carcinoma del colon-retto.

UNLABELLED: It is well known that, in patients with carcinoma, chemotherapy produces an increase of the incidence of infections and changes the immune defences of the patient. Since 1952 human immunoglobulins have been used for pathologies with immune deficiency. This study aims to evaluate the immunologic efficacy of purified human immunoglobulins in patients with colon-rectal cancer undergoing chemotherapy. MATERIALS AND METHODS: In 60 patients of both sexes, with colon-rectal cancer after surgical operation and who underwent chemotherapy with 5-FU and folinic acid, about thirty of them were treated with purified human IgG. In particular, the hemochrome and the microbiologic parameters were evaluated. RESULTS: The percentage of infections in patients treated with purified human immunoglobulins was less in comparison to patients treated only with chemotherapy and in this sphere, a prevalence of sepsis sustained by Gram-, was observed in the control group in respect to patients treated with purified human IgG. DISCUSSION AND CONCLUSIONS: The authors have observed a positive qualitative variation in the functional state of the immunocompetent cells; the IgG would play the role of functional stimulation of immediate immunity, pointed out by an inferior number of infections in patients treated with IgG. Therefore, it is evident that the use of such therapeutic factors that can help in the reintegration of a slackened control of immunity represented by neutropenic leucocytes, might contribute to rendering the diffusion of the tumour more difficult.

[Psychopathological and clinical features among the ambulatory population of obese patients]. / Caratteristiche psicopatologiche e cliniche di una popolazione ambulatoriale di pazienti obesi.

Aim of the present study is the evaluation of psychopathological and clinical features of these outpatients followed by the Outpatient Clinic of the Section of Metabolic Diseases and Diabetes, University of Florence. 84 obese patients and 217 non-obese control subjects were studied using the Structured Clinical Interview for DSM-III-R (SCID), and applying DSM-IV criteria for Binge Eating Disorder. BITE self-reported questionnaire, STAI inventory and Ham-D rating scale were also used. Lifetime prevalence of Binge Eating Disorder in obese patient was 11.9%, markedly lower than that reported in studies on North American samples. Prevalence of depressive disorder (Major Depression and Dysthymia) was significantly higher (p < 0.005) in obese patients than in control subjects. This confirms the important relationships between eating and mood disorders. The prevalence of subclinical eating disorders resulted to be significantly higher in obese patients (p < 0.01) when compared with control subjects. Significant correlations (p < 0.01) of BITE scores were observed with STAI and Ham-D scores, but not with body mass index. These results underline the need for an accurate psychopathological assessment in obese patients, in order to formulate a correct diagnosis and plan adequate therapeutical interventions.

[Anatomopathological and clinical aspects of primary gastric lymphoma]. / Aspetti anatomopatologici e clinici del linfoma gastrico primitivo.

The authors utilised several reviews of the literature and own experience based on 6 cases of non Hodgkin's primary gastric lymphoma. They refer about the importance and the difficulties to make differential diagnosis and on the staging. The authors believe that the treatment of choice is a surgical therapy but the role of radiotherapy and chemotherapy is very interesting in several cases.

[Barrett esophagus. The diagnostic and therapeutic aspects]. / Esofago di Barrett. Aspetti diagnostici e terapeutici.

The authors, after a dissertation on the aetiopathogenesis of "Barrett's oesophagus", dwell on the precancerous nature of this pathology involving the oesophageal-gastric junction. Its frequent association with cancer explains the necessity for an accurate follow-up in these patients: many investigations can be useful, the radiological study of oesophagus and stomach, manometry, pH-metry, but an irrefutable diagnosis can only be achieved through endoscopy, which makes possible a histological examination of the bioptic fragments. The authors also deal with the ideal therapeutic strategy and differentiate the cases in which the pharmacological therapy is more appropriate from those that need a surgical approach.

[Carcinoma of the gallbladder. State of the art]. / Il carcinoma della colecisti. Stato dell'arte.

The authors examine the most interesting data about gallbladder cancer. They emphasize the difficulties of an useful approach to this pathology: an early diagnosis is quite impossible and the surgical treatment very disappointing.

How long is a 6 cm margin of resection in the stomach?

In order to assess whether the gastric wall undergoes some change in length during gastrectomy operation for cancer, we measured the variation in length of the anterior gastric wall in 25 patients. The first measurement was made at the beginning of laparotomy by placing two stitches on the anterior gastric wall and registering the distance between them. A second and a third measurement were recorded when the stomach was fully isolated just before its transection and subsequently on the anatomic table. The results indicate that the usual recommendations made by pathologists to maintain a 6 cm margin of tissue clearance proximally to the cephalic edge of the tumour, can be safely followed by the surgeons who can correctly assess, during operation, the distance between tumour and the desirable line of transection since no misleading reduction in size of the resected specimen takes place.

Human breast cancer: prognostic significance of the c-erbB-2 oncoprotein compared with epidermal growth factor receptor, DNA ploidy, and conventional pathologic features.

PURPOSE: A study was undertaken to define the prognostic value of the expression of the c-erbB-2 oncoprotein in a series of breast cancer patients when compared by multivariate analysis with expression of the epidermal growth factor receptor (EGFR), DNA ploidy, and conventional clinicopathologic features. PATIENTS AND METHODS: Prognostic indicators were analyzed in 165 primary breast cancers. The c-erbB-2 oncoprotein was recognized by the polyclonal antibody 21N using an immunocytochemical method. Expression of the EGFR was stated immunocytochemically using the monoclonal antibody EGFR1. DNA ploidy was assessed in paraffin-embedded sections using a standard flow-cytometric method. RESULTS: Overall, 27% of carcinomas had membrane 21N-staining and were classified as c-erbB-2-positive. Overexpression of the c-erbB-2 oncoprotein was poorly associated with EGFR expression and the conventional pathologic features, and it was weakly associated with DNA ploidy and nodal status. Univariate analysis showed that c-erbB-2 expression, nodal status, DNA ploidy, and EGFR provided significant prognostic information concerning 4-year relapse-free survival (RFS) with the odds ratios (ORs) of not relapsing of 2.94, 2.83, 2.34, and 2.20, respectively. Regarding overall survival (OS) at 4 years, only nodal status and DNA ploidy had prognostic significance, with the ORs of not dying of 2.68 and 2.80, respectively. Applying multivariate analysis to RFS, 21N when adjusted for nodal status, EGFR, and DNA ploidy (full model) failed to retain prognostic value (P = .202), whereas nodal status was the most significant indicator of relapse (P = .027) followed by DNA ploidy (P = .056) and EGFR (P = .093). CONCLUSIONS: This study suggests that overexpression of the c-erbB-2 oncoprotein appears to be an important indicator of relapse in stage I-II breast cancer when singly evaluated. Multivariate analysis shows that the determination both of nodal status and DNA ploidy improves our ability to identify subsets of patients with different prognoses, and allows for a better selection of patients for systemic adjuvant treatments.

Estrogen and progesterone receptors in breast cancer. Immunohistochemical assay on scraping material.

In order to demonstrate the reliability of immunocytochemical results on cytologic specimens for receptor analysis, the expression of estrogen and progesterone receptors was investigated using immunohistochemistry on frozen sections and on scraping material from the same samples of 50 breast carcinomas. The level of agreement between the two procedures was evaluated by the kappa statistic, as was that between each immunohistochemical procedure and the dextran-coated-charcoal assay since the latter is still the assay employed most frequently for steroid receptor determination and is used for official reports. Statistical results revealed very good agreement regarding the estrogen receptor analysis, with kappa values of .910 and .952 for the comparison of the dextran-coated-charcoal assay with immunocytochemistry on frozen sections and on scrapes, respectively, and .950 for the comparison between the two immunocytochemical procedures. As to progesterone receptors, the kappa values were .795 and .712 for the comparison between the biochemical and immunocytochemical results and .915 for agreement evaluation between the two immunocytochemical procedures. The study showed that the scraping procedure is a valuable tool for the immunocytochemical assessment of steroid receptors in small mammary tumors; it yields representative cellular samples, thus permitting the investigation of heterogeneously distributed substances in tissues.