Gastric paraganglioma: case report and review of the literature.

Very few cases of gastric paragangliomas have been reported in the literature to date. We report a rare case of parietal gastric paraganglioma fortuitously detected during intraoperative exploration. A 82-years-old woman presented to our emergency room for abdominal pain. On physical examination abdomen was painful on palpation and Blumberg's sign was present. The laboratory exams showed a neutrophilia in absence of leukocytosis. Acute appendicitis was suspected and a laparoscopy was performed. At exploration, the vermiform appendix was normal while a lumpy, hard-fibrous and white-pinkish extraluminal lesion of the anterior wall of the gastric body near the greater curvature of about 2 cm in diameter was present. Laparoscopic resection of the gastric lesion was performed. The patient was discharged in good condition in the fourth postoperative day. Pathologic examination revealed a gangliocitic paraganglioma. The patient is alive and well without evidence of relapse 6 months after surgery. Gastric paraganglioma is a very rare tumor and its diagnosis is very difficult. Surgical excision is the treatment of choice which can be performed successfully with laparoscopy.

Antibiotic prophylaxis for open mesh repair of groin hernia: systematic review and meta-analysis.

PURPOSE: A meta-analysis was performed to asses whether antibiotic prophylaxis is effective in reducing the incidence of surgical site infection (SSI) after open mesh repair of groin hernia. METHODS: A literature search for randomized controlled trials (RCT) evaluating the effectiveness of antibiotic prophylaxis in adult patients undergoing open mesh repair of groin hernia was performed in November 2015. Incidence of overall and deep SSI was considered as primary and secondary outcome measures, respectively. Only studies with a clear definition of SSI and a follow-up of at least 1 month were included. Effect size from each RCT was computed as odds ratio (OR) and 95 % confidence interval (CI) and then data were pooled using a random-effects model. RESULTS: Sixteen RCTs with a total number of 5519 patients were included in the meta-analysis. Considering all the RCTs, antibiotic prophylaxis significantly reduced the overall incidence of SSI from 4.8 % to 3.2 % [OR 0.68, 95 % CI (0.51-0.91)]. However, after removal of two outlier studies, which were identified by evaluating the standardized residual, the result of the meta-analysis became non-significant [OR 0.76, 95 % CI (0.56-1.02)]. The incidence of deep SSI was very low (0-0.7 %) and the effect of antibiotic prophylaxis was not significant [OR 0.80, 95 % CI (0.32-1.99)]. CONCLUSIONS: The results of this meta-analysis do not support the routine use of antibiotic prophylaxis for the open mesh repair of groin hernia. In clinical settings with unexpectedly high rates of SSIs, the appropriateness of surgical asepsis should be carefully checked.

Tailored anterior tension-free repair for the treatment of recurrent inguinal hernia previously repaired by anterior approach.

PURPOSE: The purpose of this study is to describe our policy in selecting different types of anaesthesia and anterior tension-free techniques for the repair of recurrent inguinal hernias previously treated by anterior approach and to evaluate early and late outcomes. METHODS: The medical records of 111 patients who underwent recurrent inguinal hernia repair by anterior approach in the period 2000-2013 were reviewed. Fifty patients (45 %) were over 70 years old and 63 (56.7 %) had one or more co-morbidities. Hernias with large defects were the most frequently observed (59.5 %), and no-mesh techniques were the most frequent failed repair (75.7 %). Different anterior tension-free techniques and types of anaesthesia were used, depending on hernia and patient characteristics. Seventy-three patients (65.8 %) were operated on an outpatient basis. RESULTS: Mean follow-up period was 89 months (range 10-183). No perioperative deaths, medical events, or visceral injuries were recorded. Early postoperative complications occurred in 11 patients: 4 haematomas (3.6 %), 5 seromas (4.5 %), 1 superficial wound infection (0.9 %) and 1 ischemic orchitis (0.9 %). Late complications consisted in 3 cases of chronic moderate pain (3.2 %) and 2 re-recurrences (2.1 %). CONCLUSIONS: Recurrent inguinal hernia previously treated by open anterior technique can be repaired using the same approach, often on an outpatient basis, with a low rate of recurrence and postoperative complications. To be safe and effective, the repair should be performed by appropriately trained surgeons, well versed in the use of different types of anaesthesia and surgical techniques depending on patient and hernia characteristics.

Differentiated thyroid cancer: feasibility of loboisthmectomy in an endemic region.

AIM: The aim of the present retrospective study was to assess the feasibility of loboisthmectomy for the treatment of differentiated thyroid cancer in a endemic area, evaluating the histopathological features and the results of a case series of 1154 patients. PATIENTS AND METHODS: The clinical records of 1154 patients submitted to total thyroidectomy in our Department were retrospectively reviewed to analyze the histopathological characters and the results. RESULTS: In 1044 cases (90.5%) a papillary cancer was observed, in 110 (9.5%) a follicular carcinoma; microcarcinomas were 399 (34.5%). Multifocality was present in 323 cases (28%), in 142 unilateral (12.3%) and in 181 bilateral (15.7%). Thyroiditis coexisted in 472 patients (40.9%), multinodular goiter in 404 (35%), Graves' disease in 48 (4.1%), and multinodular toxic goiter in 38 (3.3%). Complications were: postoperative bleeding in 20 patients (1.7%), transient unilateral vocal cord paralysis in 20 (1.7%) definitive in 10 (0.86%), a transient bilateral paralysis in 1 (0.08%), a transient hypoparathyroidism in 351 (30.4%), and a definitive in 24 (2.07%). Nodal recurrence occurred in 25 patients (2.16%). CONCLUSIONS: Total thyroidectomy remains the safest treatment in differentiated thyroid cancer, especially if performed in high volume centers in which complications can be minimized. Loboisthmectomy can be a viable and safe alternative in small (< 1 cm) unifocal tumors in patients at low risk. Loboisthmectomy is limited in endemic areas by the association with other thyroid diseases. A correct and detailed information of the patient is essential before planning surgery.

Intraoperative recurrent laryngeal nerve monitoring in thyroid surgery: is it really useful?

AIM: The aim of this study was to evaluate the ability of intraoperative recurrent laryngeal nerve monitoring to predict the postoperative functional outcome and the potential role of this technique in reducing the postoperative nerve palsy rate. MATERIALS AND METHODS: Between June 2007 and December 2011, 1693 consecutive patients who underwent thyroidectomy by a single surgical team were evaluated. We compared patients who have had a neuromonitoring and patients who have undergone surgery with the only visualization. Patients in which NIM was not utilized (Group A) were 942 against the others 751 (group B). RESULTS: In group A there were 28 recurrent laryngeal nerve injuries (2.97%) of which 21 were transients (2.22%) and 7 were permanents (0.74%). In group B there were 20 recurrent laryngeal nerve injuries (2.66%) of which 14 (1.86%) transients and 6 (0.8%) permanents. Differences between the two groups were not statistically significative. CONCLUSIONS: The technique of intraoperative neuromonitoring in thyroid surgery is safe and reliable in excluding postoperative recurrent laryngeal nerve palsy; it has high accuracy, specificity, sensitivity and negative predictive value. Neuromonitoring is useful to identify the recurrent laryngeal nerve and it can be a useful adjunctive technique for reassuring surgeons of the functional integrity of the nerve but it does not decrease the incidence of injuries compared with visualization alone. Its application can be particularly recommended for high-risk thyroidectomies.

Difficulties in the diagnosis of thyroid paraganglioma: a clinical case.

Thyroid Paragangliomas are exceptionally rare tumors and only 35 documented cases have been reported in the literature. We report an additional unusual male case of thyroid Paraganglioma associated to a chronic lymphocytic thyroiditis and a papillary microcarcinoma. A 45-year-old man presented with a solitary thyroid nodule. Physical examination revealed a smooth, well-circumscribed, firm, mobile, painless thyroid nodule in the right lobe measuring 3 cm. Ultrasound examination showed a 40 mm hypoechoic, non-homogeneous nodule with peri- and intra-nodular vascular flow. An ultrasound-guided fine needle aspiration biopsy was performed showing the presence of atypical cells (Thy 3). He underwent a total thyroidectomy associated to VI level lymphectomy. Histology showed a thyroid Paraganglioma associated to a chronic lymphocytic thyroiditis and a papillary microcarcinoma measuring 0.3 cm in the greatest dimension. Thyroid Paraganglioma is an elusive tumor. It is difficult to diagnose and should be included in the differential diagnosis of all neuroendocrine tumors of the thyroid, even those arising in men or behaving in a locally aggressive fashion.

Risk factors in reoperative thyroid surgery for recurrent goitre: our experience.

AIM: Reoperative thyroid surgery is an uncommon operation associated with a higher complication rate; we reviewed our series of patients on whom reoperative thyroid surgery was performed. METHOD: 106 patients had a thyroid reoperation for recurrent multinodular goiter (93 patients), recurrent thyrotoxicosis (3) or suspected malignancy (10); bilateral completion thyroidectomy was performed in 68 cases, lobectomy in 36, removal of a mediastinal recurrence and of a pyramidal remnant in 1 patient respectively. RESULTS: Temporary hypoparathyroidism occurred in 41 patients (38.67%), definitive in 7 (6.6%), transient recurrent laryngeal nerve palsy in 5 (4.71%), permanent nerve palsy in 1 (0.94%); in 3 cases (2.83%) surgical revision of haemostasis was necessary for postoperative haemorrhage. After monolateral surgery we had 13 cases of transient hypoparathyroidism (34.21%), 2 of definitive (5.26%) and 1 transient recurrent laryngeal nerve palsy (2.63%); after bilateral surgery we had 29 cases of transient hypoparathyroidism (42.64%), 5 of definitive (7.35%), 4 of transient recurrent laryngeal nerve palsy (5.88%), 1 of definitive (1.47%) and 3 of postoperative bleeding (4.41%). CONCLUSIONS: Reoperative thyroid surgery is a technical challenge with a high incidence of complications. Scarring, edema and friability of the tissues together with distortion of the landmarks make reoperative surgery hazardous. A higher risk of complications is described when previous surgery has been performed on both sides. Total thyroidectomy should be considered the procedure of choice for benign multinodular goiter eliminating the potential of a reoperation. Whenever necessary, reoperative thyroidectomy may be performed safely with little morbidity in experienced hands.

Intraoperative parathyroid hormone assay during focused parathyroidectomy for primary hyperparathyroidism: is it really mandatory?

AIM: Intraoperative parathyroid hormone (PTH) assay has become an essential tool in focused parathyroid surgery. The aim of this study was to evaluate the present role of intraoperative PTH monitoring during focused parathyroidectomy for primary hyperparathyroidism in our experience. METHODS: One hundred sixty-one patients were submitted to focused parathyroidectomy with rapid intraoperative Parathyroid hormone assay monitoring. RESULTS: A >50% decrease of PTH occurred in 147 patients (91.3%); in this group persistent hypercalcemia was found in 1; in the remaining 14 (8.7%) values of PTH decreased less than 50% and bilateral neck exploration was performed. An additional pathologic parathyroid was removed in 8 cases, a third in one; in the other five further neck exploration was negative and in four of these persistent postoperative hypercalcemia was demonstrated. In 136 patients >50% decrease of PTH was obtained after 10 minutes, in the other 11 after 20. The overall operative success of the patients was 96.9% with a 5.6% incidence of multiglandular disease. Intraoperative parathormone monitoring changed the operative management in 8.7% of cases. Intraoperative parathormone monitoring was accurate in predicting operative success or failure in 98.7% of patients, with a sensitivity of 99.3%, a specificity of 92.8%, a positive predictive value of 99.3% and a negative predictive value of 92.8%. DISCUSSION AND CONCLUSION: The measurement of intraoperative PTH represents a useful tool to assist the surgeon during parathyroid surgery and its routine use significantly improves cure rates of focused parathyroidectomy. We believe that the use intraoperative PTH is still mandatory in focused parathyroidectomy avoiding relapses and consequent reintervention.

The burden of hospitalization related to diabetes mellitus: a population-based study.

BACKGROUND AND AIMS: To estimate the impact of diabetes and its complications, overall and in different age classes, on the likelihood of hospital admission for specific causes. METHODS AND RESULTS: We carried out a record-linkage analysis of administrative registers including data on 8,940,420 citizens in 21 Local Health Authorities in Italy. Individuals with pharmacologically treated diabetes (≥2 prescriptions of antidiabetic agents during the year 2008) were paired in a 1:1 proportion with those who did not receive such drugs (controls) based on propensity-score matching. Odds Ratios (ORs) of hospitalization for macro and microvascular conditions in individuals with diabetes as compared to controls were estimated. The system identified 498,825 individuals with diabetes pharmacologically treated (prevalence of 5.6%). Prevalence of diabetes in people aged <14 years, 14-39 years, 40-65 years, and ≥65 years was 0.1%, 0.6%, 6.4%, and 18.2%, respectively. Overall, 23.9% of subjects with diabetes and 11.5% of controls had had at least a hospital admission during 12 months for the causes considered. Diabetes increased the likelihood of hospitalization by two to six times for the different causes examined. In absolute terms, diabetes was responsible for an excess of over 12,000 hospital admissions per 100,000 individuals/year. CONCLUSION: Despite the availability of effective treatments to prevent or delay major complications, diabetes still places an enormous burden on both patients and the health care system. Given the continuous rise in diabetes prevalence both in middle-aged and elderly individuals, we can expect an additional, hardly sustainable increase in the demand for health care in the near future.

Isolated inguinal endometriosis. Case report with ultrasonographic preoperative diagnosis.

Inguinal endometriosis is rare and accounts for 0.3-0.6% of patients affected by endometriosis. A correct preoperative diagnosis is rare. Diagnosis is frequently made by histologic examination. A 36-year-old nulliparous woman presented with a painful mass in her right groin of 2 years duration. The pain fluctuated according to the menstrual period. Physical examination revealed an elastic hard mobile mass measuring 2 x 2 cm in the right inguinal region. Ultrasound examination confirmed a hypoechoic tumor in the right inguinal region with poorly defined boundaries and perilesional and intralesional vascular flow suspect for endometriosis. Wide excision of the lump with a part of the round ligament was carried out. Histology showed endometrial glands and stroma within the fibrous tissue. The patient had an uneventful recovery and was discharged the next day. After surgery, the pain disappeared completely. No signs of recurrence occurred at approximately 16 months after the surgery. Although rare, extrapelvic endometriosis should be considered in the differential diagnosis in women of reproductive age presenting with an inguinal mass, especially if the groin mass is associated in size and tenderness with menstrual variability. US appearance is very useful in diagnosis so ultrasonography can be considered the examination of choice.

Epidemiology of SHOX deficiency.

Deletion of short stature homeobox-containing (SHOX) gene, in the pseudoautosomal region (PAR1) of X and Y chromosomes, is an important cause of short stature. Homozygous loss of SHOX results in the more severe Langer mesomelic dysplasia, while SHOX haploinsufficiency cause a wide spectrum of short stature phenotypes, including patients with Turner syndrome, Leri Weill dyschondrosteosis (LWD), and idiopathic short stature (ISS). In Turner syndrome, haploinsufficiency of SHOX gene, as well as short stature, are present in 100%; nevertheless, SHOX deficiency accounts for only two-thirds of Turner patients' short stature. In LWD the prevalence of SHOX gene anomalies varies from 56% to 100%. This wide range might be due to different factors such as selection criteria of patients, sample size, and method used for screening SHOX mutations. The real challenge is to establish the prevalence of SHOX deficiency in ISS children given that published studies have reported this association with a very broad frequency range varying from 1.5% to 15%. An important variable in these studies is represented by the method used for screening SHOX mutations and sometimes by differences in patient selection. Short stature is present by definition in 3 out of 100 subjects; if we consider a frequency of SHOX defects of 3% among ISS, we should expect a population prevalence of 1 in 1000. This prevalence would be higher than that of GH deficiency (1:3,500) and of Turner syndrome (1:2,500 females), suggesting that SHOX deficiency could be one of the most frequent monogenetic causes of short stature.

[New techniques in parathyroid surgery]. / Nuove Tecniche nella chirurgia delle paratiroidi.

The diseases of parathyroid glands have assumed a growing importance for innovations in diagnosis and surgery which have enabled a more precise identification and therapy. Use of Sesta-MIBI scintigraphy allows a correct localization of the adenoma; the introduction of intraoperative monitoring of intact parathyroid hormone made possible unilateral neck exploration with a mini-incision above the adenoma. The emergence of videotechnology has led the innovation of endoscopic parathyroidectomy, realized for the first time in 1996 and subsequently performed without the use of CO2. Currently, the SPECT scintigraphy allows a three-dimensional vision of the adenoma and is the more precise localization study, allowing to use mini-invasive access. Prerequisite for the use of minimally invasive techniques is the determination of intraoperative PTH, possible with various techniques. Our experience is based on 135 patients undergoing parathyroidectomy in the last 8 years with 5 cases of persistent hyperparathyroidism submitted to reoperation, an average hospital stay of 2 days and only 6 complications (1 bleeding and 5 temporary hypoparathyroidisms). The use of new technologies in parathyroid surgery can achieve optimal results, a better cosmetic result and quicker postoperative recovery, with a low incidence of recurrence and complications.

Antioxidant properties of anesthetics: the biochemist, the surgeon and the anesthetist.

General anesthesia can impair immunological defense mechanisms while inducing an inflammatory reaction. Generalized inflammatory reactions involve leucocytes which in turn release inflammatory mediators and free oxygen radicals. General anesthetics include a series of gaseous and intravenous sedative-hypnotic agents indicated for induction and maintenance of general anesthesia as well as for sedation of intubated, mechanically ventilated adults in intensive care units (ICU). Some anesthetics, such as propofol, are characterized by a phenolic structure similar to that of alpha-tocopherol, and exhibit antioxidant properties that have been demonstrated both in vitro and in vivo. Similarly, other anesthetics show antioxidant and protective roles but this mechanism is to be related to their ability to induce antioxidant enzyme (i.e., heme oxygenase-1). The aim of the present review is to evaluate the antioxidant properties of anesthetics in various experimental models and if they may be considered efficient therapeutic tools in counteracting oxidative stress during general anesthesia and sedation in ICU.

Primary mesenteric liposarcoma. Report of a case.

Primary mesenteric liposarcomas are very rare neoplasms. The authors report a case of mesenteric liposarcoma recently observed. The patient presented with a history of dyspeptic syndrome, meteorism and abdominal pain associated with a change in bowel habit and constipation. On physical examination there was a large, well-circumscribed, abdominal mass. Computed tomography revealed an abdominal, dishomogeneous, low-density mass. Surgical excision with a tumour-free margin was achieved. The histologic appearances were those of a well-differentiated liposarcoma (atypical lipomatous tumour). The patient is alive and disease-free 33 months after the surgery. Primary mesenteric liposarcoma is often resectable and requires aggressive surgical management; in consideration of the high risk of tumour recurrence, the treatment of choice is a wide surgical excision.

Features of metabolic syndrome in non-diabetic Italians and Brazilians: a discriminant analysis.

This aim of this study was to compare the characteristics of metabolic syndrome (MetS) in a Brazilian and an Italian population. The subjects were non-diabetic men and women aged 40-74 years from population-based surveys: 1242 from Brazil and 1198 from Italy. Logistic regression models were used to compare adjusted prevalence rates and make a discrimination analysis to distinguish the subjects with a diagnosis of MetS in the two groups. Dyslipidemia [low high-density lipoprotein (HDL)-cholesterol] and impaired fasting glucose were more prevalent among the Brazilians, and increased blood pressure and abdominal obesity (in men) among the Italians. Generally, the Italians showed higher prevalence of overall obesity and high pulse-pressure, and the Brazilians had higher prevalence of metabolic markers of insulin resistance. Among the subjects with the syndrome, HDL-cholesterol was the most discriminant factor, followed by plasma uric acid levels (which were higher in the Brazilians). The Italian men had a larger waist circumference and the Italian women higher body mass index values than the Brazilians. Italians had higher systolic and lower diastolic pressure values. The patterns of the metabolic alterations seemed to be more linked to insulin resistance among Brazilian subjects, whereas obesity seemed to play a more important role among the Italians. Although they are not sufficient to support the hypothesis of differences in the underlying pathophysiological processes between these groups, our results illustrate the difficulty of using a single unifying definition of MetS, and suggest that different benefits may be obtained from treatments targeting obesity, blood pressure or insulin resistance.

Follicular vascularity is not predictive of pregnancy outcome in mild controlled ovarian stimulation and IUI cycles.

BACKGROUND: Although follicular vascularity has been shown to be a good indicator of oocyte quality in IVF, scant evidence is currently available on the predictive value of this variable in terms of pregnancy rate during controlled ovarian stimulation (COS) and intrauterine insemination (IUI) cycles. METHODS: Three-hundred and eighteen patients who had received mild COS underwent transvaginal ultrasound scan before performing the IUI. Using power Doppler imaging, vascularity of follicles with a mean diameter > or =16 mm was graded into a three grades according to the circumference of the follicle in which flow was identified. When more than one follicle was observed, grading was performed for all of them, and the highest vascularity grade was recorded. RESULTS: Clinical pregnancy rate (number/total) in the low-, medium- and high-grade vascularity groups was 14.1% (14/99), 10.0% (10/100) and 11.8% (14/119), respectively (P = 0.66). Similar results were observed when only monofollicular cycles were considered. CONCLUSIONS: Follicular vascularity does not predict the chance of pregnancy in women undergoing mild COS and IUI cycles.

Role of SPECT/CT in the preoperative assessment of hyperparathyroid patients.

PURPOSE: Our purpose was to assess the clinical value and additional benefit of fusion single-photon computed tomography (SPECT) and computed tomography (CT) images in locating the parathyroids in a selected group of patients affected by primary (PHP) and secondary hyperparathyroidism (SHP). MATERIALS AND METHODS: Sixteen patients (11 women and five men; age range 35-80 years) with severe hyperparathyroidism (HP) (ten PHP, six SHP) were studied by ultrasound (US), and, after i.v. injection of 370 MBq of 99mTc-sestamibi, by planar parathyroid scintigraphy, SPECT and SPECT/CT using a dual-detector scintillation camera GE Infinia Hawkeye. All patients underwent parathyroidectomy. RESULTS: US findings were inconclusive in 12/16 patients affected by multinodular goitre, and two probable eutopic parathyroid glands were identified. "Double phase" parathyroid scintigraphy identified 14 probable parathyroid glands, SPECT 23 (14 ectopic and nine eutopic) and SPECT/CT confirmed all 23 probable parathyroid lesions, offering more precise localisation and an evident improvement in diagnostic accuracy. Sixteen of these foci of increased uptake were hyperplastic parathyroid glands, six were adenomas, one was a parathyroid carcinoma and one was a thyroid follicular carcinoma. Surgical detection of the 23 sestamibi-positive lesions was correctly matched with 100% of SPECT/CT images and 61% of SPECT data alone. Hybrid imaging thus provided additional data in 39% of lesions, and in three patients with retrotracheal glands, it modified the surgical approach. CONCLUSIONS: We believe 99mTc-sestamibi SPECT/CT to be a more reliable presurgical method to study a patient subgroup affected by PHP or SHP in whom conventional US and other scintigraphic methods have failed for intrinsic reasons due to the concomitant presence of multinodular goitre or ectopic parathyroid gland. The additional practical benefit derived from this methodology was evident. In fact, anatomical information provided by CT enables precise localisation of the functional abnormalities highlighted by SPECT, and both are essential to a correct surgical approach.

Medicines for children licensed by the European Medicines Agency (EMEA): the balance after 10 years.

OBJECTIVE: The 1995-2005 balance of EMEA activities in the field of paediatric medicines was evaluated, taking into account the number both of drugs authorised for children and paediatric studies supporting the Marketing Authorisation (MA). METHODS: Data on drugs authorised by EMEA were extracted from EPARs (European Public Assessment Reports). Active substance, year of approval, anatomical, therapeutic and chemical (ATC) code, indication, orphan status, ages, and registrative clinical studies characteristics were assessed. RESULTS: The percentage of authorised substances for paediatrics is 33.3%. This percentage decreased or increased when different subsets of medicines were considered [medicines for children under 2 years (23.4%), N-ATC code drugs (6%) and orphan drugs (46.4%)]. A total of 165 trials were included in the MA dossiers of 51 drugs at the time of approval, and additional 22 studies were added to the dossiers of 12 active substances submitted for paediatric variations. PK and Efficacy/Safety studies were performed for 32 (52%) active substances, while either one PK or one Efficacy/Safety study was carried out for 43 (69%) and 45 (73%) substances, respectively. CONCLUSIONS: This report demonstrates that the total number of paediatric medicines approved by EMEA is stable over the 10-year period, while an increase in drugs to treat serious or orphan diseases has been observed. In addition, under the Centralised Procedure, a valuable number of paediatric trials have been submitted to support drug approval.

Lifestyle correlates of anthropometric estimates of body adiposity in an Italian middle-aged and elderly population: a covariance analysis.

OBJECTIVE: To study the relationship between behavioural factors, body adiposity and muscle mass. SUBJECTS AND METHODS: A total of 1415 Italian individuals (705 men and 710 women) aged 40-74 years from a population-based survey carried out in the town of Bollate (Milan). Analysis of covariance was used to refine and improve the precision of the comparisons. RESULTS: Men: Smoking and sedentary behaviour were related to larger waist circumference (WC) and smaller hip circumference (HC). Increased WC was also associated with high-fat diet and moderate-to-heavy drinking (compared to light drinkers). Those more educated (completed high school) were leaner and ex-smokers had higher body mass index (BMI) than non-smokers. Women: BMI was inversely related with education, the more educated having also lower muscle mass. The light drinkers were leaner and moderate-to-heavy drinkers had less muscle mass than abstainers. Moderate-to-heavy drinkers had larger WC than light drinkers. A strong negative trend was found in the relationship between dietary fibre and WC. Overall adiposity (BMI) and, more weakly, HC and peripheral subcutaneous fat increased with more TV watching, whereas BMI lowered, together with WC and muscle mass (as measured by the mid-arm circumference), with more walking/cycling. CONCLUSIONS: Modifiable habits such as smoking (men) and moderate-to-heavy alcohol drinking are associated with a pattern that is particularly deleterious to health: increased intra-abdominal fat and less muscle mass. Prevention strategies should be simultaneously aimed at promoting physical activities and reducing sedentary behaviours. A low-fat, fibre-rich diet seems to be closely related to a healthy distribution of body fat.

Help-seeking behaviour for sexual problems: the global study of sexual attitudes and behaviors.

The Global Study of Sexual Attitudes and Behaviors (GSSAB) investigated various aspects of sex and relationships among 27,500 men and women aged 40-80 years. Here, we report help-seeking behaviours for sexual problems in this population. A questionnaire was administered using the accepted survey method in each country. Although almost half of all sexually active respondents had experienced at least one sexual problem, less than 19% of them (18.0% of men and 18.8% of women) had attempted to seek medical help for their problem(s). The most frequent action taken by men and women was to talk to their partner (39%). Only 9% of men and women had been asked about their sexual health by a doctor in a routine visit during the past 3 years. Although sexual problems are highly prevalent, few men and women seek medical help for these problems. Overall, men and women show similar help-seeking behaviours.