Psychological consequences of the 1998 landslide in Sarno, Italy: a community study.

OBJECTIVE: This community study assessed the prevalence of post-traumatic stress disorder (PTSD) and the psychosocial consequences of the landslide which occurred in Sarno, Southern Italy, in May 1998. METHOD: A random sample (n=272) of the population living in the highest risk area of Sarno, and a control group recruited in a small town situated near the disaster area, but not affected by the event, were assessed 1 year after the disaster by standardized instruments. RESULTS: Of the subjects recruited in Sarno, 27.6% met DSM-IV criteria for PTSD; 59% subjects recruited in Sarno and 35% of the control group were identified as "probable cases" by the GHQ-30 (P<0.0001). Subjects recruited in Sarno had significantly higher scores on the four GHQ-30 subscales identified by factor analysis. CONCLUSION: This study emphasizes the negative impact of a natural catastrophic event on mental health, and the need for preventive interventions.

Bonding orthodontic lower 3 to 3 retainers with a rubber dam: a second generation step-by-step procedure.

This article describes a step-by-step procedure for bonding lower anterior retainers with a rubber dam. Because of a significant rate of failures, the rubber dam was used in order to have a better access to the lingual aspects of lower incisors and canines, while providing dry conditions.

Spectral dependence of the scattering coefficient in case 1 and case 2 waters.

An approximate linear relationship between the scattering coefficient and the wavelength of light in the visible is found in case 1 and case 2 waters. From this relationship, we estimate scattering at an unknown wavelength from scattering at a single measured wavelength. This approximation is based on measurements in a 1.5-m-thick surface layer collected with an AC9 instrument at 63 stations in the Arabian Sea, northern Gulf of Mexico, and coastal North Carolina. The light-scattering coefficient at 412 nm ranged from 0.2 to 15.1 m(-1) in these waters, and the absorption coefficient at 412 nm ranged from 0.2 to 4.0 m(-1). A separate data set for 100 stations from Oceanside, California, and Chesapeake Bay, Virginia, was used to validate the relationship. Although the Oceanside waters were considerably different from the developmental data set (based on absorption-to-scattering ratios and single-scattering albedos), the average error between modeled and measured scattering values was 6.0% for the entire test data set over all wavelengths (without regard to sign). The slope of the spectral scattering relationship decreases progressively from high-scattering, turbid waters dominated by suspended sediments to lower-scattering, clear waters dominated by phytoplankton.

Subcutaneous administration of a depot gonadotropin-releasing hormone agonist induces profound reproductive axis suppression in women.

OBJECTIVE: To compare the i.m. and s.c. routes of depot GnRH agonist administration. DESIGN: Prospective, controlled pharmacokinetics study. SETTING: Volunteers in an academic research environment. PATIENT(S): Forty women with benign gynecologic disorders. INTERVENTION(S): Triptorelin administration (3.75 mg) at 28-day intervals for 6 consecutive months. Twenty patients were treated with IM triptorelin, and 20 patients were treated with SC triptorelin. MAIN OUTCOME MEASURE(S): Assessment of side effects, GnRH test results, and triptorelin, LH, FSH, estradiol, and progesterone levels. RESULT(S): The occurrence of injection site redness and itching and of some hypoestrogenic side effects was increased significantly in the SC group. Plasma triptorelin levels were significantly higher in the IM group in the first month of treatment; thereafter, the pattern reversed, with a nonsignificant trend toward higher plasma triptorelin levels in the SC group. Serum LH, FSH, estradiol, and progesterone levels were low after the first month of treatment and did not differ between the two treatment groups. On day 196 (2 months after the last depot triptorelin injection), triptorelin was still measurable and gonadotropins and gonadal steroids were still suppressed. Spontaneous menses returned significantly later in the SC group than in the IM group. CONCLUSION(S): Subcutaneous triptorelin can be administered by the patient. Both IM and SC triptorelin administration are cliniclly effective, but they result in different triptorelin pharmacokinetics. Subcutaneous triptorelin is associated with more prolonged amenorrhea than is IM triptorelin, suggesting enhanced pituitary-ovarian suppression. These results suggest that SC triptorelin may allow lower drug dosage administration and/or longer administration intervals.

Remote-sensing technique for determination of the volume absorption coefficient of turbid water.

We use remote-sensing reflectance from particulate R(rs) to determine the volume absorption coefficient a of turbid water in the 400 < lambda < 700-nm spectral region. The calculated and measured values of a(lambda) show good agreement for 0.5 < a < 10 (m(-1)). To determine R(rs) from a particulate, we needed to make corrections for remote-sensing reflectance owing to surface roughness S(rs). We determined the average spectral distribution of S(rs) from the difference in total remote-sensing reflectance measured with and without polarization. The spectral shape of S(rs) showed an excellent fit to theoretical formulas for glare based on Rayleigh and aerosol scattering from the atmosphere.

Effect of suspended particulate and dissolved organic matter on remote sensing of coastal and riverine waters.

We use remote sensing reflectance (RSR) together with the inherent optical properties of suspended particulates to determine the backscattering ratio b(b)/b for coastal waters. We examine the wavelength dependence of b(b)(lambda) and f(lambda)/Q(lambda) and establish the conditions when C(lambda) in RSR(lambda) approximately or = C(lambda)b(b)(lambda)/a(lambda) can be treated as a constant. We found that for case 2 waters, RSR was insensitive to the natural fluctuations in particle-size distributions. The cross-sectional area of the suspended particulate per unit volume, x(g), showed an excellent correlation with the volume scattering coefficient.

Role of different GnRH agonist regimens in pituitary suppression and the outcome of controlled ovarian hyperstimulation.

Gonadotrophin-releasing hormone (GnRH) agonists have become irreplaceable addition to gonadotrophins in ovulation induction for assisted reproduction. Of the several schemes currently employed, long regimens appear to be maximally effective to optimize patient scheduling and to improve clinical results.

The Società Italiana di Neurologia: origins.

This paper describes the history of the Italian Society of Neurology (Società Italiana di Neurologia, SIN), originally an offshoot of the Società Freniatrica Italiana, whose origins go back to Aversa in 1861, when Biagio Gioacchino Miraglia founded the Società Frenopatica, the first neuropsychiatric organisation for Italian scientists. The "Società Freniatrica" was founded in Rome in 1873 and was to bring together neurologists and psychiatrists until 1907, when the SIN was founded with its own Articles of Association (subsequently modified in 1971) and the two specialisations of neurology and psychiatry were recognised as being distinct entities. The first SIN Congress was held in Naples in 1908, and an analysis of its themes and those of subsequent Congresses highlights the fact that, right from the start, the interests of neurologists covered the whole range of the neurosciences: neuroanatomy, histology, physiopathology and clinical neurology. Over the years, special Groups have been established to enable the more profound study of specialised aspects, and the Society of Hospital Neurologists founded.

Is multiple pregnancy an unavoidable complication of ovulation induction? The case for pulsatile GnRH.

Ovarian hyperstimulation (OHS) and multiple pregnancy are dreaded complications of ovulation induction. The use of pulsatile GnRH permits to prevent the occurrence of OHS and results in few multiple pregnancies. Low-dose GnRH administration, avoidance of preovulatory hCG, patient selection, and the use of GnRH agonist pituitary desensitization in selected patients permits to limit multiple conceptions to a level comparable with the occurrence of this complication in normal unstimulated women.

Different gonadotropin and leuprorelin ovulation induction regimens markedly affect follicular fluid hormone levels and folliculogenesis.

OBJECTIVES: To clarify the endocrine mechanisms underlying the outcome of different ovulation induction regimens with gonadotropins and GnRH agonists (GnRH-a). DESIGN: Prospective study. SETTING: Reproductive Endocrinology Center, University of Bologna. PATIENTS: Forty eumenorrheic women randomly assigned to four groups of 10 subjects each. INTERVENTIONS: Ovulation induction regimens: group A, purified FSH only; group B, purified FSH and flare-up GnRH-a; group C, purified FSH and long GnRH-a; and group D, hMG and long GnRH-a. MAIN OUTCOME MEASURES: Pelvic ultrasound and hormone levels in daily serum samples and in follicular fluid drawn immediately before hCG administration. RESULTS: Exogenous gonadotropin dose did not differ among groups. Group B had fewer preovulatory follicles than group C. Group B had higher serum LH, FSH, E2, P, T, and follicular fluid LH, E2, T, and alpha-inhibin than groups C and/or D. Groups C and D did not differ. CONCLUSIONS: Long GnRH-a regimens improved follicle yield and the endocrine milieu in spite of comparable exogenous gonadotropin dose and lower serum FSH and thus appear to be preferable in assisted reproduction. Reduced folliculogenesis found in flare-up GnRH-a regimens could be mediated by the atretic effects of high intraovarian androgens. Efficacy of purified FSH and hMG was comparable.

Treatment of anovulation with pulsatile gonadotropin-releasing hormone: prognostic factors and clinical results in 600 cycles.

Pulsatile GnRH (pGnRH) was administered to 292 anovulatory patients in 600 consecutive cycles between February 1984 and February 1993. This represents the largest single pGnRH series ever reported. Patients were divided into the following groups: primary hypogonadotropic amenorrhea (PHA), 73 patients, 161 cycles; other hypogonadotropic hypogonadisms (OHH), 57 patients 107 cycles; multifollicular ovary (MFO), 39 patients 75 cycles; polycystic ovary (PCO), 85 patients 172 cycles; and other hyperandrogenic anovulations (OHA), 38 patients 85 cycles. GnRH was administered iv at a dose of 1.25-20.0 micrograms every 30-120 min; most cycles (505) were performed with a regimen of 2.5-5.0 micrograms GnRH every 60-90 min. In 228 cycles of MFO, PCO, and OHA patients, pGnRH was preceded by GnRH agonist (GnRH-A) suppression. Ovulatory rates were 75%, and pregnancy occurred in 105 cycles (pregnancy rate of 18%/treatment cycle and 23%/ovulatory cycle). Ovulatory and pregnancy rates were higher in PHA, OHH, and MFO and lower in PCO and OHA. Only 4 multiple pregnancies occurred (3.8%), none after GnRH-A suppression. The abortion rate was 30% and was highest in PCO (45%). GnRH-A pretreatment improved ovulatory rates only in PCO (from 49% to 71%; P < 0.001), whereas it had no significant effect on pregnancy and abortion rates in any group. Higher weight and insulin were associated with lower ovulatory and pregnancy rates; higher LH and testosterone were associated with lower ovulatory rates only. We conclude that 1) pGnRH is a highly effective ovulation induction method; 2) pGnRH does not cause ovarian hyperstimulation; 3) low dose pGnRH is associated with a remarkably low incidence of multiple pregnancy; 4) GnRH-A pretreatment improves pGnRH outcome in PCO and further lowers the incidence of multiple pregnancy; 5) pGnRH is associated with relatively elevated abortion rates, particularly in PCO; and 6) pGnRH is less successful in overweight patients and when high baseline LH, testosterone, and insulin levels are present.

Increased insulin secretion in patients with multifollicular and polycystic ovaries and its impact on ovulation induction.

OBJECTIVE: To assess the oral glucose tolerance test (OGTT)-stimulated insulin secretion and its relation to pulsatile GnRH ovulation induction outcome in patients with multifollicular or polycystic ovaries (PCOs). DESIGN: Prospective study. SETTING: Reproductive Endocrinology Center, University of Bologna, Bologna, Italy. PATIENTS: Eight normal and 29 anovulatory women (8 with multifollicular ovaries and 21 with PCOs). INTERVENTION: A standard OGTT was performed in all subjects. In all anovulatory patients, ovulation was induced with pulsatile GnRH (5 micrograms i.v. every 60 minutes). In multifollicular ovary patients, pulsatile GnRH was administered alone, whereas in PCOs it was preceded by GnRH agonist (GnRH-a) suppression. MAIN OUTCOME MEASURES: Glucose, insulin, and C-peptide response to the OGTT, expressed as area under the curve (AUC). Ovulatory rates in response to pulsatile GnRH. RESULTS: Insulin and C-peptide AUC were greater than controls in both multifollicular ovary and PCO patients. Insulin AUC was positively correlated to ovarian volume. Ovulation was achieved in 88% and 57% of multifollicular ovary and PCO patients, respectively. Body mass index and glucose AUC but not insulin and C-peptide AUC were significantly greater in the anovulatory PCO. CONCLUSIONS: [1] Insulin AUC was increased in both multifollicular ovary and PCO patients; [2] derangements of insulin secretion may be present in a greater variety of anovulatory patients than previously thought; [3] insulin levels during the OGTT did not predict a response to pulsatile GnRH in PCOs, suggesting complex insulin interactions at the ovarian level; [4] given the in vitro stimulatory properties of insulin on granulosa cells synergistic with FSH, we propose that excessive insulin levels may contribute to the ovarian enlargement often found in multifollicular ovary and PCO patients.

Charcot and his drawings: images from "les leçons du mardi à la Salpêtrière 1887-1888".

In this paper, the authors pay tribute to Jean Martin Charcot in the centenary of his death (16th August 1893), concentrating on his artistic sense and drawing ability. The authors give some examples of the drawings Charcot used to illustrate his Tuesday Lessons at Salpêtrière, together with his highly precise clinical and semiological descriptions.

Role of gonadotrophin releasing hormone secretory dynamics in the control of the human menstrual cycle.

The pattern of episodic gonadotrophin releasing hormone (GnRH)-driven luteinizing hormone (LH) secretion changes dynamically across the human menstrual cycle. Adherence to a specific regimen of pulse amplitude and frequency is critical for normal ovulation, menstrual cyclicity and reproductive function. Derangements of episodic LH secretion are associated with anovulation. We have shown that in the human slowing of GnRH-induced LH pulses results in lower ovulatory rates and dysfunctions of the mid-cycle LH surge. This information is relevant for the understanding of the endocrine dynamics of the menstrual cycle both in normal and anovulatory subjects.

Comparison of the suppressive capacity of different depot gonadotropin-releasing hormone analogs in women.

Different depot GnRH analogs (GnRH-A) are currently used for the reversible suppression of the pituitary-ovarian axis in several reproductive and neoplastic disorders in women. In spite of anecdotal reports of incomplete suppression by some depot GnRH-A, this issue has never been systematically investigated in adult women. Thus, we elected to study 40 normally cycling women with male-related infertility or benign reproductive disorders; each group of 10 subjects received a different GnRH-A for 3 months: buserelin (group B; 300 micrograms, sc, every 12 h, as a control), goserelin (group G; 3.6 mg, sc, every 28 days), leuprorelin (group L; 3.75 mg, im, every 28 days), and triptorelin (group T; 3.75 mg, im, every 28 days). Depot GnRH-A was administered by one of the investigators. GnRH tests (100 micrograms, iv) were performed before treatment (cycle day 7; test A) and on treatment days 57 (i.e. 1 day after the third depot GnRH-A; test B) and 84 (i.e. 28 days after the third depot GnRH-A; test C). Immunoreactive (i) LH levels were measured with an ultrasensitive immunochemiluminometric assay. Profound suppression of the iLH response to the GnRH test occurred in all subjects during treatment. Conversely, FSH levels in the third month of treatment tended to be higher in the depot GnRH-A groups than in group B, and this difference achieved statistical significance (P < 0.05) in groups G and L during test C. In GnRH test B, while the mean estradiol (E2) level was less than 75 pmol/L (< 20 pg/mL) in all group B subjects, individual E2 levels were greater than 75 pmol/L in five patients receiving depot GnRH-A (two in group G, one in L, and two in T). Finally, individual E2 levels during test C were greater than 75 pmol/L in only two patients of group G, who also reported vaginal spotting. Thus, we conclude that in adult women, 1) iLH was profoundly suppressed in the third month of administration of all GnRH-A tested; 2) FSH suppression with depot GnRH-A was less marked than that with high-dose short-acting sc buserelin; and 3) signs of an incomplete block of ovarian function can be present in the third month of depot GnRH-A administration, particularly when goserelin is employed.

The care of epileptics: from the madhouse to the League against Epilepsy.

We trace the first steps in the organization of the International League against Epilepsy, the great initial impetus for which came from an Italian savant, Prof. Tamburini, among others. The League came into being because of the need to differentiate epilepsy from insanity and to channel into a single institution all research into the etiopathogenesis, new therapies and principles of care to ensure their rapid diffusion all over the world.