Reproductive factors and risk of endometrial cancer.

The role of reproductive factors in endometrial cancer risk has been analyzed in a case-control study conducted since 1983 in the greater Milan area on 568 women (cases) with histologically confirmed endometrial cancer and 1925 women (controls) who were admitted for acute, nonmalignant, hormonal, gynecologic conditions to hospitals that cover a comparable catchment area. Compared with nulliparous women, parous women had a 30% lower risk of endometrial cancer, but there was no evidence of a decline in risk with increasing number of births. The risk of the disease decreased with number of spontaneous or induced abortions; the multivariate relative risk estimates were, compared respectively with no spontaneous or induced abortions, 0.5 for women with two or more spontaneous abortions and 0.3 for women with two or more induced abortions; both trends in risk were statistically significant. When parous women only were considered, no association emerged between endometrial cancer and age at first birth, but the risk decreased with increasing age at last birth: compared with women whose last birth occurred before age 25, the relative risk was 0.5 for women who were greater than or equal to 35 years old at last birth, and the multivariate trend in risk was statistically significant. For most of the reproductive factors that were considered, the risk estimates tended to be greater at younger age or among premenopausal women and to flatten off in subsequent strata of age. An association between endometrial cancer and age at first birth was observed in women who were less than or equal to 49 years old, but not in older groups. The observation that later age at last birth as well as later first birth in younger women decreases the risk of endometrial cancer suggests a short-term protective effect of pregnancy. This finding is consistent with a late-stage (promotional) effect of reproductive factors on endometrial carcinogenesis.

[Acute abdomen caused by spontaneous perforation of the colon]. / Addome acuto da perforazione spontanea del colon.

The literature on simple ulcer of the colon is reviewed. Three successfully treated cases of spontaneous perforation of the colon due to ulcer of the sigmoid, and single and multiple ulceration of the caecum are described, with particular reference to their aetiopathogenesis. The view that simple ulcer is caused by mechanical and circulatory factors, with or without inflammation, is expressed. Surgical management of this lesion must take the patient's age and local and general condition into account. These parameters will determine the type of operation employed, ranging from simple colorrhaphy to variously extensive resection of the perforated segment.

[Adenolymphoma of the parotid gland]. / Adenolinfoma della parotide.

Three personal cases of adenolymphoma of the parotid are described and attention is drawn to the rarity and benign nature of this form. Its anatomical and pathological features are discussed, along with the various theories concerning its histogenesis. Of these, the salivary theory is the most widely accepted. Lastly, an account is given of the symptoms (primarily consisting of cosmetic damage), differential diagnosis, and treatment (simple enucleation). The long-term prognosis is always good. Recurrences (also benign) are very rare.

[Treatment of gastroduodenal ulcers perforated into the free peritoneum. Apropos of 122 cases]. / Sul trattamento delle ulcere gastro-duodenali perforate in peritoneo libero. A proposito di 122 casi.

The treatment used in 122 patients suffering from perforation of gastroduodenal ulcer in free peritoneum is presented. 77 were subjected to straightforward suture of the perforation. Hemigastrectomy was carried out in 43 and in 2 superselective vagotomy associated with removal of the duodenal ulcer and duodenoplasty. Mortality in the series was 11.04% after suture but allowance must be made here for the serious condition of the patients who underwent this form of operation. Of the patients treated with straightforward perforation suture, 36.5% were reoperated for the reappearance of ulcerous symptomatology, while the remaining 63.7% were cured. On the basis of this experience, it is considered that superselective vagotomy associated or otherwise with pyloroplasty, and subtotal gastrectomy are indicated in patients in good general condition and in whom ulcer perforation symptomatology goes back less than 12 hours.