Risk of sporadic amyotrophic lateral sclerosis associated with seropositivity for herpesviruses and echovirus-7.

We examined the association between risk of sporadic amyotrophic lateral sclerosis (ALS) and seroprevalence of antibodies to echovirus-7 (echo-7) and herpesviruses 6, 7, and 8 through a population-based case-control study. We enrolled in a northern Italy area 20 newly diagnosed ALS cases and 20 referents. Risk of ALS was higher in subjects seropositive for echo-7 when we used the immunofluorescent assay, while little increase was noted with the neutralization test. Considering the different characteristics of these two serological assays, these results suggest an association between disease risk and infection with enterovirus (EV) family members (not specifically echo-7). ALS risk was slightly associated with seropositivity of human herpesvirus-6 (odds ratio: 3.2; p = 0.102) and more strongly with human herpesvirus-8 seropositivity (odds ratio: 8.4; p = 0.064), though these point estimates were statistically unstable due to the limited number of observed cases. The findings of this study warrant further investigation in larger studies of the possible etiologic role of EV or herpesvirus infection in sporadic ALS.

[The biological effects of a nuclear explosion. Introduction of a new system on a colorimetric scale (black, grey, red, orange, yellow and white zone) to estimate the effects of fall-out on civilian populations]. / Effetti biologici di un'esplosione nucleare. Introduzione di un nuovo sistema in scala colorimetrica (Zona Nera, Grigia, Rossa, Arancione, Gialla e Bianca) per la stima degli effetti da Fall-out su popolazioni civili.

Following September 11 the eventuality of terrorist attacks using bags containing nuclear devices is considered possible in western cities like New York, London, Paris, Rome, Berlin, Moscow etc. However, with a modern Civil Defence programme the effects of a catastrophe of this nature can be partially limited, at least as far as Fall-out is concerned. The present paper explains the medical reasons for building anti-fall-out shelters for the larger part of western populations: from the USA to Russia. The paper also sets out a new method for classifying levels of radioactive Fall-out based on a scale of colours (black, grey, red, orange, yellow and white) whatever kind of radioactivity is involved (total gamma levels, Cesium 137 levels, Strontium 90 levels). The arrival times for fall-out in each area of the scale are fixed, whatever the energy of the explosion and the speed of the wind might be. The radioactive decay in each area of the scale, from the time of arrival of the fall-out is described with precision. Also described are the acute radiation syndrome, tumours, miscarriages and genetic diseases. A nomogram is attached for civil defence purposes showing the leeward extension of these areas, easily measurable in just a few minutes, if four parameters are known: ground zero (locality) of the explosion, the energy of the explosion, the direction of the wind and the speed of the wind.

Mortality in a population with long-term exposure to inorganic selenium via drinking water.

We analyzed the 1986-1997 mortality in a cohort of 2065 residents of an Italian municipality which had been exposed to drinking water with a high content of inorganic selenium over a long period of time, and compared it with mortality in the remainder of the municipal population. Mortality from malignant neoplasms increased [standardized mortality ratio (SMR) 1.17, 95% confidence interval (CI) 0.96-1.42], mainly due to an excess mortality from melanoma and colorectal cancer in both sexes, kidney cancer in men, and lymphoid malignancies in women. Overall cardiovascular mortality changed little (SMR 1.05, 95% CI 0.89-1.23), despite the higher cerebrovascular mortality (SMR 1.43, 95% CI 1.03-1.93). Coronary disease mortality slightly decreased (SMR 0.87, 95% CI 0.63-1.16), due to a low mortality among women. We also noted an excess mortality from Parkinson's disease in men and from motor neuron disease in women. Evaluation of these findings is, however, hampered by the lack of information about potential lifestyle confounders, the fact that the exposure could only be characterized by a simple dichotomization, and the inconsistencies of most estimates between the two sexes.

Prevalence and risk factors for urinary incontinence in Italy.

OBJECTIVES: To analyze the frequency and risk factors for urinary incontinence (UI) in Italy. METHODS: Eligible for this cross-sectional study were men aged >/=50 years and women aged >/=40, randomly identified among registered subjects of a network of general practitioners during the period March-October 1997. All subjects were invited by telephonic interview to determine the presence of UI, reported by the subjects as loss of urine in the last year. The subjects with UI were further questioned at home for evaluation of the type, degree and frequency of UI episodes. RESULTS: Of the 5,488 subjects interviewed (2,767 women and 2,721 men), 92 (3%) men and 316 (11%) women reported at least one episode of UI during the year before the interview. The frequence of UI increased with age both in men and women, being 2 and 11% in men and women, respectively, aged 50-60 years and 7 and 16% in those aged >/=70. Of the subjects with UI identified, 229 women and 64 men and a group of 289 subjects without UI were questionned at home using a detailed questionnaire. Six and 55% of men and women, respectively, reported stress incontinence, 20 and 12% urge incontinence and 20 and 24% mixed incontinence. The risk of UI increased with body mass index in women. A history of recurrent urinary infection was associated with UI in men and less markedly in women. No association emerged between education, smoking and alcohol or coffee consumption and risk of UI. Parity was directly associated with the risk of UI in women. CONCLUSIONS: The study offers a quantitative estimate of the prevalence of UI and its main risk factors in this Italian population.

Combined carboplatin plus ifosfamide and cisplatin in patients with advanced ovarian carcinoma. A phase I-II study. GOCS (Gynecological Oncology Cooperative Study).

Because of the relative lack of overlapping toxicity, carboplatin (PPL) and cisplatin (CDDP) can be easily combined for treatment of ovarian cancer to increase total platinum dose intensity. Ifosfamide (IFO), one of the most effective single agents in ovarian cancer, has a low hematological toxicity when administered in continuous infusion. From January 1991 to December 1993, 34 patients with advanced ovarian cancer, previously untreated with chemo- or radiotherapy, were enrolled in a phase I-II study with the aim of determining the maximum tolerated dose (MTD) of CDDP (on day 8 of a 28-day cycle) in combination with PPL (300 mg/m2 on day 1) and IFO (4,000 mg/m2/24 h by continuous infusion on day 1). The initial dose level of CDDP was 40 mg/m2, which was continuously increased by 10 mg/m2 up to the MTD defined as one dose level below that inducing dose-limiting toxicity (DLT) in at least two-thirds of treated patients; no dose escalation was allowed in the same patient. Grade 3-4 leukopenia and thrombocytopenia were observed in 54 and 49% of patients, respectively. The DLT was reached at 70 mg/m2 and therefore the dose recommended for the phase II study was 60 mg/m2. Complete (CR) plus partial response was observed in 88% of patients with a 21% pathological CR. With a minimum follow-up of 32 months (median 40 months), median progression-free survival and overall survival were 21 and 39 months, respectively. In conclusion, the combination of CDDP, PPL, and IFO provides an effective regimen for ovarian cancer with an acceptable toxicity profile.

Transvaginal color Doppler ultrasound for monitoring the response to neoadjuvant chemotherapy in advanced cervical cancer.

BACKGROUND: To evaluate the role of transvaginal color Doppler ultrasound in monitoring the response to neoadjuvant chemotherapy in patients with locally-advanced cervical cancer. METHODS: Fourteen patients with locally-advanced cervical cancer, scheduled for neoadjuvant chemotherapy, were investigated with transvaginal color Doppler ultrasonography before and at the completion of chemotherapy in order to study hemodynamic changes in cervical and intratumoral vessels. Twenty healthy women matched for age and parity served as a control group. Statistical analysis was performed with Student's t test for paired data. RESULTS: Statistically different blood flow recording between patients with cervical cancer and healthy controls could be observed only in intratumoral vessels. A significant increase of RI and PI values, recorded in both cervical artery and intratumoral vessels, have been observed in the group of patients responding to neoadjuvant chemotherapy. In patients with stable disease at the completion of chemotherapy, flow characteristics did not change significantly. CONCLUSION: Preliminary results of our study suggest that transvaginal color Doppler ultrasound evaluation of flow characteristics in the cervical and intratumoral vessels might be useful in monitoring the response to neoadjuvant chemotherapy in patients with invasive cervical cancer.

Giant malignant fibrous histiocytoma of the uterus.

A case of giant (32 Kg) malignant fibrous histiocytoma (MFH) arising from the uterus and occupying the entire abdomen and the pelvis is reported. The patient had debulking surgery, followed by combination chemotherapy, but died 7 months after diagnosis.

[La Peyronie's disease: anatomical and functional evaluation using color Doppler echography]. / Malattia di La Peyronie: valutazione anatomica e funzionale con ecocolor Doppler.

We performed color duplex ultrasound in patients with Peyronie's disease in order to define the anatomy of corpora cavernosa and penile vascular abnormalities. We evaluated 20 patients, affected by Peyronie's disease, using echo-color-doppler after pharmaco-injection of PGE1 and autostimulation. We find that impotent patients had decreased EDV after 30 Minutes and after autostimulation; all patients had a normal PSV. The echo-colo-doppler is a useful tool in the evaluation of the penile vasculature, in patients with Peyronie disease, for its high sensitivity, low invasiveness, and good acceptance from patients. The results of this test could safely guide the therapeutic choice.

[Role of expectant therapy in prostatic carcinoma of low grade and staging]. / Ruolo della expectant therapy nel carcinoma della prostata di basso grado e stadio.

Low stage and grade prostate cancer can be treated by radical prostatectomy, radiotherapy and expectant therapy. Preoperative evaluation with biopsy is in many cases unreliable to pathological stage and grade. In this study we considered 31 patients with prostate cancer, evaluated with directed ultrasound guided biopsy (15) or with sextant biopsy (16). Sextant biopsy showed better results. Grading was confirmed by radical prostatectomy specimen in 62.5%. The role of expectant therapy is then discussed.

[Transvaginal color-Doppler sonography for monitoring the response to neoadjuvant chemotherapy in patients with locally advanced cervical cancer]. / Eco color-Doppler transvaginale nel monitoraggio della risposta alla chemioterapia neoadiuvante in pazienti con cervicocarcinoma localmente avanzato.

Changes in blood flow characteristics, observed with transvaginal color-Doppler ultrasonography have recently been reported in patients with advanced cervical cancer. In order to evaluate the reliability of TVCDUS in monitoring the response to neoadjuvant chemotherapy in patients with locally advanced cervical cancer, a prospective study was undertaken on the blood flow characteristics of the cervical vessels. Pulsatility Index (PI) and Resistance Index (RI) of the uterine and cervical arteries of 12 patients with histologically proven advanced cervical cancer, scheduled for neoadjuvant chemotherapy were evaluated at diagnosis, during every cycle of chemotherapy and before surgery. A significantly lower value of mean PI and RI between cervical and uterine arteries was observed in patients with cervical cancer (PI = 1.671 +/- 0.18 vs 2.159 +/- 0.24)-(RI = 0.43 +/- 0.17 vs 0.72 +/- 0.22). Mean RI and mean PI of the descending branches of the uterine arteries were significantly lower in patients with cervical cancer, compared to healthy control women. No difference in blood flow parameters could be detected between stage I vs stage II-III, and between left and right cervical artery in patients with cervical cancer. Both RI and PI values appeared strictly related to the tumor response to chemotherapy. In fact in 8 patients in which treatment resulted in tumor regression, evaluated by pelvic examination and MR imaging, a significant (p < 0.01) increase of resistance indices was observed (PI = 1.671 +/- 0.18 vs 2.158 +/- 0.22)-(RI = 0.43 +/- 0.17 vs 0.79 +/- 0.16). On the other side 4 patients not responding to chemotherapy, had stable values of both PI and RI. Transvaginal color-Doppler ultrasonography might be useful in monitoring the response to neoadjuvant chemotherapy in patients with locally advanced cervical carcinoma.

[Familial neoplastic syndromes of the ovary. A family study]. / Sindromi neoplastiche familiari dell'ovaio. Studio di una famiglia.

The authors describe a case of Lynch II type familial ovarian cancer syndrome. The family was first observed following the almost contemporary manifestation of ovarian cancer in two sisters. A subsequent analysis of family history among first and second degree relatives showed the presence of ovarian cancer in two maternal aunts, carcinoma of the colon in the father and breast cancer in a sister of the patients. Surgical treatment was selected for ovarian cancer associate with polychemotherapy in both cases. The patients' only living sister underwent preventive ovariectomy at the end of her reproductive programme. The latter is still undergoing follow-up due to the risk of developing neoplasia starting from the peritoneum. The diagnosis of ovarian cancer should result in a careful analysis of the pedigree of the patient suffering from the disease in order to highlight cancer at an early stage in other members of the same family.

[Ultrasonically guided biopsy of the prostate for the diagnosis of carcinoma]. / La biopsia ecoguidata della prostata per la diagnosi di carcinoma.

Echoguided biopsy of the prostate is a new method used in the diagnosis of carcinoma. False negatives, which range between 7% and 27% of transperineal biopsies, can be reduced to 11% using ultrasound control. In 50% of cases carcinoma are located in the hypoechogenic area, in 45% in mixed echogenic areas and in 5% in hyperechogenic areas. The diagnosis of carcinoma was performed in 40.7% of patients examined. In conclusion, this method is shown to be a valuable and advisable aid.