Uterine myomas and smoking. Results from an Italian study.

OBJECTIVE: To evaluate the relationship between smoking and uterine myomas requiring surgery. STUDY DESIGN: We conducted a case-control study in Milan between 1986 and 1992. Cases were 476 patients under 55 years of age with histologically confirmed myomas. Controls were 1,283 women admitted to the hospital for a spectrum of acute, other-than-gynecologic, hormonal or neoplastic conditions (30% trauma, 25% nontraumatic orthopedic conditions, 25% surgical, 20% other miscellaneous). RESULTS: Cases were less frequently current smokers (22%) than controls (32%). In comparison with never smokers, the multivariate relative risk (RR) for myomas was 0.5 (95% confidence interval [CI], 0.4-0.7) in smokers. Ex-smokers were 10% of cases versus 7% of controls (RR 1.2, 95% CI 0.9-1.8). No clear trend in risk was observed with the number of cigarettes smoked per day or duration of smoking and risk of fibroids. The estimated RRs were largely consistent when separate analyses were performed in strata of age and other selected covariates, including indices of body weight. CONCLUSION: Current smoking seems to reduce the risk of myomas.

Validity of self-reported smoking habits in pregnancy: a saliva cotinine analysis.

BACKGROUND: We examined the validity of self-reported cigarette smoking during the third trimester of pregnancy using saliva cotinine as a marker. METHODS: Eligible for the study were 109 pregnant women attending the outpatient Prenatal Service of the Luigi Mangiagalli Clinic (the largest maternity clinic in Milan) for routine prenatal visits during the third trimester of pregnancy on twenty days in 1994. Women self-reporting current smoking or quitting smoking in pregnancy were asked to provide a saliva sample. Cotinine concentration was analyzed and classified as follows: cotinine not detectable, not probable nicotine use or passive exposure; cotinine <10 ng/ml, not probable nicotine use/probable passive exposure; cotinine, > or = 10 ng/m, probable occasional or regular nicotine use. RESULTS: A total of 57 (52.3%) women were non-smokers at conception and were excluded from any subsequent analysis. Of the remaining 52 women, 25 self-reported quitting smoking in pregnancy and 27 were current smokers. Saliva cotinine levels were below 10 in 20 of the 25 subjects reporting quitting smoking in pregnancy. The five cases with cotinine > or = 10 reported a husband smoking more than 10 cigarettes per day. Among the 26 current smokers, seven had a cotinine level <10 ng/ml (four reported smoking fewer then five cigarettes per day and two reported smoking five or more per day); in 20 cases the cotinine value was > or = 10 ng/ml. CONCLUSIONS: These findings provide evidence of a satisfactory validity of self-reported smoking habits in pregnancy.

Oral contraceptive use and risk of uterine fibroids.

The association between oral contraceptive (OC) use and the risk of uterine fibroids was analyzed in a case-control study conducted between 1986-1990. The subjects were 390 patients under 55 years of age with histologically confirmed fibroids and 1136 controls in hospitals for a spectrum of acute conditions (other than gynecologic, hormonal, or neoplastic) apparently unrelated to OC use. A total of 78 cases (20%) and 200 controls (18%) reported OC use. Compared with never-users, the multivariate relative risk for ever-users was 1.1 (95% confidence interval [CI] 0.8-1.5). No direct relationship emerged with duration of use, the estimated relative risk being 1.3 (95% CI 0.9-2.0) in users of OCs for less than 3 years and 0.8 (95% CI 0.5-1.3) in users for 3 years or more. The risk of fibroids was apparently (though not significantly) greater with longer recency of use: The estimated relative risks were 0.9 and 1.5, respectively, in women reporting last OC use less than 10 years before and 10 or more years before diagnosis of the disease. No relationship emerged with latency of use. There was no noteworthy interaction regarding risk of fibroids between OC use and potential covariates. These findings suggest that fibroids are unrelated to the use of OCs.

Indomethacin-related serum sickness-like illness with IgM lambda cryoparaprotein?

A unique association of a transient IgM lambda monoclonal gammopathy and a serum sickness-like illness, appearing after a short course of indomethacin, is described. The IgM lambda monoclone did cryoprecipitate along with fibronectin in hypotonic medium and disappeared with the resolution of the clinical picture. Emphasis is given to the role of some foreign antigens in the induction of benign monoclones.