Risk factors for Caesarean section in Italy: results of amulticentre study

A recent large increase in Caesarean section (CS) in Italy was the initial stimulus for a study to identify risk factors for CS and, if possible, to suggest strategies to counteract the rise. The study was conducted in three hospitals where a wide range of individual variables was collected from the clinical records and from personal interviews. Crude CS rates and odds ratios were evaluated for each single variable while logistic regression has been used to investigate possible confounding factors. The study involved 1316 consecutive deliveries. Crude CS rates were 29.4%, 15.7% and 16.1%. Variables identified as high risk factors were pre-eclampsia, previous CS, breech and other non-vertex presentations. Antenatal care under an obstetrician working in the same hospital, a low number of antenatal consultations, previous miscarriages, offer (by obstetrician) and request (by women) for CS showed significantly high odds ratios (ORs). Previous live births was strongly negatively associated with CS. No relationship between type of delivery and social status was observed while a physician factor was detected in all three hospitals where rates for different physicians ranged from 0% to 52.8%. Apart from the main medical indications for Caesarean section (previous CS, breech presentation), the results seem to indicate that individual practice style may be an important determinant of the wide variation in the rates of Caesarean delivery. While this may have been suspected before this study, these results are the first hard data to indicate that, in Italy, CS is widely performed for non-medical reasons.     

Associations of Dietary Patterns with Incident Depression: The Maastricht Study

Our aim was to assess the association between a priori defined dietary patterns and incident depressive symptoms. We used data from The Maastricht Study, a population-based cohort study (n = 2646, mean (SD) age 59.9 (8.0) years, 49.5% women; 15,188 person-years of follow-up). Level of adherence to the Dutch Healthy Diet (DHD), Mediterranean Diet, and Dietary Approaches To Stop Hypertension (DASH) were derived from a validated Food Frequency Questionnaire. Depressive symptoms were assessed at baseline and annually over seven-year-follow-up (using the 9-item Patient Health Questionnaire). We used Cox proportional hazards regression analyses to assess the association between dietary patterns and depressive symptoms. One standard deviation (SD) higher adherence in the DHD and DASH was associated with a lower hazard ratio (HR) of depressive symptoms with HRs (95%CI) of 0.78 (0.69–0.89) and 0.87 (0.77–0.98), respectively, after adjustment for sociodemographic and cardiovascular risk factors. After further adjustment for lifestyle factors, the HR per one SD higher DHD was 0.83 (0.73–0.96), whereas adherence to Mediterranean and DASH diets was not associated with incident depressive symptoms. Higher adherence to the DHD lowered risk of incident depressive symptoms. Adherence to healthy diet could be an effective non-pharmacological preventive measure to reduce the incidence of depression.     

Development of an immuno-lectin-enzymatic assay for the detection of serum cancer-associated glycoproteins bearing Tn determinant

We report the development of an immuno-lectin-enzymatic assay (CA83.4) with the purpose of quantifying serum glycoproteins bearing Tn determinant (GalNAc alpha-O-Ser/Thr). An anti-Tn monoclonal antibody (83D4) is bound to the solid phase in order to capture glycoproteins. After the addition of a test sample, we used biotinylated isolectin B4 from Vicia villosa and avidin-peroxydase to act as a detection system. The linear relationship between CA83.4 determinations and the serum dilutions, the reproducibility of the dosage in intra- and inter-assay, and the specificity of the test for the N-acetylgalactosamine residue in a-glycosidic O-linkages, demonstrated the reliability of this trial. Self-recognition of Vicia villosa B4 molecules (K-D: 0.73x10(-6) M determined using biosensor technology) could determine an additional step of signal amplification in this assay. Using 0.25 units/ml of CA83.4 antigen as the cut-off level, higher values were found in 25/49 patients with breast cancer, 8/13 with colorectal carcinoma, 3/11 with lung cancer, but in none of the 49 patients with non-malignant diseases nor in 97 healthy controls. This first report on soluble Tn-glycoprotein detection assays suggests that Tn-glycoproteins are specific serological tumor markers and we believe that they could represent a valuable tool in the diagnosis of cancer.     

Sexuelles Verhalten der italienischen Jugendlichen in Bezug auf das AIDS-Risiko

Zusammenfassung Ziel unserer Untersuchung ist es, die Kenntnisse und Einstellungen zum Thema AIDS sowie das sexuelle Verhalten der Jugendlichen zu erforschen. Die im Jahr 1993 begonnene Untersuchung wird durch die Aussendung eines anonymen Fragebogens an eine randomisierte Mustergruppe von 52 000 Jugendlichen im Alter von 19 bis 24 Jahren aus 363 Gemeinden durchgeführt. Für die gegenwärtige Zwischenauswertung sind 6929 der 18 132 bis zum jetzigen Zeitpunkt ausgesandten Fragebogen analysiert worden, wobei alle italienischen Regionen proportional eingeschlossen sind. Unsere Daten haben bislang ergeben, dass das Verhalten der Jugendlichen nicht immer darauf hinzielt, das Risiko einer sexuellen Übertragung der HIV-Infektion zu vermeiden. Es sind aber immerhin zwei Veränderungen beobachtet worden: Ein Ansteigen des Durchschnittsalters beim ersten Geschlechtsverkehr und ein häufigerer Gebrauch von Kondomen.

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Sexual behaviour of young Italians as regards risk of contracting AIDS

Summary The objective of this survey is to evaluate knowledge and sexual behaviour among young Italians (19 to 24 years). The project, began in 1993, is being carried out through an anonymous postal questionnaire, sent to a representative sample of the young Italian population (a total of 52 000 people from 363 Italian towns). In the present intermediate evaluation, we have analysed 6929 of the 18 132 questionnairs sent till now, with all Italian regions being proportionally included. Our data show that, after sexual activity has been started, it hardly seems to be limited to monogamy or to be always regulated by AIDS-preventing practices. Data show that the age of the first sexual intercourse is increasing (after age 18) and that condoms are used more frequently, particularly in occasional sex.

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Les comportements sexual des jeunes Italiens rapport le risque de contracter le SIDA

Résumé L'objectif de l'enquète est d'evaluer les connaissances et les comportements sexuels des jeunes Italiens d'àge consideré à risque pour l'infection du HIV (19–24 années). Le projet, débuté en 1993, à été mené avec un anonyme questionnaire postal, envoyé à l'echantillon représentatif des jeunes d'Italie (52 000 individues de 362 villes italiennes). Dans la présent partielle évaluation, nous avons evalué 6929 questionnaires des 18 132 jusqu'ici envoyé, toutes les régions italiennes sont proportionnellement compris. Les donnés montrent que, si les jeunes sont sexuellement actifs, c'est difficile qu'ils tendent à la monogamie ou qu'ils aient toujours pratiques sans risque du SIDA. Les donnés montrent aussi que l'âge du premier rapport sexuel est augmenté (àpres 18 ans) et que le preservatif est assez utilisé, surtout dans les rapports sexuels occasionels.

     

Tentorial Meningiomas. Report on Twenty-Seven Cases

Summary ? Objective. Report our experience with 27 tentorial meningiomas (TM) surgically treated between 1985 and 1998.  Methods. The records of 27 patients with TMs were retrospectively reviewed for clinical presentation, neuroradiological evaluation, surgical treatment and long-term outcome. The extent of tumor resection was scored according to the Simpson's grading for tumor removal. Long-term results were evaluated according to the Glasgow Outcome Score (GOS).  Results. The average age was 53 years. Female predominance was 74%. The most common complaints at presentation were headaches (51%), gait ataxia (33%), memory disturbances (30%) and hypo-acousia (30%). A classification of TMs into 5 subgroups according to tumor site is proposed on the basis of imaging studies. A cerebrospinal fluid shunt was established prior to direct approach in 7 patients and as the sole procedure in one inoperable patient. Twenty-seven direct approaches were undertaken in 26 patients, including 17 infratentorial and 10 supratentorial approaches. Total tumor removal was achieved in 20 patients (77%) and subtotal removal in 6 (23%). Fifteen patients (55%) experienced 22 postoperative complications. One patient died three months after a subtotal resection (mortality=3,7%). With a mean follow-up of 54 months, all 26 survivors are currently alive with 23 having resumed their normal activities and 3 needing assistance. Five of 6 patients with subtotal resection survived and were followed for a period ranging from 72 to 132 months: none showed residual tumor progression and no re-operation was considered. An additional patient experienced a ?true? recurrence 6 years after total removal, with no tumor progression 2 years after his recurrence was recognized.  Discussion. The best surgical approach to TMs is still a controversial matter. The advantages and drawbacks of conventional versus transbasal approaches are reviewed. Our experience suggests that subtotal removal can be associated with long recurrence-free intervals and preserved quality of life. TMs located at the tentorial edge carried a definitely worse prognosis than peripheral forms.     

Contrast-Enhanced Spectral Mammography and tumor size assessment: a valuable tool for appropriate surgical management of breast lesions

Purpose

To compare the accuracy of Contrast-Enhanced Spectral Mammography (CESM), MG, US, and breast MRI in estimating the size of breast lesions requiring surgery. The postoperative histology size of the lesion was used as the gold standard.

Material and methods

Two hundred thirty-three non-benign lesions in 189 patients were included in the analyses. All the selected patients underwent CESM and at least one other conventional diagnostic exam (US, MG, or MRI). Subsequently, all the patients underwent surgery preceded by cytological/histological examination. The largest diameter of the lesion at imaging was measured by a radiologist with more than 10 years’ experience and then compared with the size of the lesion in the histological sample at the surgery (gold standard).

Results

Among the 233 breast lesions, 196 were evaluated with US, 206 with MG and 160 with MRI. We found no statistically significant differences between size measurements using CESM and MRI compared with the measurements at the surgery (p value 0.63 and 0.51), whereas a significant difference was found for MG and US (p?<?0.001).

Conclusion

CESM is a reliable method for estimating the size of breast lesions: its performance seems superior to US and MG and comparable to MRI.

     

One-Year Angiographic Follow-Up after WEB-SL Endovascular Treatment of Wide-Neck Bifurcation Intracranial Aneurysms

BACKGROUND AND PURPOSE:Endovascular coiling of wide-neck intracranial aneurysms is associated with low rates of initial angiographic occlusion and high rates of recurrence. The WEB intrasaccular device has been developed specifically for this indication. To date, there has been no report of the long-term follow-up of a series of patients with aneurysms treated with this type of device, to our knowledge. Our aim was to evaluate a 1-year follow-up of angiographic results in a prospective single-center series of patients treated with the WEB-Single-Layer (SL) device.MATERIALS AND METHODS:All patients treated with the WEB-SL device in our center between August 2013 and May 2014 were prospectively included. One-year angiographic outcomes were assessed. Results at follow-up were graded as complete occlusion, neck remnant, or residual aneurysm.RESULTS:Eight patients with 8 unruptured wide-neck aneurysms were enrolled in this study. Average dome width was 7.5 mm (range, 5.4–10.7 mm), and average neck size was 4.9 mm (range, 2.6–6.5 mm). One-year angiographic follow-up obtained in all aneurysms included 1 complete aneurysm occlusion (12.5%), 6 neck remnants (75%), and 1 aneurysm remnant (12.5%). Of 8 aneurysms, worsening of aneurysm occlusion was observed in 2 (25%) by compression of the WEB device. There was no angiographic recurrence of initially totally occluded aneurysms. No bleeding was observed during the follow-up period.CONCLUSIONS:Endovascular therapy of intracranial aneurysms with the WEB-SL device allows treatment of wide-neck aneurysms with a high rate of neck remnant at 1 year, at least partially explained by WEB compression. Initial size selection and technologic improvements could be an option for optimization of aneurysm occlusion in WEB-SL treatment.

The WEB aneurysm embolization system (Sequent Medical, Aliso Viejo, California) is an intrasaccular braided device specifically developed for endovascular treatment of wide-neck intracranial aneurysms with the goal of disrupting flow at the aneurysm neck and promoting aneurysmal thrombosis without the need for reconstruction of the entire parent artery segment with a stent. Several types of WEB devices are currently available¹: the WEB-Dual-Layer (DL), which is made of 2 layers held together and creating 2 compartments, and the WEB-Single-Layer (SL), which is a single-layer device creating only 1 compartment. Only a few studies on the treatment of intracranial aneurysms by using the WEB-DL have been published,^2–5 and to date, only a single published article on aneurysms treated with WEB-SL reported a series including any anatomic follow-up.⁶ We recently published the 6-month clinical and anatomic outcomes of WEB-SL endovascular treatment.⁷The purpose of this study was to evaluate the 1-year angiographic results of patients managed with the WEB-SL device in a prospective single-center series.