Pulmonary and extrapulmonary acute respiratory distress syndrome are different

Acute respiratory distress syndrome (ARDS) can be derived from two pathogenetic pathways: a direct insult on lung cells (pulmonary ARDS (ARDSp)) or indirectly (extrapulmonary ARDS (ARDSexp)). This review reports and discusses differences in biochemical activation, histology, morphological aspects, respiratory mechanics and response to different ventilatory strategies between ARDSp and ARDSexp. In ARDSp the direct insult primarily affects the alveolar epithelium with a local alveolar inflammatory response while in ARDSexp the indirect insult affects the vascular endothelium by inflammatory mediators through the bloodstream. Radiological pattern in ARDSp is characterised by a prevalent alveolar consolidation while the ARDSexp by a prevalent ground-glass opacification. In ARDSp the lung elastance, while in ARDSexp the chest wall and intra-abdominal chest elastance are increased. The effects of positive end-expiratory pressure, recruitment manoeuvres and prone position are clearly greater in ARDSexp. Although these two types of acute respiratory distress syndrome have different pathogenic pathways, morphological aspects, respiratory mechanics, and different response to ventilatory strategies, at the present, is still not clear, if this distinction can really ameliorate the outcome.

[The role of human papillomavirus in cyto-histological practice: distribution and prevalenceof hig-risk strains (16, 18, 31, 33, and 35) in intraepithelial lesions and neoplasia of the uterine cervix]

INTRODUCTION

Many studies have already shown the association of persistent infection of human high risk papillomavirus (HPV) with the development of pre-invasive and invasive cervical disease.

MATERIALS AND METHODS

We evaluated the use of high risk HPV testing in a study of about 1908 women, aged 29-78, who attending, from 1996 to 1998, the Sant'Anna Hospital in Turin for routine, second level smears and histopathological diagnosis. We considered all cervical lesions: ASCUS, LSIL, HSIL, squamous and adeno invasive cancers. HPV testing was performed by polymerase chain reaction (PCR) using L1 consensus primers which can detect almost all infections (high and low risk types). The most important high risk HPV types (16, 18, 31, 33 and 35) were tested using specific primers.

RESULTS

The prevalence of high risk HPV was: ASCUS 42.2%, LSIL 39%, HSIL 73.5%, squamous invasive cancers 98.3% and adeno 100%. In addition HPV 16 is the most represented type in all lesions: ASCUS 40%, LSIL 62%, HSIL 71.2% squamous invasive cancers 73.3% and adeno 50.6%. In addition we study the mean age of cervical cancer onset compared with the different high risk HPV types. We found that HPV 18 related cancer occurs in younger women (mean age 41 years; range 39-42).

CONCLUSIONS

The addition of high risk HPV testing to cytology may improve early identification of women at risk for cervical cancer.

Psychological investigation in female patients suffering from urinary incontinence

The available data about the hypothesis that psychological conditions cause urinary incontinence are contradictory. This study was based on a group of patients undergoing urodynamic investigation to define the type of incontinence. Patients were submitted to a battery of psychological tests, including STAXI, CES-D and IBQ (in their Italian version). Patients suffering from urge incontinence showed higher degrees of inner anger and anger trait than those suffering from stress or mixed incontinence. Neither group showed signs of depression. The conviction of illness was greatest in patients suffering from stress or mixed incontinence, whereas irritability and general hypochondria prevailed in patients suffering from urge incontinence. Such patients tend to develop psychosomatic reactions that may contribute to the severity of their symptoms.

Hepatitis C virus, non-Hodgkin's lymphomas and hepatocellular carcinoma

In a case-control study in northeastern Italy hepatitis C virus infection seemed to increase by about 50-fold the risk of non-Hodgkin's lymphoma involving the liver and major salivary glands (i.e. larger than that for hepatocellular carcinoma) and by about fourfold the risk of lymphomas at other sites.

[Genital lichen in girls. General aspects and clinical course]

BACKGROUND

The authors re-examine the clinical aspects of infantile vulvar Lichen sclerosus in the light of the latest reports in the literature.

METHODS

A group of 40 girls was studied with a mean age of 8 years old suffering from this pathology; 8 of the subjects had reached a prepuberal age. The group received different types of therapy and maintenance during a six-month and then annual follow-up. The results are reported correlated to the type of treatment. The results obtained were also evaluated depending on the age of the subject, the onset of puberty in some during the course of the study, the age at onset of disease.

RESULTS

It was seen that recovery was mainly linked to aging and hence the evolution of puberty rather than the type of treatment, given that every drug has a predominantly symptomatic effect. The mean recovery time was 2.5 years (namely the average interval between diagnosis and puberty).

CONCLUSIONS

Contrary to the findings reported in the literature, lesions with an early onset (prior to adrenarche) recovered more slowly and later.

[Comparative study of diagnostic hysteroscopy and transvaginal ultrasonography in patients with abnormal uterine hemorrhage during the peri- and post-menopausal period]

BACKGROUND

The aim of this study was to determine the diagnostic value of hysteroscopy and transvaginal ultrasonography in patients with abnormal uterine bleeding (AUB) in the peri and postmenopausal period.

METHODS

302 patients with AUB, underwent hysteroscopy and in 86 cases, also a transvaginal ultrasonography before hysteroscopy was performed. Results were compared with the histological diagnosis.

RESULTS

The diagnostic accuracy of hysteroscopy was very high in the cases of endometrial carcinoma (sensibility 100%, specificity 99%), and lower in the cases of endometrial hyperplasia (sensibility 69%, specificity 72%) and endometrial atrophy (sensibility 29% and specificity 97%). Sonography proved to be less reliable in the diagnosis of endometrial pathology (carcinoma: sensibility 57%, specificity 100%, hyperplasia: sensibility 62.5% specificity 63%). The results of this study show that sonography may be used as a first choice diagnostic test in the investigation of women with AUB.

CONCLUSIONS

Hysteroscopy represent a second diagnostic step for achieving a proper histologic diagnosis.

Age differences in stress, coping, and appraisal: findings from the Normative Aging Study

Controversies exist concerning the influence of age on the stress and coping process, in part due to differences in methods across studies. We examined age differences in stress, appraisal, and coping, using both semistructured interview questions and a coping checklist in middle-aged, young-old, and old-old men. Despite extensive probing, nearly a quarter of the old-old reported having had no problems and they expended less coping effort even when they did have problems. The types of problems reported varied systematically with age. Middle-aged men were more likely to appraise their problems both as challenges and as annoyances than the older men. Different age patterns emerged from the coping interviews vs the checklists, but controlling for type of problem significantly attenuated age differences. However, there were no age differences in perceived stressfulness of the problem, appraisals of harm/loss, or helpless appraisals, number of emotions reported, or coping efficacy. One interpretation of these results is that the nature of stress changes with age, from episodic to chronic, which in turn affects appraisal and coping processes.

Influence of length of time on dialysis before grafting on kidney transplant results

The outcome of kidney transplantation was evaluated in 246 nondiabetic, CsA-treated recipients of primary cadaver transplant, divided into 4 groups according to length of time on dialysis: group < or = 2, 0-24 months; group 2-5, 25-60 months; group 5-15, 61-180 months; group > 15, over 180 months. The 4 groups did not differ in graft survival, proteinuria (g/die), or estimated GFR values at 1, 2, 3, 4, and 5 years after grafting. They did not differ in the frequency of cataract, hip osteonecrosis, tumors, or posttransplant diabetes mellitus at 3 years after grafting. Ocular hypertone (p < 0.02), tendon ruptures (p < 0.001), arterial occlusive disease of lower limbs (p < 0.01), cholelithiasis (p < 0.05), and chronic hepatitis--which occurred only in anti-HCV and/or HBs Ag-positive patients--(p < 0.001), were more frequent in group > 15, and in all these cases but ocular hypertone a linear trend of increasing frequencies with increasing dialytic age was statistically significant. Group 5-15 had the lowest patient survival (p < 0.02). Moreover, a progressive decline of patient survival with increasing dialytic age was noted in groups < or = 2, 2-5, and 5-15. Unexpectedly, group > 15 had remarkably good survival, and this finding denies the hypothesis of a purely linear decline of patient survival after transplantation with increasing dialytic age.

Importance of donor/recipient body weight ratio as a cause of kidney graft loss in the short to medium term

The importance of the donor/recipient body weight ratio (DRBWR) as a cause of kidney graft loss was evaluated in 112 non-diabetic, ciclosporin-treated, first cadaver kidney transplant recipients. According to the DRBWR, the patients were divided into three groups: 'low' (< or = 0.80), 'medium' (0.81-1.20), and 'high' (> 1.20). The three groups did not differ in patient or graft survival, and the DRBWR was not a predictor of graft failure at multivariate analysis (Cox models), even after only patients with graft survivals > 1 year were considered. The three groups did not differ in glomerular filtration rate (GFR) and proteinuria 6-60 months after renal transplantation. When the 55 patients with a follow-up period > 4 years were considered, no differences between groups were found in GFR or GFR evolution over time. Hypertension was significantly less frequent in group 'high' (Mantel-Cox p = 0.04), but very likely as a consequence of uneven recipient gender (an independent predictor of hypertension at multivariate analysis) distribution between groups, the significance being lost when survival curves were rebuilt by stratifying for recipient gender. DRBWR never resulted as a significant predictor of GFR at multivariate analysis when GFR values 6-60 months after transplantation were analyzed. We conclude that the DRBWR has no major effects on kidney graft function and survival in the short to medium term.

[Sports and adolescence: the effect of competitive athletics on menstrual function]

A group of 381 girls, 12 up to 19-years-old, engaging in competitive sports (athletics, basketball, dancing, gymnastics, swimming, ski-ing, tennis, volley-ball) was examined. Age at menarche and menstrual characteristics were correlated with the body weight, the competitive practice start age, the kind of the sport and the amount of training hours/week. Collected data were compared with the ones from a pool of 387 girls of equivalent mean age, not playing any sport. Delay of menarche and larger frequency of menstrual disorders, found among athletes, turned out to be directly proportional to the amount of time devoted to training and to the kind of performed sports. Irregular cycles are more frequent in athletes having a normal or lower body weight and do not normalise proceeding in sporting activities.

Clinical significance of vesicoureteral reflux after kidney transplantation

In this study 103 out of our 125 CsA-treated patients who received between January 1985 and December 1989 a first cadaver kidney transplant that functioned for at least one year were studied with voiding cystography (VC) for vesicoureteral reflux (VUR). All patients had an external uretero-neo-cystostomy. VUR occurred in 89 (86.4%) patients. Patients were grouped according to VUR: absence of VUR (group 0), VUR grade I-II (group 1-2), and VUR grade III (group 3). The 3 groups were comparable for male/female ratio, cause of renal failure, cause of donor death, recipient and dialytic age, immunosuppressive therapy, follow-up, time of VC performance after transplantation. At 6 months and 1, 2, 3, 4, and 5 years after transplantation graft function, number of rejection episodes, and number of urinary tract infections (UTIs) were similar in the 3 groups. In groups 1-2 and 3 hypertension was more frequent than in group 0 and occurred even after the 6th month (whereas this did not happen in group 0), but the differences between the 3 groups were not significant. However, when only the 13 patients who were followed for 5 years were considered, the prevalence of hypertension after 5 years was significantly higher in groups 1-2 and 3 (both 100.0%) than in group 0 (33.3%) (chi-square = 7.88; p < 0.02). Finally, 4.5% of patients with VUR and no patients without VUR had septic episodes linked to UTIs, but the difference was not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cardiac rhythm disorder in infection caused by cytomegalovirus in patients with kidney transplant]

A higher incidence of arrhythmias was observed in 16 renal allograft recipients infected with Cytomegalovirus (CMV), as compared to 26 patients who were transplanted during the same period and did not contract the infection (43.7% vs. 3.8%; p less than 0.01). There was a highly significant difference in the incidence of sinus tachycardia (37.5% infected vs. 0% not infected; p less than 0.005), while the incidences of atrial fibrillation and ventricular ectopic beats were not significantly different. The arrhythmias always appeared in the early phases of the infection and disappeared after a certain period, lasting from one week to months. It is proposed that arrhythmias arising during CMV infection may be due to a myocardial CMV involvement.

Radioisotope evidence of varying transit of solid food in gastrectomized patients with and without dumping syndrome

Of 29 Billroth II gastrojejunostomy patients studied by scintigraphy, 11 were dumpers and 18 were non-dumpers; of 20 controls, 11 were patients with different gastric complaints and 9 volunteers with no history of gastrointestinal pathology. The tracer used was human albumin microspheres labelled with 99mTc, mixed thoroughly with a fresh scrambled egg, cooked as an omelet and eaten as a sandwich with white toasted bread. The transit and emptying of the radiolabelled meal in the gastric and derivative loop areas were followed with gamma camera 90-120 min. In the dumpers half-emptying times were significantly shorter than in the controls; in the non-dumpers they were even shorter. Dynamic selective analysis of the radiolabelled food transit through derivative afferent and efferent loops showed, on the other hand, different patterns for the two groups of gastroresected patients: the progression of propulsive waves was very irregular and constantly hyperperistaltic only in the dumpers.

[Dynamics of food transit in gastrectomized patients with and without dumping syndrome studied with the gamma camera and a marked meal]

Scintigraphy was performed on a group of patients following the administration of a solid radiolabelled meal. As a tracer, human albumin microspheres were used with 99mTc, mixed with fresh scrambled eggs, eaten as a sandwich in two slices of white bread. The analysis of transit and emptying-rate of the radiolabelled meal in the gastric or derivative loop areas was performed by means of a medium field (300 mm) gamma camera interfaced with a digital computer; the data were collected at 15" frames for 90'-120'. Twenty-nine patients were examined who had undergone sub-total gastrectomy: 11 of them were "dumpers" and 18 "non-dumpers"; moreover, 9 volunteers without any history of gastrointestinal diseases and 11 patients with different gastric disorders were checked. In the first group of gastrectomized patients the half-emptying time (T50) was significantly shorter than in the 11 people being checked (Md = 27.5 +/- 10.8 versus 69.6 +/- 19 minutes); in "non-dumpers" T50 was even shorter (Md = 24.2 +/- 13 min). There was no significant statistical difference between the two classes of gastroresected patients in both T50 and emptying-rate of the radioactive solid food, which excludes the accelerated transit as a factor in the functional post-prandial symptoms of the dumping syndrome. On the contrary, the dynamic selective analysis of the radiolabelled food transit through derivative afferent and efferent loops showed different patterns in the two groups of gastroresected patients: the progression of the propulsive wave was very irregular and constantly hyperperistaltic only in the dumpers.

[The effect of estrogens in the etiopathogenesis of endometrial adenocarcinoma]

Recent data suggesting that oestrogens also encourage the onset of adenocarcinoma of the endometrium in man are reviewed. Emphasis is placed on the fact that this is most likely to occur when prolonged oestrogeni stimulation is not suitably opposed by progesterone. It is felt that the latter, or its synthetic homologues, should be employed in all long-standing cases of exogenous or endogenous hyperoestrogenism.