Validity of Italian adaptation of the Dizziness Handicap Inventory (DHI) and evaluation of the quality of life in patients with acute dizziness.

The impact of dizziness on Quality of Life (QoL) can be assessed by the Dizziness Handicap Inventory (DHI), which is used as a discriminative and evaluative tool. Although the DHI is available in several languages, an equivalent version for the Italian population is not yet available. Aim of this study was to translate the DHI into the Italian language (DHI-I), assess its correlation to the Italian version of the Short Form-36 Health Survey and to investigate its reliability in evaluating the QoL of patients with acute dizziness. The study population consisted of 50 patients (76% females and 24% males), mean age 51.6 years, range 25-85 years (SD = 14.5). A cross-sectional design was used to examine the internal consistency (Cronbach's α) and concurrent validity (Pearson's product moment correlation r). The application followed the stages of translation from English to Italian and linguistic adaptation, grammatical and idiomatic equivalence review. To confirm the external validity of DHI-I, the Pearson correlation test between the total score and single subscales of DHI-I and the 8 scales of the Short Form Health Survey (SF-36) was performed. The Cronbach α coefficients for internal consistency were 0.92 for the DHI-I and 0.82, 0.84 and 0.75 for the sub-scale functional, emotional and physical, respectively. The frequency distribution of no one item showed a percentage higher than 75% in a single possible answer (0, 2, 4), excluding a ceiling or floor effect. Correlations with the total score of DHI-I were consistent and the correlation between total score of DHI-I and total score on SF-36 was -0.593. Of the single subscales, the emotional scale showed a closer correlation with almost all scales of the SF-36. The correlation between the total score of SF-36 and the single sub-scale of DHI-I (functional, emotional, physical) were respectively -0.599, -0.563, -0.398. The DHI was culturally and linguistically adapted for its application in the Italian population. The DHI-I demonstrated a good reliability and is recommended as a measure of disability in patients with dizziness and unsteadiness. According to the DHI-I, patients with acute dizziness and with a clinical diagnosis of vestibular syndrome presented a decreased QoL; the physical aspects were the most compromised.

Determination of ortho-cresyl phosphate isomers of tricresyl phosphate used in aircraft turbine engine oils by gas chromatography and mass spectrometry.

Tricresyl phosphate (TCP) is used as an anti-wear additive in aircraft turbine engine oil. Concerns about its toxicity are largely based on the tri-o-cresyl phosphate isomer content. However, the presence of other and more toxic isomers has been previously suggested. In this work, the structural isomers of TCP have been determined by two methods (experimental and semi-theoretical). First, the TCP isomers were separated by gas chromatography (GC) and identified by mass spectrometry (MS). Second, after base cleavage of TCP, GC was used to quantify the cresol precursors. These results were used to calculate the TCP isomer distribution based on the assumption of a statistical distribution of the TCP isomers. The results from the two determinations showed reasonable agreement for three of the four oils studied. The o-cresyl isomers were found to be present almost exclusively as the more toxic mono-o-cresyl isomers in the concentration range 13-150 mg/L. The ability to analyse for the mono-o-cresyl isomers allows the toxicity of TCP to be based on the latter isomers rather than on the less toxic tri-o-cresyl phosphate isomer.

Dietary fats, fatty acids and insulin resistance: short review of a multifaceted connection.

Insulin resistance is a growing worldwide phenomenon, which progressively develops over years, and finally, if unchecked, predisposes to cardiovascular disease and diabetes mellitus type 2. Insulin resistance is a generalized metabolic disorder characterized by inefficient insulin function in skeletal muscle, liver and adipocytes. There is growing evidence that an increased free fatty acid level, and more importantly, the relative amounts of saturated and unsaturated fatty acids contributing to it, plays an important role in the development of insulin resistance. In turn, this is a reflection of the composition of dietary fat. Ultimately both the dietary intake and plasma levels determine the fatty acid composition of cell membranes. Higher levels of membrane saturated fatty acids seem to greatly impair the action of insulin, whereas the presence of polyunsaturated fatty acids, especially of the omega-3 and -6 families, in contrast, improves insulin sensitivity. In vitro studies, however, have not always corroborated the clinical evidence. Possible roles played by the various saturated and unsaturated fatty acids in the insulin-signaling pathway are discussed in light of recent evidence. Fatty acids have also been shown to alter gene expression in cells, in particular the peroxisome proliferator-activated receptor-gamma2 gene, adding to this multifaceted connection. As man has moved over the centuries from a hunter-gatherer diet to greater intakes of saturated and trans-fatty acids, insulin resistance has appeared with its related pathology. Greater understanding of the role played by dietary fat and plasma fatty acids in pathogenesis of insulin resistance, will allow for more timely prevention and improved treatment in the future.

Otoacoustic emissions: a new method for newborn hearing screening.

Pediatric deafness is a handicap affecting approximately 2/1000 newborns. Currently, its diagnosis is markedly delayed, since it occurs approximately at 24 to 36 months of age; at this age rehabilitation procedures (i.e., acoustic prosthesis, speech therapy, psychological interventions on the family, or cochlear implants in the most serious situations) are unable to ensure a complete development of both the voice and the speech, thus preventing the full participation of the deaf child in social living. The turning point has taken place when methods and techniques were developed; they are aimed at the very early diagnosis of infantile deafness and are based on the recordings of otoacoustic emissions, that is, acoustic signals of extremely weak intensity originating in the inner ear, which not only is a passive transducer, but is able to generate sounds also. Any lack of or any change in otoacoustic emissions is a accurate index of disabling deafness. The test under study allows to perform selectively a mass screening on newborns (it is carried out 2 or 3 days after birth) since it is definetely non-invasive, it is done very rapidly (a few seconds only), it is cost-effective and higly reliable. The newborn hearing screening is being accepted, at a faster growing pace, by an increasing number of health systems in the whole world.

Distortion product otoacoustic emmissions in Ménière's disease.

Distortion product otoacoustic emissions (DPOAEs) are an objective, non-invasive measure for evaluating outer hair cell (OHC) activity. In this study DPOAEs were measured in 70 patients affected by Meniere's disease (MD). In addition 58 out of 70 patients performed both an audiometric threshold evaluation pre- and postglycerol administration (i.e. glycerol test) and DPOAEs pre- and post-osmotic drug assumption. The purpose of this combined form of testing was to explore the effects of glycerol on the active non-linear mechanisms of the cochlea. More than 60% of the ears with MD emitted DPOAEs despite the presence of an average hearing threshold level above 40 dB (HTL). Changes in the DPOAE baseline measures were observed in 32.4% of cases after glycerol administration. Patients were divided in four groups according to the different pattern of DPOAEs shown after the glycerol test. In particular, three-quarters of cases showed a significant increase in DPOAE amplitude, one-quarter of patients, who initially did not express DPOAEs, eventually did after intake of the osmotic agent, while no decreased DPOAEs were observed in these series. The different expressions of DPOAEs should be associated with the evolutive phases of MD. In addiction, elucidation of the relationship between DPOAEs and the stages of MD was an outcome of this test.

[The contralateral ear in acquired cholesteatoma in children and adults]. / L'orecchio controlaterale nel colesteatoma acquisito del bambino e dell'adulto.

Contralateral ear pathologies are frequently found in patients suffering from acquired cholesteatoma. A retrospective study was performed on 85 pediatric patients and 105 adults surgically treated for acquired middle ear cholesteatoma. All the patients were checked and the otomicroscopic picture photographed and compared in an attempt to gain insight into the pathogenesis and clinical indications by comparing two samplings from different age groups. In both groups the frequency of pathological contralateral ear manifestations was higher than found in the normal population. Similar results were obtained in the two groups and indicate that the same mechanisms come into play in both ears, starting at infancy. The finding of a particularly common association between cholesteatoma and contralateral retraction pockets with sinus cholesteatoma or pars tensa in the pediatric group appears to confirm that tubal dysfunction plays a pathogenic role in the genesis of cholesteatoma. From the practical point of view, systematic preventative measurement of the contralateral ear can lead to a reduction in major surgery and can affect the choice between open or closed tympanoplasty. Moreover, it may also condition the precision and length of the follow-up.

Residual uterine septum of less than 1 cm after hysteroscopic metroplasty does not impair reproductive outcome.

The objective of this study was to ascertain if incomplete correction leaving a residual uterine septum of < or = 1 cm affects fertility outcome. Reproductive outcome in 17 women with a residual septum of between 0.5 cm and 1 cm after hysteroscopic metroplasty was compared to that in 51 women with no residual septum or one of < 0.5 cm. Septal lysis was performed with microscissors or resectoscope. One month after operative hysteroscopy, abdominal ultrasonography was performed on all the women and those with a residual septum of > 1 cm then underwent a second operative hysteroscopy to complete the lysis. The cumulative pregnancy and birth rates were calculated and the curves compared using the log-rank test. The cumulative 18 month probability of becoming pregnant was 44.5% in the patients with residual septum and 52.7% in those with no residual septum (not significantly different), and the cumulative 18 month probability of giving birth to a child was 27.5 and 36% respectively (also not significant). The presence of a residual uterine septum of between 0.5 and 1 cm as shown by ultrasonography appears not to worsen the reproductive prognosis compared with that in women in whom the septum has been completely or almost completely corrected.

Histological impact of medical therapy--clinical implications.

The medium- and long-term effects of gestrinone and danazol on the endometrium were examined in 36 patients with endometriosis. Endometrial biopsies were taken from each patient before treatment and after 3 and 6 months of treatment with 600 mg danazol daily (n = 17) or with 2.5 mg gestrinone twice weekly (n = 19). Endometrial samples were analysed by light, scanning and transmission electron microscopy. At 3 months' treatment the endometria of patients treated with danazol appeared more atrophic than those of the women treated with gestrinone; some cell organelle involution was evident in all patients. After 6 months of treatment a marked atrophy was observed in patients of both treatment groups. A complete involution of cytoplasmic organelles with cytoplasmic collapse and a shift of nucleoplasmic ratio in favour of the nucleus occurred in patients treated with danazol; the cytoplasmic organelle involution was less marked in patients treated with gestrinone. Compared with gestrinone, danazol induces more rapid endometrial atrophy, with greater impairment of the cytoplasm and cell secretory activity.

Relief of dysmenorrhea associated with septate uteri after abdominal or hysteroscopic metroplasty.

We analyzed the postoperative modifications of dysmenorrhea in 90 patients with septate or subseptate uterus, but no other genital or pelvic disorders, who underwent metroplasty according to Tompkins (n = 28) or hysteroscopic metroplasty (n = 62). The frequency of dysmenorrhea fell from 50% to 32.1% after the Tompkins' procedure and from 54.8% to 17.7% after hysteroscopic metroplasty. The severity of dysmenorrhea evaluated with two scales, one linear and one multidimensional, showed a significant postoperative decrease in both the groups. In view of the limited cost and low risks of hysteroscopic metroplasty, primary dysmenorrhea associated with septate or subseptate uterus may be considered an indication for this intervention.

Reproductive prognosis after hysteroscopic metroplasty in 102 women: life-table analysis.

OBJECTIVE: To evaluate reproductive prognosis after hysteroscopic metroplasty. DESIGN: The cumulative proportions of women who became pregnant and gave birth, subdivided according to previous obstetric history, were calculated by the product limit method and compared using the log rank test. SETTING: Outpatient infertility clinic of Milan University. PATIENTS: One hundred two consecutive patients with complete (n = 23) or partial septate uterus (n = 79) referred because of infertility or repeated abortion. INTERVENTION: Hysteroscopic metroplasty performed by microscissors (n = 80), argon laser (n = 10), or electroresectoscope (n = 12). MAIN OUTCOME MEASURES: Postoperative cumulative pregnancy and birth rates. RESULTS: At 36 months the cumulative pregnancy and birth rates were 89% and 75%, respectively, in the septate uterus group and 80% and 67% in the subseptate uterus group. CONCLUSIONS: Reproductive prognosis after hysteroscopic metroplasty was favorable and not influenced by the malformation subclass.

Buserelin acetate in the treatment of pelvic pain associated with minimal and mild endometriosis: a controlled study.

OBJECTIVE: To evaluate the changes of pain symptoms induced by buserelin acetate, a gonadotropin-releasing hormone agonist, in a group of patients with endometriosis. DESIGN: Thirty-five infertile patients with one or more of the following symptoms (dysmenorrhea, pelvic pain, deep dyspareunia, and endometriosis stage I or II) were allocated randomly to treatment with buserelin acetate 1,200 micrograms/d IN for 6 months (n = 19) or expectant management (n = 16). Pain symptoms were recorded by the women themselves using a questionnaire that included two scales for pain evaluation: one analogue and one multidimensional. The treated and untreated patients were followed for a minimum of 18 and 12 months from the time of randomization, respectively. RESULTS: Buserelin acetate markedly reduced dysmenorrhea, pelvic pain, and dyspareunia during the treatment and also for the 12 subsequent months. During follow-up of the expectant management group, dysmenorrhea resolved in 19% (3/16) of the cases, and pelvic pain did not recur after diagnostic laparoscopy in one of the three women affected nor did deep dyspareunia in two of the five who reported the symptom before laparoscopy. CONCLUSION: Buserelin acetate induced a significant improvement of pain symptoms that persisted in approximately half of the patients even after withdrawal of the drug. However, symptoms associated with endometriosis showed a spontaneous remission in approximately one fifth of the untreated patients.

Presacral neurectomy for the treatment of pelvic pain associated with endometriosis: a controlled study.

OBJECTIVE: Our objective was to evaluate the efficacy of presacral neurectomy combined with conservative surgery for the treatment of pelvic pain associated with endometriosis. STUDY DESIGN: In a randomized, controlled study performed in a tertiary institution 71 patients with moderate or severe endometriosis and midline dysmenorrhea were randomly assigned to conservative surgery alone (n = 36) or conservative surgery and presacral neurectomy (n = 35). Main outcome measures were relief of dysmenorrhea, pelvic pain, and deep dyspareunia after surgery according to a multidimensional and an analog pain scale. RESULTS: Presacral neurectomy markedly reduced the midline component of menstrual pain, but no statistically significant differences were observed between the two groups in the frequency and severity of dysmenorrhea, pelvic pain, and dyspareunia in the long-term follow-up. After presacral neurectomy, constipation developed or worsened in 13 patients and urinary urgency occurred in three and a painless first stage of labor in two. CONCLUSION: Presacral neurectomy should be combined with conservative surgery for endometriosis only in selected cases.

Pain symptoms associated with endometriosis.

We evaluated the prevalence and severity of dysmenorrhea, pelvic pain, and deep dyspareunia and their relation to disease stage and site in 124 infertile women with endometriosis and 67 infertile women with normal findings. Seventy-eight endometriosis patients had stages I-II disease and 46 had stages III-IV. The frequency of dysmenorrhea was similar in patients and controls; pelvic pain was more frequent only in patients with stages III-IV, whereas deep dyspareunia was more prevalent regardless of disease stage. Dysmenorrhea was significantly more severe in stages III-IV patients than in either stages I-II patients or controls. Pelvic pain was more severe in stages III-IV, but we observed a statistically significant difference only in comparison with stages I-II. An association of two or more pain symptoms was more frequent in women with endometriosis than in those with normal pelves (relative risk = 3.1, 95% confidence interval 1.52-6.46). Ovarian endometriomas were the only lesions significantly associated with severe dysmenorrhea and pelvic pain. We conclude that endometriosis in infertile women causes pelvic pain, the severity of which is related to the extent of the disease.

Endometriosis and nonobstructive müllerian anomalies.

We reviewed the case records of all women (N = 748) who underwent laparoscopy for infertility in our department from 1985-1990. The patients were divided into two groups, cases and controls, according to the presence of nonobstructive müllerian anomalies (N = 198) or absence of such anomalies (N = 545); women with obstructive müllerian anomalies (N = 5) were excluded. The patients were analyzed for the presence of endometriosis, malformation class, and productive history. The frequency of endometriosis was 30.8% in the women with nonobstructive müllerian anomalies, versus 38.5% in the controls (P = .209). Among the subjects with unicornuate uterus, the prevalence of endometriosis (55%) was significantly greater compared with the patients with other nonobstructive müllerian anomalies (28%) (P less than .05), but not compared with the controls (38.5%). Overall, no differences were observed in the frequency of endometriosis between infertile women with and without nonobstructive müllerian anomalies. Our results seem to exclude a common pathogenetic factor underlying endometriosis and nonobstructive müllerian anomalies.

Ultrastructural aspects of endometrial surface in Kartagener's syndrome.

The endometrium of an infertile patient with Kartagener's syndrome showed initial secretory phase characteristics at SEM, whereas TEM analysis demonstrated several alterations in the central and peripheral microtubular distribution in 87% of the cilia examined. Such aspects seemed appropriate for a normal implantation, but the ciliary immotility or dyskinesia could cause an altered flow of the endometrial secretions and compromise the upstream movement of the spermatozoa.

Endometrial patterns during therapy with danazol or gestrinone for endometriosis: structural and ultrastructural study.

We treated 36 women with laparoscopically proven endometriosis with danazol 600 mg/d (n = 17) or gestrinone 5.0 mg/wk (n = 19) for 6 months. Endometrial samples were obtained before and at 3 and 6 months of treatment and were studied by light, scanning, and transmission electron microscopy. At 3 months of treatment, the endometria of the danazol-treated patients were more atrophic than those of the women who received gestrinone. Some cell organelle involution was evident in patients of both treatment groups. After 6 months of treatment, marked endometrial atrophy was observed in all the patients, including those in whom spotting had occurred. The ultrastructural investigation demonstrated complete involution of the cytoplasmic organelles with cytoplasmic collapse in glandular cells of patients treated with danazol, whereas in the gestrinone group degeneration phenomena were observed in both nucleus and cytoplasm. Irregular secretory transformation was seen in the endometria of patients in both groups. Long-term treatment with danazol caused endometrial atrophy similar to that induced by gestrinone, but it appeared earlier; thus, the former drug seems preferable in short-term treatment.

Endometrial patterns during danazol and cyproterone acetate treatment for endometriosis: structural and ultrastructural study.

We studied the endometrial structure and ultrastructure in serial biopsies from 16 patients with endometriosis treated with danazol (n = 9) or the combination cyproterone acetate plus ethinyl estradiol (n = 7) for 6 months. Biopsies were performed before and at 3 and 6 months of treatment. The material obtained was studied by light (LM), scanning (SEM) and transmission electron microscopy (TEM). A morphometric analysis was performed evaluating three morphometric and three stereologic indices. The results indicate that danazol had a progestational effect on endometrial glands and stroma, associated with a marked hypotrophy of the mucosa. The cyproterone acetate/ethinyl estradiol combination induced progressive atrophy of the endometrium with an increase in the stromal component and a reduction of glandular tissue.