Liver cirrhosis and the risk of primary liver cancer.

The relationship between liver cirrhosis and hepatocellular carcinoma is recognized, but quantification of risk is still uncertain. Therefore, we analysed data from a case-control study conducted in Italy between 1984 and 1997 on 499 cases of incident, histologically confirmed hepatocellular carcinoma and 1,552 controls in hospital with acute, non-neoplastic disease. Overall, 87 (17.4%) cases vs 10 (0.6%) controls reported clinical history of liver cirrhosis. The corresponding odds ratio (OR) was 27.5 (95% confidence interval (CI), 14.3-15.2) after allowance for sociodemographic factors, and 16.2 (95% CI, 7.9-32.9) after simultaneous allowance for all identified confounding factors, including alcohol consumption and clinical history of hepatitis. The association was of similar magnitude for subjects whose cirrhosis was diagnosed < 55 years (OR = 14.8) or at age 55 or over (OR = 20.0), and the multivariate OR was 33.7 < 5 years after diagnosis of cirrhosis, 37.3 between 5 and 9 years, and 7.6 (95% to 2.7-21.3) > or = 10 years since diagnosis of cirrhosis. The association was stronger in males (OR = 23.4) than in females (OR = 5.9), similar in various age groups, and somewhat stronger in more educated subjects (OR = 53.7), with history of hepatitis (OR = 33.1), reporting heavy alcohol consumption (OR = 24.9) or high body mass index (OR = 58.1), although the interaction term was significant only for sex. In terms of population attributable risk, 17% of hepatocellular carcinomas in this population can be attributed to clinical history of liver cirrhosis.

Protein nitrogen appearance in CAPD patients: what is the best formula?

BACKGROUND: The protein equivalent of nitrogen appearance is an indirect index commonly used to assess dietary protein intake in patients on CAPD. Moreover it has been suggested that the ratio between nitrogen appearance and dietary nitrogen intake (fractional urea synthesis) can predict nitrogen balance in uraemic patients. Several formulae to directly calculate the protein equivalent of nitrogen appearance have been published. It has not been established, however, what formulae give the most appropriate estimate of protein intake and nitrogen appearance. STUDY DESIGN: Nitrogen balance studies were carried out in seven stable patients on CAPD. All of the patients were receiving a diet whose protein content (1.2 g/kg/body wt/day) and calorie content (35 kcal/kg/body wt/day) were rigorously controlled. Six formulae for calculating protein equivalent of nitrogen appearance and nitrogen appearance were tested and the agreement of the estimating formulae was evaluated by means of the Bland and Altman method. RESULT: Net nitrogen balance was 1.68 +/- 0.9 g/N day, protein intake (g/day) 81 +/- 19, protein intake (g/kg) 1.05 +/- 0.17. Differences in protein equivalent of nitrogen appearance of up to about 20% were found. The smallest differences between protein equivalent of nitrogen appearance and protein intake were obtained by the formulae of Bergstrom (1 +/- 7 g, limits of agreement -12 and +15 g) and Blumenkrantz (-2 +/- 5 g, limits of agreement -11 and +7 g). The formula of Bergstrom most closely estimated nitrogen appearance (-0.35 +/- 0.89 g). Using such formula, the fractional urea synthesis was 54 +/- 12%, giving evidence of positive nitrogen balances. CONCLUSION: For the routine monitoring of protein equivalent of nitrogen appearance in CAPD patients, we recommend Bergstrom's formula with the determination of dialysate protein losses.

Number of sexual partners, condom use and risk of human immunodeficiency virus infection.

BACKGROUND: To analyse the relation between number of sexual partners, selected sexual habits and the risk of human immunodeficiency virus (HIV) infection. METHODS: We conducted a case-control study nested in a cross-sectional survey conducted among subjects attending sexually transmitted diseases (STD) clinics in Northern Italy. Eligible for the study were 1711 subjects (1259 males, 452 females) who referred themselves for the first time between September 1988 and March 1993 to three STD clinics in Northern Italy for suspected STD or STD treatment. A total of 145 subjects (113 males and 32 females) were HIV positive. RESULTS: In comparison with subjects reporting no or one sexual partner over the 3 years before the interview, the estimated odds ratios (OR) of HIV serum positivity were 1.2 (95% confidence interval [CI]: 0.6-2.3), 0.8 (95% CI: 0.4-1.8) and 0.3 (95% CI: 0.4-2.5) in subjects reporting 2-3, 4-5, and > or = 6 partners, respectively. The results were similar considering separately males and females and in men reporting only homosexual partners. Regular condom use decreased the risk of HIV infection: in comparison with subjects reporting no or occasional use of condoms, the OR of HIV infection was 0.5 (95% CI: 0.4-0.8) for regular users. Considering men only, compared with men with no homosexual intercourse, the OR of HIV infection was 2.3 (95% CI: 1.4-3.9) in those reporting bisexual intercourse and 2.2 (95% CI: 1.2-4.2) in men reporting only homosexual intercourse (among homosexuals). There was no relation between HIV infection risk and receptive anal sex. CONCLUSIONS: The risk of HIV infection does not increase linearly with the number of sexual partners in this population. This is reasonable, as the prevalence of HIV infection in this population is essentially determined by drug use. Caution is needed in the interpretation of these results since the analysis of role of number of sexual partners in male intravenous drug users is impaired by low statistical power.

PIP: It remains to be clearly established how multiple sex partners affect the risk of HIV infection. Northern Italy is a region where the prevalence of HIV infection is high mainly among IV drug users. The authors conducted a case-control study nested in a cross-sectional survey among subjects attending three STD clinics in Bergamo, Brescia, and Verona with the goal of analyzing the relationship between the number of sex partners, selected sex practices, and the risk of HIV infection. The study population was comprised of 1259 males and 452 females who referred themselves for the first time between September 1988 and March 1993 to the clinics for suspected STD or STD treatment. The men were of median age 30 years in the range of 16-70, while the women were of median age 28 years in the range of 16-61. 113 males and 32 females were HIV-seropositive. In comparison with subjects reporting no or one sex partner over the three years before the interview, the estimated odds ratio (OR) of HIV serum positivity were 1.2, 0.8, and 0.3 in subjects reporting 2-3, 4-5, and 6 or more partners, respectively. The risk of HIV infection therefore does not increase linearly with the number of sex partners in this population. These results were similar considering separately males and females and among the 91 men reporting only homosexual partners. 165 men reported themselves as being bisexual. Regular condom use decreased the risk of HIV infection such that the OR of HIV infection was 0.5 for regular users compared to subjects who reported no or occasional use of condoms. Considering men only, compared with men with no homosexual intercourse, the OR of HIV infection was 2.3 among those reporting bisexual intercourse and 2.2 among men reporting only homosexual intercourse. There was no relation between HIV infection risk and receptive anal sex. IV drug use was strongly associated with HIV-seropositivity, while a history of STD was more frequently reported by HIV-positive subjects than by HIV-negative subjects.

Determinants of sexual habits in Italian females.

OBJECTIVE: To identify characteristics of women reporting multiple sexual partners and early age at first intercourse in Italy. METHOD: Information on 1139 control women (median age 54 years) interviewed as part of a case-control study of cervical neoplasia conducted in the greater Milan area, Northern Italy were analysed using stratified analysis and multiple logistic regression. RESULTS: Overall, 81% of the study sample reported no more than one sexual partner, 10% two and 9% three or more. The proportion reporting multiple sexual partners tended to be higher among younger and more educated women (4% vs 19% of women with respectively less than 7 and 12 or more years of education reported three or more partners). Ever smokers reported a higher number of sexual partners than never smokers. The proportion of nulliparae reporting three or more sexual partners was higher than that of parous women. These findings were confirmed after taking into account in a multivariate analysis the role of potential confounding factors. Furthermore similar findings emerged from an analysis restricted to women aged 40 years or less. Always considering number of sexual partners, no relationship emerged with marital status, spontaneous or induced abortions, lifetime number of reported Pap smears and contraceptive habits. With reference to age at first intercourse, 25% of the study population reported their first intercourse at age 18 or before, 34% between 19 and 22 years, and 41% at age 23 or later. Younger women (that is, more recent cohorts) more frequently reported earlier age at first intercourse and the proportion of never married women reporting early intercourse was higher (51% vs 22% of never married vs married women). No relationship emerged between education, smoking habits, parity, history of spontaneous or induced abortions, number of Pap smears, contraceptive habits, and age at first intercourse. CONCLUSION: This study documents conservative sexual habits in Northern Italian females (at least on the basis of self reporting) but indicates that any educational compaigns towards safe sex should be focused towards younger women, particularly smokers, unmarried and nulliparae.

Segmental lentiginosis with "jentigo" histologic pattern.

We report a case of segmental lentiginosis (unilateral lentiginosis), that is, asymmetric distribution of lentigines on one side of the body, in a 23-year-old woman. Lesions involved the right side of the face and the cervical region, mostly within the area of division of the trigeminal nerve. Histologic examination disclosed a lentiginous pattern as well as some nests of melanocytes at the dermal-epidermal junction (so-called jentigo pattern). Similar cases have been described in the literature under the term "zosteriform lentiginous nevus," which in our opinion makes for confusion since the same term has also been used to describe cases that fit the diagnostic criteria for speckled lentiginous nevus (nevus spilus).

Risk factors for HIV infection in adults attending sexually transmitted disease clinics in Italy.

We assessed prevalence and risk factors for human immunodeficiency virus (HIV) infection in 637 patients (506 men, 131 women; median age 30 years, range 17-64) attending between September 1988 and July 1989 for the first time two sexually transmitted disease (STD) clinics in Northern Italy, for suspected or STD treatment. A total of 44 subjects (6.9%, 95% confidence interval, (Cl): 4.9-8.9) were seropositive for HIV antibodies. The prevalence of HIV infection decreased with age, from 9% in patients aged 24 years or less to 3% in those aged 45 years or more (chi 21 trend 4.97, p less than 0.05). Women tended to have a lower prevalence of infection than men (5.3% versus 7.3%) but this was not statistically significant. Compared with men reporting no homosexual intercourse, HIV infection risk was about 50% higher in those reporting bisexual intercourse (age- and sex-adjusted odds ratio (OR) 1.5,95% Cl: 0.6-3.6) and about fourfold in those reporting only homosexual intercourse (OR 3.8, 95% Cl: 1.7-8.5). No clear trend in risk was observed with number of sexual partners both in men and in women. Intravenous drug users had an increased risk of HIV infection; compared with non-users, the OR was 5.6 (95% Cl: 3.0-10.5) in users, and the point estimates increased with frequency of use, from 3.3 (95% Cl: 0.8-11.5) in occasional users to 6.4 (95% Cl: 3.2-12.8) in regular users. The risk of HIV infection was 2.2 (95% Cl: 1.1-4.3) in patients reporting a history of STD, and 1.6 (95% Cl: 0.8-3.3) in those reporting syphilis.(ABSTRACT TRUNCATED AT 250 WORDS)