Cancer in pregnancy: maternal and fetal implications on decision-making.

BACKGROUND: Cancer complicates one out of 1,000 pregnancies. No standardized therapeutic interventions have been reported for these patients. METHODS: Fifteen patients with cancer during pregnancy were diagnosed between 6.5 and 36 weeks of gestational age between January 1991 and December 2007. RESULTS: Among the 15 cases one patient with early diagnosis (11 weeks) asked for interruption of pregnancy, two patients rejected chemotherapy in order to avoid fetal effects, seven patients underwent surgery during the first or second trimester, and two patients agreed to start the treatment only after delivery. Standard platinum-based chemotherapy (cisDDP) was postponed in six patients to the second trimester (administered after surgery in 2 cases). Chemotherapy was started between 18.3 and 29.6 weeks (median 22.3 weeks). One patient had pPROM (22.3 weeks) after chemotherapy with cisDDP. Ten patients were delivered by elective cesarean section and three by vaginal delivery. Mean gestational age at delivery was 33.5 weeks (range 32.1-40.0); mean weight at birth was 2,550 g (range 1,250-3,450). None of the newborns showed congenital malformations, and all had normal Apgar scores. Anemia occurred in two newborns. At a median follow-up of 56 months (range 2-198 months) all children were well and healthy. Eleven out of 15 mothers are alive and well, and one is alive with disease. An advanced neoplasm was diagnosed in three patients who died. CONCLUSION: When platinum-based chemotherapy is administered during the 2nd-3rd trimester, adverse effects in newborns are comparable to those in the general population. Deliberate treatment delay to achieve fetal viability or to improve fetal outcome may be reasonable for patients with early-stage cancer.

Hepatitis C: reality of a renal unit.

Hepatitis C virus (HCV) seems to be the most important agent of non-A, non-B hepatitis. This study was undertaken to assess the prevalence of hepatitis C in our renal unit. Twelve patients (29%) had antibodies against HCV (anti-HCV). Seropositive patients were on hemodialysis for a longer period than seronegatives. Statistically significant associations with anti-HCV were: blood transfusions, at least 1 episode of elevated value of transaminases (2-fold) and fluctuations of transaminases. Our findings confirm the high prevalence of anti-HCV in hemodialyzed patients, the importance of parenteral transmission and the high probability of liver disease in anti-HCV-positive patients.

Active and inactive renin and kidney function in young subjects with different predisposition to develop essential hypertension.

Renal and cardiac function were measured in 65 offspring of hypertensive parents (OHP) and in 56 offspring of normotensive parents (ONP). In two additional groups of 24 OHP and 42 ONP plasma renin activity (PRA) and plasma active (PRAC), inactive (PRIC) and total (PRTC) concentration were measured. OHP had significantly higher renal plasma flow (p less than 0.01), glomerular filtration rate (p less than 0.02) and 24-hour urinary output than ONP, while PRA was lower (p less than 0.01). The measurements of the different forms of renin gave the following results: PRIC and PRTC were lower in OHP than in ONP, but the only statistically significant difference concerns PRIC (p less than 0.025). A possible interpretation of these findings is that a primary increased tubular ion and water reabsorption might be the cause of the kidney function pattern seen in OHP.

Renal dysfunction as a possible cause of essential hypertension in predisposed subjects.

In 65 young normotensive subjects with two hypertensive parents (HP), and in 55 matched subjects with two normotensive parents (NP), the following factors were measured: renal plasma flow (RPF), glomerular filtration rate (GFR) both as Inutest and creatinine clearances; 24-hr urinary output; plasma renin activity (PRA); Na and K in plasma and in 24-hr urine and 24-hr urinary excretion of aldosterone. In 30 HP and in 34 NP, the cardiac output and plasma concentrations of noradrenaline, adrenaline, and dopamine were also measured in the supine position and after 10 min of standing. The HP have greater RPF (P less than 0.01), faster GFR (P less than 0.02), greater 24-hr urinary output (P less than 0.05), and lower PRA (P less than 0.01) than the NP. All the other factors were similar in the two groups of patients. It is proposed that the differences in renal function in the HP and the NP may be due to an abnormality in tubular handling of ions and water in the HP, which may be responsible for the increase in blood pressure in a proportion of patients with essential hypertension.

[An approach to hypertension in a native population]. / Metodo di approccio all'iperteso su una popolazione naturale.

In the article the authors illustrate: a) a community detection program designed to identify subjects with high blood pressure for treatment; b) the degree of participation; c) the cost of realization; d) the prevalence of arterial hypertension. A total of 4.149 subjects, or 65% of the examined population over age 8, were screened. The opportunity to have their blood pressure checked were offered with a letter of invitation to a centralized ambulatory. The cost of realization was L. 360 for every screened subject. The prevalence of hypertension was 20.4%.

A renal abnormality as a possible cause of "essential" hypertension.

The renal abnormality which causes hypertension in the Milan hypertensive strain of rats disappears as hypertension develops. Because of the many analogies between the condition in these rats and "essential" hypertension in man, the same pattern of change may occur if a renal abnormality is the cause of essential hypertension in man. This hypothesis was tested in two groups of young normotensive subjects matched for age, sex, and body-surface area; in the first group both parents were hypertensive, and in the second group both parents were normotensive. Renal plasma-flow, glomerular filtration-rate, plasma-volume, plasma-renin activity, plasma-concentrations of Na+, K+, and catecholamines, 24 h urinary excretion of Na+, K+, and aldosterone, and the cardiac index were measured so that renal function and the role of factors affecting blood-pressure regulation could be assessed. Renal plasma-flow was significantly higher (p less than 0.01) in the first group, whereas results of tests for all the other factors were almost the same in both groups. The hypothesis that a primary kidney abnormality causes hypertension in a proportion of patients with essential hypertension is proposed.