Risk factors for voluntary interruption of pregnancy and possible preventive public health actions.

INTRODUCTION: Voluntary interruption of pregnancy (VIP) is one of the most frequent healthcare procedures in the world and a Public Health concern in many countries, especially after liberalization of the abortion laws. The study has been carried out to identify the factors that still influence a fraction of female population towards abortion in the absence of fetal malformations. METHODS: We conducted a cross-sectional study in the period 2012-2016. The survey was carried out on all VIPs performed at the Gynecology and Obstetrics Unit of the University Hospital "G. Martino" in Messina, Italy. RESULTS: The analyzed sample consisted of 1131 women, aged between 16 and 50 years. Only 4% of VIPs was due to a diagnosis of fetal malformation. In relation to the presence or absence of fetal malformations as the possible reason for VIP, the sample was split up into two groups and the socio-demographic characteristics were considered. VIPs in the absence of malformations were significantly more frequent in younger women with a lower educational level, in unmarried and unemployed women and in women who already had children. These results were confirmed to Pearson test that indicated that all these variables were related to VIP in the absence of malformations. CONCLUSIONS: Based on our results, it is crucial to further prevent requests for VIPs through information and sex education programs for adolescents in schools and consultants, and responsible procreation promotion programs.

Capecitabine plus oxaliplatin and irinotecan regimen every other week: a phase I/II study in first-line treatment of metastatic colorectal cancer.

BACKGROUND: A phase I/II study was performed to determine the safety and activity of a capecitabine plus oxaliplatin and irinotecan (COI) regimen using capecitabine concurrently with oxaliplatin and irinotecan in previously untreated patients with metastatic colorectal cancer. PATIENTS AND METHODS: Patients received irinotecan on day 1, oxaliplatin (85 mg/m(2)) on day 2 and capecitabine (1000 mg/m(2) orally twice daily) on days 2-6 of a biweekly schedule. Three dose levels ranging from 150 to 180 mg/m(2) were explored for irinotecan in sequential cohorts of three to six patients. Once the recommended dose was determined, a total of 28 eligible patients were planned at this dose level. RESULTS: Thirty-eight patients received a median of six cycles. The recommended phase II dose of irinotecan was 180 mg/m(2). Toxicity was manageable: the most common severe toxicities were diarrhoea (24%) and nausea (16%). Of 27 assessable patients treated at the recommended dose, 17 achieved a partial response (overall response rate (ORR) 63%; 95% confidece interval (CI), 44 to 78%), with eight patients undergoing liver metastasectomy. Estimated progression-free survival and overall median survival were 8.5 and 23.5 months, respectively. CONCLUSIONS: Biweekly COI is feasible and active. Tolerability and ease of administration make the regimen well suited for downsizing hepatic colorectal metastases before curative surgery.

Wearing-off detection in clinical practice: the wearing off real practice key (WORK-PD) study in Parkinson's disease.

OBJECTIVE: Verifying the validity and feasibility of the WOQ-19 as a useful tool in routine clinical practice and in management of patients. METHODS: 532 consecutive Parkinson's disease (PD) patients were recruited from 6 different neurological outpatient units, specialized in movement disorders, of central Italy. Inclusion criteria were diagnosis of PD and any current pharmacological treatment of PD while exclusion criteria were evident cognitive or depressive impairment, infusion with dopamine agonists or Duodopa, or Deep Brain Stimulation therapy. Patients were asked to complete the Italian version of WOQ-19 before the neurological visit. A medical form for the collection of demographic and clinical data of patients and for the evaluation of comprehensibility and usability the WOQ-19 was filled by the neurologist during the visit. RESULTS: Our data confirmed that WOQ-19 was able to identify WO in 69% of patients, a percentage similar to the recently reported in the Italian WOQ-19 validation study. Motor symptoms were more frequent than non-motor symptoms (80% vs. 20%). Patients who experienced WO had a higher age of PD onset, more severe disease, longer disease duration and were more likely to be female. CONCLUSIONS: The WOQ-19 was understandable for the patient, easily administered and suitable for routine outpatient use. It could be also particularly useful in clinical practice in the early identification of non-motor symptoms, often under reported by patients and revealed only with clinical support.

Plasma growth hormone and prolactin response to dopaminergic GABAmimetic and cholinergic stimulation in Huntington's disease.

We studied the acute effects of pharmacologic stimulation of neurotransmitter systems implicated in growth hormone and prolactin regulation in eight patients with Huntington's disease and matched control subjects. Both apomorphine, a dopamine agonist, and muscimol, a GABA agonist, produced an exaggerated rise in plasma growth hormone levels in the Huntington patients. Neither the growth hormone response to a muscarinic agonist, arecoline, nor the prolactin response to any of these drugs differed in the patients and controls. Loss of somatostatin activity in the hypothalamic-pituitary axis in Huntington's disease could account for these endocrinologic changes.

THIP treatment of Huntington's disease.

We evaluated the therapeutic efficacy of gamma aminobutyric acid (GABA) system stimulation in four patients with classical Huntington's disease and one with the hypokinetic-rigid form. Orally administered THIP (4,5,6,7-tetrahydroisoxazolo-[5,4,-c] pyridin-3-ol), a novel GABA receptor agonist, failed to improve motor or cognitive function during a 2-week trial. At maximum levels, THIP mimicked another putative GABA agonist, muscimol, in causing unsteadiness of gait, diminished attention to sensory stimuli, and somnolence. These effects suggest that central GABA systems participate in the regulation of some human and behavioral functions. CSF content of homovanillic acid, a major metabolite of dopamine, increased during high-dose THIP therapy, suggesting that augmentation of dopaminergic function may have contributed to the drug's lack of efficacy.

The role of MAO-b inhibitors in the treatment of Parkinson's disease.

The classical treatment of Parkinson's disease (PD) using L-dopa plus a peripheral decarboxylase inhibitor (DI) often leads after 3-5 years to the onset of the so-called long-term L-dopa syndrome (LTS). LTS could depend on the chronic overload of L-dopa + ID and could be due to a consequent "receptor disease" and derangement of the neuronal functionality mainly in regard to the enzymatic chains, storage mechanisms and hyperactivity of the monoamine oxidase type B (MAO B). Deprenyl is a selective MAO-B inhibitor thought to be able to slow down the catabolism of dopamine and therefore to allow a decrease of the therapeutic regimen of L-dopa while in the meantime to obtain a more stable plasma and tissue levels and a constant therapeutic response. 76 parkinsonian patients were studied. Their L-dopa regimen was halved and 10 days after (-)deprenyl was added. After the decrease of L-dopa therapy a worsening of symptomatology was observed as expected. The association with (-)deprenyl was able to reverse this trend and when the inhibition of MAOB was really effective patients showed an improvement of symptoms even when compared to baseline values. No relevant side effects were observed and no patients dropped out.

Abnormal involuntary movements: a study of dopaminergic receptor interaction.

UNLABELLED: Abnormal involuntary movements caused by chronic levodopa treatment in Parkinson's disease, tardive dyskinesia resulting from long-term treatment with neuroleptics, and Huntington's disease all seem to be related to functional alteration and/or derangement of the DA/ACh systems. Recent data show the presence of different types of DA receptors D1 and D2, which seem to be involved in the pathogenesis of AIM: an alteration of their mutual equilibrium could account for movements disorders. In addition, hypofunction of the ACh system also seems to play a role in the pathogenesis of AIM. The purpose of this study was to verify an alteration of DA/ACh relationships by evaluating the clinical responses to pharmacological stimuli in patients affected by AIM secondary to chronic levodopa and chronic neuroleptic treatment. The following drugs were used to evaluate the DA receptors: lisuride (0.007 mg/kg i.v.) and tiapride (2.85 mg/kg i.v.) as agonist and antagonist, respectively, at D2 receptors; oxopentphylline (2.85 mg/kg i.v.) and alpha-flupenthixol (.057 mg/kg p.o.) as agonist and antagonist, respectively, at D1 receptors. Levodopa plus carbidopa (250 mg + 25 mg) was also used. The ACh system was studied using orphenadrine (1.1 mg/kg i.v.) as an antagonist and physostigmine (0.014 mg/kg i.v.) and neostigmine (0.26 mg/kg i.v.) as agonists. Our results suggest an involvement mainly of D1 receptors in the pathogenesis of TD, whereas D2 receptors seem to be important in the onset of AIM after chronic levodopa treatment in Parkinson's disease.

In vitro short-term chemosensitivity test in head and neck tumors.

A new method to test the sensitivity of human tumor cells has been developed. A suspension of mechanically dissociated tumor cells is kept in continuous incubation for 24h, in cultures with antineoplastic agents. Drug induced cell cycle perturbations are monitored by flow cytometric computer analysis and DNA distributions of the cells stained with propidium iodide are expressed in percentage. The test is used in 15 head and neck human solid tumors. The drugs tested were: VCR, EpiDx, CDDP, MTX, 5-FU, CPM, BLM. The results obtained reveal that tumor sensitivity varies independently from the stage and malignity grading. Therapeutic combinations are assigned by selecting the drugs on the basis of the individual in vitro response.

Long-term idebenone treatment of vascular and degenerative brain disorders of the elderly.

A multicentre study with an open experimental design was carried out on 118 patients suffering from mild to moderate cognitive decline due to cerebrovascular and degenerative disorders (chronic cerebrovascular disorders, CCVD; multi-infarct dementia, MID; aging brain, AB; dementia of Alzheimer's type, DAT). All patients, after a wash-out period of 3 weeks, were treated with idebenone (45 mg twice daily by oral route) for a period of 6 months. Behavioral and cognitive measures (Sandoz Clinical Assessment of Geriatrics, SCAG; Serial Learning Test) were applied to evaluate the long term therapeutical aspects. The results, analyzed by multivariate analysis of variance and chi2 test, showed a significant improvement of the cognitive profile in all patients, more evident in CCVD and AB groups. No remarkable side-effects were found in all groups of patients, thus confirming good tolerability of idebenone.

[Immunologic study on patients with head and neck cancer treated with thymopentin associated with surgery, chemotherapy and radiotherapy]. / Studio immunologico di pazienti con neoplasie ORL trattati con timopentina con terapia adiuvante la chirurgia, la chemioterapia e la radioterapia.

Patients with H&N tumours treated with surgery, chemo- and radiotherapy also underwent an immunologic therapy with timopentina to evaluate clinic and immunologic efficacy during a 1-year follow-up. Twenty-five patients were recorded in this study divided at random into two groups. In group A the patients were administered timopentina (50 mg/3 times per week/6 weeks) subcutaneously in 4 o 5 cycles during the year. Group B were not administered timopentina. The immunologic state was assessed through investigation of the following: Evaluation of PBL and their T and B cell subpopulations Phagocytosis and blastigenesis Surface receptor and soluble receptor of IL2 NK activity IL1 production. The immunologic values of the two groups were correlated against a control group of twenty non-neoplastic patients. Our study revealed a better immunologic conditions at the end of follow-up in patients treated with timopentina compared to the other patients.

Definition and therapy of chronic cerebro-vascular diseases.

Chronic cerebro-vascular disorders could be considered in a broad sense as a large body of knowledge in which three main categories of clinical disturbances have to be be considered: 1) Pathological aging that manifest itself with light short term memory impairment associated with a mild parkinsonian symptomatology or pseudobulbar signs. 2) Senile dementia Alzheimer type and multi infarct dementia. 3) Chronic cerebro-vascular disorders as defined by the Ad Hoc Committee (Paris, 1980). At present the therapy of chronic cerebro-vascular disorders is based on two main groups of drugs and can be divided into: 1) A treatment of prevention or secondary prevention which tends to correct or modify the different risk factors. 2) A treatment that seeks to control and modify the neurological and neuropsychological after effects and the disorders of the higher nervous activities which result from the lesion.

New strategies in the management of Parkinson's disease: a biological approach using a phospholipid precursor (CDP-choline).

CDP-choline, an intermediate in the phospholipid metabolic pathway supposed to improve the functionality of the dopamine (DA) system, was administered to parkinsonian patients in a double-blind cross-over study versus placebo. All patients were already treated with L-dopa + dopa decarboxylase inhibitor. Clinical evaluations were carried out using the Webster Rating Scale (WRS), the Northwestern University Disability Scale (NUDS) and a semiquantitative rating scale for tremor, rigidity and bradykinesia. CDP-choline treatment showed a significant improvement of rigidity and bradykinesia and a less important amelioration of tremor. NUDS and WRS showed a similar positive result. Comparing the results obtained by placebo, we found that the actual clinical efficacy of CDP-choline regards mainly bradykinesia and rigidity (23 and 33% improvement, respectively). The positive effect of CDP-choline on parkinsonian patients already treated with L-dopa + dopa decarboxylase inhibitor stands for a possible action on the DA receptor through an activation of the phospholipid metabolism.

Twenty-four hour plasma levels of growth hormone and prolactin in Huntington's disease.

Since hypothalamic neural degeneration is thought to occur in individuals with Huntington's disease, anterior pituitary hormone secretion which is in part regulated by the hypothalamus, was postulated to be altered in patients with this disease. To test this proposal, nine females with Huntington's disease were matched with controls to participate in a 24-hour basal level study of growth hormone and prolactin concentration in plasma. Patients who were free from all centrally active medication for at least six months and normal volunteers had blood sampled at 30-minute intervals over 24 hours in a minimal stress environment. The results demonstrated that plasma levels of growth hormone were elevated throughout the 24-hour time period in Huntington's disease individuals. Despite the elevation, the mean growth hormone curve of the Huntington's disease group retained characteristics similar to the control curve throughout the 24-hour time. Basal 24-hour plasma prolactin concentrations in Huntington's disease patients showed no difference from those in control individuals.