Boys who are born preterm show a relative lack of fat-free mass at 5 years of age compared to their peers.

AIM: Prematurity is associated with features of metabolic syndrome in young adulthood. We investigated the body composition and blood pressure of children born preterm. METHODS: A longitudinal, observational study was conducted with preterm infants who had a birth weight of <1500 g and a gestational age of <32 weeks. Growth and body composition were assessed by air displacement plethysmography at term equivalent age and at school age and were compared to those of 61 healthy, term breastfed subjects. RESULTS: A total of 63 preterm infants were enrolled. At term equivalent age, growth and fat-free mass were lower in preterm infants than in term newborns, but fat mass was higher. At 5 years of age, children born preterm were still lighter and shorter than children born at term. When the results were analysed by gender, the fat-free mass index was lower in boys born preterm than in their peers (12.1 ± 1.1 versus 13.0 ± 1.0 kg/h(2) p < 0.005), whereas no difference was detected among girls. Diastolic blood pressure was higher in children born preterm than in children born at term (61.14 ± 7.8 vs 56.69 ± 8.2 mmHg, p = 0.009). CONCLUSION: Boys born preterm showed a relative lack of fat-free mass at school age compared to their peers.

[Effect of prematurity on fat mass distribution and blood pressure at prepubertal age: a follow-up study]. / Effetto della prematurità sulla distribuzione della massa grassa e sulla pressione arteriosa in età prepubere: studio di follow-up.

OBJECTIVES: Preterm infants may develop altered adiposity, a risk factor for metabolic syndrome. The aim was to evaluate if body composition and blood pressure were altered in a cohort of children born preterm followed up to prepubertal age. METHODS: Observational, longitudinal, explorative study. Forty children born preterm underwent growth and body composition assessment by an air displacement plethysmography system at term c.a. and at 5 years. BMI, skinfold thicknesses and blood pressure were further measured at 5 years. Inclusion criteria were birth weight <1500 g and gestational age <32 weeks. Exclusion criteria were congenital/chromosomal or surgical diseases. Forty-three healthy children born at term were the reference group. RESULTS: At term c.a. preterm children were lighter (2455 +/- 484 g vs 3247 +/- 345 g; p<0.001) and shorter (45.6 +/- 3.4 cm vs 49.1 +/- 2.3 cm; p<0.001) than children born at term and their fat mass was higher (14.8% vs 8.6%; p=0.02). At 5 years of life, weight and height of children born preterm were lower than those of their counterpart (18.328 +/- 3.01 vs 20.302 +/- 3.01 g; p=0.008 and 109.7 +/- 6.5 vs 112.7 +/- 4.3 cm; p=0.02, respectively). No difference in percentage of fat mass was detected. Abdominal, subscapular and suprailiac skinfolds (mm) were larger in the preterm group (6.9 +/- 3.6 vs 5.3 +/- 2.8, p=0.002; 6.5 +/- 2.8 vs 5.0 +/- 1.6, p=0,01 and 11.8 +/- 4.3 vs 9.3 +/- 3.8, p=0,01, respectively). Diastolic pressure (mmHg) was higher in the preterm group (62.2 vs 57.5, p=0.01). CONCLUSIONS: At prepubertal age children born preterm tend towards a greater truncal adiposity and increased values of diastolic pressure which might have adverse consequences for later health.

[Growth and body composition changes in late preterm infants in the first months of life]. / Crescita e composizione corporea di neonati late-preterm nei primi mesi di vita.

OBJECTIVES: The aim of this study was to compare growth and body composition of late preterm infants to that of extremely preterm and full-term infants. METHODS: Observational longitudinal study. Forty-nine late preterm infants and 63 extremely preterm infants were included in the study. Forty healthy, full-term, breast-fed infants were enrolled as a reference group. Anthropometric parameters and body composition by an air displacement plethysmography system were assessed at 36th week, at term, at 1 and 3 months of corrected age in all groups. Late preterm infants were also assessed on the fifth day of life. RESULTS: Late preterm infants showed higher weight, length and head circumference values than those of very low birth weight infants but lower fat mass values on the fifth day of life and at 36th week of corrected age. However, at 3 months of corrected age, percentage of fat mass in late preterm infants reached values comparable with those of very low birth weight infants, probably because of the fast catch-up fat recorded between the fifth day of life and term corrected age. Moreover, percentage of fat mass in the first month of corrected age in preterm infants was higher as compared with full-term infants. This difference was no longer found at 3 months of corrected age. CONCLUSIONS: Further studies are needed to investigate whether this rapid increase in fat mass may modulate the risk of chronic diseases.

[Prevalence and duration of breastfeeding during the first six months of life: factors affecting an early cessation]. / Prevalenza e durata dell'allattamento al seno nei primi sei mesi di vita e fattori che influenzano.

OBJECTIVES: To assess the mean duration, prevalence and reasons that lead to an early cessation of breastfeeding in a group of healthy term infants in the first six months of life. METHODS: Prospective, observational study. One-hundred Caucasian, non smoking mothers, that intended to breastfeed for at least 12 weeks, were enrolled. Information on anthropometric parameters, type of delivery, socio-demographic characteristics, mode of feeding and reasons for stopping breastfeeding have been obtained through three different questionnaires (submitted at enrollment, on the 7th day, at 1, 2, 3 and 6 months). RESULTS: Exclusive breastfeeding gradually decreased from the 7th day to the 6th month of life. Most of the mothers stopped breastfeeding during the first month and a half or after 3 months and a half. Two percent of the mothers stopped on the 7th day whereas at 6 months the percentage of cessation was 14%. The cumulative percentage of interruption at 6th month was 45%. Maternal factors, like sore nipples or delayed onset of lactation, were the most frequent reasons that led to an early cessation, while during the following months inadequate breast milk and latch-on problems were predominant. On the other hand, attending a pre-natal course or having a previous successful breastfeeding experience were significantly associated with a long-lasting breastfeeding. CONCLUSIONS: Promotion of breastfeeding during the prenatal course and a better support for lactation management during the first months seem to be the areas where more efforts are needed to implement breastfeeding rates.

Transvaginal ultrasound predicts delayed response to chemotherapy and drug resistance in stage I low-risk trophoblastic neoplasia.

OBJECTIVES: Methotrexate (MTX) resistance is defined on the basis of the human chorionic gonadotropin (hCG) curve. The aim of this study was to identify low-risk non-metastatic patients with gestational trophoblastic neoplasia (GTN) who can achieve resolution by continuing MTX treatment despite a transient hCG plateau. METHODS: Before starting chemotherapy, 24 patients with FIGO Stage I GTN underwent transvaginal ultrasonography with power Doppler in order to identify myometrial lesions (areas of increased echogenicity and increased power Doppler signal). Ultrasound response to chemotherapy was defined when myometrial lesions decreased in echogenicity, Doppler signal or size. When ultrasound response occurred, despite chemoresistance defined by hCG values, MTX treatment was continued. RESULTS: MTX was continued in three out of seven chemoresistant patients because ultrasound suggested response to MTX. All three of these patients achieved a complete response, thus nearly halving the MTX-resistance rate. CONCLUSION: Among patients who are candidates for second-line treatment on the basis of hCG, ultrasound may identify those in whom further MTX administration can induce a delayed complete response.

[Intra-abdominal adiposity in preterm infants: an explorative study]. / Adiposità intra-addominale in nati pretermine: studio esplorativo.

OBJECTIVE: The aim of the present study was to compare the total body fat mass and the intra-abdominal adipose tissue between preterm infants assessed at term corrected age and full-term newborns. METHODS: An observational explorative study was conducted. 25 preterm and 10 full term infants were evaluated at 0-1 month of corrected and postnatal age, respectively. The total body fat mass was assessed by means of an air displacement plethysmography system (Pea Pod COSMED, USA) and the intra-abdominal adipose tissue by means of magnetic resonance imaging (software program SliceOMatic, Version 4.3,Tomovision, Canada). RESULTS: Total body fat mass (g) of preterm and term infants was 633 (+/- 183) and 538 (+/- 203) respectively while intra-abdominal fat mass (g) was 14.2 (+/- 4.9) and 19.9 (+/- 11.4). CONCLUSIONS: Preterm infants, although exhibiting a total body fat mass higher than full term infants, do not show an increased intra-abdominal adipose tissue.

Metastatic placental site trophoblastic tumor. Report of a case with complete response to chemotherapy.

BACKGROUND: Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic neoplasia, commonly insensitive to chemotherapeutic agents. CASE: We report on long-term remission in a patient with metastatic PSTT after etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine combination chemotherapy. The 27-year-old patient with metastatic lung PSTT was alive, without evidence of disease, > 40 months after treatment. CONCLUSION: Treatment with multiagent chemotherapy can produce long-term remission, even in patients with metastatic PSTT.

Leisure and occupational physical activity at different ages and risk of endometriosis.

OBJECTIVE: Cohort and case-control studies have suggested that adult physical activity (PA) may lower endometriosis risk and improve symptoms, but evidence is still controversial. To add information on leisure and occupational PA impact, if any, on endometriosis risk, we have analyzed data from a small case-control study conducted in Milan (Italy). STUDY DESIGN: Ninety cases and 90 controls (median age 35 years, range 18-76) were compared. Endometriosis was laparoscopically diagnosed within the year before interview. Information on demographic variables, menstrual and reproductive history, occupational and recreational physical activity was collected. RESULTS: A consistent protective effect emerged between leisure PA and endometriosis risk. For <2-4 and ≥5h/week (reference no PA), the estimated odds ratios (ORs) were, respectively: 0.36 (95% CI 0.18-0.74) and 0.83 (95% CI 0.27-2.53) as regards PA in early adolescence; 0.31 (95% CI 0.15-0.63) and 0.78 (95% CI 0.25-2.38) as regards PA in teenage years; 0.34 (95% CI 0.12-0.94) and 0.33 (95% CI 0.08-1.28) for PA in adulthood. However, no significant trend was seen according to hours spent in leisure PA. Occupational PA did not show statistical significant differences among different types or across age classes. CONCLUSIONS: These results suggest that leisure PA in early adolescence, teenage years and adulthood may, to some extent, decrease the risk of endometriosis. In the interpretation of these results, however, the role of potential biases cannot be totally ruled out.

Management of low-risk gestational trophoblastic tumors with etoposide (VP16) in patients resistant to methotrexate.

Careful selection and treatment monitoring of patients with gestational trophoblastic tumors (GTT) is critical because 20 - 50% of patients may develop a resistance and consequently require alternative chemotherapeutic agents. In our study we propose and demonstrate the efficacy of etoposide (VP16) as a second-line drug. An average of 5 courses with VP16 were used to achieve a remission in 12 patients resistant to MTX with low-risk GTT. Toxicity was mild and no resistance to VP16 was observed. A follow-up of 66 months (range, 22-109) has been performed for the patients and all of them are now disease free. Two patients had a pregnancy, respectively, 3 and 4 years after treatment. The others did not desire any pregnancy.

Concomitant radiotherapy and paclitaxel for high-risk endometrial cancer: first feasibility study.

OBJECTIVE: Postoperative radiotherapy (RT) is the most used adjuvant treatment in high risk endometrial cancer (HREC), and it appears to reduce the incidence of pelvic relapses but doesn't seem to improve survival. Paclitaxel (P) has shown in vitro and clinical activity against endometrial cancer, and it is also a potent radiosensitizer by blocking dividing cells in G2/M phase. This is the first study that verifies the feasibility of a treatment with concomitant weekly chemotherapy and RT to potentially reduce the incidence of local and distant relapses in order to improve survival in HREC. PATIENTS AND METHODS: Thirteen patients with HREC have entered the feasibility study at San Raphael Hospital University of Milan. All patients underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and surgical staging. Four patients presented stage IC disease, 2 women had IIB stage tumors, 5 patients revealed IIIA stage disease, and 2 had stage IIIC. The patients received P (60 mg./m(2)) via a continuous 1-h infusion once weekly during the 5 weeks of RT (mean radiation dose of 50.4 Gy). At the end of RT three additional consolidation courses of P (80 mg/m(2)) were subministered. Eleven patients received only pelvic irradiation; in 2 cases radiotherapy was performed on an extended field. RESULTS: Eleven of the 13 enrolled patients have completed the radiochemotherapy regimen. A total of 100 courses of P were performed. All patients completed the RT. Adverse effects were evaluated. Hematological toxicity was mild: four cycles (4%) were delayed 1 week because of grade 1 neutropenia. No severe thrombocytopenia was identified. No hemotrasfusions were performed. One cycle was delayed for fever. Gastrointestinal adverse effects were observed in 2 patients, in which the cycles were delayed 1 week because of diarrhea. One cycle was delayed 1 week because of dermatitis. One patient developed a subocclusion 8 weeks after the end of the treatment, with medical resolution. No patients developed hypersensitivity reactions. CONCLUSIONS: Concomitant P and RT is safe and acceptable treatment in patients with HREC. Prospective clinical studies are necessary to evaluate the benefits of this regimen for the long-term survival rate.

[18F]fluorodeoxyglucose positron emission tomography as a useful indicator of metastatic gestational trophoblastic tumor: preliminary results in three patients.

OBJECTIVE: The goal of this study was to evaluate the usefulness of positron emission tomography with [(18)F]fluorodeoxyglucose ([(18)F]FDG-PET) in detecting metastases in patients with gestational trophoblastic tumor (GTTs). METHODS: A retrospective study was conducted on three patients with GTTs who had been studied with [(18)F]FDG-PET and computed tomography (CT) after an increase in human chorionic beta-gonadotropin (betahCG) serum levels. PET scans were performed with a multiring whole-body positron emission tomograph 45 min after an intravenous bolus injection of [(18)F]FDG ( approximately 5.2 MBq/kg). CT studies were obtained on a spiral scanner prior and after administration of intravenous iodinated contrast material. Within a week of CT and [(18)F]FDG-PET studies, the patients underwent surgical procedures for histological diagnosis. RESULTS: In one patient, a lung lesion positive for neoplastic tissue with [(18)F]FDG-PET and negative with CT was confirmed to be a GTT metastasis at histology. In another patient, [(18)F]FDG-PET was negative, while CT was positive for the presence of lung metastasis; no viable tumor tissue was found at histological analysis. The remaining patient had a positive [(18)F]FDG-PET and CT study for lung metastasis; this was confirmed at histological analysis. In the same patient, both [(18)F]FDG-PET and CT depicted the presence of a liver lesion. Necrotic lesion regression after treatment was clearly documented with [(18)F]FDG-PET only. CONCLUSIONS: Our preliminary results suggest that [(18)F]FDG-PET may be useful for the assessment of metastatic disease in patients with GTTs.