Carotid dissection with and without ischemic events: local symptoms and cerebral artery findings.

OBJECTIVE: To study whether spontaneous dissections of the cervical internal carotid artery dissection (ICAD) with and without ischemia of the brain or retina differ in the prevalence of vascular risk factors, local neurologic signs and symptoms, and stenoses and occlusions of the cerebral arteries. METHODS: The authors prospectively studied 181 consecutive patients with 200 ICAD. Diagnosis was based on ultrasonography and MRI or catheter angiography. Vascular risk factors, presenting local (headache, neck pain, Horner syndrome, pulsatile tinnitus, cranial nerve palsy on the side of the ICAD) and ischemic signs and symptoms, and ultrasonographic findings in the carotid and basal cerebral arteries were evaluated. RESULTS: ICAD with ischemic events (n = 145) had a higher prevalence of hypercholesterolemia (p < 0.05), >80% stenoses and occlusions of the ICA (p < 0.0001), and intracranial obstructions (p < 0.001). ICAD without ischemic events (n = 55) had a higher prevalence of Horner syndrome (p < 0.001), cranial nerve palsy (p < 0.01), and normal ICA findings (p < 0.0001). CONCLUSIONS: These data suggest that ICAD causing high-grade stenosis and occlusion are more likely to lead to intracranial obstructions and cerebral or retinal ischemic events. Conversely, ICAD without luminal narrowing cause more local signs and symptoms.

Cancer mortality among relatives of children with soft-tissue sarcoma: a national survey in Italy.

Information was obtained on the living status or cause of death of 2223 close relatives of 195 children with soft-tissue sarcomas (STS) diagnosed under age 15. Three-hundred nine relatives had died, from all causes, before STS diagnosis in the index child. The expected figure estimated from age- and sex-specific mortality rates in Italy was 293.3. Cancer was reported as cause of death in 76 relatives (75.1 expected). Seven grandmothers, 2 aunts, 1 uncle and 0 mothers died from breast cancer vs. 4.6, 0.9, 0.0 and 0.2 expected. Three siblings died from cancer (0.2 expected, P less than 0.01), i.e. STS, ependymoma and non-Hodgkin lymphoma. These results confirm and expand previous observations that STS in children are associated with other cancers, particularly childhood and breast cancer, in members of the same family.

Mortality of parents of children with cancer: a population-based study in Turin, Italy.

AIMS AND BACKGROUND: A cohort study was conducted in order to measure cause-specific mortality among parents of children recorded in the Childhood Cancer Registry of Piedmont. It is the first study carried out on the subject in southern Europe. METHODS AND STUDY DESIGN: The study comprised the 740 children resident in Turin and in whom a cancer had been diagnosed in the period 1967-1991. Nominal data were obtained for 723 fathers and 733 mothers. At the end of the follow-up in 1995, 645 fathers were alive, 68 dead and 10 untraceable. Corresponding figures for mothers were 700, 28 and 5. Cause of death was known for 91 of 96 parents. RESULTS: The period of observation of parents started on the birth of the index child, however mortality analyses were restricted to the period after 1965 because of limited availability of local reference rates. Total mortality was lower than expected among fathers (66 observed deaths vs 88.2 expected, P <0.05) and mothers (28 vs 31.4). Fathers showed deficits (not statistically significant) of lung neoplasms (4 vs 9.9), cardiovascular diseases (18 vs 27.1) and hepatic cirrhosis (2 vs 6.6). No statistically significant variations in mortality were observed with time from diagnosis or according to life status of the children. No cancer deaths occurred among the mothers of sarcoma cases whereas 1.9 were expected. CONCLUSIONS: The data do not indicate any increase in mortality from cancer or other causes end, on the contrary, show a reduction in mortality which was more evident for the causes related to life style.

Time trends in survival of children with acute lymphocytic leukemia in Piedmont, Italy: a report from the Population-Based Cancer Registry.

AIMS AND BACKGROUND: The Childhood Cancer Registry of Piedmont (RTI) periodically updates the life status of each registered child. Given its size, the RTI is the major (albeit geographically limited) Italian source of population-based survival rates of cancer in children. The present report describes time trends in survival of children with acute lymphocytic leukemia (ALL). METHODS: During 1970-87, 429 residents in Piedmont aged 0-14 were diagnosed as having ALL: they have been followed up until 1991. RESULTS: Five-year survival rates increased from 21% to 72% for children diagnosed ALL respectively in 1970-72 and 1985-87. Major improvements occurred up to the mid-seventies and again between cases diagnosed in the early and late eighties. Improvement in survival was statistically significant for children belonging to classes comprised between 2 and 10 years of age at diagnosis. Period of diagnosis was unrelated to probability of survival among the 13 cases diagnosed ALL at age 0. Survival was unrelated to sex, even in the early seventies and even after consideration of children dying more than 5 years after diagnosis. Between 1976-81 and 1982-87, an improvement in survival was found in all categories of WBC count at diagnosis: the ratio between the two estimates was somewhat higher for children with more than 50,000 WBC/mm3 at diagnosis than for other children. CONCLUSIONS: Present data are compared with those resulting from other population-based series: this exercise can be useful for an overall evaluation of delivery of cancer therapy at the population basis.

Physical impairment and social life goals among adult long-term survivors of childhood cancer: a population-based study from the childhood cancer registry of Piedmont, Italy.

AIMS AND BACKGROUND: The study describes the health status and the attainment of life goals in the adult survivors of childhood cancer recorded at the Childhood Cancer Registry of Piedmont. METHODS AND STUDY DESIGN: A postal questionnaire was sent to the general practitioner of the 690 cases born before 1976 and alive in 1991 after at least 5 years from diagnosis. The answer was received for 485 (72.9%) included in the analyses. Items in the questionnaire were: sequelae related to cancer and its treatment, health-related quality of life (according to Bloom's criteria), educational level attained, and employment status. RESULTS: Vital and marital status were obtained for all 690 cases at the offices of the town of residence. No medical condition was reported for 309 cases (63.7%). The overall proportion with a high school or university education was compared to corresponding figures for Piedmont in 1991, adjusted by age, and was as high as in the general population. Similar results are observed for occupation. Patients of both genders were married less than expected. Patients with leukemia (112 cases), non-Hodgkin's lymphoma (34) or Hodgkin's lymphoma (52) were reported to have the highest quality of life. In contrast, patients with tumors of the central nervous system (151) had the highest frequency of sequelae and the lowest score for health-related quality of life. They-also presented the lowest educational achievement, the lowest proportion of employment and, among males, the lowest frequency of marriage. CONCLUSIONS: Our study shows a good social adjustment of adult survivors from childhood cancer, with the exception of central nervous system tumors. From the methodologic point of view, the present study shows the feasibility of surveillance surveys on health-related quality of life with the contribution of general practitioners.

Neurofibromatosis and malignant childhood cancers: a survey in Italy, 1970-83.

Neural tumors, Wilms' tumor, rhabdomyosarcoma and several types of leukemia have been previously described in association with neurofibromatosis (NF). In a nation-wide collection of cases in Italy, 15 children (0-14 years of age) with NF and cancer or leukemia were identified; 13 of them had been diagnosed with cancer between 1976-83. The expected number of children with cancer and NF in 1976-83 was 4.48. The distribution of tumor types was different from that found in the general population, with a higher proportion of tumors of neural crest origin as well as soft tissue sarcomas. In 7/15 the family history was positive for NF; in 5/7 the individuals affected included the mother and/or a maternal relative.

Results of a multicenter retrospective study on pediatric brain tumors in Italy.

This retrospective study was undertaken to evaluate the clinical characteristics, course and treatment of children (0-14 years of age) diagnosed with a primary CNS tumor during the period 1976-1982 in Italy. Four hundred and sixty-two patients (263 males and 199 females) were followed by 18 various neurosurgical and pediatric oncology centers. The histologic types most frequently reported were: medulloblastoma (23%), astrocytoma (16%), ependymoma (11%) and spongioblastoma (11%). Of the 388 patients who underwent surgery, radical excision was reported in 42%, partial excision in 32%, biopsy only in 6%, and unqualified surgery in 4%; 19% had no surgery. Radiotherapy and chemotherapy combined were administered in 61% of the 143 patients followed at pediatric oncology centers; 19% received radiotherapy alone, 3% chemotherapy alone, and 17% neither treatment. Forty-six percent of the patients were reported alive, 40% dead, and 14% lost to follow-up. Performance status was identified for 62 patients. The investigation revealed marked differences in the therapeutic treatment administered, thus precluding valid data analysis. This emphasizes the need to coordinate efforts among the institutions and the disciplines involved in the treatment of this form of childhood cancer.

[Pediatric Tumor Registry of Piedmont. Descriptive epidemiology of malignant tumors in children in Piedmont, 1976-1994]. / Il Registro dei Tumori Infantili del Piemonte. Epidemiologia descrittiva dei tumori maligni in età pediatrica in Piemonte, 1967-1994.

Since 1967, the Childhood Cancer Registry of Piedmont measures cancer incidence and lethality among children aged 0-14 residents in the Region. Two thousand seven hundred twenty cases were recorded in the period 1967-94. Males were 55.4%. The highest frequency was observed in the age class 0-4 including 41.3% of cases. The most frequent malignancies were: Acute Lymphocytic Leukemias, CNS Tumours and Lymphomas. Incidence rates showed limited variation, both for total neoplasm and for the largest diagnostic categories. On the contrary, lethality decreased markedly: rate (per million children years) was 77.2 in 1967-69 and 59.4 in 1988-94. This trend as more evident for acute leukemias and CNS tumours. Better diagnostic techniques, anticancer and support therapies are the likely explanation for the improved prognosis. Prevalence increased, as a consequence of improved survival and curability: in the Province of Torino it increased from 62 cases per 100,000 children (age 0-14) in 1980 to 98 cases in 1994.

Elevada frecuencia de enfermedad tiroidea funcional en embarazadas chilenas sin antecedentes de patología tiroidea utilizando el estándar de TSH internacional / Frequency of subclinical thyroid problems among women during the first trimester of pregnancy

Background: Thyroid hormones play an important role in fetal neural and cognitive development. Therefore thyroid abnormalities should be detected and treated early during pregnancy. Aim: To assess the frequency and risk factors for functional thyroid disorders during the first trimester of pregnancy. Material and Methods: A blood sample was obtained from women during their first trimester of pregnancy, consulting in a prenatal care facility. Women with known thyroid diseases were excluded from the study. Thyroid stimulating hormone (TSH), total thyroxine (T4) and free thyroxine (fT4) were measured by electrochemoluminiscence. Antithyroid peroxidase antibodies (anti TPO) were measured by enzyme immunoassay. Results: Five hundred and ten women aged 25.7 ± 6.6 years were assessed. The frequency of clinical hypothyroidism was 0.6%, subclinical hypothyroidism 35.3% and clinical hyperthyroidism 1%. Five percent of women with hypothyroidism and 3.5% of euthyroid women had positive anti TPO antibodies. There was no association between the frequency of thyroid diseases and risk factors for thyroid diseases. Conclusions: There is a high frequency of subclinical thyroid diseases among women consulting in this prenatal care clinic.

[Transient ischemic attacks and prolonged reversible ischemic neurologic deficit. Diagnosis, differential diagnosis and treatment]. / Transiente ischämische Attacke und prolongiertes reversibles ischämisches neurologisches Defizit. Diagnose, Differentialdiagnose und Behandlung.

Cerebral and ocular ischemic events are classified according to their duration and localisation in transient (< 24 hours) or permanent (> or = 24 hours) cerebral (transient ischemic attack (TIA), cerebral infarct) and ocular (amaurosis fugax, retinal infarct) deficits. The terms "Prolonged Reversible Ischemic Neurological Deficit" (PRIND, > or = 24 hours to < or = 7 days) and "Reversible Ischemic Neurological Deficit" (RIND, > or = 24 hours to < or = 3 days) are no longer used. The differential diagnosis of TIAs and ischemic strokes is discussed. Ischemic strokes are an emergency and should be referred within five hours at the latest to a centre, which offers around the clock acute therapies such as fibrinolysis and an organised stroke management. Secondary stroke prevention after TIA or stroke encompasses the treatment of vascular risk factors, carotid endarterectomy, anticoagulation in the presence of cardiac embolism (target international normalised ratio, 2.5; range 2.0-3.0) and the administration of platelet inhibitors. Carotid endarterectomy is indicated, when luminal narrowing is at least 70%, and not indicated when it is less than 50%. The benefit of endarterectomy in 50-69% stenoses decreases, and individual predictors of the operation risk are useful for choosing the appropriate treatment. Patients without indication for carotid endarterectomy or oral anticoagulation are treated with platelet inhibitors. We use the combination dipyridamole-aspirin as first choice drug, because it has been shown to be superior to aspirin and dipyridamole alone. In the presence of adverse effects or contraindications for dipyridamole we prescribe aspirin (100-300 mg daily). We administer clopidogrel (75 mg daily) if dipyridamole and aspirin are not indicated, have caused adverse effects, or did not prevent ocular or cerebral ischemic events.