TNF-α gene promoter polymorphisms and risk of venous thromboembolism in gastrointestinal cancer patients undergoing chemotherapy.

BACKGROUND: TNF-α has been proposed as a predictive factor for venous thromboembolism (VTE). Genetic polymorphisms could regulate TNF-α production. However, the relationship between TNFA gene variants and VTE is not clarified. This study aims to investigate the predictive role of five different TNFA gene promoter SNPs, or their haplotype combination(s), for a first VTE episode in gastrointestinal cancer out-patients treated with chemotherapy. PATIENTS AND METHODS: Serum TNF-α levels and TNFA -863C/A, -857C/T, -376G/A, -308G/A and -238G/A gene promoter polymorphisms were retrospectively evaluated in 314 subjects, including 157 controls and 157 Caucasian patients with histologically diagnosed GI cancers beginning chemotherapy delivery (5-fluorouracil either as monotherapy or in combination with platinum compounds or irinotecan). RESULTS: Haplotype analysis showed that a five-loci haplotype (CTGGG haplotype) has higher frequency in GI cancer patients who developed VTE (n = 15) during chemotherapy [odds ratio = 2.7, 95% confidence interval (CI) 1.04-7.11, P = 0.04]. GI patients who remained VTE-free did not differ in CTGGG haplotype frequency from controls. No association was observed between serum TNF-α levels and TNFA haplotype, but both were independent predictors of VTE. Approximately 20% of GI cancer patients carrying the CTGGG haplotype developed VTE compared with 4% of the remaining 101 patients (hazard ratio = 5.6, 95% CI 1.8-17.6, P = 0.003). CONCLUSION: These results suggest that TNFA might represent a candidate gene contributing to VTE pathogenesis in GI cancer patients and suggest that VTE risk during chemotherapy might be genetically identified. Validation studies are needed for translation into clinical practice.

Ecosystem of the Anticolana Valley.

The results of an integrated environmental study on the geological, hydrogeological and ecological features of the area of formation of the low mineral content water of Fiuggi are briefly presented. The research programme, that was started in 1996 and is now in its final phase, was aimed at the following: (a) identifying the geological-structural limits of the hydrogeological basin; (b) building a model of the deep water circulation that should include an analysis of the rainfall and of the water balance, and (c) determining the vulnerable characteristics of the aquifer in relation to the human impact and setting up a monitoring system to control the different environmental parameters.

[A case of atypical ectopic pregnancy]. / Su di un caso atipico di gravidanza ectopica.

The authors report the case of a 38-year-old woman who underwent total laparohysterectomy for multiple uterine leiomyomas and right adnexectomy following the intraoperative finding of a right tubal abortion.

Spontaneous remission of double pulsatile umbilical venous flow in twin-twin transfusion syndrome: a case report.

Double umbilical pulsatile venous flow is a rare event generally associated with fetal right heart failure. We observed, at 21 weeks' gestation, this venous flow pattern in a case of twin-twin transfusion syndrome occurring in the recipient twin affected by severe hydrops. In spite of a spontaneous remission of fetal hydrops at 30 weeks, the fetus died suddenly in utero, 2 weeks later. We hypothesized that this unexpected event was related to reversed acute twin-twin transfusion, and concluded that fetal hydrops remission in twin-twin transfusion syndrome must not be considered as a reassuring prognostic index but as an indication of the need for continuing biophysical monitoring.

Ultrasound dating-curve analysis in the assessment of gestational age.

The accurate assessment of gestational age is very important in everyday practice. By the use of multiple regression analysis, in a longitudinal study, ultrasound dating-curves were calculated for the crown-rump length, biparietal diameter, femur length, humerus length, binocular distance and transverse cerebellar diameter. All the examined parameters showed a good statistical correlation with gestational age; however, the earlier the estimation of the gestational age, the more accurate it is. The crown-rump length has been shown as the best parameter during the first trimester. Later on, the other biometric parameters become easier and more reliable. If determination of gestational age is required during the third trimester, the use of multiple parameters is recommended.

[Vaginitis and vaginosis. Comparison of two periods]. / Vaginite e vaginosi. Due periodi a confronto.

Vaginitis is the most frequent gynecological disease. It is characterized by objective and subjective signs of inflammation and differs from bacterial vaginosis (BV) which is an abnormal condition of the vaginal ecosystem caused by the excessive growth of aerobic and anaerobic flora normally present in the vagina with an increased risk of pelvic inflammatory disease (PID). The authors report the results of a study carried out at the Centre for Gynecological Infections at the Clinic of Obstetrics and Gynecology of the University of Parma. 828 patients were enrolled in the study during the period 1985-86 and 1559 patients during the two-year period 1991-92. The aim of the study was to evaluate variations in epidemiological data for vaginitis and bacterial vaginosis in the two periods examined. No significant changes were observed (p > 0.05) with regard to the prevalence of Ca, Tv and BV forms. On the other hand, there was a significant reduction (p < 0.001) in the forms sustained by other microorganisms (above all, streptococcus and enterobacteria) between the first and second periods with a parallel increase in the number of negative cases. The analysis of the age distribution of vaginitis and BV showed a reduction of other microorganisms and an increase in negative vaginal swabs in adults (> 20 years old).