Physical activity and health-related quality of life among postmenopausal women with breast cancer treated with aromatase inhibitors.

PURPOSE: Breast cancer is the most common non-cutaneous cancer in women with an estimated 268,600 new cases diagnosed in 2019, joining the over 3 million women living with the disease. To reduce cancer recurrence, postmenopausal women (highest incidence and prevalence of breast cancer) who test positive for hormone receptors in their tumors are candidates for adjuvant endocrine therapy (i.e., aromatase inhibitors [AIs]). Despite the benefits of AIs in the treatment for breast cancer, many women remain at risk for complications, including osteoporosis and fractures, all of which can adversely affect health-related quality of life (HRQoL). Increased attention is being paid to the role physical activity (PA) may have in improving health outcomes in survivors of breast cancer, but few studies focus on postmenopausal women. We sought to examine (1) the percentage of women in our sample meeting (or not meeting) the American College of Sports Medicine (ACSM) PA recommendations, (2) the relationship between AI use and three types of PA (leisure time, strength training, and walking), and (3) the relationship between PA and HRQoL by AI use, controlling for covariates. METHODS: Postmenopausal women with breast cancer (n = 170), ages 50-95 years (M = 68.7), diagnosed with stage 1-3 disease, 45% on AIs, were recruited. Demographic, HRQoL, and PA data were collected via patient self-report, while clinical data (AI use) were abstracted from patient medical records. To address study aims, we utilized descriptive statistics, chi-square analyses, and multiple linear regressions, respectively. RESULTS: Half of the sample met the ACSM recommendations for total leisure-time PA (vigorous and moderate intensity combined), and 65.3% (n = 111) weekly walking. With regard to strength training, 36.5% of the women met these ACSM recommendations. Generally, there were positive relationships between AI use and most HRQoL domains. There were no statistically significant relationships between PA (meeting recommendations or not) and HRQoL by AI use. CONCLUSION: The proportion of women meeting guidelines for walking activity was encouraging. It is imperative that healthcare professionals providing care to breast cancer survivors follow up regarding symptoms, side effects, and physical activity in tandem to fully understand their relationship on an individual level.

The application of different correlation coefficients to assess the reproducibility of a food frequency questionnaire.

We computed four different correlation coefficients to investigate the degree of reproducibility of the weekly consumption of 77 food items or groups of foods and of seven summary questions from a food frequency questionnaire developed in Italy for a case-control study on cancers of the breast and digestive tract. The questionnaire had been administered twice to 452 Italian men and women. These included Pearson correlation coefficients (a) using the weekly frequencies of consumption without any transformation (P1); (b) after applying the transformation log (x + 1) (P2); (c) after applying the transformation log (x + 0.01) (P3); and (d) the Spearman correlation coefficient (SP). The mean values were 0.55 for P1, 0.59 for P2, 0.56 for P3 and 0.59 for SP. All coefficients were positively correlated, although to variable extents: the Spearman correlation coefficient between P2 and SP was 0.92, and that between P1 and P3 was 0.53. Differences between the four coefficients were more marked for food items with a lower kappa statistic and lower intraclass correlation, ie for those items with more severe reproducibility problems. Thus, a single correlation coefficient may not be enough to detect zones of the distribution of a food item where misclassification problems are more severe. The correlation coefficients used to investigate reproducibility should therefore be chosen on the basis of subsequent data analyses.

Haemodynamic and metabolic effects of surface rewarming after coronary revascularization.

Cardiac surgery is often associated with a postoperative increase in the patient's metabolic rate; surface rewarming has been suggested to decrease the energy expenditure by preventing hypothermia. Thirty patients, undergoing coronary revascularization, were randomly divided into two groups; after surgery group A was rewarmed by a new device that acts by both conduction and convection, while group B was just covered with cotton blankets. Blood, oesophagus and skin (thigh and foot) temperatures were recorded on admission to the intensive care unit (ICU) and 30, 60, 90, 180, 270, and 450 min later. Haemodynamic parameters, oxygen delivery, calculated oxygen consumption, and plasma lactate concentration were assessed as well. Group A warmed up quicker than group B as far as the skin was concerned while the core temperature was unaffected. Group A was also characterized by lower cardiac indices and oxygen consumption. As the occurrence of a dependence of oxygen consumption on delivery could be reasonably ruled out in warmed patients because blood lactate levels were lower than in the controls, we conclude that surface rewarming might have some positive effect in decreasing metabolic demand after cardiac surgery even if the patient's core temperature is little affected. The inhibition of skin temperature receptors could possibly explain this finding.

Creatine-kinase isoenzyme pattern in colonic infarction consequent to acute aortic dissection. A case report.

Bowel infarction can complicate acute aortic dissection (AAD); in that case early diagnosis, which decreases the high mortality, is often difficult. We report the case of one patient who underwent surgery for AAD and developed a colonic infarction, which was clinically manifest on the 4th postoperative day. However, bowel ischemia was suspected already 48 hours after surgery, on the basis of the suggestive CK pattern and the absence of myoglobin in plasma. Total CK activity reached the highest level only 48 hours after surgery (92,800 U/l); the peak was coincident with LDH, which increased proportionally less; CK-MM constituted 100% of total CK activity. The absence of myoglobin in plasma excluded the presence of rhabdomyolysis. We conclude that such laboratory findings suggest the occurrence of severe bowel ischemia.

Somatomedin-C plasma levels after coronary revascularization.

The decrease of Somatomedin-C (SM-C) plasma levels has been recently proposed as an index of acute malnutrition in critically ill patients. In this study SM-C values were determined before surgery for coronary revascularization, on the 2nd and 5th postoperative day. Twenty-four patients were admitted to the study; most of them (16 cases; 66%) presented with an increase of SM-C levels after surgery unlike 8 patients who showed unchanged or decreased levels. Multivariated analysis was applied to the factors that may affect SM-C values. SM-C significantly related to the Modified Predictive Nutritional Index, which was calculated prior to surgery, while no significant relationship was observed with patient age and type of oxygenator. No sign of liver damage was observed, so we concluded that decreased and, perhaps, unchanged SM-C levels after coronary revascularization were probably caused by acute nutritional deficiency. The incidence of this finding was remarkably high (33%) in spite of the absence of apparent malnutrition before surgery.

Arterial-venous PCO2 gradient in early postoperative hours following myocardial revascularization.

OBJECTIVE: To investigate the utility of the arterial-venous PCO2 gradient (P(a-v)CO2) as a marker of the increased risk of postoperative complications in the early postoperative hours following myocardial revascularization. EXPERIMENTAL DESIGN: Prospective study. SETTING: The Postoperative Intensive Care Unit (ICU) of a University Hospital. PATIENTS: Thirty patients (28 males and 2 females; aged 39-70) that consecutively underwent myocardial revascularization. INTERVENTIONS: None. MEASURES: Thirty minutes following arrival at the ICU the hemodynamic parameters were recorder; the arterial and mixed venous hemogasanalyses were obtained; the mixed venous blood hemoglobin saturation (SvO2) and the O2 consumption (VO2) were calculated; and plasma lactate was determined. The arterial and mixed venous hemogasanalyses were determined again 90 minutes after the admission to the ICU. RESULTS: P(a-v)CO2 at 30 minutes was 8.1+/-2.3 mmHg and was only slightly lower at 90 minutes (7.5+/-2.3 mmHg) so that any significant influence of patient transport to the ICU could be ruled out. P(a-v)CO2 did not significantly relate with cardiac index, mixed venous blood O2 saturation, and blood lactate. Twenty-one patients (70%) showed P(a-v)CO2 values higher than 7 mmHg at 30 minutes: in comparison with the others they were characterized by higher arterial blood PCO2 (PACO2) (37+/-5 vs 32+/-3 mmHg; p<0.05) in spite of similar ventilatory variables, by higher mixed venous blood PCO2 (PVCO2) (47+/-6 vs 37+/-3 mmHg; p<0.01), and by lower cardiac index values (2.0+/-0.3 vs 2.3+/-0.6 1/min/m2; p<0.05). The patients that presented abnormally high P(a-v)CO2 values showed a higher rate of postoperative complications, including inadequate cardiac performance, cardiac arrhythmias, prolonged mechanical ventilation, increased plasma creatinine, and jaundice (11 patients out of 21 vs 1 patient out of 9; p<0.05). Finally P(a-v)CO2 was related with arterial-mixed venous O2 content difference (regarded as an index of O2 consumption), hematocrit, blood temperature and PACO2 by multiple linear regression (R=0.74; p<0.01). The coefficients of all factors but hematocrit were significant; hence, apart from the cardiac index, P(a-v)CO2 was influenced by the metabolic rate, the body temperature (possibly because of CO2 release during rewarming), and the impaired CO2 elimination through the lungs. CONCLUSIONS: P(a-v)CO2 represents a useful even if aspecific parameter to monitor patients during the early postoperative period after myocardial revascularization.

Cancer mortality by urbanization and altitude in a limited area in Northeastern Italy.

The geographical patterns of cancer mortality have been studied in Friuli-Venezia Giulia Region (1.2 million inhabitants), the North-eastern part of Italy, with respect to certain characteristics (i.e., rural, mixed, urban) and the altitude of the commune where the deceased subjects lived permanently at the time of death. In males, significantly increased mortality rates in rural versus urban communes (after allowance for altitude) were found for cancer of the oral cavity and pharynx, oesophagus and stomach. Conversely, significantly decreased mortality rates emerged for cancer of the colo-rectum, liver, lung, bladder, kidney and Hodgkin's disease. In females, significantly increased mortality rates in rural as compared to urban communes were observed for stomach cancer while significantly decreased mortality rates emerged for cancer of the colo-rectum, gallbladder, lung, breast, ovary, bladder and brain. With respect to altitude, residence above 200 meters retained a significant association in males, after allowance for the degree of urbanization of the commune of residence, for cancer of the oral cavity and pharynx, stomach and larynx (positive) and cancer of the colorectum and brain (negative). Women in locations above 200 meters seemed significantly at risk for stomach cancer, but protected from cancer of the colo-rectum and kidney. These results may provide a useful summary guide for further aetiological investigations into the risk factors associated with the diseases and give practical indications for local strategies of cancer control.

Smoking habits and prostate cancer: a case-control study in northern Italy.

BACKGROUND: Cigarette smoking has been associated with increased risk for prostate cancer in 2/13 case-control studies and 4/12 cohort studies conducted on this topic. The relationship between tobacco smoking and prostate cancer was further studied in a hospital-based case-control study in northern Italy. METHODS: Two hundred seventy-one cases of histologically confirmed prostate cancer and 685 controls were interviewed during their hospital stay about smoking habits and various other covariates. Controls comprised a group of males admitted to the same hospitals as the cases, but with acute conditions exclusive of malignant tumors, urological diseases, or any condition known to be related to tobacco or alcohol consumption. Odds ratios and 95% confidence intervals from logistic regression equations were reported for all smoking characteristics. RESULTS: No increased risk was found among the current smokers (odds ratio = 0.9; 95% confidence interval, 0.6-1.4), or the ex-smokers (odds ratio = 0.8; 95% confidence interval, 0.5-1.1). No trend in risk emerged with number of cigarettes smoked per day (odds ratio = 1.0; 95% confidence interval, 0.5-2.0 for smokers of 30 or more cigarettes compared with nonsmokers). Similarly, long duration of smoking habit, early smoking onset, and consumption of high-tar cigarettes were not associated with prostate cancer. CONCLUSION: The present study did not demonstrate any association between prostate cancer and various measures of tobacco smoking.

Alcohol and colorectal cancer: a case-control study from northern Italy.

The role of alcohol consumption in the etiology of colorectal cancer has been investigated in a case-control study conducted from 1985 to 1990 in the northern part of Italy, on 889 cases of colon cancer, 581 cases of rectal cancer, and 2,475 controls admitted to hospital for acute, non-neoplastic, nondigestive disorders. After allowance for age, education, study center, body mass index, and approximate total energy intake, no significant associations between alcohol intake and the risk of cancer of the colon or rectum were found (odds ratios [OR] for greater than or equal to 42 drinks/week cf none = 1.0 (95 percent confidence interval [CI] = 0.8-1.4) and 0.7 (CI = 0.5-1.0) for cancer of the colon and rectum, respectively). A significant increase in the risk of colon cancer with increasing alcohol consumption was, however, observed in females (OR for greater than or equal to 28 drinks/week cf none = 1.8 (CI = 1.1-3.0). While the results of the present case-control study do not suggest that alcohol plays a role in the etiology of colon or rectum cancer overall, they provide a hint for a weak association between alcohol consumption and colon cancer among females which, because of the similarities with breast cancer, should be evaluated in the context of the possible relationship between colon cancer, alcohol intake, and female hormones.

[Incidence of thrombi in implantation of pulmonary artery catheters]. / Incidenza di trombi negli introduttori impiegati per il cateterismo dell'arteria polmonare.

AIM: To evaluate the occurrence of thrombi in introducers employed for pulmonary artery catheterization. DESIGN: prospective study. SETTING: cardiac Surgery ICU in a University Hospital. PATIENTS: three groups of 20 subjects each: in group A, undergoing mitral or aortic valve replacement, a pulmonary artery catheter was placed through an introducer; in group B, undergoing myocardial revascularization, a pulmonary artery catheter was placed through an introducer; in group C, undergoing myocardial revascularization, only an introducer was placed. METHODS: The introducers were removed between the 2nd and the 8th postoperative day and the external surface and the lumen were inspected for thrombi. RESULTS: Endoluminal thrombi were observed in 40% of the introducers, but the patency of the lumen was always maintained. The incidence of thrombi was significantly higher in group A (23% in aggregate) than in group B (10%; p < 0.05) and in group C (6%; p < 0.05); by contrast no significant difference was observed between groups B and C. CONCLUSIONS: Endoluminal thrombi are very frequent in introducers employed for pulmonary artery catheterization but they are hardly suspected since the patency of the lumen is usually preserved. The lower incidence of thrombosis in groups B and C could hypothetically originate from antiaggregant therapy started within 24 hours from the end of surgery for myocardial revascularization.

[Control of postoperative pain in heart surgery. Comparison of analgesics]. / Il controllo del dolore postoperatorio in cardiochirurgia. Analgesici a confronto.

BACKGROUND: Evaluation of the efficacy of three analgesic drugs (tramadol, ketorolac, and morphine) for the control of postoperative pain in cardiac surgery. DESIGN: prospective randomized study. SETTING: University Hospital, Postoperative intensive care unit. PARTICIPANTS AND INTERVENTION: sixty patients, who underwent cardiac surgery, were studied. They were randomly allocated in four groups, treated with a different postoperative analgesic therapy: A) tramadol in continuous infusion; B) ketorolac in continuous infusion; C) tramadol, in repeated boluses; D) morphine, in repeated boluses. MEASUREMENTS: the analgesic efficacy of each drug and administration protocol was evaluated by hemodynamic stability, arterial blood gases analysis, Visual Analogue Scale (VAS), resting and after cough, the VAS derivatives PID and SPID, the concentration of plasma epinephrine and norepinephrine, at eight postoperative times. Adverse effects were also registered. RESULTS: Only tramadol, in continuous i.v. infusion, achieves the required analgesic effect, significantly decreasing both VAS scores, at the end of the administration of the drug. This treatment reduced epinephrine plasma levels in the first postoperative day, when the residual analgesic effect of surgical anesthesia can be considered disappeared. CONCLUSIONS: Tramadol in continuous infusion (dose 12 mg/h) proved to be effective for the control of postoperative pain after cardiac surgery. The proposed dose represents a good compromise between analgesic efficacy and interference with the vital functions of operated patients.

Fertility drugs and risk of epithelial ovarian cancer in Italy.

The report of an increase of ovarian cancer risk among women who had used fertility drugs prompted us to analyse the relationship between fertility drugs and ovarian cancer in a case-control study which has been ongoing in four areas of Italy since 1992. The present analysis is based on 195 epithelial ovarian cancer cases and 1339 controls admitted to hospital for diseases other than gynaecological or malignant conditions. Fewer ovarian cancer cases than controls reported use of fertility drugs (odds ratio, after allowance for potential confounding factors: 0.7, 95% confidence interval: 0.2-3.3). Among nulligravid women, 5/177 control women compared with 0/36 cancer cases reported having ever used fertility drugs. Although only based on small numbers of women who were suffering from ovarian cancer and who had also used fertility drugs, the present study indicated that a role of ovarian stimulation in the aetiology of epithelial ovarian cancer is not established, although it is worth investigating.

Cancer risk in farmers: results from a multi-site case-control study in north-eastern Italy.

The relationship between farming and cancer risk was investigated in an integrated series of case-control studies conducted from 1985 to 1991 in the Friuli Venezia Giulia region, north-east Italy. Patients with cancer of the oral cavity and pharynx, larynx, oesophagus, colon and rectum, pancreas, breast, thyroid gland, kidney and urinary tract, bladder, prostate, soft-tissue sarcomas, Hodgkin's diseases, non-Hodgkin's lymphomas and multiple myelomas, and controls admitted to hospital for acute, non-neoplastic conditions, were interviewed. For males, a significantly elevated relative risk was seen for oral cavity and pharynx. Farming, however, was associated with a significant protection against cancer of the colon and rectum and bladder. In females, only one significant association emerged, for multiple myeloma. A few significant interactions between cancer risk and year of birth (i.e., before 1930 or 1930 and after) were observed. The risk of cancer of the larynx was significantly elevated in younger male farmers but not in older ones. Our multi-site case-control study confirms that farmers have, for some cancer sites, a distinctive pattern. Excesses of cancer of the oral cavity and pharynx in farmers are characteristic of the present study area and, possibly, of similar European rural populations who have in common high levels of alcohol consumption and, at least in the past, unbalanced diets.

Condom use and sexual habits of heterosexual intravenous drug users in northern Italy.

In order to assess modes of human immunodeficiency virus (HIV) transmission from heterosexual intravenous drug users (IVDUs) to their partners, condom use and sexual habits with both steady and occasional partners were investigated. A total of 349 heterosexual IVDUs (247 men and 102 women) who ignored, at the time of interview, their HIV serostatus were interviewed. Respondents were asked for information on condom use and sexual habits for the three year period prior to the interview. Nearly 40% of IVDUs reported sexual intercourse with both steady partners and occasional partners. Fifty-four percent of their steady partners and 48% of their occasional partners were individuals who did not belong to groups at risk for HIV infection. Anal intercourse with steady partners was reported by 29% of IVDUs and 24% of IVDUs with occasional partners. Condom use during vaginal intercourse was seldom reported: 83% of IVDUs never used a condom with steady partners and 75% did not use one with occasional partners. IVDUs who were 1) unmarried, 2) enrolled in the study after 1986, 3) partners of not at-risk individuals, 4) partners of a foreigner and, 5) aware of their partners HIV seropositivity showed significantly higher, albeit still low, frequencies of condom use with steady partners. Conversely, all these factors seemed to have little impact on condom use with occasional partners. Condom use and sexual habits were similarly reported by HIV-positive and HIV-negative IVDUs. The present study shows that high-risk sexual behaviours among IVDUs are very widespread and it stresses the need for intensive counselling to promote condom use among IVDUs.

[Transcatheter radiofrequency ablation in supraventricular tachycardia in children: immediate results and mid-term follow-up]. / Ablazione transcatetere con radiofrequenza delle tachicardie sopraventricolari in età pediatrica: risultati immediati e di un follow-up a medio termine.

OBJECTIVES: The purpose of this study was to evaluate the efficacy and safety of radiofrequency ablation of supraventricular tachycardias due to a reentry circuit in a group of closely followed-up pediatric patients. PATIENTS: Forty-six pediatric patients (mean age 12.6 years, range 3-18) underwent a total of 48 radiofrequency ablation procedures for reciprocating supraventricular tachycardia. Thirty-nine had an orthodromic reentry tachycardia, 6 an atrioventricular node reentry tachycardia and 1 a permanent junctional reciprocating tachycardia. METHODS: To ablate the overt accessory pathways, the Kent potential (K) was identified and then the shortest A-K, and delta wave-K intervals were measured. The shortest V-A interval was identified for those concealed. For the left-sided accessory pathways, we used the retrograde transaortic approach in 10 procedures and the transseptal approach in 18. Atrioventricular node reentry tachycardia was ablated at the site where the slow-pathway electrogram was recorded. Follow-up clinical data, electrocardiogram, 24-hours Holter monitoring and transesophageal atrial stimulation were obtained and evaluated. RESULTS: Early: We performed a total of 48 procedures. Among 41 procedures performed in the 39 patients with accessory pathway, 38 were successful (92,6%). Mean fluoroscopy time was 31 +/- 18 min. For left sided accessory pathways, mean fluoroscopy time of procedures with retrograde approach was 45 +/- 10 min and with transseptal 23 +/- 12 min (p < 0.01). Ablation of slow-pathway in patients with intranodal reentry tachycardia was successful in 3/6 cases (50%). The patient with permanent junctional reciprocating tachycardia was successfully ablated. Late: All patients are alive and none was lost during the follow-up after a mean time of 12.9 months (range 5-33). Success at last follow-up was 100% in patients with an accessory pathway and 33% in patients with atrioventricular node reentry. In patient with permanent junctional reciprocating tachycardia, the arrhythmia appeared again one month after the procedure, thus a second successful attempt was performed. COMPLICATIONS: Major complications (6,5%) including a right femoral vein thrombosis (one patient), an hematoma without pulse loss (one patient) and a non-sustained monomorphic ventricular tachycardia (one patient). CONCLUSIONS: Our data show high efficacy of radiofrequency ablation in pediatric patients with accessory pathways. The risks are low at follow-up evaluation, but might be helpful a longer-term follow-up in order to evaluate the risk of a long fluoroscopy time and the arrhythmogenic effect of the scar.