Environmental factors in a population-based inception cohort of inflammatory bowel disease patients in Europe--an ECCO-EpiCom study.

BACKGROUND AND AIMS: The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe possibly due to changes in environmental factors towards a more "westernised" standard of living. The aim of this study was to investigate differences in exposure to environmental factors prior to diagnosis in Eastern and Western European IBD patients. METHODS: The EpiCom cohort is a population-based, prospective inception cohort of 1560 unselected IBD patients from 31 European countries covering a background population of 10.1 million. At the time of diagnosis patients were asked to complete an 87-item questionnaire concerning environmental factors. RESULTS: A total of 1182 patients (76%) answered the questionnaire, 444 (38%) had Crohn's disease (CD), 627 (53%) ulcerative colitis (UC), and 111 (9%) IBD unclassified. No geographic differences regarding smoking status, caffeine intake, use of oral contraceptives, or number of first-degree relatives with IBD were found. Sugar intake was higher in CD and UC patients from Eastern Europe than in Western Europe while fibre intake was lower (p<0.01). Daily consumption of fast food as well as appendectomy before the age of 20 was more frequent in Eastern European than in Western European UC patients (p<0.01). Eastern European CD and UC patients had received more vaccinations and experienced fewer childhood infections than Western European patients (p<0.01). CONCLUSIONS: In this European population-based inception cohort of unselected IBD patients, Eastern and Western European patients differed in environmental factors prior to diagnosis. Eastern European patients exhibited higher occurrences of suspected risk factors for IBD included in the Western lifestyle.

Intrathecal methotrexate affects cognitive function in children with medulloblastoma.

BACKGROUND: Cognitive impairment occurs after malignant brain tumor treatment in children, following brain radiotherapy and systemic and intrathecal chemotherapy. OBJECTIVES: 1) To compare two groups of children who underwent surgery for cerebellar medulloblastoma with their cousins and siblings, assessing intelligence, executive function, attention, visual perception, and short-term memory. Both groups were treated with the same combined radiotherapy-chemotherapy, but differed in that only one group received intrathecal methotrexate (MTX+). 2) To relate these measures to MRI findings (leukomalacia). RESULTS: The two groups performed worse than their control subjects in all tests. The MTX+ group younger than 10 years performed significantly worse in all tests, particularly executive ones. The group older than 10 years performed significantly worse only in short-term memory. Younger patients without MTX performed significantly worse than controls only in some neuropsychological measures; there were no differences between older patients and control subjects. Only in the MTX+ group was there a direct correlation between extent of leukomalacia and performance in some tests. CONCLUSIONS: The administration of intrathecal methotrexate to children with medulloblastoma worsens the cognitive deficits induced by chemotherapy and radiotherapy. The use of intrathecal methotrexate in the treatment of medulloblastoma and other malignancies should be reassessed.

[Dysspermia due to inflammation. The evaluation of sperm cultures]. / Dispermie su base flogistica. Valutazione delle spermioculture.

The study evaluates 160 cases of positive spermioculture taken from 522 sterile individuals examined by the authors at the Couple Sterility Outpatient unit in Department A of the Institute of Gynecology and Obstetrics at Turin University during the period between January 1984 and December 1993. The germs responsible for infection were assayed in order to evaluate the strains which showed the highest incidence every year. Whereas there was no significant change in the absolute number of cases of sterility over the period, the number of cases caused by infection increased significantly during the second five-year period. It was found that the germs predominantly implicated in the genesis of male sterility formed part of the so-called mixed flora group, responsible in women for syndromes of often asymptomatic bacterial vaginosis which are not identified and consequently not treated.

[Ovarian hyperstimulation syndrome (OHS): borderlines between physiology and pathology]. / Sindrome da iperstimolazione ovarica (SIO): limiti tra fisiologia e patologia.

The use of gonadotropins in therapy has led to the appearance of a complication due to hyperstimulation, referred to as "syndrome due to ovarian hypertension" (SOH). There are three clinical stages of SOH: slight, moderate and severe, caused by a pathogenetic mechanism which is thought to involve the action of prostaglandins and the renin-angiotensin system leading to an alteration in capillary permeability with increased ovarian diameter. SOH can be prevented using a protocol to evaluate clinical conditions during therapy mainly based on hormone assays and echographic monitoring. SOH can be predicted but not prevented, thus making it important to commence immediate treatment for in-patients so as to restore the volume of blood and the blood protein load in the most severe cases.

Is tubal rupture a discriminating factor in the surgical conservative treatment of ectopic pregnancy?

217 women have been submitted to a surgical intervention for ectopic pregnancy in the years 83 - 84 - 85 in five hospitals in Piedmont. The rupture has been observed in 147 cases (67%). The percentage of women who presented a rupture was higher among those who underwent annexiectomy (75%), average among those who underwent salpingectomy (69%) and lower in case of conservative intervention (52%). Owing to these rather high percentages, we cannot state that the rupture is a discriminating factor as far as it concerns the choice of intervention, even if a fairly more conservative orientation is evident in case of unruptured tube.

Ectopic pregnancy: which treatment? Analysis of 217 cases.

The Authors describe the various types of treatment performed on 217 cases of ectopic pregnancy examined, which took place in the years 1983 - 84 - 85 in five among the main Hospital in Piedmont. 136 salpingectomies (62%), 41 annexiectomies (18%), 40 conservative interventions (20%) were performed. In most cases the destructive intervention was performed in the presence of a tubal rupture; no meaningful relations between the location and the type of surgical treatment have been found in the ectopic pregnancy. Conservative interventions have been more frequent on young women (under 35: 97%) and desiring children either because nullipara (65%) or because uniparous (27%). The highest number of conservative interventions was performed in the largest of the five Hospitals examined (23 cases: 57%). There is therefore a remarkable relation between diagnostic and therapeutic means and the possibility of performing the surgery most appropriate to the specific requirements of each case.

Comparative evaluation of ectopic pregnancy surgical treatment between a specialized hospital and a general hospital.

The surgical approaches followed in cases of ectopic pregnancy by the operators in two centres in Piedmont, one specialized in ostetrics and gynecology, the other a general county hospital are taken into consideration and compared. 131 cases have been registered in Turin and 30 in Biella. The salpingectomy has been performed on most cases in both centres with 56.5% and 66% respectively in the specialized Hospital and in the General one. The annexiectomy has been chosen for 25%. The intervention aiming at preserving the tube has been chosen for 17.5% in Turin and 34% in Biella. The most discriminating factor in choosing the type of intervention is mainly based on the patient's amnestic history, and therefore on her age, parity, any preceeding tube intervention and also on her desire for children.