Obsessions and compulsions in women with postpartum depression.

OBJECTIVE: The quantity, content, and intensity of the obsessions and compulsions of women with postpartum onset major depressive disorder were compared with those of women with major depressive disorder with non-postpartum onset. METHOD: Sequential cases of women with postpartum onset major depression (N = 37) and major depression (N = 28) who presented to our Women's Mood Disorders program were included. Psychiatric examination using DSM-IV criteria and the Inventory to Diagnose Depression established the diagnosis of major depression. Obsessive thoughts and compulsions were reported on the Yale-Brown Obsessive Compulsive Scale and reviewed during the psychiatric examination. Comparisons between groups were performed with chi-square statistics, Fisher exact test and its extensions, and Mann-Whitney U test. RESULTS: Although more women with postpartum onset major depression (N = 21, 57%) than major depression (N = 10, 36%) reported obsessional thoughts, the difference between the groups was not significant (p = .13). However, for women who endorsed obsessions, those with postpartum onset had a higher median number (median = 7) than women without postpartum onset (median = 2, p = .00). Most of the difference in frequency of thoughts was owing to more women with postpartum onset major depression having aggressive thoughts (N = 20, 95%) than women with major depression (N = 6, 60%, Fisher exact p = .03). The most frequent content of the aggressive thoughts for women with postpartum onset major depression was causing harm to their newborns or infants. The presence or number of obsessional thoughts or compulsions was not related to severity of the depressive episode. CONCLUSION: Childbearing-aged women commonly experience obsessional thoughts or compulsions in the context of major depressive episodes. Women with postpartum onset major depression experience disturbing aggressive obsessional thoughts more frequently than women with non-postpartum major depression.

Efficacy of high dose of recombinant alpha 2b interferon on long term response in chronic hepatitis C and cirrhosis: prospective randomized multicentre study.

BACKGROUND/AIMS: The long-term response to alpha-Interferon in HCV-related chronic liver diseases is disappointing. A randomized controlled trial was conducted to investigate: 1) if doubling the standard regimen of 3 MU recombinant alpha 2b-interferon thrice weekly for one year could improve the long-term response, and 2) the efficacy of these two schedules in cirrhotic patients. PATIENTS AND METHODS: A series of 80 anti-HCV positive patients with biopsy proven liver disease (52 chronic hepatitis and 28 cirrhosis) were randomized to receive either 3 MU or 6 MU alpha 2b-interferon. RESULTS: Based on "intention-to-treat analysis", 38% in the 3 MU group and 53% in the 6 MU group had end-of-treatment response. After 24 months, 18% had long-term response: 5% in 3 MU group and 30% in 6 MU group (p < 0.008). HCV genotype had no influence on the response rate. Thirty-eight percent of the cirrhotics treated with 6 MU had long-term response, while none of those treated with 3 MU had long-term response (difference 38%; 95% confidence internal 10%-67%; p = 0.03). At the end of treatment, 38% of patients lost HCV-RNA. After 24 months only 19% remained HCV-RNA negative: 12 patients (31%) in the 6 MU group and 2 (6%) in the 3 MU group (p < 0.05). CONCLUSIONS: 6 MU of alpha 2b-interferon thrice weekly for 12 months is significantly better than 3 MU in inducing a long-term response and permanent loss of HCV-RNA. This result is particularly striking in the subgroup of cirrhotics.

[Assessment of radiation dose to patients in hysterosalpingography]. / Valutazione della dose di radiazioni alla paziente nell'isterosalpingografia.

INTRODUCTION: The optimization principle applied to the patient radioprotection, recently introduced in Italian legislation, requires a careful analysis of the working procedures and clinical protocols generally used in radiological practice, to avoid unnecessary exposures with no loss in diagnostic information. We carried out this analysis in hysterosalpingography, which is the radiological examination usually performed on fertile women to detect uterine and tubal conditions. MATERIALS AND METHODS: The dosimetric survey was carried out on 35 patients, 22 to 40 years old, to evaluate: a) entrance dose and dose x area product; b) doses to the most irradiated organs, that is ovaries and uterus; c) effective dose equivalent and effective dose. The doses were measured with LiF thermoluminescent dosimeters, while an ionization chamber enabled us to the calculate dose area product. Ovaries and uterus doses were calculated with a Monte Carlo program using skin entrance exposure data and some technical parameters of the examination. RESULTS: The good agreement of the results obtained with both dosimetric methods demonstrated their equivalence in this specific case where the use of a clinical protocol, with no lateral projection, made the dosimeters lie always within the X-ray beam. DISCUSSION AND CONCLUSIONS: The mean dose was 4.5 mGy for the ovaries and 6.2 mGy for the uterus. Following the recommendations of the International Commission on Radiological Protection, both effective dose equivalent, with a mean value of 2.0 mSv, and effective dose, with a mean value of 1.95 mSv, were estimated. In conclusion, our results show that the patient dose can be reduced by limiting the use of fluoroscopy, using small size films and decreasing the number of exposures.

99mTc-MIBI prone scintimammography in patients with high and intermediate risk mammography.

Mammographic lesions can be classified into categories of high (HR), intermediate (IR) and low risk of breast cancer. We have performed 99mTc MIBI scintimammography on 85 patients with high or intermediate risk lesions in order to verify its ability to diagnose cancer before biopsy. The scintimammography was performed in prone lateral view; all the patients were submitted to excisional biopsy. HR lesions showed 86% of cancers and scintigraphic accuracy of 0.81. The accuracy of scintimammography was 0.97 in lesions larger than 1 cm. IR lesions showed 47% of cancer with scintigraphic accuracy of 0.95. The scintigraphic sensitivity was 0.97 lesions larger than and 0.50 in lesion smaller than 1 cm, whereas the specificity was always about 90%. Our results suggest that scintimammography can substantially decrease the need of biopsy for breast cancer diagnosis.

Gastric antral erosions and Helicobacter pylori infection in cirrhotic patients: a pilot controlled study of oral bismuth vs ranitidine therapy.

A controlled study was performed comparing bismuth and ranitidine oral therapy in the treatment of chronic antral erosions and chronic active gastritis and in clearing Helicobacter pylori in cirrhotic patients. Forty four patients took part in the randomized study. H pylori was present in more than 50% of the patients in the study. There was a close association between the presence of H pylori and inflammatory activity of gastritis at an antral level (p less than 0.001). CBS was significantly better than ranitidine in clearing H pylori (p less than 0.001) and reducing inflammatory activity of gastritis (p less than 0.001). This reduction was related to H pylori clearance. No action of the two medications was observed in improving endoscopic findings of erosive gastritis. H pylori clearance did not influence amelioration of endoscopic chronic erosive antral gastritis (EG) in cirrhotic patients. These findings suggest that H pylori does not seem to play a pathogenetic role in the aetiology of EG in cirrhotic patients while it represents an important factor in determining and maintaining the inflammatory activity of histologically confirmed gastritis in these patients.

Prevalence of antibody to hepatitis C virus (anti-HCV) in chronic liver diseases (CLD) in southern Italy.

Two hundred and sixty-three patients consecutively admitted to our Unit for CLD were investigated for the antibody to Hepatitis C Virus (anti-HCV) in the serum using the recently developed enzyme immunoassay. The overall prevalence of anti-HCV was 45%; in patients with cryptogenic CLD it was significantly higher (69%) than in patients with markers of viral hepatitis (15%). Anti-HCV was found in 62% of the patients with hepatocellular carcinoma; this finding favours a potential role of HCV in determining the neoplastic transformation of the cirrhotic liver. In alcoholic liver disease the prevalence of anti-HCV was 52%; this finding poses the interesting question of aethiology of liver damage in these patients. The presence of anti-HCV was significantly associated with older age, irrespective of aethiology and stage of liver disease. The importance of the detection of this antibody for the aethiological diagnosis of chronic liver damage remains to be elucidated.

[Mid-term natural course in Naples of chronic HBeAg positive infection caused by the HB-virus. Prospective study, preliminary to antiviral treatment]. / L'andamento naturale a medio termine a Napoli della infezione cronica da HB-virus HBeAg positiva. Studio prospettivo, preliminare al trattamento antivirale.

41 consecutively observed patients with chronic HB virus infection in replication phase (HBeAG positive) were followed up for an average period of 60 months with a view to evaluating the frequency of spontaneous HBeAg/anti-HBe seroconversion and the influence of the event on the clinical course of the liver disease. The 41 patients, of mean age 22 years, suffered from: 26 ECP, 7 ECA, 8 CIRR. 18 patients (41%) presented HBeAg/anti-HBe seroconversion with an annual percentage of 12%, all with stable normalisation of hepatic cytolysis tests. Factors related to HBeAg/anti-HBe seroconversion were: female sex, higher mean starting values of transaminase, positive history for EVA, absence of Virus Delta superinfection. The effectiveness of antiviral treatments will only be demonstrated when seroconversion (inhibition of viral replication) is produced much more frequently than that which occurs spontaneously. Candidates for current antiviral treatment are indicated.

[Variations of functional parameters in chronic aggressive HBAg positive and negative hepatitis by means of radioimmunologic method (preliminary note)]. / Variazioni dei parametri funzionali nelle epatiti croniche aggressive HBAg positive e negative con metodo radioimmunologico (nota preliminare)

43 subjects, affected by chronic aggressive hepatitis (CAH) have been divided into two groups according to the presence of HBAg. No statistically significant differences between the two groups have been provided. The two classes of subjects (HBAg + and -) were also divided into the already treated (with immunosuppressive drugs) and untreated to investigate the eventual differences existing between the two classes. The results of this division was that previously treated subjects present a lower total bilirubin (P less than 0.05) in respect to those that were not treated previously. The results of all the other comparisons carried out and the tested correlations were negligible. In conclusion, bearing in mind the inadequate methods used up to now to research the HBAg, the transversal studies show that CAH patients are both affected by the same syndrome, whether the HBAg is positive or negative. However, it is probable that it is not the carrier state of HBAg which enables the liver disease evolution but the liver disease itself enables the cellular immunity disorders that often appear in the course of CAH.