Caesarean section in the world: a new ecological approach.

INTRODUCTION: This study aimed to estimate the most recent caesarean section rates in the world and examine the association between these rates and old and new indicators of health care. METHODS: Authors analyzed the Caesarean Section (CS) rates, also in geo-economic and economic groups, and correlated them to maternal and neonatal mortality, to births attended by skilled health personnel and to births among adolescents. Analysis of covariance and piecewise regressions were used for the statistical analysis. RESULTS: In 47.2% of the countries, the CS rate exceeded 15%. Countries of Latin America and the Caribbean along with Europe, North America and Oceania had the highest values. The analysis showed an inverse association between CS rates and Maternal Mortality (MMR) and Neonatal Mortality (NMR) for all geographical areas except for Europe. The greatest association was observed in lower-middle-income countries. In developing countries only 50% of cases, occur in medical facilities and only half of these are seen by medical, nursing and obstetrical staff. Age of the mother appears to influence the outcome and choice of delivery type. Countries where an high ABR rate is present have low CS use. CONCLUSIONS: To best evaluate the consequences of the increasing rate of CS, it would be useful to identify the most sensitive outcome indicators.

Essential thrombocythemia following polycythemia vera: an unusual sequence.

Myeloproliferative disorders (MPD) are prone to modification and evolution during the progression of the disease. While post-polycythemia myeloid metaplasia and chronic myelogenous leukemia following polycythemia vera have been frequently described, no report is available about the evolution of polycythemia vera into essential thrombocythemia. Our case is probably the first report on this occurrence. In the course of a fortuitous observation of electrocardiographic alterations, a diagnosis of polycythemia vera was ruled out in accordance with polycythemia vera study group criteria. At the time of diagnosis, RBC was 6 x 10(12)/L, WBC 15 x 10(9)/L, Ht 59% and platelets 1000 x 10(9)/L. The patient was treated with phlebotomies and radioactive phosphorus achieving a good remission or the disease. Five years later, platelets rose to over 3300 x 10(9)/L without significant modification or RBC, WBC and Ht. The restaging or the disease was consistent for an essential thrombocythemia. In particular, RBC mass was within normal levels. During the last ten years, the patient has been followed recurrently and the blood picture remained stationary, without an increase in the hematocrit but with a platelet count between 658 and 800 x 10(9)/L. We conclude that this report may complete data concerning the evolution of MPD in others.

Essential thrombocythemia and pregnancy: a report of six normal pregnancies in five untreated patients.

OBJECTIVE: To report our experience with essential thrombocythemia complicating pregnancy. METHODS: Over a 5-year period, we studied 21 women of reproductive age affected by essential thrombocythemia. Diagnoses were based on previously published Polycythemia Vera Study Group criteria. RESULTS: Five of our 21 patients became pregnant (total six pregnancies). All pregnancies were carried to term, with uncomplicated deliveries of normally formed infants. No thrombotic or hemorrhagic complications were encountered. CONCLUSION: Normal pregnancy and delivery is readily possible in patients with essential thrombocythemia.

Myeloproliferative disease in patients with a history of multiple blood donations: a report of 8 cases.

BACKGROUND: The clonal origin of myeloproliferative disorders has been clearly demonstrated and it is known that reactive thrombocytosis occurs as a non specific response to various inflammatory or neoplastic conditions. Only a few papers have discussed the topic of myeloproliferative diseases in blood donors. MATERIALS AND METHODS: We report 8 cases of myeloproliferative diseases (3 polycythemia vera and 5 essential thrombocythemia) in blood donors out of a total of 44 myeloproliferative disorders diagnosed in our Department during the last 5 years on the basis of the criteria established by the Polycythemia Vera Study Group criteria. As controls we considered 61 patients with reactive thrombocytosis referred to our Department in the same period of time. The estimated odds ratio was calculated according to standard methods. RESULTS: The prevalence of blood donors with myeloproliferative disorders was 18.1%, while that of donors with reactive thrombocytosis was 3.2%. The estimated odds ratio was 6.56 with a 95% confidence interval between 1.07 and 17.3. No other single factor except blood donations was frequent in the past history of these patients. CONCLUSIONS: Our data seem to indicate that both thrombocytosis and erythrocytosis resembled primary forms in these subjects; however, none of them suffered serious thrombotic and/or hemorrhagic symptoms. Our study indicates the importance of paying due attention to the blood cell counts of blood donors.

Post-polycythemia myeloid metaplasia: experience with a large cohort of patients.

The common origin of myeloproliferative disorders can explain the possible evolution of polycythemia vera to post-polycythemia myeloid metaplasia (PPMM). Such a possible event is usually considered linked to the use of myelosuppressive agents in particular 32P. Occasionally, myelofibrosis following essential thrombocythemia has also been described. We report here 19 cases of post-polycythemia myeloid metaplasia out of 214 polycythemia vera patients (8.8%). The majority of these patients received 32P therapy. However, busulfan also seems to have some role in the modification of polycythemia vera. In particular, the association of more than one myelosuppressive agent may favour the evolution of PPMM.

Prevalence of specific thrombotic accidents in patients with thrombocytosis.

The prevalence of specific thrombotic accidents recognized in 260 patients with thrombocytosis are reported. Ninety one were affected by PV, 86 by ET, 20 by MF and 63 by ST. The highest incidence of thrombosis was in the PV group. About half of ET and MF patients experienced a thrombosis. In all the patients thrombosis preferentially affected the cerebrovascular district (17.3% of the cases). Coronary artery disease occurred in PV while peripheral vascular disease was frequent in ET. Portal vein district thrombosis is not rare during the course of all MPD (7.1%). Apparently, deep vein thrombosis occurs in all patients with both primary and secondary thrombocytosis.

Sex and age as prognostic factors in essential thrombocythemia.

BACKGROUND: The major causes of morbidity and mortality in essential thrombocythemia (ET) are bleeding and thrombotic accidents, but a prognostic pattern for these complications has not yet been discovered. MATERIALS AND METHODS: In this study we report data from a large cohort of patients with thrombocytosis, distinguished for sex and age, in order to define their thrombotic risk. The prevalence of vascular complications recognized in 86 patients with essential thrombocythemia was studied. In addition, 91 patients with polycythemia vera (PV), 20 with myelofibrosis (MF) and 63 with secondary thrombocytosis (ST) were evaluated. RESULTS: 6.3% of ET subjects younger than 40 (4.6% of males and 7.0% of females), 11.8% of patients between 40 and 65 years old (14.9% of males and 9% of females), and 16.8% of subjects over 65 (14.6% of males and 17.8% of females) showed thrombotic accidents. In the PV and MF groups thromboses occurred more frequently than in the ET groups for all ages and for both sexes. On the contrary, ST subjects showed fewer thromboses than ET patients, but their incidence rose with patient age; moreover the prevalence of males in this group was limited. In ET patients, particularly in females, the incidence of thrombosis was low under 40 years of age, but rapidly increased later. CONCLUSIONS: ET females over 40 must be followed with particular attention in order to prevent thrombotic complications.

Incidence of thrombocytosis in lymphomas.

Reactive thrombocytosis due to malignancies and in particular those related to lymphomas have not yet been extensively evaluated. We report data on thrombocytosis recognized in 18 out of 101 patients with lymphomas diagnosed in our department over the last 3 years. All showed high platelet counts at the time of diagnosis. The incidence of thrombocytosis seems to be more frequent in males (21.2%) than in females (14.8%) and a slightly higher frequency was found in Hodgkin's disease (21.4%) than in non Hodgkin's lymphomas (16.4%). The incidence of thrombocytosis in lymphomas seems to be similar to that seen in other malignancies and because of this we conclude that a high platelet count cannot be used to distinguish malignancies.

Decrease of fibrinogen in patients with peripheral atherosclerotic disease by ticlopidine.

Ticlopidine (Ticlodone: CAS 55142-85-3) is able to develop a positive effect on claudication in patients affected by peripheral atherosclerotic disease (PAD). It is also known that ticlopidine decreases fibrinogen levels in plasma. 15 PAD patients treated with ticlopidine for 3 months were studied, evaluating the drug's effect both on maximum walking distance and on fibrinogen. Plasma fibrinogen as coagulable protein, fibrinogen antigen (Partigen method), 125I-fibrinogen survival, euglobulin lysis time and plasminogen were determined with the aim of clarifying if the decrease of plasma fibrinogen induced by ticlopidine is due to an increased destruction of a decreased production of the molecule. The normal levels of all tests before and after therapy both in ticlopidine treated patients and in the control group (acetylsalicylic acid + dipyridamol) indicate that the two hypotheses are not true. It is proposed that ticlopidine developing the known effect in decreasing the binding of fibrinogen to platelets induces a decrease only of activated fibrinogen.