Parity is associated with a longer time to reach irreversible disability milestones in women with multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) frequently affects women of childbearing age. While short-term effects of pregnancy on MS course are well-known, whether pregnancy may influence long-term disability progression is debated. METHODS: A two-centre retrospective study to investigate long-term effect of pregnancy on disability was performed in a population of MS women. Survival analyses and multivariate Cox proportional regression models (including early predictors of MS severity and exposure to disease-modifying treatments) were performed to compare time to reach well-established disability milestones in nulliparous women and in those with pregnancies after MS onset ('parous'). Women with pregnancies before MS onset were excluded from analyses as they represent a heterogeneous group. RESULTS: Data about 445 women (261 nulliparous, 184 'parous') were analysed. A longer time to reach Expanded Disability Status Scale (EDSS) 4.0 and 6.0 was observed in parous women; Cox regression models revealed a lower risk for 'parous' than nulliparous women in reaching EDSS 4.0 and 6.0 (HR = 0.552, p = 0.008 and HR = 0.422, p = 0.012 respectively). CONCLUSION: Our findings suggest that pregnancy after MS onset is associated with a slower long-term disability progression. Whether this represents a biological/immunological effect, or reflects a higher propensity toward childbearing in women with milder disease, it remains uncertain deserving further investigations.

Growth and shape modelling of the rabbit tibia: study of the dynamics of developing skeleton.

The proliferative impulse of the growth plate cartilage and related structures and its effect on the dimensions of long bones are well documented. The modulation of shape, however, is less known, and in general, it is referred to the coupled resorption/apposition process of bone modelling. A morphometric study was carried out on rabbit tibiae comparing size increments and shape changes in relation to age. Utilizing measurements made using dried bones, radiography and computerized tomography, it was possible to perform a three-dimensional analysis of shape modulation occurring during a period of growth extending from 3 months to 1 year of age. The dynamics of the shape changes related to growth were studied with a fluorescent tetracycline labelling. This enabled correlation of shape modulation with the 3-D distribution of apposition and resorption. The current thinking behind the influences and mechanical forces affecting bone architecture was discussed in the light of these findings. Several factors play a role in the structural organization of the human and upper vertebrates' skeleton, whose shape is genetically determined in the complex process usually referred as 'modelling'. This does not conflict with the existing evidence of remodelling being influenced by mechanical stimuli, but the unsolved question remains how physical forces (strains) act on the biological substrate of cartilage and bone cells.

[The psychological characteristics of dyspepsia. A controlled study with gastroscopic follow-up]. / Caratteristiche psicologiche della dispepsia. Studio controllato con follow-up gastroscopico.

It's known that some psychologic factors could be implicated in dyspepsia. Therefore, the psychologic aspects of 38 dyspeptic patients (17 males, 21 females, aged 18-65 years), who underwent digestive endoscopy, were evaluated by means of Rorschach and MMPI test. Patients with previous peptic ulcer history, with chronic ethanol or NSAID intake, operated on digestive tract and patients with behavioural problems were excluded. The results of psychological tests enhanced two main groups: anxiety patterns (17 patients--49%) and normal patterns (21 patients--55%). Endoscopic and histological findings moreover showed: "anxious" group--12 patients with chronic gastritis (HP+ 50%), 5 patients with normal endoscopy; "normal" group--16 patients with chronic gastritis (HP+ 87.5%), 5 patients with normal endoscopy. This study suggests that in about 50% of dyspeptic patients anxious pattern is present. Moreover chronic gastritis is more frequently associated to Helicobacter pylori in non-anxious patients.

[A high-resolution computed tomographic study of the pulmonary interstitium in systemic autoimmune diseases]. / Studio con tomografia computerizzata con alta risoluzione dell'interstizio polmonare in alcune malattie autoimmuni sistemiche.

This study was aimed at assessing the diagnostic capabilities of radiologic imaging in systemic autoimmune diseases. Forty-one patients (37 women and 4 men, mean age: 57.9 years, range: 37-73) were examined: 17 of them had rheumatoid arthritis, 8 Sjögren's syndrome, 11 progressive systemic sclerosis, 3 systemic lupus erythematosus, 1 mixed connective tissue disease and 1 undifferentiated connective tissue disease. The clinical features were compared with chest X-ray and HRCT findings. Functional lung examination (spirometry) was performed in 30 patients and in 22 of them chest X-ray findings could be compared with HRCT results since the examinations were performed on the same day. Seventeen patients complained of dyspnea (41.4%) and CO diffusion was reduced in 53% of the investigated patients. Chest films showed interstitial changes in 14 of 22 patients (63.6%), while HRCT findings were abnormal in 90.2% of the patients. Significant changes in HRCT patterns were detected only in 7 of the patients complaining of dyspnea (41.1%) and in 5 of the patients with reduced CO diffusion. In conclusion, HRCT proved to be much more sensitive than plain chest films. Dyspnea and functional respiratory tests correlated poorly with HRCT findings.

[The effect of colloidal bismuth and its combination with amoxicillin on the elimination of Helicobacter pylori in patients with a duodenal ulcer and chronic antral gastritis]. / Effetto del bismuto colloidale e dell'associazione con amoxicillina sull'eradicazione dell'Helicobacter pylori in pazienti con ulcera duodenale e gastrite cronica antrale.

Although the aetiopathogenetic role of Helicobacter Pylori (HP) in duodenal ulcer and in chronic gastritis seems now well defined, we have not yet standardized therapeutic schedules to achieve disappearance of HP. This study was aimed at evaluating the efficacy of two different therapeutic schedules, colloidal bismuth alone [CB(1200 mg/day)], vs. association with amoxicillin [CB+A(3 g/day)] for six weeks, to clear HP from antral specimens in a cohort of dyspeptic patients. 49 consecutive patients (23 females, 26 males, mean age 47 years, range 22-69) with HP in gastric specimens, 30 suffering from chronic antral gastritis (CG) and 19 affected by duodenal ulcer (DU) were treated with CB (37 pts) or with CB+A (12 pts). DU patients were given also H2-blockers. These latter patients were all healed at the endoscopic control performed after therapy. 4 out of 13 DU patients (31%) treated with CB were found HP free. In 4 out of 6 DU patients (66%) treated with CB+A, HP was no more detectable. As for CG patients, 12 out of 24 (50%) were free from HP at control when treated with CB, while only 2 out of 6 (33%) when CB+A was administered. This study suggests that colloidal bismuth is more effective when administered associated with amoxicillin, but this concerns only DU patients. No relation between endoscopic healing of UD and HP presence was found.

[Magnetic resonance imaging in study of the temporo-mandibular joint. II. Pathologic findings]. / La Risonanza magnetica nello studio dell'articolazione temporo-mandibolare. Parte seconda. Riscontri patologici.

A total of 107 temporomandibular joints (TMJ) were examined with two superconductive MR units at 1T and 1.5T. In 73 TMJs, MR revealed 55 disk displacements, 7 disk perforations, 10 joint space adhesions, 33 osteoarthrities, 3 avascular necroses of the mandibular condyle, and 25 joint effusions. These abnormalities are described and discussed. In spite of some limitations--e.g., motion artifacts and patients' claustrophobia--MR imaging is the procedure of choice in abnormal TMJs, because it yields useful information as to therapeutic choice (conservative versus surgical). Arthrography can be used as a complementary study technique in the patients with marked disagreement between clinical and MR findings. Arthroscopy should be used as a surgical procedure in abnormal TMJs selected by previous MR studies.