A multidimensional examination of affective and cognitive empathy in anorexia nervosa.

Socio-emotional features are crucial in the development and maintenance of anorexia nervosa (AN). The present study investigates the patterns of altered and preserved empathic abilities in AN. Empathy is an umbrella term that comprises the ability to recognise another's emotional state, take another's perspective, and fantasise (cognitive empathy), as well as the ability to experience vicarious emotions and signal them (affective empathy). These empathic abilities were measured in 43 AN patients and 33 healthy women through a multi-method approach comprising self-report measures, behavioural tasks and bodily correlates. Further, we assessed self-reported approach-avoidance attitudes towards suffering others. Results showed that, within the domain of cognitive empathy, AN patients reported impairment in recognising emotional expressions of anger and fantasising. Concerning affective empathy, they manifested lower sharing of others' positive emotions, higher self-reported distress, and higher facial expressiveness during a video depicting a suffering person. Finally, AN patients reported lower motivation to approach suffering others. Our results draw a complex picture of preserved and altered empathic abilities in AN and capture which are the deficits mediated by the higher levels of anxiety and depression reported by the AN population and those that seem to persist independently from these co-morbid conditions.

Clinical and radiological presentation of parasellar ectopic pituitary adenomas: case series and systematic review of the literature.

PURPOSE: Parasellar ectopic pituitary adenomas (pEPAs) are extremely rare tumors located out of the sella turcica. PEPAs are heterogeneous entities in terms of anatomical localization and secretion of anterior pituitary hormones. METHODS: Multicenter retrospective study. Clinical charts' consultation of patients diagnosed with parasellar lesions, to identify all subjects fulfilling the diagnostic criteria of parasellar EPAs. Systematic review of the literature focused on the medical management of prolactin-secreting pEPAs and on the prevalence of radiological bone invasion in pEPAs. RESULTS: We identified four cases of pEPAs: (1) 54-year-old female with a prolactin-secreting suprasellar EPA successfully treated with cabergoline; (2) 74-year-old male with a non-functioning EPA of the sphenoidal sinus treated with endoscopic transsphenoidal surgery; (3) 75-year-old female with a giant lesion of the skull base (maximum diameter 7.2 cm) diagnosed as a non-functioning EPA after biopsy; (4) 49-year-old male with a silent corticotroph EPA of the sphenoidal sinus and clivus. Three out of four cases had radiological evidence of invasion of the surrounding bone structures. A systematic review of the literature highlighted that medical therapy can be effective in prolactin-secreting pEPAs. Overall, we found mention of local invasiveness in 65/147 cases (44.2%), confirmed by radiological signs of bone invasion/erosion. CONCLUSION: Our experience confirms the heterogeneity of pEPAs in terms of clinical and radiological presentation, as well as hormone secretion. PEPAs show a high frequency of radiological bone invasion, though similar to that of sellar pituitary adenomas. Although extremely rare, pEPAs need to be considered in the differential diagnosis of parasellar lesions.

Endocrine effects of tamoxifen in postmenopausal breast cancer patients.

The effects of tamoxifen on plasma concentration of gonadotropins, prolactin (PRL), estrone (E1), estradiol-17 beta (E2), and sex hormone-binding globulin (SHBG) were studied in 40 postmenopausal breast cancer patients. In addition, the changes induced by the drug on endometrium and vaginal epithelium were investigated. After 6-8 weeks of tamoxifen treatment, a significant decrease in FSH, LH and PRL basal levels was observed, whereas the concentrations of E1 and E2 were not significantly affected. A significant increase in SHBG levels was induced by prolonged treatment with the drug. In addition, tamoxifen caused a partial estrogenization of vaginal smears, and a weak stimulatory effect on endometrium was also apparent. These findings indicate that tamoxifen produced agonistic effects on some targets and antagonistic effects on the others.

Plantar verrucae in patients with human immunodeficiency virus. Clinical presentation and treatment response.

Several previous studies have yielded data showing that plantar and other cutaneous verrucae follow a more aggressive course in patients infected with human immunodeficiency virus (HIV) than in uninfected individuals. A pilot study was undertaken to identify trends in a sample population that would support this characterization of plantar verrucae in HIV+ patients and to determine whether there are differences in treatment response between HIV+ and HIV- patients. The results show that the HIV+ patients in the study presented with a significantly greater number and total area of lesions than did the HIV- patients. Furthermore, the HIV+ patients experienced a greater frequency of recurrence of their lesions following treatment with surgical curettage. These findings should provide the foundation for other extensive, multicenter studies to further characterize the treatment response of these lesions in HIV+ patients and to develop effective guidelines for their management.

[Use of propofol in intracranial surgery in 83 consecutive patients]. / Utilisation du propofol en chirurgie intracranienne chez 83 patients consécutifs.

Propofol is an intravenous anesthetic agent with a short half-life allowing rapid recovery; it has cerebral hemodynamic effects similar to those of thiopental. The aim of the present study was to describe 83 patients (mean age 50.6 +/- 15.1 yrs) scheduled for intracranial surgery in whom a total intravenous anesthesia technique (TIVA) with propofol was used. 16 patients were operated in the sitting position. Mean propofol induction dose was 2.1 +/- 0.8 mg/kg combined with 2.3 +/- 1.8 micrograms/kg of fentanyl, 1.5 mg/kg of lidocaine, and 0.08 mg/kg of vecuronium to facilitate intubation. Before installation of the Mayfied pin-head holder, the site of the pins was infiltrated with 2-3 cc of lidocaine 1%. Anaesthesia was maintained with propofol 5.9 +/- 2.1 mg/kg/h and fentanyl 1.6 +/- 0.65 micrograms/kg/h. Mean values of mean arterial pressure and heart rate showed less than 10% variation at intubation, application of the pin-head holder and skin incision. Intracranial pressure measured by the lumbar route (after checking the patency of the CSF passage from the cerebral to the spinal compartments) varied by slightly more than 10%, starting at 11.3 +/- 6.0 mmHg before induction and 11.3 +/- 5.2 mmHg at intubation down to 9.5 +/- 4.5 mmHg after skin incision. The lumbar drainage in place allowed the surgeon to improve brain relaxation by drawing 5-20 cc of lumbar CSF. Duration of anaesthesia was 367 +/- 96 mn from induction to extubation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Expression of the cdx2 gene in benign intestinal-type mucinous ovarian tumors]. / Espressione del gene cdx2 nei tumori ovarici mucinosi benigni di tipo intestinale.

INTRODUCTION: Cdx2 gene belongs to the homeobox caudal gene family and it is located, in humans, on the 13q12.3 chromosome; in particular it codifies for a specific nuclear transcription factor which induces intestinal epithelium development, differentiation and preservation. Cdx2 expression in the human embryo can be observed in the intestinal epithelium starting from the sixth week of gestation. In the foetus and in adults it is observed in the whole enteric tube from the duodenum to the anal canal. Because of its organ specificity, cdx2 is an important marker for metastatic neoplastic lesions. Cdx2 is expressed in intestinal metaplasia and it is focally positive in adenocarcinomas of intestinal type of the stomach, pancreas and gall bladder as well as in ovarian mucinous adenocarcinomas. FINALITY OF THE STUDY: The aim of our study is to detect cdx2 positivity, with evaluation of its characteristics and expression, in ovarian mucinous cistoadenomas. MATERIALS AND METHODS: We examined cdx2 expression in 50 ovarian mucinous cistoadenomas (mean age between 17 and 85), 19 of which were localised in the right ovary while 31 in the left one. Standard staining techniques (H&E), histochemistry (AB-PAS) ed immunohistochemistry with monoclonal antibodies against cdx2 (Biogenex/Menarini cdx2-88, batch MU3920402XS) were performed on formalin fixed and paraffin embedded material. For each case two samples were analysed. RESULTS: Morphological evaluation of the 50 benign mucinous tumours distinguished 47 of endocervical type and 3 of intestinal type. These data were also confirmed by characterisation of mucin profile by AB-PAS staining. Using anti-cdx2 antibodies tumours of endocervical type were negative, while 3 intestinal type tumours were positive. In particular 2 cases presented diffuse nuclear positivity, while in one positivity was only focal. DISCUSSION: Until today only two studies deal with cdx2 expression in mucinous ovarian tumours: 5 and 14 cases strong respectively. In the former, cdx2 expression was positive in all cases (100% positivity--5/5), in the latter cdx2 expression was positive in 64% of cases (9/14). In order to explain the lack of consistency in these data one must analyse ovarian mucinous tumours in detail. These neoplasms are divided into two subtypes: endocervical type and intestinal type. Distinction between these two types is near to impossible in malignant tumours, difficult in borderline tumours while it becomes easy in benign ones. Among benign tumours, endocervical type tumours are the majority, while intestinal type are much more infrequent. Our 50 case strong casistic is sufficiently ample to include 3 cases of intestinal type, all of which are cdx2 positive, compared to a complete negativity in the remaining 47 tumours clearly of endocervical type. We believe that the lack of consistency between the aforementioned studies is probably due to the fact that neither work contemplates the subdivision in intestinal and endocervical types. It is hence possible to hypothesise a selective and specific correlation between cdx2 positivity and the intestinal type epithelial component of ovarian tumours.

[Comparison between different radioimmunological methods for the determination of steroid hormones]. / Confromto fra differenti metodiche radioimmunologiche per il dosaggio degli ormoni steroidei.

17 beta-Oestradiol, Progesterone and Testosterone levels were assayed using different methods involving both I125 or H3 ad tracer in 15 female sera. Wide variations were observed only using the direct assay of 17 beta-Oestradiol, while the results of the three others assays were overlapped. None of the three methods used for the assay of Progesterone gave remarkably variations in results. One of the two direct methods used for Testosterone produced higher results than those obtained using previously extracted samples.

Management of a spinal catheter that became intravascular.

The management of a misplaced spinal catheter in an 83-year-old women undergoing elective knee surgery, in whom clear cerebrospinal fluid and blood were alternately aspirated through the catheter during the surgical procedure, is described. In the face of catheter misplacement, before administering general anesthesia, the authors recommend using a small "test dose" of local anesthetic to confirm subarachnoid location of catheter despite lack of frank reflux of cerebrospinal fluid.

Alkalinization of lidocaine 2% does not influence the quality of epidural anaesthesia for elective caesarean section.

This double-blind randomized study compared the effects of an epidural injection of lidocaine hydrochloride 2% (HCl) (Group 1), alkalinized lidocaine 2% (1 ml NaHCO3 per 10 ml of solution) injected either immediately (Group 2) or one hour after preparation (Group 3) in 45 parturients (n = 15 per group) scheduled for elective Caesarean section. Each patient received 16 ml of one of the three solutions. The mean pH values measured just before administration with a pH-meter PHM 64 Metrohm AG were 6.77 for the HCl lidocaine 2% solution, 7.34 for the freshly alkalinized solution and 7.35 for the solution prepared one hour before injection. The median maximal sensory level (range) observed was T3 (T8-C7), T4 (T5-C8) and T4 (T6-C6), obtained after 19 +/- 6 min, 18 +/- 8 min and 16 +/- 6 min respectively for each group. A motor block of grade 2 or 3 on the Bromage scale was obtained in 11, 10 and 14 patients respectively. No failure was observed although 3, 5, and 2 patients in Groups 1, 2, and 3 respectively required a supplementary bolus 20 min after the initial injection because of inadequate sensory level or pain at the operative site. In conclusion, this study shows that neither fresh alkalinization of 2% lidocaine nor the delay of one hour between preparation and injection of the alkalinized solution influences the onset or quality of epidural anaesthesia for elective Caesarean section.

Comparison of 5 mg tetracaine diluted in 1 ml, 2 ml and 4 ml of 10% glucose for spinal anesthesia.

The influence of variations in the volume of injectate when maintaining an identical dose of a hyperbaric local anesthetic has not previously been investigated when performing spinal anesthesia. This study compares spinal anesthesia of 5 mg of lyophilized tetracaine diluted in 1 ml, 2 ml or 4 ml of 10% glucose in 45 elderly patients undergoing elective hip surgery. While supine and horizontal, each patient received double-blind one of the three solutions through a catheter inserted 4 cm into the intrathecal space at the L2-L3 or L3-L4 interspace. No difference in the anesthetic effects was found between the three groups. The median value of the maximal sensory level was T6 (range T3-L2), T4 (range T3-T9) and T5 (range T3-T11) in the 1-ml, 2-ml, and 4-ml groups, respectively. The number of patients with a motor blockade of grade 2 or 3 was 12/15, 14/15 and 13/15, and the time from the initial dose to the need for the first top-up dose (mean +/- s.d.) was 88 +/- 35 min, 75 +/- 15 min and 68 +/- 15 min for the 1-ml, 2-ml and 4-ml groups, respectively. Hemodynamic changes were also comparable between the three groups. The authors conclude that in elderly patients, undergoing spinal anesthesia while supine and horizontal, variations in volume from 1 to 4 ml do not influence the characteristics of hyperbaric spinal anesthesia while injecting an identical dose of local anesthetic.

Gamete intrafallopian transfer and plasma chorionic gonadotropin dynamics: evidence of a delayed appearance.

The purpose of this study was to compare early human chorionic gonadotropin secretion in two groups of pregnancies. These pregnancies were obtained, in one group, during a natural cycle, while, in the other group, they resulted from gamete intrafallopian transfers performed in hyperstimulated cycles. A logarithmic regression analysis was chosen to allow statistical comparison of serial plasmatic evaluation as hormone determinations were obtained, among patients, at different postovulatory days. The regression lines of the two groups of patients presented similar slopes. The unpaired t test performed on calculated data for 3 different days constantly revealed significantly higher levels (P less than 0.005) of natural vs stimulated cycles; thus a different origin on the x axis (days of the luteal phase) is deduced. These findings support the possibility of a delay in the appearance of human chorionic hormone in the patients undergoing gamete intrafallopian transfer technique.

Advantages of intrathecal nalbuphine, compared with intrathecal morphine, after cesarean delivery: an evaluation of postoperative analgesia and adverse effects.

UNLABELLED: We performed a prospective, randomized, double-blinded, multicenter study to compare the analgesic efficacy and adverse effects of intrathecal nalbuphine, at three different doses, and intrathecal morphine for postoperative pain relief after cesarean deliveries. Ninety healthy patients at full term who were scheduled for elective cesarean delivery with spinal anesthesia were enrolled in the study. They received 10 mg of hyperbaric bupivacaine 0.5% with either morphine 0.2 mg (Group 1), nalbuphine 0.2 mg (Group 2), nalbuphine 0. 8 mg (Group 3), or nalbuphine 1.6 mg (Group 4). Only patients in Groups 1 and 2 reported pain during surgery. Postoperative analgesia lasted significantly longer in the morphine group, compared with the nalbuphine groups (P: < 0.0001). In the nalbuphine groups, postoperative analgesia lasted longest with the 0.8-mg dose. The additional increase to 1.6 mg did not increase efficacy. The incidence of pruritus was significantly higher in Group 1 (11 of 22), compared with Group 2 (0 of 22, P: < 0.0002), Group 3 (0 of 23, P: < 0.0001), and Group 4 (3 of 20, P: < 0.02). Postoperative nausea and vomiting were more frequent in Group 1 (5 of 22), compared with Group 2 (0 of 22, P: < 0.05), Group 3 (0 of 23, P: < 0.05), and Group 4 (3 of 23, not significant). There was no maternal or newborn respiratory depression. Neonatal conditions (Apgar scores and umbilical vein and artery blood gas values) were similar for all groups. This study suggests that intrathecal nalbuphine 0.8 mg provides good intraoperative and early postoperative analgesia without side effects. However, only morphine provides long-lasting analgesia. IMPLICATIONS: Small doses of intrathecal nalbuphine produce fewer adverse effects, such as pruritus and postoperative nausea and vomiting, compared with intrathecal morphine. This may allow earlier discharge of patients from the recovery room.

Postoperative analgesia with "3-in-1" femoral nerve block after prosthetic hip surgery.

PURPOSE: To evaluate the efficacy of a single shot "3-in-1" femoral nerve block for prosthetic hip surgery in association with general anaesthesia on post-operative analgesia. METHODS: Forty patients, ASA 1 to 3, received sham block or "3-in-1" femoral nerve block, following Winnie's landmarks with a nerve stimulator, and 40 ml bupivacaine 0.5% with epinephrine were injected after induction of anaesthesia. Vecuronium, 0.1 mg.kg-1, was added after performing the block and anaesthesia was maintained with isoflurane, oxygen 40% and nitrous oxide 60%. Fentanyl, 1.5 microgram.kg-1, was administered before incision to all patients. Heart rate, blood pressure, fentanyl requirements and FETiso were measured throughout surgery. During the post-operative period, 75 mg diclofenac i.m. and/or 0.1 mg.kg-1 morphine s.c. were administered when pain score was > 3/10 and repeated when necessary. Pain scores at first analgesic intervention, at 24 hr and 48 hr as well as diclofenac and morphine requirements after surgery were recorded. RESULTS: There was no difference in anaesthetic requirements during surgery. The time from performance of sham or "3-in-1" femoral nerve block to the first analgesic intervention (261 +/- 49 min versus 492 +/- 40 min, P < 0.05) and time from extubation to the first analgesic intervention (61 +/- 44 min vs 298 +/- 39 min, P < 0.05) were prolonged in the study group. However, pain scores and the analgesic requirements in the postoperative periods (24 and 48 hr) were similar. CONCLUSION: There is a short-term benefit during the first few postoperative hours in using a single shot "3-in-1" femoral nerve block to complement general anaesthesia for elective hip surgery.

Comparison of a blocking vs. a flare-up protocol in poor responders with a normal and abnormal clomiphene citrate challenge test.

This study aimed to standardize the clomiphene citrate test (CC-t) in our laboratory while comparing two different protocols of controlled ovarian stimulation in poor responders. One hundred and forty-four patients scheduled for assisted reproductive techniques were submitted to the CC-t within 3 months before starting stimulation; 133 underwent controlled ovarian stimulation with a blocking protocol. Poor responders in the first cycle (n = 30) were subsequently treated with a flare-up protocol. Although it was not statistically significant, more patients reached oocyte retrieval with the flare-up protocol. In the completed cycles, more gonadotropin ampules (55 +/- 15 vs. 34 +/- 13; p < 0.001) and more stimulation days (12.6 +/- 1 vs. 11.6 +/- 1.2; p < 0.005) were needed in the blocking than in the flare-up protocol. No difference was observed in peak 17 beta-estradiol levels, preovulatory follicles, oocytes retrieved or pregnancy rate between the two protocols. According to the threshold values, established on CC-t of patients who obtained a clinical pregnancy (n = 44), the incidence of abnormal results was 10%. All but one patient with abnormal CC-t were poor responders during the first stimulation cycle. The flare-up protocol did not improve the ovarian response in these patients.

Laparoscopic extraperitoneal inguinal hernia repair complicated by subcutaneous emphysema.

The case of a healthy 59-yr-old man who underwent elective laparoscopic extraperitoneal inguinal hernia repair and general anaesthesia is presented. After one hour of surgery, a sudden increase in the FETCO2 from 5.0% to 9.4% in relation to a massive subcutaneous emphysema, but without any haemodynamic instability, was noticed. The acute rise of FETCO2 was the first sign of an abnormal event. Nevertheless, subcutaneous emphysema was diagnosed with chest wall examination and palpation. Subcutaneous emphysema and hypercarbia are potential complications of laparoscopic surgery, but are more likely to occur in extraperitoneal surgery, since insufflated CO2 can diffuse easily into the surrounding tissues. High insufflation pressures will increase chances of this occurring and was the most likely cause of this complication. This case encouraged us to make recommendations for the management of laparoscopic extraperitoneal surgery which included: monitoring of CO2 insufflation pressure, routine examination and palpation of chest wall, use of N2O with caution, adjusting ventilation to physiological FETCO2 and excluding other causes of subcutaneous emphysema and hypercarbia.

Efficacy of three test doses to detect epidural catheter misplacement.

PURPOSE: To determine among three currently used epidural test doses which is the most reliable for the detection of accidental intrathecal misplacement of an epidural catheter, and which clinical sign is to be used as a marker. METHODS: Ninety orthopedic patients were allocated to either the continuous epidural or the continuous spinal group according to age, < or > 70 yr. They received, in a randomized, double-blind fashion, one of the three solutions: 60 mg lidocaine 2% (L2%), 7.5 mg bupivacaine 0.25% (B0.25%), or 15 mg bupivacaine 0.5% (B0.5%); all three solutions contained epinephrine. Objective variables studied every two minutes over the first ten minutes after injection included: presence of a sensory level > or = T12, presence of a motor block > or = 1, and anesthesia of segments L1, L2, S2 and S5. Subjective variables studied over the same period included paresthesias, sensation of warmth or cold, and muscle weakness. RESULTS: When using presence of motor block > or = 1 on the Bromage scale, the administration of 60 mg L2% with epinephrine identified all patients having an intrathecal catheter six minutes after injection, whereas none of the patients receiving the same solution through the epidural catheter presented a motor block. This was not the case for the other two solutions studied. CONCLUSION: Lidocaine 2% with epinephrine at a dose of 60 mg is the test dose of choice to detect the intrathecal misplacement of an epidural catheter. The presence of motor block > or = 1 is the only reliable clinical sign.

The duration of pituitary suppression by means of intranasal gonadotropin hormone-releasing hormone analogue administration does not influence the ovarian response to gonadotropin stimulation and success rate in a gamete intrafallopian transfer (GIFT) program.

The aim of the study was to compare the ability to prevent endogenous luteinizing hormone interferences, ovarian response, and success rate between two groups of patients undergoing GIFT procedures and treated with the same stimulatory protocol but with a different timing in the administration of the gonadotropin hormone-releasing hormone analogue (GnRH-a). The former underwent a concomitant administration of gonadotropin and analogue; the latter started stimulation only after the achievement of complete hypogonadotropinism. The analogue was always given intranasally and stimulation was identical in the two groups. Our results showed that (1) prevention of premature luteinization is obtained with both approaches and (2) no significant difference in terms of length of stimulation, gonadotropin doses, ovarian response, and success rate was recorded between the two groups.

Effect of lisuride on inhibition of lactation and serum prolactin.

Lisuride, a new semisynthetic ergot derivative, was given to 53 women to inhibit lactation; 26 women had 300 micrograms daily and 27 had 600 micrograms daily for seven days. Eight lactating women acted as controls. Lisuride effectively inhibited lactation and also suppressed the serum prolactin levels; the latter effect was dose related. Lisuride produced no untoward side effects.

The use of sulprostone to induce abortion in the second trimester.

We have used a derivative of PGE2, sulprostone, to induce abortion in the second trimester of pregnancy in 26 women. 500 micrograms of sulprostone were administered i.m. every four or six hours and clinical rating of the efficiency of the treatment was done using a scale ranging from 20 to 100. FSH, prolactin, 17-beta-estradiol, progesterone, hPL and beta-hCG plasma levels were monitored during treatment. The drug was effective in 20 cases (79.9%) while in three cases additional administration of oxytocin was necessary and in three cases no effect was seen. Treatment was interrupted, due to the appearance of unpleasant side effects, in only one case. No specific variation in hormone levels was seen. In three cases in which only two doses of the drug were sufficient to induce abortion, hormone levels dropped more rapidly and to a greater extent than in the remaining cases. A correlation exist between the rate of decrease in progesterone and 17-beta-estradiol plasma levels and the time required for the treatment to induce abortion.