Evolution of HIV-1 encephalopathy in children

BACKGROUND

This study has been conducted on a series of HIV-1 infected children, with the aim of illustrating the features of encephalopathy onset, its evolution and its influence on life expectancy. The most useful exams for diagnosis are also outlined.

METHODS

The perspective study lasted from January 1989 to June 1997. Forty six symptomatic patients, out of 142 seropositive children, were followed up in the Department of Paediatric and Adolescence Sciences of the University of Turin. The patients, now between 1 yr 2 mth and 13 yr 9 mth old, were born from HIV-1 seropositive mothers; seroreverters have been excluded. Scheduled neuropsychiatric consultations were used, consisting of a neurologic exam and an interview with parents, cognitive evaluations, EEGs, Evoked Potentials and CT scans. The results have been evaluated with log-rank test for the analysis of the survival curves.

RESULTS

We found a significantly higher mortality rate in encephalopathic versus non encephalopathic patients; encephalopathic patients, in whom neurologic signs began in the first year of life, have a worse prognosis than the other patients, in whom encephalopathy appeared later. We did not find a statistical correlation between clinical course and immunological deficit. The clinical features of encephalopathy are mainly characterized by pyramidal signs and cognitive deterioration. Clinical sign evolution is linked to the age of encephalopathy onset: plateau pattern encephalopathy, characterized by an early onset, severe motor signs and cognitive delay from the very beginning, shows a greater severity and a shorter survival than progressive encephalopathy, characterized by a slowly progressive evolution of pyramidal signs, to which a cognitive deterioration may be added.

CONCLUSIONS

Neuropsychological exams can be helpful in the diagnosis and follow-up of encephalopathy.

Cardiac dysrhythmias induced by extracorporeal shockwave lithotripsy

PATIENTS AND METHODS

We evaluated in 269 consecutive patients the incidence and gravity of dysrhythmic complications during nonsynchronized extracorporeal shockwave lithotripsy (SWL) using an electromagnetic lithotripter.

RESULTS

Dysrhythmia occurred during treatment in 22 patients (8.8%) with no previous cardiac dysrhythmia. Ventricular extrasystoles occurred in 14 patients, atrial extrasystoles in 7 patients, and sinus bradycardia in 1 patient. It was not necessary to terminate treatment because of the occurrence of dysrhythmia in any of the patients. For 13 of the 22 patients (59%), it was sufficient to interrupt the treatment momentarily to obtain resumption of the normal rhythm. For 8 patients (36%), treatment was continued after triggering the release of the shockwaves with the refractory phase of the heart cycle. For one case of bradycardia (42 beats/min), it was possible to continue with the treatment after intravenous administration of atropine 0.5 mg. Pretreatment dysrhythmias were revealed by the electrocardiographic examination in 16 of the patients studied (6.3%).

CONCLUSIONS

Extracorporeal shockwave lithotripsy without ECG triggering has been found to be fast and efficient and not correlated with the occurrence of dysrhythmic episodes of any particular clinical significance. No significant correlation was found between the occurrence of dysrhythmia, the side treated, the number and strength of the shockwaves, or the administration of analgesics. It was found, however, that dysrhythmia occurred almost exclusively in treatments involving the kidneys. The ECG-triggering option was indispensable in some patients in order to complete the lithotripsy without complications.

Surgical palliation in pancreatic head carcinoma and gastric cancer: the role of laparoscopy

BACKGROUND/AIMS

In all patients with pancreatic and gastric cancer we always make a laparoscopic exploration to complete the staging. Lately we have adopted the following technique for nonresectable cancers of the head of the pancreas: following endoscopic retrograde cholangiography we position a biliary stent to restore bile flow and obtain regression of jaundice, a laparoscopic-assisted gastroentero-anastomosis (GEA) is then performed as an antecolic isoperistaltic side-to-side gastrojejunostomy. Also in case of nonresectable gastric cancer we perform a laparoscopic-assisted gastrojejunostomy.

METHODOLOGY

From January 1994-February 1998 we performed a total of 25 laparoscopic assisted gastrojejunostomies. We adopted this minimally invasive technique for 11 out of 20 patients (55%) with nonresectable cancers of the head of the pancreas, 7 men and 4 women, whose median age was 73 (range: 60-89). A video-assisted gastrojejunostomy was also performed in 14 patients out of 28 (50%), 10 men and 3 women, with a median age of 70 (range: 58-76), with nonresectable distal gastric cancers and 1 woman with non-resectable and obstructing duodenal cancer. The operative time of the video-assisted procedure was 35 min (range: 25-40 min).

RESULTS

There were no intra-operative complications and no mortality. All the patients had a very satisfactory post-operative course, with only 1 (4%) with post-operative complications (hyperpyrexia in a patient due to an infection of the biliaryendoprosthesis, with precocious regression after replacement of the prosthesis) and minimal post-operative pain. Median post-operative hospital stay was 3 days (range: 2-4). Median survival after operation was 6 months (range: 2-12) for gastric cancer and 9 months (range: 5-15 months) for pancreatic head carcinoma.

CONCLUSIONS

We believe that this technique, for the obstructive syndrome of the pylorus and duodenum, offers these patients the best results/trauma ratio. Two currently remaining types of indications for a GEA, namely non-malignant ulcer and unresectable duodenal or antropyloric obstructive cancer.

[Social determinants and risk of acute viral hepatitis]

The authors examined the relationship between viral hepatitis risk and social determinants in Piedmont region population surveyed by SEIEVA (sistema epidemiologico integrato dell'epatite virale acuta). The education and the working position showed different correlation with incidence rates of different types of viral hepatitis A, B, non-A non-B. The hepatitis A risk is proportional to education and the probability of hepatitis B and non-A non-B is higher in low social classes. This situation is only apparently a balanced risk: the clinical seriousness and the strong probability of complications of hepatitis B and non-A non-B make the risks deeply unequal.

Duodenal perforations after laparoscopic cholecystectomy

Duodenal perforations after laparoscopic cholecystectomies are rarely reported. The aim of this study is to focus on this complication and to suggest ways to reduce its occurrence and avoid diagnostic mistakes and therapeutical delays that could be fatal. We reviewed four personal cases and a number of others reported in the literature. Duodenal perforations are caused by improper use of the irrigator-aspirator device when retracting the duodenum, or by electrosurgical and laser burns. A duodenal perforation should be suspected in cases of bile leakage, peritonitis, intraabdominal or retroperitoneal collections, high serum or drainage amylase concentration, absence of bile leakage from the biliary tree, and the existence of a retroduodenal mass. Diagnosis requires a gastrografin upper GI series. Differential diagnosis is mainly with biliary lesions and other causes of peritonitis. Relaparoscopy may require intraoperative upper GI endoscopy or Kocher's duodenal mobilization to detect the perforation. Early diagnosis allows primary repair, usually by laparoscopy. Perforations of the duodenal cap are easier to diagnose and have a better prognosis than those of the descending duodenum. A lumbar abscess is a frequent complication.

[Hypertension in pregnancy. Retrospective epidemiologic study]

BACKGROUND

Pregnancy hypertension today has not a valid etiological explanation. It's possible however that the association of more factors could determine the symptoms. The pregnancy hypertensive disorders are not uncommon, with an incidence estimated from 6 to 8%. Epidemiological studies have shown hypertension in pregnancy increases fetal and maternal mortality and morbidity. Preterm delivery is more common in women with hypertension in pregnancy. The aim of this retrospective study was to verify some epidemiological aspects of pregnancy hypertension at the IV Divisions of I Institute of Obstetrics and Gynaecology of the "La Sapienza" University of Rome.

METHODS

1926 pregnant women have been hospitalised at the IV Division from January 1993 to December 1997. Of these 101 had hypertension. Age, hypertension degree, type of job, smoking, parity, previous hypertension developed by patients and their relatives, birthweight, stage of development of hypertension and delivery procedures have been evaluated in this group.

RESULTS

The main data obtained from this study are: strong correlation of primiparity and hypertension (55, 45% of observations); increased risk to have hypertension induced by pregnancy in women that have just incurred in hypertension in previous pregnancy; the high incidence of caesarean section in the group considered with respect to the general population (70.9%).

CONCLUSIONS

Hypertension is still a frequent disorder in pregnancy which may lead to serious complications.

[Perineal modification in pregnancy and puerperium, risk of urinary incontinence]

Pregnancy and delivery are important etiopathological factors in the alteration of pelvic equilibrium; in particular and the first delivery is the decisive factor in terms of perineal sequelae affecting pelvic equilibrium and urinary continence. Epidemiological studies have identified a number of pathogenic risk factors related to pregnancy (abnormal increase in maternal weight, diabetes in pregnancy and macrosoma) and the newborn (cranial circumference, newborn weight). Mechanical stress caused by the passage of the fetus may lead to the overstretching of the pelvic floor and the failure to recognise muscular damage even in the absence of macroscopic lesions. In the immediate postpartum or after a number of years these may damage the function of the musculo-aponeurotic structures of the perineum and foster the onset of alterations to pelvic equilibrium and urinary incontinence. In this study the authors have evaluated the modifications to the perineum and continence during pregnancy and puerperium.

METHODS

Clinical data were analysed for 40 puerperae all of whom underwent a through perineal examination to assess the function of perineal muscles, both on discharge and 6 months after delivery.

RESULTS

The authors tried to identify the main risk factors which predisposed the onset of changes to pelvic equilibrium and urinary continence. On the basis of the contemporary outcome of the Q-TIP test and TP, all women were divided into 4 groups: Group A (TP < 3 and positive Q-TIP test) (22.5%).

CONCLUSIONS

In the light of these results, the authors affirm that during gestation it is important to concentrate preventive action on these risk factors.

[The role of antenatal courses in preventing the onset of altered pelvic statics and urinary incontinence]

BACKGROUND AND AIMS

This study was prompted by the frequent finding of urinary incontinence in peri- and postmenopausal women. In an attempt to reduce this incidence, the authors evaluated the role of antenatal courses as an important preventive and operative means of providing information aimed at preventing the onset of alterations to pelvic statics and urinary incontinence. The clinical data of 40 puerperae, of whom 45% had followed our antenatal course, were examined for this purpose.

METHODS

A functional examination of the perineum was made in all subjects on discharge after birth and 6 months later.

RESULTS

These findings appear to indicate that antenatal courses play an important role in preventing obstetric perineal complications.

CONCLUSIONS

During the courses all women were given useful advice on hygiene and diet, including guidelines for suitable regular exercise, the need to drink about 1 litre of unsweetened liquid daily, a balanced diet and advice regardingf perineal relaxation. Subsequently, all subjects were advised to continue exercising after birth to ensure the correct rehabilitation of the perineal floor and they were also given a sheet containing the different learnt during the antenatal courses. In this way these subjects increased their awareness of the need not to underestimate the early symptoms of urinary incontinence should they occur after birth.

Laparoscopic treatment of peptic ulcers. A review after 6 years experience with Hill-Barker's procedure

BACKGROUND/AIMS

This study illustrates our experience in treating duodenal ulcers by means of laparoscopy over a period of 6 years and the results after a lengthy careful follow-up.

METHODOLOGY

From October 1991 to October 1997 we submitted 35 patients, 28 men and 7 women of an average age of 51 years (range: 22-78), to vagotomy with minimally invasive access: 23 Hill-Barkers, 2 Taylors, 6 thoracoscopic truncal vagotomies, and 4 laparoscopic truncal vagotomies. Of the patients submitted to surgery with the Hill-Barker technique, 8 were resistant to medical therapy, 11 decided not to continue with long-term medical therapy, 3 assumed an irregular medical therapy, and 1 who had been suffering for a long time from an ulcerous disease required vagotomy in association with laparoscopic cholecystectomy. In 16 patients a bleeding complication preceded surgery.

RESULTS

In our experience, the average duration of the operation with the Hill-Barker technique is 40 min (range: 30-80 min), with return to normal feeding in 1 day without any disorders and return home on day 3 (range: 2-5). The patients have been followed for 3-54 months. One patient (4.3%) was lost during the follow-up. Twenty-one (91.3%) out of the 23 submitted to anterior superselective and posterior truncal vagotomy were pain and ulcer-free without medical therapy. There was only one relapse (4.3%) after 7 months where the patient underwent left thoracoscopic truncal vagotomy.

CONCLUSIONS

In our opinion, as posterior truncal and anterior superselective vagotomy using the Hill-Barker technique guarantees the same excellent results, it is preferable due to the speed and ease of performance and to the low cost compared with other procedures which take more time (e.g., Taylor's section and suture of the anterior gastric wall) and require the use of particularly expensive equipment (e.g., Gomez-Ferrer's mechanical sectioning and suturing).

[Hydatidiform mole. A case of hydrothorax, expression of a non-neoplastic complication]

Marked stimulation of the chorionic gonadotropins underlies the frequent finding in the mole of larger ovaries with multiple luteal cysts, identifiable using ultrasound imaging, resembling ovarian hyperstimulation syndrome. The authors report a case of hyadatid pregnancy which presented serious non-neoplastic complications. Laboratory tests showed high values of beta-hCG and GOT/GPT, electrolytic alterations, hypoproteinemia, hypoalbuminemia, associated with conditions of severe dyspnea and tachycardia following hydrothorax diagnosed by X-ray. USG showed hypertrophic placenta containing anechoid lacunar areas and swollen ovaries with multiple luteal cysts. Positive results were achieved by using intensive therapy leading to the restitutio ad integrum of damaged functions. Endocrine hyperactivity of the molar trophoblast, with high levels of beta-hCG was responsible for ovarian hyperstimulation. Important findings for the early diagnosis of hyadatid pregnancy are: beta-hCG assay and ultrasound scan; moreover, an adequate follow-up lasting about 6 months is necessary to evaluate the serial trend of beta-hCG and the disappearance of ovarian luteal cysts.

Peptic ulcer disease and thoracoscopic left truncal vagotomy

BACKGROUND

This study illustrates our experience in treating duodenal ulcer by means of thoracoscopy and laparoscopy over a period of six years.

MATERIALS AND METHODS

From October 1991 to October 1998, we submitted 38 patients (31 males and 7 females), average age 51 years (range 22-78 years), with duodenal ulcer to vagotomy with minimally invasive access: 23 Hill-Barkers, 2 Taylors, 9 thoracoscopic truncal vagotomies and 4 laparoscopic truncal vagotomies. The patients submitted to thoracoscopic truncal vagotomy had previous gastric surgery (5 ulcers of the neostoma in patients who had undergone gastric resection, 3 hemorrhagic gastritis of the gastric neostoma and 1 incomplete abdominal vagotomy).

RESULTS

The average time required for the thorascopic approach was 30 minutes (range 20-40 minutes) with return to normal feeding in 1 day, without any difficulty, and discharge on day 3 (range 2-5 days). The patients were followed for 3-54 months. Twenty-two patients (91.3%) out of 23 submitted to anterior superselective and posterior truncal vagotomy, and the patients submitted to thoracoscopic vagotomy, were pain free without medical therapy. One patient (4.3%) was lost to the follow-up. There was only one relapse (4.3%) after seven months where the patient underwent left thorascopic truncal vagotomy. We had no mortality and no intraoperative or postoperative complications.

CONCLUSIONS

In our opinion, minimally invasive treatment of peptic ulcer disease may represent the "gold standard." It is simple, quick, effective and delivers the same excellent results of open surgery but with minimum trauma.

In vitro production of type 1 and type 2 cytokines by peripheral blood mononuclear cells from subjects coinfected with human immunodeficiency virus and Leishmania infantum

To explore the type 1 and type 2 cytokine profile in cases coinfected with human immunodeficiency virus (HIV) and Leishmania infantum, production of interleukin-4 (IL-4), interleukin-10 (IL-10), interferon-gamma (IFN-gamma), and interleukin-2 receptor (IL-2R) was investigated in mitogen-stimulated and unstimulated peripheral blood mononuclear cell cultures from eight HIV/Leishmania coinfected subjects matched with eight anti-HIV-positive subjects with no evidence of Leishmania coinfection. Levels of IL-4 and IL-2R increased significantly from the baseline levels in the peripheral blood mononuclear cell supernatants of HIV/Leishmania coinfected subjects following stimulation with phytohemoagglutin, whereas the postchallenge concentration of IFN-gamma was significantly increased in the HIV-infected group. The levels of IL-4 and IL-10 were significantly higher in the HIV/Leishmania group throughout evaluation. Post-stimulation IFN-gamma production was significantly higher in the HIV-positive group in comparison with that of the HIV-Leishmania coinfected subjects. These observations support the notion that a Th2 cytokine response is present during a Leishmania infection, even among HIV-coinfected individuals.

Laparoscopic appendectomy and minilaparoscopic approach: a retrospective review after 8-years' experience

BACKGROUND

This is a presentation of our 8-year experience in laparoscopic appendectomy, showing complications and results to determine the advantages and efficacy of laparoscopy.

METHODS

We used this technique from December 1990 to December 1998 on 282 consecutive and non-selected patients (169 females and 113 males) with an average age of 24 years (range 5-86 years). All patients were suffering from sub-acute appendicitis or chronic appendicopathies, except for 84 (29.7%) cases of acute appendicitis and 25 (8.9%) cases of gangrenous appendicitis with peritonitis. All patients with suspected appendicitis were evaluated with a laparoscopic exploration.

RESULTS

In 39 patients (13.9%), appendectomy was performed along with 19 enucleated or endocoagulated ovarian cysts, 8 adhesiolyses, 6 transperitoneal hernioplasties (4 right and 2 left), 2 cholecystectomies, 2 excisions of a Meckel diverticulum, 1 aspiration and suture of a right tubal pregnancy and 1 electrodesiccation of pelvic endometriosis. Thirty-five patients (12.5%) revealed the presence of a gynecological-type pathology. We performed 2 (0.7%) conversions to open exploration and experienced 6 (2.1%) complications, of which only 1 (0.35%) was a major complication: a delayed hemoperitoneum (1 liter), re-operated elsewhere, the cause of which was not identified. We performed 4 (1.4%) relaparoscopies for retrocecal abscess (three patients with primary gangrenous appendicitis and peritonitis presenting with an abscess in the right iliac fossa and in one patient with widespread intestinal adhesions with primary acute appendicitis). No patient with a diagnosis of a normal appendix developed an intraperitoneal abscess. Mortality was non-existent. The postoperative course, which was subjectively better than in cases operated in the traditional way, was, on an average, 2 days (range 1-18 days) for appendectomies carried out with the traditional laparoscopic technique and 1 day for appendectomies carried out with the minilaparoscopic technique (6 patients).

CONCLUSION

We believe that the laparoscopic technique can handle any type of clinical situation, as it can cure several pathologies during the same session with minimal trauma and maximum benefit for the patient. The advantages of a minilaparoscopy approach are based on its low invasiveness and small surgical wounds.

Early impairment of renal hemodynamic reserve in patients with asymptomatic heart failure is restored by angiotensin II antagonism

BACKGROUND

The early/asymptomatic stages of heart failure (HF) are characterized by sodium retention secondary to derangement of sodium reabsorption at the proximal nephron level. Because this phenomenon is reversed by ACE inhibition, abnormalities of renal sodium handling may depend on intrarenal changes of angiotensin II (AII)/nitric oxide (NO) levels. Renal hemodynamic reserve (ie, the glomerular vasodilatory response to amino acid infusion) has been proposed as a reliable test to assess in vivo AII/NO balance.

METHODS AND RESULTS

In this study, the effects of 6 weeks of treatment with 5 mg/d of enalapril or with 50 mg/d of losartan on systemic hemodynamics and renal function were assessed, at baseline and after amino acid infusion (AA), in patients with mild HF (NYHA class I) and in healthy volunteers. Untreated HF patients showed a basal renal function comparable to that of healthy subjects. After AA, glomerular filtration rate and renal plasma flow significantly increased in healthy subjects (+29.0% and +30.4%, respectively), whereas no vasodilatory response was observed in HF. Although they did not affect basal renal hemodynamics, both enalapril and losartan restored a normal response to AA in HF patients. Blood pressure and heart rate were comparable in HF subjects and healthy subjects at baseline and were not modified by either treatment. Left ventricular ejection fraction was depressed in HF but did not change after either drug. Urinary excretions of cGMP and nitrate (indexes of NO activity in the kidney), comparable in healthy subjects and in HF patients, were unchanged by either enalapril or losartan and did not correlate with renal reserve.

CONCLUSIONS

(1) Renal functional reserve is absent in patients with early/asymptomatic HF and normal renal function and (2) both enalapril and losartan restore a normal vasodilatory response to AA in these patients without affecting basal systemic and renal hemodynamics. These data suggest a major role of AII in the development of early abnormalities in patients with HF.

Nine more cases of human infections by Dirofilaria repens diagnosed in Italy by morphology and recombinant DNA technology

Dirofilariosis is a mosquito-borne disease of carnivors due, in Italy, to Dirofilaria repens and D. immitis species which are sympatric in many areas. Nine more cases of human infection are here reported, detected in Italian patients living in northern regions (where D. immitis and D. repens are largely present), in Tuscany (where D. repens is more frequent than D. immitis), and in Sicily (where D. immitis is present only sporadically). The nematodes surgically removed (7 female and 2 male specimens) have been identified by a PCR-based method and by morphology as D. repens. Morphological, clinical, and epidemiological data of these human infections are discussed.

[Clinical use of leuprolide acetate depot in a group of gynecologic patients in the preoperative period]

BACKGROUND

The authors examined 33 patients with symptomatic uterine leiomyomas due to undergo total hysterectomy in order to evaluate the effects of treatment with GnRH analogues on leiomyoma and estrogen and progesterone receptors.

METHODS

The patients were divided into two groups: one group was treated with leuprolide acetate (Group A) and the other did not receive treatment (Group B).

RESULTS

A significant reduction in the volume of leiomyomas and estrogen and progesterone receptors was noted in patients in Group A.

CONCLUSIONS

Treatment with GnRH analogues therefore represents a valid aid for patients with uterine leiomyomas and sideropenic anemia awaiting surgery.

Somatostatin release in response to glucose is impaired in chronic renal failure

In order to evaluate somatostatin (SRIH) secretion in uremia, plasma SRIH concentrations were determined in basal conditions and after an oral glucose tolerance test (OGTT) in 14 non-dialysed patients with chronic renal failure (CRF), seven of whom had normal glucose tolerance (NGT) and seven impaired glucose tolerance (IGT). Plasma insulin, C-peptide and glucagon and blood glucose concentrations were also evaluated. The results were compared with those obtained in a group of age- and sex-matched normal subjects. In CRF patients, plasma SRIH fasting values (8.6 +/- 0.6 and 7.8 +/- 0.6 pmol/L in NGT and IGT patients, respectively) were comparable to those recorded in controls (7.7 +/- 0.5 pmol/L). SRIH response to OGTT, evaluated as area under curves (AUC) above basal, was similar in both groups of CRF patients (412.9 +/- 84.5 and 415.6 +/- 51.9 pmol/L per min), and significantly lower than in controls (660.1 +/- 58.5 pmol/L per min). Data indicate that chronic uremia induces a loss of SRIH secretory cell responsiveness to glucose. A possible effect of impaired SRIH secretion on glucose metabolism in CRF is discussed.

Cross-cultural adaptation and validation of an Argentine Spanish Version of the Stanford Childhood Health Assessment Questionnaire

OBJECTIVES

To translate into Argentine Spanish and cross-culturally adapt the Childhood Health Assessment Questionnaire (CHAQ) and validate the adapted instrument in Argentine patients with juvenile rheumatoid arthritis (JRA).

METHODS

Five bilingual Argentine pediatric rheumatologists translated into Argentine Spanish and cross-culturally adapted the United States English CHAQ. Pretesting was done in a sample of 23 parents using a probe question technique. Parents of 70 patients with JRA and 21 healthy children (controls) participated in the validation phase. All were from Argentina.

RESULTS

The mean disability index (DI) scores for patients with systemic, polyarticular, or pauciarticular onset JRA were 0.64, 0.32, and 0.1, respectively. Healthy controls averaged 0.2. Intercomponent correlations were between 0.4 and 0.9, suggesting internal consistency, but also some redundancy. Test-retest reliability, studied at a 1-week interval, was moderate (mean DI 0.44 [in clinic] and 0.29 [one week later], Pearson's correlation = 0.82). We compared CHAQ scores from 15 parents with those of their children > 10 years of age. Significantly higher DI scores were given by patients than their respective parents (P > 0.019), but the pairwise scores (parent-patient) were highly correlated (r = 0.986).

CONCLUSIONS

Cross-cultural adaptation of the US CHAQ to Argentina required few changes. Although DI scores for all patient subgroups were higher than for controls subjects, the scores were low, particularly for those with pauciarticular disease. Prospective studies designed to examine the sensitivity to change and predictive validity will help to assess further the usefulness of the adapted CHAQ in the Argentine population.

[Maternal attitude and psychophysical adaptation of women undergoing primary and secondary cesarean section]

BACKGROUND

The increase of cesarean sections, which is typical of the most industrialised countries, resulted in a higher rate of repeat cesarean sections. The previous CS is the main indication for cesarean delivery. The purpose of this study is to compare women who had a primary cesarean with women who had a repeat cesarean section in order to assess their different emotional reactions as well as their psychophysical consequences.

METHODS

A questionnaire was administered to 36 patients who had a primary cesarean section and to 34 patients who had a repeat cesarean section, 6-12 months after birth. All these women were similar for age and gestational age of the birth.

RESULTS

Results underline that patients are more disposed to accept the operation in repeat cesarean rather than in primary cesarean. Women who have a repeat cesarean section are more likely to accept this kind of delivery since the beginning, with positive effects on their postoperative course. Women who have a repeat cesarean section face more serenely not only prenatal but also post-natal period and show less serious psychophysical sequelae with respect to primary cesarean section because of their previous experience.

CONCLUSIONS

As a result, an appropriate psychological support coupled with adequate information can reduce discomfort in cesarean patients.