Prevalence of primary headaches in Italian elderly: preliminary data from the Zabút Aging Project

We describe preliminary 1-year prevalence data of recurrent migraine headache (MH), tension-type headache (TTH), and other headaches (OH) in a rural elderly population. A door-to-door two-phase survey was conducted on all elderly (>or=65 years) residents of a rural village in southern Italy. Participants underwent a two-phase screening including a validated semi-structured questionnaire for headaches based on the International Headache Society criteria, and a neurological evaluation. Recurrent headache was defined as 3 or more attacks within the past 12 months. Out of 1031 participants evaluated, 225 (21.8%) suffered from recurrent headaches. One-year prevalence rates for headaches were respectively 4.6% for MH, 16% for TTH, and 1.3% for OH. For MH and TTH, but not for OH, prevalence rates were significantly higher for women than for men. Only MH prevalence rates significantly decrease with increasing age. In our population, about one-fifth of elderly subjects suffered from recurrent primary headaches. Prevalence rates were higher in women, and tended to decline with increasing age.

Investigation of a genetic variation of a variable number tandem repeat polymorphism of interleukin-6 gene in patients with multiple sclerosis

Interleukin-6 (IL-6) plays an important role in the regulation of the inflammatory response in multiple sclerosis (MS) and its animal model, experimental autoimmune encephalomyelitis (EAE). Previous reports indicated that the C allele of a variable number tandem repeat (vntr) polymorphism located in the 3'flanking region of the IL-6 gene ( IL-6) is associated with reduced activity of IL-6 in vivo. Since disease-modifying genes are likely to contribute to phenotypic differences in MS patients, we tested the hypothesis that the IL-6 C allele is associated with the clinical course of MS. The IL-6 C allele was equally distributed between 217 MS patients of German Caucasian origin and 111 age-mached healthy controls. Stratification of patients according to the course of disease revealed no significant difference of IL-6 C allele distribution between patients with primary progressive and those with either relapsing-remitting or secondary progressive MS although IL-6 C allele was more frequent in patients with RR-MS. Since IL-6 C allele has been associated with a benign course in Sardinian MS patients, we further analysed an independent sample of 125 Sardinian MS patients revealing that IL-6 C allele was much more frequent than in German MS patients. Taken together, a disease-modifying effect of IL-6 C allele could not be demonstrated in MS patients of German Caucasian descent.

Vinorelbine, methotrexate and fluorouracil (VMF) as first-line therapy in metastatic breast cancer: a randomized phase II trial

BACKGROUND

The purpose of this study was to determine the best tolerated and efficacious dose of vinorelbine given once or twice in 3-week cycles in combination with methotrexate and fluorouracil (VMF).

PATIENTS AND METHODS

Vinorelbine 40 mg/m(2) was given as follows: 20 mg/m(2) on days 1 and 8 (group 1); 30 mg/m(2) on day 1 and 10 mg/m(2) on day 8 (group 2); or 40 mg/m(2) on day 1 (not exeeding 60 mg/m(2)) (group 3). The methotrexate dose was 40 mg/m(2) on day 1 and the fluorouracil dose 600 mg/m(2) on days 1 and 8. Thirty patients with evaluable metastases were randomly allocated to the groups (first step). The second step was to exclude the worst tolerated regimen and then to expand the study to 60 patients. Thus, group 1 had 26 patients, group 2 had 24 patients and group 3 had 10 patients.

RESULTS

World Health Organization (WHO) grade 3 hematological toxicity occurred in 23%, 36% and 50% of patients and grade 4 in 39%, 32% and 50% of patients in groups 1, 2 and 3, respectively; grade 3 infections were observed in 15%, 9% and 10% of patients in groups 1, 2 and 3, and grade 4 infections in 5% and 10% of patients in groups 2 and 3, respectively. Nonhematological toxicity included a mild to moderate neurotoxicity manifesting as constipation, abdominal colics and myalgia in the majority of patients. One patient in group 3 had serious convulsions after vinorelbine administration; she also developed neutropenic sepsis; all symptoms were reversible. No patient died from side-effects. The objective response rates were 50%, 55% and 44% for groups 1, 2 and 3, respectively. Median time to progression was 7, 10 and 8 months and median survival time was 26, 23 and 16 months in groups 1, 2 and 3, respectively.

CONCLUSION

VMF regimens where the vinorelbine dose (40 mg/m(2)) is divided (20 + 20 mg/m(2) and 30 + 10 mg/m(2)) between days 1 and 8 of a 3-week cycle are equally well tolerated and the efficacy is comparable to other modern first line regimens used in the treatment of metastatic breast cancer.

The diagnosis and management of 689 chronic leg ulcers in a single-visit assessment clinic

OBJECTIVES

accurate diagnosis is essential if patients with chronic leg ulceration are to receive optimal treatment. This prospective study describes the findings of a standardised assessment protocol and the initial management of a consecutive series of patients with chronic leg ulceration presenting to a single-visit leg ulcer assessment clinic.

METHODS

between January 1993 and January 1999, a total of 555 patients (220 men and 335 women of median age 73, range 28-95 years) with 689 chronic leg ulcers were assessed. Full clinical assessment, ankle:brachial pressure index and lower limb venous duplex scan were performed according to a standardised protocol and diagnostic and management data were recorded prospectively on a computerised database.

RESULTS

venous disease alone was responsible for 496 of 689 (72%) ulcers. Isolated superficial venous reflux (SVR) was identified in 52% of limbs and two-thirds of these had superficial venous surgery. Combined SVR and segmental deep venous reflux (DVR) was present in 13%, and full-length DVR was present in 33% of limbs. Nineteen (4%) limbs had deep venous stenosis or obstruction. Overall, superficial venous surgery was performed in 43% and compression bandages or hosiery alone were applied in 52% of limbs. Mixed arterio-venous ulceration was present in 100 (14.5%) limbs of which 56 had arterial revascularisation, 38 had superficial venous surgery and 23 had compression alone. Fifteen limbs with pure arterial ulceration had angioplasty (n=13) or simple dressings alone (n=2). Ulceration due to lymphoedema (n=17), mixed lymphoedema and venous reflux (n=11) and other causes (n=50) were managed by compression, dressings or skin grafting.

CONCLUSIONS

a standardised protocol of clinical and duplex assessment can lead to a diagnosis in 97% of chronic leg ulcers. Duplex is essential to confirm or exclude potentially correctable venous disease and allow tailored surgical intervention for those patients who many benefit.

Electrocardiographic algorithm for assignment of occluded vessel in acute myocardial infarction

BACKGROUND

This study was performed to elaborate an electrocardiographic (ECG) algorithm enabling assignment of an occluded coronary artery in acute myocardial infarction (AMI).

PATIENTS AND INTERVENTIONS

In 109 patients (age, 59+/-12 years) with AMI (pain onset, 3.6+/-1.7 h), coronary angiography with PTCA/stenting of the culprit lesion was performed. The diagnosis of AMI was confirmed by emergency coronary angiography and laboratory analyses. Admission ECG parameters (amplitude of R-wave, ST-segment deviation, presence of Q-wave, deflection of T-wave) in standard 12-lead ECG plus extended (V(3)R to V(6)R and V(7-9)) leads were subjected to classification and regression tree (CART) analysis.

RESULTS

Continuous CART analysis assessed ST-segment deviations in V(2) and V(5)R. AMI of the left anterior descending (LAD), right coronary artery (RCA) and left circumflex coronary artery (CX) were correctly classified in 94, 64, and 91% of cases, respectively. Dichotomised CART analysis assessed ST-segment deviations in V(2), V(5)R, and aVF. True classification rates for LAD, RCA, and CX amounted to 84, 74, and 71%, respectively.

CONCLUSIONS

Dichotomised CART analysis is a simple means of differentiation of CX from RCA occlusion during AMI.

[Carcinoma of the pancreas head, papilla Vateri, and cystadenocarcinoma--different biologic entities and different results]

Between 1986-1995 we operated 337 patients with ductal adenocarcinoma of the pancreas, 45 cases of carcinoma of the papilla of Vater and 11 patients with cystadenocarcinoma of the pancreas. The evaluation of prognostic factors showed the influence of lymph node invasion. Furthermore we saw a significant influence of lymph- and haemangiosis carcinomatosa, of tumor-grading and tumor-size. The carcinoma of the papilla showed a better 5-year survival even in nodal-positive patients--this as a result of a different biological behaviour. We think that--instead of missing improvement of cure in ductal adenocarcinoma over the past decade--there is no place for therapeutic nihilism especially in non-ductal cancer, which represents almost 15 % of all pancreatic neoplasms.

Sites of recurrence in oral and oropharyngeal cancers according to the treatment approach

OBJECTIVE

The purpose of this study is to evaluate the rates and the sites of tumour recurrence in patients with oral and oropharyngeal carcinomas.

DESIGN

This is a retrospective study of a series of cases treated in a single institution.

PATIENTS AND METHODS

A series of 2067 patients with oral and oropharyngeal squamous carcinoma, treated from 1954 to 1998 were analysed. The treatment approach was: surgery, 624 cases (30.2%); radiotherapy alone, 729 cases (35.3%); radiotherapy and surgery, 552 cases (26.7%) and radiotherapy and chemotherapy, 162 cases (7.8%).

MAIN OUTCOME MEASURES

Tumour recurrence was observed in 1079 patients (52.2%): 561 cases of local recurrences (27.1%); 168 neck recurrences (8.1%); 252 locoregional recurrences (12.2%); 59, distant metastasis (2.9%) and 39 (1.9%), combination of distant metastasis with local, neck or locoregional recurrence.

RESULTS

The rates of recurrence varied significantly according to the treatment performed. Oral cavity cancer patients undergoing radiotherapy alone or in combination with chemotherapy presented the highest rates of neck recurrences (22.5 and 40.0%, respectively) for clinical stage (CS) I/II and of local (41.2 and 30.1%) and locoregional (21.7 and 31.1%) recurrences for CS III/IV; yet, for CS III/IV, surgery without neck dissection was associated with the highest rates of neck recurrences (20.7%), but no differences were observed in the rates of local or locoregional recurrences for CS I/II patients. For oropharynx cancer patients with CS I/II there was no difference in the rate of locoregional failures according to the treatment. However, patients with CS III/IV undergoing radiotherapy present a highest rate of local (42.3%) and locoregional (28.8%) failures.

CONCLUSION

The results suggest that surgery should be the first option for initial clinical stage oral and oropharyngeal cancers. For advanced cases independently of the site of the tumour, surgery and postoperative radiotherapy should be the standard of care because it is associated with the lowest rates of locoregional recurrence.

Influence of dental care for infants on caries prevalence: a comparative study

PURPOSE

The influence of early dental care on the prevalence of dental caries was determined in children ages 35 to 40 months divided into 2 groups of 160 children each, with 1 group participating in a dental care program from the first year of life to the time of the study, while the other group did not receive any dental care.

METHODS

The clinical conditions considered for the evaluation were: sound teeth, enamel caries without cavitation, enamel caries with cavitation, and dentinal caries. The proportion and chi-square tests were used for statistical analysis with the level of significance set at 5%.

RESULTS

A significant difference regarding the presence of dental caries, especially in the number of children presenting enamel caries with cavitation (P < .0001), was observed between the 2 groups. The number of children with enamel caries without cavitation and dentinal caries was similar for the 2 groups.

CONCLUSIONS

Considering the aspect of dental caries prevention, the authors concluded that children in the age range of 3 to 4 years who received early dental care showed better oral conditions.

Dental care of a child in pain -- a comparison of treatment planning options offered by GDPs in California and the North-west of England

OBJECTIVE

To compare the treatment plans offered by general dental practitioners (GDPs) in the North-west of England (UK) and California (USA) in dealing with a child in pain.

METHODS

A cross-sectional postal survey of a convenience sample of 135 UK and 170 USA GDP. These GDPs were asked to consider a case scenario of a 5-year-old child with pain from a lower first primary molar and to offer a treatment plan. The plan was to have three phases: immediate care, follow-up care and longer term preventive strategy. The influence of cost on treatment plans was also recorded.

RESULTS

Response rates for the GDPs were 117 (86.6%) from the UK and 139 (81.8%) from the USA. The major differences in immediate care were as follows: 98% of Americans would take a radiograph, 41% would consider extraction, 37% would place a space maintainer and 4% would use general anaesthesia to extract a tooth. Comparable proportions for the English dentists were 20%, 21%, 2% and 40%. Later clinical options also showed differences: 39% of UK dentists would extract all first primary molars compared to only 1% of Americans. Eighty-eight per cent of USA dentists would place a nickel chrome crown compared to 4% of UK respondents. There were also differences in the longer term preventive measures. Greater proportions of American dentists would offer fluoride varnish (30%) and fluoride mouthrinse (37%). Comparable UK responses were 13% and 28%. Cost of care was only mentioned by 3% of UK dentists, whereas 70% of USA dentists mentioned cost as a factor in treatment planning.

CONCLUSION

There were marked differences in the treatment of a child in pain between general practitioners in the UK and the USA. Further investigations are required to elucidate the reasons for these differences.

Reduced expression of actin-binding proteins, h-caldesmon and calponin h1, in the vascular smooth muscle inside melanoma lesions: an adverse prognostic factor for malignant melanoma

BACKGROUND

The structural integrity of the blood vessels such as small arteries and veins is studied less frequently in malignant tumours than is angiogenesis. Objectives To clarify the characteristics of small arteries and small veins of melanoma lesions.

METHODS

We immunohistochemically investigated various types of melanocytic tumours using antibodies specific for endothelial and vascular smooth muscle cells, and analysed the relationship between the expression of these molecules in the blood vessels and the biological characteristics of the tumours. Formalin-fixed, paraffin-embedded sections of 15 cases of benign melanocytic tumours and 64 cases of malignant melanomas were investigated.

RESULTS

Significant suppression of expression of h-caldesmon (h-CD) and calponin h1 (CNh1) was observed in the blood vessels of malignant melanomas compared with both benign melanocytic tumours and normal tissues. In particular, the level of h-CD expression was inversely correlated with the frequency of metastasis and positively correlated with the survival rate in patients with malignant melanoma.

CONCLUSIONS

These findings suggest that alterations of the tumour vessels are an important factor for the prognosis of malignant melanoma, and that suppression of h-CD and CNh1 in the blood vessels in malignant melanoma reflects a structural fragility of the vessels, leading to their easy penetration by tumour cells. Defective expression of these molecules is likely to be an important marker for metastatic potential and for poor prognosis of melanoma.

Increased prevalence of antibodies to enteropathogenic Yersinia enterocolitica virulence proteins in relatives of patients with autoimmune thyroid disease

Infections have been implicated in the pathogenesis of a number of autoimmune diseases, and Yersinia enterocolitica (YE) might play a role in the development of autoimmune thyroid disease (AITD). Clinical evidence in support of this hypothesis has been inconclusive. We reasoned that looking earlier in the natural course of AITD might enhance chances of finding evidence for YE infection. Consequently, we determined seroreactivity against YE in subjects at risk of developing AITD, i.e. in 803 female relatives of AITD patients in self-proclaimed good health. As a comparison group we used 100 healthy women who participated in a program for reference values. IgG and IgA antibodies to virulence-associated outer membrane proteins (YOPs) of YE were measured by a specific assay. Serum thyroid peroxidase antibodies (TPO-Ab) as indicators of AITD were considered to be positive at levels of> 100 kU/l. The prevalence of YOP IgG-Ab was higher in AITD relatives than in controls (40.1% vs. 24%, P = 0.002), and the same was true for YOP IgA-Ab (22% vs. 13%, P < 0.05). Of the 803 AITD relatives, 44 had an increased or decreased plasma TSH, and 759 were euthyroid as evident from a normal TSH; the prevalence of YOP-Ab did not differ between these three subgroups. TPO-Ab were present in 10% of controls and in 27% of the AITD relatives (P < 0.001). The prevalence of TPO-Ab in the euthyroid AITD relatives was not different between YOP IgG-Ab positive and negative subjects (23.3% vs. 24.7%, NS), nor between YOP IgA-Ab positive and negative subjects (21.2% vs. 24.9%, NS). In conclusion, healthy female relatives of AITD patients have an increased prevalence of YOP antibodies, which, however, is not related to the higher prevalence of TPO antibodies in these subjects. The findings suggest a higher rate of persistent YE infection in AITD relatives. Susceptibility genes for AITD may also confer a risk for YE infection.

A study of dental implants in medically treated hypothyroid patients

PURPOSE

The purpose of this study was to investigate the success outcomes of implants and prosthodontic treatment placed in patients with a previous history of hypothyroidism that was being controlled with medications.

MATERIALS AND METHODS

Twenty-seven female patients with a medically confirmed history of primary hypothyroid disease who were on replacement medications at the time of implant surgery were selected as the study group. They were matched with 29 control patients by age, gender, location (jaw and zone) of implants, type of prosthesis, and dental status of the opposing arch. Additional factors studied were medical history, medications, smoking habits, and bone quality and quantity.

RESULTS

There was no statistical difference in the number of implant failures between the two groups (p = .781). The hypothyroid patients had more soft tissue complications (p = .018) following stage 1 surgery. More bone loss around implants in the hypothyroid patients was recorded after year 1 of loading when compared with loss in their matched controls (p = .017).

CONCLUSIONS

This study suggests that medically controlled hypothyroid female patients treated with dental implants are not at higher risk of implant failure when compared with matched controls, and that a history of controlled hypothyroidism does not appear to be a contraindication for implant therapy with endosseous implants.

Luteinizing hormone following light exposure in healthy young men

Urinary luteinizing hormone (LH) and the melatonin metabolite (6-sulfatoxymelatonin; aMT6s) were measured in normal young men following early morning light exposure. Eleven young healthy men ages 19-30 years participated in this study. During separate weeks in counterbalanced order, each subject received both 5 days of bright light treatment (BL) and 5 days of placebo light treatment (PL) for 1 h (05:00-06:00). LH excretion was increased 69.5% after bright light exposure, but was not changed by placebo light exposure. The acrophases and offsets of aMT6s were advanced, but the duration of aMT6s excretion was not changed after BL. Light stimulation of LH could have interesting applications in psychiatry and reproductive endocrinology.

T-type calcium channel gene alpha (1G) is not associated with childhood absence epilepsy in the Chinese Han population

We investigated whether the T-type calcium channel gene alpha (1G) is associated with childhood absence epilepsy (CAE), a form of idiopathic generalized epilepsy. We carried out direct sequencing of exons 1-37 and the exon-intron boundaries of the alpha (1G) gene in 48 Han Chinese patients with CAE and 48 normal controls. We found no mutation in the exons of alpha (1G). However, we did identify six single nucleotide polymorphisms (SNPs). Using two of these as markers, we carried out a case-control study in 192 patients with CAE and 192 normal controls. The allele and genotype distributions of all the SNPs studied were not significantly different between cases and control groups, thus the alpha (1G) gene is not an important susceptibility gene for CAE, at least in the Chinese population.

Cancer patients' needs during hospitalisation: a quantitative and qualitative study

BACKGROUND

The evaluation of cancer patients needs, especially during that delicate period when they are hospitalized, allows the identification of those areas of care that require to be improved. Aims of the study were to evaluate the needs in cancer inpatients and to improve the understanding of the meanings of the needs expressed.

METHODS

The study was conducted during a "sample day", with all the cancer patients involved having been hospitalized at the Istituto Nazionale Tumori of Milan (INT) for at least 48 hours beforehand. The study was carried out using quantitative and qualitative methodologies. The quantitative part of the study consisted in making use of the Needs Evaluation Questionnaire (NEQ), a standardized questionnaire administered by the INT Psychology Unit members, supported by a group of volunteers from the Milan section of the Italian League Against Cancer. The aim of the qualitative part of the study, by semi-structured interviews conducted with a small sample of 8 hospitalized patients, was to improve our understanding of the meanings, implications of the needs directly described from the point of view of the patients. Such an approach determines the reasons and conditions of the dissatisfaction in the patient, and provides additional information for the planning of improvement interventions.

RESULTS

Of the 224 eligible patients, 182 (81%) completed the questionnaire. Four of the top five needs expressed by 40% or more of the responders concerned information needs (diagnosis, future conditions, dialogue with doctors, economic-insurance solutions related to the disease). Only one of the 5 was concerned with improved "hotel" services (bathrooms, meals, cleanliness). Qualitative analysis showed that the most expressed need (to receive more information on their future conditions) has the meaning to know how their future life will be affected more than to know his/her actual prognosis.

CONCLUSIONS

Some of the needs which emerged from this investigation could be immediately satisfied (the need for psychological support, the need for economic aid, the need for spiritual support), while others will have to be faced in the longer term; for example, the presence of a high percentage of needs in patient-physician relationships and/or information-communication issues, could be resolved by setting up structured introductory training courses for all clinicians in the institution. On the other hand, the needs related to the living infrastructure (bathrooms, meals, etc.) could encourage the Institution to improve its services.

Safety issues when using a 16% carbamide peroxide whitening solution

BACKGROUND

The scientific literature is lacking on the occurrence of side effects and other safety issues when using carbamide peroxide whitening solutions of concentrations greater than 10%. This double-blind nightguard vital bleaching study compares safety issues when using 16% carbamide peroxide against a placebo or 10% carbamide peroxide (Nite White Classic by Discus Dental Inc.). Evaluated were changes in gingival index, plaque index, nonmarginal gingival index, nongingival oral mucosal index, tooth vitality, and the patients' perceptions of tooth sensitivity and gingival irritation.

MATERIALS AND METHODS

Twenty female dental hygiene students participated in the study. Each participant wore a maxillary treatment tray for 1 week without any solution and then for 8 to 10 hours per night for 14 nights, filling each quadrant with placebo, 10% carbamide peroxide, or 16% carbamide peroxide, using a split tray design.

RESULTS

With respect to gingival index, plaque index, nonmarginal gingival index, nongingival oral mucosa index, tooth vitality, and tooth sensitivity, there were no statistically significant differences between the 16% carbamide peroxide solution and the other two solutions (p > .05). Quadrants receiving the 16% carbamide peroxide solution experienced more gingival irritation than quadrants receiving placebo or 10% carbamide peroxide solution (p > .05).

CONCLUSIONS

When evaluating the above-mentioned safety issues, except for gingival irritation, there were no statistically significant differences between a 16% carbamide peroxide solution and 10% carbamide peroxide solution or a placebo when used as described here.

CLINICAL SIGNIFICANCE

Among the 20 participants whose data were analyzed, it was found that a 16% carbamide peroxide whitening solution (Nite White Classic), when used as described in this study, can be effective in nightguard vital bleaching with no statistical differences in gingival index, plaque index, nonmarginal gingival index, nongingival oral mucosa changes, tooth vitality, or tooth sensitivity, compared with a 10% whitening solution (Nite White Classic). More gingival irritation was experienced with 16% carbamide peroxide. Additionally, 20% of the participants in this study self-reported sensitivity when wearing their treatment tray without any solution, and 36% of the participants reported sensitivity to the placebo solution.

Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life: results from cohort study

OBJECTIVE

To examine the association between hypertensive diseases of pregnancy (gestational hypertension and pre-eclampsia) and the development of circulatory diseases in later life.

DESIGN

Cohort study of women who had pre-eclampsia during their first singleton pregnancy. Two comparison groups were matched for age and year of delivery, one with gestational hypertension and one with no history of raised blood pressure.

SETTING

Maternity services in the Grampian region of Scotland.

PARTICIPANTS

Women selected from the Aberdeen maternity and neonatal databank who were resident in Aberdeen and who delivered a first, live singleton from 1951 to 1970.

MAIN OUTCOME MEASURES

Current vital and cardiovascular health status ascertained through postal questionnaire survey, clinical examination, linkage to hospital discharge, and mortality data.

RESULTS

There were significant positive associations between pre-eclampsia/eclampsia or gestational hypertension and later hypertension in all measures. The adjusted relative risks varied from 1.13-3.72 for gestational hypertension and 1.40-3.98 for pre-eclampsia or eclampsia. The adjusted incident rate ratio for death from stroke for the pre-eclampsia/eclampsia group was 3.59 (95% confidence interval 1.04 to 12.4).

CONCLUSIONS

Hypertensive diseases of pregnancy seem to be associated in later life with diseases related to hypertension. If greater awareness of this association leads to earlier diagnosis and improved management, there may be scope for reducing a proportion of the morbidity and mortality from such diseases.

Theory of mind and psychopathy: can psychopathic individuals read the 'language of the eyes'?

There have been suggestions that Theory of Mind (ToM) impairment might lead to aggressive behaviour and psychopathy. Psychopathic and matched non-psychopathic individuals, as defined by the Hare Psychopathy Checklist [The Hare Psychopath Checklist-Revised, 1991] completed the 'Reading the Mind in the Eyes' ToM Test [Journal of Child Psychology and Psychiatry, 1997;38:813]. This test requires the self-paced identification of mental states from photographs of the eye region alone. Results indicated that the psychopathic individuals did not present with any generalised impairment in ToM. The data are discussed with reference to the putative neural system mediating performance on this task and models of psychopathy.

The importance of head growth patterns in predicting the cognitive abilities and literacy skills of small-for-gestational-age children

This study evaluated the effects of head growth compromise beginning in utero and continuing, in some cases, through the first 9 months of life on the cognitive and literacy skills of school-age small-for-gestational-age (SGA) children. Seventy-one SGA children, aged 7 to 9 years (gestational ages, 24-41 weeks) and 16 full-term appropriate-for-gestational-age control children of comparable socioeconomic backgrounds and age at testing completed tests assessing intelligence, receptive language, working memory, problem solving, visual-motor integration, phonological awareness, reading, and spelling. SGA children were subdivided into head-growth pattern groups based on their head circumference at birth and at 9 months postterm. Analyses showed that SGA children with poor prenatal and postnatal head growth had the worst outcomes, followed by those with prenatal brain compromise, but good postnatal head growth. SGA children with preserved head growth in utero as well as good head growth after birth demonstrated the best outcomes, although spelling skills were deficient relative to full-term peers. The Verbal and Full Scale IQ ratings of the SGA children who had experienced brain compromise in utero declined significantly from 5 to 8 years of age. We conclude that mild intrauterine growth retardation (IUGR) has a minimal effect on the development of cognitive or academic abilities, providing that brain growth in utero is not affected. IUGR that slows brain growth in utero impairs the acquisition of some cognitive and academic abilities, even when followed by good catch-up head growth after birth, whereas poor brain growth in utero followed by little or no catch-up head growth results in widespread impairments. Findings highlight the limits to brain plasticity and emphasize the importance of optimal prenatal and postnatal brain growth.

Cerebral microbleeds in Binswanger's disease: a gradient-echo T2*-weighted magnetic resonance imaging study

We investigated the incidence and the number of microbleeds (MBs) on T2*-weighted gradient-echo magnetic resonance imaging in 30 Binswanger's disease (BD) patients with diffuse white matter lesions and a varying degree of lacunar infarction, 51 multiple lacunar stroke (MLS) patients with multiple lacunar infarction and no or mild white matter lesions, and 59 elderly controls. MBs were found in 23 (77%) patients with BD, 26 (51%) patients with MLS, and 5 (8%) controls, and the incidence and the number of MBs were significantly greater in the BD group compared with MLS and control groups. Patients with BD had a more widespread location of MBs. More specifically, MBs were commonly found in areas within or surrounded by white matter lesions of the patients with BD. When 81 patients from both the BD and MLS groups were analyzed, logistic regression analysis showed that number of lacunar infarct, severity of white matter hyperintensity, and use of antiplatelet agents were significantly associated with MBs. Patients with BD exhibited a high frequency and number of MBs, indicating advanced bleeding-prone microangiopathy within the brain, which should be taken into account in treatment and management.

[Lipoprotein(a) and Apo-A isoforms in patients with intermittent claudication]

AIM

To study a correlation between lipoprotein(a) [LP(a)], as well as the phenotype of apoprotein(a) [apo(a)] and the presence of intermittent claudication (IC).

MATERIALS AND METHODS

The study included 25 patients (9 females, 16 males; mean age, 63.4 +/- 8.2 years) and 50 individuals (21 females, 29 males; mean age, 61.3 +/- 6.1 years) of a control group.

RESULTS

In the patients, the level of LP(a) was 3 times higher than in the controls (median 39 and 13 mg/dl, respectively; p < 0.01). The low molecular-weight phenotypes of apo(a) occurred significantly more frequently in the patients than those in the controls (62 and 28%, respectively; p = 0.02).

CONCLUSION

Multifactorial analysis has shown that the level of Lp(a) is an independent and important factor associated with the presence of IC.

[Serum anti-retinal antibodies and intensity of endogenous posterior uveitis ]

PURPOSE

To analyse the correlation between the anti-retinal antibodies (ARA) and intensity of intraocular inflammation in patients with endogenous posterior uveitis.

MATERIAL AND METHODS

50 patients--29 women (58%) and 21 men (42%) in age 15-70 yrs with idiopathic posterior uveitis were examined. Intraocular inflammation intensity was scored on standard uveitis grading system prepared by BenEzra et al. In all cases the ARA were determined by indirect immunofluorescence test on normal monkey retina as a substrate and FITC-labelled goat's anti-human IgA, G, M serum (Euroimmun-Germany). The control serum was obtained from 50 blood donors: 20 women (40%) and 30 men (60%) in age 15-68 yrs.

RESULTS

The statistical analysis showed a correlation between the ARA serum levels and intraocular inflammation intensity. High correlation was found in first control between serum ARA level and the degree of vitreous inflammation and the presence of fresh vessels sheathing, characteristic for retinal vasculitis. In next three controls, this correlation was still present, but only in a case of vitreous changes. And at the end of observation no correlation was found, neither between serum ARA levels and the activity of vitreous inflammation, nor between the ARA levels and retinal vasculitis intensity.

CONCLUSIONS

The assessment of serum ARA in patients with idiopathic posterior uveitis can act as an indicator for intraocular inflammation intensity and can reflect the retinal autoimmunity.

Gender-related differences in hepatic activity of alcohol dehydrogenase isoenzymes and aldehyde dehydrogenase in humans

Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), which are most abundant in the liver, are the main enzymes involved in ethanol metabolism in humans. Gender-related differences in total liver ADH and ALDH activity among different animal species have been observed in many studies. We measured total ADH and ALDH activity, and the activity of class I-IV ADH in the livers of male and female patients. Total ADH and class I and II ADH activities were significantly higher in males than in females (P=0.0052, P=0.0074, P=0.020, respectively). Class III and IV ADH and total ALDH activities were not significantly different between the genders (P=0.2917, P=0.0590, P=0.2940, respectively). The results of our study clearly show that there is a difference in enzymatic activity between male and female patients for those isoenzymes that actively participate in ethanol oxidation in the liver (class I and II ADH), although the main form of ADH in this organ is class III ADH.

Lifetime physical and sexual abuse in chronic pain patients: psychosocial correlates and treatment outcomes

PURPOSE

This study describes a subgroup of diagnostically heterogeneous chronic pain patients, with a lifetime history of physical and/or sexual abuse, who underwent a pain management programme. A battery of psychosocial and pain measures were assessed, as well as 1-year post-treatment socio economic outcomes.

METHOD

The prevalence of a history of abuse was assessed via a semi-structured interview of 162 consecutive patients (112 females and 50 males) presenting for 4-8 weeks of treatment in an interdisciplinary, outpatient rehabilitation programme. Treatment outcome data were gathered immediately, 6 months and 1 year following discharge. The chronic pain patients with a history of abuse were compared to those without a history of abuse on several pre-treatment psychosocial variables--pain severity, psychological distress, DSM-IV Axis I comorbidity and health care utilization. Patient groups were matched on age, race, primary pain diagnosis, time in pain prior to treatment and gender.

RESULTS

Results indicated that 61% of patients had a history of lifetime physical and/or sexual abuse. Rates of sexual, and combined sexual and physical, abuse across the lifespan were higher for women than for men. Abused patients had a greater number of psychiatric diagnoses than nonabused patients. Abused patients also reported greater affective distress, less perceived life control, and a greater number of ER visits in the 6 months prior to treatment than their nonabused counterparts. A model consisting of gender (female), a higher number of psychiatric diagnoses, and higher affective distress was found to be a sensitive and relatively accurate predictor of abuse history. Finally, analyses indicated that, despite having greater psychosocial risk factors during the pre-treatment period, chronic pain patients with a history of abuse benefited from treatment and maintained treatment gains to a degree similar to nonabused chronic pain patients.

CONCLUSIONS

Chronic patients with an abuse history can successfully complete a rehabilitation programme if the programme is designed to treat their psychosocial distress. Moreover, this also carries over to treatment outcome. A history of abuse does not have to negatively impact long-term treatment outcomes in this population of chronic pain patients.

[Causes of hospitalization and death in the MANIF 2000 cohort, composed of HIV-infected patients contaminated by intravenous drug use, 1995-1999]

OBJECTIVE

To describe the causes of hospitalization and mortality among the MANIF 2000 cohort study, composed of HIV-infected patients contaminated through intravenous drug use.

METHOD

Data collection with a standardized questionnaires with clinical, biological, therapeutic and psycho-sociologic data on inclusion and every six months. Dates and causes of hospitalization and death were collected retrospectively by nurses from the hospital clinical records. Comparison were made using the chi(2) or Mann-Whitney tests with 5% significance threshold.

RESULTS

The MANIF 2000 cohort study included, between October 1995 and June 1998, 467 patients with a median age of 33 years, 30% of whom were women. On inclusion, 42.2% were still injecting drugs (half of them were on substitution therapy), 10.5% had stopped injections of drugs, 32% exhibited more than 500CD4/mm(3) and 55.7% had not taken antiretroviral treatment. As of December 31(st) 1999, 21 patients had died, i.e. a mortality rate of 19% persons/years of follow-up (10-fold greater than that expected in the general population). Less than 5 deaths were due to HIV (n=4). Suicides and liver disease each represented the same number of deaths. Out of the 335 patients not having missed more than one follow-up throughout the 24 month period, 120 had been hospitalized at least once (n=223 hospitalizations), i.e., a hospitalization rate of 2.8 per 100 persons/month of follow-up. A quarter of hospitalizations were due to benign infections or stage B or C pathologies according to the 1993 classification of HIV infections and one hospitalization out of 5 was due to psychiatric problems (in majority depressive syndromes). Other predominant causes were worsening of general state of health, trauma, problems related to alcohol consumption, drugs abuse or hepatic decompensation.

CONCLUSION

HIV-infected patients contaminated by intravenous drug use represent a particular population that cumulates many risk factors and which requires careful monitoring of co-morbidities such as hepatic and psychiatric diseases in order to avoid premature death.