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Craparo G, Gori A, Mazzola E, Petruccelli I, Pellerone M, Rotondo G. Posttraumatic stress symptoms, dissociation, and alexithymia in an Italian sample of flood victims. Neuropsychiatr Dis Treat 2014; 10:2281-4. [PMID: 25489247 PMCID: PMC4257106 DOI: 10.2147/ndt.s74317] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Several studies have demonstrated a significant association between dissociation and posttraumatic symptoms. A dissociative reaction during a traumatic event may seem to predict the later development of posttraumatic stress symptoms. Moreover, several researchers also observed an alexithymic condition in a variety of traumatized samples. METHODS A total of 287 flood victims (men =159, 55.4%; women =128, 44.6%) with an age range of 17-21 years (mean =18.33; standard deviation =0.68) completed the following: Impact of Event Scale-Revised, Dissociative Experiences Scale II, Twenty-Item Toronto Alexithymia Scale, and Peritraumatic Dissociative Experiences Questionnaire. RESULTS We found significant correlations among all variables. Linear regression showed that peritraumatic dissociation plays a mediator role between alexithymia, dissociation, and post-traumatic stress symptoms. CONCLUSION Our results seem to confirm the significant roles of both dissociation and alexithymia for the development of posttraumatic symptoms.
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Affiliation(s)
- Giuseppe Craparo
- Faculty of Human and Social Sciences, Kore University of Enna, Enna, Italy
| | - Alessio Gori
- Department of Psychology, University of Florence, Florence, Italy
| | - Elvira Mazzola
- Faculty of Human and Social Sciences, Kore University of Enna, Enna, Italy
| | - Irene Petruccelli
- Faculty of Human and Social Sciences, Kore University of Enna, Enna, Italy
| | - Monica Pellerone
- Faculty of Human and Social Sciences, Kore University of Enna, Enna, Italy
| | - Giuseppe Rotondo
- Department of Psychology, Unit of Psychotraumatology, San Raffaele Giglio Hospital of Cefalù, Cefalù, Italy
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Coopey SB, Mazzola E, Buckley JM, Sharko J, Belli AK, Kim EMH, Polufriaginof F, Parmigiani G, Garber JE, Smith BL, Gadd MA, Specht MC, Guidi AJ, Roche CA, Hughes KS. S4-4: Clarifying the Risk of Breast Cancer in Women with Atypical Breast Lesions. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-s4-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Women diagnosed with atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), lobular carcinoma in situ (LCIS), and borderline ADH/DCIS are at increased risk for breast cancer, but the precise degree of risk varies widely in the literature. Information from prior studies is limited by grouping ADH and ALH together and by small cohort sizes.
Objectives: To identify women with a pathologic diagnosis of ADH, ALH, LCIS, and borderline ADH/DCIS using Natural Language Processing. To evaluate breast cancer risk based on atypia type.
Methods: Using Natural Language Processing, we reviewed all electronically available pathology reports from Massachusetts General Hospital, Brigham and Women's Hospital, and Newton-Wellesley Hospital (members of Partners HealthCare System) from 1987–2010. We identified all women with a diagnosis of ADH, ALH, LCIS, and borderline ADH/DCIS with no prior or concurrent diagnosis of breast cancer. We determined the incidence of subsequent invasive and noninvasive breast cancer, the side of cancer diagnosis compared to original atypia side, and the time to cancer diagnosis for each atypia type.
Results: We reviewed 76,333 path reports in 42,950 unique individuals and identified 3049 women who were diagnosed with atypical breast lesions over this 14-year period; 1233 (40.4%) had ADH, 851 (27.9%) had ALH, 595 (19.5%) had LCIS, and 370 (12.1%) had borderline ADH/DCIS. The mean age for atypia diagnosis was 51 years (range: 18–93). At a mean follow-up of 66 months, cancer occurred in 7.0% of women with ADH, 11.3% of women with ALH, 11.1% of women with LCIS, and 8.4% of women with borderline ADH/DCIS. The median time to breast cancer diagnosis was 48 months with ADH, 50 months with ALH, 47 months with LCIS, and 60 months with borderline ADH/DCIS. Significantly more ipsilateral cancers developed than contralateral cancers for all types of atypia combined (p=0.027).
The development of invasive versus noninvasive breast cancer was not significantly affected by atypia type. Subsequent cancers were DCIS in 121 patients (43.4%) and invasive in 158 patients (56.6%). Kaplan Meier curves for time to cancer diagnosis based on atypia type were created. The curves for ADH and borderline ADH/DCIS were similar and significantly different than the curves for ALH and LCIS (p<0.001). The estimated 5 and 10-year breast cancer risks for each atypia type are presented in Table 1.
Conclusion: A diagnosis of ADH, ALH, LCIS, or borderline ADH/DCIS increases a woman's risk of invasive and noninvasive breast cancer in either breast. The breast cancer risk at 5 and 10 years is significantly higher in those with ALH or LCIS compared to those with ADH or borderline ADH/DCIS, but there is little difference in risk between ADH and borderline ADH/DCIS or between LCIS and ALH.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr S4-4.
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Affiliation(s)
- SB Coopey
- 1Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Newton-Wellesley Hospital, Newton, MA; Wayne State University, Detroit, MI
| | - E Mazzola
- 1Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Newton-Wellesley Hospital, Newton, MA; Wayne State University, Detroit, MI
| | - JM Buckley
- 1Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Newton-Wellesley Hospital, Newton, MA; Wayne State University, Detroit, MI
| | - J Sharko
- 1Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Newton-Wellesley Hospital, Newton, MA; Wayne State University, Detroit, MI
| | - AK Belli
- 1Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Newton-Wellesley Hospital, Newton, MA; Wayne State University, Detroit, MI
| | - EMH Kim
- 1Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Newton-Wellesley Hospital, Newton, MA; Wayne State University, Detroit, MI
| | - F Polufriaginof
- 1Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Newton-Wellesley Hospital, Newton, MA; Wayne State University, Detroit, MI
| | - G Parmigiani
- 1Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Newton-Wellesley Hospital, Newton, MA; Wayne State University, Detroit, MI
| | - JE Garber
- 1Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Newton-Wellesley Hospital, Newton, MA; Wayne State University, Detroit, MI
| | - BL Smith
- 1Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Newton-Wellesley Hospital, Newton, MA; Wayne State University, Detroit, MI
| | - MA Gadd
- 1Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Newton-Wellesley Hospital, Newton, MA; Wayne State University, Detroit, MI
| | - MC Specht
- 1Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Newton-Wellesley Hospital, Newton, MA; Wayne State University, Detroit, MI
| | - AJ Guidi
- 1Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Newton-Wellesley Hospital, Newton, MA; Wayne State University, Detroit, MI
| | - CA Roche
- 1Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Newton-Wellesley Hospital, Newton, MA; Wayne State University, Detroit, MI
| | - KS Hughes
- 1Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Newton-Wellesley Hospital, Newton, MA; Wayne State University, Detroit, MI
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Faglia E, Favales F, Aldeghi A, Calia P, Quarantiello A, Barbano P, Puttini M, Palmieri B, Brambilla G, Rampoldi A, Mazzola E, Valenti L, Fattori G, Rega V, Cristalli A, Oriani G, Michael M, Morabito A. Change in major amputation rate in a center dedicated to diabetic foot care during the 1980s: prognostic determinants for major amputation. J Diabetes Complications 1998; 12:96-102. [PMID: 9559487 DOI: 10.1016/s1056-8727(97)98004-1] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
From 1990 to 1993, 115 diabetic patients were consecutively hospitalized in our diabetologic unit for foot ulcer and 27 (23.5%) major amputations were carried out. The major amputation rate of this series of cases was compared with that occurring in diabetic subjects taken into our hospital for foot ulcer in two previous periods: 1979-1981 (17 major amputations in 42 inpatients or 40.5%) and 1986-1989 (26 major amputations in 78 inpatients or 33.3%). The comparison shows a progressive reduction in major amputation rate [Odds ratio 0.66, 95% confidence interval (CI) 0.46-0.96]. Univariate and multivariate analysis, carried out in the population of the 1990-1993 period, in order to detect the independent factors associated with major amputation show the following prognostic determinants of major amputation: Wagner grade (odds ratio 7.69, CI 1.58-37.53), prior stroke (odds ratio 35.05, CI 3.14-390.53), prior major amputation (odds ratio 3.49, CI 1.26-9.38), transcutaneous oxygen level (odds ratio 1.06, CI 1.01-1.12), and ankle-brachial blood pressure index (odds ratio 4.35, CI 1.58-12.05), while an independent protective role was attributed to hyperbaric oxygen treatment (odds ratio 0.15, CI 0.03-0.64). In accordance with other studies, we, therefore, conclude that a comprehensive protocol as well as a multidisciplinary approach in a dedicated center can assure a decrease in major amputation rate. The parameters of limb perfusion were the modifiable prognostic determinants most strongly predictive for amputation.
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Affiliation(s)
- E Faglia
- Diabetology Center, Niguarda Hospital, Italy
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Franzetti I, Donnini P, Gaiazzi M, Mazzola E, Zibetti E, Uccella R. [Lactic acidosis and severe hyperkalemia in a diabetic patient treated with metformin and enalapril: influence of acute renal disease and drugs]. Minerva Med 1995; 86:49-54. [PMID: 7753438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A 71 year old hypertensive and non insulin-dependent diabetic patients with moderate renal insufficiency taking 500 mg/d of metformin and 5 mg/d of enalapril, developed metabolic acidosis characterized by fairly elevated anion gap, hyperchloremia, severe hyperkalemia, normal plasma level of beta-hydroxybutyric acid, absence of ketonuria and high plasma level of lactic acid. This biochemical feature allowed us to ascribe the pathogenesis of metabolic acidosis both to the increased plasma level of lactic acid and to the type IV renal tubular acidosis syndrome, the precipitating factor being an infection of urinary tract (as we assumed on the basis of the urine culture). The patient was dehydrated and lethargic; the ECG revealed the presence of nonparoxysmal junctional tachycardia. The clinical evolution was favorable thanks to the treatment with the infusion of isotonic saline solutions, mild alkalinizing solutions, low-dose regular insulin and antibiotics. It is likely that metformin and enalapril, regularly assumed by the patient, could have played a iatrogenic role even if they were taken in low dosages. This event points out the importance of complying with the indications and especially the contraindications of these drugs, to avoid life threatening complications as that one occurred in this case.
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Affiliation(s)
- I Franzetti
- Unità Operativa di Diabetologia e Malattie Metaboliche, PMAO-Ospedale di Circolo e Fondazione Macchi, Varese
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Abstract
From 1985 to 1989, 67 heart transplantations were performed in our hospital, 6 of them in non-insulin-dependent (type II) diabetic patients. Six pretransplantation type II diabetic male heart recipients (mean +/- SD age 50.0 +/- 7.3 yr) were compared with 61 nondiabetic recipients (mean age 44.5 +/- 11.0 yr; 55 men, 6 women) to define whether a different posttransplantation prognosis may be caused by pretransplantation diabetes. Before transplantation, all diabetic recipients (3 newly diagnosed and 3 with diabetes duration of 5, 6, and 12 yr, respectively) were in good glycemic control (mean fasting blood glucose 7.95 +/- 1.62 mM, mean HbA1c 7.6 +/- 0.2%). None had ocular or renal microangiopathic complications, 5 were treated only with diet, and 1 was treated with oral hypoglycemic agents. All recipients were treated with the same immunosuppressive protocol (cyclosporin, prednisone, and since 1986, azathioprine and antilymphocyte globulin), and mean dose and blood levels of cyclosporin were not significantly different between diabetic and nondiabetic recipients. After heart transplantation (mean follow-up 558 +/- 340 days in diabetic and 379 +/- 338 in nondiabetic recipients), the mortality rate and complications (i.e., rejection episodes, supplementary immunosuppressive treatments, major and minor infections, arterial hypertension, and graft atherosclerosis) showed no significant differences except for the more frequent arterial hypertension in diabetic recipients (P less than 0.05), although pretransplantation incidence of hypertension was lower in diabetic candidates.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- E Faglia
- Department of Cardiology, Niguarda-Ca' Granda Hospital, Milan, Italy
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