RESUMEN

OBJECTIVE: To analyse the association between use of oral contraception and risk of pelvic endometriosis. DESIGN: We compared use of oral contraception in women with and without endometriosis. PARTICIPANTS: Eligible for the study were women with primary or secondary infertility (n = 393) or chronic pelvic pain (n = 424), requiring laparoscopy, consecutively observed between September 1995 and January 1996 in 15 obstetrics and gynaecology departments in Italy. RESULTS: Out of the 817 women included in the study, 345 had a diagnosis of endometriosis; 164 (47.5%) women with endometriosis and 139 (29.4%) without the disease reported ever using oral contraception. In comparison with never users the estimated odds ratios (OR) of endometriosis were 1.8 (95% CI 1.0-3.3) in current users and 1.6 (95% CI 1.1-2.4) in ex-users. No clear relation emerged between duration of oral contraceptive use and risk of endometriosis. In comparison with never users, the OR was 1.8 (95% CI 1.1-3.0) for women reporting their last use of oral contraception < 5 years before interview and 1.5 (95% CI 0.9-2.5) for those reporting their last use > or = 5 years before interview. CONCLUSIONS: The study suggests that oral contraception is associated with an increased risk of endometriosis but this finding is based on a selected population and cannot generalised to all women with endometriosis.

Asunto(s)

Asunto(s)

RESUMEN

The authors evaluate the incidence of carcinoid tumours out of a total of 2478 appendectomies performed between January 1984 and December 1991 at Treviglio Hospital. Histological tests, routinely performed on all appendixes removed, have revealed an incidence of 0.56% of this disease. Lesions are clinically silent in all cases. In fact, the finding of a carcinoid tumour was coincidental in 12 patients undergoing appendectomy for symptoms of appendicitis, and in two cases in which appendectomy was initially performed during the course of hysterectomy. Eleven cases were histologically of the classical type, including one with a "balloon cell" variant. Lastly, three cases were tubular type adenocarcinoids. In all cases treatment took the form of simple appendectomy. Follow-up studies are still in progress which have enabled the recidivation of neoplasia to be excluded in all patients, even 11 years after treatment.

Asunto(s)

RESUMEN

We have analyzed the association between sexually transmitted diseases (STD) and HIV infection, using data from a cross-sectional survey of subjects attending STD clinics in Northern Italy conducted since 1988. A total of 1,711 subjects (1,259 males, 452 females), who had referred themselves to three STD clinics in Northern Italy for suspected STD or STD treatment, were included for the study. Out of these, 145 subjects (113 males and 32 females) were HIV-positive. A total of 58 HIV-positive and 368 HIV-negative subjects reported a history of STD; the corresponding odds ratio (OR) was 2.3 (95% confidence interval (CI) 1.5-3.6) for subjects reporting a history of STD. Considering various STD in details, the estimated OR was 1.8 (95% CI 0.8-3.8) for a history of gonorrhoea and 1.5 (95% CI 0.8-2.7) of syphilis, and the OR was 1.8 (95% CI 1.0-3.2) and 2.2 (95% CI 1.3-3.8), respectively, for a positive TPHA and VDRL test. The results of the test for HbsAg were available in 50 HIV-positive and 1,028 HIV-negative subjects; the OR of HIV infection in subjects with HbSAg was 3.9 (95% CI 1.7-9.0). Presence of genital ulcers at clinical examination was not significantly associated with the risk of HIV infection (OR yes vs no genital ulcers 1.5, 95% CI 0.6-2.8).

Asunto(s)

RESUMEN

BACKGROUND: To analyse the relation between number of sexual partners, selected sexual habits and the risk of human immunodeficiency virus (HIV) infection. METHODS: We conducted a case-control study nested in a cross-sectional survey conducted among subjects attending sexually transmitted diseases (STD) clinics in Northern Italy. Eligible for the study were 1711 subjects (1259 males, 452 females) who referred themselves for the first time between September 1988 and March 1993 to three STD clinics in Northern Italy for suspected STD or STD treatment. A total of 145 subjects (113 males and 32 females) were HIV positive. RESULTS: In comparison with subjects reporting no or one sexual partner over the 3 years before the interview, the estimated odds ratios (OR) of HIV serum positivity were 1.2 (95% confidence interval [CI]: 0.6-2.3), 0.8 (95% CI: 0.4-1.8) and 0.3 (95% CI: 0.4-2.5) in subjects reporting 2-3, 4-5, and > or = 6 partners, respectively. The results were similar considering separately males and females and in men reporting only homosexual partners. Regular condom use decreased the risk of HIV infection: in comparison with subjects reporting no or occasional use of condoms, the OR of HIV infection was 0.5 (95% CI: 0.4-0.8) for regular users. Considering men only, compared with men with no homosexual intercourse, the OR of HIV infection was 2.3 (95% CI: 1.4-3.9) in those reporting bisexual intercourse and 2.2 (95% CI: 1.2-4.2) in men reporting only homosexual intercourse (among homosexuals). There was no relation between HIV infection risk and receptive anal sex. CONCLUSIONS: The risk of HIV infection does not increase linearly with the number of sexual partners in this population. This is reasonable, as the prevalence of HIV infection in this population is essentially determined by drug use. Caution is needed in the interpretation of these results since the analysis of role of number of sexual partners in male intravenous drug users is impaired by low statistical power.

PIP: It remains to be clearly established how multiple sex partners affect the risk of HIV infection. Northern Italy is a region where the prevalence of HIV infection is high mainly among IV drug users. The authors conducted a case-control study nested in a cross-sectional survey among subjects attending three STD clinics in Bergamo, Brescia, and Verona with the goal of analyzing the relationship between the number of sex partners, selected sex practices, and the risk of HIV infection. The study population was comprised of 1259 males and 452 females who referred themselves for the first time between September 1988 and March 1993 to the clinics for suspected STD or STD treatment. The men were of median age 30 years in the range of 16-70, while the women were of median age 28 years in the range of 16-61. 113 males and 32 females were HIV-seropositive. In comparison with subjects reporting no or one sex partner over the three years before the interview, the estimated odds ratio (OR) of HIV serum positivity were 1.2, 0.8, and 0.3 in subjects reporting 2-3, 4-5, and 6 or more partners, respectively. The risk of HIV infection therefore does not increase linearly with the number of sex partners in this population. These results were similar considering separately males and females and among the 91 men reporting only homosexual partners. 165 men reported themselves as being bisexual. Regular condom use decreased the risk of HIV infection such that the OR of HIV infection was 0.5 for regular users compared to subjects who reported no or occasional use of condoms. Considering men only, compared with men with no homosexual intercourse, the OR of HIV infection was 2.3 among those reporting bisexual intercourse and 2.2 among men reporting only homosexual intercourse. There was no relation between HIV infection risk and receptive anal sex. IV drug use was strongly associated with HIV-seropositivity, while a history of STD was more frequently reported by HIV-positive subjects than by HIV-negative subjects.

Asunto(s)

RESUMEN

We studied the effects of recombinant interferon alpha-2a (IFN-alpha) in 36 patients with polycythemia vera (PV) previously treated with phlebotomy and/or conventional cytostatic agents. In each patient, after at least 2 months of discontinuation of any cytotoxic therapy, the hematocrit (Hmt) was first brought to normal value by phlebotomy; IFN-alpha treatment was then begun at a starting dose of 3,000,000 IU s.c. three times a week. Response to treatment, which was assessed monthly, was defined as persistent normalization of Hmt without concomitant phlebotomy; in non-responsive patients the initial IFN-alpha weekly dosage was progressively increased. Twenty patients were responsive with a median duration of response of 7 months (range 2-25+ months); out of these, 7 patients are still under treatment and responsive at 13+, 17+, 20+, 22+, 23+, 25+, 25+ months. These findings indicate that a cohort, although small, of patients with PV (19.4%) are persistently sensitive to IFN-alpha; in this subset of patients, this cytokine can therefore provide a useful treatment option, since, contrary to conventional therapeutic approaches such as radioactive phosphorus, cytostatic agents, or phlebotomy, IFN-alpha is devoid of harmful side effects.

Asunto(s)

RESUMEN

STUDY OBJECTIVE: Goal of the study was to analyze the relationship between anticardiolipin antibodies, lupus anticoagulant and the risk of intrauterine late fetal death. DESIGN: A case-control study was conducted in a network of general and teaching hospitals in northern Italy. Cases studied were 99 women (median age 27 years), without clinical evidence of systemic lupus erythematosus or other immunological disorders who had an 'unexplained' intrauterine fetal death at or after the 20 weeks of gestation. The control subjects were 85 women (median age 28 years) who gave birth at term (> 37 weeks gestation) to healthy infants on randomly selected days at the same hospitals where cases had been identified. RESULTS: The presence of lupus anticoagulant was detected in four of the 99 cases (4%, 95% confidence interval 2%-15%) and none of the 85 controls. A total of 10 out of the 89 cases (11%, 95 confidence interval 6%-23%), but none of the 79 controls for whom anticardiolipin antibodies value was available had elevated anticardiolipin antibodies; this difference was statistically significant (chi 2(1) = 9.38, p < 0.01).

Asunto(s)

Asunto(s)