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Biomedical subjects

F Parazzini

Publications and source records attributed to F Parazzini.

At least 379 records · Page 21Linked to original sources
PubMed1983

Ten-year survival in 290 patients with endometrial cancer: prognostic factors and therapeutic approach.

Between 1970 and 1976, 290 patients with endometrial cancer were treated at the 1st Obstetrics and Gynecology Clinic of the University of Milan. The median age was 62 years. Surgery was completed in 262 (90.3%) patients. Abdominal hysterectomy was used in 158 (70.9%) stage I and 40 (71.4%) stage II/III) patients; vaginal hysterectomy in 55 (24.7%) stage I and nine (16.1%) stage II/III patients. Resection of the upper vagina was performed in 168 patients. Postoperative external beam radiotherapy was used in stage II/III patients and in 44 (19.7%) stage I high-risk patients. Ten-year survival, determined by the life-table method, was 84.8% in stage I (223 patients), 53.4% in stage II (37 patients), 64.4% in stage III (19 patients), and 9.1% in stage IV (11 patients). Factors associated with poorer prognosis were: late age at diagnosis (P less than 0.001); deep myometrial invasion (P less than 0.001); poorly differentiated histological grade (P = 0.11); lack of resection of the upper vagina (P = 0.13). The role and importance of surgery is discussed, with special emphasis on the selective use of the vaginal route in aged, obese and medically high-risk patients.

Adult↗
PubMedDate not supplied

The outpatient cost of diabetes care in Italian diabetes centers.

OBJECTIVE: To provide resource utilization patterns and cost estimates of outpatient care for types I and II diabetes mellitus in Italy, based on retrospectively collected data. DESIGN: Multicenter, retrospective observational study analyzing individual costs in a sample of patients with diabetes mellitus. STUDY POPULATION: A total of 2260 patients were stratified into eight groups by type of diabetes, glycemic control, and age. SETTING: Thirty-five centers for diabetes care in Italy. RESULTS: The per-patient cost of treatment was [symbol: see text] 136.8 in two months for type I diabetes (N = 592) and [symbol: see text] 123.3 for type II diabetes (N = 1668). Pharmaceutical therapy consisting of antidiabetic drugs only accounted for only 32% to 36% of treatments cost in type I patients and between 13% and 24% in type II. Diagnostic tests accounted for 27% to 42% of treatment costs in patients with both type I and type II diabetes, day-hospital days accounted for 15% to 22% in type I, 25% to 27% in type II, and consultations accounted for 16% to 20% in type I patients and between 17% and 21% in type II diabetes. CONCLUSION: Despite limitations caused by the short period considered, and considering that in Italy the cost of diabetes has received limited attention, we believe this study presents some interesting information on the burden of diabetes in this country.

Adolescent↗
PubMedDate not supplied

Risk factors for endometrial hyperplasia: results from a case-control study.

We analyzed epidemiologic characteristics of women at risk for endometrial hyperplasia (EH), using data from a case-control study. One hundred twenty nine women aged 35-73 (median 51 years) with histologically confirmed complex endometrial hyperplasia without atypies identified at the University of Milan during the period 1990-99 were examined. Controls were 258 non hysterectomized women aged 36-74 (median 52 years), admitted to a network of hospitals covering the same area where cases had been identified for conditions other than gynecological, malignant, or hormone-related. Cases with EH were more educated than controls (OR > 12 years of education vs. < 7: 2.8, 95% CI 1.7-4.8), more frequently obese (OR 2.7, 95% CI 1.5-5.0) and diabetic (OR 2.4, 95% CI 0.8-6.9). Parous women (OR 1.8) and women reporting induced abortions (OR 1.6) showed an increased risk of EH, but the associations were not statistically significant. Compared to premenopausal women, the OR of EH was 0.2 (95% 0.1-0.5) for postmenopausal ones. Compared to women reporting menopause at age 50 or less, the OR of endometrial hyperplasia was 1.5 (95% CI 0.6-3.5) and 2.2 (95%CI 0.7-6.7), respectively, in women with menopause at age 50-52 and > or = 53. Considering postmenopausal women only the OR was 3.1 (95% CI 1.1-9.3) for use of hormonal replacement therapy (HRT). We conclude that this study indicates that high education, obesity, diabetes, and HRT use increase the risk of endometrial hyperplasia.

Adult↗
PubMedDate not supplied

False-negative sentinel node in patients with vulvar cancer: a case study.

Evidence from recent studies indicates that the technique of sentinel node biopsy might be a useful solution for detecting lymph node status for primary vulvar cancer without having to perform radical inguinal lymphadenectomy. The patient in this report underwent sentinel node biopsy, then bilateral inguino-femoral node dissection, and, lastly, radical vulvectomy. The histologic analysis showed a well differentiated squamous cell carcinoma with metastases in one right inguinal node and one left inguinal node and a false-negative right sentinel node. Technically the biopsy of groin sentinel nodes should be quite easy to perform. The use of preoperative lymphoscintigraphy and the intraoperative use of the gamma probe combined with blue dye helps considerably in identifying lymphatic drainage and the sentinel node for vulvar cancer. Further results are needed to confirm the value of sentinel node dissection in the treatment of early stage vulvar cancer.

Aged↗
PubMedDate not supplied

The epidemiology of multiple births.

On the basis of MEDLINE and manual searches, we examined the main papers in the English literature regarding risk factors for spontaneous (i.e. not related to fertility drug use) multiple births. The constant frequency of monozygotic (MZ) pregnancies over time and in different geographical areas suggests that the determination of MZ twins is largely unchanged over time, and that a genetic mechanism may have a role. In contrast, temporal and geographical trends observed in dizygotic (DZ) pregnancies suggest that environmental factors play a role in determining this condition. At present, maternal age and hereditary components are the best-defined determinants for spontaneous multiple births.

Age Factors↗
PubMedDate not supplied

Risk factors for different histological types of ovarian cancer.

Various histological types of ovarian cancer may develop from different etiological aspects. Data separated by histological subtypes collected in the framework of a large case-control study on ovarian cancer conducted in Italy were analyzed. The cases were women below the age of 75 years, admitted to a network of hospitals in Milan. Cases were grouped into four categories by histological type: mucinous tumor (n = 52), serous tumor (n = 680), endometrioid tumor (n = 41), and other histologies including clear-cell and undifferentiated epithelial tumors (n = 50). Controls were 2758 patients admitted to the same network of hospitals for a wide spectrum of acute, nongynecological, non-hormone-related, non-neoplastic conditions. In comparison with nulliparae, the risk of serous, endometrioid, and other histologies of ovarian cancer tended to be lower in parous women, but the odds ratios (OR) were above unity for mucinous ovarian cancer. Oral contraceptive use was associated with OR lower than unity for serous (OR = 0.7) and endometrioid (OR = 0.8) ovarian cancers but not for mucinous (OR = 1.4) and other histologies (OR = 1.6). Finally, our results on dietary fat intake did not show substantial differences in all histological types of ovarian cancer.

Adenocarcinoma, Clear Cell↗
PubMedDate not supplied

Epidoxorubicin versus no treatment as consolidation therapy in advanced ovarian cancer: results from a phase II study.

To compare the effect of epidoxorubicin given for 4 months versus no treatment in the survival of patients with advanced ovarian cancer and complete pathologic response after first-line surgery and chemotherapy with platinum-based schedules, we conducted a multicenter randomized clinical trial. Patients with histologic diagnosis of epithelial ovarian cancer FIGO stage III or IV at first diagnosis; complete pathologic response at second-look laparotomy/laparoscopy or complete clinic response; and those who have had first-line therapy including surgery and one regimen containing cisplatin or carboplatinum were eligible for the study and were randomly allocated to epidoxorubicin 120 mg/sqm or no treatment. A total of 64 women were allocated to epidoxorubicin and 74 to no treatment. There were 20 and 19 deaths, respectively, in the epidoxorubicin and no-treatment groups. The 3-year percent overall survival was 79.0% and 78.7%, respectively, in the no-treatment and epidoxorubicin groups (log-rank test, P= 0.93).

Adenocarcinoma↗
PubMedDate not supplied

Lifelong menstrual pattern and risk of breast cancer.

The relationship between lifelong menstrual pattern and the risk of breast cancer has been analyzed using data from a large case-control study conducted since 1983 in the greater Milan area including 3,037 cases, aged 74 years or less, with histologically confirmed breast cancer and 2,569 control subjects admitted for acute nongynecological, nonneoplastic nonhormone-related conditions to the same network of hospitals where cases had been identified. Compared with women reporting lifelong regular cycles, those reporting irregularities were at significantly reduced risk of breast cancer, relative risk estimate being 0.6, with 95% confidence interval (CI) ranging from 0.5 to 0.8. This protection was restricted to women reporting totally irregular menstrual cycles; compared to women reporting menstrual cycles lasting 25 days or less, the estimated relative risks were 1.0 and 1.2 in those reporting cycles lasting 26-30 days or 31 days or more, respectively, but 0.6 (95% CI 0.5-0.8) for those reporting totally irregular cycles. The effect of irregular menstrual cycles was similar in different strata of age and main risk factors for breast cancer.

Adult↗
PubMedDate not supplied

Treatment with tamoxifen and progestins for metastatic breast cancer in postmenopausal women: a quantitative review of published randomized clinical trials.

The efficacy of tamoxifen (TAM) was compared to that of progestins (medroxyprogesterone acetate, MPA, and megestrol acetate, MA) in the treatment of metastatic breast cancer in postmenopausal women by a quantitative analysis of the results of published randomized clinical trials. Seven studies involving a total of 801 subjects compared TAM with MPA. Overall, the frequency of complete and partial response was 9 and 18%, respectively, in the women treated with TAM, versus 9 and 28% in those given MPA. Considering complete and partial responses together, the frequency of response was 29% in the TAM group and 39% in the MPA group, the corresponding pooled odds ratio (OR) of response being 1.5 (95% confidence interval, CI, 1.1-2.0). The median duration of response was greater in the TAM-treated patients; however, the difference was small (14 vs. 11 months). The probability of response to MPA treatment was about 3-fold higher compared with the response to TAM treatment in the subgroup with bone metastases (OR 3.4), and 2-fold higher in the subgroup with visceral metastases (OR 2.2), but the difference in the OR estimates was not statistically significant. The response to the two drugs was similar in the subgroup with metastases in soft tissues. Four studies compared TAM with MA, taking in 463 subjects. The overall frequency of complete and partial response was 35% in the patients who received TAM compared with 29% in those treated with MA. The corresponding pooled OR was 0.8 (95% CI 0.5-1.1). Analysis of the results according to site of metastases revealed no significant difference in the frequency of complete or partial response in the two treatment groups.

Bone Neoplasms↗
PubMedDate not supplied

Bacterial vaginosis in pregnancy and preterm birth: evidence from the literature.

We review below the evidence from the literature about the relationships between bacterial vaginosis, its treatment and pregnancy outcome. The literature indicates that there is a well-defined association between the presence of bacterial vaginosis during pregnancy and the risk of premature membrane rupture and preterm birth. Less definite is the role of the treatment of such pathology in reducing the frequency of preterm birth and/or premature rupture of membranes. The results of the controlled clinical trials are not entirely consistent. Of the most studied therapies, clindamycin seems to have shown favourable results most consistently but the published data are limited to trials including just a few hundred subjects. Only the availability of further data from controlled clinical trials will clarify the role of such treatment for bacterial vaginosis in pregnancy.

Anti-Bacterial Agents↗
PubMedDate not supplied

A phase I-II trial of high-dose ifosfamide in patients with ovarian cancer refractory or resistant to platinum and/or paclitaxel-containing chemotherapy.

AIMS AND BACKGROUND: To evaluate the toxicity of high-dose ifosfamide in ovarian cancer patients refractory or resistant to platinum and/or paclitaxel-containing chemotherapy. METHODS: This was an open, non-randomized phase I-II trial of high-dose ifosfamide. Eligibility criteria were: patients aged 18-75 years affected by ovarian cancer with refractory or resistant disease or early relapse after first-line treatment including platinum or paclitaxel. Three patients were given escalating ifosfamide doses; if no severe adverse events occurred, the ifosfamide dose was increased. The starting dose of ifosfamide was 10 g/m2 i.v. and the dose increase was 1 g/m2 every four weeks for a total of five courses; 12 g/m2 was the maximum ifosfamide dose to be administered. The trial then progressed to a phase II trial, in which ifosfamide was given at the maximum tolerated dose reached during the escalating dose phase. RESULTS: A total of 36 patients entered the trial. Nine patients were involved in phase I of the study; 3 received 10 g/m2 ifosfamide, 3 11 g/m2 and 3 12 g/m2. Of the 32 evaluable patients 6 (18.8%) achieved a complete response and three (9.4%) a partial response, giving an overall response rate of 28.1% (95% CI, 15-61% based on Poisson's approximation). The median number of ifosfamide courses was five. G1, G2 and G3 neurotoxicity was reported in 3 (8%), 2 (5%) and 2 (5%) patients, respectively. CONCLUSION: This phase I-II trial indicates that high-dose ifosfamide has some activity but also a relevant degree of toxicity in resistant or refractory platinum and paclitaxel-pretreated ovarian cancer.

Adult↗
PubMedDate not supplied

The relationship between oral contraceptive use, cancer and vascular disease.

An overview of the available epidemiological evidence on the connection between oral contraceptives and cancer or vascular disease is presented, including the observation that epidemiological studies have produced important indications for changing both the composition and prescription patterns of oral contraceptives to avoid a large proportion of vascular side effects. Further, the evidence is remarkably clear and consistent in relation to the elevated risks of cervical neoplasms and, although based on a limited number of small studies, of primary liver cancer; protection against endometrial and ovarian cancers up to middle age; and the absence of association with malignant melanoma. There are still uncertainties regarding breast cancer, mainly related to the role of time factors, and the potential persisting risk related to long term use at younger age: published studies, in fact, show elevated risks for long term use in women below age 35 or perhaps up to age 45, but no evidence of association in middle age. Since breast cancer and ovarian cancer account for most of the mortality burden in women up to age 50 or 55 in developed countries, a clarification of the risk relationship for these 2 neoplasms will determine most of the quantitative evaluation on positive or adverse effects of oral contraceptives. The impact of other neoplasms and of cardiovascular disease, on the basis of current oral contraceptive composition, is comparatively limited, if not negligible.

Contraceptives, Oral↗
PubMedDate not supplied

Risk factors for unexplained dyspermia in infertile men: a case-control study.

This study was conducted to analyze risk factors for dyspermia in infertile subjects in a population of men attending outpatient services for infertility in Milan, Northern Italy. Between September 1989 and November 1990 we conducted a case-control study on risk factors for dyspermia. Cases included infertile men with a diagnosis of unexplained dyspermia consecutively observed for the first time during the study period at the Outpatient Service for Infertility of the First Obstetric and Gynecologic Clinic of the University of Milan. Specific work-up was done to exclude the major known or potential causes of dyspermia and infertility in patients and their partners. Two control groups were selected. The first included normospermic men of infertile couples with negative work-up for any disease that might affect fertility, observed in the same outpatient service where cases had been identified. The second control group included fertile men of unknown semen quality who were the partners of women who gave birth at term (> 37 w gestation) to health infants in randomly selected days at the same clinic. In comparison with those who have never smoked, current smokers were at increased risk of dyspermia versus both normospermic men of infertile couples and fertile men of unknown semen quality, and the risk increased with number of cigarettes smoked per day and duration of smoking. The risk of dyspermia increased with the number of cups of coffee drunk per day compared with men drinking no or one cup per day. Likewise, alcohol drinkers were at increased risk and the risk increased with number of drinks/d.(ABSTRACT TRUNCATED AT 250 WORDS)

Case-Control Studies↗
PubMedDate not supplied

Declining sperm count and fertility in males: an epidemiological controversy.

There have been several suggestions from different populations that sperm count has decreased in the past 20 years. Concerns have, however, been raised in the interpretation of these findings, particularly with regards to subject selection mechanisms and data-analysis. Furthermore, these findings are inconsistent with the reports that male infertility rates have remained constant during the past 3 decades. The increased number of men seeking consultation on infertility may only be the result of the tendency of couples to delay pregnancy and the increased availability of treatment. Moreover, sperm concentration is not always in itself the determinant of male fertility, so the use of sperm count as an indicator of male infertility in epidemiological studies should be considered with caution.

Humans↗
PubMedDate not supplied

[Follow-up of children included in the Italian Study on the Use of Low-Dose Aspirin During Pregnancy: development at 18 months of life and birth weight].

To assess the relationship between birthweight and the child's development at 18 months of age, we sent a postal questionnaire to the parents of 861 singleton children, born in the framework of the Italian Study of Aspirin in Pregnancy, 18 months after delivery. A total of 623 (72.4%) were returned. There were 94 children weighing < 2500-1500 g at birth and 19 < 1500 g. Children with weight and height less than the 10th percentile at 18 months were significantly more frequent in the low birthweight group (p < 0.01). Motor problems were about six times more common in children with birthweight less than 2500 g than in those with birthweight > or = 2500 g (p < 0.001). A larger proportion of children with birthweight < 2500 g than > or = 2500 g had respiratory problems (15% vs 11%, p = ns). Finally admission to hospital was more common in children with birthweight less than 2500 g (p < 0.01). This study confirms the differences in growth and development for children in low and normal birthweight groups.

Adult↗
PubMedDate not supplied

[Causality relationship of drug adverse reactions: experience in the use of HIV-protease inhibitors].

PURPOSE: To establish the exact cause and effect relationship between protease inhibitors (PIs) and adverse events. MATERIALS AND METHOD: Prospective, cohort, multicenter study on HIV-positive patients who are beginning treatment with a PI. Causal relationships are evaluated using the RUCAM algorithm. RESULTS: Since the beginning of the study 1207 patients have been enrolled. Average time of observation is 10.7 months. To date, 784 adverse events have been observed, distributed as follows: excluded 3.8%, improbable 18.5%, possible 41.3%, probable 30.1%, and highly probable 6.3%. Saquinavir shows a statistically significant difference in the rate of non-correlated events with respect to other groups. CONCLUSIONS: Over 20% of adverse events during PI treatment are shown to be non-correlated to these drugs. Saquinavir shows the highest rate of non-correlated events.

Adult↗
PubMedDate not supplied

[Follow-up of children in obstetrical clinical trials: research experience in Italy].

The effectiveness of treatments for the mother exposed to adverse events in pregnancy is not always interpreted in the light of possible effects on the child. The follow-up of infants is an important component of obstetric and perinatal audit not only in randomised clinical trials but as part of routine health care. The results of the 18 month's follow-up of children born from women recruited in the Italian Study of Aspirin in Pregnancy and in the Italian Trial on Nifedipine in Pregnancy are discussed. No significant differences emerged between treatment and no-treatment groups with respect to indicators of development and health status. Malformations, diseases, and other health problems showed no specific patterns and were much the same in the groups. Our findings suggest that the use of low-dose aspirin and calcium channel blocker nifedipine in pregnancy is safe with respect to the risks of malformation and of major impairment in development at 18 months of age.

Aspirin↗