Gabriella Dardanoni

Pseudocysts in Acute Nonalcoholic Pancreatitis (Incidence and Natural History)

Epidemiological studies on pancreaticpseudocysts are retrospective analyses on alcoholicpatients. The aims of this study were to investigate theincidence, natural history, and predictors of theappearance and disappearance of pancreatic fluidcollections and pseudocysts after nonalcoholic acutepancreatitis. We carried out a prospective cohort studyin a series of 926 patients with acute pancreatitis.Pancreatic fluid collections or pseudocysts were treatedonly after complications. We studied pancreatic fluidcollections from 83 patients (8.9%): 48 of whomdeveloped pseudocysts (5.1%). Both were less frequent after biliary pancreatitis (P < 0.0001). Inthe first 60 days of follow-up, patients with fluidcollections or pseudocysts showed more complicationsthan spontaneous disappearance; two of them died. After the 60th day, spontaneous disappearancewas more frequent, and at one year the cumulativeincidence of complications and spontaneous disappearancewas 36% and 56%, respectively. A total of 33 patients with fluid collection needed interventionaltreatment (surgery or percutaneous or endoscopicdrainage). Pseudocysts that were small (<5 cm) ordeveloped in the tail had a higher incidence ofspontaneous disappearance: 22/24 (91.7%) and 11/12 (91.7%),respectively. In conclusion, fluid collections andpseudocysts after nonalcoholic pancreatitis have a lowincidence of complications and mortality with a high rate of spontaneous disappearance. Wesuggest treating them only aftercomplications.

Prevalence and risk factors of diabetic retinopathy in adult and elderly subjects: The Casteldaccia Eye Study.

PurposeTo investigate the prevalence and risk factors of diabetic retinopathy in subjects aged 40 years or older living in Casteldaccia, Sicily.MethodsA population-based survey was performed on 1,588 subjects randomly enrolled among people aged 40 years or older. A total of 1,068 persons could be examined and in 1,019 the fundus of the eye was adequately observed (64.2% of the enrolled population). Diabetic retinopathy was diagnosed by ophthalmoscopy and fundus photographs; fluorescein angiography was performed in 91% of retinopathic subjects. In addition, a case–control study was carried out in order to demonstrate the association of diabetic retinopathy with a number of variables.ResultsDiabetic retinopathy was found in 4.4% of the whole population studied and in 34.1% of the diabetics. Nonproliferative diabetic retinopathy was found in 29.6% and proliferative diabetic retinopathy in 4.5% of the diabetics. Diabetic retinopathy was significantly associated with the following univariate variables: duration of diabetes, duration and type of antidiabetic treatment, and duration of alcohol intake. After multivariate logistic regression the only variable independently associated with diabetic retinopathy was duration of antidiabetic treatment.ConclusionDiabetic retinopathy affects more than one third of diabetics and represents a leading cause of retinal disease. The antidiabetic treatment is the most important risk factor for diabetic retinopathy, even stronger than the duration of diabetes.

Ascites, pleural, and pericardial effusions in acute pancreatitis. A prospective study of incidence, natural history, and prognostic role.

Ascites and pleural and pericardial effusions can be observed during acute pancreatitis. The aims of this study were to evaluate their incidence, natural history, and prognostic role in patients with acute pancreatitis. One hundred patients consecutively admitted with a diagnosis of acute pancreatitis were prospectively submitted to abdominal, pleural, and cardiac ultrasonography at admission and during follow-up. Ascites was found in 18 patients, pleural effusion in 20, and pericardial effusion in 17. Twenty-four patients of this series had severe pancreatitis; three of them died. All effusions disappeared spontaneously in patients who survived pancreatitis up to two months after dismissal. At multivariate analysis ascites and pleural effusion were demonstrated to be accurate independent predictors of severity. The respective odds ratios were 5.9 [95% confidence interval (CI), 1.5–23.0%) and 8.6 (95% CI, 2.3–32.5%). Furthermore the presence of pleural effusion, ascites, and pericardial effusion were associated with an increased incidence of pseudocyst during follow-up. Ascites and pleural and pericardial effusions are frequent during acute pancreatitis. Pleural effusion and ascites are accurate predictors of severity in these patients.

Risk factors of ocular hypertension and glaucoma The Casteldaccia Eye Study

A case-control study was planned as a part of the Casteldaccia Eye Study in order to investigate about risk factors of ocular hypertension and glaucoma. Cases were 44 subjects with glaucoma or intraocular pressure of 24 mm Hg or more. Controls were 220 subjects with intraocular pressure of 20 mm Hg or less and no signs of glaucoma. A number of environmental, behavioral, systemic and ocular variables were studied. Among the others we investigated the following: sunlight exposure, smoking, alcohol intake, pregnancies, systemic hypertension, diabetes, use of corticosteroids, refractive status, anterior chamber depth, lens nuclear sclerosis, iris color and texture. After univariate analysis the use of ocular corticosteroids and antibiotics, myopia, shallow anterior chamber and myopic macular degeneration were associated with ocular hypertension or glaucoma. However, the logistic regression showed that only the use of ocular corticosteroids (odds ratio = 7.79) and the myopia (odds ratio = 5.56) were independently associated.

Clinical presentation and ultrasonography in the diagnosis of pancreatic cancer.

One thousand twenty patients consecutively admitted because of a clinical suspicion of pancreatic cancer were investigated to evaluate the accuracy of simple clinical, laboratory, and ultrasonographic data in the diagnosis of pancreatic cancer. Age, weight loss, recent-onset diabetes mellitus, palpable abdominal mass or gallbladder, elevated serum bilirubin or alkaline phosphatase levels, and ultrasonography were significant criteria in discriminating 80 pancreatic cancers from 940 controls. The most sensitive criteria were ultrasonography (83%). weight loss (66%), and bilirubin level of >3 mg/dl(61%); the most specific were ultrasonography (99%), recent-onset diabetes (97%), and a distended palpable gallbladder (94%). Only ultrasonography demonstrated an elevated positive predictive value (86%), while weight loss, elevated bilirubin and alkaline phosphatase, besides ultrasonography had an elevated negative predictive value (95%). These results show that advanced pancreatic cancer may be excluded with simple clinical and laboratory data; ultrasonography can confirm the diagnosis with a high degree of accuracy. We suggest that the results of any new diagnostic tests for pancreatic cancer be compared with these clinical findings.

Survival of patients with cancer of the stomach, colon and rectum, lung and breast in Ragusa, Sicily.

Survival of 1747 patients with cancer of the stomach, colon/rectum, lung and female breast was investigated on incident cases registered by the Ragusa Cancer Registry, covering the Province of Ragusa (275,000 inhabitants) between 1981 and 1986. Cases known from the death certificate only were excluded. Date of death was obtained by a linkage with death certificates issued for Ragusa residents. Living status was assessed directly at the Registrars Office. Analysis was performed also by sex, age group and presence of histologic verification. Relative survival at 5 years of Ragusa cancer cases was of the same order of magnitude as that observed in the U.S.A. (1980) and in Switzerland (1970-1980). However, the slight differences observed were mostly in favor of the Swiss and American patients. Sex did not significantly influence survival, but younger patients survived longer than older ones. Lack of histologic verification was associated with poor survival.

Risk factors of female cancers in ragusa population (sicily) - I. Endometrium and cervix uteri cancers

A case-control study on breast, cervix and endometrium cancer cases registered in Ragusa between January 1, 1983 and June 30, 1985 has been conducted. Information on risk factors has been obtained by means of a structured questionnaire.Risk factors for endometrium cancer were: few children (1–2 vs > 4 OR 15.18, 95%CL 1.96–117.64), oestrogenic treatment (OR 2.20, 95%CL 1.05–4.90), obesity (Quetelet index >30 vs <22 OR 10.42, 95%CL 1.30–83.86), family history (OR 2.87, 95% CL 1.05–7.83).Risk factors for cervix uteri cancer were: multiple abortions (>2 vs 0 OR 9.87, 95%CL 1.46–66.66), no contraception (OR 8.33, 95%CL 2.38–25.00), younger age of mother at birth (OR 6.89, 95%CL 1.71–27.70).Age at menarche, age at menopause and years of fertile life were not found to be related to either endometrium or cervix uteri cancer.The existence of influencing differences (ancestry, environment, lifestyle) has been postulated.

Risk factors of female cancers in Ragusa population (Sicily). 2. Breast cancer

A case-control study on breast, cervix and corpus uteri cancer cases registered in Ragusa between January 1, 1983 and June 30, 1985 has been conducted. Information on risk factors has been obtained by means of a structured questionnaire.Risk factors for breast cancer were: few pregnancies (1–2 vs > 4 OR 2.14, 95%CL 1.13–4.04), few children (for postmenopausal only, chi trend 4.84), previous breast disease (OR 1.97, 95%CL 1.20–3.23), family history (OR 3.57, 95%CL 1.92–6.63), alcohol (OR 1.68, 95%CL 1.12–2.53), high socioeconomical status (1 vs 4 OR 2,93, 95%CL 1.22–70.03). A protective role was evident for: early age at first birth (for premenopausal only, <20 vs >20 OR 0.11, 95%CL 0.01-0.90), previous ovary disease (OR 0.26, 95%CL 0.08–0.88).Age at menarche, age at menopause, years of fertile life and breast feeding were not found to be related to breast cancer. A different distribution of risk factors among cases with and without family history has been suggested.A synoptic table shows the distribution of the most important risk factors of the three investigated female cancers in the Ragusa population, reported in the present and in an accompanying paper.

DESCRIPTIVE EPIDEMIOLOGY OF STOMACH CANCER IN RAGUSA, SICILY, 1981-1988

An epidemiologic study was carried out on 475 incident cases of gastric cancer registered by the Ragusa Cancer Registry (Sicily) between 1981 and 1988. Distribution by sex, age, subsite, year of incidence, and survival was investigated. A reduction of incidence and mortality between 1981–84 and 1985–88 was observed in both sexes, and was more evident in males than in females. Survival was not significantly different for cancers of the various subsites.

Cancers of the female genital tract in Ragusa, Sicily

A descriptive study of cancers of the female genital tract (cervix, endometrium, ovary, labia, vulva and vagina) in the province of Ragusa (Sicily) was carried out using incidence and mortality data of the Ragusa Cancer Registry, covering the years 1981–1987. Corpus uteri was the most frequent site of cancer, followed by cervix utery and ovary; the highest mortality rates were exhibited by ovary cancer, whose survival at five years was 18.1 percent. A comparison of incidence and mortality rates with those observed by Italian and European registries shows that while in Ragusa rates for cancers of all sites were lower, female genital tract cancers, particularly of the uterus, were more frequent in Ragusa than in other Italian and European areas. In contrast with what has been reported by cancer registries of most developed countries, incidence of cervix cancer in Ragusa has apparently not decreased between 1981 and 1987, while mortality has increased.