Laura Michelacci

Italian Validation of the Symptom Rating Test (SRT) and Symptom Questionnaire (SQ)

Two self-rating scales of psychological distress, the Symptom Rating Test (SRT) and the Symptom Questionnaire (SQ), have been validated in translations in Italy. They were administered in several studies to psychiatric patients (neurotics and depressives), matched controls, and patients suffering from various organic illnesses (dermatologic disorders, hypertension, secondary amenorrhea and patients undergoing amniocentesis). The SRT and the SQ sensitively discriminated between psychiatric patients and normals, between different levels of psychological distress in several of the somatic illnesses, and detected significant changes in the psychological status of patients participating in medical procedures such as amniocentesis. The scales were found to be useful in research in psychiatry and psychosomatic medicine. The findings suggest that the Italian translations are valid and sensitive scales of distress and can apparently be used as effectively in research as the original. They are likely to be of value in cross-cultural research in Canada. Both scales may be helpful in the psychological assessment of Italian immigrants in North America and Australia, especially in those whose English is poor.

Prenatal diagnosis and outcome of partial agenesis and hypoplasia of the corpus callosum

To present antenatal sonographic findings and outcome of fetuses with hypoplasia or partial agenesis of the corpus callosum.

Psychological Reactions to Ultrasound

Twenty women underwent ultrasound examination three times during low-risk pregnancy. Before and after ultrasonography, the Symptom Questionnaire was applied to evaluate changes in psychological distress. Anxiety, depression, somatic symptoms, and hostility significantly decreased after the patients received video and verbal feedback during the first ultrasound examination. Such changes were consistently observed also during the subsequent two examinations.

Psychological reactions to amniocentesis: A controlled study

Fifty women who underwent amniocentesis and a matched control group of pregnant women were administered the Symptom Questionnaire to evaluate changes in distress. Anxiety, depression, and somatic symptoms had significantly decreased after the results of amniocentesis were communicated to the patient, but the decrease was similar in the normal control women. Hostility was higher in the amniocentesis group and decreased to normal levels after amniocentesis was performed, even before the results were communicated to the patient.

Increased insulin secretion in patients with multifollicular and polycystic ovaries and its impact on ovulation induction.

OBJECTIVE To assess the oral glucose tolerance test (OGTT)-stimulated insulin secretion and its relation to pulsatile GnRH ovulation induction outcome in patients with multifollicular or polycystic ovaries (PCOs). DESIGN Prospective study. SETTING Reproductive Endocrinology Center, University of Bologna, Bologna, Italy. PATIENTS Eight normal and 29 anovulatory women (8 with multifollicular ovaries and 21 with PCOs). INTERVENTION A standard OGTT was performed in all subjects. In all anovulatory patients, ovulation was induced with pulsatile GnRH (5 micrograms i.v. every 60 minutes). In multifollicular ovary patients, pulsatile GnRH was administered alone, whereas in PCOs it was preceded by GnRH agonist (GnRH-a) suppression. MAIN OUTCOME MEASURES Glucose, insulin, and C-peptide response to the OGTT, expressed as area under the curve (AUC). Ovulatory rates in response to pulsatile GnRH. RESULTS Insulin and C-peptide AUC were greater than controls in both multifollicular ovary and PCO patients. Insulin AUC was positively correlated to ovarian volume. Ovulation was achieved in 88% and 57% of multifollicular ovary and PCO patients, respectively. Body mass index and glucose AUC but not insulin and C-peptide AUC were significantly greater in the anovulatory PCO. CONCLUSIONS [1] Insulin AUC was increased in both multifollicular ovary and PCO patients; [2] derangements of insulin secretion may be present in a greater variety of anovulatory patients than previously thought; [3] insulin levels during the OGTT did not predict a response to pulsatile GnRH in PCOs, suggesting complex insulin interactions at the ovarian level; [4] given the in vitro stimulatory properties of insulin on granulosa cells synergistic with FSH, we propose that excessive insulin levels may contribute to the ovarian enlargement often found in multifollicular ovary and PCO patients.

Inversion mode spatio-temporal image correlation (STIC) echocardiography in three-dimensional rendering of fetal ventricular septal defects

We read with interest the report of Yagel et al.1 addressing the use of four-dimensional (4D) color Doppler ultrasound implemented by spatio-temporal image correlation (STIC) technology in prenatal imaging of a ventricular septal defect (VSD). In their recent paper, an isolated muscular VSD is nicely documented in a 23-week fetus by means of 4D color STIC echocardiography. Diastolic shunting of blood flow through the defect is accurately displayed on a volume-rendered image of ventricular septum, whose reconstruction is carried out alternatively on coronal, axial and sagittal planes. We report here a case of an isolated VSD that was demonstrated in a mid-trimester fetus and confirmed at postnatal follow-up. A 40-year-old nulliparous woman had been referred to our ultrasound unit at 21 weeks of gestation for a detailed anomaly scan, including fetal echocardiography due to her advanced age. Extracardiac anatomy appeared unremarkable. During standard twodimensional echocardiography the suspicion of a VSD was raised by detection of color turbulence across the ventricular septum in the four-chamber view. Based on this finding, detailed imaging of the fetal heart was carried out using 4D STIC color technology. The volume dataset was acquired by a 10-s transverse sweep of 25 degrees through the fetal chest at the level of the fourchamber view. Volume reconstruction of the fetal heart was achieved in color mode focusing on the ventricular septum where a discontinuity was confirmed by diastolic shunting of blood across it (Figure 1). Further confirmation of previous findings was provided by the recently introduced inversion mode algorithm. Through this latter 4D ultrasound rendering option, blood flow shunting across the VSD was depicted as a hyperechogenic flap bridging the two ventricles in the diastolic phase of the cardiac cycle (Figure 2). Furthermore, by measuring in diastole the depth of the bridge between the ventricles (Figure 3), the defective area on the ventricular septum could be derived ((0.27/2)2 × 3.14 = 0.057 mm2). 4D echocardiography implemented by STIC technology has been recently introduced as an adjunctive option in prenatal imaging of congenital heart diseases2. As suggested by the acronym itself, STIC allows multiplanar view and volume rendering of moving structures such as fetal heart. Thanks to this algorithm, following a dynamic acquisition of a volume dataset including fetal heart, a single cardiac cycle is virtually reconstructed according to heart rate with fundamental section planes being displayed Figure 1 Volume reconstruction of four-chamber view by color spatio-temporal image correlation echocardiography: diastolic shunting through the interventricular septum is clearly depicted suggesting a ventricular septal defect (arrow).

Hypochondriacal fears and beliefs in pregnancy

Illness attitudes were evaluated in 26 pregnant women and 26 control subjects matched for sociodemographic variables, by means of a self‐rating scale, on 3 different occasions. For each trimester of pregnancy, women displayed more hypochondriacal fears and beliefs and conviction of disease (disease phobia) than normal controls. In the third trimester, they also reported more fear of dying and bodily preoccupations. The findings should alert physicians to ask their pregnant patients whether they are preoccupied with fear of dying, or are concerned that they suffer from an undiagnosed physical illness, or dread a specific illness such as cancer or heart disease. Hypochondriacal fears and beliefs are liable to affect well‐being and the health attitudes of pregnant women. If properly recognized, they may effectively be treated.

Polycystic ovary syndrome: Abnormalities and management with pulsatile gonadotropin-releasing hormone and gonadotropin-releasing hormone analogs

Ovulation induction with pulsatile gonadotropin-releasing hormone achieves high ovulatory and pregnancy rates in hypogonadotropic hypogonadism while limiting the occurrence of ovarian hyperstimulation and multiple pregnancy. However, this form of therapy is apparently less effective in polycystic ovary syndrome. The administration of a gonadotropin-releasing hormone analog for 4 to 8 weeks before the initiation of pulsatile gonadotropin-releasing hormone ovulation induction can temporarily correct endocrine abnormalities of polycystic ovary syndrome, such as excessive luteinizing hormone and androgen secretion, and improve ovulatory and pregnancy rates in these patients. For optimal results, this pretreatment should probably be repeated before each pulsatile gonadotropin-releasing hormone ovulation induction cycle. Obesity is associated with a lower success rate, and spontaneous abortion remains a prominent complication in polycystic ovary syndrome even after gonadotropin-releasing hormone analog suppression. With this regimen the risks of ovarian hyperstimulation and multiple pregnancy are virtually abolished. Thus, pulsatile gonadotropin-releasing hormone appears to be highly effective and safe for ovulation induction in patients with polycystic ovary syndrome also, provided that this treatment is preceded by pituitary-ovarian suppression with a gonadotropin-releasing hormone analog.

Psychological Distress and Amniocentesis

40 women who underwent amniocentesis were administered the Symptom Questionnaire to evaluate changes in psychological distress. Anxiety, depression, somatic symptoms and hostility significantly decreased after the results of the procedure were communicated to the patient, replicating the findings in a previous study. Psychological distress, however, returned to the initial levels in the third trimester of pregnancy. Women whose only indication for amniocentesis was an age of 35 years or older displayed significantly higher hostility and somatic symptoms and less contentment before the procedure than the other women. Subsequently these differences lost their significance and the two groups showed similar patterns of psychological distress throughout the pregnancy.

Prenatal diagnosis of the prune belly syndrome.

A male fetus with prune belly syndrome was diagnosed by ultrasound at 30 weeks of gestation. The diagnosis was confirmed after birth.