Biomedical subjects
C Cislaghi
Publications and source records attributed to C Cislaghi.
First 10,000 chorionic villus samplings performed on singleton pregnancies by a single operator.
Chorionic villus sampling (CVS) was performed in 10,000 consecutive singleton pregnancies by a single principal operator, working in two institutions. The procedure was performed between 8 and 32 gestational weeks: transabdominal (TA) sampling was carried out in 8479 cases and transcervical (TC) in 1521. Patients were referred for chromosomal risk in 89.1 per cent of cases, Mendelian disorders in 10.5 per cent, and DNA investigations for paternity or infectious agents in 0.4 per cent of cases. The sampling success rate for both TA and TC techniques by the second insertion was 99.8 and 99.2 per cent, respectively. TA sampling succeeded in a higher number of cases at the first insertion (98 per cent vs. 86.8 per cent) and was associated with smaller samples (< 10 mg) in fewer cases (3.2 per cent vs. 4.9 per cent). Cytogenetic analysis was highly successful (99.4 per cent) and accurate; however, in one case a de novo structural rearrangement of chromosome I was not recognized. Mosaicism or rare trisomies were reported in 1.30 per cent of cases. Five diagnostic errors in DNA investigation (0.51 per cent) ended with the birth of affected fetuses. Fetal loss through 28 weeks' gestation in the pregnancies intended to continue was 2.58 per cent; the rate increased with maternal age (1.22 per cent at less than 30 years to 3.8 per cent at 40 years or more), while gestational age affected the abortion rate only at 8 weeks (odds ratio=2.22, P<0.05). Rates of premature delivery, low birth weight, and perinatal mortality did not differ from the Italian standards. By comparison with the Italian Birth Defects Registry data, no differences were found for the major malformations, including transverse limb reduction defects (TLRDs) (4.34 vs. 3.28 x 10,000). Total malformations and TLRDs did not show any pattern relation to either maternal age or gestational age.
Lichens, air pollution and lung cancer.
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[Geographic distribution of digestive system tumor mortality in Italy, 1970-87].
The geographical distribution of mortality rates from tumours of digestive tract in Italy is analyzed in this paper. The analysis is based on official mortality data collected by the National Institute of Statistics (ISTAT). Age-adjusted mortality rates for stomach cancer presented the highest values in some provinces of the North and the Center, and the lowest values in the South of Italy. A same geographical pattern was observed for men and women, and during the whole considered period. Colorectal cancer presented the highest rates in the North-West of the country, and in some provinces of Liguria and Tuscany. The lowes rates were observed in the South, particularly in Calabria and Sicily. Mortality for this cancer was positively associated with degree of urbanization. The geographical pattern remained fairly constant in time, but the North-South differences narrowed during the years 1980s. A similar geographical distribution, characterized by the highest mortality levels in the north-eastern regions of Italy, was observed for cancers of the oral cavity and pharynx, of the oesophagus, of the pancreas, and for male tumours of the liver. Female liver cancer presented, on the contrary, the highest mortality levels in the southern regions.
First-trimester Down's syndrome screening using nuchal translucency: a prospective study in patients undergoing chorionic villus sampling.
The value of the measurement of nuchal translucency thickness for predicting fetal Down's syndrome and other aneuploidies was prospectively evaluated at 8-15 weeks of gestation in 1819 consecutive pregnancies scheduled for karyotyping by chorionic villus sampling. In 43 cases, a chromosomal unbalanced aberration was found. Two teams of ultrasonologists who examined patients attending either National Health Service (Series 1) or private practice clinics (Series 2) were involved in the study. The same type of ultrasound machine and standardized approach were used in both study groups. In those cases in which the maximum subcutaneous thickness of the translucency was 3 mm or greater, the incidence of chromosomal aberration was 18.6% compared to 1.7% in the cases in which this was below 3 mm. The sensitivity, specificity and relative risk for all aneuploidies were 30%, 96% and 10.83, respectively, and no difference was found between trisomy 21 and other types of aneuploidy. The sensitivity and specificity and relative risk were significantly higher at 9-10 weeks than between 11 and 15 weeks. The results were concordant in the two series; however, the overall values for sensitivity (20% vs. 39%), specificity (94% vs. 98%) and relative risk (4.13 vs. 24.20) were clearly higher in the group of private patients. The results obtained confirm the potential application of the measurement of nuchal translucency thickness for fetal aneuploidy screening before the end of the first trimester and suggest that a multiplicity of individual, structural and organizational factors may interact and play a crucial role in determining the actual efficiency of ultrasound screening programs.
[The Italian mortality map at the municipal level].
The Italian Atlas of mortality at municipality level is the result of a research project coordinated by the Emilia-Romagna region and supported by the Health Ministry. To the realisation of this project have collaborated the Institute of Medical Statistics of Milano and the CILEA under the supervision of Prof. Cesare Cislaghi. Compared to previous equivalent products, this Atlas contains a number of methodological and content innovations. This was a consequence of the development of new statistical methods and the need of achieving different aims. First of all, the Atlas was aimed at describing the mortality at small area level, which is obtained via Kernel estimates; secondly, the objective was to identify suspect clusters of deaths which may suggest the existence of high risk areas. The Mortality Atlas is formed by 31 tables, one for each of the analysed cause of death; each table has a circular shape of 100 hundred kilometers radius and contains a variable number of municipalities; each municipality may be present in more than one circle. The Atlas is available on magnetic support and for each cause of death are provided several statistical analyses and indicators included in different files. One of these files can be directly used to build high quality maps using the graphical package MAPINFO.
[The analysis of the spatial aggregation of health events using risk surface density estimation methods].
Methods for the analysis of the spatial aggregation of health events has received growing attention under the pressure of public opinion concern and as tools for the identification of potential risk sources, for monitoring relevant geographical areas and, finally, for public health decisions. The development of statistical methods for the detection and localization of spatial clusters has mainly concerned individual data. This paper is aimed at describing one of the methods proposed for the identification of clusters in the case of information at individual level and at presenting its extension to grouped data. This method, the surface density estimation method using the Kernel approach, offers remarkable advantages in terms of simplicity of implementation and flexibility, this latter being an extremely important characteristic in the case of exploratory analyses. For exemplification purposes, the density estimation method has been applied to individual data concerning the spatial distribution of cerebral tumors in Campi Bisenzio (FI) and to the distribution of gastric cancer mortality in the municipalities around Arezzo and Pesaro.
[A new approach for the automatic detection of health event clusters].
The Italian Morality Atlas at municipality level, sponsored by the Health Ministry and realized by the Emilia-Romagna region in collaboration with the Institute of Medical Statistics of Milano, is aimed at: 1) supporting and stimulating the local production of mortality maps and the use of geographical data; 2) providing a working and research tool to local health planners; 3) setting a routine procedure for the detection of spatial clusters. This procedure is organized in several steps: the definition of the spatial domain and of the spatial distance metrics; the choice of the effect indicator and the standard population; the estimate of the density risk surface via kernel methods; the identification of "local maxima"; the analysis of local maxima for cluster detection; the description of the identified clusters. The paper investigates the meaning and the characteristics of spatial clusters, describes the procedure for their identification and discusses the opportunity to use an automated approach for map reading.
Evaluation of allergenic potency by REAST inhibition. A new tool for the standardization of allergenic extracts.
The potency of allergenic extracts can be determined in vitro by RAST inhibition, and this has become the preferred method for the standardization of allergens. A disadvantage of this technique is the impossibility of obtaining data about allergens bound to the solid phase, i.e., the counterpart of the inhibiting extract. The REAST (reverse enzyme allergosorbent test) is based on the capture of IgE by a specific antibody bound to microtiter wells, the reaction of captured IgE with biotinylated allergen and the development of a colour reaction by subsequent addition of streptavidin-peroxidase and chromogenic substrate. The addition of an allergen extract in a dose-response fashion competes with the biotinylated allergen and inhibits the test. In the present study REAST inhibition has been evaluated with Dermatophagoides pteronyssinus, Parietaria judaica and mixed grass pollen extracts. The correlation of REAST inhibition with RAST inhibition and both intra-assay and inter-assay reproducibility have been evaluated. REAST inhibition is a potentially valuable new tool for the standardization of allergenic extracts.
[Preliminary notes on the definition of several ethics guidelines in environmental epidemiology].
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Cancer mortality in Italy, 1989, and an overview of trends from 1955 to 1989.
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[Health problems of foreign immigrants in Italy: the answer from the institutions].
The possibility and the result of the meeting between immigrant's health problems and the health services system are conditioned by legal bonds and by the ability of the system to meet different cultures and values. In the present work we outline the Italian legislation about immigration to search those critical points that may help to understand some features of immigration in Italy. We describe the foreigner's health problems, according the present documentary evidence, and we outline adequate answers.
Effects of treatment with verapamil SR and captopril on the lipid profile of hypertensive patients.
The potential beneficial effects of antihypertensive drugs on cardiovascular morbidity and mortality may be compromised by their adverse effects on serum lipid levels. In our study we compared verapamil and captopril and evaluated their effects on blood pressure and on serum lipid and lipoprotein levels, with particular attention to lipoprotein(a) [Lp(a)]. 20 hypertensive patients were treated with sustained release verapamil 240mg once daily or captopril 25mg twice daily for 3 months in a double-blind randomised study. Diastolic blood pressure was reduced from 100 +/- 3mm Hg to 87 +/- 6mm Hg (p < 0.01) and from 100 +/- 5mm Hg to 92 +/- 7mm Hg (p < 0.05) in the verapamil and captopril groups, respectively. Small but significant changes in serum lipid levels were noted: total cholesterol was reduced from 6 to 5.8 mmol/L (verapamil) and from 6.1 to 5.9 mmol/L (captopril); low density lipoprotein (LDL) cholesterol was reduced from 4 to 3.8 mmol/L (verapamil) and from 4.2 to 3.9 mmol/L (captopril); apolipoprotein C-III was reduced from 0.3 +/- 0.07 to 0.2 +/- 0.06 mmol/L (9.7 +/- 2.5 to 9.2 +/- 2.3 mg/dl) [verapamil] and from 0.2 +/- 0.1 to 0.2 +/- 0.09 mmol/L (9.1 +/- 3.7 to 8.3 +/- 3.4 mg/dl) [captopril]; apolipoprotein A-II increased only with verapamil (p < 0.02). Lp(a) levels showed only minor changes in individual patients. In conclusion, in our study verapamil and captopril were effective antihypertensive agents and did not adversely effect the lipid profile.
[Analysis of the geographic distribution of mortality in Italy caused by tumors of the respiratory system].
This paper describes the geographical distribution of respiratory cancers in Italy during the period 1970-87. We analysed mortality rates for cancers of the larynx, of the lung, of the paranasal sinuses, and of the pleura in the 95 Italian provinces. For all considered sites, Northern Italy showed the highest levels of mortality. Only Rome and Naples, the most urbanized provinces in the Central and Southern Italy respectively, presented mortality rates comparable to the Northern provinces, particularly in the early 1970's. The geographical distribution of mortality for all considered sites appears to be consistent between the two sexes. For lung cancer, however, the difference between the North and the rest of the country during the considered period decreased in men but steadily increased in women.
Cancer mortality in Italy: an overview of age-specific and age-standardised trends from 1955 to 1984.
Number of certified deaths, age-specific and age-standardised rates and percentages of all cancer deaths from 30 cancers or groups of cancers (plus total cancer mortality) for each five-year calendar period between 1955 and 1984 in Italy are presented in tabular form. From these data, three graphs are derived, including trends in age-standardised rates, age-specific rates centered on birth cohorts and maps plotted in different shades of grey to represent the surfaces defined by the matrix of various age-specific rates. These analyses quantified the rises in overall cancer mortality in males (from 137 to 192/100,000 world standard), chiefly due to increases in lung and other tobacco-related neoplasms. Overall cancer mortality was stable in females (around 100/100,000). Appreciable cohort effects were evident for tobacco related neoplasms, but also for other major cancer sites, such as intestines or breast, whose rates, after earlier rises, are now stable in earlier middle age. Since the early 1970's, cancer mortality rates have been declining in all age groups below 40 in males and below 55 in females. These declines reflect improvements in therapy for leukemias, lymphomas and germ cell tumors, and general improvements in food availability and storage, hygiene and early diagnosis, which have led to the declines in stomach and cervical cancer. Although moderate in absolute terms and smaller than in other western countries where tobacco-related neoplasms have also been falling in more recent cohorts, these declines are encouraging for the indication they provide on the most likely patterns over the next decades in the same and subsequent generations.
Cancer mortality in young adults: Italy 1955-1985.
Although cancer mortality in young adults accounts for only a small proportion of all cancer deaths, it is important since it provides useful indications of the most likely future trends, and relevant information on the role of exposure to specific, or newer, carcinogens. We, therefore, analysed trends in cancer mortality between 1955 and 1985 among Italian men and women aged 20-44 years. In those three decades, overall cancer mortality declined steadily, by 27% in young women (from 33.8 to 24.7/100,000, world standard) but only by 3% (from 27.3 to 26.4/100,000) among men. The decline for men, however, was 16% from the peak rate of 31.5 reached in 1970-1974. The major underlying component causing the different trends in the two sexes was lung and other tobacco-related neoplasms, which had been considerably on the increase in young men up to the early 1970s, and levelled-off thereafter, while showing no appreciable change in women. The falls were about 50% for stomach cancer in both sexes, and over 80% for cervical cancer. A clear impact of improved treatment was reflected in the substantial declines in Hodgkin's disease, of testicular cancer in the last decade and, possibly, in the favourable trends in cancers of the breast, bone, brain and leukemias over the most recent calendar periods. Only two sites showed appreciable and persisting upward trends: oral cavity in men and skin melanoma in both sexes. They therefore constitute priorities for intervention in the near future.
Trends surface models applied to the analysis of geographical variations in cancer mortality.
To discuss different trends of the geographical distribution of cancer mortality, progressively more complex surface models were fitted to cancer death certification data in the 95 Italian provinces for the period 1975-77, using trend surface analysis. This method is based on fitting first to sixth order regression equations, where dependent variables are latitude and longitude, and the independent one is the standardized mortality ratio (SMR) for various cancer sites. The procedure was implemented using the SYMAP package and appropriate routines ad hoc developed. General patterns in geography of cancer in Italy were therefore identified (such as the marked North/South gradient in mortality from most sites), thus helping in discerning main underlying pictures and permitting identification of local abnormalities (positive or negative residuals, corresponding to high or low mortality areas), which are often obscured by more general patterns using standard methods of analysis. Results and maps are presented and discussed in detail with reference to total mortality and three major sites (lung and intestines in males and female breast) for which regression surfaces with satisfactory fitting were identified. Some of the positive residuals (i.e. those for lung and breast cancer in women in urban concentrations of Central and Southern Italy) were already known, and explainable in terms of available knowledge of the causes of the neoplasms, chiefly smoking and reproductive habits in the past. Other findings, such as the consistent area of positive residuals in a chiefly rural area around the mouth of the river Po, offer useful suggestions for further aetiological research.