clinico pathological features treatments and survival of malignant insulinomas a multicenter study

Introduction Management of malignant insulinomas is challenging due to the need to control both hypoglycaemic syndrome and tumor growth. Literature data is limited to small series. Aim of the study To analyze clinico-pathological characteristics, treatments and prognosis of patients with malignant insulinoma. Materials and methods Multicenter retrospective study on 31 patients (male: 61.3%) diagnosed between 1988 and 2017. Results The mean age at diagnosis was 48 years. The mean NET diameter was 41 ± 31 mm, and 70.8% of NETs were G2. Metastases were widespread in 38.7%, hepatic in 41.9% and only lymph nodal in 19.4%. In 16.1% of the cases, the hypoglycaemic syndrome occurred after 46 ± 35 months from the diagnosis of originally non-functioning NET, whereas in 83.9% of the cases it led to the diagnosis of NET, of which 42.3% with a mean diagnostic delay of 32.7 ± 39.8 months. Surgical treatment was performed in 67.7% of the cases. The 5-year survival rate was 62%. Overall survival was significantly higher in patients with Ki-67 ≤10% (P = 0.03), insulin level <60 µU/mL (P = 0.015) and in patients who underwent surgery (P = 0.006). Peptide Receptor Radionuclide Therapy (PRRT) was performed in 45.1%, with syndrome control in 93% of patients. Conclusions Our study includes the largest series of patients with malignant insulinoma reported to date. The hypoglycaemic syndrome may occur after years in initially non-functioning NETs or be misunderstood with delayed diagnosis of NETs. Surgical treatment and Ki67 ≤10% are prognostic factors associated with better survival. PPRT proved to be effective in the control of hypoglycaemia in majority of cases

Trends in the prescription of antidepressants in urban and rural general practices

Analyzed the relationship between antidepressant drug (AD) prescription by general practitioners and population density in Italy between 1983 and 1988. The association between AD prescription and major sociodemographic variables was examined, and the seasonal pattern of prescribing was investigated. Data were calculated as defined daily dose (DDD), and the area was divided into 25 districts, classified on the urban-rural continuum according to population density. An increase in the levels of prescription of AD was observed over the 6 yrs. No correlation was found between DDD/1000 inhabitants/day rate and population density. Only the proportion of females in the population was significantly associated with AD prescription. Analysis of the seasonal variation in prescription showed a moderate degree of seasonality in all districts; however, seasonality was correlated only with the number of pharmacies available in each district. (PsycLIT Database Copyright 1992 American Psychological Assn, all rights reserved

Suicide and unemployment in Italy: Description, analysis and interpretation of recent trends

Provides descriptive, longitudinal, and cross-sectional aggregate-level analyses and also trends in individual-level and population risks for suicide in relation to unemployment from 1977 to 1987. Evidence for an association between suicide and unemployment among women was not convincing. Individual-level analyses for each year confirmed that unemployed women were more likely to commit suicide than their employed counterparts, although the overall relative risk was low. Among men, the unemployment rate (UR) was positively correlated over time with the suicide rate (SR). However, change in the SR across 18 geographic regions of Italy was unrelated to change in the UR. Unemployment was also positively related to the SR among the employed and population attributable risk, but unrelated to the rate among the unemployed or the relative risk. Comparison of SRs among the employed and unemployed revealed an excess of suicide among the latter in each year. (PsycLIT Database Copyright 1993 American Psychological Assn, all rights reserved

Suicide and unemployment in Italy: a replication study

Suicidi