Flare-Up study and gonadotropin-oestradiol extinction pattern were examined in two groups of 11 and 10 patients during treatment with Triptorelin LA. Plasmatic gonadotropin and oestradiol levels were evaluated by LIA and RIA respectively. The resulting data confirm that LH levels show an increase sixfold than basic values (Flare-Up effect), while FSH levels increase twice after two days of treatment. This effect was exhausted in five days. Gonadotropin-oestradiol extinction pattern demonstrates a condition of hypogonadotropic hypogonadism after two weeks of treatment with LHRHa. This study could explain some aspects of a LHRH-a action, namely for their clinical use in ovulation induction protocols.
The Authors after an overview on the most important causes of postsurgical adhesions, drove their attention to the tissue injury determined, during abdominal surgery, by exposure of pelvic serosa to the humidity of operating area. The AA tested body temperature in the Douglas pouch and under the liver on 30 patients who were operated by conservative surgery (myomectomy) and on 8 patient who underwent laparoscopy. A decrease of one degree in the Douglas pouch after one hour on the patient who had a Pfannestiel incision has been detected. While on the patients with longitudinal laparotomy no difference was evidenced. Serosal biopsies done at the beginning of surgery after pelvis exposure to the external conditions (temperature, humidity) showed a marked phlogosis in the tissue of the patients not treated at all. These tissue injuries were almost absent in the group treated with saline tissue irrigation and absent in the group that had parenteral prehydration, too. The AA suggested the use of the two techniques in conservative surgery in order to obtain in the open abdomen surgery results similar to those of the endoscopic one.
Effects of frequency and dose variation of GnRH administration by minipumps Zyklomat, were studied in five women during luteal phase. As controls were assumed the same patients; in fact they had been previously treated with pulsatile GnRH with constant dose and frequency all over the cycle. Then the patients received the same treatment but the dose and the frequency of infusion were changed in the luteal phase. Our data show an increase of mean levels of progesterone and oestradiol during the luteal phase and a better pregnancy rate when the frequency and the dose of GnRh administration were changed.
The P-C test was performed on 296 unselected women to verify if its parameters were all useful for a screening program: the 0-5 contraction strength score resulted unnecessarily too elaborated, a linear relationship was always seen between muscular endurance and contraction strength, muscular exhaustion was never detected during the testing, antagonist muscular synergies were observed only in some of the patients with low contraction strength score; marked agonist synergies were never detected. For screening purpose therefore could be sufficient to evaluate only the contraction strength identifying three levels of its activity: no activity, low activity, good activity.
Although endometrial carcinoma is characterized by a precocious symptomatology, in 28.4-22.6% of cases at the time of diagnosis it is found to be at clinical stage higher than I. In the present study the diagnostic delay is related to the stage of disease. Our data suggest that diagnostic delay can cause a higher risk of advanced-stage disease; all the cases of stage III and IV disease, in fact, were diagnosed after more than 7 months. Diagnostic delay was also directly related to depth of myometrial invasion; the mean diagnostic delay was significantly shorter in patients with stage I disease and superficial myometrial invasion (3.92 vs 8.76 months) (p < 0.001). Therefore, diagnostic delay is directly related to well-established prognostic variables as well as to clinical stage and depth of myometrial invasion.
The data of three years of activity (1985-1987) at the 4th Obstetrics and Gynecology Department of the University of Milan, S. Gerardo Hospital in Monza, for a total of 5595 deliveries and 5672 new-borns are reviewed. Each case of perinatal death has been evaluated for gestational age, weight, way of delivery and preexisting or pregnancy-induced maternal diseases, trying to single out the primary causes of death. In order to compare these data with the ones of the previous three years the results have been divided, following the gestational age, in two groups (less or more and equal than 28 weeks). Late perinatal death rate (including all the babies older than 24 weeks of gestational age, still-born or live-born and dead within the 28th day of life) has been 1.8%, compared to the 2.1% in the previous 3 years. Obstetrical procedures and neonatal outcomes are analyzed in depth. Puerperium was pathological in 8.9% of patients. Only 4.2% of women decided not to breast-fed their babies.
Recent knowledge on the pathogenetic mechanisms which are thought to be responsible for primary dysmenorrhea in most young females allow us to abandon old therapeutical approaches for several medical solutions with high effectiveness rates. But a number of patients remain for whom these treatments are not suitable or not effective. Mainly for these patients, today we can offer a valid alternative, a new kind of electroanalgesy, TENS, now easier to use owing to the miniaturization of the machine. In fact, in two groups of patients resistant or insensitive to modern medical therapies, we obtained good analgesia during the menstrual period, without important side effects and with high compliance by the patients.
UNLABELLED:Advances in hysteroscopic surgery provide additional options to hysterectomy for the treatment of dysfunctional uterine bleeding resistant to medical therapy and multiple curettages. Two techniques are now available: (a) Resectoscopic endometrial ablation. (b) Electrocoagulation or laser photovaporisation of endometrium. 52 patients underwent resectoscopic endometrial ablation at the Gynaecology Department of Parma University from January 1991 to April 1993. All patients suffered from dysfunctional uterine bleeding without atypical histologic findings on endometrial biopsies and had a normal shaped uterine cavity. 41 patients were subsequently contacted for follow-up. Follow-up period ranged from a minimum of 3 months to a maximum of 24 months. 78.1% of the patients reported a satisfactory outcome (amenorrhea or decreased menstrual flow). No operative complication occurred. Post operative complications included one case of hematometra.CONCLUSIONS:resectoscopic endometrial ablation is an advantageous technique but our follow-up period is relatively short and long term sequelae have yet to be determined.
Several authors, confronting the mother-child relationship during pregnancy and breast-feeding, talk about an uterine and extra-uterine symbiosis. In this way, one bypasses the fact that the so called unions end with the processes of separation constituted by the birthing/birth (by the termination, that is to say, of the first maternal nurturing (that of placenta) as well as by the termination of the second maternal nurturing (that of the individual breast-feedings). The careful observation of these unions demonstrates that they coexist and they imply equilibrium through the processes of separation that not only allow a partial autonomy of the developments of mother and child, but also make room for the detachments represented by the birthing/birth and by the end of the individual breast feedings. The author is trying to illustrate some physiological and pathological equilibrium between these tendencies towards reciprocal dependence and reciprocal mother-child autonomy.
Fifty consecutive cases of cervical cancer from the Afagnan Hospital in Togo have been reviewed in their clinical features, and in ten out of these and five additional ones from the year 1979 the histological specimens were reexamined. The high rate of late diagnosis was the most striking clinical data observed, while the histopathological study revealed a high quota of undifferentiated or rare patterns, very different from the types commonly observed in Europe. In spite of the very poor public health level of the population, an almost complete absence of histological signs of HPV infection in the neoplastic tissue should be remarked.
Sixty-five couples with male infertility or unexplained infertility or infertility due to cervical factor underwent 156 cycles of homologue intrauterine insemination. The overall pregnancy rate was 16.5% with 2.4 mean value of insemination cycles for each couple. The highest pregnancy rate was observed in cases of cervical factor infertility. The mean age of patients who had pregnancy was 30 years (overall mean value 34 years) and the mean time of sterility was 3 years (overall mean value 4.4 years).
Exposure to extremely low frequency electromagnetic field (EMF) is very common and concern about its harmful effects has been raised. Video display terminals (VDT) in the office are among the most important sources of exposure. Animal studies have shown adverse effects on reproduction, but the role of EMF in human reproduction is not clear. Twelve papers considering the effects of VDT and other EMF exposure on pregnancy outcome are reviewed. Concerning VDT exposure, the pooled OR for spontaneous abortion was 1.0 (95% Confidence Interval, CI, 0.9-1.0). There was no significative trend in risk with exposure intensity. No significative risk emerged for low birth weight nor for congenital malformations. Regarding other sources of EMF (electric blankets, heated waterbeds, ceiling cable electric heat and power lines), some studies have suggested that spontaneous abortion, growth retardation and congenital defects are more frequent during the coldest month of the year (when the exposure to these EMF would have been higher). However, data on the issue are scanty.
Neoplastic myometrial invasion is an important prognostic factor in local advanced endometrial carcinoma, conditioning therapeutic choice. In 34 patients with stage I and II endometrial carcinoma, the depth of myometrial invasion was evaluated by transvaginal sonography (TVS). In comparison with pathological findings, TVS showed an overall accuracy of 82.3% with a sensitivity of 82.6% and a specificity of 81.8%. The principal error was related to the underestimation of the lesion: negative predictive value of 49.2% vs positive predictive value of 90.4%. In conclusion, TVS is an accurate imaging method for staging of local advanced endometrial carcinoma.
The Authors report chromocolposcopic pictures with AZEA (Azure 2 + alcohol-soluble eosine + ethanol) and related histologic pictures in six women under oral contraception. Columnar epithelium develops violet or blue-violet areas histologically corresponding to endocervicitis. Aceto-white epithelium develops reddish color in case of medium-mature metaplasia, brown-violet in case of mature metaplasia, lilac in case of superficial koilocytosis on metaplasia. Native epithelium appears dark brown, or yellow-brown in case of koilocytosis.
The problem of warts' therapy is of great interest for the diffusion of this pathology, for its high rate of recurrence and for its relation to CIN. So we evaluated the efficacy of different therapeutic methods for vulvar condylomata, used in 254 patients treated in our center from January '86 to July '90. 55 women underwent hot cautery, 31 laser-therapy, 42 excisional biopsy, 62 were treated with alpha interferon, 11 with beta interferon, 13 with thymopentin in association with electro-cautery or laser and in 40 cases no treatment was performed. The follow up, from 6 to 36 months, showed a remission of 88.1% in excisional biopsy, of 77.4% in laser-therapy, of 70.9% in electro-cautery, of 45.4% in beta interferon, of 45.2% in alpha interferon, of 76.9% in thymopentin and of 65% in the not treated group. No one therapy yielded optimal results, although surgical methods appeared to allow complete removal of the wart lesion with one application only, and to be better accepted by the patients because of the psychologic benefit of immediate remission notwithstanding the possibility of recurrencies. The results of the studied medical therapies appeared scanty. We conclude that, being the tissues around florid lesion purely affected by HPV, medical therapy needs further research in the hope of a more radical treatment.
From January 1st, 1984 to December 31st, 1988 67 cases of cholestasis during pregnancy (frequency rate 0.7%) have been reviewed. In the 79% of the cases cholestasis arose after the 32nd week. Preterm deliveries were 19.5% and cesarean sections were 19.4%. Perinatal mortality was 30%. Pregnancy complicated by cholestasis is a high risk problem in obstetrics. An attempt to show a clinical management is exposed.
The association between oral contraceptives (o.c.) and disease risk was reviewed on the basis of data from a network of a case-control studies conducted in northern Italy since the early 1980's on about 150 cases below age 55 with acute myocardial infarction, 150 with gallstone disease, 350 with uterine fibromyoma, 170 with endometrial cancer, 700 with benign or malignant ovarian tumours, 2000 with breast cancer, 360 with intraepithelial and 370 with invasive cervical cancer, 20 with liver cancer plus over 2000 control women admitted to hospital for acute, non hormone-related non neoplastic diseases. The relative risk (RR) of myocardial infarction was 2.1 (95% confidence interval from 0.7 to 7.1) among current o.c. users, but only 4% of women were current users. There was no association between gallstone disease, uterine fibromyoma and o.c. use. Significant protections were observed with reference to endometrial cancer and benign, borderline and malignant ovarian tumours, while the RR was above unity (RR = 1.9) for invasive cervical cancer, but not for intraepithelial cervical neoplasia. A significantly increased risk was observed for primary liver cancer, which is however extremely rare in young women. With reference to breast cancer, there was no consistent duration-risk relationship, and the RR was 0.8 for use for 5 or more years. Thus, these data provide reassuring information on the relationship between o.c. use and the risk of several important diseases in a Southern European population.
The paper describes a case of mullerian adenosarcoma of the uterus. The patient, a 58-year old postmenopausal woman, presented with atypical vaginal bleeding and enlarged uterus. A total hysterectomy was performed. The intrauterine mass measured 10 cm in largest diameter and had bossolated surface and 2 pedicles of 3 and 4 mm each. The cut section was white-pink in color and contained small cysts in about two third of its volume. Myometrium was not infiltrated by tumor. On microscopic examination, the tumor consisted of round glands surrounded by myofibroblastic stroma which was condensed around the glands. Glandular epithelium was pseudostratified and showed ciliated, tubal and mucinous differentiation. Periglandular stroma cells were atypical and pleiomorphic and mitotically active. The part of the tumor which lacked glands had prominent smooth muscle differentiation. Immunohistochemically stromal cells stained positively for vimentin and smooth muscle specific alpha-actin; desmin without predigestion was extensively negative.
Echographic examination allows correlations between crown-rump length and gestational age. In this study the embryonic and early fetal growth after in vitro fertilization and embryo transfer was evaluated by ultrasound (U.S.) marks. 97 measurements in 54 pregnancies between day 39 and 80 after successful fertilization has been performed. Early fetal growth retardation was detected by U.S. when compared to the Robinson curve for normal pregnancy and confirmed after correction for the instrument error. This delay of 3, 3.5 days disappears around the 13 week of pregnancy and is not related to the baby weight at birth. An implantation delay may explain this difference in growth rate between normal and after F.I.V. and E.T. pregnancies.
Conization is frequently used as a diagnostic and curative method for the prevention of the cervical cancer on women of the fertile age. Conization was performed on 408 women up to 40 years in our Clinics during the years 1967 to 1989. The percentage of attested postoperative pregnancies among these women amounts to 13.51% and declines with age; it is high among women up to 25 years of age (29%) and low (3%) among women between 36 and 40 years. The percentage with premature births before the operation was 15.25%; after the operation the percentage declined to 13.31%. Preventive cerclage was used on one part (8.1%) of the latter percentage and no cerclage on the remaining 5.4%. It is concluded that there is not high danger of premature birth after conization and therefore performance of the operation does not seem to necessitate preventive cerclage.
