9 Obstetrics Department, Hospital of Cetraro, Cosenza, Italy 10 School of Specialization in Gynaecology and Obstetrics, University of Cagliari, Cagliari, Italy 11 University of Milano and IRCCS Policlinico of Milan, Milan, Italy 12 Obstetrics and Gynaecology Clinic, University of Palermo; University Hospital “Policlinico “Paolo Giarrone”, Palermo, Italy 13 Department of Gynaecology, Hospital of Copertino, Lecce, Italy 14 UOC of Gynaecology, University “Policlinico Tor Vergata”, Rome, Italy 15 Department of Gynaecology, Ente Ospedaliero Ospedali Galliera, Genova, Italy 16 Department of Gynaecology and Obstetrics, Presidio Azienda Ospedaliera Vito Fazzi, Lecce, Italy 17 Department of Gynaecology and Obstetrics, “San Martino” Hospital, Genova, Italy 1 UOC Obstetrics and Gynaecology, Hospital of Conegliano Veneto (TV); Centre for Medically Assisted Procreation of Conegliano, Conegliano Veneto (TV), Italy 2 UO of Gynaecologic Urology, “San Carlo di Nancy”, Rome, Italy 3 “IRCCS Policlinico” of Milan, Milan, Italy 4 Department of Gynaecology and Obstetrics, Faculty of Medicine and Surgery, University of Catania; University Hospital "Policlinico Vittorio Emanuele", Catania, Italy 5 Department of Gynaecology and Obstetrics, Obstetrics University Course, University Hospital “Policlinico II Università degli Studi” of Napoli, Napoli, Italy 6 Hospital of Grosseto, Grosseto, Italy 7 Gynaecology Endocrinology, Centre of Diagnosis and Therapy for Couple Sterility, Hospital of Siena, Siena, Italy 8 Obstetrics and Gynaecology Clinic, Institute of Biomedical Sciences, University of Milan, “San Gerardo” Hospital, Monza, Italy Characteristics of women attending first level gynecological outpatient services with symptoms suggesting urinary tract infection: an observational study

Objective: We analysed risk factors for high blood pressure (BP) among women around menopause.Methods: Eligible women were consecutively attending first-level outpatient menopause clinics in Italy for general counseling or treatment of menopausal symptoms. During the visit BP was measured three times. The mean of second and third of the three diastolic BP values for women was > 90 mm of mercury and/or reporting any current pharmacological treatment for high BP were considered hypertensive. Out of 45,204 women who entered the study with information on blood pressure, 12,150 had high BP.Results: The odds ratios (OR) of high BP increased with age: in comparison with women aged < 50 years, the multivariate OR were 1.44 (95% confidence interval (CI), 1.34-1.55), 1.61 (95% CI, 1.50-1.74) and 1.91 (95% CI, 1.77-2.06) in women aged 51-53, 54-57 and >= 58, respectively. Women with high BP were less educated than those without (OR education > 12 versus < 7 years, 0.79, 95% CI, 0.74-0.84). In comparison with women with a body mass index (BMI) < 24, the multivariate ORs were 1.48 (95% CI, 1.39-1.57) and 2.56 (95% CI, 2.41-2.71) for women with BMI 24-26 and > 26. In comparison with women reporting no regular physical activity, the multivariate OR of high BP was 0.93 (95% CI, 0.87-0.99) for women reporting regular activity. In comparison with peri-menopausal women, post-menopausal women were at increased risk (OR 1.14, 95% CI, 1.03-1.24) and the risk tended to increase with age at menopause. Current use of hormonal replacement therapy (HRT) was associated with a lower risk of high BP (OR 0.88, 95% CI, 0.84-0.94).Conclusions: This large cross-sectional study suggests that, after taking into account the effect of age, post-menopausal women are at greater risk of high BP, but current HRT use slightly lowers the risk. Other determinants of high BP were low level of education, overweight, and low level of physical activity. (c) 2005 Elsevier Ireland Ltd. All rights reserved.

Objective: To obtain data on correlates of climacteric symptoms in women around menopause attending menopause clinics in Italy.Methods: Since 1997 a large cross sectional study has been conducted on the characteristics of women around menopause attending a network of first level menopause outpatient's clinics in Italy. A total of 66,501 (mean age 54.4 years) women are considered in the present paper.Results: The odds ratios of moderate and severe hot flashes/night sweats were lower in more educated women and (for severe symptoms only) in women reporting regular physical activity. Depression, difficulty to sleep, forgetfulness and irritability tended to be less frequent in more educated women and (depression only) in women reporting regular physical activity. Parous women reported more frequently these symptoms.Conclusions: This large study confirms in Southern European population that low education, body mass index and low physical activity are associated with climacteric symptoms. Parous women are at greater risk of psychological symptoms. (c) 2005 Elsevier Ireland Ltd. All rights reserved.

Objective To obtain data on correlates of total cholesterol (TC) levels in women around menopause attending menopause clinics in Italy.Methods Since 1997, a large cross-sectional study has been conducted concerning the characteristics of women around the time of the menopause attending a network of first-level menopause out-patient clinics in Italy for general counselling about the menopause or treatment of menopausal symptoms. Women observed consecutively at the participating centers were eligible for the study. Up to March 2000, TC was measured in 23 018 cases, which are considered in this analysis.Results The adjusted mean level of TC rose with age, from 216 mg/dl in women aged < 50 years to 234 mg/dl in those aged > 57 years. Mean TC increased with body mass index (BMI, kg/m(2)), being 224 mg/dl in women with BMI < 24, 227 mg/dl in those with BMI 24-26 and 228 mg/dl in those with BMI > 26. Considering menopausal status, the crude mean TC level was 216 mg/dl in premenopausal women, 227 mg/dl in women reporting a surgical menopause and 229 mg/dl in women reporting a natural menopause. These differences were still present when the analysis took into account the effect of age and other potential covariates, the adjusted values being 221, 225 and 227, respectively. Similar findings emerged when we considered the distribution of study subjects according-to selected levels of TC (< 210, 210-250, 251-290, < 290). For example, the odds ratio of TC 210-250 mg/dl and > 250 mg/dl vs. < 210 mg/dl was, respectively, 1.8 and 2.8 in women aged greater than or equal to 57 years in comparison with women aged < 50 years. The corresponding odds ratio values for women with a BMI > 26 vs. < 24, and for women in spontaneous menopause vs. premenopause, were all 1.2 (all statistically significant).Conclusions This analysis, based on a large data set, confirms the role of overweight as a determinant of TC in postmenopausal women, and indicates the role of the menopause as a determinant of TC level in women aged 50-60 years.

Objective To determine the frequency and causes of preterm ovarian failure (menopause before 40 years of age) and early menopause (menopause between 40 and 45 years).

Objective To analyze determinants of body mass index (BMI, kg/m(2)) in women attending menopause clinics in Italy.Methods Eligible for the study were women attending a network of first-level outpatient menopause clinics in Italy for general counselling about the menopause or treatment of menopausal symptoms. Women observed consecutively during the study period were eligible. A total of 49 122 women (mean age 54 years) entered the study.Results and conclusions The mean BMI increased slightly with age, being 25.8 (standard deviation, SD 4.8) in women aged < 50 years and 26.3 (SD 4.6) Hi those aged 57 years or more. This trend was statistically significant also after taking into account the potential confounding effect of menopausal status.The mean BMI was higher in less educated women (27.2, SD 5.1) than in those with high-school education or a university degree (25.0, SD 4.5) (P < 0.05), in non-smokers (26.4, SD 4.9) than in smokers (25.4, SD 4.5), in never-users of hormone replacement therapy (HRT) (26.3, SID 4.9) than in ever-users of HRT (25.4, SID 4.4) and in women self-reporting no physical activity (26.5, SID 4.9) than in those reporting regular physical activity (24.9, SD 4.2).The BMI was higher in women following a surgical menopause than if it was spontaneous (p < 0.05), but there was no difference between the mean BMIs of prernenopausal women and those with a spontaneous menopause. Women with diabetes and hyper-tension had a higher BMI. There was no relation between history of osteoporosis/osteopenia and BMI.

Objective: In order to offer data on the epidemiological profile of women with low bone density (LBD), we have considered information collected in the framework of a large cross-sectional study conducted on women around menopause attending a network of first level outpatients menopause clinics in Italy. Methods: During 1997 and 2000, a large cross sectional study was conducted on the characteristics of women around menopause attending a network of first level outpatients menopause clinics in Italy for general counseling about menopause or treatment of menopausal symptoms. Eligible for the study were women consecutively observed during the study period. Up to March 2000 a total of 42464 women (mean age 53 years) were observed at the 268 participating centers. Bone mass density was measured in 25 113 cases, which are considered in this analysis. LBD (i.e. osteopenia or osteoporosis) was defined according to WHO classification. Results: The frequency of LBD increased with age: in comparison with women aged less than or equal to 51 years, the odds ratio (OR) of LBD was 1.5 and 2.2, respectively, in women aged 52-55 and greater than or equal to 56. No association emerged between LBD and parity: in comparison with nulliparae, the OR of LBD were 1.1 and 1.0, respectively, in women reported 1 or 2 or more full term pregnancies. Smokers were at increased risk of LBD, the corresponding OR being for smokers, in comparison with non smokers, 1.2 (95% confidence interval, CI, 1.1-1.3). In comparison with women in the lower tertile of body mass index, the OR of LBD decreased in subsequent tertiles, being, respectively, 0.9 and 0.7 in the middle and highest tertile. The OR of LBD was 2.2 in postmenopausal women, in comparison with premenopausal ones and the OR decreased increasing age at menopause. Ever OC users were at slightly decreased risk of LBD: in comparison with never OC users, the OR was 0.9 (95% CI 0.8-1.0) in ever OC users. Conclusion: The results of this large study confirm, in a Souther European population, the association of age at menopause and body mass on the risk of LBD, and suggest that ever OC women are at decreased risk of LBD. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

Objective: The objective of the study was to analyze medical and general factors associated with hormone replacement therapy (HRT) use in women attending a network of menopause clinics in Italy.Design: Between 1997 and 1999, we conducted a large cross-sectional study on the characteristics of women around menopause attending a network of first level outpatient menopause clinics for general counseling about menopause or treatment of menopausal symptoms. All women consecutively observed during the study period at the participating centers were eligible for the study. A total of 42,464 women (mean age 54 years) entered the study. The characteristics of women who had at some time used HRT were compared with those of women who were never users.Results: Of the 42,464 women considered, 4,909 ( 11.6%) reported having used HRT at some time. In comparison with premenopausal women, the odds ratio (OR) of HRT use was 2.1 and 4.0, respectively, in women with natural and surgical menopause; the frequency of use tends to be lower in women with later age at menopause. In comparison with women reporting primary school education, the OR was 1.4 in women with a secondary or university degree. In comparison with nulliparity, the OR of HRT use was 0.7 (95% confidence interval [CI] 0.6-0.7) in women with two or more births. HRT use was less frequent in women reporting a history of diabetes (OR 0.7, in comparison with women with no history, 95% CI 0.5-0.9) and cardiovascular diseases (OR 0.8, 95% CI 0.7-0.8) and more frequent in women with a history of osteopenia/osteoporosis (OR 1.2, 95% CI 1.0-1.5), but the latter finding was not statistically significant.Conclusion: The results of the study indicate that HRT use is more common in this population in women of higher education with early age at menopause and with a history of osteoporosis/osteopenia and less frequent in women with a history of cardiovascular disease and diabetes.

Objective : To analyse determinants of hysterectomy for benign uterine conditions with or without oophorectomy in Italy, a country with among the lowest rates of hysterectomy worldwide. Methods: Between 1997 and 1999, a large cross sectional study was conducted on the characteristics of women around menopause attending a network of first level outpatients menopause clinics in Italy for general counselling about menopause or treatment of menopausal symptoms. A total of 25 644 women entered the study. Characteristics of women who underwent and women who did not undergo hysterectomy and oophorectomy were compared. Results: Out of the 25 644 women considered, 4727 were hysterectomized (18.4%). Mean age at surgery was 46.8 years. The OR of hysterectomy decreased with increasing educational level: in comparison with women with primary and none education, the OR of hysterectomy was 0.8 (95% CI 0.7- 0.9) and 0.6 (95% CI 0.5-0.7) respectively for women with intermediate or high/university degree. Body mass index (BMI, kg m(-2)) was related to the frequency of hysterectomy; in comparison with women with BMI less than or equal to 23.8, the OR of hysterectomy was 1.2 (95% CI 1.1-1.3) and 1.4 (95% CI 1.2-1.5) respectively for women with a BMI 23.8-27.2 and > 27.2. The frequency, of bilateral oophorectomy increased with age at hysterectomy: in comparison with women who have had hysterectomy when aged less than or equal to 43 years, the OR of bilateral oophorectomy during hysterectomy was respectively 1.9, 3.4 and 4.3 in women who had hysterectomy at age 44-47, 48-51 and greater than or equal to 52 years. The Frequency of bilateral oophorectomy was lower in more educated women: in comparison with women reporting none or primary degree, the OR was 1.0 and 0.8 respectively for women with intermediate and high/university degree. Conclusions: The results of this analysis indicate that hysterectomy for benign conditions is more frequently performed in less educated women, in nulliparae and in women with higher BMI. During hysterectomy for benign conditions, bilateral oophorectomy is more frequent in less educated women and its frequency increases with women's age. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.

Objective: To analyze determinants/risk factors for uterine prolapse in a population of women around menopause. Methods: Between 1997 and 1999, we conducted a large cross sectional study on the characteristics of women around menopause attending a network of first level outpatients menopause clinics in Italy for general counselling about menopause or treatment of menopausal symptoms. Eligible for the study were women consecutively observed during the study period. All women underwent a gynecological examination. Results: Considering the 21 449 non-hysterectomized women, uterine prolapse was diagnosed in 1182 cases (5.5%). Of those, 772 (65.3%) had prolapse degree I and 410 (34.7%) degree II or III. The frequency of uterine prolapse increases with age: In comparison with women aged less than or equal to 51 years, the odds ratio OR of uterine prolapse was 1.3 and 1.7 respectively for women aged 52-55 and greater than or equal to 56 years. In comparison with women with none/primary education, the OR of uterine prolapse was 0.8 (95% confidential interval CI 0.7-0.9) and 0.8 (95% CI 0.6-0.9), respectively, for women with intermediate or high school/university degree. The risk of uterine prolapse increased with body mass index (BMI; kg/m(2)) value: In comparison with women with BMI<23.8, the OR was 1.4 (95% CI 1.2-1.7) and 1.6 (95% CI 1.3-1.9) for women with BMI 23.8-27.2 and >27.2. In comparison with nulliparae, the OR of uterine prolapse increased with number of births, being 3.0 (95% CI 2.1-4.3) in women reporting greater than or equal to3 births. A history of caesarean section or of a delivery of a fetus weighing >4500 g were not associated with increased risk of uterine prolapse. When the analysis was conducted separately in strata of grade of uterine prolapse (I and greater than or equal to II), no marked differences emerged in the OR estimates. Conclusions: This study indicates that, in this population, the risk of uterovaginal prolapse increase with the number of vaginal births and was higher in overweight women, offering some quantitative estimates of the role of these factors on the risk of the condition. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.

The objective of this study was to analyze determinants of age at menopause in a large sample of Italian women consecutively attending a network of 235 outpatients menopausal clinics in Italy. A total of 6961 women aged greater than or equal to 55 years and in spontaneous menopause are included in the present analysis. Main determinants of age at menopause were: current smoking and regular menstrual cycles and age at menarche.

Background A series of meta-analyses of randomised controlled trials raised the question of whether the three-drug combination of CAP (cyclophosphamide, doxorubicin, and cisplatin) was more or less effective than optimal-dose single-agent carboplatin for women with advanced ovarian cancer.Methods We carried out an international, multicentre, randomised trial to compare CAP with single-agent carboplatin in women with ovarian cancer requiring chemotherapy. 1526 patients were entered from 132 centres in nine countries. Analyses were by intention to treat.Findings 728 patients have died (368/766 allocated CAP vs 360/760 allocated carboplatin) and the survival curves show no evidence of a difference between CAP and carboplatin (hazard ratio 1.00 [95% CI 0.86-1.16]; p = 0.98). The results indicate a median survival of 33 months and a 2-year survival of 60% for both groups. We found no evidence that CAP or carboplatin were more or less effective in different subgroups defined by age, stage, residual disease, differentiation, histology, and coordinating centre. CAP was substantially more toxic than carboplatin, causing more alopecia, leucopenia, and nausea. More thrombocytopenia occurred with carboplatin.Interpretation Single-agent carboplatin, with the dose calculated by the area-under-the-curve method, is a safe, effective, and appropriate standard of treatment for women with advanced ovarian cancer.

The following description is a clinical case of placenta accreta and its conservative treatment. According to some authors, abnormal adhesion of the placenta depends on the alteration of the equilibrium between the trophoblastic tissue invasion and the reaction of the decidua. Consequently we have various degrees of penetration of the myometrium by chorionic villi into areas of deficit, sparse or absent decidua. Whatever the pathogenetic mechanism, the final clinical picture is slight to deep penetration of the trophoblastic tissue into the uterine wall. That causes absence of the normal plane of cleavage between placenta and maternal decidua, no spontaneous placental detachment during the third stage of labour and no possible manual removal. The patient, primigravida, was admitted at the 36th Week of gestation with PROM and physiologically delivered a neonate weighing 1820 g, after she spontaneously began labour. The newborn was admitted in the neonatal-pathology ward because it was premature although the Apgar score at 1-5 minutes after birth was 5-9. Placental ejection was awaited for 1 hour, then manual exploration of the uterine cavity was undertaken. The normal plane of cleavage between placental tissue and decidua was absent and therefore manual extraction of the placenta was impossible. Surgery was stopped and, after informed consensus was obtained from the patient, a conservative treatment was tried. After cutting the umbilical cord as short as possible and checking for vaginal bleeding, the patient was moved to obstetrics ward.(ABSTRACT TRUNCATED AT 250 WORDS)

This paper describes a case of acute pancreatitis occurring in a patient immediately after delivery and in primigravida. The patient had a family case history of dyslipidemia (Type IV). The pregnancy had been complicated by preeclampsia treated at home with nifedipine tablets (one tablet three times a day) with good results on pressure values; lipidic values were high despite dietary measures taken. The baby at birth weighed 3830 g after physiologic labour and a natural delivery. Acute pancreatitis was diagnosed after observation of epigastralgia with irradiation on the left shoulder, vomiting, symptoms of acute abdomen such as sweating, increased pulse rate, hypotension, abdominal pain on palpation, and absence of peristalsis. An analysis of the blood showed high levels of amylase and hyperglycemia, an increase in XDP, and leucocytosis. Instrumental tests such as pancreatic echography revealed an increase in pancreatic volume, uneven structure of the parenchyma and higher levels of liquid in the peritoneum. The patient was moved to intensive-care, a nasal gastric probe inserted, hydroelectrolytic treatment was begun, vital functions monitored, pain kept under control by medical therapy, and antibiotics administered. Subsequent tests showed an improvement in the parameters of pancreatic functions (amylase, lipase, calcium hematic) and their gradual return to normal values. The computerized tomography of abdomen additionally revealed the presence of pancreatic pseudo-cysts and effusion of peritoneal liquid near the right kidney. The patient was discharged after two weeks in the surgical ward. There are many caused of acute abdomen during and immediately after pregnancy, and one of these is acute pancreatitis, though rare (occurring between 1:3800 and 11.467 according to Rabkin).(ABSTRACT TRUNCATED AT 250 WORDS)

Thirty-four patients, with a history of persistent abnormal uterine bleeding and dilatation and curettage or suction curettage performed within the previous year, were evaluated by office hysteroscopy and biopsy. For 16 patients (47%) the hysteroscopic diagnosis was in agreement with the curettage. Hysteroscopy revealed more information in 18 patients (53%): 8 had polyps, 6 had submucous or pedunculated myoma, 2 had endometrial neoplasia, 1 had myoma and polyp, 2 had endometrial neoplasia and 1 had synechia. Moreover in 3 patients with diagnosis of suspected myoma by curettage, hysteroscopy revealed a normal cavity. The high incidence of missed diagnosis of pathologic conditions by "blind" curettage supports the opinion that diagnostic hysteroscopy is the method of choice in the evaluation of abnormal uterine bleeding.