Annali di ostetricia, ginecologia, medicina perinatale最新文献

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.

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 results of descriptive epidemiological study on hysterectomy for benign conditions are presented. Between October 1990 and September 1991, 1189 surgeries for fibroids, disorders of menstruation and ovarian cysts performed in 15 gynaecological clinics in Lombardy (Northern Italy) were registered using standard sheets. Fibroids was the most common indication for hysterectomy (74.3% of total). Most surgeries were performed in women aged 40-59. We observed a relatively high frequency of longitudinal incision in young and thin women with small fibroids, a relatively high execution of bilateral oophorectomy in premenopausal women (35% of surgeries for fibroids or menstrual disorders), a median hospital stay of 12 days, a great variability in thromboembolic and antibiotic prophylaxis.

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.

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.

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.

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.