Annali di ostetricia, ginecologia, medicina perinatale最新文献

One-hundred ten cervical or vaginal bioptic samples have been submitted to in-situ HPV typing with biotinylated probes. All samples had been taken from women with colposcopic findings suggesting HPV infection, and at histopathology showed koilocytosis sometimes associated with CIN or VAIN. Sixty-four samples were positive (16 for HPV 6/11 - 37 for HPV 16/18, 11 for HPV 31/35/51). Histopathological and cytological specimens were reviewed to detect the possible existence of morphological patterns typical of the various viral types. Papillomatosis, slightly increased nuclear size with finely granular chromatin, low number of mitoses, and scarce cyto-polymorphism, were associated with HPV 6/11, as well as the absence of intraepithelial neoplasia. A higher number of mitoses (and/or atypical ones), cyto-polymorphism, association with intraepithelial neoplasia, nuclear vacuolization, nuclei of increased size, with irregular borders, hyperchromic, with dark and lumpy chromatin were indicative of high or medium risk HPV (16/18 or 31/35/51). In cytological smears also the finding of dyskeratocytes was associated with these viral types, while multiple nuclei were present in the case of HPV 31/35/51 detection.

The Authors report on the behaviour of the urinary concentrations of a micro-protein (beta-2-microglobulin) in normal, at risk and preeclamptic pregnancies. The results of this study give one more information on the renal function during pregnancy. The urinary evaluation of beta-2-microglobulin can be used as a diagnostic method in the study of renal damage the gestosis syndrome.

This paper presents crude rates (per 1000 women aged 15-49 years) and ratios (per 1000 livebirths) of induced abortion in Italy, North-Central and South Italy and within subgroups of women according to general and social characteristics. Incidence of induced abortion has diminished of 30% between 1982 and 1989, although this decrement is less marked in the South. Women between 30 and 34 years reported more induced abortions than those of other ages, but they present--together with women aged from 20 to 29--a more important decrease of their rates (from 25 induced abortions/1000 women in 1982 to 19/1000 in 1987). On the other hand, there is no decrease in rates and there is some increase in ratios in women aged 40-49 years. Married women have a greater incidence, but also a greater reduction of rates and ratios than not married women. A high level of education is related to high rates and ratios in early 80's, but these values have shown an important decrease in the period 1982-1987. Frequency of induced abortion is higher in women with two children than in other groups of women. In the frame of general decrement of induced abortion incidence, women with higher values in early 80's have shown greater reductions in the last ten years.

During the last decade the development of a great amount of knowledge about the menopause has allowed to establish almost standardized hormonal treatments in order to prevent its symptoms and its late sequelae. Nevertheless, up to now the relationship between typical climacteric symptoms and the actual risk of late sequelae has not been assessed. The climacteric symptoms have hence been related to the involutional aspects of the external genitalia and to the levels of the sex steroids and gonadotropin hormones. An inverse relation between neuropsychical manifestations (insomnia, anxiety, depression, reduced memory, reduced libido) and 17-beta-oestradiol and progesterone levels has been shown. On the contrary, FSH and LH levels showed a direct relationship with neurovegetative symptoms. The relationship between the involutional aspects of the external genitalia and the atrophy related and the neuropsychical symptoms shows the need to evaluate these classes of symptoms, which appear to be most related to oestrogen and progesterone deprivation, in decision making toward hormonal replacement therapy.

Obstetric hysterectomy is often performed as an emergency life-saving procedure. This retrospective report reviews the 11 years experience (1-1 1980 through 31-12-1990) at Mangiagalli Hospital, Milan. During this time 50 obstetric hysterectomies (incidence rate = 0.12%) were performed; cesarean hysterectomies were 30 (60%), hysterectomies after cesarean section 14 (28%) and after vaginal delivery 6 (12%). Its rate during or after cesarean section was 0.44% and after vaginal delivery was 0.02%. Thirty-six per cent of patients were nulliparous. Main indications were placental disorders, uterine atony with uncontrollable bleeding, disseminated intravascular coagulation (DIC). In 7 cases was performed an elective operation, in 4 cases for neoplasia and in 3 cases for myomata uteri. Maternal mortality rate was 2.04%, five patients (10%) developed hematomas and required further interventions.

The Authors analyzed the premature deliveries performed between 1982 and 1988 at the IV Clinica Ostetrica e Ginecologica of the University of Milan at the S. Gerardo Hospital, Monza, 1267 newborns out of 12507 were preterm. The rate was between 8.7 and 11.0% (average 9.8%). The early neonatal mortality is 10.6% (excluding malformed newborns, 8.3%), the late neonatal mortality is 12.7% (excluding malformed newborns, 9.8%). The early mortality is significantly lower starting from the 32nd week of pregnancy (35.4% vs 3.2%) and with a newborn's weight greater than 1500 grams (36.9 vs 3.2%). The early mortality is lower for females (8.4%) than for males (11.1%). In spite of other Authors, the early mortality is significantly higher than for AGA newborns (19.4 vs 7.9%). The causes of the early mortality are analyzed in detail.

The purpose of this study was to clarify the role of the intestinal anaerobic bacteria colonizing the intestine of the newborn delivered by cesarean section. Control of the intestinal microecology is dependent on many factors including intestinal peristalsis, the intraluminal environment, and microbial interactions, that deter the overgrowth of pathogens populations. Numerous factors help achieve this normal balance. The effect of feeding seems to induce bacteriological changes.

A critical review of the surgical treatments performed during the years 1967 to 1989 in cases of squamous cell vulvar cancer at the 1st Department of Obstetrics and Gynecology of the University of Milan has been carried out. Two hundred and seventy cases of primary squamous cell vulvar carcinoma have been studied after a restaging according to recent FIGO recommendations. Depending on the type of surgical approach the early and late complications and the 5 year-cancer-related survival have been analyzed. The present investigation supports the importance of a complete and accurate surgical staging of vulvar carcinoma, particularly as far as it concerns the lymph nodes status. Thus, performing a node dissection in case of an invasive neoplasia is extremely important, not only for a precise staging but mainly for a prognosis formulation. In fact, 5 year cancer related survival dramatically falls from almost 90% to 25% in case of pelvic node metastasis.

465 intravenous drug abuser (IVDA) women were studied to evaluate the prevalence of sexually transmitted diseases, 2207 university students have been considered as control group. A complete gynecological evaluation with Pap smear and cervico-vaginal cultures were performed. Informations on sexual and behavioural patterns were collected using a standard questionnaire. IVDAs show early onset of sexual activity (15 vs. 18 yrs) and many sexual partners; just a small percentage of them use condom, efficacious in the protection against venereal diseases. These peculiar behavioural patterns and the immunodeficiency ascribable to the drug abuse may condition the high frequency of viral and bacterial infections of lower genital tract (53% vs 0.8% and 67% vs 10% respectively). Cervical intraepithelial neoplasia has been found significantly more frequently in IVDA women (16%) than in control group (1%) p less than .01.

Myometrial biopsies were taken on 45 women less than 40 years old either by laparoscopy or laparotomy, searching for adenomyosis "in vivo". A positive response of 5 cases (11.11%) may prove adenomyosis to affect significantly young women too and not to be closely connected with the usually reported pathogenetic factors.