Annali di ostetricia, ginecologia, medicina perinatale最新文献

The relationship between usual laboratory indexes of bone metabolism and dual photon densitometry in perimenopausal women at anamnestic risk for osteoporosis are studied. One hundred and twenty five women, with one or more risk factors for osteoporosis, have been investigated by: plasma calcium, phosphorus, osteocalcin, ALP-bone-isoenzyme, PTH, and 24 hours urinary calcium and hydroxyproline, besides dual photon densitometry of lumbar spine. Laboratory indexes are indicated as "above normal values" and, within the range of normality, "at lower limits", "average values", and "at upper limits". More than 90% of patients show laboratory findings at the upper limits. Furthermore, 46% of them show both hydroxyproline greater than 20 mg/24 h and urinary calcium greater than 200 mg/24 h; 81.7% osteocalcin greater than 7.00 ng/ml and plasma calcium greater than 4.9 mEq/l; 87.9% osteocalcin greater than 7.00 ng/ml and urinary calcium greater than 200 mg/244; 86.4% densitometric values less than 0.700 g/cm2 and osteocalcin greater than 7.00 ng/ml. Our at risk population shows a wide agreement among the laboratory indexes, to indicate an increased bone metabolism.

Records from 6820 deliveries of three year (1980, 1985 and 1988) were reviewed in order to collect informations on cesarean section trend and its indications in a public hospital of Milan, Italy. Data show the magnitude of the phenomenon in the wards considered and an evident increase of cesarean section proportion from 1980 (18.6%) to 1988 (26.9%). The frequencies of major indications has not changed much apart from dystocia which has decreased and previous cesarean section which has increased. A logistic regression model was performed to evaluate cesarean section risk factors. Distribution of cesarean section during the days of the week show higher (about 30%) cesarean section proportion Monday through Thursday compared with low proportion (20% or less) on Fridays and weekend-days; this suggesting a possible high proportion of pre-programmed cesarean section.

This paper describes a case of mullerian adenosarcoma with sarcomatous overgrowth. This 75-year old woman presented with atypical vaginal bleeding and enlarged uterus. On ultrasonography the endometrium was described as "thick" (4 cm) with cysts and aggregates of sarcomatous cells were seen on VABRA curettage. TAH & BSO was performed. The polypoid intrauterine mass measured 10 cm in the largest size and protruded through the external orifice. It was yellow with scattered cysts at the base and hemorrhagic at the apex. Myometrial invasion was evident. Microscopically most of the tumor consisted of a fibrosarcoma like tissue. It contained rhabdomyoblastic elements and mitosis count was 15 or more for 10 HPF. A small part of the tumor shared the features of mullerian adenosarcoma with glands surrounded by condensed stroma. The pseudostratified glandular epithelium was ciliated and focally mucinous. Periglandular tissue was pleiomorphic and mitotically active. Immunohistochemically stromal cells showed a slight positive staining for vimentin and a strong positivity for smooth muscle specific alpha actin. With the exception of scattered cells, desmin and striated muscle specific actin were extensively negative.

In a case group of 341 perimenopausal women the following signs of reduced trophism of external genitalia have been studied: mons pubis hair rarefaction, pale mucosae, labia minora edge thinning, and labia minora involution, as well as their correlation with age, time lapse after the menopause, and plasma FSH, LH, progesterone and 17-beta-estradiol. Signs of reduced trophism appear to be present even in the younger considered ages, but a positive trend with age is shown. The passage from less than one year inveral from the menopause to one to three years interval shows the most marked increase in the appearance of involutional aspects, but at six years from the menopause one fourth of the women still show normal trophism of the external genitalia. An inverse relation with 17-beta-estradiol levels is shown for pale mucosae and labia minora edge thinning while the trend of mons pubis hair rarefaction shows no relation with the hormone level. An inverse relation is shown for progesterone levels and the trend of mons pubis hair rarefaction, while for the other signs of reduced trophism the same kind of relation as for 17-beta-estradiol was shown. FSH and LH levels show an inverse relation with "normal" trophism, a direct relation with pale mucosae and labia minora involution, and no relation with mons pubis hair rarefaction and labia minora edge thinning.

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.

The Authors have studied the haematic levels of CA 125, CA 19-9, CA 50, CEA, and TPA in 23 women with ovarian cancer and in 14 healthy women. The results showed as the simultaneous use of CA 125 and TPA can premise the diagnosis of ovarian cancer in high percentage.

During a first one year period a random treatment for climacteric symptoms with "Estriol vaginal cream" vs "Trazodone and Estriol vaginal cream" and, after it and only in patients not complaining of dyspareunia, with "Trazodone" vs "Veralipride" has been conducted. After the first year all women complaining of dyspareunia were treated with Estriol vaginal cream. Eighty women were enrolled in the five treatment groups. After three months of treatment, a good remission of symptoms was shown, with differences in relations to treatment schedules. Dyspareunia subsided for more than 70% in women treated with Estriol vaginal cream (either by itself or in association), and Estriol vaginal cream achieved the best response from the highest number of the considered symptoms, besides being the only active treatment in insomnia. A good answer on hot flushes and "irritability, anxiety, depression" was obtained by Trazodone, while Veralipride showed to be more active on all neurovegetative symptoms (hot flushes, sweatings, tinglings, palpitations, astenia).

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.

The process of tissue repair or regeneration is the attempt of the injured tissue to be restructured and to reestablish its function as it existed prior to injury. The cytologic alterations depend on the original tissue site, the elapsed time after the incurred injury as well as on the type of the injury itself. From a practical standpoint, the importance of the recognition of tissue repair alterations as such, is the avoidance of false positive cytologic diagnoses and/or the under evaluation of existing malignant lesions with potentially severe clinical consequences. The computerized on-line file of patients examined cytologically and histologically since the year 1959 which contains over two million patient records was searched for those cases identified as "tissue repair". The major criteria of cytomorphology of tissue repair and differential diagnoses are described. For the purpose of enhancing the differential diagnostic accuracy two procedures useful as diagnostic aids are presented: (1) local administration of estrogens, and (2) computerized cell image analyses evaluated and guided by an artificial intelligence expert system.

The most widely used ablative techniques in the therapy of benign cervical lesions are physical treatments with cauterization or laser vaporization; these are, however, usually used for the largest or symptomatic lesions. Many Authors suggest, after physical treatment, the use of topical chemotherapy in order to abolish any possible inflammatory reaction. The use of drugs such as polydeoxyribonucleotide (PDRN) 5 mg (POLIDES 5--Farmigea), provided with reepithelialization and anticomplement action, seems to promote a quicker recovery of the cauterized or vaporized zone, avoiding, at the same time, the secondary inflammatory reaction. The Authors have assessed the quality of reepithelialization by means of PDRN 5 mg ovules of the cervical zone which has been previously subjected to laser vaporization or cauterization for benign cervical lesions or CIN I. The trial was performed with two groups of patients: Group A: laser vaporization, 45 patients, 23 of whom treated with PDRN and 22 with placebo. Group B: cauterization, 46 patients, 24 treated with PDRN and 22 with placebo. The treatment with PDRN 5 mg ovules started on the day of physical treatment and continued for twelve days. The examination of the patients, performed before the treatment (TO) included the following tests: bacteriological test; PAP-smear, colposcopic examination with eventual direct biopsy. The first follow-up (T 1) was performed after 14 days and included a Pap-smear, colposcopic examination and microcolpohysteroscopy (MC) carried out in the zone where physical treatment had been performed, in order to obtain a map of the reepithelialization process process.(ABSTRACT TRUNCATED AT 250 WORDS)