Annali di ostetricia, ginecologia, medicina perinatale最新文献

This study was aimed to evaluate the effect of polydeoxyribonucleotide (PDRN), as reported in relevant literature, on cervical epithelia dynamics. Particularly, the interactions taking place between columnar epithelium and the squamous one have been examined. For the purposes of the study, the following computerized techniques, already widely known, have been used: The colposcope is joined to a videocamera connected with a computer (AT compatible). The computer is equipped with a graphic card capable to record and to digit the image, i.e. to make it recognizable by the computer itself. Thereafter, many operations can be performed on the colposcopic images: reductions, enlargements, retouches, record, recall, analysis, etc. Moreover, irregular epithelial areas can be easily determined to a good approximation and, using pre-established enlargement ratios, their evolution can be evaluated. By means of this technique 12 out-patients with uterine cervix ectopias, with or without normal transformation zone (NTZ), have been examined. The monthly therapy was 12 pessaries, each containing 5 mg polydeoxyribonucleotide (POLIDES 5--Farmigea), from the 7th to the 18th day of the cycle, repeated for 3 months. Since the first month of treatment a reduction of the ectopic columnar epithelium has been noted in most patients (9 on 12), with a squamous epithelium increase (peripheral reparative process). This process has kept on increasing during the following months in the 9 patients responding to the treatment, whose ectopic areas were covered by squamous epithelium (average 55% of the area; range 33%-78%). No response to the treatment has been shown in 3 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

The pharmaco therapeutic effect of polydeoxyribonucleotide vaginal suppositories in two dosages (PDRN 1,65 mg and PDRN 5 mg)* on vaginal dystrophy was studied. 40 women, aged more than forty, in surgical or physiological climacteric with cervico-vaginal dystrophy were examined. The study was carried out according to the double-blind method, randomized, between groups. Both treatments produced important ameliorations of subjective symptomatology and objective signs. No significant difference emerged between the two preparations. PDRN was proved to be a valid alternative to local hormonal therapies.

This paper evaluates the common practice of a topic medical treatment following cautery (or other kinds of microsurgery) of the uterine cervix. Firstly, a controlled clinical trial on 116 patients treated with kanamycin sulphate alternated to polydeoxyribonucleotide vaginal suppositories, and 124 controls has been conducted. Subjective parameters (leukorrhea, bloody discharge, odorous discharge, more than three weeks vaginal discharge, itching, pain, burning) and colposcopy (Schiller test reactivity, squamo-columnar junction location, abnormal transformation zones, vascular striae, deepithelialized areas or frail epithelium) appeared more favorable in the treated group, the colposcopic finding of phlogosis being the only unfavorable finding more frequent among the treated patients. Successively, a controlled double blind clinical trial with kanamycin sulphate alternated to placebo vs PDRN at different dosages has shown an increase in number of epithelial cells in the treated patients and a better stimulation of fibroblasts by higher dosages of active substance. These results show the efficacy of the studied post cautery treatment schedule, and of PDRN in particular.

Thirty patients in fertile age affected by ectropion were treated with Polydeoxyribonucleotide (PDRN) (*) vaginal suppositories for 24 days. No other local or general therapy was allowed. The following parameters were evaluated: local symptomatology, tolerability and compliance, vaginal cytology, colposcopic examination, bioptic sampling of affected area prior to and after treatment, and local immune response. The results show the efficacy of PDRN. In fact, after the treatment: reduction of subjective symptomatology with decrease of average score for each symptom; excellent or good tolerability and acceptability; reduced inflammation; increased iodine-dark areas; reestablishment of normal balance in T- and B-lymphocytic populations have been found.

Molar tissue expresses HLA antigens evidenced in the father. These antigens are present on the trophoblastic extravillous tissue, not on the syncytium and cytotrophoblast. These antigens show some characteristics of Qa murine antigens mapped in the HLA system linked to class I antigens. Antibodies anti HLA against the partner antigens and lymphocytotoxic antibodies have been evidenced in the serum of patients with vesicular mole. In vesicular mole the production of antibodies should be determined by the immunogenicity of cells that infiltrate the decidua, expressing paternal HLA antigens. It has been demonstrated that the recognition of "not self" antigens in the mother should stimulate a cellular immune response. We do not know why the tumor grows. Maybe the woman is not able to produce anti HLA antibodies although recognizes them as "not self", or the patients is not antigenically stimulated because there is immunocompatibility between the two partners. The literature shows that the development and progression of the disease are stimulated by histocompatibility, although this factors does not seem fundamental. If the two partners are histocompatible the tumor can be less immunogenic, so the mother shows a lower response and the growth of the tumor appears to be favoured.

The Authors review, on the basis of their experience, the literature data concerning chemo-antibiotic prophylaxis in gynaecological surgery. Prophylaxis is widely employed although some important aspects are still under evaluation: bacterial selection and resistance, benefit in case of abdominal hysterectomy or elective Cesarean section, risk of pseudomembranous colitis. The most effective drugs are Piperacillin/Mezlocillin given in a single dose preoperatively. The same drugs are useful in the treatment of postsurgical infections.

A case of severe haemolytic disease of the fetus due to six rare alloantibodies is described. In a pregnant women at 23 weeks gestation after the finding of a positive indirect Coombs test maternal antibodies have been precisely identified and titrated: anti-I: 1/23, anti-c: 1/64, anti-S: 1/16, anti-Fya: 1/128, anti-M: 1/64, anti-Jka: 1/32000. Fetal blood group, free and red blood cell adherent antibodies have been investigated on fetal blood samples obtained by means of cord centesis. A compatible donor has been found. Severe fetal anemia has been corrected by ultrasound guided intrauterine transfusions (one abdominal and two intravascular transfusions) with positive outcome of the pregnancy.

The evolution of research on cervical cancerogenesis in the forty years from 1951 to 1990 is reviewed by the Author, who took part in it under the guidance of prof. G.B. Candiani. The modifications of the views on the subject by both the gynecologist and the pathologist, that have led through new guidelines of Health politics and of clinical behaviour, to a substantial decrease of the mortality from this disease, are highlighted.

The frequency and determinants of cesarean section rates in Italy were analyzed using data collected routinely by the Italian Central Institute of Statistics on more than 2,400,000 deliveries in 1980-83. The rate of cesarean section in Italy rose from 11.2/100 deliveries in 1980 to 14.5 in 1983. This increase was comparable with other European countries, although the rate of abdominal deliveries was still about 30-40% lower than in the United States and Canada. In the southern (and less rich) areas, the rate of cesarean section was about 40% lower than in the North or Centre of Italy. The rate of cesarean birth rose constantly with maternal age; being in comparison with teen-agers, about three times higher in women aged 45 years or more. Compared with women with primary or intermediate degree, those with university education reported about 40% higher rate of cesarean section, but this differences was markedly reduced after taking into account maternal age and birth weight. In southern areas of the country the frequency of cesarean birth was about 40% higher in public hospital than in private ones (11.5 and 8.1/100 deliveries, respectively), while in northern and central areas the frequency of cesarean birth was higher in private hospital than public ones (18.5 vs 14.7/100 deliveries in the North, and 19.6 vs 14.6/100 deliveries in the Centre). There were relationships between cesarean rates and birth weight or gestational weeks. The lowest values were observed in very low birth weight (less than or equal to 999 gr) as in babies weighing 3000-3999 gr and in deliveries occurred between the 25th and 27th gestational weeks and in term deliveries. About 55% of deliveries with breech presentation were delivered by cesarean section.

The purpose of this study is to determine the advantages of surgical procedures performed on tubal sterility. The results of tubal reconstructive microsurgery are reported on the basis of the type of surgical procedure: lysis of adhesion (13 cases); terminal salpingoneostomy and combined procedures (23 cases); unilateral tubo-tubal anastomosis (1 case). Twenty out of 36 patients had adequate follow up: uterine pregnancy was achieved in 50% of patients who had a pure microsurgical lysis of adhesions and in 41.6% of patients who had a microsurgical salpingostomy. The ectopic pregnancy rate was 0%. The percentage of success in terms of uterine pregnancies obtained agrees with that of many other authors.