Annali di ostetricia, ginecologia, medicina perinatale最新文献

One thousand and fourteen women who were delivered in the Obst. Gynec. Clinic "L. Mangiagalli" were investigated to evaluate the real incidence of varicose disease, its correlation with some factors and the development of complication. The observation period was comprised between the 1st and the 4th day of puerperium in which women were investigated by obstetricians through a detailed questionnaire and underwent an angiological visit. The mean age of the puerperae was 29.6 years (range 15-47 yrs); 587 women were primiparas (57.9%). The prevalence of varicose disease's different aspects resulted 57.9%, while the incidence related to pregnancy was 26.1%. The prevalence and the incidence resulted to be respectively 26.8% and 14.4% for varicosities, 5.6% and 3.1% for saphenous varicosis. Complications were observed in 10 patients (0.99%). 45.3% of patients reported family positivity for varicose disease; this group has shown a statistically significant difference (p less than 0.01) for the onset of different aspects of varicose syndrome.

We considered 49 patients suffering from urinary stress incontinence, operated from January 1984 to December 1989 by Marshall-Marchetti modified after Symmonds procedure. 13 patients had one or more previous surgical procedures. We made urodynamic preoperative tests and a stress test (after Ferrari) in all our cases. We obtained: complete recovery in 80% of our cases, improvement in 14% and failure in 6%; particularly the recovery percentage in our patients operated for the first time was the 97.2%; in the recurrences we had complete success in 46%, an improvement in 38.5% and surgical failure in 15.5%. Complications were observed in 1 patient affected by pubic osteitis, treated with medical therapy. Only 3 patients had an incomplete bladder emptying one year after the surgical operation, with value of the post micturitional residual volume of about 1/3 of the maximal cystometric capacity.

This work comparatively evaluates the results of therapy for CIN (in terms of recovery persistence and relapse) in 362 women submitted to electrocauterization, laser vaporization, laser conization, diathermy loop conization, cold knife conization, from January 1980 to December 1989. Parameters as age, CIN grade, time elapsed between diagnosis and therapy, contraceptive exposition, have been considered. The results show a slight difference in the persistence and relapse rates between conization globally considered (traditional, laser, loop) and local surgery (cauterization, laser) in favour of the latter. Nevertheless the difference was too little to suggest abandoning one treatment in favour of the others. Moreover this work indicates that the results of therapy are independent from the type of contraceptive used. Furthermore, the finding of relapses during follow up only in CIN grade 2 indicates that this grade of CIN must be considered at risk, requesting adequate consideration and follow up.

In 96 women, followed in ambulatory from 1983 to 1986, the use as a local contraceptive of a sponge treated with benzalkonium has been studied. This substance has not only shown itself a good contraceptive but may result even a useful precautionary measure against STD.

Two cases are reported of acardiac-acephalic twin pregnancy, a rare malformation of multiple gestations with large placental vascular anastomosis. In both cases, respectively 25 and 30 weeks of gestation, ultrasound scan revealed a first normal fetus and a nonviable twin without cardiac activity and head, but increasing in size at serial scans. The authors describe the obstetric management, the Rx details and the anatomo-pathological findings emphasizing the analogies between the two acardiac fetuses.

Drug prescription in pregnancy for the treatment of maternal diseases and the first attempts to obtain therapeutic effects even on the product of conception make necessary to know the pharmacokinetics of drugs in pregnancy. The Authors discuss how changes of physiological maternal parameters and the presence of the placenta and of the foetus can affect drug pharmacokinetics in a clinically important way. The possibility that the unique multicompartmental structure of the maternal-placental-foetal unit can "trap" drugs in the foetus is highlighted. Methodological, ethical and legal problems make the acquisition of data on these changes difficult, but their knowledge is needed in order to prevent adverse and toxic effects both in the pregnant woman and in the foetus and to attempt a therapy of foetus diseases in intrauterine life.

A 26 year old patient is urgently submitted to cesarean section for acute fetal pain. After 23 days, hysterectomy has been performed because of haemorrhagic shock. The pathology revealed a placenta increta. The lack of risk factors and the long, asymptomatic period between delivery and haemorrhage make this case noteworthy.

Efficacy of Naproxen sodium and Ibuprofen have been compared in the treatment of primary dysmenorrhoea on 67 women aged between 13 and 20 casually divided into two groups. No statistically significant difference has been noticed in the remission of symptomatology between the two groups at therapeutic dosage, although Naproxen sodium has a longer plasmatic half-life than Ibuprofen.

The authors considered psychological problems concerning the communication to patients about a diagnosis of Sexual Transmitted Disease and particularly of HPV disease. In the past this sort of affection was related to some well identified social groups, but with the recent changes in sexual behavior, cultural and moral principles, the reference models are changed too. Consequently today it is difficult to recognize a rigid identification. However it is still possible that during the communication of the diagnosis the physician unconsciously transfers to the patient "his" classification with a given model among the groups of STD affected. This is particularly true for the gynecologist that is reporting on HPV infection or disease. Therefore the physician has to pay a great attention to the way he communicates, because in addition to the clinical concept there are psychological effects on the patient and on her relationships that could result iatrogenic.

On the premises that there is a difference between infection and symptomatic HPV disease the Author looks for the possible reasons why it becomes manifest at a particular time of life. The comparison between an indigenous population sample and a group of women affected by florid HPV revealed no difference in sexual habits, behaviour or life style. This suggests the hypothesis that the genital apparatus uses a symbolic language expressing unease with, or rejection of a conflicting emotional situation not capable of being resolved directly. Condylomatosis may be instrumental as the actual pretest for the interruption or modification of sexual or other relationships which have become intolerable.