Serum oestradiol and progesterone concentrations during prolonged coasting in 15 women at risk of ovarian hyperstimulation syndrome following ovarian stimulation for assisted reproduction treatment.

Serum oestradiol and progesterone concentrations were examined for up to 7 days after withholding gonadotrophins whilst continuing pituitary down-regulation in 15 women at serious risk of severe ovarian hyperstimulation syndrome (OHSS) (serum oestradiol >6000 pg/ml and >15 follicles per ovary). Serum oestradiol concentrations rose on day 1 of coasting in all but two of the 15 women before falling, the decrement being in the order of 40% on each day. This observation permits a rational basis for the estimation of frequency of serum oestradiol measurements and duration of coasting. The trends and rates of fall of serum oestradiol do not seem to predict the occurrence of moderate and severe OHSS, being similar in the six women who developed OHSS compared with nine women without OHSS. The trends in progesterone concentrations were unrelated to any aspects of the clinical outcome.

Allo-immunization elicits CD8+ T cell-derived chemokines, HIV suppressor factors and resistance to HIV infection in women.

We assessed the potential for an allogeneic-based vaccine against HIV infection in women who were allo-immunized with their partners' mononuclear leucocytes to prevent spontaneous recurrent abortion. Within 1 month of allo-immunization, there was significant upregulation in the concentrations of CD8 cell-derived suppressor factor activity, RANTES, and macrophage inflammatory proteins 1alpha and 1beta. Allo-immunization also downregulated the proportion of cells with CCR5 and CXCR4 receptors. We also found a dose-dependent decrease in HIV infectivity of CD4+ cells in vitro after allo-immunization with both primary and T-cell line adapted HIV-1. This study provides a rational basis for an alternative or complementary strategy of allo-immunization against HIV infection.

Hemocoagulative pathology and immunological recurrent abortion.

To assess the relation between immunological disorders and recurrent abortion, 15 pregnant women with previous unexplained recurrent abortivity were submitted to serum screening for antiphospholyeid antibodies syndrome (APA) syndrome. The screening included specific tests for autoimmune diseases (ANA, specific organ antibodies, immune complexes research, etc.), the immunoenzymatic assay (ELISA) for the research of anticardiolipin antibodies (ACA) and the determination of the kaolin coagulation time (KCT) through Exener method for lupus anticoagulant (LAC). Nine gravids out of 15 were positive both to LAC and ACA antibodies, two gravids were positive to only ACA antibodies, while four had no antibody reaction. Therefore, whatever the effective mechanism is, it seems ascertained that several cases of unexplained recurrent abortion are related to APA syndrome. Nowadays the above-mentioned syndrome is successfully treated using corticosteroid immunosuppressors and platelet antiaggregators which reduce autoimmune reaction and thrombotic episodes.

[A case of myomectomy for infertility and a following twin pregnancy associated with hyperthyroidism]. / Considerazioni su un caso di miomectomia per infertilità e successiva gravidanza gemellare associata ad ipertiroidismo.

The authors describe an infertility case caused by a posterior wall subendometrial fibromyoma of the uterus and treated by traditional transcavitary myomectomy dwelling upon details of the operative technique. The following pregnancy is complicated by twin gestation, hyperthyroidism and preterm delivery. Fetuses were born by caesarean section one in good condition, the other affected by myelomeningocele with good prognosis. Clinical pictures emerged during pregnancy are discussed, in particular the therapy of hyperthyroidism, beta 2-adrenoceptor stimulants drugs, diagnosis and multifactorial genesis of fetal malformation.

[Role of cervical infections in the genesis of premature rupture of membranes]. / Ruolo delle infezioni cervicali nella genesi della rottura prematura delle membrane.

In order to assess the importance of cervical infections due to CT, Neisseria Gonorrheae and group B Streptococci in the genesis of PMR, the authors examined 80 pregnant women suffering from this pathology who had been admitted to hospital between the 27th and 36th week of gestation. The only statistically significant causal link (p < 0.01) was cervical CT infection found in 40% of patients with PMR. In these cases we also observed a marked rise in neonatal mortality (10%) and neonatal morbidity (51%). For these reasons careful screening should be carried out during the course of pregnancy in order to identify the infection and treat it appropriately so as to reduce correlated perinatal morbidity and mortality rates.