The impact of urinary stress incontinence in young and middle-age women practising recreational sports activity: an epidemiological study.

OBJECTIVES: To evaluate the prevalence of urinary stress incontinence (USI) in menstruating women practising recreational sports activity, to detect specific sports with a stronger association with urinary incontinence (UI) and to evaluate risk factors possibly related to this condition. DESIGN: Epidemiological study. SETTING: Non-competitive sports organisations in the province of Varese, Italy. PARTICIPANTS: 679 women of fertile age, practising recreational sports activity. INTERVENTION: Anonymous questionnaire on UI. MAIN OUTCOME MEASUREMENTS: The questionnaire included questions about patients' general characteristics, occurrence of UI in relation to sport or daily general activities, time of onset of this condition, frequency of leakage episodes, correlation of incontinence with types of movements or sports, subjective impression of being limited on such occasions and/or necessity to modify the type of sport. RESULTS: UI was reported by 101 women (14.9%). Of these, 32 (31.7%) complained of UI only during sports activity, 48 (47.5%) only during daily life and 21 (20.8%) in both circumstances. Body mass index and parity were significantly associated with the risk of UI. Looking at the different sports activities, a higher rate of incontinence was found in women participating in basketball (16.6%), athletics (15%), and tennis or squash (11%). 10.4% of women abandoned their favourite sport, because of USI, and a further 20% limited the way they practised their favourite sport to reduce leakage episodes. CONCLUSIONS: Female UI affects a significant proportion of young women practising non-competitive sports activity; it can cause abandonment of the sport or limitation of its practice.

Cervical ripening with the Foley catheter.

OBJECTIVE: To evaluate maternal and neonatal outcomes in a large series of patients undergoing cervical ripening with a Foley catheter. METHODS: The database of the Labor and Delivery Unit of the University of a teaching hospital in Italy was used to identify consecutive patients with a Bishop score (BS) of 4 or less who underwent pre-induction cervical ripening with a Foley catheter. The main outcome measures were clinical chorioamnionitis, endometritis, and suspected and culture-proven neonatal sepsis. RESULTS: Of 602 women undergoing cervical ripening with a Foley catheter, 160 (26.6%) went into active labor without additional interventions. Oxytocin was administered immediately after removal of the Foley catheter in 188 (31.2%) of the women, and 254 (42.2%) required an application of prostaglandin E2 vaginal gel. The cesarean delivery rate was 25.6%. The median time to delivery was 1469 min (range, 94-3350 min). Of the women who gave birth vaginally, 225 (50.2%) were delivered within 24 h. Clinical chorioamnionitis and postpartum endometritis occurred in 3 (0.5%) and 6 (1.0%) of the women, respectively. Neonatal sepsis was suspected in 4 (0.7%) of the newborns but blood culture results were negative in all cases. CONCLUSION: Transcervical use of the Foley catheter is safe for pre-induction cervical ripening, and the associated risk of maternal or perinatal infections is negligible.

Female psychopathologic profile during menopausal transition: a preliminary study.

OBJECTIVES: To evaluate the psychopathological profile and the incidence of major depressive disorders in consecutive women attending a Menopause Clinic. METHODS: Women attending outpatient menopause clinic at Filippo del Ponte Hospital in Varese (Italy), referring to the centre from 1 March to 30 April 2005, were invited to fill up a specific questionnaire while waiting for the visit. The questionnaire included demographics and history (e.g. current or past use of antidepressant drugs); symptoms check list (SCL-90-R); Beck depression inventory (BDI). RESULTS: Sixty-four women were enrolled to the study. On the SCL-90-R, "somatic" symptoms cluster was the most frequent. Patients diagnosed as depressed using the Beck depression inventory (BDI) were 18 (28.1%). Thirteen (70%) of currently depressed women presented a positive history of depressive disorders. The analysis of depressed women according to previous depressive disorders revealed higher scores for women with positive history in both scales. Depressed patients have a significantly lower mean age compared to non-depressed patients (53.3+/-6.2 years versus 57.33+/-4.9 years, p=0.023). CONCLUSIONS: Our preliminary data show a high correlation between a history of depressive disorder and recurrence of depression in the menopausal period. Perimenopause seems to be a higher risk period for the development of a depressive disease compared to menopausal status. The somatization cluster warrants further investigation.

Case-control study on risk factors for premature ovarian failure.

Objective of this case-control study was to investigate the potential risk factors for premature ovarian failure (POF). Seventy-three patients with secondary hypergonadotropic amenorrhea and, as control group, 144 women with acute, non-gynecological, non-neoplastic, non-hormone-related diseases were included in the study. Information was obtained on sociodemographic characteristics, gynecological and obstetric data, general lifestile habits, smoking habits and history of selected gynecological and other clinical conditions. A statistically significant association between high education level and POF was found (p = 0.03). Parity was related to a reduced risk of POF and this reduction increased with the number of live births (p = 0.02). No association emerged between POF risk and age at menarche, cycle length and oral contraceptive use. Women with POF could not be distinguished from control women by behavioral and reproductive history, except for lower fertility. The minor influence that reproductive and lifestyle factors have on the occurrence of POF suggests that genetic inheritance plays a more important role.

The idiopathic forms of premature menopause and early menopause show the same genetic pattern.

Genetic factors may influence the timing of menopause. Premature ovarian failure (POF) has recently been identified as a genetic entity, but no genetic data are available on early menopause (EM). We investigated 36 patients with EM (age of menopause between 40 and 45 years of age) using cytogenetic and pedigree analysis. In 30 patients of this study the EM was idiopathic and 15 subjects (50%) had a familial condition of EM or POF. Pedigree analysis revealed a dominant pattern of inheritance of EM through maternal or paternal relatives. Our data reveal that POF and EM patients show the same genetic features and we postulate that these conditions may be a variable expression of the same genetic disease.

The effect of menopause on blood lipid and lipoprotein levels. The Icarus Study Group.

There is increasing evidence from epidemiological studies that exogenous estrogen (hormone replacement therapy) protects against the elevated risk of cardiovascular disease in women after the menopause. However, it is still uncertain whether the postmenopausal decrease in endogenous estrogen in itself contributes significantly to this increase in risk. Most of the studies that have provided evidence linking cardiovascular disease with menopause have involved North American women, who may differ significantly from Europeans in terms of lifestyle and diet. ICARUS (Italian Climacteric Research Group Study) is an observational study that involves Italian Menopause Clinics, with the objective of collecting observational data on menopause and its management. The results of a cross-sectional analysis of 9309 women, free from any hormonal treatment and enrolled up to March 1997, are reported here. Data show that the menopause has a marked effect on the circulating levels of lipids and lipoproteins. From pre- to post-menopause there are significant increases in total cholesterol (6.9% before and 4.4% after adjustment for covariates including chronological age, educational level, center, BMI, smoking habits, hypertension and diabetes, previous contraceptive use, and time since menopause), LDL (7.5% before, 4.0% after), and triglycerides (9.0% before, 3.2% (ns) after). However, there is no significant change in HDL. Among postmenopausal women, no effect on lipid profile of time since menopause was observed.

Inheritance in idiopathic premature ovarian failure: analysis of 71 cases.

Premature ovarian failure is defined as cessation of ovarian function under the age of 40 years and affects approximately 1% of women in the general population. The aetiology of this disorder is still unknown in most cases. Although there have been some reports of familial premature ovarian failure, very little is known about the incidence and inheritance pattern of its idiopathic form. The aims of this study were to investigate the incidence and inheritance pattern of familial premature ovarian failure in a homogeneous group of patients with premature idiopathic menopause and to identify possible clinical differences between patients with the familial and the sporadic form of premature ovarian failure. A total of 71 women were recruited into the study. Clinical assessments and genetic counselling showed that 22 (31%) patients had familial premature ovarian failure, this high incidence strongly suggesting that the disorder is a recognizable heritable entity. There was a statistically significant (P < 0.05) difference in the median age of precocious menopause in patients with sporadic and familial premature ovarian failure (31.0 and 37.5 years of age in the two groups, respectively). Pedigree analysis strongly suggests the existence of a familial pattern of premature ovarian failure with a dominant maternal and/or paternal transmission and incomplete penetrance. In the presence of familial history of premature ovarian failure, reproductive counselling is recommended.

A randomized clinical trial of two surgical techniques for cesarean section.

The Joel-Cohen incision followed by nonclosure of pelvic and parietal peritoneum has been advocated as an alternative method to the Pfannenstiel incision with peritonealization at cesarean section. A randomized trial was designed to compare intra- and postoperative morbidity between the two techniques. Women to undergo a cesarean section were randomly allocated to have either the Joel-Cohen incision with the parietal and pelvic peritoneum left open (group 1) or to have the Pfannenstiel incision with both peritoneal layers sutured (group 2). The myometrium was closed with 1-0 polyglactin 910 suture using a continuous single-layer nonlocking technique. Patients in group 2 had the peritoneum approximated with 2-0 polyglactin 910 suture. The fascia was sutured with continuous 1-0 polyglactin 910 suture in all cases. Opening time was defined as the interval from skin incision to the opening of the uterine cavity. Febrile morbidity was defined as a temperature > or =38 degrees C on two occasions 4 hours (hr) apart excluding the first postoperative day. Endometritis was defined as postpartum temperature > or =38 degrees C on two occasions 4 hr apart, with uterine tenderness and/or foul-smelling lochia. One hundred forty-nine and 150 patients were allocated to group 1 and to group 2, respectively. A shorter median (range) opening time [4 min (2-21) vs. 6 min (2-19), respectively, p < 0.01] and a shorter median (range) operative time [30 min (10-65) vs. 40 min (20-110), respectively, p < 0.01] were observed in group 1. No difference was found in terms of intraoperative complications, proportion of patients who required transfusion, endometritis, sepsis, febrile morbidity, and urinary tract infections. A higher rate of wound infections was found in group 2 than in group 1 [14 of 150 (9.3%) vs. 2 of 149 (1.3%), respectively, p < 0.01]. The Joel-Cohen incision without peritonealization resulted in a shorter opening and total operative time than the Pfannenstiel laparotomy with peritonealization. This was accomplished with a reduction of wound infections.

Octreotide in the management of bowel obstruction in terminal ovarian cancer.

Intestinal obstruction is a common and distressing clinical complication in ovarian cancer. The aim of our study was to assess vomit control in terminal ovarian cancer patients with inoperable gastrointestinal obstruction, using a symptomatic pharmacological treatment with octreotide which obviates the need for nasogastric tube placement. We studied 13 patients, all of whom had advanced ovarian cancer FIGO stage IIIc. Seven patients were treated in the Gynecology Department of S. Raffaele Hospital, at the University of Milan, and 6 were managed in the University of Varese Hospital. Octreotide was administered at doses starting with 0.3 up to 0.6 mg (mean 0.44 mg) a day by subcutaneous bolus or continuous infusion. Octreotide controlled vomiting in all cases to grade 0 on the WHO emesis scale. Complete relief of symptoms was achieved within 3.07 days (range 1-6 days). Vomiting stopped within 2-3 days of starting treatment in most patients. In 8 patients with a nasogastric tube, drainage decreased from 2000 to under 100 ml/day after the start of octreotide treatment. No side effects were reported. All patients died with minimal distress or pain.

Beta-interferon treatment of cervical intraepithelial neoplasia: a multicenter clinical trial.

Forty-nine women with cervical intraepithelial neoplasia (CIN) grade II were treated with systemic and/or local beta-interferon (beta-IFN) applications. The aim of the study was to compare the efficacy of different routes for the administration of beta-IFN, evaluate local and systemic beta-IFN tolerance, and determine whether disappearance of neoplastic lesions was related to the resolution of the concomitant human papillomavirus infection. The patients were randomized to receive intramuscular, intralesional or a combination of intramuscular and intralesional administration, or conventional treatment. Significant differences in the rate of lesion regression were observed between treated and untreated women. The highest frequency of complete response was observed with the therapy combining intramuscular and intralesional treatment.

Multicenter trial of prophylaxis with clindamycin plus aztreonam or cefotaxime in gynecologic surgery.

A prospective, randomized, multicenter study was conducted on the efficacy and safety of two prophylactic antibiotic regimens in both abdominal and vaginal hysterectomy. Patients received three intravenous doses of clindamycin (900 mg) plus either aztreonam (1 g) or cefotaxime (1 g); the doses were given at the induction of anesthesia and 8 and 16 hours later. A total of 170 patients undergoing abdominal hysterectomy and 142 patients undergoing vaginal hysterectomy completed the trial and were evaluated. Following abdominal hysterectomy infections occurred at the operative site in 1.2% of patients given a regimen including aztreonam and in 4.7% of those given a regimen including cefotaxime; the difference between the two groups was not significant. Neither were significant differences observed in the incidence of fever, the incidence of bacteriuria, the need for postoperative antibiotics, or the duration of postoperative hospitalization, although results were slightly better for patients receiving clindamycin plus aztreonam. Following vaginal hysterectomy, slightly but not significantly better results for the same parameters were obtained in the group given clindamycin plus cefotaxime. Diarrhea was the only adverse reaction attributable to antibiotic treatment and occurred more frequently in patients given cefotaxime. It was concluded that the two regimens were similarly effective and safe in preventing infections following hysterectomy.

Excess of HLA parental sharing in families with Turner patients.

In utero selection processes are probably related to mother-father compatibility as has been reported in abortion-prone couples and in Down syndrome studies. In order to analyse this phenomenon, we investigated families with chromosomal imbalance (Turner syndrome). We chose this model because previous data indicated a high frequency of HLA-A31 and B38 in Turner patients and in their mothers. We report high HLA antigen sharing in Turner families and great histocompatibility between mother and affected daughter, not related to abortion histories. The proportion of HLA-A homozygous cases among Turner children was higher than expected. The level of lymphocytotoxic antibodies against fetus in mothers of Turner patients was comparable to that of mothers of families with normal fertility and probably favoured these pregnancies.

Serous carcinoma of the ovary: value of computed tomography in detection of calcified pleural and pulmonary metastatic implants.

Reported are three cases of serous papillary cystoadenocarcinoma of the ovary with pleural and pulmonary calcified metastatic implants detected by computed tomography (CT), but not by chest X-ray. CT patterns of metastatic calcifications were considered because of the unexpected frequency of this finding (15.7%) and in view of a possible clinical use of CT in monitoring extraabdominal disease.

Clinical value of computerized tomography (CT) in assessment of recurrent uterine cancers.

Fifty-one patients with a clinically suspected relapse of uterine cancer were evaluated with computerized tomography (CT) in the Departments of Obstetrics/Gynecology and Radiology of the University of Pavia. The accuracy of these scans was always compared with biopsy results (31 cases) or clinical outcome (20 cases). To evaluate the role CT played in the treatment of each patient we divided the results of these examinations into "Confirmative" (when there was clinical evidence of a tumor) and "Diagnostic" (when physical examination and conventional radiologic techniques were inconclusive). Overall diagnostic accuracy was 92%, specificity 80%, and sensitivity 92%. The authors found that CT provides information that is useful for planning treatment and for avoiding unnecessary surgical exploration when a tumor is clinically evident; furthermore, CT was found to be better than conventional diagnostic means in doubtful cases, especially those in which post-therapeutic pelvic fibrosis was not extensive (correct diagnosis is 15 of 19 cases).

CT evaluation of myometrium invasion in endometrial carcinoma.

Myometrium invasion (M) is one of the principal prognostic factors in the early clinical stages of endometrial carcinoma and can be evaluated presurgically only by CT, although with conflicting results. We compared CT of 65 patients with early clinical stage endometrial carcinomas with the corresponding anatomopathological findings. Myometrial infiltration of the same degree may present different CT images. Therefore, we identified five fundamental CT patterns, each of which corresponded to one of the three degrees of myometrium infiltration (M1, M2, M3). Furthermore, we defined the infiltration index as the ratio of minimum free myometrium to maximum free myometrium. Overall diagnostic accuracy was 76%; however, for clinical purposes CT provided adequate guidelines for therapeutic decisions in 93% of the cases. These criteria proved to be less reliable in elderly women with atrophic myometria, especially when the neoplasia was polypoid in shape.

Immunogenetic aspects of preeclampsia.

The etiology of preeclampsia (PE) is so far unknown; nevertheless both clinical and experimental findings suggest the possibility that immunogenetic factors operate in this disorder. In order to verify the role of immunogenetic factors in PE, a selected group of women (n = 26) affected with PE was chosen and HLA (human leucocytes A) frequency distribution, HLA antigens sharing between couples, homozygosity, incidence of HLA phenotypes and maternal antibody production were investigated. Neither significant differences in HLA frequencies nor homozygosity condition in preeclamptic and/or in the partners have been noted. HLA typing of the couples under study however demonstrates a very high antigen sharing between partners if compared with the sharing found in couples with normal reproductive performance. In 46% of PE women it was possible to demonstrate the presence of cytotoxic antibodies against surface structures of partner lymphocytes. The role of the MHC (major histocompatibility complex) in fetal survival and outcome is discussed.

Variations of growth factors in pregnant women during labor and in newborns at delivery.

To study physiological variations in serum growth factors during peripartal period, we have measured levels of a serum growth-promoting activity (thymidine activity, TA) and radioimmunoassayable somatomedin C (Sm-C) during labor in 39 women who delivered spontaneously (group A), by caesarean section (group B) and by legal abortion (LA) (group C). TA values were higher in the group A than in the group B and C, suggesting an important effect of uterine contractions in TA generation. A major role in Sm-C production seems to be played by the length of gestation since Sm-C concentrations were significantly higher in mothers delivered by caesarean section than in LA women. During labor influence of estrogens and progesterone in growth factor production seems unlikely because of the lack of correlation with TA and Sm-C levels. The lower TA values in placental flow than in the capillary blood of newborn suggest that serum growth factors, measured as TA, are produced by the newborn and do not cross through the placenta. These data suggest that the absolute dependence of the fetus on the mother does not preclude instances of fetal autonomy.

HLA compatibility and human reproduction.

Studies carried out on inbred strains of mice have shown that conceptuses which differ at the MHC antigens from their mothers appear to enjoy a selective advantage when compared with conceptuses which are more compatible. In humans a highly significant degree of MHC compatibility can be found in couples with a history of repetitive spontaneous abortions with unknown aetiology. We HLA - typed 28 selected couples with a history of three or more consecutive spontaneous abortions of unknown aetiology and 28 normal couples as control. We found that 22/23 (79%) aborter couples shared common HLA antigens, while normally fertile couples only 7/28 (25%) (p less than 0.001). The finding of a significant HLA compatibility in couples having abortions might be consistent with the hypothesis that blocking antibodies, formed in early pregnancy as response to HLA antigens, are perhaps necessary for a successful gestation. The factor causing abortion in couples sharing HLA antigens might also refer to the homozygosity for fetal genes in linkage with HLA alleles. The sharing of HLA alleles could be a marker for other genes of the same region which are lethal for the embryo in the homozygous state.