[The role of oral probiotic for bacterial vaginosis in pregnant women. A pilot study]. / Studio pilota sul ruolo dei probiotici nel trattamento della vaginosi batterica in gravidanza.

AIM: The aim of this study was to compare the effects of a dietary supplementation with oral probiotic, and the treatment with vaginal clindamycin in pregnant women with bacterial vaginosis. METHODS: Fourty pregnant women, with a diagnosis of bacterial vaginosis according to the Amsel criteria, were enrolled between the 10th and the 34th week of gestation. The patients were randomized in two groups. Patients in the group A were treated with probiotic orally (VSL3® Ferring), 2 tablets a day for 5 days, followed by 1 tablet daily for 10 days. Patients in group B were treated with vaginal clindamycin 100 mg daily for 15 days. After 5-10 days from the end of the treatment the patients returned for the follow-up. RESULTS: After treatment the vaginal discharge was completely absent in group A, and reduced in group B. The itching occurred only in 10% of patients in each of the two groups. The improvement of constipation occurs only in the group A (P=0.002). Vaginal swabs resulted negative in both groups in particular for Gardnerella V. CONCLUSION: The oral treatment with VSL#3® is effective in the treatment of VB in pregnant women as a topical treatment with clindamycin. In particular for the resolution of leukorrhea, itching and in particular in the bacterial vaginosis caused by Gardnerella V.

The surgical anatomy of rectocele and anterior rectal wall intussusception.

The aim of the study was to analyse the dynamic anatomical supports of the posterior vaginal wall from the perspective of rectocele and rectal intussusception repair. Two groups of patients were studied. Group 1 (n = 24) with genuine stress incontinence but no major vault prolapse had vagino/proctomyograms and transperineal ultrasound examinations. Group 2 with vaginal vault prolapse, clinical rectoceles and obstructive defecation symptoms (n = 19 had single-contrast defecating proctography before and after posterior-sling surgery. The posterior vaginal wall is suspended between perineal body, which underlies half its length, and uterosacral ligaments, which also support the anterior wall of rectum. Muscle forces stretch the vagina and rectum against the perineal body and uterosacral ligaments, creating shape and strength, like a suspension bridge. Postoperative proctogram studies indicated that anterior rectal wall intussusception has the same etiology as rectocele, deficient recto-vaginal ligamentous support. Repair to uterosacral ligaments and perineal body should be considered with large rectoceles, anterior rectal wall intussusception and obstructive defecation disorders.

Factors associated with climacteric symptoms in women around menopause attending menopause clinics in Italy.

OBJECTIVE: To obtain data on correlates of climacteric symptoms in women around menopause attending menopause clinics in Italy. METHODS: Since 1997 a large cross sectional study has been conducted on the characteristics of women around menopause attending a network of first level menopause outpatient's clinics in Italy. A total of 66,501 (mean age 54.4 years) women are considered in the present paper. RESULTS: The odds ratios of moderate and severe hot flashes/night sweats were lower in more educated women and (for severe symptoms only) in women reporting regular physical activity. Depression, difficulty to sleep, forgetfulness and irritability tended to be less frequent in more educated women and (depression only) in women reporting regular physical activity. Parous women reported more frequently these symptoms. CONCLUSIONS: This large study confirms in Southern European population that low education, body mass index and low physical activity are associated with climacteric symptoms. Parous women are at greater risk of psychological symptoms.

[Preliminary experience with transobturator tape for treatment of urinary incontinence in women]. / Esperienza preliminare con benderella transotturatoria per il trattamento dell'incontinenza urinaria femminile.

AIM: Aim of this study is to report our preliminary experience with a minimally invasive surgical procedure using transobturator approach. METHODS: We enrolled in our study 19 patients with stress urinary incontinence and urethral hypermobility without genital prolapse. All patients underwent suburethral transobturator tape (TOT) procedure. Four patients underwent previous surgical procedure for incontinence (3 Kelly and 1 Burch). No patients reported previous major gynaecological surgery. Mean age was 58.68 years (range 36-75). The sling was placed according to the technique described by Delorme. RESULTS: Mean operating time was 21 min (range 14-48). No bladder lesions or intraoperative complications occurred. Fifteen patients were dismissed the same day of surgery. Mean hospital staying was 1.4 days (range 1-5). No infections, erosions or sieromas have been observed. CONCLUSIONS: Our experience shows as TOT technique is extremely rapid, reproducible and with a very short learning curve. The transobturator approach avoids the risk of bladder, bowel or vascular injuries. Compliance and patient satisfaction have been very encouraging, restoring a real functional well-being. However, the small number of patients in our study and the short follow up do not actually allow us to draw definitive results and further studies are needed to confirm the technique success.

Risk factors for type 2 diabetes in women attending menopause clinics in Italy: a cross-sectional study.

OBJECTIVE: To analyze risk factors for type 2 diabetes among women attending menopause clinics in Italy for counselling about the menopause. SUBJECTS: Women attending a network of first-level outpatient menopause clinics in Italy for general counselling about menopause or treatment of menopausal symptoms. METHODS: Cross-sectional study with no exclusion criteria. Type 2 diabetes was defined according to National Diabetes Data Groups Indications and the fasting blood glucose at an oral glucose tolerance test within the previous year. RESULTS: Out of the 44 694 considered in this analysis, 808 had a diagnosis of diabetes type 2 (1.8%). In comparison with women aged < 50 years, the multivariate odds ratios (OR) of type 2 diabetes were 1.31 (95% confidence interval (CI), 0.99-1.74) for women aged 50-52 years, 1.66 (95% CI, 1.27-2.17) at 53-56 years and 2.84 (95% CI, 2.20-3.67) in women aged > or = 57 years. Type 2 diabetes was less frequently reported in more educated women (OR high school/university vs. primary school = 0.44 (95% CI, 0.36-0.55)). Being overweight was associated with an increased risk of type 2 diabetes. In comparison with women reporting a low level of physical activity, the multivariate OR of type 2 diabetes was 0.67 (95% CI, 0.54-0.84) for women reporting regular physical activity. In comparison with premenopausal women, the multivariate OR of type 2 diabetes was 1.38 (95% CI, 1.03-1.84) in women with natural menopause. This finding was present also after allowing for the potential confounding effect of age. The multivariate OR of diabetes for users of hormonal replacement therapy was 0.58 (95% CI, 0.46-0.73). CONCLUSIONS: This large cross-sectional study suggests that postmenopausal women are at higher risk of type 2 diabetes after allowance for the effect of age. Other main determinants of risk of type 2 diabetes in women around menopause were low socioeconomic status and being overweight. Diabetes was found less frequently in those taking hormone replacement therapy.

Influence of a decisional tree on the route of hysterectomy for benign disease in Italy: personal experience.

BACKGROUND: Mainly to report our experience in the route of hysterectomy after introducing specific guidelines according to the Society of Pelvic Reconstructive Surgeons and to record all hysterectomy-related complications after abdominal and vaginal hysterectomies. METHODS: The records of 22 patients who underwent abdominal hysterectomy and 59 who underwent vaginal hysterectomy for benign disease were reviewed. Complications related to hysterectomy were recorded during surgery, postoperative hospital stay and a period of six weeks. Statistical methods used were t-tests and chi square analysis. RESULTS: Operation time was shorter with the vaginal route. Patients operated on via the vaginal route had less blood loss and shorter hospital stay. CONCLUSIONS: The main standard to select the route for hysterectomy is the severity of the clinical status. Decreasing the ratio between the abdominal and vaginal route is possible, but it is crucial to make the indications clear, based on scientific evidence.

[Benign uterine pathology in premenopause and transvaginal sonohysterography: personal experience]. / Patologia uterina benigna in premenopausa e isterosonografia transvaginale: Nostra esperienza.

BACKGROUND: In this study we report our experience about hysterosonography and its use for the diagnosis of benign uterine pathology in premenopausal women referred to our Hospital. METHODS: From May to October 2000, 58 patients underwent transvaginal sonohysterography. They referred to our Ultrasonography Center because of sterility, intermenstrual bleedings, menometrorrhagias or anomalous endometrial echopatterns which had been found by basal transvaginal ultrasound examination. All patients were in fertile age and were examined during the follicular phase of the ovarian cycle. The hysterosonographic examination consisted in introducing 20 cc of a physiological solution by catheter with inflating balloon for hysterosalpingography and assessment of the uterine cavity was possible thanks to the acoustic window created by the fluid which gradually distended the cavity itself. We considered as failures of the techniques those cases in which the profile of endometrial cavity was not clearly visualized. RESULTS: Sonohysterography was performable in 52 of the 58 patients. The failure of examination in 3 cases was due to inadequate distention of the uterine cavity, in 2 cases to cervical stenosis and in 1 case to the reflux of the contrast medium. Diagnosis effected with sonohysterography revealed 3 uterus bicornis, 16 endometrial polyps and 9 submucosal myomas. No ultrasound anomalies were found in 23 patients. All the women underwent a subsequent hysteroscopy which confirmed our ultrasound diagnosis. CONCLUSIONS: Our study shows that sonohysterography allows to obtain a precise diagnosis of benign uterine pathology, which generally basal transvaginal ultrasonography can only suspect. The applicability of positive and negative predictive values, of the sensitivity and specificity is limited by the small number of cases included in the study. The role of sonohysterography is more difficult to define when compared to hysteroscopy. The conclusion is drawn that this new method offers an important aid for gynecological diagnosis of benign pathology.

Endometriosis arises from implant of endometriotic cells outside the uterus: a report of active vesicouterine centrifugal fistula.

Vesicouterine fistula is rare, accounting for nearly 4% of all urogenital fistulas. Lower segment cesarean delivery is the main predisposing event but in the last few years other possible predisposing factors have been pointed out. Clinically, it can show itself in different forms and the diagnosis is often delayed although it is not difficult. We report our experience about a case of postcesarean vesicouterine fistula arising on a focus of vesical endometriosis and we discuss an eventual hypothetical pathogenetic correlation between bladder endometriosis and uterovesical fistula.

[Vesicouterine fistula and bladder endometriosis. A case report]. / Fistola vescicouterina ed endometriosi vesicale.

Vesicouterine fistula is rare, accounting nearly 4% of all urogenital fistulas. Cesarean delivery through uterine lower segment is the main predisposing event but in the last years other possible predisposing factors have been pointed out. Clinically, it can occur in different forms and the diagnosis is often delayed although it is not difficult. In this study personal experience in a case of postcesarean vesicouterine fistula arisen on a focus of bladder endometriosis is reported and an eventual hypothetical pathogenetic correlation between bladder endometriosis and vesicouterine fistula is discussed.

[Guaranteeing fetal well-being in water childbirth: is it possible?]. / Garantire il benessere fetale durante il parto in acqua: è possibile?

The criteria, which a modern obstetric department is based on, are to deliver serenely and naturally according to the mother's personal exigencies and preserving the child's right to his/her own safety. The attempt to offer the woman a natural place with respect for these principles has improved the knowledge about the physiologic changes of the female organism during labour and water birth. Our experience about water birth began on 1st of July 2000, the day of the inauguration of the new birth room of the maternal-infantile department of the hospital of Lavagna. We nursed 15 women during labour and water birth, 11 were multiparas, 4 were primiparas, the average age was 31-year-old. We used the existing criteria of maternal and fetal selection for the care of physiologic water birth with a low risk. Particularly, the fetal heart rate was monitored at least for 30 minutes before the immersion into water and then at scheduled intervals during labour. To this purpose we used a cardiotocograph provided with an ultrasound probe (with high density of crystals) and with a toco (with high sensitivity), both waterproof and wireless. In our sample the episiotomy was not performed and 3rd degree lacerations did not happen. The neonatal average weight was 3100 gr for the primiparas and 3040 gr for the multiparas, respectively. The Apgar measurement was never lower than 8. The average time of labour was 6 hours for the group of the primiparas and 4.25 hours for the multiparas, respectively. In conclusion the monitoring of fetal welfare during water labour does not substantially differ from the monitoring of traditional labour, but it requires specific equipments.

[Prenatal diagnosis of thanatophoric dysplasia at 21st week of pregnancy]. / Diagnosi prenatale di displasia tanatofora alla 21a settimana di gravidanza.

We report making the prenatal diagnosis of thanatophoric dysplasia without "cloverleaf" skull at 21 weeks gestation. The ultrasound examination showed short and bowed limbs, narrow thorax, and large head. Radiological and histological studies confirmed the aborted fetus to be affected with thanatophoric dysplasia. The differential prenatal diagnosis with other skeletal dysplasias is discussed.

Prenatal diagnosis of thanatophoric dysplasia at 24 weeks.

We report making the prenatal diagnosis of thanatophoric dysplasia at 24 weeks gestation. The ultrasound examination showed short limbs. By in utero radiological study, we could see the typical changes of this skeletal dysplasia. Radiological and histological studies confirmed the aborted fetus to be affected with thanatophoric dysplasia.