Three-dimensional transvaginal sonography in local staging of cervical carcinoma: description of a novel technique and preliminary results.

OBJECTIVE: To evaluate the feasibility of three-dimensional multiplanar sonography in the local staging of cervical carcinoma. METHODS: Between January 2005 and May 2006, 14 patients with invasive cervical carcinoma underwent transvaginal volume ultrasound examination prior to primary surgery. Parametrial invasion was evaluated in the coronal plane, while both bladder and rectal invasion were evaluated in the sagittal plane. Ultrasound findings were compared with surgical and histological results. RESULTS: In 12 of the 14 cases, three-dimensional ultrasound findings were compatible with pathology results. In the remaining two cases, either infiltration of right parametrium or rectal invasion were suspected at ultrasound but not confirmed at pathology. CONCLUSIONS: Despite the small number of patients evaluated, three-dimensional multiplanar sonography appears to be a promising technique in the local staging of cervical carcinoma.

AgNOR protein quantity of cervical smears correlates with that of histological sections in cervical intraepithelial neoplasia.

The quantitative distribution of AgNOR proteins has been determined by image cytometry in 52 cervical smears obtained from normal cervix (n = 20), grade I CIN (cervical intraepithelial neoplasia) (n = 3), grade II CIN (n = 5) and grade III CIN (n = 24). No significant difference was demonstrated in the mean AgNOR protein area values between normal cervix, CIN I and CIN II, while AgNOR protein scores of CIN III were significantly greater than those of normal cervix (p < 0.05). AgNOR protein quantity was also determined in 17 colposcopic directed biopsies of patients with CIN lesions (3 CIN II and 14 CIN III) already studied by cytological analysis. When AgNOR protein values of histological sections and corresponding cytological smears were compared by linear regression analysis, a significant correlation was found (r = 0.74, p < 0.05). Our results demonstrate that AgNOR protein quantity of cervical smears actually reflects that of the cervical epithelium in situ and may therefore be useful for the cytological diagnosis of cervical lesions.

Is vestibular micropapillomatosis associated with human papillomavirus infection?

The aetiology and clinical significance of vulvar papillomatosis is still controversial. To verify the association of micropapillomatosis labialis with certain types of HPV-related lower genital tract infections, 25 patients with colposcopic aspects of vulvar papillomatosis were recruited and vulvar biopsies were obtained for histologic examination and in situ hybridization. Sixteen patients with vulvodynia, without any pathologic vulvar aspects, served as a control group. Histologic evidence of HPV was found in 20 cases (80%) of vulvar papillomatosis while only one (4%) of the study patients was positive for HPV-DNA. These results seem to confirm the scarse correlation between vestibular papillomatosis and HPV. In our opinion physicians must be cautions when treating these lesions even in cases with positive histologic results. Colposcopy is, therefore, of fundamental importance for an accurate diagnosis of vestibular papillomatosis and successful management.

Systemic interferon therapy for female florid genital condylomata.

A prospective randomized study comparing systemic interferon therapy with placebo in women with florid genital condylomata was carried out. A first group of 22 patients received alpha-interferon (Alfaferone: Alfa-Wassermann Bologna, Italy). 3 x 10(6) IU by i.m. injection every other day for four weeks (total of 12 injections). A second group of 20 patients was treated with a placebo. All patients, before therapy, were submitted to a colposcopic and vulvoscopic examination, a Pap smear and biopsy, in order to confirm the clinical diagnosis. Controls were carried out on all patients as a distance of three, six and twelve months from the end of treatment using colpocytologic, colposcopic and vulvoscopic examinations. One year after the termination of the therapy with interferon 45.4% of patients had a complete recovery compared with 10% of spontaneous recovery in the control group (p = 0.028). The systemic side effects of alfa-interferon, though very frequent, did not limit the use of the product. Our results suggest that systemic alfa-interferon treatment is effective in female genital condylomata, above all in those patients with multifocal florid lesions, both in terms of complete remission and number of relapses.

A cola de fibrina humana na microcirurgia experimental / The human fibrin glue in the experimental microsurgery

Graças às suas propriedades hemostáticas, colantes e tróficas, a cola de fibrina humana teve um vasto emprego nas intervençöes de microcirurgia. Nas microanastomoses experimentais do aparelho de reproduçäo feminino, além de um menor traumatismo cirúrgico, determina uma reduçäo das formaçöes de aderências. Na microcirurgia vascular reduz notavelmente o risco trombogênico e, graças à sua açäo impermeabilizante, é muito útil na correçäo das fístulas uro-genitais

Cervical intraepithelial neoplasia in HIV seropositive patients.

In order to assess the frequency of cervical intraepithelial neoplasia (CIN) in a high risk population, 32 women infected with human immunodeficiency virus (HIV), with no AIDS-related symptoms, underwent colposcopic, cytologic and histologic examinations of the uterine cervix. In seven cases (21.9%) cervical smears showed dysplasia and in nine cases (28.1%) histologic evaluation indicated CIN. No invasive carcinomas were observed. In seven of the nine women CIN was associated with lesions due to human papillomavirus infection (HPV). These data confirm that HIV-positive women are at increased risk for developing neoplasias in the lower genital tract and are in need of regular and careful cytologic and, in particular, colposcopic and histologic examinations.

[The role of prostaglandins in fertility. Experimental research]. / Il ruolo delle prostaglandine nella fertilità. Ricerca sperimentale.

Prevention of postoperative adhesion is an issue that continues to elude the abdominal and reproductive surgeon. Adhesions seem to be a result of an inflammatory process and it is well known that prostaglandins play an important role in such an event. In an attempt to improve the results of microsurgery, we have tried in this study to examine the effect of local intraperitoneal application of prostaglandins (PGE2 and PGF2 alpha) on adhesion formation in the rat after traumatizing to the uterine horn. Prostaglandins applied locally were found to increase intraperitoneal adhesion formation at the injured sites, in comparison with controls. Also, we have reported on histological examination an increased accumulation of inflammatory cells in traumatized areas. However, we didn't observe a reduced fertility in rats treated with prostaglandins because these substances induce follicular rupture by activation of proteolytic enzyme located in the follicular wall. We conclude that prostaglandins play an important role in the process of adhesion formation. Using antiprostaglandins agents could improve the outcomes of reproductive surgery.

[Tubo-ovarian transplantation in the treatment of sterility. Experimental research]. / Il trapianto tubo-ovarico nel trattamento della sterilita'. Ricerca sperimentale.

Microsurgical transposition of fallopian tube and ovary has the potential of being an efficient therapeutic treatment in patients with tubal sterility. The Authors present their experience of microsurgical adnexal transplantation in rabbit by two different techniques: the first procedure by microvascular anastomosis of the ovarian vessels, the second one without vascular pedicle. Function is evaluated at various time after grafting by: exploratory laparotomy on day 30 to establish whether circulation to the grafts was still maintained; macroscopic and microscopic examination of ovaries and fallopian tubes. The microvascular techniques prove highly reliable in terms of immediate vascular patency rate but it is disappointing that 50% of the autografts has failed with blocked vessels by day 30. Perhaps this is due to the difficult techniques in anastomosing the ovarian vessels of small caliber. In spite of these outcomes the vascularized autografts were viable and functional after transplantation in contrast with the non-vascularized tubo-ovarian grafts which all failed. This experience encourages to believe that the microsurgical technique could be employed for homograft transplantation in woman with extensive ovarian and tubal damages.

[Microsurgery and laser surgery in conservative operations on the ovary. Experimental research]. / La microchirurgia e la chirurgia laser negli interventi conservativi dell'ovaio. Ricerca sperimentale.

In this study we compared two different conservative surgery techniques performed on 12 ovaries of female rabbits: microsurgery and CO2 Laser surgery. After the surgical procedure all the animals were investigated by a Laparotomy to evaluate the post-operative adhesion formation. Histological examinations were performed on 6 ovaries, to evaluate the possible damage to the ovarian parenchyma. We did not find significant differences between the two methods employed, particularly for the adherence formation and the parenchymal thermic damages: no post-operative adhesions were detected respectively in 3 ovaries operated on by microsurgery and 5 by laser surgery; slight adhesions were present in 2 ovaries treated with microsurgery and in 3 with laser surgery; 3 ovaries treated with microsurgery and 2 with laser surgery showed moderate adhesions. Only 2 ovaries treated with microsurgery presented severe adhesions.

[Biological and synthetic prostheses in gynecologic microsurgery]. / Le protesi biologiche e sintetiche in microchirurgia ginecologica.

Biological prostheses of human umbilical vein and synthetic prostheses of ePTFE were comparatively studied in the microsurgical anastomosis of the uterine horns in twenty rats. Patency rate after 30 days was 60% for umbilical vein and 75% for the ePTFE prostheses. Gross and histological examination of umbilical vein graft specimens showed minimal alteration with a smooth intimal surface. On the contrary tissue covering the inner surface from the adjacent ends of the uterine horns was noted in ePTFE prostheses.

[Experimental study of different techniques for partial resection of the ovary]. / Studio sperimentale di differenti tecniche di resezione parziale dell' ovaio.

The effects of leaving the ovarian cortex open after wedge resection were studied in a rabbit model. Twelve animals were operated: in one ovary the ovarian cortex was reattached with microsurgical sutures and in the contralateral it was left to heal by secondary intention. No significant differences were observed in adhesion formation and tissue reactivity between the two techniques. These data support the hypothesis that reattachment of the ovarian cortex is not necessary after conservative ovarian surgery and these findings could be useful in the laparoscopic treatment of benign ovarian pathology.

Evolution of the indications for cesarean section. Results of a retrospective study.

We have analysed in retrospect the incidence of cesarean section during the years 1977-1989 in the 1st Obstetric and Gynecologic Clinic of the University of Bologna, and the development over time of the principal indications. The average incidence (17.1%) of cesarean section increased progressively from 9% in 1977 to 28% in 1989 with a peak at the beginning of the '80s (the period during which cardiotocographic monitoring became routinely used). With regard to the indications from 1977 up to date cesarean sections carried out on account of fetal distress increased almost five-fold. The increase in cesarean sections carried out on account of maternal disease, breech presentation and previous cesarean section was less important, while those performed for dystocia resulted markedly reduced.

Immunosuppression and human genital papillomavirus infection.

A group of 39 patients who underwent iatrogenic immunosuppression for renal transplant were evaluated by means of colposcopic, cytologic, and histologic investigations. Evidence of human papillomavirus (HPV) infection was found in 30.7%, more frequently in the cervix. Biopsy specimens of the most atypical areas showed the presence of cervical intra-epithelial neoplasia in one case. The high incidence of HPV infection in this group suggests that immunodeficient patients should have close monitoring of the entire ano-genital tract.

[Effects of ovarian and peritoneal endometriosis on fertility. Experimental study]. / Effetti dell'endometriosi ovarica e peritoneale sulla fertilità. Studio sperimentale.

Fertility after ovarian and peritoneal endometriosis experimentally induced has been studied. The fertility rate in the animals with ovarian endometriosis was decreased of 40% and the same reduction was found in the animals with peritoneal endometriosis. Not only the direct effect from adhesion formation, but also changes in the peritoneal fluid or its constituents are proposed as causes of endometriosis-associated infertility.

Atypical picture of cervico-vaginal condylomatosis in a patient submitted to hepatic transplant. A case report.

A case is presented of diffused cervico-vaginal condylomata in a 32-year-old woman who had undergone hepatic transplant and successive immunosuppressive therapy, treated with DTC and beta IFN for topical use.

[Morpho-functional study of the rabbit ovary after cauterization]. / Studio morfo-funzionale dell'ovaio di coniglio dopo cauterizzazione.

The authors investigated the lower incidence of post-operative adhesion formation after cauterization in comparison with microsurgical wedge resection in rabbit ovaries. Microscopic examination of cauterized ovaries did not show extensive necrosis in the depth of ovarian tissue. Electrocautery seems to be an effective alternative to ovarian wedge resection.

[Use of prostheses made of ePTFE in anastomoses of the rat uterine horn]. / Impiego di protesi in ePTFE nell'anastomosi di corno uterino di ratto.

ePTFE prostheses were used in the microsurgical anastomosis of the rat uterine horn. Handling characteristics of this synthetic material during the performance of anastomosis were tested. Patency rates, infections and local tissue reaction were evaluated after thirty and sixty days. Connective tissue infiltration and incomplete endothelialization by normal endometrial elements were observed on the luminal surface of the prosthesis.

Estudo comparativo da prevençäo de aderências em microcirurgia experimental com o emprego de fármacos e de métodos de barreira / Comparative study of prevention of post-operative adhesions in experimental microsurgery using drugs and barrier-methods

Experimentamos a eficácia anti-aderencial da hidrocortisona, do dextran 70 e da celulose oxidada na intervençäo de microanastomose término-terminais do corno uterino de rato. Os melhores resultados foram obtidos no grupo de animais tratados com hidrocortisona observados com o dextran 70. A celulose oxidada demonstrou-se ineficaz na prevençäo de aderências