Post-traumatic amenorrhea: the role of diagnostic and operative hysteroscopy in the prevention, diagnosis, differential diagnosis and treatment.

AIM: The aim of the study was to evaluate the clinical usefulness of the selective removal of residual intrauterine trophoblastic tissue by using a hysteroscopic procedure, especially in the prevention of the Intra-Uterine Adhesion's Syndrome. METHODS: Seventy-six patients had an Asherman's Syndrome: 5 cases after laparotomic myomectomy, 1 after caesarean section, 2 after hysteroscopic myomectomy, 10 after VIP, 1 with a severe vaginal endometriosis, 1 after conisation, 4 after a post-partum hemorrhage due to coagulopathy or uterine atony, 20 cases after D&C because of PPH due to placental retention, 26 after repetitive D&Cs because of AUB due to post abortion chorial residues' retention, 6 cases after D&C for post menopausal AUB. Thirty-six patients presented AUB due to chorioplacental residues retention: 14 cases after a vaginal delivery or a caesarean section, 4 after VIP, 18 cases after repetitive D&Cs for incomplete or internal spontaneous abortion. Complete physical examination, transvaginal ultrasonography and operative hysteroscopy was offered as first treatment to all patients. Surgical treatment of IUA depends on the type (I-IV) and is based on the section of synechiae, liberation of the uterine cavity and tubal recesses, recovery of the residual endometrium to restore the physiology of the reproductive tract. Our technique to remove the chorioplacental residues is based on: correct use of loops and electric currents, enucleation by cold loops of the base of the placental implant, and to single out the level of miometrial infiltration. RESULTS: After treatment we have noticed: two hysterectomies (for persistent AUB after myomectomy and for severe bleeding after dehiscence of a C. section), restoration of regular menstruations in 94.6% of patients (6 women in menopause), disappearance of pelvic pain and dysmenorrhea in all cases (100%), 8 pregnancies of the 9 women who were wanting child after hysteroscopic synechiolysis (88.9%). CONCLUSION: According to the present study, the best way to prevent IUA is to make D&C for abortion, avoiding waiting longer than 24 hours, perform a D&C and then a diagnostic hysteroscopy after PPH in symptomatic women, reserve D&Cs only for a PPH, or an incomplete abortion, limit to only one D&C, always make a diagnostic hysteroscopy after D&C and uterine plugging for PPH.

[''Prepidil versus Propess'': pharmacological induction of labour with dinoprostone]. / ''Prepidil versus Propess'': induzione farmacologica del travaglio di parto con dinoprostone.

AIM: The aim of the study was to evaluate the effectiveness and safety of the two different pharmaceutical preparations of dinoprostone: ''Prepidil vs Propess'', in patients with medical and/or obstetrical indications to pharmaceutical induction of labour. METHODS: A retrospective analysis was carried out on 144 patients (82 with Propess vs 62 with Prepidil). INDICATIONS: post-term pregnancy, premature rupture of membranes (PROM), gestational diabetes, gestational-chronic hypertension, intrauterine growth restriction (IUGR),others (fetal macrosomia, oligohydramnios). RESULTS: The groups were homogenous regarding: age, parity, weeks of amenorrhea, Bishop score and indication to induction. Both pharmaceutical preparations of dinoprostone (Prepidil vs Propess) are effective and safe; there are some differences not statistically significant (P>0.01) regarding the percentage of spontaneous deliveries: 61.5% vs 63%, interval from induction to delivery 24.53 vs 20.45 h, number of inductions 1.35 vs 1.15 and neonatal outcome (Apgar scores at 1 and 5 min). A case of serious hyperstimulation with hysterectomy post-delivery after induction with Prepidi was observed. CONCLUSION: A greater use of Propess, especially in patients with PROM, is suggested; Propess has determined a higher percentage of spontaneous deliveries, a shorter interval from induction to delivery and less risks for the mother. It is in fact possible to remove the device easily and safely in case of complication.

[Sensitivity, specificity, predictive positive and negative value of the main clinical signs and symptoms of hydatiform mole]. / Sensibilità, specificità, valore predittivo positivo e negativo dei principali segni clinici e sintomi della mola idatidea.

AIM: Especially in the first weeks of pregnancy, complete and partial hydatiform moles are not easily detected by sonography, symptoms and clinical signs. Due to the rarity of moles, it is possible that they may be confused with abortive pregnancies until the pathological examination. The aim of this study is to identify the sensitivity, specificity, predictive positive and negative value of the main symptoms and clinical signs of molar pregnancies. METHODS: Thirteen molar pregnancies have been detected after pathological examination from January 2003 to July 2005 in Perugia. Their main clinical signs and symptoms are compared with those recorded in 288 abortive pregnancies, 56 ectopic pregnancies and 27 Hyperemesis gravidarum, observed in the same period. RESULTS: Vaginal bleeding and pelvic pain are the most sensitive symptoms and have the highest predictive negative values. The size of the uterus greater for date is the most specific sign. Pelvic pain with hyperemesis, and uterus size greater for date have the highest predictive positive values, but the lowest sensitivity. CONCLUSIONS: A mole should be excluded in patients with hyperemesis and pelvic pain, and in patients with uterus size greater for date. In the first case, a hyperemesis gravidarum may be diagnosed and, in the second one, a twin pregnancy may be confirmed with a sonographic scan.

[Surgery and postoperative radiotherapy in the treatment of stage I endometrial carcinoma]. / Chirurgia e radioterapia postoperatoria nel trattamento dell'adenocarcinoma endometrial I stadio.

From 1977 to 1985 160 endometrial carcinoma stage I patients were treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy and postoperative irradiation. Hundred-thirty-one patients received postoperative pelvic telecobalt-therapy, total dose 45-50 Gy and 29 patients received postoperative endocavitary curietherapy (Cs137) to the vagina vault, total dose 50 Gy. Median follow-up was 5.6 years (range 3-11 years). Overall actuarial five-years disease-free survival was 89% +/- 2.7. For the group of patients treated with external radiotherapy and group receiving curietherapy 5-years D.F. survival was respectively 88% +/- 2.9 83% +/- 4.7. There is no statistically significant difference in survival time between the two groups (p = 0.688). There were no cases of vaginal recurrence (0%) and 2/160 cases (1.2%) there pelvic relapse. In 2/160 cases (1.2%) distant metastases occurred. Late I II grade effects were found in 15/160 cases (9.3%). Retrospective analysis of results and casuistry lead to the conclusion that radiotherapy must, in cases at risk, follow surgery in the treatment of stage I endometrial carcinoma with the aim of reducing the loco-regional relapses and increasing survival time.

[Post-menopausal metrorrhagia. Use of danazol in endometrial hyperplasia]. / Metrorragia post-menopausale. L'uso del danazolo nella iperplasia endometriale.

The Authors, after a careful examination of the literature on endometrial hyperplasias, review the results of a preliminary study on 15 patients affected with postmenopausal metrorrhagia, cured by Danazol (200 mg/die) through 90 consecutive days. Also recognizing the best tolerance to the drug and the low incidence of the side effects, they think the results obtained by Danazol need further confirmation by more protracted controls.

[Lasers and genital (cervico-vulvo-vaginal) pathology]. / Laser e patologia genitale (cervico-vulvo-vaginale).

The authors performed laser vaporization in 240/250 cases for viral pathology of the lower genital tract, obtaining recovery at the first treatment in 232/240 cases and at the second in 238/248 cases.

[Comparative study of short-term antimicrobial chemoprophylaxis in gynecologic surgery: cefotetan versus cefazolin]. / Studio comparativo di chemioprofilassi antimicrobica a breve termine in chirurgia ginecologica: cefoteta versus cefazolina.

The results obtained in 80 patients hospitalized at the University of Obstetrics and Gynecology Clinic in Perugia for abdominal and vaginal hysterectomy are reported and evaluated in a prospective and randomized study of perioperative antibacterial prophylaxis. In the 75 patients available to study a single intravenous dose of 2 g cefotetan was compared with a triple dose of 1 g intravenous cephazolin. A reduction in the incidence of post-operative infections both in abdominal hysterectomy from 24% (cephazolin group) to 11.53% (cefotetan group) and in vaginal hysterectomy from 40% (cephazolin group) to 71.4% (cefotetan group) was noted. These results show that a single intravenous dose of 2 g cefotetan can be considered a valid therapeutic support for antibacterial prophylaxis. In addition the absence of alterations in the parameters considered (haematological, biochemical and urinary) points to the safety, effectiveness and non-toxicity of the drug.

HIV infection and pregnancy: diagnostic and follow-up program for the pregnant woman and newborn child.

The authors take as their starting point the cases of 8 pregnancies in HIV serologically positive women, admitted for their observation from July 1986 to March 1988. They emphasize the importance of clinical, anamnestic and serological screening in order to identify those subjects at risk, and thereby prevent the vertical transmission of the virus. To this end, they propose a protocol to be used for all women at risk, both pregnant and not, both seropositive and seronegative. They also advise repeated clinical and immunological checks of the children of asymptomatic carrier mothers.

Canine airway responses to acetylcholine, prostaglandin F2alpha, histamine, and serotonin after chronic antigen exposure.

Dose-response curves were obtained for aerosols of acetylcholine (ACh), prostaglandin F2alpha (PGF2alpha), histamine (H), and 5-hydroxytryptamine (5-HT) on pulmonary resistance (Rp) and dynamic lung compliance (Cdyn) in Ascaris-hypersensitive dogs. Previously, these animals had been subjected to chronic biweekly "allergic asthmatic" episodes by aerosol administration of Ascaris antigen. When examined either one week before or after antigen provocation the airways were not hyperreactive to ACh, H, or 5-HT but did demonstrate a modest hyperreactivity to PGF2alpha. When aerosol dose-response curves were obtained for these agonists immediately following an "allergic asthmatic" episode, the airways were hyporeactive to PGF2alpha, H, and 5-HT, but not to ACh. Studies with atropine indicated that the hyporeactivity was the result of decreased airway responsiveness to both direct and indirect effect of PGF2alpha and H. It is concluded that, in dogs, chronic antigen challenge is not accompanied by a general increase in airway reactivity to pharmacologic agents.