Endometrial tuberculosis: a clinical case.

Genital tuberculosis is a bacterial infection still frequent in less developed countries where lots of cases are not diagnosed nor treated. In this work we describe a rare case of primary endometrial tuberculosis in a woman of 50 years old. The diagnosis was confirmed by an ultrasonography of the pelvis and an endometrial biopsy followed by a histological examination. The patient after the diagnosis was put under antiturbecular treatment for six months with complete healing.

Primitive breast localisation of Buruli ulcer in an endemic zone: a rare case.

A case of Buruli ulcer with primitive breast localisation with evident epidemiological and clinical aspects is reported. This localisation is exceptional; the differential diagnosis with breast cancer is essential. If diagnosed early, it can be cured with surgery, broad-spectrum antibiotherapy and thermotherapy.

Tuberculosis of the cervix and infertility: report of a rare case.

Tubercolosis is a frequent bacterial infection in less developed countries. Lung and lymph node localisations are common, while the genital apparatus is less involved. In this work a rare case of cervical tuberculosis followed by some lesions causing infertility in a 20-year-old woman is reported. The diagnosis was confirmed by a histological examination from a biopsy of the cervix. The patient was offered six-month antituberculosis therapy which eliminated the cervical lesions. A few years later she came under our care for infertility due to uterine adhesions diagnosed by hysterosalpingography. Now the patient is being treated for infertility complicated by amenorrhoea.

Urinary disorders during pregnancy and postpartum: our experience.

The changes that take place in the pelvic region during birth can give rise to alterations in the genitourinary system which are at the basis of pathologies such as stress urinary incontinence (SUI). The occurrence of this condition has been correlated to a variety of factors including neonatal birth weight and obesity. We studied 120 women, 60 nulliparae, 40 primiparae and 20 multiparae who were divided into three groups on the basis of urinary problems experienced. The first group consisted of women who had reported urinary incontinence during pregnancy (76%). This was found to be significantly correlated to the number of pregnancies and weight gained; 18% of this group reported IUS during the postpartum period. The second group consisted of women who did not experience any urinary incontinence during the pregnancy or postpartum while the third group consisted of women who, although not experiencing any urinary problems during pregnancy, reported urinary incontinence in the postpartum period. These data, although only part of an initial study, reveal a consistent frequency of urinary incontinence in pregnancy and postpartum, and highlight risk factors.

Cytokine levels in amniotic fluid: a marker of preterm labor?

The aim of this study was to determine levels of Interleukin 6 (IL-6) in amniotic fluid at the beginning of the second trimester and to establish whether IL-6 can be used as a marker for premature birth as it would appear to be an important prenatal marker of chorionic inflammation. Thirty-three patients, between 16 and 19 weeks of gestation, who were undergoing amniocentesis to establish the presence or not of fetal genetic pathologies were enrolled into the study. Amniotic fluid (3 ml) was taken from each patient and used to perform enzyme-linked immunosorbent assays (ELISAs). The results were analyzed using the Mann-Whitney test and Pearson and Spearman coefficient. The patients were divided into three groups on the basis of the levels of IL-6 found: a) up to 450 pg/ml; b) between 450 and 900 pg/ml; c) over 900 pg/ml; These data were then evaluated alongside the date of parturition and the presence of any maternal or fetal pathologies. The results of our analyses, however, were inconclusive: levels of IL-6 were normal in patients presenting pathologies while obstetric pathologies were absent in patients with high levels of IL-6. In conclusion, this data would indicate that a different method or approach is required for the identification of a marker for premature birth.

Recurrent miscarriage associated with antiphospholipid antibodies: prophylactic treatment with low-dose aspirin and fish oil derivates.

PROBLEM: The aim of this study was to evaluate the effects of two different prophylactic protocols, low-dose aspirin and fish oil derivates, in the treatment of patients with recurrent pregnancy loss associated with antiphospholipid antibodies (APA) syndrome. METHODS: A prospective study included 30 patients who were alternately assigned to treatment. Each patient had had at least two consecutive spontaneous abortions, positive antiphospholipid antibodies on two occasions, and a complete evaluation. RESULTS: Among patients treated with low-dose aspirin, 12 out of the 15 (80%) pregnancies ended in live births. In the fish oil derivate group 11 out of the 15 (73.3%) ended in live births (p > 0.05). There were no significant differences between the low-dose aspirin and the fish oil derivates groups with respect to gestational age at delivery (39.9 +/- 0.4 vs 39 +/- 1.5 weeks), fetal birth weight (3290 +/- 200g vs 3560 +/- 100 g), number of cesarean sections (25% vs 18%), or complications. CONCLUSION: There were no significant differences in terms of pregnancy outcome between women with recurrent pregnancy loss associated with APA syndrome treated with low-dose aspirin or fish oil derivates.

Postoperative adhesion prevention in gynecologic surgery with hyaluronic acid.

UNLABELLED: Despite improvements in surgical instrumentation and techniques, adhesions continue to form after most procedures. Peritoneal adhesions develop in 60-90% of women who undergo major gynecological operations. This adhesion formation causes significant postoperative morbidity such as bowel obstruction (65%), infertility (15-20%), and chronic pelvic pain (40%). OBJECTIVE: To demonstrate the efficacy of a hyaluronic acid product (Hyalobarrier Gel) for the prevention of adhesions in gynecological surgery. MATERIALS AND METHODS: From October 2000 to July 2002, 18 women from 26 to 41 years old (mean age 33.66) underwent myomectomy via laparotomy as their first abdominal operation. Between August 2001 and May 2003, the patients underwent a second-look laparoscopy (7 women, 38.9%, 15 sites, 42.8%) or a second-look laparotomy (11 women, 61.1%, 20 sites, 57.1%) during which all the 35 sites corresponding to the previous myomectomies were analyzed. During the second-look procedure the presence, localization and severity of adhesions were evaluated using the Operative Laparoscopy Study Group Classification (OLSG) and American Fertility Society Classification (AFSC). RESULTS: All patients underwent a second-look laparoscopy/laparotomy and only five of 18 (27.7%) showed pelvic adhesions in seven sites (20%) of previous myomectomies. No adhesion was found on the previous sites of myomectomies of pedunculated leiomyomas so, excluding those, adhesions were found in seven of 29 sites of myomectomies (24.1%). CONCLUSIONS: The present study emphasizes the need for improved treatments to prevent adhesions, as there is no doubt that adhesions represent one of the major causes of female morbidity.

Periodontal disease and poor obstetrical outcome.

Maternal infective processes sustained especially by Gram-negative anaerobic bacteria like periodontal disease, during pregnancy, have been demonstrated to perturb the physiologic course of parturition through inflammatory cytokine production, sometimes resulting in preterm labor, preterm premature rupture of membranes and preterm low birth weight. In a matched case-control study, the hypothesis that poor oral health of pregnant women is a risk factor for low birth weight (LBW) was evaluated. Gingival crevicular fluid levels of PGE2 and IL-1beta were measured in order to determine whether mediator levels were related to current pregnancy outcome. Results indicate that GCF-PGE2 and GCF-IL-1beta levels are significantly higher in preterm low birth weight (PLBW) mothers as compared with normal birth weight controls. The data confirm that there is a possible correlation between periodontal problems typical of pregnancy and the occurrence of complications such as preterm low birth weight.

The adolescent and the gynecologist: our experience.

To evaluate adolescents' knowledge about sex, we conducted a study divided in two parts: 1) Distribution of a questionnaire; 2) Impromptu conversation with adolescents. The sample consisted of 205 questionnaires and 115 talks with students at a high school. The gathered data let us deduce that the relationship with parents was regarded as pleasant and good. As was expected the whole emotional sphere was related to friends. In order to understand which structures can help adolescents our data revealed that the mother holds first place, followed by the school and by friends. Sex education during adolescence should be carried out by other institutions so that a relationship free from conflicts can be established. In this way the figure of the expert takes shape--someone who can communicate within the structure of the school and the family and beyond--the limits of the information given by friends.

[Diagnostic hysteroscopy in the third millennium. Indications and role]. / L'isteroscopia diagnostia nel terzo millennio. Indicazioni e ruolo.

BACKGROUND: The present paper analyses a recent personal series of 284 diagnostic hysteroscopies carried out between May 1999 and December 2001 at the Operating Unit of the University Gynaecology and Obstetrics Department of the Hospital of Avezzano. Emphasis is laid on the description of the indications underlying the investigation and on the hysteroscopic and histological findings in the cases examined. METHODS: The sample was also subdivided into two groups depending on the fertility or postmenopausal status of the patients. In the sample of 284, 89 (31.3%) patients were subjected to local anaesthesia with paracervical block, while the remaining 195 (68.7%) did not receive any form of anaestetic. The hysteroscopies were generally carried out in day surgery, using the commonest and most tried and tested hysteroscopic optic systems and carbon dioxide as a means for distending the uterine cavity. None of the hysteroscopies gave rise to important complications. RESULTS: In both the group of patients in fertile age and in the group of post-menopause patients, the main indication for hysteroscopy was anomalous uterine bleeding (AUB) for which a total of 159/284 hysteroscopies (56%) were carried out, of which 68 (42.8%) in patients in fertile age and 91 (57.2%) in post-menopause patients. In the group of post-menopause patients hysteroscopy was carried out for this indication in 73.4% of cases (91/124) while in fertile age it was performed in 42.5% of cases (68/160). CONCLUSIONS: Underlying AUB in the post-menopause patient endometrial hypo-atrophy was evidenced in 59 of 91 patients examined (64.9%), while in fertile age most of the 68 cases of AUB proved to be of dysfunctional nature: hystological examination showed a proliferative endometrium in 29 cases, secretory in 7 and hyperplastic in 12 cases (11 cases of simple endometrial hyperplasia with atypia and 1 of complex hyperplasia with atypia). Finally, hysteroscopy made it possible to diagnose 6 cases of endometrial adenocarcinoma (6.6% of patients with AUB in post-menopause).

Disturbances of humour in postpartum: our experience.

The study was conducted on 64 women who were to give birth. The average age ranged from 31-44 years and the instruments for evaluation consisted of: 1) Individual and psychological questionnaires; 2) Italian version of the Short Form Health Survey Questionnaire (SF-36); 3) Sheehan Disability Scale; 4) Zung self-rating depression scale. Of the women included in the study 27.7% found their humour worsened during their last pregnancy, while 19.15% said that their humour worsened after the birth. In these patients we frequently found obstetric and/or puerperal pathologies. There was also a strong correlation with the premenstrual syndrome and with hyperemesis in the first trimester. On the contrary, there was no correlation with familiarity and socio-demographic characteristics. The data allow us to conclude that any pregnant woman can develop medium or strong symptoms of depression thus calling for great attention to be paid to the psychological dynamics of birth.

Tension-free vaginal tape procedure for treatment of USI: subjective and objective efficacy evaluation.

Urinary incontinence is a frequent functional disease affecting 5% to 25% of women. It is commonly believed that urinary stress incontinence (USI) is caused by anatomical defects, thus it can be treated by restoring anatomy. More than 100 surgical techniques have been proposed for genuine stress incontinence treatment. The tension free vaginal tape procedure (TVT) for the treatment of genuine IUS in women was first reported in 1996 by Ulmsten et al. The purpose of this study was to evaluate objective and subjective efficacy of the TVT procedure in different types of female urinary incontinence. From February 2000 to December 2001, 52 patients with urinary incontinence underwent the TVT procedure in the Obstetric and Gynecology Department of Avezzano Hospital, Italy. No difference in the cure rates was found between patients undergoing the TVT alone or associated with anterior and/or posterior colporrhaphy. In accordance with many authors we can affirm that the TVT sling technique is easy to use, the time for surgery is relatively short, and the procedure is free of complications and provides a satisfactory outcome.

[Maternal smoking in pregnancy]. / Fumo materno in gravidanza.

OBJECTIVE: In the last years has been a progressive increase of tabagism in the female sex. This study wanted to examine the influence of the pregnancy on voluntary practices and especially on smoking. PATIENTS AND METHODS: 140 women with a mean age of 33.05 years and with a mean gestational age of 28.56 weeks (range 5-42) were interviewed. Each one received a questionnaire about social and psychosocial status, a schedule about style of living (CAGE), a questionnaire "How much do you drink" (from SQQ) and a series of questions about smoking. RESULTS AND CONCLUSIONS: Our study suggests that the tabagism decreases in the greatest part of pregnant women, and them increases again after child birth. Pregnancy gets women both to finish and to decrease smoking apart from social status and any variant contemplated.

[Lifestyle and drinking habits during pregnancy]. / Stile di vita ed abitudini voluttuarie in gravidanza.

BACKGROUND: It has been reported that a high consumption of alcohol during pregnancy is correlated to fetal alcohol syndrome and other perinatal problems. Less is known about the effects linked to moderate and limited drinking during pregnancy. METHODS: A study was carried out in 140 pregnant women: the mean age was 33.05 +/- 5.22, whereas the gestational age was 28.56 +/- 12.1 weeks (range 5-42). Each woman was asked to compile a form giving personal details and details of psychosocial behaviour, a lifestyle questionnaire (CAGE) and a form entitled "How much do you drink" based on SQQ. RESULTS: 22.2% of women reported that they had drunk alcohol during the month prior to the interview. Of these, 15% had not altered their habits, 0.8% had increased their alcohol consumption and 6.4% had reduced it. Wine was the form of alcohol most frequently consumed. Only one woman was positive to the SQQ test, and only one pregnant woman was positive to CAGE. CONCLUSIONS: This study shows that dietary behaviour was correct in the majority of cases.

[Apropos of a case of Dandy-Walker syndrome associated with chromosome abnormalities]. / A proposito di un caso di sindrome di Dandy-Walker associata ad anomalia cromosomica.

A case of Dandy-Walker syndrome associated with chromosome abnormalities (46,XX,-21, +der(13)t(13;21)(q22;q11), diagnosed during pregnancy is reported. This is a pathology characterized by malformations of the central nervous system, mainly of the cerebellum. Due to several aspects and different prognosis between classic Dandy-Walker and its variants, many clinical and therapeutic problems may raise.

[Fetal malformations and chromosome abnormalities diagnosed at the Center of Prenatal Diagnosis of the University of Aquila in the 1995-1998 triennium]. / Malformazioni e cromosomopatie fetali diagnosticate presso il centro di diagnosi prenatale dell'Università dell'Aquila nel triennio 1995-1998.

BACKGROUND: Over the past few years numerous techniques have been developed, allowing an evaluation of fetal physiopathology that was unthinkable until recently. The authors describe 20 cases of fetal malformations and chromosomal abnormalities diagnosed by scan and amniocentesis at the Centre for Diagnosis and Obstetric Prophylaxis at L'Aquila University. METHODS: Between January 1995 and April 1998 a total of 1180 amniocentesis and 4000 obstetric scans were performed in a group of 1650 pregnant women. RESULTS: Of the patients examined using ultrasound scan, 8 presented manifest fetal pathologies, of which 5 were associated with chromosome abnormalities: 1) left ventricular hypoplasia, common atrium, tricuspid dysplasia; 2) omphalocele; 3) Morgagni-Stewart-Morel syndrome; 4) plurilobate cystic hygroma; 5) duodenal atresia; 6) Dandy-Walker syndrome; 7) cystic hygroma and hydrops; 8) cystic hygroma, hydrops, cardiopathy and Dandy-Walker syndrome. Among the pregnant women undergoing amniocentesis without a prior diagnosis of fetal malformation, 12 presented pathological fetal karyotypes: 2 cases of Turner's syndrome; 2 cases of Edward's syndrome; 2 cases of Klinefelter's syndrome, of deletion of a stretch of chromosome 8; 1 case of Down's syndrome; 2 cases of supernumerary marker chromosome; 1 twin pregnancy with Klinefelter's syndrome in one twin and paracentric inversion of chromosome 13 in the other; 1 twin pregnancy with a small supernumerary marker chromosome in both twins. CONCLUSIONS: Ultrasonography often enables the diagnosis of congenital abnormalities not associated with chromosome pathologies. However, karyotype studies play an essential role in pregnancies with a high genetic risk.