Surgical pathological staging of endometrial carcinoma and results of treatment.

114 women with endometrial carcinoma at clinical stage 1 to 3 were treated with surgery as first line of treatment. Patients were classified as being low or high risk on the basis of the surgical pathological patterns of the tumor. Disease limited to the uterine body, G1-G2 tumors and myometrial invasion of less than 1/3, identified low risk patients which received no adjuvant therapy. All the others were considered high risk and treated with radiation therapy. Patients were retrospectively restaged according to 1988 FIGO guidelines and survival was analyzed. Cox's proportional hazards method was employed to identify independent prognostic factors. Disease free survival (DFS) was 90% for stage 1, 83% for stage 2, and 43% for stage 3 patients. Lymphatic spread was associated to the poorer prognosis. Proportional hazards model showed that tumor grading, myometrial invasion and lymphatic spread were significantly related to the time of relapsing. Low risk patients showed better outcomes despite not having received adjuvant treatment, thus post-operative therapy is not indicated in this subset of patients. Radiation adjuvant therapy for high risk patients did not give satisfactory results. Failures were observed both locally and distantly calling for new adjuvant strategies. Surgical pathological staging of endometrial cancer is currently mandatory. Retroperitoneal lymph node sampling is indicated in patients with high risk pre- (advanced clinical disease, undifferentiated tumors) or intra-operative (deep myometrial invasion, enlarged pelvic nodes) prognostic factors. All prognostic indicators must be obtained from surgery and pathology in order to assess the risk of relapse.

Reproductive performance in women with complete septate uteri.

Of 11 women with a diagnosis of complete septate uterus, 7 did not undergo any surgical correction, whereas 4 underwent metroplasty. The diagnosis was made in eight cases (73%) for reasons not related to the anomaly. In only three cases did the patients present with infertility complaints. Eight patients, one of whom was subsequently treated, had a total of 13 pregnancies, 3 (27%) of which ended in abortion, 4 (31%) in premature delivery and 6 (42%) in term births, for a live birth rate of 61.5%. The cumulative pregnancy rate was 80% at 12 months. The cumulative probability of carrying a pregnancy to term and giving birth to a live infant was 75% and 88%, respectively, for the second pregnancy. After metroplasty one patient still did not conceive, while three had a total of five pregnancies, one of which ended in abortion and four at term, for a live birth rate of 80%. With a complete septate uterus the ability to conceive is preserved, and the gestational ability is impaired only moderately. Metroplasty, if indicated, can yield good results in terms of the live birth rate.

Hysteroscopic treatment of uterine septum.

Authors report their 4 years experience in the treatment of uterine septum by hysteroscopic metroplasty. 35 patients underwent procedure; no complications occurred. Postoperative reproductive outcome was evaluated in 29 women with follow-up longer than 6 months. Patients were divided into 2 groups according to presence or absence of associated factors compromising fertility. Group A composed of 19 women in which uterine septum was the only cause of pregnancy wastage. Preoperatively they had 40 pregnancies all ending in spontaneous abortion. Postoperatively 15 (79%) patients conceived and 13 (68%) had a live baby. Totally they had 18 pregnancies, 2 (12%) ended in abortion, 1 in molar pregnancy, 1 in premature delivery, 11 delivered at term and 3 are currently beyond 20 weeks pregnant, for a live birth rate of 78%. Life table analysis showed an estimated pregnancy rate of 82% at 12 months, monthly fecundability was 0.13. Group B composed of 10 women in which other factors compromising fertility were present. Preoperatively only 5 experienced pregnancy. Totally they had 8 pregnancies 7 (86%) of which ended in abortions and one in extrauterine pregnancy. Postoperatively only 3 (30%) had pregnancy and all had a live baby. Totally they had 4 pregnancies, 1 ended in abortion and 3 at term for a live birth rate of 75%. Life table analysis showed an estimated pregnancy rate of 11% at 12 months, monthly fecundability rate was 0.01. Hysteroscopic metroplasty proved to be safe and effective for solving pregnancy wastage caused by uterine septum. If other factors compromising fertility were present metroplasty did not increase fecundability, but improved live birth rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Reproductive impairment of women with unicornuate uterus.

The reproductive history of 18 women with a diagnosis of unicornuate uterus is reported. The study was conducted with retrospective analysis, and 7 patients with primary infertility were followed up for 1 to 6 years. Four patients had a cavitary noncommunicating horn, 12 a noncavitary rudimentary horn, and 2 no rudimentary horn. The cause of diagnosis was: primary infertility in 7 cases (39%), recurrent abortion in 6 (33%), obstetric complications in 5 (28%). Out of 7 patients that presented with primary infertility in 5 cases an associated reason was present. Twelve women had a total of 38 pregnancies, 21 (55%) ended in abortion, 3 in premature labour, 14 in term births, with a live birth rate of 39%. Of the 17 births 9 (53%) were in breech and 1 (1.6%), in transverse presentations and 11 (65%) were cesarean sections. Cervical cerclage, based on clinical or radiological indications, has been performed in 4 out 6 cases with recurrent abortion with improvement of reproductive performance in 3. Fetal survival rate passed from 0 to 83%. Reproductive impairment seems to depend equally on the difficulty in conceiving and on the reduced ability to carry a pregnancy to term.

A new technique of vaginal colpopexy.

The correction of a total or partial vaginal prolapse after hysterectomy is often difficult to perform, particularly when the possibility of sexual intercourse must be preserved. A method of vaginal retropubic colpopexy is proposed. In addition to preserving the vaginal functionality, it can be performed for preventive purposes during hysterectomy for uterine prolapse or conspicuous cystorectocele and finally, it corrects the topographic modification of the bladder and of the urethra. This method has had excellent results on 18 patients and relapse has not occurred after two or three years.

Endocrine modifications in women with premature menopause.

The Authors have found 9 cases of premature menopause out of a total of 159 observations of gynecological disfunctional disorders for a 3 year period. The functional investigation has been carried out by radioimmunoassay for PRL, FSH, LH, 17beta-estradiol, progesterone and, in those cases in which it was possible, the spontaneous pulsatility of PRL and gonadotropins has also been studied. The basal PRL was found always in normal range and the pulsatility was sufficiently flat. On the other hand a pool of gonadotropins can still be released by 100 microgram of LH-RH i.v. in spite of high basal levels of pituitary gonadotropins. The pulsatility, especially for FSH, appears like to those of postmenopausal women. 17beta-estradiol and progesterone were at low levels and could not be alterated by HMG-HCG tests. As a conclusion the Authors think that the evaluation of the above reported parameters is an unfailing diagnostic precision in many cases of secondary protovarian amenorrhea for a premature menopause syndrome.

Diagnostic problems on nosographic classification of polycystic disease of the ovary.

Nineteen patients with polycystic disease of the ovary have been studied. From the humoral point of view the group was found to consist of two populations distinguishable from one another by their basal LH levels. In type I cases LH was definitely increased (M = 53.46 +/- 12.79 mIU/ml) whereas FSH (M = 8.10 +/- 0.74 mIU/ml), prolactin (M = 10.48 +/- 2.12 ng/ml), 17beta-estradiol (M = 124.76 +/- 11.21 pg/ml), progesterone (M = 0.321 +/- 0.078 ng/ml) were all within the normal range for the follicular phase of the menstrual cycle. Testosterone levels were raised (M = 121.15 +/- 24.55 ng/100 ml) but not to an extent significantly different from that of patients with type II disease (M = 119,5 +/- 33.53 ng/100 ml). All the other hormonal parameters were within the normal range also in type II disease; for LH the difference between the means of the two groups was statistically significant (p less than 0.01). Urinary 17-ketosteroids were not significantly different in the two groups of patients and the values found always fell within the normal range for our laboratory. LH-RH stimulation (50 microgram i.v.) elicited an exaggerated response in type I and a normal one in type II. The FSH response was always deficient and delayed in both groups. Since there was no correlation of the humoral data to the macroscopic aspect of the ovary as visualized by celioscopy, the practical importanze of endocrine exploration of these cases is stressed, especially as regards LH levels and androgen secretion, at least for the identification of cases in which polycystic disease of the ovary is suspected.

[Use of Lippes Loop in the treatment of post-traumatic uterine adhesions]. / L'uso dei Lippes-Loop nel trattamento delle sinechie uterine post-traumatiche

PIP: After a description of various mechanical devices used to complement surgery in the treatment of uterine synechiae and a discussion of the difficulties involved, 10 cases treated by the authors by using Lipped loop, sometimes in conjunction with a Petit-Lefour tube, are described. As already evident from the literature, Lippes loop is the most effective means of preventing relapses, on both practical and theoretical grounds. The recovery of not only morphological characteristics, but also of functional efficiency of the uterus was demonstrated in 1 case by the occurrence of pregnancy. There were no relapses. It is emphasized, however, that even though excellent results can be obtained by proper treatment, the best treatment of these adhesio ns consists of adequate prophylactic measures.^ieng

[Sex steroids and function of the liver]. / Steroidi sessuali e funzione epatica

PIP: The effects of the sex steroids (androgens, estrogens, and protesterone) on liver function, and the metabolism of these substances and their regulation by the liver, are reviewed. The physiology of the hepatocyte is discussed in relation to the enzyme systems active in various aspects of steroid metabolism, the reductases and dehydrogenases, the hydrolases, and the isomerases. Because of the central regulatory and metabolic importance of the liver, primary genito-endocrine disorders may also have hepatic repercussions. Conversely, correlations between liver disease and menstrual disorders have been found by many authors. Reports of clinical symtomatology and laboratory findings are related to the metabolic processes of the liver and the sex hormones.^ieng