[Importance of endocervical cells in the diagnosis of CIN]. / Importanza delle cellule endocervicali nella diagnosi di CIN.

BACKGROUND AND AIM: The authors performed a comparative study to define the role played by the presence of endocervical cells on the smear in the correct diagnosis of CIN. METHODS: The study was performed from January to December 1996 at the Clinic of Obstetrics and Gynecology of the Second University of Naples and involved 67 women with a histological diagnosis of CIN made in the two previous months of the study. The smears taken earlier were re-examined to assess the endocervical component regarding columnar and metaplastic cells and a comparison was made between smears which were CIN-positive and negative. RESULTS: The difference between positive and negative CIN smears was statistically non-significant for columnar cells (66% vs 56%), unlike the findings for metaplastic cells (82% vs 61%). This demonstrated that CIN smears are more likely to include metaplastic cells compared to negative smears and the two types of smear do not differ significantly with regard to columnar cells. CONCLUSIONS: In order to make a cytological diagnosis of CIN, attention must predominantly be focused on the metaplastic component of endocervical cells.

[Psychological consequences in women with symptomatic HPV infection]. / Conseguenze psicologiche in donne con infezione sintomatica da HPV.

OBJECTIVE: Evaluation of psychological and social aspects of women with diagnosed genital HPV-infection. EXPERIMENTAL DESIGN: A retrospective study of 40 women with a diagnosis of HPV-genital infection has been made. INTERVENTIONS AND MEASURES: A questionnaire for gathering information on social life, sexuality and emotional relationship with the partner was submitted to the patients. RESULTS: There is a high percentage of sexual impairments after diagnosis of HPV-infection. CONCLUSIONS: HPV infections, as many genital pathologies, lead to problems with sexuality as well as hypochondriac fears.

[Authors' experience in the treatment of cervical intraepithelial neoplasia]. / Neoplasia intraepiteliale cervicale. Nostra esperienza di trattamento.

BACKGROUND: During the last ten years, after the destroying intervention for the treatment of cervical intraepithelial uterine neoplasia (CIN = Cervical Intraepithelial Neoplasia) was abandoned, space has been given to the conservative treatment, both destructive and excisional. In this study, conducted at the Department of Gynaecology and Obstetrics of Eboli Hospital (ASL Salerno 2) in collaboration with the Gynaecological and Obstetrical Department of the Second University of Naples, the authors compared the various therapy techniques of the conservative excisional type, using 5 different methods. METHODS: One hundred and fifty-seven women, all with lesions of the neck of the uterus of varying degrees of severity, underwent the treatment. Cytologic and colposcopical controls (follow-up) were carried out at intervals over a period of time. RESULTS: In 5 of the 95 patients (5.3%) who underwent surgical conisation, the presence of invading carcinoma was noted. Of the 19 women treated with diathermical loop, 3 cases of mature squamous metaplasia, 3 cases of CIN I, 8 cases of CIN II, and 4 cases of CIN III were observed. In the 32 patients treated with laser-therapy a complete recovery, equal to 100% was obtained although with slight margins of under-estimation and over-estimation; the same result was verified in the 3 patients treated with electroresection with high frequency radio waves and in the 8 patients treated with microneedle. CONCLUSIONS: On the basis of these results it is concluded that lasertherapy and electroresection with high frequency radio waves (3.8 MHz) using electrodes with "bands" or with "linears" (microneedle) gave the best results for both the therapeutical advantages with anatomical and functional integrity of the cervix and for economic reasons.

[Incidence of CIN in HIV-positive women]. / Incidenza della CIN in donne HIV-positive.

BACKGROUND: The aim of this study was to evaluate the incidence of CIN in HIV-seropositive women. METHODS: A group of 23 women with a mean age of 28 years was recluted. Three of them were clinically affected, and 20 were non-AIDS HIV-seropositive. The patients underwent cervical cytology, colposcopically directed biopsy and T-cell studies. In addition, HPV using the in vitro hybridization, was investigated. RESULTS: Eight of 23 patients (24.78%) had CIN. Patients with CIN had significantly lower CD4 cell counts and CD4/CD8 ratios than those without CIN. Patients with AIDS had higher grade lesions than those non-AIDS HIV-sero-positive. CONCLUSIONS: The data obtained suggest that abnormal cervical pathology is common among HIV seropositive women, and so cervical colposcopy should be part of the routine management of HIV-seropositive women.

[Triptorelin therapy in uterine leiomyomatosis. Study of 18 cases]. / Terapia con triptorelina nella leiomiomatosi uterina. Studio di 18 casi.

BACKGROUND: The validity of tryptoreline treatment in uterine myomatosis is demonstrated, both as alternative therapy to surgery in patients in fertile age and as preoperative therapy reducing myomatosis volume. MATERIALS AND METHODS: In the outpatients department of Gynecologic and Obstetric Institute of the Second University of Naples, eighteen women, from 35 to 56 years old, with symptomatic uterine myomas, diagnosed by clinical examination and confirmed by pelvic ultrasonographic were treated with a delayed-release microcapsule preparation of D-Trp-6-LHRH (triptorelin) injected im, every 28 days. The duration of treatment was 6 months. RESULTS: The results are statistically significant for 16 patients that have completed the therapy with maximal reduction in uterine and leiomyomas volumes after 3 months of treatment. Minor side effects such as hot flushes, vaginal dryness, headache, dyspareunia were frequently encountered, but they disappeared progressively after the end of therapy. CONCLUSIONS: Four months after treatment, no significant increase in uterine and myoma volume, was noted.

Therapeutic protocol of vulvar and cervical HPV-infection.

BACKGROUND: The stages of HPV (Human Papilloma Virus) infection are under the control of the immune system, which is inhibited by the virus itself. Thus, at present the treatment of condyloma acuminata is based on the use of interferon (IFN). The aim of the present study was to evaluate immune system activation and clinical response to IFN therapy. In addition, in the most serious cases, medical treatment with IFN was associated with diathermocoagulation (DTC) of persistent warts. The effectiveness of the combined therapy was also assessed. METHODS: 7 women (age range: 16-52) suffering from cervix condylomata were selected for our study. All of them were injected intramuscularly with doses of 3 million UI of IFN-alpha leucocytar every three days for six weeks together with daily applications of alpha-IFN for six weeks. The women that were still ill three months after IFN therapy, were treated with DTC. In one case, another cycle of IFN treatment was necessary. RESULTS: Clinical response to IFN treatment was complete in 46 cases, partial in 20 cases and unsuccessful in 4 cases. After three months of medical therapy, 30 women were treated with DTC. After this therapy, in 21 cases, the warts were resolved. After 24 months the percentage of relapse was 37.9% when only IFN was used, and 4.51% when IFN was combined with DTC. CONCLUSIONS: These data suggest that a successful protocol for the treatment of condyloma acuminata consist of IFN therapy associated with DTC when warts persisted.

Role of ultrasonography in the early diagnosis of ovarian cancer.

BACKGROUND: Malign ovarian carcinomas are the main cause of death from gynaecological cancer. In fact, only in 30% of cases is it diagnosed at an early stage. In our study the possibility of an early diagnosis of the ovarian malignant neoplasia was evaluated. METHODS: One hundred and thirty-nine women with adnexal swelling were subjected to pelvic echography. The sample was selected during routine gynaecological checkups. RESULTS: All the cases showing a mass diameter exceeding 25 mm were classified as positive. Echotomography showed 129 cases of positive ovarian mass with an accurate diagnosis in 92.27%. Integrating the results of echography with those of radioimmunoassay an early diagnosis of ovarian cancer was achieved in 92.53 of the cases. CONCLUSIONS: A routine pelvic examination associated with pelvic echotomography represent an effective protocol for the diagnosis of ovarian cancer at an early stage.

[Early diagnosis of adenocarcinoma by endometrial cytologic samples]. / Diagnosi precoce dell'adenocarcinoma mediante prelievo citologico endometriale.

145 endometrial cytologic samples were taken by Endocyte and they were compared to histologic samples. The diagnostic concordance was 96.55%, proliferative endometrium, secretory endometrium, hyperplastic endometrium and carcinoma were screened and only 2.75% of cases were uncertain. Endometrial cytology is advantageous because Endocyte can be used in the out-clinic without risks for patients.

[Treatment of endometriosis with GnRH analogues]. / Trattamento dell'endometriosi con gli analoghi del GnRH.

BACKGROUND: Since a continuous administration of adequate doses of luteinizing hormone-releasing hormones (LHRH) or of an agonist leads to a hypogonadism-like condition, it is possible to use this effect for the treatment of endometriosis. The present study reports the results obtained in the Gynaecology and Obstetrics Institute of the Second University of Naples, with a long-acting formulation of a GnRH analogues (D-Trp6-LHRH) in biodegradable microcapsules, at monthly intervals. MATERIALS AND METHODS: The study was carried out on 40 women with endometriosis diagnosed by laparoscopy or laparotomy. The duration of treatment in patients in stage I-II was of 6 months, in patients in stage III or IV was of 9 months. RESULTS: After 12 months from the end of therapy, 27 patients did not show any sign of endometriosis with ultrasound and clinical examination; 13 patients still showing endometriosis were from III or IV stage. CONCLUSIONS: This long-acting formulation should offer a better approach for chronic treatment.