[Prevalence of urinary incontinence and pelviperineal rehabilitation during the postpartum in a cohort of primipara and secondipara patients]. / Prevalenza dell'incontinenza urinaria e della riabilitazione pelvi-perineale nel postpartum in una coorte di pazienti primipare e secondipare.

AIM: Urinary incontinence is a classical sign of childbirth-related perineal trauma, the prevalence of which is estimated, depending on age, at between 10% and 50%. Pelviperineal rehabilitation offers an excellent opportunity to prevent pelviperineal disorders. The aim of the present study was to evaluate the prevalence of urinary incontinence and pelviperineal disorders in the local context, and also that of pelviperineal rehabilitation. METHODS: Of the 1793 women who gave birth in Udine in 2006, 900 primipara and secondipara Caucasians with single term pregnancies dated ultrasonically to be within 20 weeks of gestation, were selected. A total of 602 of them were contacted by telephone and two questionnaires were administered. RESULTS: The prevalence of pelviperineal rehabilitation in our population was 4.49%, while that of pelviperineal disorders was much higher, at around 40.20%. The prevalence of urinary incontinence was due in 27.57% of cases to stress and in 14.45% to urgency, with an overlap in 9.8% of cases and a story of prior incontinence in 9.97%. The prevalence of urinary urgency in women subjected to rehabilitation is significantly lower than in those not treated (P=0.004). Dyspareunia represents 16.11% of cases, coital incontinence 0.33%. One case of gas incontinence emerged but there was no case of faecal incontinence. CONCLUSIONS: Pelviperineal rehabilitation in the observed population has a very low prevalence, especially if compared with the high prevalence of disturbances related to dysfunctions of the pelvic floor during postpartum.

Placental corticotropin-releasing factor. An update.

Corticotropin-releasing factor (CRF) produced in placenta has paracrine effects within placenta, decidua, and myometrium and endocrine effects on mother and fetus. CRF is a potent local regulator of myometrial contractility and of prostaglandin release, Recently, urocortin, a new member of the CRF family, has been localized in human placenta and membranes. Urocortin mimics some of the local effects of CRF in intrauterine tissues, that is, increase of adrenocorticotrophic hormone (ACTH) and prostagiandin release and myometrial contractility. A local CRF-BP modulates the paracrine effects of CRF and urocortin. The various CRF receptor subtypes are well distributed in placenta and membranes. CRH also acts on placental blood vasculature and has an action on fetal adrenal gland to stimulate the production of the steroid DHEA-S. In nonpregnant women, plasma CRF levels are low; they become higher during the first and second trimesters of pregnancy. A clear increase is evident at term and when CRF-BP levels decrease. Women with preterm labor show high CRF and low CRF-BP levels, supporting an involvement of this pathway in mechanism of parturition.

[Therapeutic protocols compared in the treatment of postmenopausal osteoporotic disease]. / Protocolli terapeutici a confronto nel trattamento della malattia osteoporotica post-menopausale.

The authors have compared the results obtained using four main drugs (calcitonin, ipriflavone, transdermal estrogens, fluorine-calcium) actually employed for the treatment of post-menopausal osteoporosis, administered to four groups of fast loser patients (442) in natural (months mean 19.97 +/- 5.99) and surgical (months mean 16.94 +/- 4.29) menopause. After six months of treatment, the efficacy of therapy has been evaluated on the basis of BD (bone density) and osteoarticular pain changes. The BD results have been compared with those of 100 non-treated patients, in the same clinical conditions. The authors have noticed an increase in bone mass (from +0.47% to +1.59%) and a great improvement in osteoarticular pain with all therapeutical protocols used while in the control group there was a progressive decrease of BMC (-1.23%) and a worsening pain. Comparing the results obtained with different therapies, the difference of mean mineralometric gain is not particularly significant among several treatments; but this difference is very significant between treated and non-treated patients who have continued to lose bone mass. The collateral effects, observed during administration of different drugs, have been minimal and the suspension of therapy has been always associated to their disappearance. In the opinion of the authors the good results, achieved with different therapies, depend on the precocity of the treatment, but also on the fact that, in peri-menopausal period, their effect has been increased by the estrogens. Being osteoporosis a multifactorial pathology, a careful control of the risk factors is appropriate and needs to be enforced in order to carry out a precocious treatment with specific drugs on bone metabolism and try to balance the natural turnover with the loss of bone mass.