[Sexuality in menopause. Importance of adequate replacement therapy]. / Sessualità in menopausa. L'importanza di un adeguato trattamento sostitutivo.

BACKGROUND AND AIMS: The harmful repercussions of estrogen deficiency in menopause on the female organism are also responsible for reduced libido and uncomfortable trophic disorders of the genitourinary tract leading to reduced vaginal lubrication and severe alterations affecting sexual function, as well as for the more commonplace vasomotor phenomena and psychoemotive changes. METHODS: The authors treated 102 menopausal patients who presented reduced libido and orgasmic difficulties, as well as other menopausal problems, with 17-beta estradiol+noretisterone acetate using a transdermal route. The main advantage offered by the transdermal route is that conjugated estrogens "bypass" the liver and reach the target organs in an unmodified manner. This treatment is well tolerated by almost all patients, even those suffering from slight gastroenteric and hepatic problems. RESULTS AND CONCLUSIONS: This study showed the good tolerability and almost complete innocuousness of the drug used. None of the patients receiving replacement therapy reported any collateral effects worthy of note or the onset of malignant lesions of the breast or pelvic organs. The results obtained show that the use of 17-beta estradiol+noretisterone acetate can effectively modify menopausal symptoms, improving both quality of life and sexual function.

[Vaginal delivery following previous cesarean section]. / Il parto vaginale nelle donne precesarizzate.

BACKGROUND AND AIM: The increased use of cesarean section (CS) over the past 30 years has raised a problem which has been much debated in obstetric practice: is it always necessary to repeat CS in women who have previously undergone cesarean section? The aim of this study was to establish whether women previously undergoing CS can start trial labour? METHODS: The authors examined 195 pregnant women who had previously undergone 1 or 2 CS. Medical history, clinical examination and maternal and fetal monitoring techniques were used to select the women who could start trial labour.

[Ultrasonic monitoring as a method of preventing risks of ovarian hyperstimulation during drug therapy]. / Il monitoraggio ecografico come metodo di prevenzione dei rischi da iperstimolazione ovarica in corso di trattamento farmacologico.

BACKGROUND AND AIMS: Ultrasonographic monitoring represents the most immediate method for an early confirmation of the onset of the worst complication of the pharmacological induction of ovulation: ovarian hyperstimulation. The aim of this study was to evaluate the incidence of this complication in a sample group of anovulatory patients receiving pharmacological treatment and undergoing repeated ultrasonographic monitoring. METHODS: The authors analysed the controls performed during 1996-1997 in which a total of 413 cycles were stimulated. The patients included in the study group (mean age 28.5 years) were treated using clomiphene, oestradiol, FSH, LH and GnRH, and in 5 cases stimulation was preceded by suppression of the menstrual cycle using tryptorelin. Each patient was monitored with 3 scans, except for those treated with tryptorelin or GnRH who were more closely monitored. RESULTS: In 413 patients included in this study the authors noted the onset of slight hyperstimulation in 6 cases (1.45%) which then resolved spontaneously without the need for hospitalisation. CONCLUSIONS: The authors affirm that ultrasonographic monitoring represents a valid means of controlling and preventing the risks of ovarian hyperstimulation.

[Treatment of benign uterine hemorrhage and simple endometrial hyperplasia by endometrial ablation]. / Il trattamento del sanguinamento uterino benigno e dell'iperplasia endometriale semplice mediante l'ablazione dell'endometrio.

BACKGROUND AND AIMS: The technique of endometrial resection by resectoscope represents a valid alternative to hysterectomy in patients with a high operating risk suffering from benign uterine bleeding and simple endometrial hyperplasia refractory to medical treatment or uterine curettage. The aim of this study was to demonstrate the validity of the resectoscopic technique of endometrial ablation. METHODS: The authors performed endometrial ablation using a loop and roller resectoscope in a group of 24 women with refractory menorrhagia which failed to respond to other techniques of first choice. RESULTS AND CONCLUSIONS: The results obtained show the good tolerability of resectoscopic surgery by the patients who, for medical reasons, represented a high operating risk if subject to laparohysterectomy.

[Abnormal uterine hemorrhage in the climacteric. Diagnostic approach]. / Sanguinamenti uterini anomali in climaterio. Approccio diagnostico.

Having made a detailed list of the invasive and non-invasive diagnostic techniques used to evaluate anomalous uterine bleeding in menopause, the authors conclude by affirming that hysteroscopy undoubtedly represents the most reliable diagnostic technique and that echography should be the preferred first diagnostic step since it allows the adnexa to be examined and is less invasive and cheaper.

[Anomalous uterine hemorrhages in the climacteric. Their etiopathogenesis]. / Sanguinamenti uterini anomali in climaterio. Eziopatogenesi.

Anomalous uterine bleeding accounts for approximately two-thirds of the causes of outpatient gynecological check-ups for women in menopause. The high incidence of this pathology raises considerable problems from a clinical and social point of view. In this paper the authors outline the main causes of both organic and functional bleeding.

[Menopause. Hormone substitution therapy and prevention of cardiovascular risk]. / Menopausa. Terapia ormonale sostitutiva (HRT) e prevenzione del rischio cardiovascolare.

BACKGROUND AND AIMS: Cardiovascular disease is the major cause of death in over 60-year-old women. The mean age of onset is about 10 years later in women compared to men, a difference which can be explained by the end of physiological estrogen production in menopause. METHODS: The authors treated a group of 68 menopausal patients with HRT for a period of 5 years. RESULTS: A series of positive effects emerged from the study which were potentially capable of preventing ischemic cardiopathy. CONCLUSIONS: The authors reached the conclusion that--owing to its beneficial effects on lipid and glucose metabolism, as well as on coagulation factors and arterial pressure--HRT is able to prevent cardiovascular disease, reducing the risk of infarction by between 20 and 50%.

[Clinical efficacy of tamoxifen in the treatment of premenstrual mastodynia]. / Efficacia clinica del tamoxifene nel trattamento della mastodinia premestruale.

BACKGROUND: Premenstrual syndrome (PMS), which was first described by Frank in 1931, is a clinical condition that is not easy to classify in terms of either symptoms or from a diagnostic and therapeutic point of view. AIMS: The aim of this study was to evaluate the efficacy of tamoxifen, an antiestrogen drug, using a double-blind study with placebo in the treatment of mastodynia, one of the most frequent symptoms of PMS, given that an absolute or relative increase in estrogens is one of the most controversial etiopathogenetic hypotheses. METHODS: The study included a group of 88 outpatients aged between 22 and 40 with regular menstrual cycles and intense mastodynia. Before commencing therapy, a detailed medical history was compiled for each subject and all underwent a gynecological and breast examination, hematochemical and instrumental tests (scan and mammography) in order to rule out other PMS-related organic pathologies. The patients were randomly divided into two groups of 44: one group received tamoxifen at a dose of 10 mg by mouth from day 5 to day 24 of the menstrual cycle, whilst a placebo was administered to the other group using the same dosage scheme. All women underwent a thorough control examination at the end of treatment and two months after the end of treatment. RESULTS: At the end of treatment 90% of patients reported a complete resolution of symptoms, whilst 10% only showed a slight improvement. In the control group, 86% showed a transitory reduction in symptoms and 13% did not report any improvement. CONCLUSIONS: On the basis of the results obtained, the authors affirm the validity and efficacy of tamoxifen in the treatment of mastodynia in PMS owing to both its innocuity and its atoxity.

[Estrogen and progestin treatment in postmenopause. Effects on the endometrium]. / Trattamento con estrogeni e progestinici in età post-menopausale. Effetti sull'endometrio.

BACKGROUND AND AIMS: It has been well demonstrated that menopausal disorders resulting from the lack of estrogens may be delayed and partly eliminated by appropriate hormone replacement therapy. The aim of this study was to demonstrate the absolute innocuity of the association of estrogen and progestin. METHODS: The authors used an association of conjugated equine estrogens and medroxi-progesterone acetate to treat menopausal syndrome in 80 women aged between 48 and 55 years old. The study lasted 2 years. RESULTS AND CONCLUSIONS: The results obtained showed the good tolerability and marked efficacy of the drugs used, as well as the absolute innocuity in relation to the target organs, namely the breast and endometrium. No cases of endometrial hyperplasia with atypical development or malignant evolution were reported during the study and there was a significant improvement in lipid metabolism, vasomotor or psychomotive disorders, as well as increased trophism of the genitourinary tract and skeleton.

[Abnormal uterine hemorrhage in climacteric. Medical management]. / Sanguinamenti uterini anomali in climaterio. Terapia medica.

Following a review of the literature, the authors examine the drugs which are currently used to treat anomalous uterine bleeding during menopause, illustrating their aims and justifying the rationale underlying their use. They conclude by stating that a satisfactory treatment often does not exist, but it is the task of the specialist to gauge the level and sequence of treatments in order to achieve the hoped-for result.

[Use of a GnRH analogue (leuprorelin) in the therapy of endometriosis]. / Utilizzazione di un analogo del GnRH (leuprorelin) nella terapia dell'endometriosi.

BACKGROUND: Endometriosis is undoubtedly an extremely complex disease from both a diagnostic and therapeutic point of view. The finding that the continuous administration of GnRH analogs suppresses gonadotropin release by the hupophysis, thus blocking ovary function, has promoted researchers to use these drugs in the treatment of endometriosis. AIM: Having reviewed the data reported in the literature, the authors selected from the numerous drugs used to resolve implants (oestroprogestogens, danazol, progestogens, clomiphene citrata, GnRH analogs), a GnRH analog with a depot action known as leuprorelin (D-Leu6-Pro9-NH-Ethylamide). MATERIALS AND METHOD: This drug was administered to 98 patients suffering from endometriosis at a dose of one intramuscular phial every 30 days for six months. RESULTS AND CONCLUSIONS: The results obtained (complete resolution of disease in 610.2% of cases, partial remission in 30.6% of cases, transient improvement in 9.2% of cases owing to reduced patient compliance, percentage of pregnancies after treatment 12%), allow the authors to conclude that the use of a GnRH antagonist, like leuprorelin, owing to its efficacy and good tolerability, represents a valid alternative to oestroprogestogens and Danazol in the treatment of implants and the symptoms of endometriosis.

[Dysspermia due to inflammation. The evaluation of sperm cultures]. / Dispermie su base flogistica. Valutazione delle spermioculture.

The study evaluates 160 cases of positive spermioculture taken from 522 sterile individuals examined by the authors at the Couple Sterility Outpatient unit in Department A of the Institute of Gynecology and Obstetrics at Turin University during the period between January 1984 and December 1993. The germs responsible for infection were assayed in order to evaluate the strains which showed the highest incidence every year. Whereas there was no significant change in the absolute number of cases of sterility over the period, the number of cases caused by infection increased significantly during the second five-year period. It was found that the germs predominantly implicated in the genesis of male sterility formed part of the so-called mixed flora group, responsible in women for syndromes of often asymptomatic bacterial vaginosis which are not identified and consequently not treated.

Asymptomatic bacteriuria in pregnancy: a diagnostic and therapeutic approach.

Pregnancy is a predisposing factor for urinary tract infection and pregnant women suffering from this pathology are exposed to dangerous risks which may condition maternal wellbeing and fetal prognosis. The apparently paradoxal finding of a higher incidence of perinatal problems in pregnant women with asymptomatic bacteriuria compared to those with manifest infections may be explained by the fact that the latter are adequately treated, whereas asymptomatic bacteriuria, which is difficult to diagnose, may continue in a subtle form for the entire duration of pregnancy. This emphasises the importance of the early diagnosis of infection using a protocol based on urine tests and urine culture and the adequate treatment of all cases of asymptomatic bacteriuria in order to reduce the incidence of maternal and fetal complications (acute pyelonephritis, increased fetal morbidity and mortality). The choice of the antibiotic to be used must be made on the basis of the urine culture test, the stage of gestation, maternal clinical data and the characteristics of the antibiotic itself (pharmacokinetics, maternal and fetal toxicity). With regard to the treatment protocol, the "single-dose" protocol is currently preferred. After negative urine culture tests, all patients must carry out a complete urine test each month with hormonal and echographic monitoring of the fetoplacental unit.

Asymptomatic bacteriuria in pregnancy: maternal and fetal complications.

From an analysis of the data reported in the literature it is clear that pregnancy is a predisposing factor for urinary tract infection and that pregnant women with this pathology are exposed to dangerous risks which may influence maternal wellbeing and fetal prognosis. Authors do not concur on the specific risks to the mother and fetus, one reason being that the statistics reported to date reveal discrepancies relating to the presence of disorders prior to pregnancy and the environmental, working and socio-hygienic conditions of the populations studied. The apparently paradoxical finding of a higher incidence of perinatal problems in pregnant women with asymptomatic bacteriuria compared to manifest forms can be attributed to the fact that the latter are treated with adequate therapies whereas asymptomatic bacteriuria, which is difficult to diagnose, may persist throughout pregnancy. This underlines the importance of early diagnosis using a protocol which entails the execution of serial urine tests and urine cultures and adequate treatment of all cases of asymptomatic bacteriuria in order to reduce the incidence of urinary tract infections and materno-fetal complications. Non-treated asymptomatic bacteriuria in fact represents a considerable risk factor since it may lead to the onset of acute pyelonephritis in approximately 5% of pregnant women and may increase the risk of fetal mortality.

[Intramuscular beta-interferon in the treatment of cervical intraepithelial neoplasia (CIN) associated with human papilloma virus (HPV) infection]. / Beta-interferone per via intramuscolare nel trattamento delle neoplasie cervicali intraepiteliali (CIN) associate ad infezione da human papilloma virus (HPV).

In an attempt to find less aggressive and more efficacious tools for the treatment of cervical neoplasia (CIN) associated with genital HPV infection, the authors have examined a therapeutic approach based on the strengthening of natural defences. For this purpose, a group of 10 patients diagnosed with CIN associated with HPV infection received beta-IFN therapy at a dose of 300,000 UI/die i.m. for 7 days, continuing the same dose on alternate days for 2 weeks. At the end of the follow-up results were satisfactory especially if compared with those from a control group of 9 patients. These results appear to indicate beta-IFN as the treatment of choice in HPV infections in young women wishing to have children in order to preserve the anatomic and functional integrity of the lower genetical tract.

[Ovarian hyperstimulation syndrome (OHS): borderlines between physiology and pathology]. / Sindrome da iperstimolazione ovarica (SIO): limiti tra fisiologia e patologia.

The use of gonadotropins in therapy has led to the appearance of a complication due to hyperstimulation, referred to as "syndrome due to ovarian hypertension" (SOH). There are three clinical stages of SOH: slight, moderate and severe, caused by a pathogenetic mechanism which is thought to involve the action of prostaglandins and the renin-angiotensin system leading to an alteration in capillary permeability with increased ovarian diameter. SOH can be prevented using a protocol to evaluate clinical conditions during therapy mainly based on hormone assays and echographic monitoring. SOH can be predicted but not prevented, thus making it important to commence immediate treatment for in-patients so as to restore the volume of blood and the blood protein load in the most severe cases.

Antineoblastic activity of antioxidant vitamins: the role of folic acid in the prevention of cervical dysplasia.

The authors made a study on 90 patients affected by various degrees of uterine cervix dysplasia searching for folic acid plasmatic concentrations. The team members affected by CIN have been compared with a test team consisting of women with normal pap-test and vaginoscopy. The study proved that the average levels of folic acids have significantly decreased in cases of dysplasia compared with the test team. These results allow stating that low folic acid plasmatic concentrations may be associated with cervix neoplasms development.

Danazol in the treatment of endometrial hyperplasia.

The paper reports the results of a study performed in 62 menorrhagic women with endometrial hyperplasia treated with Danazol. The efficacy and tolerability of the above drug was found to be satisfactory.

[Cholestasis in pregnancy]. / La colestasi gravidica.

The authors report the main morphological and functional alterations of the liver during the course of pregnancy. The size of the organ does not change and there is a slight (20%) reduction of hepatic flow. Hepatic function is partially modified in view of the following factors: reduced protein synthesis (in particular the albumin component), increased serum levels of cholesterol and triglycerides mediated by steroid hormones, inhibition of canalicular secretion and consequent diminution of the liver's excretory function, variations in serum levels of many markers of cholestasis so much so that they become unreliable due to pregnancy. The high level of sexual steroids also influences cholecystic kinetics: progesterone, in particular, negatively affects the contractile response to cholecystokinin-pancreozymin stimulus. The paper then reports some historical data including those which led to the definition of "gravidic cholestasis" as a clinical condition. The incidence of the disease varies considerably in relation to the geographical area and genetic factors. In Sweden and Finland the percentage ranges between 1 and 3%, whereas much higher values (12-22%) are reported in Chile and among the American Indians. The latest data for Italy reveal an incidence of 0.34%. The onset of disease is conditioned by familial predisposition due to an enhanced sensitivity to estrogens or excessive production of estrogenic metabolites. Among the hepatocytic changes induced by estrogens are the reduced fluidity of sinusoidal plasmatic membranes and the inhibition of vasolateral Na+K+ ATPase pump activity. The last months of gestation are characterized by a "cholestatic state" which may vary in severity from slight symptoms, to itching and idiopathic jaundice.(ABSTRACT TRUNCATED AT 250 WORDS)

Perinatal mortality and morbidity in premature birth.

In a study carried out in 100 cases of premature birth in Section "A" of the Department of Gynecology and Obstetrics of the University of Turin, the authors report a perinatal mortality rate of 5.4%. Perinatal morbidity was found to be very high (68.2%). These findings--which are perfectly in line with those reported in the literature--explain why premature birth is one of the most important topics of research in modern obstetrics.