[Peritoneal cystic mesothelioma]. / Mesotelioma cistico del peritoneo.

Cystic mesothelioma of peritoneum is a rare neoplasia that was identified as a individual entity by ultrastructural and immunoistochemical studies. It is more frequent in young woman and often it tends to recur. Because of its rarity and difficulty in differential diagnosis, the Authors describe a case of cystic mesothelioma observed.

[Importance of an outpatient record in obstetric anesthesia]. / Importanza dell'ambulatorio di anestesia ostetrica.

A computerised record was used to collect data following an anesthesiological check-up of pregnant women at approximately 30 weeks of pregnancy. The record was input onto a portable PC in the anesthesia outpatient clinic, memorized on disk (3.5") and then transferred onto a PC network (one PC for each operating theatre) for "real time" consultation of each patient's data. All pregnant women attending the antenatal clinico were also given a folder illustrating epidural anesthetic techniques. Seven hundred and nine outpatient visits have been performed over the past two years with a 62% utilisation ratio. The collection of data using a computerised system allows a rapid and efficacious system of communication to be set up among the membranes of the anesthesiological team, thus encouraging the use of epidural techniques during labour. The distribution of the folder also facilitated the task of the anesthetist who found that pregnant women visiting the anesthesia clinic were already familiar with the epidural technique.

[Continuous infusion peridural analgesia in labor]. / Analgesia peridurale per infusione continua nel travaglio di parto.

A technique of continuous infusion epidural anesthesia was used during labour in 933 patients divided into three groups according to age: Group A (14-18 years old), Group B (19-35 years old) and Group C (greater than 35 years old). Infusion was carried out using the following system: a PVC pressurized bag containing 0.3% marcain connected to 2 flow regulators which ensured a flow of 6 ml/h. During the dilatation phase, 85% of patients received sufficient analgesia, whereas 15% required extra boluses. During the expulsive phase 80% of patients received adequate analgesia of the perineal plane, 12% received an extra bolus of marcain 0.3% and local anesthesia was performed in 8% to allow infiltration. Instruments were required in 5.6% of patients in Group A, 11.3% in Group B and 7.4% in Group C. The incidence of Caesarian section was 5.6% in Group A, 9% in Group B and 14.8% in Group C. No maternal complication was observed. Epidural anesthesia via continuous infusion was therefore shown to be an efficacious and safe method for ensuring analgesia during labour.

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)

New issues for nosografic setting of "HELLP syndrome".

In 1982 Weinstein reported a syndrome marked by Hemolysis, Elevated Liver enzymes, Low Platelets (HELLP Syndrome). Following that report a critical review by MacKenna & Coll. reported that typical signs of the syndrome (observed in 223 cases of preeclampsia) were related to the preeclampsia so denying any nosografic autonomy to it. This report was confirmed by Killan that in 1974 described the classic HELLP syndrome as a complication of hypertensive syndrome in pregnancy. Our case report presents some patterns that may contribute to acquire new data in order to place the HELLP syndrome in its appropriate nosografic allocation.

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