Gestational diabetes and fetal growth acceleration: induction of labour versus expectant management.

AIM: The aim of the study was to compare elective induction of labour at 38 weeks versus expectant management in A1 and A2 gestational diabetes (GDM) pregnancies with fetal growth acceleration. Primary outcome of the study was C-section (CS) rate, while secondary outcomes were macrosomia incidence and adverse perinatal outcomes. METHODS: A retrospective cohort study was carried out. Data were collected between 1996 and 2006 and evaluated through patients' records analysis. Differences between the two study groups were investigated using non-parametric tests for continuous variables and χ2 test for categorical ones. RESULTS: There was no significant difference between induction and expectant management in terms of caesarean section rate. A trend favoring women in the induction group in terms of incidence of macrosomia and neonatal outcomes was identified, but results were not statistically significant. CONCLUSION: Labour induction at 38 weeks in GDM patients with fetal growth acceleration does not seem to determine an increased incidence of C-section in comparison to expectant management, particularly in case of maternal obesity.

[Stress urinary incontinence: an overview on actual surgical trends]. / Incontinenza urinaria da sforzo. Una panoramica su gli attuali trend chirurgici.

Stress urinary female incontinence (IUS) is an unpleasant symptom describing a loss of urine during physical exertion; genuine stress incontinence (GSI) is a socially unacceptable, involuntary loss of urine in absence of detrusor activity from the urethra associated with sudden cough or strain. The incidence of IUS is less than 10% in reproductive-age women but may approach 10-20% in postmenopausal women. The IUS pathophysiology is connected with two specific mechanisms: the urethral-bladder sliding out of anatomical area involves the normal system of endobladder/intraabdominal pressures, with a loss of urine; the second mechanism involves the damaged urethral sphincteric function, with a reduction of the urethral closure pressure and a urinary loss after minimal physical stimulation. The IUS medical therapy is troublesome and often inefficient, and the only approved effective measures are the surgical procedures, actually reserved for cases of unsuccessful medical therapy; surgical treatments can be classified according to the access as: vaginal, abdominal, associated and complex. They intend to reposition the urethral-bladder sliding in its normal intra-abdominal position, to allow equal transmission of increased intraabdominal pressure to the bladder and the proximal urethra. In the scientific literature there are more than one hundred surgical procedures for IUS correction, but the IUS surgical approach is anyway the actual gold standard therapy.

[Magnetic resonance (MR) in endometrial carcinoma preoperative evaluation]. / Impiego della risonanza magnetica (RM) nella valutazione preoperatoria del carcinoma endometriale.

BACKGROUND: Myometrial invasion of endometrial carcinoma is an important prognostic factor because the degree of myometrial invasion is correlated with the rate of lymphnode metastases and of recurrences. The aim of the study was a preoperative evaluation of endometrial carcinoma by Magnetic Resonance (MR). METHODS: The authors present a prospective study performed on 54 cases of endometrial carcinoma collected at the Department of Gynecology and Obstetrics of the University of Trieste (Italy). All the patients were considered as Stage I after hysteroscopy and endocervical curettage. Prior to surgery all the patients underwent MR at the Department of Radiology of the University of Trieste (Italy) in order to evaluate the depth of myometrial invasion. The surgical procedure included total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic and lomboaortic lymphadenectomy in high risk cases. Statistical evaluation was performed by Fischer's exact test. RESULTS: Statistically significant positive correlation was found (p<0.001) between MR staging and surgical staging. The sensitivity reported in our series for distinguishing between superficial disease (Stage IA and IB) and deep myometrial invasion (Stage IC) was 92%. CONCLUSIONS: Preoperative MR is helpful in selecting patients at high risk of nodal involvement and it is suggested that, although MR is considered an expensive examination, its use should be always considered before surgical treatment of patients with high surgical risk.

[Sexual behavior and adolescence]. / Costumi sessuali ed adolescenza.

BACKGROUND: Adolescence represents the period with the highest frequency of negative consequences associated with sexual activities (sexually transmitted diseases and unwanted pregnancies). An epidemiological study was carried out in symptomatic patients attending our Outpatient Clinic for Sexually Transmitted Diseases between April 1995 and April 1999 in order to evaluate the behaviour pattern of the adolescent population and identify the differences compared to the adult population. METHODS: A questionnaire was used to assess the characteristics of two groups of patients: the first consisted of 54 teenagers (13-19 years-old) and the second, the control group, consisted of 917 women aged between 20 and 40 years old. RESULTS: A high percentage of pregnancies (22.2%) and voluntary abortions (41.6%) was observed in teenagers, associated with different sexual behaviours. The age of sexual intercourse was below 15 in 44.4% of adolescents (vs 7.7% of controls), whereas 61.1% had more than one sexual partner and 20.4% had changed partners in the last 6 months (vs 7.4%). 50% of teenagers did not use any method of contraception (vs 44.2%) and barrier methods were only used by 20.4% (vs 18.4%). CONCLUSIONS: Our study confirms the existence of a high-risk behavioural pattern in the adolescent population and draws attention yet again to the need for a serious programme of prevention and sexual education which will allow adolescents to experience the discovery of their own sexuality with greater awareness and safety.

[Typification of HPV in clinical practice]. / Tipizzazione dell'HPV nella pratica clinica.

OBJECTIVE: To improve the sensitivity of cervical carcinoma screening and to determine the optimal management with an ASCUS Pap result we evaluated the effectiveness of combining thin layer cytologic slides (ThinPrep) and HPV DNA testing. METHODS: A total of 170 women were studied with conventional Pap smears, liquid based cytology, HPV testing and colposcopy with eventual histologic evaluation. RESULTS: The ThinPrep method yielded 12.5% more high grade lesions than did the conventional smears (and more severe diagnoses as compared to the conventional smears). HPV prevalence was significantly associated with disease status. Of 30 patients with ASCUS, HPV testing detected 100% of high grade lesions and 67% of low grade. If colposcopy had been limited to HPV+ women, 47% of case would have been spared. CONCLUSIONS: Liquid based cell collection improves sensitivity for the detection of disease. For women with ASCUS cytology, HPV DNA testing of residual specimen can identify the majority of high risk cases using a single sample.

[Villoglandular adenocarcinoma of the cervix uteri. A case report and analysis of the literature]. / Adenocarcinoma villoghiandolare del collo uterino. Descrizione di un caso e analisi della letteratura.

The authors described a case of villoglandular adenocarcinoma of the uterine cervix treated with radical hysterectomy (Piver type 2) and pelvic lymphadenectomy. The cytohistologic and clinical aspects of this rare neoplasia are debated also considering the literature data where, until 1996, 41 cases of villoglandular adenocarcinoma of the uterine cervix were reported (10 cases at Stage 0 and 31 cases at Stage IB), all with favorable prognosis.

Study of the partners of women with human papillomavirus infection.

BACKGROUND: Genital human papillomavirus (HPV) infection is one of the most common sexually transmitted diseases, and it has been identified as a significant risk factor for the development of dysplasia and cancer of the uterine cervix. The possible influence of male HPV lesions on female cervix oncogenesis has not been elucidated so far. In the present study we evaluate the male partners of women with clinical or subclinical HPV infection with particular interest in the clinical features of this infection in both partners. METHODS: We examined 81 male partners of women affected with human papillomavirus infections. Condylomata acuminata were searched for by visual inspection. Subclinical lesions were searched by 5 power optical magnification lens after application of 5% acetic acid. RESULTS: In men we observed the following percentage of infection: 67% of the partners of women affected with condylomata acuminata, 46% of the partners of women affected with subclinical lesions (acetic acid positive), and 40% of the partners of women with association of HPV and cervical intraepithelial neoplasia. CONCLUSIONS: Our data stress that very often the partners of women with HPV subclinical infection, especially when associated with CIN, do not present lesions, and consequently primary prevention may be very difficult.

Immunological study of vulvar lichen sclerosus: preliminary considerations.

Sclero-atrophic lichen (LSA) is a dermatosis that is well defined from the clinical and histological viewpoints, but the etiology remains unknown. The main symptom is a permanent pruritus which results in a gynecological consultation. We have studied the immunological status of 48 patients with LSA and 33 controls. The LSA patients showed a significant diminution of peripheral CD3 and CD1 and tissue CD2, CD3, CD1 and CD8. There was no difference of IgG, IgM or tissue C3c, or serum C3c and C4. These patients also had a higher incidence of autoantibodies.