[Treatment of uterine fibromyoma with bilateral uterine artery embolization: state of the art]. / Trattamento di fibromioma dell'utero mediante embolizzazione bilaterale dell'arteria uterina. Stato dell'arte.

Uterine fibroids are common tumors of the female pelvis. Uterine artery embolization (UAE) is a minimally invasive alternative procedure in appropriate candidates to conventional myomectomy and hysterectomy for symptomatic uterine leiomyoma, reducing or eliminating leiomyoma-related symptoms of bleeding, bulk, and/or pain. In order to completely block the arterial blood supply to the fibroid, UAE is typically performed in both uterine arteries. At 1 year follow-up, the uterus may shrink by up to 55%, however, a re-growth of the fibroid may occur. The rate of major complications and amenorrhea following this procedure is low, ranging in most series from 1% to 3.5% and 1% to 7%, respectively. Nevertheless, the rate of amenorrhea in women over 45 seems to be higher. Women who wish to become pregnant should be cautioned about potential complications during pregnancy. Despite the lack of controlled studies that compared UAE with conventional surgery, and despite limited extended outcome data, UAE has gained rapid acceptance, primarily because this procedure preserves the uterus, is less invasive, and has less short-term morbidity than most surgical options. This review focuses on recent publications evaluating UAE and concludes that it is a safe treatment option, providing substantial improvement in both health-related quality of life and symptom control for most patients, with a very low rate of major complications. Any centre that offers UAE should adhere to published clinical guidelines, maintain ongoing assessment of quality improvement measures, and observe strict criteria to obtain procedural privileges. The gynecologist is likely to be the primary initial consultant to patients who present with myomas symptoms. Therefore, they must be familiar with the indications, exclusions, outcome expectations, and complications of UAE. When hysterectomy is the only option, UAE should be seriously taken into consideration. At this particular moment in time, data are needed from randomized controlled trials comparing UAE with surgical procedures. Current efforts to provide prospective objective assessment of treatment outcomes and complications after UAE will help to optimize women options and clinical guidelines.

[Tocolysis: which are the benefits?]. / Qual é il reale beneficio dell'utilizzo dei tocolitici?

Spontaneous preterm labor is still a major problem in perinatal medicine and it is associated to overwhelming risks of neonatal morbidity and mortality. Delaying delivery for hours, days or sometimes weeks may greatly reduce the short- and long-term perinatal morbidity improving fetal maturity of several organs and systems. Inhibition of uterine contractions may in fact allow to take advantage of the prenatal administration of glucocorticosteroids, which have been shown to reduce the incidence and severity of newborn respiratory distress syndrome. Moreover, delaying delivery may allow the transfer in utero to a maternity attached to a neonatal intensive care unit, therefore guaranteeing the best care for the preterm newborn. Every day gained between 22 and 28 weeks gestation increases survival by 3%. However, since most of preterm deliveries happened to be after 29 weeks, newborn survival is a secondary issue while the main aim of delaying labor in these cases is to improve the function of fetal systems and to try to understand if it is the case of prolonging pregnancy balancing risks of a hostile intrauterine environment towards the possible complications of a premature extrauterine life.

[Vaginal intraepithelial neoplasia and human papillomavirus infection: a report of 75 cases]. / La neoplasia intraepiteliale vaginale e l'infezione da virus del papilloma umano. Un resoconto di 75 casi.

AIM: Vaginal intraepithelial neoplasia (VaIN) is an uncommon and poorly understood disease. Risk factors other than human papillomavirus (HPV) infection could be linked to the onset and evolution of some VaIN. METHODS: In this paper, the results achieved from the analysis of 75 patients with VaIN are reported. From these cases, women with HIV, previous hysterectomy, autoimmune diseases and radio- and chemotherapy have been excluded. Thus, most of these selected cases should be linked to the HPV infection. They have been examined after a distinction between grade and association with coilocytosis. VaIN preferential localization, mean age of patients and manifestation pattern after vaginal colposcopy have then been examined. RESULTS: Although the population size cannot allow evidences, it seems that VaIN with coilocytosis and VaIN I without coilocytosis have preferential localization in the upper third of the vagina. It does not appear that mean age of patients for each grade of VaIN differs significativly, both associated and not associated with coilocytosis. Finally, after vaginal colposcopy, the pattern of VaIN for each grade is absolutely not typical, and it seems that white thin epithelium or negative Lugol area are usually the manifestation of high grades of VaIN too. CONCLUSIONS: These results, if confirmed, could mean that VaIN due to HPV may have a different natural history relating to the site of localization in the vagina and, moreover, that also VaIN of high grade could appear with an innocent vaginal pattern.

Visual fatigue in video display terminal operators: objective measure and relation to environmental conditions.

The lighting conditions, luminance, contrast, and design of the workplace were studied in video display terminal (VDT) work stations operated by a group of female VDT data-acquisition clerks. VDT-induced symptoms were assessed by means of subject answers to a questionnaire. To measure VDT-induced ocular fatigue objectively, refraction power was determined before and at the end of workshift by an infrared autorefractometer. Job-induced refraction changes were then related to visual complaints and conditions in the workplace. The results confirmed that VDT data-acquisition work can lead to temporary myopia (myopization) in a remarkable percentage of operators; a significant correlation between eye discomfort, ocular asthenopia, and myopization was also found. Illumination levels, luminance, and contrast seem to be of paramount importance regarding visual symptoms: neither asthenopia nor myopization was observed when all of these conditions were adequate. If the ergonomic design of the workplace and the viewing distance are adequate, there are also usually fewer musculoskeletal symptoms. Our results suggest that changes in the ocular refraction status before and at the end of the work-shift, as determined by an automatic refractometer, provide a good objective index of VDT-induced "ocular fatigue", which in our study proved to be significantly related to workplace conditions.

Analysis of nandrolone esters in oily injections by reversed-phase high-performance liquid chromatography.

A specific liquid chromatographic (HPLC) procedure is presented for the analysis of nandrolone esters (phenylpropionate, decanoate and undecanoate) in commercial oily injections. The analysis was carried out under isocratic, reversed-phase (RP8 column) conditions using a UV detector (240 nm). The system discriminates between nandrolone alcohol, a potential impurity, and its esters and permits the quantitation of trace benzaldehyde derived from the oxidative degradation of benzyl alcohol. The proposed HPLC method was found to be more specific and accurate than the pharmacopoeial spectrophotometric assay procedure (isoniazid reagent). The interference of benzaldehyde with the isoniazid method was also investigated.