Evaluation of nonspecific immunity and plasma levels of interferon-gamma, interleukin-6 and tumor necrosis factor-alpha in preeclampsia.

In this study we evaluated the maternal cell-mediated immune aspects of preeclampsia in terms of phagocytosis and killing of monocytes and polymorphonuclear cells. To evaluate the contribution of cytokines (Cks) in the pathophysiology of preeclampsia, we investigated the plasma levels of interferon-gamma (IFN-gamma), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha), respectively, by an enzyme-linked immunosorbent assay. Data showed that phagocytic and killing activities of monocytes were depressed in preeclamptic and normal pregnancies. At the same time, IFN-gamma plasma levels were undectable in both groups. Conversely, we detected significant levels of TNF-alpha in plasma from preeclamptic and normal pregnancies. Moreover, since in three preeclamptic patients the onset of severe preeclampsia was associated with a sharp increased of TNF-alpha plasma levels, we suggest that an increased production of this CK may be implicated in the pathophysiology of preeclampsia.

Postmenopausal users of long-term hormonal replacement therapy: social-cultural features.

OBJECTIVE: To study of influence of social-cultural factors on the effects of long-term hormonal replacement therapy (HRT) in preventing cardiovascular disease and menopausal osteoporosis. METHOD: We examined, perspectively the social-cultural features of 394 postmenopausal women who attended the menopausal out-patient department and were eligible for long term HRT. RESULTS: The HRT users were thinner and younger, with earlier menopause, physically more active, healthier, with more oophorectomies and with more professional work. Data shows that, as a whole, a greater number of healthy women are selected or self-selected for HRT. CONCLUSION: Evaluating the results of long-term HRT in preventing cardiovascular disease and menopausal osteoporosis, the social-cultural features of HRT users must be carefully considered before any mass preventive interventions.

Recurrent peripartum cardiomyopathy.

Peripartum cardiomyopathy (PPCM) is an uncommon myocardial disease arising in the latter part of pregnancy or during the first five postpartum months, in the absence of any obvious cause and with no previously known heart disease. The risk of recurrence of PPCM is considered low when left ventricular size and function return to normal: We illustrate a case of peripartum cardiomyopathy recurred in subsequent pregnancy despite the rapid return to normal of heart size and function.

[Ultrasonic evaluation of endometrial changes induced by cyclic sequential hormone substitution therapy]. / Valutazione ecografica delle modificazioni dell'endometrio indotte dalla terapia ormonale sostitutiva sequenziale ciclica.

BACKGROUND: At present the hormonal replacement therapy on postmenopausal women with uterus needs the use of progestins additionally to estrogens, to eliminate the risk of endometrial hyperplasia and carcinoma connected with the use of estrogens alone. The check of the endometrium during these therapies can be made by transvaginal ultrasound that permits the evaluation of the thickness, structure, and contour of the endometrial rima. The aim of this study was to establish the changes of endometrial thickness during cyclic sequential hormonal replacement therapy on healthy postmenopausal women with transvaginal ultrasound. METHODS: The endometrial thickness with transvaginal ultrasound has been evaluated during the cyclic sequential hormonal replacement therapy on 20 healthy women in physiological menopause before the treatment, during the phase of treatment with estrogens alone and during the phase of treatment with the addition of the progestins. RESULTS: Significant differences during the estrogenic phase compared to before treatment have been underlined (5.7 mm vs 3.5 mm p = 0.002), but not during progestinic phase compared to estrogenic (6 mm vs 5.7 mm p = 0.712). CONCLUSIONS: Transvaginal ultrasound is a useful investigation to evaluate the modifications of the thickness and structure of the endometrium during hormonal replacement therapy and can help early diagnosis of endometrial diseases during these treatments.

[Delivery in nulliparous women aged < or = 18 years]. / Il parto nelle nullipare di età < o = 18 anni.

METHODS: A retrospective study of 733 nulliparous women who gave birth at the Department of Obstetrics and Gynecology at the University of Bari, in the period from 1-1-1994 to 31-12-1995, was performed to evaluate the outcome of pregnancy and neonatal outcome in adolescents < or = 18 years old. The sample was subdivided into two subgroups; the first of 114 girls < or = 18 years old; the latter of 619 women 22-34 years of age, and they were compared. RESULTS: We have found a more lengthy term of pregnancy (39.66 weeks vs 39.27 weeks p = 0.008) and a greater incidence of vacuum extraction (VE) in the group of < or = 18 years old (7.89% vs 3.23% p = 0.03).

Smoking and menopause.

A retrospective study on 293 women who attended the Physiopathology of Human Reproduction menopausal out-patient clinic at Bari University Hospital throughout 1995, has been carried out to evaluate correlations between smoking and climacteric syndrome. From the data we have discovered an earlier onset of menopause in the smokers. Fewer smokers were married and they worked more, drank more, and were more educated. The incidence of climacteric syndrome did not differ between smokers and non-smokers.

Climacteric syndrome and body-weight.

A retrospective study on 181 women who attended the menopausal out-patient clinic of Physiopathology of Human Reproduction at Bari University Hospital throughout 1995, has been carried out to evaluate the relation between body-weight (valued as BMI) and the climacteric syndrome. From the data we have discovered that hot flushes and sweating are more common in women with greater body-weight. Also, women with BMI > 23.8 were found to have a lower level of education.

[Blood transfusion in benign obstetric-gynecologic disorders]. / La trasfusione nelle affezioni benigne ostetrico ginecologiche.

Objective of our study was to determine the incidence of blood transfusions in patients treated with abdominal or vaginal surgery for benign pathologies, because of high risks (especially infections) connected to this practise, and to evaluate the possibility of a simple medical treatment in patients with anemia and not to use blood transfusions. Examining our activity in a five-year period, from 1988 to 1992, we report that the use of blood was required for only 21 women, 1.5 percent of patients with gynecological problems (10 over 639) and 0.17 percent of pregnant patients (11 over 6208). We had more anemia in the abdominal approach than in the vaginal way. A group of 20 young women, with the efficient cardiovascular system, with severe-mild anemia too, were treated with simple medical support, obtaining, in a short time, good clinical conditions.