[Microbiological and serological study in cases of infertility with or without sterility with particular emphasis on the etiological role of Chlamydia trachomatis]. / Indagini microbiologiche e sierologiche in casi di infertilita' e/o sterilita' con particolare riguardo al ruolo svolto in essi da Chlamydia trachomatis.

Microbiological investigations were carried out on two groups of men and women--a) with genital non gonococcal pathology and--b) in infertile/sterile people of the same sex and age (mean age 28.4 y) with the aim to document in them the prevalence of various microorganisms particularly of Mycoplasma/Ureaplasma and Chlamydia trachomatis as aetiological agent of their pathology. Serum antibodies to Chlamydia trachomatis were also studied by microimmunofluorescence, immunoperoxidase and ELISA methods in the same population in comparison with apparently healthy blood donors of the same sex and age as control. Finally, 56 infertile/sterile couples were included in this study to investigate the possible role of Chl. trachomatis. Various microorganisms were isolated more frequently from women of the group b) (45.5%-22.9% respectively p less than 0.01). Mycoplasma/Ureaplasma in comparison with Chl. trachomatis were prevalent in all groups investigated (p less than 0.01). Infertile/sterile women had higher anti Chl. trachomatis antibodies than did women with genital non gonococcal pathology or women of the control group (p less than 0.01). Mycoplasma/Ureaplasma strains were isolated from infertile/sterile couples more frequently than Chl. trachomatis but the women of these couples had high titres (greater than 128) of anti Chl. trachomatis antibodies. Finally, IgA as well as IgG anti Chl. trachomatis antibodies were demonstrated in two out of nine peritoneal fluid samples obtained from women affected by PID. In one case, a pregnancy underwent after an ad hoc therapy of the two partners from whom two Ureaplasma strains were isolated.(ABSTRACT TRUNCATED AT 250 WORDS)

Hysteroscopic metroplasty: the role of ultrasound in the diagnosis and monitoring of patients with uterine septa.

52 patients with septate uterus underwent hysteroscopic metroplasty in the Obstetric and Gynecologic Clinic "R" in Palermo. In this group of patients ultrasound examinations were also performed in order to define their role in diagnosis of type of malformations and in monitoring the endoscopic surgical procedure. Preliminary results seem to indicate that real-time ultrasound is a reliable technique for both purposes.

Microbiological investigations on genital infections: a nosocomial experience in Palermo.

The new methods for in vitro fertilization and GIFT induced the authors to carry out a retrospective survey on microbiological investigations done on 820 patients (641 women and 179 men) affected with genital infections and 62 newborns hospitalized during the period 1980-1986 to the aim of studying the prevalence of the various microorganisms responsible for sexually transmitted diseases in our area. The biological material obtained from men gave positive results less frequently than that obtained from women (p less than 0.001) although the prevalence of "significant" microorganisms isolated from the same material was overlapping for both sexes (p greater than 0.5). Chlamydia trachomatis positive samples were rare in men (6.1%) as well as in women (4.2%); in one case C. trachomatis was contemporaneously observed in the auricular swab of a newborn and from the cervical swab of the mother. Herpes Simplex virus positive samples were observed in 4 (11.8%) out of 36 women only. This study confirms the usefulness of the microbiological investigation before undertaking attempts for in vitro fertilization.

Treatment of endometrial hyperplasia with levonorgestrel releasing intrauterine devices.

The effectiveness of a new levo-norgestrel releasing intrauterine device is assessed in fourteen patients with histologically confirmed hyperplastic lesions of the endometrial mucosa. The morphologic response of the hyperplastic endometria to the action of the levo-norgestrel in this study explains the regression of the cases so treated.

PIP: Levonorgestrel was inserted into the uterine cavity by means of a Nova-T device loaded with 46 mg of the drug in a study designed to assess the effectiveness of Levonorgestrel in the treatment of hyperplastic lesions of the endometrial mucosa. The device is programmed to release 3 mcg of L-norgestrel, a strong synthetic progestin, a day for a period of 5 years. The device was inserted from 60 to 27 days preceding the hysterectomy in the 1st group of patients -- 5 women ranging in age from 36-49 years who were candidates for hysterectomy because of benign uterine pathology. The 2nd group was made up of 14 patients with histologically confirmed endometrial hyperplasia. In 6 cases it was a simple form; 4 were suffering from cystic hyperplasia. The remaining 4 cases were diagnosed as adenomatous hyperplasia, 1 with and 3 without cytological atypica. In these 14 patients, the L-norgestrel-releasing device was inserted immediately after hysteroscopic examination with direct biopsy sampling to determine the condition of the endometrium before the treatment. The 1st hysteroscopic follow-up examination with direct biopsy was performed about 60 days after the beginning of the treatment. In the 1st group, the aim of the histological investigations was to determine whether the effect of the L-norgestrel was limited to the area immediately adjacent to the device or whether the whole thickness of the endometrium had been affected by the morphological changes caused by the hormone. The samples taken at different levels of the uterine cavity in the 5 hysterectomized cases show a uniform picture, i.e., without any variations due to the sampling site or nearness to the device. In all cases, the endometrial mucosa was substantially hypotrophic or even atrophic. The glands were reduced in size and morphologically atrophic. The epithelial lining was cylindrico-cubic, monostratified, and without mitosis. The effect of the hormones could be observed throughout the whole thickness of the endometrial mucosa, as far as the basal layer. In the 2nd group, all the 6 cases of simple hyperplasia of the endometrial mucosa showed a morphological picture of glandular atrophy and extensive predecidual reaction from the very 1st control performed after 2 months. After 5 months, the 4 cases of glandular-cystic hyperplasia showed that the original morphological picture had given way to the typical changes produced by L-norgestrel. In the 3 cases without cytological atypica, hysteroscopic and bioscopic examinations after 2, 5, and 8 months showed a gradual disappearance of the irregular proliferation of the endometrial mucosa, and the appearance of a morphological picture of predecidual transformation of the endometrial stroma and much atrophy of the glandular structures.

In vitro sperm capacitation and intrauterine insemination (IVC-Insem): a simple technique for the treatment of refractory infertility unrelated to female organic pelvic disease. Clinical results and immunological effects: a preliminary report.

12 couples, with infertility due to male subfertility, female antisperm isoimmunization, male antisperm autoimmunization, cervical mucus insufficiency or unexplained infertility underwent intrauterine A.I.H. with capacitated sperm and controlled ovarian stimulation. The pregnancy percentage was of 41.6% per woman treated and of 31.2% per treatment cycle; five pregnancies were obtained, of which two resulted in abortions. Five cases of oligoasthenospermia were treated, three severe and two moderate; two pregnancies occurred in the former and one in the latter. S.I.T. and S.I.T.-cap. were performed on the serum, and Micro-S.I.T. and Micro-S.I.T.-cap. on the cervical mucus in order to exclude the possibility that intrauterine A.I.H. with capacitated sperm might have caused capacitated or non-capacitated antisperm immunization. Intrauterine A.I.H. would seem to be a useful alternative to G.I.F.T. and to I.V.F./E.T. or at least a technique which should be performed before these two in cases of infertility not caused by female organic pelvic disease; it is cheap, simple and extremely well-accepted by the patient.

Superficial endometrial involvement by cervical intraepithelial neoplasia detected by intrauterine cytology. A case report.

A case of cervical carcinoma in situ with superficial spread to the endometrium is presented. The role of endometrial cytology in the diagnosis of such neoplastic diffusion spread is emphasized.