[Screening for carcinoma of the cervix today]. / Lo screening del carcinoma cervicale oggi.

A revision of the more recent literature has been made in the order to establish which are, actually, the "gold standard" procedures in the planning out and the management of screening programs for cervical cancer. The problem of the false negatives responses, which make necessary the adoption of adequate reporting systems and quality control programs, is relevant. A centralized and "organized" screening policy, involving most of the female population, is also mandatory, keeping in the mind the amount of work for the public health services. The ultimate goal is to assure a "cover" percentage higher than the actual levels, reaching an acceptable balance in terms of cost-efficiency.

The efficacy of clarythromycin (A-56268, TE-031) in the treatment of genital chlamydial infection.

The authors report the preliminary results of an experience of treatment with clarythromycin in Chlamydia trachomatis endocervicitis/endourethritis; 100% of 51 outpatients treated had negative ELISA results 7-10 days after the end of treatment with clarythromycin 500 mg. b.i.d. for 7 days. Among 64 female outpatients with chlamydial cervicitis treated with erythromycin 1 g b.i.d. for 7 days, 88% were negative at ELISA at the same intervals after therapy. The authors conclude that the efficacy of clarythromycin in this experience makes it use worthy of other and more extensive studies.

Failure in intrauterine contraception. Analysis of 137 cases of unfavourable outcome.

137 cases of unfavourable outcome in IUD insertion (i.e. early removal or expulsion because of complications) were investigated as regards age, parity, previous intrauterine contraception, previous induced abortion, type of device inserted, and type of complications observed. Moreover, this group was compared for each feature mentioned with a control group of 454 women who successfully concluded the prescribed period from the insertion. All the devices were inserted with a significantly higher rate of favourable outcome in pluriparous versus nulliparous patients; age probably didn't affect the outcome, but strongly conditioned the prevalence of particular complications such as PID and abnormal bleeding. Progesterone-loaded IUD didn't show a more favourable outcome than copper devices.

PIP: The factors associated with 137 cases of IUD expulsion or early removal due to complications were investigated in a case-control study conducted at an Italian family planning clinic. The 454 controls were women who did not experience adverse IUD outcomes. Complications in the study group included: bleeding (35%), expulsion (13%), pregnancy (13%), pelvic pain (15%), and pelvic inflammatory disease (24%). The majority of complications occurred 6-12 months after IUD insertion. Previous IUD use and the type of IUD inserted were unrelated to outcome. Most significant in terms of outcome was parity. There was a statistically significant (p .001) difference between the percentage of nulliparae in the study group (34%) compared with the control group (17%). Although most of the nulliparae in the study group were under 20 years of age, age did not have a significant correlation with IUD outcome. Pelvic inflammatory disease was significantly more prevalent in women under 30 years of age, while excessive bleeding was more common in cases above this age.

[Comparison of cytology and ELISA in the research on cervical Chlamydia infection]. / Citologia ed ELISA a confronto nella ricerca della Chlamydia cervicale.

Papanicolaou smears from 100 woman with ELISA Chlamydia-positive (42) and negative (58) endocervical smears were examined. Chlamydial endocellular inclusions were found in 3 ELISA positive and 2 negative smears, with an evident low sensitivity (7%) of cytology in the diagnosis of the endocervical infection. Furthermore, by statistical analysis it is clear that a negative test doesn't add anything to the pre-test probability (prevalence) of the infection. On the other hand a positive pap-smear adds a poor information, if compared with immunoenzimathic assay and IF staining. Thus, the Papanicolaou smear can't be considered of diagnostic value for Chlamydial infection. Furthermore, it proves unsuitable even for screening programs on high-risk patients, concerning which the immunoenzymatic assay appears, as previously affirmed, the most suitable effort.

[Experience with intrauterine contraception. Survey of 600 IUD users at the S. Anna University Hospital in Rome]. / Esperienze di contraccezione intrauterina. Rilievi su 600 utenti di IUD presso l'Ospedale Universitario S. Anna in Roma.

PIP: A group of 600 IUD users aged 26 to 35 were studied. 440 women were married; 434 were pluriparae and 166 nulliparae. 24 (5.5%) had undergone cesarean section, and 266 (44.3%) had had induced abortion. 23% of single women had opted for voluntary termination of pregnancy, while 72% had previous experience with IUDs or oral contraceptives. 273 (45.5%) relied on behavioral methods of contraception, 33 (5.5%) used the diaphragm, 279 (46.5%) used pills, 124 (20.6%) used condoms (50.6%) used ML-250 IUD, 144 (24%) used Progestasert, 87 (14.5%) used Gravigard, 42 (7%) used Minigravigard, 18 (3%) used Nova-T, 4 (0.6%) used Anticon, and 1 (0.1%) relied on No-Gravid. The IUD was removed prematurely in 119 cases, 339 were removed at the end of usefulness, dropout occurred in 51 cases, and expulsions in 14 cases. IUD failure was registered in 103 cases corresponding to 21.8% of the total. Bleeding caused 31 instances, 22 were due to dislocation, there were 15 intra -uterine pregnancies, 14 expulsions, 11 cases of pelvic pain, 4 cases of pelvic inflammatory disease, 3 cases of extrauterine pregnancy, and 3 other failures of IUDs. 31% of failures occurred in the 31-35 age group, and 40% of nulliparous women had IUD experience, but only 22.8% had a positive experience. 83.9% of those who used progesterone-containing pills had success with them, only 16.1% failed. Pluriparae over 30 used Progestasert most successfully. Nulliparous women did not represent the ideal candidates for IUD use, previous positive experience was an important element of success, while less important factors were age and abortion history.^ieng