AlphaScope vs lens-based hysteroscope for office polypectomy without anesthesia: randomized controlled study.

In this randomized controlled study, effectiveness, operative time, and acceptability of endometrial polypectomy were compared using an AlphaScope vs an office operative lens-based hysteroscope (LBH). One hundred fifty women with a diagnosis of endometrial polyp were operated on using an AlphaScope or LBH in the office setting. In 73 procedures using the AlphaScope (97.3%) and 68 using the LBH (90.7%), the polyp was successfully removed completely. In the AlphaScope group, 2 procedures were incomplete because of excessive endometrial mucosa thickness. In the LBH group, 3 procedures were incomplete because of difficulty in management of a large polyp, and 4 procedures were stopped because of patient pain and low compliance. Time to completion of the procedure and complete removal of the polyp was significantly shorter in the AlphaScope group than in the LBH group (p < .05). Similarly, the pain score at the end of the procedure was significantly lower in the AlphaScope group than in the LBH group (p < .05). The AlphaScope is an effective operative hysteroscope that increases the possibility of performing endometrial polypectomy in the office setting without anesthesia and improves the indications for and acceptability of office hysteroscopy.

Prenatal sonographic imaging of an immature intracranial teratoma.

This article describes the prenatal sonographic diagnosis of a rare case of intracranial immature teratoma in a fetus at the 35th week of gestation which looked normal at previous examinations. At sonography a markedly enlarged fetal head containing a complex irregular mass and hydrocephalus was detected. Color Doppler examination of the mass showed intense vascularization with low resistance flows.

Improvement of Pap smear sensitivity using a visual adjunctive procedure: a co-operative Italian study on speculoscopy (GISPE).

The present study evaluates whether speculoscopy, a magnified chemiluminescence examination, combined with Pap smear can improve the detection of cervical lesions, as compared with Pap smear alone. The investigation was a prospective practice-based research carried out as a multicentre cohort study throughout the Italian territory. The participants were 3,300 asymptomatic women age > or = 18 years undergoing routine pelvic and cytological screening. All participants were subjected to Pap smear, speculoscopy and colposcopy investigations in succession. The 646 women with positive colposcopy underwent biopsy. Of the 267 women with positive histology 25 were high-grade intraephitelial lesions (HGSIL) and 242 were low-grade intraephitelial lesions (LGSIL). The histological findings were correlated with the results of Pap smear and speculoscopy alone and combined (PPS). Pap smear alone detected 76% of HGSIL, speculoscopy alone identified 84% of HGSIL, and PPS indicated 100% HGSIL. Of the 242 women with LGSIL, Pap smear alone detected 37% of the cases, speculoscopy alone detected 54% of the cases, and PPS identified 91% of the cases. Together, the two tests missed 9% of the LGSIL. The combination PPS was found to increase sensitivity from 40% to 92%, but to lower specificity from 94% to 23%. Speculoscopy combined with Pap smear can yield a higher percentage of women with biopsy-confirmed cervical pathology than the use of Pap smear as a sole screening test. This is particularly true of patients with LGSIL. The mechanisms of pathological detection and the use of speculoscopy should be investigated further.

Solitary intracranial metastases from primary endometrioid ovarian cancer.

A rare case of involvement of the Central Nervous System characterized by brain and subsequent cerebellar metastases without abdomino-pelvic spread is reported. The patient was treated by craniotomy plus external radiation to the brain. Subsequently, Carboplatin-based chemotherapy was started when paraaortic lymph-nodes involvement has been detected. Follow-up is uneventful after clinical complete remission.

Ascitic fluid-associated lymphocytes in patients with metastatic ovarian cancer. Analysis of lymphocyte subsets and of phenotypical changes induced by "in vitro".

Ascitic fluid and peripheral blood samples, from seven patients affected by peritoneal carcinomatosis secondary to ovarian tumors, were analyzed to examine the phenotypic properties of ascitic fluid-associated lymphocytes (AFAL) and then asses T-cell activities in the presence of different interleukins. The AFALs showed a relative enrichment of CD2+, CD3+, CD5+, CD4+ T cells compared to the peripheral blood samples, while the contrary was true for CD56+ and CD57+ cells. The same phenomenon was observed in both CD3+, CD56+ and CD2+, CD56+ cell populations. Fewer CD71+ and CD25+ cells were found in the ascitic fluid suspensions whilst the opposite was true for HLA-DR+ lymphocytes. The data obtained from the in vitro incubation of AFALs in the presence of IL-1 (or), IL-2, IL-4, IL-6 or IFN showed that IL-1, IL-2 and IFN- can induce a two-fold increase in the percentages of HLA-DR+ T lymphocytes. IL-6, IL-2 and IL-1 seemed to have a fairly modest effect on CD25. A better survival of CD56+ cells was found only in the presence of IL-4 and IL-6. Even though preliminary and based on a limited number of patients, our results would seem to invite caution in instituting intraperitoneal administration of one or more cytokines for the treatment of such lesions in humans.

Variations of lymphocyte sub-populations in vulvar condylomata during therapy with beta-interferon.

Several experiences induced us to consider genital HPV infection as an expression of a local immunodeficiency. The aim of our study was to research the effect of immunotherapy on the lymphocyte subpopulations and Langerhans cells in vulvar condyloma. Twenty women with persistent vulvar condylomata, treated with 2,000,000 IU/die of beta-interferon for 15 days, were submitted to vulvar biopsy before and 2-5 months after medical treatment. The frozen sections obtained were assayed with the following monoclonal antibodies: OKT4 (T helper lymphocytes), OKT8 (T suppressor lymphocytes), OKB7 (B lymphocytes) and S-100 protein (Langerhans cells). Using a morphometric evaluation, the average number of both intraepithelial and stromal lymphocyte subsets and of the intraepithelial Langerhans cells was assessed. In all the biopsies preceding the medical treatment we found a low number of T helper lymphocytes both in the epithelium and stroma, with inversion of T4/T8 lymphocyte ratio and rare presence of Langerhans cells. In patients with a good therapeutic response (50-100% of condyloma reduction) we observed an increase in intraepithelial T4 lymphocytes and a decrease in both intraepithelial and stromal T8 lymphocytes. In cases with persistent disease after therapy, the histological pattern was similar to that observed in the first biopsy, with the exception of a significant increase in the average number of Langerhans cells. Our data correlate the clinical response to the immunotherapy with the histology of lymphocyte subsets in the vulvar condylomata. The increase in Langerhans cells observed in patients with negative response may be interpreted with a probable inability of these cells to promote the immune reaction.

Variations of lymphocyte sub-populations in vulvar condylomata during therapy with beta-interferon.

Several experiences induced us to consider genital HPV infection as an expression of a local immunodeficiency. The aim of our study was to research the effect of immunotherapy on the lymphocyte subpopulations and Langerhans cells in vulvar condyloma. Twenty women with persistent vulvar condylomata, treated with 2,000,000 IU/die of beta-interferon for 15 days, were submitted to vulvar biopsy before and 2-5 months after medical treatment. The frozen sections obtained were assayed with the following monoclonal antibodies: OKT 4 (T helper lymphocytes), OKT 8 (T suppressor lymphocytes), OKB 7 (B lymphocytes) and S-100 protein (Langerhans cells). Using a morphometric evaluation, the average number of both intraepithelial and stromal lymphocyte subsets and of the intraepithelial Langerhans cells was assessed. In all the biopsies preceeding the medical treatment we found a low number of T helper lymphocytes both in the epithelium and stroma, with inversion of T4/T8 lymphocyte ratio and rare presence of Langerhans cells. In patients with a good therapeutic response (50-100% of condyloma reduction) we observed an increase in intraepithelial T4 lymphocytes and a decrease in both intraepithelial and stromal T8 lymphocytes. In cases with persistent disease after therapy, the histological pattern was similar to that observed in the first biopsy, with the exception of a significant increase in the average number of Langerhans cells. Our data correlate the clinical response to the immunotherapy with the histology of lymphocyte subsets in the vulvar condylomata. The increase in Langerhans cells observed in patients with negative response may be interpreted with a probable inability of these cells to promote the immune reaction.

Endocervical adenocarcinoma. Clinico-pathologic and histochemical study of 29 cases.

Twenty-nine women were treated for endocervical adenocarcinoma in the University of Bari in the years 1975-1981. The histological type was "endocervical" or "mucinous" in 12 patients (41.4%), "endometrioid" in 12 (41.4%), "clear cell" in 2 (6.9%), "adenosquamous" in 2 (6.9%), and "serous" or "papillary" in 1. Foci of papillary and endometrioid metaplasia were present in 2 adenocarcinomas of endocervical type. The following histochemical methods were used: PAS reaction, PAS reaction with diastase predigestion, Bleu Alcian at pH 2.5 and pH 1, mucicarmine, Toluidine Bleu at 0.3%. The "endocervical" type adenocarcinoma showed mucicarmine positive and PAS positive, diastase resistant material in the whole cytoplasm. This material was not metachromatic and Bleu Alcian positive only in the well differentiated forms. In the "endometrial" adenocarcinoma only in the apex of the glandular cells was PAS positive diastase resistant, Alcian and mucicarmine positive. "Clear cell" and "adenosquamous" carcinomas showed only few cytoplasmatic PAS positive, diastase sensitive granules (= glycogen). No positivity was present in the "papillary" or "serous" carcinomas. Our results permit us to unify the histological and the histochemical patterns of the cervical adenocarcinomas and those of the similar forms of the endometrium and of the ovary, and stress the common müllerian origin of these neoplasms.

Chemotherapy with CDDP.

The Authors report the results obtained in 30 patients affected by ovarian carcinoma and treated with chemotherapy using the parenteral route in 27 cases and the intraperitoneal one in 3 women. Parenteral chemotherapy following surgical staging and extensive tumour removal with the last residual tumour, consisted of a therapeutic scheme of mono- and poli-chemotherapy. The doses of cisplatin (CDDP) in mono-chemotherapy were correlated to the intensive anatomical-radiological-surgical staging. The patients treated with poli-chemotherapy underwent cycles with CDDP + alkylating agents. Moreover, 3 of the patients received low doses of cisplatin by intraperitoneal administration. In 27 cases pre- and post-therapy enzymuria was evaluated: it represents, in fact, the most reliable laboratory test to discover an acute tubulo-toxicity and is able to reveal chronic tubular damage. Our results demonstrate that a suitable nephrologic monitoring of the patients allows a more accurate use of the cisplatin with a better cost-benefit relation.

Possible role of mast cells in the mechanism of action of intrauterine contraceptive devices.

The presence and number of mast cells and their relationship to other inflammatory cells were investigated in smears from intrauterine contraceptive devices. The results obtained suggest a possible role of mast cells in the mechanism of action of intrauterine contraceptive devices, on the basis of the peculiar known functions of mast cells.

PIP: The presence and number of mast cells and their relationships to other inflammatory cells were investigated in smears from IUDs. Triplicate slide smears were obtained from IUDs removed from 5-25 months after insertion in 100 healthy women (age range 24-40 years). Normal endometrial smears were obtained from 30 women (age range 28-41 years). The slides were stained by Papanicolaou, toluidine blue, and Giemsa methods, and cellular populations were identified and counted, with particular attention being given to the mast cells. 22 samples were studied by electron microscopy. The cellular layers adherent to the IUDs were fixed in glutaraldehyde for 20 minutes, washed, postfixed in 1% osmium tetroxide solution for 1 hour, dehydrated, and embedded in Araldite. Neutrophils, lymphocytes, endometrial cells, and macrophages were observed. The latter cells predominated, and they had hyperchromatic nuclei with distinct nucleoli, and vacuolated cytoplasm with or without phagocytosed material. No giant cells were seen, but red blood cells, degenerated spermatozoa, and cellular debris were present. Mast cells were observed in all smears examined, with a range of from 120-180 cells/10 microscopic fields at 100x for each slide, as compared with smears of endometrium obtained from 30 normal women, which had only 10-50 cells. Pelvic pain, spotting, and other manifestations of pathologic conditions due to use of IUDs were observed in most cases with highly increased numbers of mast cells, whereas no clinical manifestations were present in a few cases, although the number of mast cells was similarly elevated. Endometrial cells were present, free or in clumps, and did not show dysplastic or neoplastic alterations. A conspicuous number of mast cells was intermingled with the other inflammatory cells and endometrial cells, thus confirming the aspects observed with light microscopy. Most mast cells presented with semilunar features of granules characteristic of a slow but progressive degranulation in response to low level but constant stimulation. Mast cells were in close physical contact with the other inflammatory cells. Some mast cells had peculiar morphologic aspects. The exact roles of mast cells in inflammatory and immunologic phenomena, other than the classic reaginic primary type reaction, are largely unknown, but there is reason to believe, on both biochemical and morphologic grounds, that these roles are complex.

Detection of Leptotrix vaginalis in obstetric pathology.

The authors report on the presence and classification of Leptotrix vaginalis in the vaginal flora of 150 women and compare cytologic and cultural data. This microorganism was detected in 7 cases through observation of stained smears (Papanicolaou's method). But the cultural examination in many elective media showed different microbic forms in 5 cases and mycetes in two cases only. The authors conclude that the observation of the vaginal fluor, fresh or in preparations stained according to Papanicolaou's method, is insufficient to identify this germ. The smear should always be supplemented by the cultural examination.