[Magnetic resonance in the evaluation of Mullerian duct anomalies]. / La risonanza magnetica nella valutazione delle anomalie dei dotti di Müller.

Müllerian duct alterations in development or fusion in the embryo cause congenital uterine anomalies which may be responsible for decreased fertility or problems in carrying out a normal pregnancy. In this study, the MR findings in uterine agenesis (1 case), unicornuate (2 cases), didelphys (3 cases), bicornuate (3 cases), arcuate (6 cases) and septate uterus (8 cases) are described, together with the optimal section planes for their demonstration. The examinations were performed with an 0.5-T superconductive magnet, the spin-echo technique and mostly T2-weighted sequences. The anomalies were grouped according to Buttram and Gibbons classification, which is the most used in clinics. In particular, the bicornuate uterus was distinguished from the septate uterus, the latter associated with the highest spontaneous abortion rates, on the basis of external fundal outline appearance. In such anomalies, the muscular or fibrotic nature of any intracavitary septum was assessed based on septal thickness more than on signal intensity at this level. MR diagnostic accuracy in 23 patients with Müllerian anomalies, compared with surgical, hysteroscopic, laparotomic and laparoscopic findings, was 100%. Nevertheless, if Müllerian duct anomalies responsible for gynecologic-obstetric problems are known or suspected, MRI should always be used, on the basis of a close gynecologist-radiologist collaboration, for classification agreement and the evaluation of any intracavitary septum morpho-biometric appearance and possibly nature, to discuss treatment options.

Ipriflavone-treatment of senile osteoporosis: results of a multicenter, double-blind clinical trial of 2 years.

Eighty-four out of 100 enrolled female patients affected by osteoporosis completed a double-blind, randomized trial, using ipriflavone (IP) in a dose of 3 x 200 mg/day (41 patients) or placebo (P)(43 patients). All patients received 1 g/day oral calcium supplementation. Inclusion criteria were: age over 65 years; at least one vertebral fracture in the past; bone mineral density measured at the distal tenth of the radius lower than the normal average -2 x S.D. The trial period was between June 1990 and November 1993. Patients of the IP group showed a significant increase in bone mineral density (P < 0.05) compared with the starting values during the whole study period. Pain decreased rapidly, intake of analgesics dropped, and often significant decreases in calciuria, hydroxyprolinuria, alkaline phospatase, osteocalcin and parathormone values were observed. Only two new fractures occurred during the trial in the IP group. Patients of the P group at the end of the study displayed decreased bone mineral densities (P < 0.05), increased pain, greater consumption of analgesics, and often significant increases in the bone metabolism parameters listed for the IP group. In the

[Carcinoma of the uterine cervical canal. Staging and biometric assessment with magnetic resonance]. / Il carcinoma del canale cervicale dell'utero. Stadiazione e valutazione biometrica con risonanza magnetica.

In uterine cervical canal carcinoma, the current clinical FIGO criteria often fail not only to differentiate stage IA2 from stage IB but also to demonstrate possible parametrial involvement. Moreover, the analysis of tumor volume and of the depth of neoplastic stromal invasion is not very reliable. The authors investigated MR accuracy in the definition of such variables: to this purpose, 24 patients with histologically confirmed endocervical adenocarcinoma were submitted to MRI, which was performed with an 0.5-T superconductive magnet. Sagittal and oblique transverse or sometimes coronal SE images, oriented so as to be perpendicular to longitudinal cervical major axis were obtained with T2 weighting (TR 1800 ms, TE 25-90 ms). MR data were correlated with pathologic findings. MR accuracy in demonstrating parametrial involvement was 92%, its sensitivity was 86% and specificity 97%. Volumetric MR data showed a high correlation (r = 0.970) with those derived from pathologic findings. In 92% of cases stromal invasion exceeded 5 mm. MRI, thanks to its high accuracy, should be included in diagnostic pretreatment protocols, even though FIGO criteria do not require it yet, especially in the presence of an endocervical adenocarcinoma. Moreover, the accurate definition of tumor volume can allow less extensive surgery with the same survival rates and fewer complications, which are frequently observed after radical hysterectomy.

Chlamydia trachomatis diagnosis: a correlative study of pap smear and direct immunofluorescence.

From June 1989 to September 1990, 255 women with recurrent vaginitis, were evaluated, at the "Service of Precocious Diagnosis and Therapy of Gynecological Tumor" of the 1st Department of Obstetrics and Gynecology. They were compared with a control group of 255 women selected in the same time. All patients between the ages of 18-40 years, with normal sexual behaviour, had a negative colposcopy for HPV and HSV2 infections. The cervical smear with Papanicolaou technique and direct immunofluorescence (DIF) was performed in all patients. The specimens were examined with a fluorescence microscope (Leitz). Positive determinations were confined by examination a tha magnification of 600 X. Slides were scored as positive if at least 5 distinct apple-green fluorescence-stained elementary body per field was observed. The two groups were entirely comparable in age, parity, method of contraception, and number of sexual contacts over the preceding three months. Our data confirmed a higher incidence of Chlamydial infections in women with recurrent vaginitis (34.1%) than in control group (8.23%). In symptomatic women, more cases of metaplastic cells with cytoplasmic vacuolation, less inflammatory alteration and a lack of specific agents like CA and TV, were found than in the control group. The DIF positivity, in both groups, was connected with a cytological findings of metaplastic cells with cytoplasmic vacuolation in 72.3% and 50% respectively.

Goserelin treatment in glandular hyperplasia.

Glandular Hyperplasia is commonly associated with meno and/or metrorrhagia. We treated 84 patients suffering from meno and/or metrorrhagia associated with simple glandular hyperplasia with a gonadotropin releasing hormone agonist, goserelin, (Zoladex, ICI Pharmaceuticals, Macclesfield. Cheshire, England), available in a depot formulation. Subcutaneous administration of goserelin 3.6 mg was repeated every 28 days for 6 months. Within the first 4 weeks from the start of therapy 45% of the patients became amenorrhoeic, within 12 weeks 100%. Only 3 patients reported continued spotting. Hysteroscopic evaluation and biopsy have shown in the 84 evaluable patients, a positive result in 76 (90.4%), demonstrating the validity of the use of this analogue in this indication. In the future it would be of value to increase the period of treatment in selected cases as well as increasing the length of the follow-up period.