Silicone gel mammary prostheses: immune pathologies and breastfeeding.

Augmentation mammoplasty is the most frequent request among esthetic surgery procedures but numerous controversies have been raised about the security of the silicone gel prostheses. Today a new question needs an answer: is the prosthesis a risk factor for pregnancy? In this paper the results of a hematochemical study performed on a group of patients with term pregnancies and silicone gel breast implants (group A) compared with a control group without implants (B) are described. For laboratory screening the valuation of antibody (TRIM) and silicone concentrations in blood and maternal milk and in neonate blood was performed.

Study of pubertal development in Abruzzo (Italy) and analysis of factors implicated in puberty variability.

The aim of the study was to confirm whether there is a secular trend towards the early onset of puberty without an early onset of menarche. The study included a total of 1,266 subjects, 771 females and 495 males, with an age range between 5.9 and 18.2 years. In all subjects height, percentile of height, weight, percentage of overweight, bone age and pubertal stages were evaluated. On the basis of pubertal stage the population was subdivided into Tanner's corresponding classes. The obtained data for the female population showed a stabilized onset of puberty compared to the last decades and prolonged length of the pubertal period. Pubertal development in males, instead, did not appear to have changed over the last decades. The study is in line with American studies; the earlier onset of puberty verified in the last decades has slowed prolonging the length of the pubertal period. The specific mechanisms implicated in sexual maturation are not yet well known and need further studies.

Ovarian cancer after kidney transplantation.

Malignancies are one of the major causes of morbidity and mortality in transplant patients. The incidence is progressively increasing either because of the increased age transplant patients and the increase of immunosuppressive therapy or the increased follow-up range post-transplantation. The main causes of increased tumor incidence in transplant patients with respect to the general population are the reduced immunosurveillance and the high incidence of infections due to oncogenic viruses. This problem might become more and more serious in the near future due to the introduction of new immunosuppressive strategies that significantly extend allograft survival. A case of ovarian cancer in a kidney transplant patient is described. Attention is focused on the potential dual role of immunosuppressive therapy in the development of malignancies in transplant patients.

Endometriosis: rare localizations in two cases.

Endometriosis is a disease in continuous evolution due to its various aspects and atypical localizations. Every year many women all over the world are affected by it. In typical localizations the diagnosis is simple; the symptoms include pelvic pain and in most of cases sterility. In rare localizations the symptoms are non-specific and the diagnosis is difficult. In particular an intestinal isolated localization is often asymptomatic or can cause non-specific pelvic pain, irregular intestinal activity and in such case, a subocclusive condition often with a diagnosis of inflammatory bowel disease. Two cases of rare localizations of endometriosis are described in the intestinal wall and a cesarean section scar. An analysis of the etiopathogenesis and diagnostic approach in these rare localizations is presented.

Gorlin syndrome associated with basal cell carcinoma of the vulva: A case report.

Gorlin syndrome, also known as nevoid basal cell carcinoma syndrome (NBCCS), is a hereditary condition transmitted as an autosomal dominant trait with high penetrance and variable expressivity. The syndrome is characterized by numerous manifestations: basal cell carcinomas (BCCs) and odontogenic keratocysts (OKCs) are the leading ones. In this article a typical Gorlin syndrome case associated with basal cell carcinoma of the vulva is described.

The use of a decremental dose regimen in patients treated with a chronic low-dose step-up protocol for WHO Group II anovulation: a prospective randomized multicentre study.

BACKGROUND: In women with chronic anovulation, the choice of the FSH starting dose and the modality of subsequent dose adjustments are critical in controlling the risk of overstimulation. The aim of this prospective randomized study was to assess the efficacy and safety of a decremental FSH dose regimen applied once the leading follicle was 10-13 mm in diameter in women treated for WHO Group II anovulation according to a chronic low-dose (CLD; 75 IU FSH for 14 days with 37.5 IU increment) step-up protocol. METHODS: Two hundred and nine subfertile women were treated with recombinant human FSH (r-hFSH) (Gonal-f) for ovulation induction according to a CLD step-up regimen. When the leading follicle reached a diameter of 10-13 mm, 158 participants were randomized by means of a computer-generated list to receive either the same FSH dose required to achieve the threshold for follicular development (CLD regimen) or half of this FSH dose [sequential (SQ) regimen]. HCG was administered only if not more than three follicles >or=16 mm in diameter were present and/or serum estradiol (E(2)) values were <1200 pg/ml. The primary outcome measure was the number of follicles >or=16 mm in size at the time of hCG administration. RESULTS: Clinical characteristics and ovarian parameters at the time of randomization were similar in the two groups. Both CLD and SQ protocols achieved similar follicular growth as regards the total number of follicles and medium-sized or mature follicles (>/=16 mm: 1.5 +/- 0.9 versus 1.4 +/- 0.7, respectively). Furthermore, serum E(2) levels were equivalent in the two groups at the time of hCG administration (441 +/- 360 versus 425 +/- 480 pg/ml for CLD and SQ protocols, respectively). The rate of mono-follicular development was identical as well as the percentage of patients who ovulated and achieved pregnancy. CONCLUSIONS: The results show that the CLD step-up regimen for FSH administration is efficacious and safe for promoting mono-follicular ovulation in women with WHO Group II anovulation. This study confirms that maintaining the same FSH starting dose for 14 days before increasing the dose in step-up regimen is critical to adequately control the risk of over-response. Strict application of CLD regimen should be recommended in women with WHO Group II anovulation.

Management of ovarian cysts in pregnancy: a case report.

According to recent epidemiological studies on ovarian cysts during pregnancy one out of 600 are, in most cases, benign neoformations. The most frequent histological type reported is mature cystic teratoma (50% of the cases), followed by functional cysts (13%), benign cystadenomas (20%) and ovarian cancer (0.6%). Most adnexal masses are asymptomatic and spontaneously resolve before the 16th week of amenorrhoea. On the other hand, some cases are persistent forms which can cause complications for the mother and fetus. The objective of this work was to review the existing literature from an epidemiological point of view, with an emphasis on diagnostic and therapeutic management. We have paid particular attention in our review to the use of diagnostic techniques and non surgical therapies such as laparoscopy, which in expert hands and adopting particular skills, can be considered as on approach to ovarian cysts in pregnancy. We present the case of a patient with an ovarian cyst during pregnancy that was a successfully treated with laparoscopy.

Venous thromboembolism in pregnancy. A case report of deep venous thrombosis (DVT) in puerperium.

The authors describe a case of DVT during pregnancy in a 41-year-old woman who had a normal haemocoagulative picture during pregnancy and in puerperium (PT, PTT, S protein, C protein, ATIII, xdp and fibrinogenous). All the haemocoagulative dosages were within the norm and compatible with the gestation period. Both homocysteine and antiphospholipid antibodies (mostly in puerperium) were always within normal limits. The authors believe that DVT occurs infrequently but it is also unforeseeable. Systematic heparin prophylaxis for seven to ten days, ante- and postpartum, can prevent this problem.

Malignant vulvar melanoma: colposcopic evaluation and review of the literature. A case report.

Because of the rarity of this kind of vulvar neoplasia, the diagnostic difficulties (clinical and histopathological) conditioning the therapeutic approach and the missing iconographical material, we report a case of vulvar melanoma seen at the Department of Obstetrics and Gynecology of the University of L'Aquila in April 2001, together with a review of the literature. Owing to radical vulvectomy and bilateral inguinal lymphadenectomy with the Byron three-incision approach the histological report was: epithelioid cell apigmented melanoma radially spreading (MMSS), a tumor-free margin of at least 1.7 cm with sufficient lympholitic infiltration.

Genital tuberculosis in a menopausal woman. A case report.

We have analysed the role played by genital tuberculosis (TBC) in Italy today, and in particular in L'Aquila, in the light of a worrying recrudescence. We report the case of a 64-year-old patient, in menopause for the past 11 years or so, referred to the Gynecology and Obstetrics Clinic of the University of L'Aquila, with an anamnesis of menometrorrhagia since the age of 55. The patient was studied from a gynecological and internist profile including the following procedures: gynecological examination and pap-test, colposcopy, transvaginal scan, chest X-ray, abdominal and pelvic CAT, laboratory tests and Mantoux reaction. The uterus was found to be fibromatous during the gynecological examination and scan, whereas colposcopy revealed a small ectropion and the presence of very adherent yellowish mucus. The Mantoux test was positive. CAT showed cicatricial sequelae in the pulmonary parenchyma. It was decided to perform curettage, but this was prevented by the presence of pyometra. The patient was treated with specific chemotherapy and then underwent total laparohysterectomy with bilateral adnexectomy. The histological findings confirmed genital TBC. Genital TBC is now undergoing a worrying recrudescence. We need to have a full knowledge of the pathology, the diagnostic means with which to discover it and the correct therapeutic instruments to overcome it.

[Ectropion of the uterine cervix in adolescence. Study of a topical drug as an alternative to surgical treatment]. / Ectropion della cervice uterina in età adolescenziale. Valutazione clinica di un prodotto ad uso topico come alternativa alla terapia parachirurgica.

The Authors, studied the ectropion of the uterine cervix in the teen-agers (young ladies) and the effect of the desossiribonucleic acid therapy in topic way by 5 mg/die for 20 days in 80 patients with an ectropion of the I degree and the II degree portion of the uterine cervix. The patients were separated in two groups. 40 patients treated by desossiribonucleic acid therapy, 40 patients didn't take any medicament. In conclusion the results show that the desossiribonucleic therapy could be an alternative way for the treatment of the ectropion of the uterine cervix.

[Isolated inguinal endometriosis. Report of a clinical case]. / Endometriosi inguinale isolata. Descrizione di un caso clinico.

The case of a patient with inguinal isolated endometriosis in whom laparoscopy revealed no evidence of pelvic endometriosis is presented. Following the observation of this case and the published reports by other authors on frequency, pathogenesis, diagnosis and therapy, the article supports the hypothesis that inguinal endometriotic lesions are likely associated with lymphatic spread of endometrial cells.

[Maternal smoking in pregnancy]. / Fumo materno in gravidanza.

OBJECTIVE: In the last years has been a progressive increase of tabagism in the female sex. This study wanted to examine the influence of the pregnancy on voluntary practices and especially on smoking. PATIENTS AND METHODS: 140 women with a mean age of 33.05 years and with a mean gestational age of 28.56 weeks (range 5-42) were interviewed. Each one received a questionnaire about social and psychosocial status, a schedule about style of living (CAGE), a questionnaire "How much do you drink" (from SQQ) and a series of questions about smoking. RESULTS AND CONCLUSIONS: Our study suggests that the tabagism decreases in the greatest part of pregnant women, and them increases again after child birth. Pregnancy gets women both to finish and to decrease smoking apart from social status and any variant contemplated.

[Lifestyle and drinking habits during pregnancy]. / Stile di vita ed abitudini voluttuarie in gravidanza.

BACKGROUND: It has been reported that a high consumption of alcohol during pregnancy is correlated to fetal alcohol syndrome and other perinatal problems. Less is known about the effects linked to moderate and limited drinking during pregnancy. METHODS: A study was carried out in 140 pregnant women: the mean age was 33.05 +/- 5.22, whereas the gestational age was 28.56 +/- 12.1 weeks (range 5-42). Each woman was asked to compile a form giving personal details and details of psychosocial behaviour, a lifestyle questionnaire (CAGE) and a form entitled "How much do you drink" based on SQQ. RESULTS: 22.2% of women reported that they had drunk alcohol during the month prior to the interview. Of these, 15% had not altered their habits, 0.8% had increased their alcohol consumption and 6.4% had reduced it. Wine was the form of alcohol most frequently consumed. Only one woman was positive to the SQQ test, and only one pregnant woman was positive to CAGE. CONCLUSIONS: This study shows that dietary behaviour was correct in the majority of cases.

[Antibiotic prophylaxis of infective complications after cesarean section. Our experience]. / Profilassi antibiotica delle complicanze infettive dopo taglio cesareo. Nostra esperienza.

BACKGROUND: The efficacy of a single dose of antibiotic vs multiple doses of the same drug, in reducing maternal infections following the cesarean section, is evaluated. METHODS: A total of 206 pregnant women undergoing elective or emergency cesarean section from 1st June 1998 to 30 June 1999, at the Department of Obstetrics and Gynecology of the University of L'Aquila, were included in a randomized study to compare the efficacy of prophylaxis with a single dose of piperacillin sodium (2 g i.v. after the umbilical cord clamping; group A) vs triple doses of the same antibiotic (2 g i.v. at 6 hourly intervals, beginning from the umbilical cord clamping; group B). RESULTS: The incidence of infective morbidity in group A was 7.3%, with a 2% wound infections, 1% urinary infections and 4.16% febrile morbidity. The incidence of infective morbidity in group B was not much higher (9%), with 2.7% wound infections, 1.8% urinary infections and 4.5% febrile morbidity. CONCLUSIONS: In order to obtain a useful antibiotic prophylaxis in cesarean sections, the single-dose seems to be preferable to the multiple-doses, since the single-dose not only has equal efficacy, but also less cost, smaller risk of super-infections by resistant organisms and it involves smaller care from the-medical and nursing staff.

[Apropos of a case of Dandy-Walker syndrome associated with chromosome abnormalities]. / A proposito di un caso di sindrome di Dandy-Walker associata ad anomalia cromosomica.

A case of Dandy-Walker syndrome associated with chromosome abnormalities (46,XX,-21, +der(13)t(13;21)(q22;q11), diagnosed during pregnancy is reported. This is a pathology characterized by malformations of the central nervous system, mainly of the cerebellum. Due to several aspects and different prognosis between classic Dandy-Walker and its variants, many clinical and therapeutic problems may raise.

[Fetal malformations and chromosome abnormalities diagnosed at the Center of Prenatal Diagnosis of the University of Aquila in the 1995-1998 triennium]. / Malformazioni e cromosomopatie fetali diagnosticate presso il centro di diagnosi prenatale dell'Università dell'Aquila nel triennio 1995-1998.

BACKGROUND: Over the past few years numerous techniques have been developed, allowing an evaluation of fetal physiopathology that was unthinkable until recently. The authors describe 20 cases of fetal malformations and chromosomal abnormalities diagnosed by scan and amniocentesis at the Centre for Diagnosis and Obstetric Prophylaxis at L'Aquila University. METHODS: Between January 1995 and April 1998 a total of 1180 amniocentesis and 4000 obstetric scans were performed in a group of 1650 pregnant women. RESULTS: Of the patients examined using ultrasound scan, 8 presented manifest fetal pathologies, of which 5 were associated with chromosome abnormalities: 1) left ventricular hypoplasia, common atrium, tricuspid dysplasia; 2) omphalocele; 3) Morgagni-Stewart-Morel syndrome; 4) plurilobate cystic hygroma; 5) duodenal atresia; 6) Dandy-Walker syndrome; 7) cystic hygroma and hydrops; 8) cystic hygroma, hydrops, cardiopathy and Dandy-Walker syndrome. Among the pregnant women undergoing amniocentesis without a prior diagnosis of fetal malformation, 12 presented pathological fetal karyotypes: 2 cases of Turner's syndrome; 2 cases of Edward's syndrome; 2 cases of Klinefelter's syndrome, of deletion of a stretch of chromosome 8; 1 case of Down's syndrome; 2 cases of supernumerary marker chromosome; 1 twin pregnancy with Klinefelter's syndrome in one twin and paracentric inversion of chromosome 13 in the other; 1 twin pregnancy with a small supernumerary marker chromosome in both twins. CONCLUSIONS: Ultrasonography often enables the diagnosis of congenital abnormalities not associated with chromosome pathologies. However, karyotype studies play an essential role in pregnancies with a high genetic risk.

[Pelvic floor rehabilitation in women affected with stress urinary incontinence. Authors' experience]. / La rieducazione del pavimento pelvico nelle donne affette da incontinenza urinaria da stress. Nostra esperienza.

BACKGROUND: This study evaluated pelvic floor rehabilitation as a possible treatment for urinary stress incontinence: a challenge to tradition. METHODS: In this study 20 female subjects with urinary stress incontinence had rehabilitation therapy, at first in the outpatients clinic with motivated physiotherapists and afterwards by home exercises. RESULTS: At the end of 3 months of training, stress incontinence had disappeared in 7 patients (35%), while an improvement was recorded in 13 (65%). CONCLUSIONS: In summary, pelvic floor rehabilitation program can be an effective alternative to surgical approach in reducing the frequency of urinary leakage. Further studies are needed to identify factors predicting success and to improve the techniques of pelvic floor rehabilitation.

[Injectable progesterone in hormone replacement therapy in menopause]. / Il progesterone iniettabile nella terapia ormonale sostitutiva in menopausa.

PURPOSE: To evaluate activity and tolerability of intramuscular administration of 17-alpha-hydroxyprogesterone caproate (Lentogest-Amsa) in hormone replacement therapy in menopause. PATIENTS AND METHODS: Intramuscular slow releasing 17-alpha-hydroxyprogesterone caproate was given to 30 postmenopausal women. Patients were divided into two groups according to the number of monthly doses (1 or 2). RESULTS: In both groups of patients a regular monthly bleeding was obtained. Echographic assessment did not show abnormal endometrial thickness. CONCLUSIONS: The results of this study have pointed out the efficacy of intramuscular progesterone-caproate administration with a better compliance in the single dose group.