Clinical-Psychological Aspects Involved in Gynecological Surgery: Description of Peri-Operative Psychopathological Symptoms and Illness Behavior.

Background: Within the current literature concerning the gynecological surgery, there are only a few studies that focus on the psychological aspects that characterize the peri-operative period. In this research, the psychopathological symptoms and the illness behavior were assessed in order to confirm previous results about clinical variables such as the type and method of intervention, as well as psychological aspects regarding the positive anamnesis for mental disorders. Moreover, other factors including the desire for maternity and previous surgical interventions and pregnancies were also investigated. Methods: In this observational research, 58 women (age = 41.5±8.8), that undergone gynecological surgery (conservative and non-conservative) for benign pathologies, were consecutively recruited. Information on psychopathological symptoms was collected 15 days (T0) and one day before surgery (T1), and at the time of discharge (T2) through the Symptom Questionnaire (SQ). At T2, the Illness Behavior Questionnaire (IBQ) was also administered. Results: The descriptive analyzes conducted on the total sample demonstrated that while anxious activation and irritable mood decrease from T0 to T1, somatizations and depression mood increase between T1 and T2. Moreover, the comparisons between groups, dividing the sample according to the clinical-medical and psychological variables, highlighted that the type and modality of the intervention, as well as a positive history for the presence of psychological disorders, the desire for maternity, and previous surgical interventions and pregnancies, can influence the course of psychopathological symptoms. Conclusion: This study highlights the need to include a clinical-psychological evaluation and to pay attention to specific clinical variables regarding women that are undergoing a conservative or non-conservative gynecological surgery. Considering the psychological impact of these type of interventions, the clinical history of these women, as well as their fears and desires, could facilitate a better management of the patients in terms of well-being, adherence to treatment, and recovery.

Fundamento: Dentro de la literatura actual referente a la cirugía ginecológica, existen pocos estudios que se centren en los aspectos psicológicos que caracterizan el perioperatorio. En esta investigación se evaluaron los síntomas psicopatológicos y la conducta de enfermedad con el fin de confirmar resultados previos sobre variables clínicas como el tipo y método de intervención así como aspectos psicológicos en cuanto a la anamnesis positiva para trastornos mentales. Además, también se investigaron otros factores, como el deseo de maternidad y las intervenciones quirúrgicas y embarazos previos. Métodos: En esta investigación observacional, se reclutaron consecutivamente 58 mujeres (edad=41.5±8.8), sometidas a cirugía ginecológica (conservadora y no conservadora) por patologías benignas. La información relativa a los síntomas psicopatológicos se ha recogido durante 15 días (T0) y un día antes de la cirugía (T1), y en el momento del alta (T2) a través del Cuestionario de Síntomas (SQ). En T2 también se administró el Cuestionario de Conducta de Enfermedad (IBQ). Resultados: Los análisis descriptivos realizados sobre la muestra total demostraron que mientras la activación ansiosa y el estado de ánimo irritable disminuyen de T0 a T1, las somatizaciones y el estado de ánimo depresivo aumentan entre T1 y T2. Además, las comparaciones entre grupos, dividiendo la muestra de acuerdo con las variables clínico-médicas y psicológicas, destacaron que el tipologia y modalidad de la intervención, así como una historia positiva para la presencia de trastornos psicológicos, deseo de maternidad y antecedentes quirúrgicos, las intervenciones y los embarazos pueden influir en el curso de los síntomas psicopatológicos. Conclusión: Este estudio pone de relieve la necesidad de incluir una evaluación clínico-psicológica y prestar atención a variables clínicas específicas en mujeres que se someten a una cirugía ginecológica conservadora o no conservadora. Considerando el impacto psicológico de este tipo de intervenciones, la historia clínica de estas mujeres, sus miedos y deseos podría facilitar un mejor manejo de las pacientes en términos de bienestar, adherencia al tratamiento y recuperación.

L-arginine supplementation in women with chronic hypertension: impact on blood pressure and maternal and neonatal complications.

OBJECTIVE: To evaluate L-arginine (L-Arg) supplementation in pregnant women with chronic hypertension and its effects on blood pressure (BP) and maternal and neonatal complications. METHODS: We enrolled 80 women affected by mild chronic hypertension referred to the High Risk Clinic of the Mother-Infant Department of the University of Modena and Reggio Emilia. Each woman after obtaining oral consent was randomized to receive oral L-Arg versus placebo and thereafter submitted to 24-h ambulatory BP monitoring. The primary outcome was BP change after 10-12 weeks of treatment. Secondary outcomes were as follows: percentage of women on antihypertensive treatment at delivery, maternal, and fetal outcome. RESULTS: The BP changes after 10-12 weeks of treatment did not differ between groups. A lower percentage of women received antihypertensive drugs in the L-Arg group than the placebo group. The incidence of superimposed preeclampsia indicated delivery before the 34th weeks and certain neonatal complications tended to be higher in the placebo group. CONCLUSIONS: L-Arg supplementation in pregnant women with mild chronic hypertension does not significantly affect overall BP but is associated with less need for antihypertensive medications and a trend toward fewer maternal and neonatal complications. The results of the study were limited by the small sample size and by the exclusion of women with severe chronic hypertension. In our policy, these patients needed many hypertensive drugs and were normally managed by the cardiologist. Nevertheless, considering the promising results on maternal and fetal outcome, we believe that further studies should be performed to confirm such data and to clarify the role of L-Arg as a protective supplement in high-risk pregnancy.

Alveolar rhabdomyosarcoma of the uterine cervix. A case report confirmed by FKHR break-apart rearrangement using a fluorescence in situ hybridization probe on paraffin-embedded tissues.

Alveolar rhabdomyosarcoma (ARMS) is a very rare malignant soft tissue tumor found in the uterine cervix. In fact, to our knowledge, only 3 cases have previously been described in the literature. A 49-year-old premenopausal woman who had a history of vaginal bleeding underwent hysterectomy for multiple uterine nodules. Pathologic examination showed multiple leiomyomas in the uterus and ARMS in the cervix. An FKHR break-apart rearrangement by fluorescence in situ hybridization (FISH) probe on paraffin-embedded tissues identified specific chromosomal abnormalities. Systemic chemotherapy and pelvic irradiation were also performed. She remains in clinical remission from neoplastic recurrences 14 months after surgery. The literature has been reviewed; the histologic differential diagnosis of this rare lesion has been discussed and FISH has been suggested to be useful in differentiating ARMS from other poorly differentiated round cell tumors.

Maternal anaphylaxis and fetal brain damage after intrapartum chemoprophylaxis.

We report a case of maternal anaphylaxis following intrapartum chemoprophylaxis. The term fetus developed severe brain damage as a consequence of intrapartum asphyxia. The lesions resulted from maternal hypotension following anaphylaxis. We discuss the feto-maternal risks and the controversial treatment of such a condition. The increasing number of penicillin-treated parturients will result in further cases of maternal anaphylaxis than previously found.