A randomised placebo-controlled trial of ursodeoxycholic acid and S-adenosylmethionine in the treatment of intrahepatic cholestasis of pregnancy.

A randomised placebo controlled study was performed in 32 women with intrahepatic cholestasis of pregnancy. The population was divided into four groups: for 20 days each group was treated only with ursodeoxycholic acid, or S-adenosylmethionine, or a combination of both drugs, or a placebo (vitamin). Itching, standard liver function tests and serum total bile acids were measured before, during, and after treatment. Itching improved in all the women as well as the biochemical abnormalities. No side-effects in the mother or in the infant were recorded during and after therapy. A combination of ursodeoxycholic acid and S-adenosylmethionine is more effective than placebo and than either drug alone.

Ursodeoxycholic acid therapy in pregnant women with cholestasis.

OBJECTIVE: To test the efficacy and safety of ursodeoxycholic acid (UDCA) in the treatment of intrahepatic cholestasis of pregnancy (ICP) by a randomized, double-blind, placebo-controlled trial. METHOD: Eight patients with pruritus and abnormal liver function tests received 600 mg/day of UDCA in two doses for 20 days, compared with a control group of eight patients who received placebo for 20 days. RESULTS: No adverse reactions were detected in any patient. During UDCA therapy a statistically significant improvement in pruritus, serum bile salt levels, serum glutamic pyruvic transaminase, alkaline phosphatase, gamma-glutamyl transpeptidase and total and direct bilirubin was observed. Only two patients treated with UDCA underwent cesarean sections due to reasons unrelated to the therapeutic trial. All newborns had an Apgar score >7 and normal postnatal growth. CONCLUSION: Although the number of patients in this study was very small, we suggest that UDCA treatment has a role in improving clinical and biochemical results in ICP.

Development of melanoma throughout two close pregnancies. Case report.

Primary melanoma is the most malignant and the least frequent of all cutaneous tumors. Its incidence in pregnancy varies from 0.1 to 2.8/1000. Up to today, impact of pregnancy on melanoma's course is still a much debated question in the literature. Some earlier reports suggested a particularly serious prognosis for melanoma associated with pregnancy, while more recent studies show that pregnancy may influence relapses without significantly altering survival. This paper reports the case of a woman affected by melanoma, whose clinical conditions became more and more serious during her second pregnancy and the following puerperal period. The progressive impairment of her clinical condition has suggested a correlation between the two close pregnancies and the unfavourable course of her disease.

Long-term follow-up of women with amenorrhea-galactorrhea treated with bromocriptine.

The present study is aimed at investigating whether long-term use of bromocriptine on patients affected by amenorrhea and galactorrhea may improve the clinical picture after discontinuation of treatment. For this reason 26 patients with amenorrhea and galactorrhea have been studied. Sixteen had high PRL values and 10 were normoprolactinemic. The normoprolactinemic patients underwent a TRH test. All the patients underwent computed skull axial tomography (CT scan) and were treated with bromocriptine, at a daily dosage variable from 2.5 to 10 mg for an average period of 26 months. After discontinuation of treatment, follow-up was carried-out for 20 months. Eighty-seven percent of the patients affected by amenorrhea, galactorrhea and hyperprolactinemia had regular menses, in 75 of the patients galactorrhea completely disappeared. Of the ten patients with normoprolactinemic amenorrhea and galactorrhea, only those who positively responded to the TRH test had regular menstruation and showed disappearance of galactorrhea. Upon discontinuation of treatment amenorrhea recurred in 68% of the cases whereas galactorrhea recurred in 80%. CT scans revealed disappearance of 3 microadenomas and reduction in size of the macroadenoma. Long-term use of bromocriptine represents the first choice treatment for the syndrome of galactorrhea-amenorrhea. In case of relapse, treatment must be continued for an undefined period of time.

Induction of multifollicular growth in patients non responding to clomiphene citrate and gonadotropins or gonadotropins only.

OBJECTIVE: We aimed at inducing multifollicular recruitment in patients with chronic anovulation-resistant to Clomiphene Citrate (CC) and/or exogenous gonadotropins. DESIGN: At the II Department of Obstetrics and Gynecology we treated our patients with exogenous gonadotropins and concomitant endogenous gonadotropin suppression obtained by the use of a GnRH analog (Buserelin). PATIENTS: We studied 14 patients with chronic anovulation due to either hypothalamic dysfunction or polycystic ovarian syndrome. MEASUREMENTS: We monitored the follicular growth ultrasonographically from the eighth day of the menstrual cycle, and assessed E2 and LH daily dosage from the tenth day. RESULTS: With this protocol we obtained 2 or 3 mature follicles, and reached an ovulatory rate of 80.7% and a pregnancy rate of 71.4%. Premature luteinization never occurred, and progesterone increase took place only after human chorionic gonadotropins administration.

Neoplastic association of leiomyoma, bizarre leiomyoma and leiomyosarcoma uteri. Case report.

Leiomyoma uteri is the commonest mesenchymal neoplasia of this organ. Leiomyosarcoma uteri is the most frequent histologic variant of all sarcomatous forms. Among these there is bizarre leiomyoma, a borderline lesion with potential malignity, whose differential diagnosis is very difficult. This paper reports the case of a 44 year old woman who was simultaneously diagnosed with these anatomicoclinical lesions. The singularity of this case is represented by the coexistence in the same patient of three different lesions that, according to our data and those reported in the latest literature, do not seem to be correlated.