[Hormones and embryogenesis of the uterine cervix]. / Hormones et embryogénèse du col utérin.

In the absence of the T.D.F. gene, differentiation of the genital tract follows the female development with Wolffian ducts regression, elaboration of Müllerian ducts, and homologous uro-genital sinus organization. Up to week 32, the fetal ovary secretes no organizing substance and no estrogen. Even if the maternal body is heavily impregnated by estrogens from the fetal-placental unit, the estrogenic and progestogenic activity of any steroid hormones which cross the placental barrier and enter the fetal body is reduced as a result of metabolic degradation within the fetal liver. It is only from week 32 that in normal pregnancies, phenomena of estrogenic action on the uterine cervix of the fetus are seen. This consists of hyperplasia of the endo-cervical epithelium and its emergence towards the exo-cervix. The slightest addition of non-steroid synthetic estrogens administered to the mother may interfere with this hormonal environment of the fetus and result in abnormal development of Müller's tract, particularly in the cervico-vaginal zone.

[Chromo-colposcopic images during oral contraception]. / Immagini cromocolposcopiche in corso di contraccezione orale.

The Authors report chromocolposcopic pictures with AZEA (Azure 2 + alcohol-soluble eosine + ethanol) and related histologic pictures in six women under oral contraception. Columnar epithelium develops violet or blue-violet areas histologically corresponding to endocervicitis. Aceto-white epithelium develops reddish color in case of medium-mature metaplasia, brown-violet in case of mature metaplasia, lilac in case of superficial koilocytosis on metaplasia. Native epithelium appears dark brown, or yellow-brown in case of koilocytosis.

[Cancer of the uterine cervix in Togo. Epidemiological observations and anatomopathological characteristics]. / Il carcinoma del collo uterino nel Togo. Osservazioni epidemiologiche e caratteristiche anatomopatologiche.

Fifty consecutive cases of cervical cancer from the Afagnan Hospital in Togo have been reviewed in their clinical features, and in ten out of these and five additional ones from the year 1979 the histological specimens were reexamined. The high rate of late diagnosis was the most striking clinical data observed, while the histopathological study revealed a high quota of undifferentiated or rare patterns, very different from the types commonly observed in Europe. In spite of the very poor public health level of the population, an almost complete absence of histological signs of HPV infection in the neoplastic tissue should be remarked.

[Psycho-social and sexology study of women with florid genital condylomatosis]. / Indagine psico-sociale e sessuologica in donne portatrici di condilomatosi florida genitale.

During the last 20 years studies about sexual transmitted diseases have introduced decisive changes in the knowledge of both their pathogenesis and pathology and their clinical treatment. Only nowadays the psychological aspects of the diseases have been taken into consideration. Our research studied particularly the life style of women affected by florid condylomatosis. In this regard we developed a questionnaire with both open and closed answers and we handed it out to a group of women affected by HPV and to an unaffected control group. We took into account different parameters, in order to outline the profile of personality, the life style, in Adlerian terms, of the women affected by HPV. Looking at the result of our research we can state that the female group affected by flourishing condylomatosis does not show relevant differences with the controls as to the economical, social and cultural parameters, the sexual habits and behaviour. Whereas the results show a particular, conscious and unconscious conflict, which expresses itself by means of contradictory interrelational behaviour and reactions.

[Florid vulvar condylomatosis. Comparison of therapeutic schedules]. / Condilomatosi florida vulvare. Confronto fra alcuni schemi terapeutici.

The problem of warts' therapy is of great interest for the diffusion of this pathology, for its high rate of recurrence and for its relation to CIN. So we evaluated the efficacy of different therapeutic methods for vulvar condylomata, used in 254 patients treated in our center from January '86 to July '90. 55 women underwent hot cautery, 31 laser-therapy, 42 excisional biopsy, 62 were treated with alpha interferon, 11 with beta interferon, 13 with thymopentin in association with electro-cautery or laser and in 40 cases no treatment was performed. The follow up, from 6 to 36 months, showed a remission of 88.1% in excisional biopsy, of 77.4% in laser-therapy, of 70.9% in electro-cautery, of 45.4% in beta interferon, of 45.2% in alpha interferon, of 76.9% in thymopentin and of 65% in the not treated group. No one therapy yielded optimal results, although surgical methods appeared to allow complete removal of the wart lesion with one application only, and to be better accepted by the patients because of the psychologic benefit of immediate remission notwithstanding the possibility of recurrencies. The results of the studied medical therapies appeared scanty. We conclude that, being the tissues around florid lesion purely affected by HPV, medical therapy needs further research in the hope of a more radical treatment.

[Cervico-vaginal infection by HPV: cyto-histological morphology in the different viral strains]. / Infezione cervicovaginale da HPV: morfologia citoistologica nei differenti tipi virali.

One-hundred ten cervical or vaginal bioptic samples have been submitted to in-situ HPV typing with biotinylated probes. All samples had been taken from women with colposcopic findings suggesting HPV infection, and at histopathology showed koilocytosis sometimes associated with CIN or VAIN. Sixty-four samples were positive (16 for HPV 6/11 - 37 for HPV 16/18, 11 for HPV 31/35/51). Histopathological and cytological specimens were reviewed to detect the possible existence of morphological patterns typical of the various viral types. Papillomatosis, slightly increased nuclear size with finely granular chromatin, low number of mitoses, and scarce cyto-polymorphism, were associated with HPV 6/11, as well as the absence of intraepithelial neoplasia. A higher number of mitoses (and/or atypical ones), cyto-polymorphism, association with intraepithelial neoplasia, nuclear vacuolization, nuclei of increased size, with irregular borders, hyperchromic, with dark and lumpy chromatin were indicative of high or medium risk HPV (16/18 or 31/35/51). In cytological smears also the finding of dyskeratocytes was associated with these viral types, while multiple nuclei were present in the case of HPV 31/35/51 detection.

[The natural history of carcinoma of the cervix uteri: from morphology to multidisciplinary interpretation of the pathogenesis]. / La storia naturale del carcinoma della cervice uterina: dalla morfologia alla interpretazione multidisciplinare della patogenesi.

The evolution of research on cervical cancerogenesis in the forty years from 1951 to 1990 is reviewed by the Author, who took part in it under the guidance of prof. G.B. Candiani. The modifications of the views on the subject by both the gynecologist and the pathologist, that have led through new guidelines of Health politics and of clinical behaviour, to a substantial decrease of the mortality from this disease, are highlighted.

[Cultural identification of patients with sexually transmitted diseases]. / Identificazione culturale dell'affetto da M.S.T.

The authors considered psychological problems concerning the communication to patients about a diagnosis of Sexual Transmitted Disease and particularly of HPV disease. In the past this sort of affection was related to some well identified social groups, but with the recent changes in sexual behavior, cultural and moral principles, the reference models are changed too. Consequently today it is difficult to recognize a rigid identification. However it is still possible that during the communication of the diagnosis the physician unconsciously transfers to the patient "his" classification with a given model among the groups of STD affected. This is particularly true for the gynecologist that is reporting on HPV infection or disease. Therefore the physician has to pay a great attention to the way he communicates, because in addition to the clinical concept there are psychological effects on the patient and on her relationships that could result iatrogenic.

[Sexually transmitted diseases: yesterday and today]. / Le malattie sessualmente trasmesse: ieri e oggi.

A review of the history of the sexually transmitted diseases is outlined, emphasizing the pathways of their diffusion throughout the world, their impact on the sexual customs and the history of the attempts to know their etiopathogenesis before the scientific discoveries of the second half of the 19th century.

[Assessment of human papilloma virus colposcopic findings of the cervix (in the Italian colposcopic classification]. / L'inquadramento dei reperti colposcopici da HPV in sede cervicale (nella classificazione colposcopica italiana).

HPV-induced flat condylomatosis is not only much more frequently observed on the hexocervix than the florid type, but it also induces colposcopic changes in the epithelium without completely altering its morphology. HPV-induced changes have now been largely identified and are recognisable in colposcopy. They can therefore be classified in the various patterns that characterise colposcopically the transformation epithelium, with undeniable advantages not only from the point of view of their correct classification but also from that of their prognostic evaluation. This is important because viral modifications ANTZ have a different diagnostic and prognostic significance from those observable in the notice squamous epithelium. A classification proposal of the various findings of flat HPV condylomatosis based on italian colposcopic classification is therefore presented.

[Analysis of the performance of several technicians in the echographic evaluation of the uterus]. / Analisi del comportamento di diversi operatori nella valutazione ecografica dell'utero.

The reproducibility degree in echographic biometry of uterus, studied by three diameters (longitudinal, transverse and antero-posterior), is mainly influenced by the anatomic characteristics of the structures. Starting from this observation a study about if and how much the understanding difficulties can influence differently the evaluation by four operators has been performed. Data, obtained from ten women, have been elaborated for appraising precision and accuracy of the four operators. Results show an almost univocal interpretation of the images and also that the data inhomogeneity in the less reproducible diameters valuation is caused by real difficulty in the interpretation of the pictures.