[Use of antibiotics in prevention and therapy in obstetrics and gynaecologic surgery]. / Impiego in profilassi e terapia di farmaci ad azione antibiotica in chirurgia ostetrica e ginecologica.

BACKGROUND: The antibiotic treatments employed in 1999 in cases of gynaecologic and obstetric surgery in the first clinic of the Gynaecology and Obstetrics Department of the University of Turin have been evaluated. METHODS: 1131 gynaecological operations (major interventions, minor interventions, laparoscopies) and 492 laparotomic operations in obstetrics (mostly Cesareans) were assessed. Modalities of administration of chemoantibiotics (CAB) both at the prophylaxis stage and during the therapy stage were evaluated. RESULTS: A great application of chemoantibiotic prophylaxis (CABP) was noted as regards the gynaecological interventions (57.4% of cases) and low resort to chemoantibiotic therapy (CABT) (9%), thus highlighting the effectiveness of prophylaxis in reducing the incidence of infectious complications in the postoperative course in gynaecological surgery. As for obstetrics, the low percentage resort to CABP (36%) and the high resort to CABT (26%) were noted. It is proposed to obviate this fact by increasing the number of cases of CABP for obstetrics so as to reduce the massive recourse to CABT. CONCLUSIONS: Finally, some pharmacoeconomic remarks are offered regarding the rationalisation of the use of CABs in hospital surgical obstetrics and gynaecology.

Transvaginal sonographic tubal patency testing using air and saline solution as contrast media in a routine infertility clinic setting.

Tubal patency testing by transvaginal sonography has been implemented in our infertility clinic since 1991. We report our experience with this technique during the last year of routine outpatient activity. A total of 154 infertile patients, including three patients on two occasions, underwent tubal patency testing by transvaginal sonography; 36 also underwent laparoscopy or hysterosalpingography, with a further three undergoing both. A detailed account of the method used to visualize the passage of air and saline through the salpinx is described. The 'gold standard' for tubal patency was laparoscopy. In any cases that were doubtful or if there was tubal occlusion, laparoscopy was advised. The diagnoses by transvaginal sonography in the 154 patients consisted of: 106 with bilateral tubal patency (68.8%), 34 with unilateral tubal occlusions (22.1%), and 13 with bilateral occlusion (8.4%); one case was undiagnosed. Tubal disease was present in 25 out of the 36 (69.4%) patients undergoing laparoscopy or hysterosalpingography (69.4%). The sensitivity, specificity, accuracy, positive and negative predictive values were respectively 80, 85, 82.7, 85 and 80% for the 29 patients undergoing transvaginal sonography and laparoscopy. When the number of tubes examined was considered, these values were respectively 85, 91.6, 89.3, 85 and 91.6%. No discordance was observed in the ten patients undergoing hysterosalpingography. Demonstration of the tubal course relies on a positive contrast medium filling the tubal lumen. Air and saline were successful for this purpose. In our study, the results of tubal patency testing by transvaginal sonography were very similar to those of hysterosalpingography, but differed in about 10% of the cases from those of laparoscopy. The most difficult problem to rule out was distal tubal occlusion without hydrosalpinx. Tubal patency testing by transvaginal sonography can be used safely as a first-step examination of tubal patency. Easy tubal passage can allow medical treatment, while a doubtful or frankly occluded salpinx should be investigated by laparoscopy.

A new technique to test tubal patency under transvaginal sonographic control.

OBJECTIVE: Since 1990 we have undertaken a trial to evaluate if TVS, even without contrast media, could diagnose tubal patency. MATERIALS AND METHODS: A detailed description of the technique is given. Two hundred and seventy-three patients underwent sonosalpingography in our department in the period 1990-1993. The sonographic findings were matched in 43 cases to hysterosalpingography and in 55 cases to laparoscopy. RESULTS: Tubal patency was demonstrated in 218 patients (80.5%), monolateral patency in 41 (15.1%) patients and bilateral tubal occlusion in 12 (4.4%) patients. In the 43 patients undergoing hysterosalpingography, discordance between the two examinations was observed in five cases (11.6%). However, only six out of 86 salpinxes had different results (6.9%). In only one case was total discordance observed. In three out of four other cases the difference was due to patency diagnosed at SSG and occlusion at HSG. Of the 55 patients undergoing laparoscopy 12 cases (21.8%) had discordant results. Complete discordance was observed in two cases while in ten cases one salpinx had a different patency report. The discordance goes to 12.7% when we take into account all the salpinxes evaluated. CONCLUSION: Sonosalpingography gives very similar results to hysterosalpingography and may be used on clinical basis for tubal patency evaluation.

Transvaginal salpingo-sonography (TSSG) in the evaluation of tubal patency.

Transvaginal sonography was used in 78 patients to evaluate tubal patency as a control in infertility workup. The cervix was fitted with a Semm cervix-adapter (Wisap); air and saline were injected through it. Careful scanning of the uterine angles and of the tubes permitted to demonstrate bilateral passage of the contrast medium in 52 of the 55 patients and monolateral passage in 3. 21 patients had also other conventional evaluations of tubal patency. Two patients were excluded from protocol. Total agreement with hysterosalpingography (HSG) was found in 69.2% of the cases, partial agreement in 23%. Total agreement with laparoscopy (LPS) was found in 83.3% of the cases. In conclusion transvaginal sonosalpingography (TSSG) can be used as a first ambulatorial evaluation of tubal patency in infertility work-up.

[Correlation of positivity for serum anti-chlamydia antibodies and tubal damage as a cause of infertility. Preliminary study]. / Correlazioni tra positività per anticorpi anti-chlamydia sierici e fattore tubarico come causa di infertilità. Studio preliminare.

Chlamydia Trachomatis is one of the most frequently bound aetiological agents in acute salpingitis. Chlamydia infection often runs asymptomatically or with slight symptomatology, so patients do not call in their doctor. This hypothesis is backed by the observation that serum antibody positivity for Chlamydia and tubal infertility are often found together. The purpose of the present study was to determine the positivity of serum antibodies for Chlamydia in infertile women observed at this Centre and compare it with a control group of non-sterile patients. Further, in those patients in whom antibody positivity exists, it was also proposed to seek tubal lesions at hysterosalpingography or coelioscopy. The antibody titre in infertile women is compared with that of the control group. The study was carried out in 30 sterile women and in 30 patients in the definitely fertile control group. The "Ipazyme" (Sorin) immunoperoxidase test was used to seek IgG and IgA anti-Chlamydia antibodies. The geometric mean of the antibody titre was calculated in those women with a titre equal to or greater than 64 for IgG antibodies and equal to or greater than 16 for IgA antibodies. It is now intended to study whether the titre is higher in infertile women compared to the control group and if positivity is more significant in these patients.