[Analysis of decline in seminal fluid in the Italian population during the past 15 years]. / Analisi del declino qualitativo del liquido seminale in Italia negli ultimi 15 anni.

BACKGROUND AND AIMS: The authors wished to study whether there has been a real decline in the quality of semen over the past years, as reported in the literature by a number of studies. This paper analyses the basic parameters of semen from 1068 males who have acted as donors during the past 15 years (1981-1995) for our semen bank. METHODS: Tables have been drawn up showing the number of cases examined every year, the mean concentration of spermatozoa, the mean percentage of mobile sperm and the mean percentage of non-conforming elements. RESULTS: An analysis of the data reported here shows that the mean concentration of spermatozoa in semen has shrunk from 88 x 10(6)/ml in 1981 to 61 x 10(6)/ml in 1995, a reduction of 30.7%; mean total motility has diminished from 74 to 66%, whereas the mean percentage with typical morphology has fallen from 76 to 63%. No statistical analysis was performed since variance analysis could not be performed on the sample in question to isolate the various sources of error. CONCLUSIONS: In conclusion, there has been a marked fall in the quality of semen over the past few years in individuals who regard themselves as fertile and are selected as semen donors. In the discussion the authors examine the various hypotheses regarding the possible causes of this deterioration in quality, opting for the argument based on the increased use of pollutants during the period in question in urban and rural areas.

The efficacy of clarythromycin (A-56268, TE-031) in the treatment of genital chlamydial infection.

The authors report the preliminary results of an experience of treatment with clarythromycin in Chlamydia trachomatis endocervicitis/endourethritis; 100% of 51 outpatients treated had negative ELISA results 7-10 days after the end of treatment with clarythromycin 500 mg. b.i.d. for 7 days. Among 64 female outpatients with chlamydial cervicitis treated with erythromycin 1 g b.i.d. for 7 days, 88% were negative at ELISA at the same intervals after therapy. The authors conclude that the efficacy of clarythromycin in this experience makes it use worthy of other and more extensive studies.

Failure in intrauterine contraception. Analysis of 137 cases of unfavourable outcome.

137 cases of unfavourable outcome in IUD insertion (i.e. early removal or expulsion because of complications) were investigated as regards age, parity, previous intrauterine contraception, previous induced abortion, type of device inserted, and type of complications observed. Moreover, this group was compared for each feature mentioned with a control group of 454 women who successfully concluded the prescribed period from the insertion. All the devices were inserted with a significantly higher rate of favourable outcome in pluriparous versus nulliparous patients; age probably didn't affect the outcome, but strongly conditioned the prevalence of particular complications such as PID and abnormal bleeding. Progesterone-loaded IUD didn't show a more favourable outcome than copper devices.

PIP: The factors associated with 137 cases of IUD expulsion or early removal due to complications were investigated in a case-control study conducted at an Italian family planning clinic. The 454 controls were women who did not experience adverse IUD outcomes. Complications in the study group included: bleeding (35%), expulsion (13%), pregnancy (13%), pelvic pain (15%), and pelvic inflammatory disease (24%). The majority of complications occurred 6-12 months after IUD insertion. Previous IUD use and the type of IUD inserted were unrelated to outcome. Most significant in terms of outcome was parity. There was a statistically significant (p .001) difference between the percentage of nulliparae in the study group (34%) compared with the control group (17%). Although most of the nulliparae in the study group were under 20 years of age, age did not have a significant correlation with IUD outcome. Pelvic inflammatory disease was significantly more prevalent in women under 30 years of age, while excessive bleeding was more common in cases above this age.

[Comparison of cytology and ELISA in the research on cervical Chlamydia infection]. / Citologia ed ELISA a confronto nella ricerca della Chlamydia cervicale.

Papanicolaou smears from 100 woman with ELISA Chlamydia-positive (42) and negative (58) endocervical smears were examined. Chlamydial endocellular inclusions were found in 3 ELISA positive and 2 negative smears, with an evident low sensitivity (7%) of cytology in the diagnosis of the endocervical infection. Furthermore, by statistical analysis it is clear that a negative test doesn't add anything to the pre-test probability (prevalence) of the infection. On the other hand a positive pap-smear adds a poor information, if compared with immunoenzimathic assay and IF staining. Thus, the Papanicolaou smear can't be considered of diagnostic value for Chlamydial infection. Furthermore, it proves unsuitable even for screening programs on high-risk patients, concerning which the immunoenzymatic assay appears, as previously affirmed, the most suitable effort.

[Contraception in women over forty]. / La contraccezione nella donna oltre i quarant'anni.

PIP: Nonhormonal contraceptives, include the condom that is safe and frequently used lately because of its ability to help in the prevention of sexually transmitted diseases. There is often psychological resistance to the use of diaphragm in the over 40 age group. The rhythm method is not reliable especially in irregular menstrual cycles, and its lack of reliability can cause anxiety. In the US 16% of women over 40 use spermicides. The IUD is recommended to women over 40 because of 1-time insertion, no requirement of care, efficacy, and the risk of pelvic inflammatory disease is modest at this age. IUDs with progesterone are particularly effective and seem to reduce the risk of inflammatory disease by making the cervical mucus more viscous. Surgical sterilization is not recommended at this age. Women over 40 who are not obese, do not smoke, and do not have a family history of cardiovascular disease have no contraindications to using modern oral contraceptives, (OCs). On the other hand, family history of diabetes and hyperlipidemia has to be assessed on an individual basis. Low dose contraceptives can have outright beneficial effects in vascular pathology by improving the hemostatic profile. Recently, animal research has suggested the possibility of a protective effect of OCs on the cardiovascular system. OCs also protect against osteoporosis. Although the debate is still unresolved, at the moment there is no proof whatsoever that OCs increase the risk of breast cancer in women over 40. The evaluation of patients for OC use has to include a diabetic history of mother or father, familial cardiovascular disease, overweight by more than 20%, smoking more than 10 cigarettes a day, and hypertension. If findings are negative, there is no appreciable risk for the patients. Mammography every 2 years for those with familial precedents, laboratory tests (lipid profile, coagulation, and hepatic function) and semiannual checkups are also be recommended.^ieng

[A new antiprogestational compound, mifepristone (RU-486)]. / Prospettive d'uso di un nuovo steroide ad azione antiprogesteronica: il Mifepristone (RU 486).

PIP: RU-486 is a steroid with antiprogestational action synthesized by the French firm Roussel-Ulcaf in 1980. When given in the middle of the menstrual cycle before the peak of luteinizing hormone (LH), it can inhibit ovulation by interfering with the function of the hypothalamus- hypophysis-corpus luteum-endometrium axis. A single dose of RU-486 in the late luteal phase induced uterine bleeding in all cases according to research done by Yen. A single 600 mg im dose of this agent was most effective for inducing abortion. There were positive results up tot he 41st day of amenorrhea in 85-90% of cases, but after the 7th weeks, this percentage declined, dropping to 60% by the 10th week. Advanced pregnancy increased the risk of incomplete expulsion of the conceptus, thus it is advisable to administer RU-486 in combination with a low-dose prostaglandin. Ru-486 is effective in advanced phases of pregnancy; it induces rapid expulsion with minor blood loss or side effects. Uterine bleeding starts 2-3 days after administration, lasting 11.6 + or - 5.8 days, and blood loss exceeds the normal rate in only 3.6% of cases. In 18% of patients, a significant decrease of hemoglobin occurred, but curettage or transfusion was never needed. Increased doses given for a long time produced nausea and asthenia. Possible teratogenic effects in cases of failure await to be investigated. RU-486 could be used for contraception, based on its ability to inhibit ovulation; for post- coital contraception; for regulation of menstruation; and for dilatation of the cervix.^ieng

[Experience with intrauterine contraception. Survey of 600 IUD users at the S. Anna University Hospital in Rome]. / Esperienze di contraccezione intrauterina. Rilievi su 600 utenti di IUD presso l'Ospedale Universitario S. Anna in Roma.

PIP: A group of 600 IUD users aged 26 to 35 were studied. 440 women were married; 434 were pluriparae and 166 nulliparae. 24 (5.5%) had undergone cesarean section, and 266 (44.3%) had had induced abortion. 23% of single women had opted for voluntary termination of pregnancy, while 72% had previous experience with IUDs or oral contraceptives. 273 (45.5%) relied on behavioral methods of contraception, 33 (5.5%) used the diaphragm, 279 (46.5%) used pills, 124 (20.6%) used condoms (50.6%) used ML-250 IUD, 144 (24%) used Progestasert, 87 (14.5%) used Gravigard, 42 (7%) used Minigravigard, 18 (3%) used Nova-T, 4 (0.6%) used Anticon, and 1 (0.1%) relied on No-Gravid. The IUD was removed prematurely in 119 cases, 339 were removed at the end of usefulness, dropout occurred in 51 cases, and expulsions in 14 cases. IUD failure was registered in 103 cases corresponding to 21.8% of the total. Bleeding caused 31 instances, 22 were due to dislocation, there were 15 intra -uterine pregnancies, 14 expulsions, 11 cases of pelvic pain, 4 cases of pelvic inflammatory disease, 3 cases of extrauterine pregnancy, and 3 other failures of IUDs. 31% of failures occurred in the 31-35 age group, and 40% of nulliparous women had IUD experience, but only 22.8% had a positive experience. 83.9% of those who used progesterone-containing pills had success with them, only 16.1% failed. Pluriparae over 30 used Progestasert most successfully. Nulliparous women did not represent the ideal candidates for IUD use, previous positive experience was an important element of success, while less important factors were age and abortion history.^ieng

[Relationships between contraception and gynecologic infections]. / Relazioni tra contraccezione e flogosi genitali nella donna.

PIP: Infections of the upper genital tract are commonly referred to as pelvic inflammatory disease (PID) and are often accompanied by fever, leucocytosis, and adnexal tumefaction. Risk factors are sexual activity at an early age, types of microbes, number of partners, and frequent sexual intercourse. Some studies found more incidence of mycotic vaginitis in women using oral contraceptives (OC) with a high estrogen content. It was also suggested that OC use reduced gonococcal pelvic infections by 50% by means of reducing menstrual flow and by modifying cervical mucus, making it impenetrable to bacteria. Nevertheless, OCs protect only in severe cases of PID. OC users appear to have a higher rate of chlamydial infections of the lower genital tract. IUD users have a 1.6 to 9.3 times higher risk of getting pelvic infections depending on age, number of partners, and frequency of intercourse. The risk is highest in the first 30 days after receiving the IUD, and long use (2 years) augments the risk of severe PID. There is increased risk of gonococcal infection in IUD users. Significantly increased numbers of anaerobic bacteria are present in cervical cultures of IUD users. Longterm IUD use is linked to a higher prevalence of actinomycetes. Among barrier methods, the use of the condom reduces the risk of infection with gonorrhea or chlamydia eightfold. The diaphragm provides effective protection against gonococcal and chlamydial infections, although its incorrect size and prolonged contact with spermicide can produce microlesions. Sterilization is associated with the reduction of genital infections; however, these are low-risk women aged 30 who are married. The spread of sexually transmitted diseases is an important factor to consider when choosing a contraceptive.^ieng

[Oral contraceptives and their minor side effects: comparison of three low-dose estroprogestinic combinations]. / Contraccettivi orali ed effetti collaterali minori: confronto fra tre estroprogestinici a basso dosaggio.

PIP: 3 groups of women aged 19-25 with normal weight and in good physical health were studied. In the first group, 40 subjects received a monophasic oral contraceptive (OC) containing .15 mg of levonorgestrel (LNG) and .03 mg of ethinyl estradiol (EE). In the second group, 32 women received a triphasic OC containing LNG and EE (.05 mg of LNG + .03 mg of EE; .075 mg of LNG + .04 mg of EE; .125 mg of LNG + .03 mg of EE). In the third group, 34 women received a monophasic OC containing .15 mg of desogestrel (DSG) and .03 mg of ethinyl estradiol (EE). The observation lasted 6 month, involving 646 menstrual cycles. 3 months and 6 months later, checkups were conducted to find out about characteristics of the cycles, spotting or BTB (hemorrhagic rupture), weight change, and other minor disorders. After 3 months, spotting occurred in 4.1% of the monophasic LNG group, in 5.8% of the monophasic DSG group, and in 1% of the triphasic group (significantly higher in the DSG group). Heavy bleeding decreased from 25% in the LNG group, 25% in the triphasic group, and 17.6% in the DSG group to 0 after 6 months. Likewise, dysmenorrhea disappeared in all 3 groups. Weight change occurred in 50% of the LNG group, in 57% of the triphasic group, and in 76% of the DSG group. Premenstrual disorders, such as mastodynia, dropped from 40 to 25% in the LNG group, from 75 to 50% in the triphasic group, and from 54.5 to 36.3% in the DSG group after 6 months. Depression decreased from 20 to 8.3% in the LNG group and from 18.1 to 4.5% in the DSG group. Acne fell from 25% to 0 in the triphasic group and from 31.8 to 9 in the DSG group. These OCs were well tolerated without major differences between their minor side effects.^ieng

Mothers' evaluation of a parent training program completed three and one-half years earlier.

The purpose of the present study was to examine the long term effects of a parent training program. Mothers who completed treatment, a mean of 3.6 yr earlier, were asked to fill out measures that examined parent perceptions of child adjustment and parent satisfaction with treatment. Of the 68 mothers to whom questionnaires were mailed, 34 (50%) returned them while 10 questionnaires were returned with an insufficient address. A comparison of pre-treatment, post-treatment and follow-up child adjustment scores indicated that the mothers perceived their children as significantly better adjusted after treatment and that this effect maintained at follow-up. Generally favorable responses were also reported by mothers on a consumer satisfaction measure.