[Anxiety and acceptance of gynecological laparoscopic operations]. / Ansia e gradimento degli interventi eseguiti in laparoscopia ginecologica.

BACKGROUND: To evaluate the acceptance of gynecological laparoscopic operations. METHODS: A comparative analysis has been performed in a group of 32 women by analyzing a) the cognitive component, by means of 2 questionnaires administered before and after the operation and b) the emotional component, by evaluating the pre- and post-operative anxiety levels (State anxiety) and the constitutional ones (Trait anxiety) using the STAI Y test. The anxiety level of our group has been compared with that attributed to the general population by means of the Z test. Moreover, significant correlations have been searched between: 1) pre- and postoperative Trait and State anxiety, through the Pearson's correlation test; 2) the variables investigated by the two informational questionnaires and the anxiety measures, through the Student t test; 3) the informative variables themselves through the c2 test. RESULTS: Postoperative State anxiety is lower than that of the general population (p<0.05); a significant correlation exists between post- operative State and Trait anxiety (p<0.05); Trait anxiety is higher when fantasies linked to the operation are characterized by fear (p<0.05), and attribution of the decision to operate to the doctor (p<0.05); post-operative State anxiety is higher when the level of education is low (p<0.05) and the attribution of the decision to operate is to the doctor (p<0.05); a significant correlation exists between fantasies characterized by fear and the experience of postoperative pains, between postoperative pains and attribution of the decision to operate to the doctor (p<0.05) and between fantasies characterized by fear and attribution of the decision to operate to the doctor (p<0.05). CONCLUSIONS: Higher anxiety levels have been detected in the pre-operative phase, in less educated patients and when the decision to operate has been attributed to the doctor. A not wholly convinced personal attitude has been accompanied by preoperative fantasies characterized by fear and has resulted in subjectively more painful postoperative course.

[Psychologic consequences of a case of aortic perforation during an intervention of laparoscopic surgery]. / Le conseguenze psicologiche di un caso di perforazione aortica durante un intervento di chirurgia laparoscopica.

Although rare, the severe complications inherent in the laparoscopic technique can be physically devastating, whereas from a psychological point of view they may be very traumatic because they are perceived by the patient as unexpected and totally out of proportion compared to the perceived expectation of risk prior to surgery. The possible psychological consequences of a case of aortic perforation with cardiac arrest were evaluated using the Rorschach test in a patient who had undergone exploratory laparoscopy for secondary amenorrhea. An analysis of the test did not show psychotraumatic data attributable with certainty to this experience.

[Non-invasive instrumental method in uncontrollable post-partum hemorrhage (an alternative to hemostatic hysterectomy)]. / Tecnica strumentale non invasiva nelle emorragie irrefrenabili del post-partum (in alternativa all'isterectomia emostatica).

A new non-invasive instrumental technique which is useful to stop the most severe post-partum haemorrhages is described. This technique is proposed as an alternative to more invasive methods such as the binding of uterine or hypogastric arteries, which is itself a trauma, not always effective and could promote the obstetric shock. The method proposed by the authors is not invasive, can be performed in a few minutes and performed without the help of anaesthesia. Very encouraging results were achieved and have allowed to avoid the use of the so-called "haemostatic" hysterectomy.

[Premature membrane rupture. Comparison of diagnostic tests]. / Rottura intempestiva delle membrane. Test diagnostici a confronto.

BACKGROUND: Objective of this study was to evaluate the accuracy of the vaginal pH-test, the Fern-test, the research of foetal cells and of foetal fibronectin in vaginal discharge, which are used to diagnose premature rupture of membranes. METHODS: To this aim 40 pregnant patients between 24th and 37th weeks gestation have been examined, considered at risk for sub-clinic loss of aminiotic fluid: 23 were affected by preterm labour and 17 by suspected rupture of membranes. RESULTS: Subsequently amniotic sac was confirmed to be ripped in 10 cases (25%): 2 (8.7%) in the 23 patients with preterm labour, and 8 (47%) in the 17 patients with suspected PROM. Sensibility, specificity and accuracy were respectively: 70, 97 and 90% for pH-test; 70, 100 and 93% for Fern-test; 50, 93 and 82% for foetal cells; 100, 90 and 93% for fibronectin test. CONCLUSIONS: In personal experience fibronectin test appeared to be the most sensible and accurate marker. Fern-test was the most specific, while the research of foetal cells appeared to be the least reliable.

Prospective multicenter study on the clinical utility of ca-72.4 in postmenopausal patients with pelvic mass.

The study objective was to evaluate the sensitivity and specificity as well as the positive predictive value and negative predictive value of CA 72.4 and CA 125 determination, separately and in combination, for diagnosing ovarian tumors in post-menopausal women with pelvic mass. The 299 patients recruited in this study underwent gynecological examination, plasma determination of CA 72.4 and CA 125, and laparotomy with histological definition of pelvic mass. CA 72.4 assay values were under 3.9 U/ml in 194 cases (70.8%); values ranged from 3.9 to 4.5 U/ml in 7 cases (2.5%) and were greater than 4.5 U/ml in 73 cases (26.6%). CA 72.4 assay was positive (>4.5 U/ml) in 56 cases (57.1%) of malignant ovarian pathology, in 4 cases (25%) of malignant extra-ovarian pathology as well as in 9 cases (7.1%) of benign ovarian pathology and in 4 cases (11.8%) of benign extra-ovarian pathology. With a cut-off at 3.9 U/ml, CA 72.4 showed a specificity of 91.3% and a sensitivity of 62.2%, whereas with a cut-off at 4.5 U/ml specificity was 92.9% and sensitivity 57.1%. Results of CA 125 assay for diagnosing a pelvic neoplasia (ovarian or extra-ovarian), showed a specificity of 85.3% and sensitivity of 68.8%. The agreement of the two markers (CA 125 and CA 72.4) as negative or positive shows a specificity of 77% and a sensitivity of 84.7% for ovarian cancer and a specificity of 73.5% and sensitivity of 75% for the diagnosis of pelvic neoplasias.

Clotting inhibitors and fibronectin as potential markers in preeclampsia.

OBJECTIVES: As conventional laboratory tests fail to identify early preeclampsia, the aim of this study was to seek a marker of endothelial injury and select more sensitive tests for monitoring the activation of the coagulation cascade. METHODS: Using routine blood sampling methods, PT, PTT, AT-III, proteins C and S, platelets, fibrinogen and fibronectin were measured in 18 preeclamptic patients and 17 controls with a normal pregnancy. RESULTS: Preeclampsia was associated with higher fibronectin and lower AT-III, protein C and protein S. The platelet count, fibrinogen and PT were similar. PTT was longer in preeclampsia. CONCLUSION: As AT-III revealed compensated coagulopathy and fibronectin demonstrated preeclamptic vascular lesions before these were apparent from routine tests, measuring these elements could contribute to the earlier diagnosis and better treatment of chronically-altered coagulation in preeclampsia.

[Emergency surgical indications in pregnancy (3 rarely encountered cases)]. / Indicazioni chirurgiche d'urgenza in gravidanza (tre casi di raro riscontro).

The authors evaluated 3 cases of acute abdomen during pregnancy: Spontaneous rupture of splenic artery at 30th gestational week (gw). Torsion of left normal Fallopian tube at 33rd gw. Left adnexal torsion at 36th gw. The symptomatology, the etio-pathology and the anatomo-pathological characteristics of every case wore discussed. In women that are usually young, maternal and fetal exitus in the first case and salpingectomy or adnexectomy in the second and third case can be avoided only thanks to timely surgical intervention.

Endometrial cytology for the prevention and early diagnosis of endometrial neoplasias.

One hundred and forty women, aged between 46 and 70 years, were submitted to periodic colpocytologic, colposcopic and cytologic endometrial checking. None of the patients had been treated by estrogenic therapy. We evaluated the possible morphologic modifications of the endometrium over time by periodic cytologic checks, personalized on the basis of the anamnestic and actual risks of the patients. From the data it was noted that the endometrium in pre- and in post-menopause may present changes in the absence of substitutive therapies. In fact in women in post-menopause we found 33% of atrophic endometria at first check, going down to 22.3% at the second, while the incidence of hyperplasia increased slightly. At the second check we always diagnosed 2 cases (2.6%) presenting atypia, confirmed by subsequent curettage. At the third check an increase was observed of atrophic endometria (41.8%) and a reduction of focal hyperplasia (4%). Among women in pre-menopause there was a high incidence of endometria with focal hyperplasia, 37.5% at the first check, 40.6% at the second and 39.6% at the third; hyperplasia in 11.5% of cases at first check, 12.5% at the second and 6.3% at the third; presence of atypia in 1.5% of cases at the second check and 3.2% at the third. Curettages subsequently confirmed diagnosis in these last three patients. In the cases where small fragments of endometrial tissue appeared in the cytological sample we found good agreement between histologic and cytologic diagnoses; the latter slightly overestimated focal hyperplasia and diffuse hyperplasia.(ABSTRACT TRUNCATED AT 250 WORDS)

Colposcopic pictures of Abnormal Transformation Zone (ANTZ): colpocytological and histological findings.

The Authors have examined the correlation between the colposcopic pictures of the Abnormal Transformation Zone (ANTZ), in its varying degrees, and the colpocytological and histological examinations in order to seek a better definition of the indications of carrying out aimed biopsies. From our results a good agreement has been observed from the colpocytological and histological examination and the colposcopic pictures of the ANTZ. In patients with colposcopic images of ANTZ G2 the colpocytological examination diagnosed a CIN 3 in 80.6% of cases, invasive carcinoma in 6.4%, and in histologic examination CIN 3 in 71% and microinvasive carcinoma in 10.7%. Instead in the ANTZ G1, CIN 3 was revealed colpocytologically in 7.9% of the cases and histologically in 7.3%. Among these last, in half of the cases, the focuses of CIN 3 were present at the level of third inferior of the cervical canal. Finally, in ANTZ G0 there was cytological evidence in 6.6% of cases of CIN 3 with a histological correspondence of 3.9%. In particular the focuses of CIN 3, small and limited, had resulted from biopsies carried out on some glandular openings not clearly attributable to ANTZ G1. With regard to the opportuneness of carrying out aimed biopsies, mandatory in the cases of ANTZ G2, we feel it would be useful to carry them out also for ANTZ G1, above all if alterations are diagnosed at the colpocytologic examinations, and in ANTZ G0 if colpocytological alterations are present. Therefore integrating colposcopic and colpocytologic examinations and aiming the biopsies would seem to lead to good diagnostic reliability and adequate successive personalized treatment.