[Therapeutic abortion intrauterine fetal death in the second trimester. Treatment with a gemeprost-sulprostone combination]. / L'aborto terapeutico e la morte endouterina del feto nel secondo trimestre. Trattamento mediante impiego combinato gemeprost-sulprostone.

UNLABELLED: This study reports the results obtained in the medical introduction of abortion during the second trimester of pregnancy in 52 patients following intrauterine fetal death or the diagnosis of fetal malformations. METHODS: The protocol consisted of the alternate use of intravaginal suppositories of gemeprost and intramuscular injections of sulprostone. The results were analysed using statistical methods and evaluated in relation to the different parameters present (intrauterine fetal death or therapeutic abortion, maternal age, gestation period and parity). RESULTS: It was seen that the time required to induce abortive labour was significantly shorter in patients with IFD compared to patients with live fetus. The comparison between patients with a gestation period < or > 18 weeks revealed shorter induction times in the former group without reaching statistical significance. CONCLUSIONS: Maternal age (under and over 30) and parity (P = 0 and P > or = 1) did not influence the results obtained.

[Preclinical lymph node metastasis in ovarian cancer. Report of a case]. / Metastasi linfonodale preclinica di carcinoma ovarico. Descrizione di un caso.

The involvement of inguinal lymph nodes in the spread and metastatic process of ovarian cancer is not common and has been reported in a very small percentage of cases (1-3%) and at relatively advanced stages. This paper examines the case of a patient in whom lymph node metastasis at inguinal level became manifest at quite an early stage in the form of a swelling, initially mistaken for a crural hernia, and preceding by about one year the onset of papilliferous serous cystoadenocarcinoma which subsequently developed in the right ovary. This case, which to the authors' knowledge represents the second observation of this kind reported in the literature, aims to draw attention to the need to examine and monitor these patients more carefully and accurately (at both instrumental and biochemical levels) in order to intervene as rapidly and appropriately as possible.

Hyaluronan can be protected from free-radical depolymerisation by 2,6-diisopropylphenol, a novel radical scavenger.

The scavenging effect of 2,6-diisopropylphenol on hydroxy radicals produced by xanthine oxidase was assessed by evaluating the in vitro depolymerisation of hyaluronan in artificial synovial fluid by size-exclusion chromatography. After 1 hour, the number-average molecular weight of hyaluronan remained unchanged (100%) with 2,6-diisopropylphenol, whereas it dropped to 90% with methylprednisolone added, to 55% with the antioxidant 2,6-tert-butyl-4-methylphenol added, and to 10% of its initial value in the absence of scavenger.

Purification and characterization of hyaluronan from synovial fluid.

An easy and rapid method for the purification and characterization of hyaluronan from synovial fluid has been developed. Lipids were removed by filtration through a hydrophobic filter prior to the removal of proteins by phenol-chloroform extraction. The hyaluronan recovery was 95%, as measured by three different methods. The average molecular weight of hyaluronan did not change during the purification. Furthermore, it was found that an optimized enzymatic protein digestion of pathological human synovial fluid prior to filtration yielded up to five times more hyaluronan recovered. In addition, the molecular weight of hyaluronan from synovial fluid not digested with pronase E was apparently higher because of the presence of aggregates. After the purification of hyaluronan (ca. 15 min), a single size-exclusion chromatography step allowed the simultaneous determination of its concentration and the reasonable estimate of its average molecular weight and molecular weight distribution curve. The logarithm of the molecular weight showed a linear dependence on the size-exclusion chromatography elution volume for hyaluronan in the molecular weight range 2.0 x 10(6)-1.0 x 10(4). The removal of proteins allowed the determination of fairly low-molecular-weight fractions of hyaluronan, compared to untreated samples for which hyaluronan and protein peaks partially overlap.

Sex hormone binding globulin, cortisol binding globulin, thyroxine binding globulin, ceruloplasmin: changes in treatment with two oral contraceptives low in oestrogen.

It is generally assumed that the oral contraceptives cause the carrier proteins to change. Notoriously this effect is used to evaluate indirectly their estrogenicity/gestagenicity ratio. In order to assess the residual intrinsic androgenic activity of two new 19-nor-derivative components, Desogestrel (DG) 150 micrograms and Gestodene (GD) 75 micrograms, both in association with Ethinylestradiol (EE) 30 micrograms, Sex Hormone Binding Globulin, Thyroxine Binding Globulin, Ceruloplasmin and Free Androgen Index (FAI), were studied in 40 young normally cycling healthy volunteers, matched for body mass index and age. The participants were randomly assigned to either EE-DG or EE-GD treatment. A marked significant increase in all the carrier proteins was found. Conversely, the values for FAI decreased significantly. The changes in the two groups were substantially of the same magnitude. These results are an indirect confirmation of the well-known negligible receptor binding affinity of the two progestogen in vitro, also supporting for these compounds the lack of relevant androgenic effects.

PIP: The residual androgenic activity of two new combined oral contraceptives (OCs)--30 mcg of ethinyl estradiol in combination with either 150 mg of desogestrel or 75 mcg of gestodene--was investigated in 40 healthy volunteers. Measured in these volunteers were modifications in transport protein levels. These levels are known to be increased by estrogen, but this increase can be counterbalanced, to varying degrees, by gestagens. For both OCs, there was a marked percentage increase in sex hormone binding globulin (SHBG), corticosteroid binding globulin (CBG), thyroxine binding globulin (TBG), and ceruloplasmin (CP) and a similar reduction in total testosterone and the free androgen index. The modifications in SHBG, CBG, TBG, and CP are interpreted as an expression of the correlated value of the estrogenicity/gestagenicity ratio of the OCs studied and suggest that these particular formulations have greater estrogenicity. The relatively negligible biological androgenic activity of desogestrel and gestodene and their elevated affinity progesterone receptor/androgen receptor ratio reflect the high selectivity of these agents. Moreover, the lack of androgenic effects makes desogestrel and gestodene appropriate treatment agents for hyperandrogenism.

Changes in the plasma levels of proteins C and S in young women on low-dose oestrogen oral contraceptives.

The physiological importance of proteins C and S as natural anticoagulants is demonstrated by the increased risk of thromboembolic disease among subjects with hereditary deficiency of both proteins. In the present study the effects were evaluated of low-dose oestrogen oral contraceptives (OC) on the plasma levels of immunological protein S, as free (PS-f), and in reversible complex with C4b-binding protein as well as functional protein C (PC) in a homogeneous group of 20 young healthy women. The participants were randomly given either gestodene (75 micrograms) or desogestrel (150 micrograms) in combination with ethinyl oestradiol (30 micrograms). Blood samples were taken prior to the initiation of the treatment and at the end of the sixth 21-day treatment cycle. The mean concentration of both free and bound PS fell significantly, the decrease still being within the reference range. Conversely, the plasma values for PC rose to a statistically significant extent. There were no significant differences between the two OCs. Hypothetically, the changes in PS-f (active fraction) might be conducive to a procoagulant state, which the increased PC may compensate. The reverse effect of two OCs on the activity of the protein C-protein S anticoagulant system might suggest a different regulation of their synthesis.

PIP: The influence of low-dose oral contraceptives (OCs) on plasma levels of proteins C and S was investigated i 20 healthy women. These proteins, along with antithrombin III, are the most significant inhibitors of coagulation. Blood samples were collected after 6 months of treatment with an OC containing 30 mcg of ethinyl estradiol and either 150 mcg of desogestrel or 75 mcg of gestodene. A significant increase in functional protein C concentrations (from 55.70 + or - 9.84 to 117.48 + or - 21.29 in the desogestrel group and 68.80 + or - 19.11 to 135.60 + or - 28.66 in the gestodene group) was recorded between baseline and the 6-month measurement. There was a corresponding decrease in plasma concentrations of free protein S (from 98.48 + or - 9.64 to 73.96 + or - 12.07 in the desogestrel group and 104.79 + or - 31.52 to 83.14 + or - 18.28 in the gestodene group). Although these OC-induced changes were statistically significant, all values remained within the normal range. The differences between the 2 OC formulations were not significant. It is hypothesized that the changes in the active fraction of protein S recorded in OC users produce a procoagulant state and increases in protein C reflect an effort to compensate for this change. The findings that OC use increases protein C and decreases protein S values suggests that the two proteins differ in the regulation of their synthesis.

Treatment of hirsutism related to micropolycystic ovary syndrome (MPCO) with two low-dose oestrogen oral contraceptives: a comparative randomized evaluation.

In order to evaluate the clinical and endocrinological efficacy of two low-dose oral contraceptives (OC) containing 30 micrograms Ethinylestradiol (EE) and 150 micrograms Desogestrel (DG) and 75 micrograms Gestodene (GD), respectively, an open randomized study was carried out in 34 young hirsute women, matched for body mass index and age. All of them met endocrine and ultrasonic criteria for Micropolycystic Ovary Syndrome (MPCO). The participants were randomly assigned to one of two pill groups (each of 17). The serum values for Total Testosterone (TT), Free Testosterone (FT), Androstenedione (A), Dehydroepiandrosterone (DHEA), Dehydroepiandrosterone Sulphate (DHEAS), 17-Hydroxyprogesterone (17Pg), Sex Hormone Binding Globulin (SHBG), Ceruloplasmin (CP), as well as Ferriman-Gallwey Index (FGI) and Free Androgen Index (FAI) were evaluated prior to and after EE-DG and EE-GD 6 cycle treatment. A significant decrease in TT, FT, A, 17Pg, DHEA, DHEAS, FGI, FAI was observed, SHRG and CP increased significantly. There were no significant differences between the two OC. Our results seem to indicate that both OC are equipotent as far as their pharmacological profile and residual androgenic activity are concerned. Therefore, these OC may represent a highly effective and suitable alternative to the treatment of hyperandrogenism related to MPCO.

PIP: In order to evaluate the clinical and endocrinological efficacy of 2 low-dose oral contraceptives (OCs) containing 30 mcg ethinyl estradiol (EE) and 150 mcg desogestrel (DG) and 75 mcg gestodene (GD) respectively, an open randomized study was carried out on 34 young, hirsute women, matched for body mass index and age. All met endocrine and ultrasonic criteria for micropolycystic ovary syndrome (MPCO); participants were randomly assigned to 1 of 2 pill groups (n=17 each). The serum values for total testosterone (TT), free testosterone (FT), androstenedione (A), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphase (DHEAS), 17-hydroxyprogesterone (17Pg), sex hormone binding globulin (SHBG), ceruloplasmin (CP), as well as Ferriman-Gallway Index (FGI), and Free Androgen Index (FAI) were evaluated prior to and after EE-DG and EE-GD 6-cycle treatment. Significant decreases in TT, FT, A, 17PG, DHEA, DHEAS, FGI, and FAI were observed; SHBG and CP increased significantly. There were no significant differences between the 2 OCs. These results seem to indicate the both OCs are equally potent in pharmacological profile and residual androgenic activity. Therefore, these OCs may represent a highly effective and suitable alternative to the treatment of hyperandrogenism related to MPCO.

Effects of desogestrel and gestodene in low-dose oral contraceptive combinations on lipid and lipoprotein status. A randomized prospective study.

This study was designated to assess the effects of two low-dose oral contraceptives (OC) on serum lipids and lipoproteins and to compare, at same oestrogen dose (30 micrograms), the effects of desogestrel (DG) with those of a new progestin, gestodene (GD). Fifty-four young women, matched for Quetelet's Index, age, diet, alcohol consumption, smoking and exercise habits, were randomly assigned to one of two regimens. Serum high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, total triglycerides (T) and cholesterol (C), apolipoprotein A-1 (Apo A) and apolipoprotein B (Apo B) were measured prior to the OC commencement and after 6-cycle treatment. Sex hormone binding globulin (SHRG) and ceruloplasmin (CP) were determined as well. LDL-C, Apo A, C, T, increased significantly from baseline values, being still the increase within the reference range. Apo B changed proportional to the LDL-C increase. A rise in HDL-C occurred but it was statistically significant in the EE-DG group only. This result would suggest that the EE-DG combination is more estrogen-dominant that the EE-GD combination. However, this hypothesis was not consistent with the increase to the similar extent for SHBG and CP, which reflect the estrogenicity/gestagenicity of the two OCs. The disproportion of change between HDL-C and Apo A in only EE-GD group might reflect some compositional change in HDL particle. There were no significant differences between the two formulations for the parameters investigated.

PIP: This study was designed to assess the effects of 2 low-dose oral contraceptives (OCs) on serum lipids and lipoproteins and to compare, at the same 30 mcg estrogen dose, the effects of desogestrel (DG) with those of a new progestin, gestodene (GD). 54 young women, matched for Quetelet's Index, age, diet, alcohol consumption, smoking, and exercise habits, were randomly assigned to 1 of 2 regimens. Serum high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL), cholesterol, total triglycerides (T), and cholesterol (C), apolipoprotein A-1 (Apo A), and Apo B were measured prior to the OC commencement and after 6 cycles of treatment. Sex hormone binding globulin (SHBG) and ceruloplasmin (CP) were determined as well. LDL-C, Apo A, C, and T increased significantly from baseline values, still remaining within the reference range. Apo B changed proportionally to the LDL-C increase. A rise in HDL-C occurred but it was statistically significant in the EE-DG group only. This result would suggest that the EE-DG combination is more estrogen dominant than the EE-GD combination; however this was not consistent with the increase to a similar extent of SHBG and CP, which reflect the estrogenicity/gestagenicity of the 2 OCs. The disproportionate change between HDL-C and Apo A in only the EE-GD group might reflect some compositional change in HDL particles. There were no significant differences between the 2 formulations for the parameters investigated.

Short-term treatment of hirsutism related to micropolycystic ovary syndrome with a combination type oral contraceptive containing desogestrel.

The antiandrogen effects of an oral contraceptive containing 0.03 mg. Ethinyl Oestradiol and 0.15 mg. Desogestrel have been evaluated in 17 non-obese hirsute women, with normal serum LH and FSH values and their ratio, and evidence for Micropolycystic Ovary Syndrome (MPCO) on ultrasound examination. At the completion of 5 cycles (21 days) of treatment, a statistically significant decrease in serum Total Testosterone, Free Testosterone, Androstenedione levels was observed. Similarly, serum values for Dehydroepiandrosterone Sulphate and 17-OH-Progesterone showed a marked fall. The Sex Hormone Binding Globulin (SHBG) values rose about four-fold, so that the Free Androgen Index was suppressed. The clinical score, evaluated according to the method of Ferriman and Gallwey, was found sharply reduced. Therefore, the well defined improvement of biochemical and clinical parameters, along with the absence of discernible side effects, are undoubtedly confirming the effectiveness of the treatment in hyperandrogenism of women with MPCO.

"Etiological characterization of hirsutism by means of a chemometric technique: the linear discriminant analysis".

This preliminary study concerns the evaluation of a chemometric technique, the so called Linear Discriminant Analysis (LDA) for an adequate nosological characterization of the more common forms of hirsutism: i.e., the Micropolycystic Ovary Syndrome (MPCO) and the Idiopathic Hirsutism (I.H.). The obtained data and, particularly, the evidence of statistically significant values of the Linear Discriminant Function (mean = 12.7; p less than 0.02), clearly show the effectiveness of LDA as a practical and suitable method for a more proper detection and classification of MPCO and I.H.

[Influence of some anesthesiologic methods on blood loss in procedures for voluntary termination of pregnancy]. / Influenza di alcune metodiche anestesiologiche sulla perdita di sangue in interventi per interruzione volontaria di gravidanza.

PIP: 120 patients in good health, aged 25-38, all in the first trimester of pregnancy, and requesting interruption of pregnancy, were divided into 4 groups and given different types of anesthesia; 1) general anesthesia with volatile anesthetics; 2) general anesthesia without volatile anesthetics; 3) dissociated anesthesia with Ketamin; and, 4) paracervical block with Mepivacain 1%. All interventions were done through curettage, and lasted 7-18 minutes; in all cases blood loss was carefully collected and measured. Minimum amount of bleeding was noted with paracervical block; maximum amount with volatile anesthetics such as ethrane. For every type of anesthesia blood loss increased with age of pregnancy. There were no postoperative complications. As confirmed by the published literature anesthesia by paracervical block is an easy, uncomplicated method, which requires little preparation time and which can be done at low cost.^ieng