Leiomyomatosis peritonealis disseminata: pregnancy, contraception and myomectomy of its pathogenesis.

Leiomyomatosis peritonealis disseminata (LPD) is a rare smooth muscle tumour characterized by multiple small nodules on the omentum and peritoneal surface, composed of benign smooth muscle cells with minimal mitotic activity, frequently admixed with decidual cells. The possible pathogenetic mechanisms include hormonal dysfunction, differentiation of subperitoneal mesenchymal stem cells, myofibroblastic metaplasia and genetic and iatrogenic causes (resection of myomas during laparoscopic surgery). Diagnosis is easily made on biopsy specimens. Reduction of oestrogen exposure, surgical castration or gonadotrophin releasing hormone agonists are generally sufficient to cause regression of LPD. We report a case of an asymptomatic 36-year-old pregnant woman with long-term use of oral contraceptives, and previous myomectomy, who had a mass of uncertain origin which was, histopathologically, diagnosed as leiomyomatosis peritonealis diffusa with foci of ectopic decidua. Ectopic decidua was also present in a pelvic lymph node. To the best of our knowledge, this is the first case of LPD containing foci of ectopic decidua in a pregnant woman with a past history of myomectomy and use of oral contraception for three years; ectopic decidua was also detected in a pelvic lymph node.

[Rokitamycin in the treatment of female genital Chlamydia and Mycoplasma infections. Comparative study vs josamycin ]. / Trattamento delle infezioni genitali da Chlamydia e Mycoplasma con rokitamicina. Studio controllato vs josamicina.

BACKGROUND: The macrolides are among the most effective antibiotics against infections due to Chlamydia and Mycoplasma. The drug in such cases must have marked antibacterial activity, good oral bioavailability, and high intracellular diffusion--indispensable for instance with Chlamydia infection. Rokitamycin, a macrolide with a 16-atom lactone ring, has the features for use in the treatment of genital infections caused by Chlamydia or Mycoplasma, penetrating the cell and reaching considerably higher concentrations than other drugs of the same class. The aim of this trial was to gain further knowledge of rokitamycin in genital infections, including cases infected with Mycoplasma hominis, comparing the efficacy and safety of this drug with josamycin, another macrolide widely employed in clinical practice. METHODS: Patients of either sex, over the age of 18 years, with infections due to Chlamydia trachomatis and Mycoplasma hominis, were admitted. The trial was conducted in accordance with the Declaration of Helsinki and amendments. Fifteen patients were given rokitamycin, one 400 mg tablet every 12 h, and another fifteen received josamycin, one 500 mg tablet every 8 h, for 14 days. Before starting treatment, after the 14 days and after 42 days' follow-up the severity of the following symptoms was assessed: pruritus, burning, erythema, pollakiuria, dysuria, using a four-point rating scale (0 = absent, 1 = mild, 2 = moderate, 3 = strong). The presence or absence of leukorrhea was noted. Patients entered the severity of subjective symptoms daily in a diary. At the end of the trial overall assessments were made on the clinical response, microbiological outcome and efficacy. RESULTS: Thirty patients of both sexes were admitted, age 21-43 years, with genital infections due to Chlamydia trachomatis and/or Mycoplasma hominis. Fifteen were given rokitamycin, 800 mg/day, and 15 josamycin, 1500 mg/day, for 14 days. In 13 cases in each group an antibiotic was prescribed for the partner too. At the start of the trial microbiological samples were taken; in 13 cases a urethral swab was taken (six in the josamycin and seven in the rokitamycin group), and 17 cervical swabs were taken (respectively nine and eight). At the end of the trial 93% of patients gave a negative microbiological result. Mycoplasma hominis was isolated from one patient treated with rokitamycin, and Chlamydia trachomatis from one patient given josamycin. Symptoms improved at a similar rate in both groups, with no significant differences between the drugs. Safety was excellent in both groups, with no complaints of adverse reactions. CONCLUSIONS: This trial demonstrates the excellent activity of macrolide antibiotics against genital infections due to Mycoplasma hominis and Chlamydia trachomatis. Rokitamycin and josamycin both gave good or excellent clinical and microbiological outcomes in more than 90% of the cases. Both were extremely well tolerated. These findings confirm and extend the indications for rokitamycin, found in earlier trials to be extremely effective in the treatment of urethritis due to Chlamydia trachomatis and--as a whole--in infections caused by this microrganism.

First-trimester Down's syndrome screening using nuchal translucency: a prospective study in patients undergoing chorionic villus sampling.

The value of the measurement of nuchal translucency thickness for predicting fetal Down's syndrome and other aneuploidies was prospectively evaluated at 8-15 weeks of gestation in 1819 consecutive pregnancies scheduled for karyotyping by chorionic villus sampling. In 43 cases, a chromosomal unbalanced aberration was found. Two teams of ultrasonologists who examined patients attending either National Health Service (Series 1) or private practice clinics (Series 2) were involved in the study. The same type of ultrasound machine and standardized approach were used in both study groups. In those cases in which the maximum subcutaneous thickness of the translucency was 3 mm or greater, the incidence of chromosomal aberration was 18.6% compared to 1.7% in the cases in which this was below 3 mm. The sensitivity, specificity and relative risk for all aneuploidies were 30%, 96% and 10.83, respectively, and no difference was found between trisomy 21 and other types of aneuploidy. The sensitivity and specificity and relative risk were significantly higher at 9-10 weeks than between 11 and 15 weeks. The results were concordant in the two series; however, the overall values for sensitivity (20% vs. 39%), specificity (94% vs. 98%) and relative risk (4.13 vs. 24.20) were clearly higher in the group of private patients. The results obtained confirm the potential application of the measurement of nuchal translucency thickness for fetal aneuploidy screening before the end of the first trimester and suggest that a multiplicity of individual, structural and organizational factors may interact and play a crucial role in determining the actual efficiency of ultrasound screening programs.