[Severe form of herpes gestationis]. / Herpes gestationis. Una forma severa.

We report a very severe form of herpers gestationis that arose at the 26(th) week of pregnancy and reached us for observation at the 30(th) week. Herpes gestationis in an autoimmune vesicobullous dermatosis characterised by skin eruptions, intense itching and consequent increase in fetal morbility, with delayed intrauterine growth and prematurity. Owing to its particular severity (involvement of the entire body surface including the face), between the 30th and the 32(nd) weeks we had to address a severe clinical condition characterised by anaemia, marked hypoproteinaemia, hypoalbuminaemia, hupertension and hyperglycaemia which led us to resort to the maximum dose of oral corticotherapy in association with topical therapy using clobetasol propionate. In our opinion the results obtained were highly statisfactory with the result that at the end of the 37(th) week, in consideration of the patient's obstetric history, podalic presentation and parity, we performed a Caesarean delivering a newborn of 3000 g in excellent condition. The patient was discharged symptom-free on the 6(th) day and the newborn was in full healt.

Benign metastasizing leiomyoma in the lung: a case report.

The authors report a rare case of leiomyomatosis of the lung diagnosed in a women with uterine leiomyomatosis not previously treated. The absence of mitosis with nuclear atypism in all histological samples opens the question of whether the origin of the tumor in the lung was from uterine leiomyomas metastasizing or multifocal amarthomas, synchronous or metachronous. Hamartomas or real metastasis of uterine leiomyomas? The response to GnRH analogue treatment was evaluated.

Efficacy of a soy rich diet in preventing postmenopausal osteoporosis: the Menfis randomized trial.

OBJECTIVES: To compare the effect of a soy rich diet and hormone replacement therapy (HRT) on the main biomarkers of bone turnover and bone mineral density (BMD) at postmenopausal age. METHODS: 187 healthy asymptomatic postmenopausal women, aged 39-60, were recruited and randomized into a soy rich diet group, a HRT group, and a control group. Bone biomarkers and BMD were evaluated at baseline and after 6 months at the end of the study. RESULTS: Diet is not as effective as HRT in reducing the postmenopausal turnover; however diet stimulates bone osteoblastic activity, as evidenced by significant increase in osteocalcin concentrations. BMD decreases significantly only in the control group, but not in the intervention groups. CONCLUSIONS: Our data suggest that soy products could be effective in reducing the risk of osteoporosis in asymptomatic postmenopausal women, but our findings should be confirmed before recommending the diet as a valid alternative to HRT.

The effects of a soy rich diet on serum lipids: the Menfis randomized trial.

OBJECTIVE: To assess beneficial effects of a soy rich diet on the main biomarkers of cardiovascular health in menopause, compared with the effects of the hormone replacement therapy (HRT). METHODS: 187 healthy asymptomatic postmenopausal women, aged 39-60, were recruited and randomized into three groups: a soy rich diet group, a HRT group, and a control group. Lipid profile, body mass index, blood pressure, endometrial thickness, uterine artery resistance index (RI), were evaluated in all the participants at the baseline, after 6 months, and at the end of the study. RESULTS: After a 6-month intervention period, the lipid profile in the soy rich diet group showed a favourable outcome, similar to that observed in the HRT group, but compliance to the diet was low. CONCLUSION: Soy products may be used in the prevention of cardiovascular risk in postmenopausal women because of their efficacy in contrasting the negative effects of menopause on the cardiovascular system, but our findings should be confirmed; moreover, suitable strategies to improve the compliance have to be considered.

Postmenopausal osteoporosis and celiac disease.

Individualizing risk factors is the most important tool to prevent late consequences of menopause. Celiac disease is a predisposing condition not very considered for some postmenopausal diseases, such as postmenopausal osteoporosis. In this review the authors examine climacteric conditions that could be heightened by a celiac status especially if disregarded and untreated.

Vertical transmission of hepatitis C virus in a cohort of 2,447 HIV-seronegative pregnant women: a 24-month prospective study.

BACKGROUND: Mother to infant transmission of hepatitis C virus (HCV) has been extensively studied in mothers with human immunodeficiency virus (HIV) infection, whereas fewer data are available on the vertical HCV transmission in HIV-negative women. METHODS: Between January 1995 and June 1997, 78 consecutive HCV-positive/HIV-negative women with their offspring entered this prospective study aimed to define the prevalence of and risk factors for HCV vertical transmission. Risk factors for HCV were carefully sought, and HCV viral load and genotype were determined in all positive mothers. The infants were tested for alanine aminotransferase (ALT) and HCV-RNA at birth and at 4, 8, 12, 18, and 24 months of age. RESULTS: Eight of 60 (13.3%) infants born to HCV-RNA positive mothers acquired HCV infection, but only 2 (3,3%) were still infected by the end of follow-up. Infants' genotypes matched that of the mothers. ALT levels were in the normal range in all study subjects throughout the follow-up. High maternal viral load (P < 0.05), possession of HCV risk factors (P < 0.004), and history of blood transfusion (P < 0.05) were associated with increased risk of HCV vertical transmission. CONCLUSIONS: This long-term prospective study shows that, although vertical transmission from HIV-negative mothers occurs in 13% of cases, there is a high rate of spontaneous viral clearance (75%). High maternal viral load and mothers belonging to HCV risk categories were the only variables predictive of the vertical transmission.

Evaluation of nonspecific immunity and plasma levels of interferon-gamma, interleukin-6 and tumor necrosis factor-alpha in preeclampsia.

In this study we evaluated the maternal cell-mediated immune aspects of preeclampsia in terms of phagocytosis and killing of monocytes and polymorphonuclear cells. To evaluate the contribution of cytokines (Cks) in the pathophysiology of preeclampsia, we investigated the plasma levels of interferon-gamma (IFN-gamma), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha), respectively, by an enzyme-linked immunosorbent assay. Data showed that phagocytic and killing activities of monocytes were depressed in preeclamptic and normal pregnancies. At the same time, IFN-gamma plasma levels were undectable in both groups. Conversely, we detected significant levels of TNF-alpha in plasma from preeclamptic and normal pregnancies. Moreover, since in three preeclamptic patients the onset of severe preeclampsia was associated with a sharp increased of TNF-alpha plasma levels, we suggest that an increased production of this CK may be implicated in the pathophysiology of preeclampsia.

Postmenopausal users of long-term hormonal replacement therapy: social-cultural features.

OBJECTIVE: To study of influence of social-cultural factors on the effects of long-term hormonal replacement therapy (HRT) in preventing cardiovascular disease and menopausal osteoporosis. METHOD: We examined, perspectively the social-cultural features of 394 postmenopausal women who attended the menopausal out-patient department and were eligible for long term HRT. RESULTS: The HRT users were thinner and younger, with earlier menopause, physically more active, healthier, with more oophorectomies and with more professional work. Data shows that, as a whole, a greater number of healthy women are selected or self-selected for HRT. CONCLUSION: Evaluating the results of long-term HRT in preventing cardiovascular disease and menopausal osteoporosis, the social-cultural features of HRT users must be carefully considered before any mass preventive interventions.

Spontaneous and induced release of prostaglandins, interleukin (IL)-1beta, IL-6, and tumor necrosis factor-alpha by placental tissue from normal and preeclamptic pregnancies.

PROBLEM: The objective of this study was to clarify the role of the main proinflammatory cytokines (interleukin [IL]-1, IL-6, tumor necrosis factor [TNF]-alpha) in the pathogenesis of preeclampsia and how these cytokines affect one another and the production of prostaglandins (PGs). METHOD OF STUDY: The concentrations of cytokines and PGs in supernatants of placental tissue from preeclamptic and normal women were determined by enzyme-linked immunosorbent assay. RESULTS: The concentrations of the PGs from unstimulated preeclamptic placental tissue were significantly higher compared to the concentrations of PGs from normal unstimulated placental tissue. Significant levels of IL-1beta were observed only in the supernatants of preeclamptic placental tissue. Of interest, an increase in TNF-alpha production was detected in the supernatants of IL-1-stimulated preeclamptic placental tissue. CONCLUSIONS: The overproduction of TNF-alpha may be related not only to the effect of a stimulant like IL-1beta, but mainly to the lack of mechanisms down-regulating the production of TNF-alpha.

A randomised placebo-controlled trial of ursodeoxycholic acid and S-adenosylmethionine in the treatment of intrahepatic cholestasis of pregnancy.

A randomised placebo controlled study was performed in 32 women with intrahepatic cholestasis of pregnancy. The population was divided into four groups: for 20 days each group was treated only with ursodeoxycholic acid, or S-adenosylmethionine, or a combination of both drugs, or a placebo (vitamin). Itching, standard liver function tests and serum total bile acids were measured before, during, and after treatment. Itching improved in all the women as well as the biochemical abnormalities. No side-effects in the mother or in the infant were recorded during and after therapy. A combination of ursodeoxycholic acid and S-adenosylmethionine is more effective than placebo and than either drug alone.

[Breast cancer in pregnancy. Resistance to screening]. / Il carcinoma mammario in gravidanza. Resistenze allo screening.

BACKGROUND: An increasing number of women decide to become pregnant after 30 years of age, an age which begins to superimpose that of greater incidence of breast cancer, and therefore an ever-increasing number of women are destined to become pregnant during the growth of their cancers. Pregnancy associated breast cancer has a worse prognosis, but this prognosis is caused mainly from a delay in the diagnosis; for this reason the aims of this study have been to ascertain the reasons for this delay. METHODS: A sample of 500 pregnant women at term at the age of over 30 years spontaneously applied to the II Dept of Obstetrics and Gynecology at the University of Bari, were perspectively examined through a questionnaire about non-instrumental breast checks carried out during the pregnancy. RESULTS: Only the 7.4% of the women have been subjected to breast examination during pregnancy, most (67.6%) without troubles. The habit of self-examination has fallen from 28.4% to 6.2%. A greater care for cervical carcinoma has been underlined. CONCLUSIONS: Pregnancy is a moment of less attention for the physician and patient about breast cancer, and this causes a delay in the diagnosis with consequent prognostic worsening. For this reason there must be a greater interest to this problem and a different diagnostic approach.

[The multipara today: a socio-biological analysis]. / La multipara oggi. Analisi socio-biologica.

OBJECTIVE: To evaluate if and in which way work affects the choice of pregnancy and what is the outcome of pregnancy in multipara. METHODS: A retrospective study of 820 women who delivered at the Dept. of Obstetrics and Gynecology II at the University of Bari, in the period 1993-1996 was performed. RESULTS AND CONCLUSIONS: The results show that work and its problems influence the choice of having more children and that multiparity is related to a greater incidence of premature deliveries.

[Ultrasonic evaluation of endometrial changes induced by cyclic sequential hormone substitution therapy]. / Valutazione ecografica delle modificazioni dell'endometrio indotte dalla terapia ormonale sostitutiva sequenziale ciclica.

BACKGROUND: At present the hormonal replacement therapy on postmenopausal women with uterus needs the use of progestins additionally to estrogens, to eliminate the risk of endometrial hyperplasia and carcinoma connected with the use of estrogens alone. The check of the endometrium during these therapies can be made by transvaginal ultrasound that permits the evaluation of the thickness, structure, and contour of the endometrial rima. The aim of this study was to establish the changes of endometrial thickness during cyclic sequential hormonal replacement therapy on healthy postmenopausal women with transvaginal ultrasound. METHODS: The endometrial thickness with transvaginal ultrasound has been evaluated during the cyclic sequential hormonal replacement therapy on 20 healthy women in physiological menopause before the treatment, during the phase of treatment with estrogens alone and during the phase of treatment with the addition of the progestins. RESULTS: Significant differences during the estrogenic phase compared to before treatment have been underlined (5.7 mm vs 3.5 mm p = 0.002), but not during progestinic phase compared to estrogenic (6 mm vs 5.7 mm p = 0.712). CONCLUSIONS: Transvaginal ultrasound is a useful investigation to evaluate the modifications of the thickness and structure of the endometrium during hormonal replacement therapy and can help early diagnosis of endometrial diseases during these treatments.

[Delivery in nulliparous women aged < or = 18 years]. / Il parto nelle nullipare di età < o = 18 anni.

METHODS: A retrospective study of 733 nulliparous women who gave birth at the Department of Obstetrics and Gynecology at the University of Bari, in the period from 1-1-1994 to 31-12-1995, was performed to evaluate the outcome of pregnancy and neonatal outcome in adolescents < or = 18 years old. The sample was subdivided into two subgroups; the first of 114 girls < or = 18 years old; the latter of 619 women 22-34 years of age, and they were compared. RESULTS: We have found a more lengthy term of pregnancy (39.66 weeks vs 39.27 weeks p = 0.008) and a greater incidence of vacuum extraction (VE) in the group of < or = 18 years old (7.89% vs 3.23% p = 0.03).

Smoking and menopause.

A retrospective study on 293 women who attended the Physiopathology of Human Reproduction menopausal out-patient clinic at Bari University Hospital throughout 1995, has been carried out to evaluate correlations between smoking and climacteric syndrome. From the data we have discovered an earlier onset of menopause in the smokers. Fewer smokers were married and they worked more, drank more, and were more educated. The incidence of climacteric syndrome did not differ between smokers and non-smokers.

Sexuality in the climacterium.

A retrospective study on 421 women who spontaneously attended the Menopausal Center of Physiopathology of Human Reproduction at Bari University has been carried out to evaluate the incidence of the decrease of libido in climacterium and factors that affect it. The results show a high incidence of decreased libido (46%) and a correlation with age, dyspareunia and housewife status.