[Hypercoagulability during pregnancy: evidences for a thrombophilic state]. / Trombofilia in gravidanza: evidenze clinico-sperimentali di uno stato trombofilico.

AIM: The development of thrombotic disorders is a major threat for young women during pregnancy. It is one of the main causes of pregnancy-related disorders, which may also result in harm for the conceptus. Successful pregnancies require an even balance of coagulation and fibrinolysis, in order to secure stabilization of the basal plate as well as adequate placental perfusion. Broad spectrum assays which measure a range of thrombin/fibrin formation in serum have become an established means of identifying activation of blood coagulation and/or fibrinolysis. There is considerable interest in the application of these assays to the diagnosis of other hypercoagulable states, such as thrombophilia during pregnancy. We investigated coagulation/fibrinolysis parameters for significant differences between pregnant women during their gestation (first, second and third trimester) with or without pregnancy loss and healthy nonpregnant women. METHODS: Thirty-nine pregnant women, aged 24-39 years, were studied. They were subdivided according to pregnancy trimester: 15 patients in the first trimester; 13 in the second and 11 in the third. The selection of patients was carried out in cooperation with the Transfusion Center of the Second University of Naples in order to obtain a homogeneous sample group. The control group included 400 healthy patients. Biochemical and blood coagulation tests were performed for each patient and the results obtained were compared with the control group. RESULTS: A decrease in free protein S (PS) and fibrinolysis (t-PA/PAI-1) activities and an increase in Factor VII, Factor VIII, prothrombin fragment 1+2 (F1+2), D-dimer (D-dimer) were observed in pregnant women during the follow-up of gestation. However, there were statistical differences between the groups of women with one or more pregnancy loss where it was found the lowest values in t-PA and PAI and the highest values in FVII and F1+2. Among subjects with more than one abortion, coagulation/fibrinolysis derangements before the partum were more prominent. A significant association exists between consecutive recurrent abortions and pregnancy complications such as placental abruption, hypertensive disorders and CS. This association persists after controlling for variables considered to coexist with recurrent abortions. CONCLUSIONS: These findings suggest that an excessive hypercoagulable state is associated with the termination of pregnancy resulting into a moderate risk for thrombosis during the different trimesters of pregnancy. The follow-up of fibrinolytic markers could represent a useful diagnostic tool for termination of pregnancy.

[The effects of phytoestrogen therapy on the endometrium in postmenopausal women]. / Effetti della terapia con fitoestrogeni sulla mucosa endometriale in postmenopausa.

AIM: The purpose of the present study was to carry out a comparative histological analysis of the endometrium in postmenopausal women who made use of phytoestrogens in order to assess the efficacy and possible side effects of this therapy. METHODS: This study was carried out by forming 2 groups in order to compare the results. One group was given a dietary supplement of phytoestrogens for 24 months, whereas the other was given a placebo for the same period of time. At the beginning of this study endometrial bioptical samples were taken from those patients who had been previously selected at our University Centre. This study was started only with those postmenopausal patients whose bioptical sample was histologically suitable, and it was neither hyperplastic, nor cancerous and nor secretive. During these 24 months there have been frequent contacts aimed at verifying the standard therapeutic behaviour, symptoms and appearance of side effects. At the end of the study new and final bioptical samples of endometrium were taken from both groups. RESULTS: One-hundred and forty-one patients completed the study. Five patients (3.4%) who were submitted to phytoestrogens therapy showed a weak proliferative endometrium bioptical sample. All the other biopsies at the beginning and at the end of the study showed an atrophic and inactive sample. Hot flushes, night sweats, vaginal dryness and dyspareunia improved at the end of the study for the group treated with phytoestrogens as compared to the one treated with a placebo. Although there have not been very significant differences ias to symptoms and side effects, it was noted that insomnia was the most common symptom in the group treated with non-hormonal therapy based on phytoestrogens. CONCLUSIONS: Phytoestrogens did not cause any sensitive and worrisome stimulation of the endometrial mucosa. Insomnia was more frequent in the group treated pharmacologically in the 24 months of the study, whereas hot flushes, night sweats, vaginal dryness and dyspareunia persisted or increased as compared to the beginning of the study in the group treated with a placebo, but this did not occur for the group treated with phytoestrogens.

Effects of Centella asiatica extract on mucopolysaccharide metabolism in subjects with varicose veins.

The effects were studied of the total triterpenic fraction of Centella asiatica on serum levels of the uronic acids and lysosomal enzymes involved in mucopolysaccharide metabolism (beta-glycuronidase, beta-N-acetylglucosaminidase, arylsulfatase) in patients with varicose veins. The basal levels of uronic acids (467.7 +/- 69.3 micrograms/ml) and of lysosomal enzymes (beta-glycuronidase 1.8 +/- 0.4 microM/min/l, beta-N-acetylglucosaminidase 23.1 +/- 0.4 microM/min/l, arysulfatase 0.078 +/- 0.003 microM/min/l) were elevated, indicating an increased mucopolysaccharide turnover in subjects with varicose veins. During treatment with Centella asiatica extract (60 mg/day for three months), these levels fell progressively. At the end of treatment the serum uronic acid (231.8 +/- 51.5 micrograms/ml), beta-glycuronidase (1.2 +/- 0.05 microM/min/l), beta-N-acetylglucosaminidase (17.7 +/- 0.7 microM/min/l) and arysulfatase (0.042 +/- 0.003 microM/min/l) levels were highly significantly lower than the basal levels (p less than 0.01). The results of this trial provide an indirect confirmation of regulatory effects of the extract of Centella asiatica on metabolism in the connective tissue of the vascular wall.

Immunopharmacological properties of flavonoids.

The flavonoids are a heterogeneous group of ubiquitous plant polyphenols that abound in the human diet and are endowed with several biological activities, including immunomodulating and antioxidant activities. The bioactivity of flavonoids is tightly correlated with their chemical structure and action mechanisms, mostly inhibitory, on enzymatic systems involved in cellular activation. The aim of this study was to evaluate the effects of acetonic extracts from Lunularia cruciata gametophytes and Feijoa sellowiana fruits on human phagocyte functions. A purified native flavonoid, a catechin, and two of its derivatives were also tested. The extract, and its flavonoid activity, was evaluated by analyzing luminol-dependent chemiluminescence emitted by human circulating phagocytes, at rest or activated by phorbol miristate acetate (PMA). The results demonstrate that both the raw extracts and flavonoids significantly inhibit CL emission by leukocytes, especially when these cells are activated by PMA. The antioxidant activity of flavonoids can be increased by changing the chemical structure of the native molecule.

[Peritoneal cystic mesothelioma. A clinical case and review of the literature]. / Mesotelioma cistico peritoneale. Caso clinico e revisione della letteratura.

Multicystic peritoneal mesothelioma is an extremely rare benign neoplastic disease with high tendency to recur locally, but no tendency to malignancy. Correct diagnosis can be made with histopathologic examination and always with immunohistochemical and ultrastructural evaluation. A case in a twenty-eight-year-old woman is reported and the anatomo-clinical characteristics of multicystic peritoneal mesothelioma from sixty-nine cases described in the literature are specified, discussing the management of this disease and emphasizing the importance of a nondemolitive approach.