[Vulvovaginal candidiasis: a therapeutic approach]. / Vulvovaginiti da candida. Approccio terapeutico.

The vulvovaginal candidiasis represents, after the bacterial vaginosis, the most frequent cause of vaginal affection. It is esteemed that around the 75% of the women of reproductive age suffered from an episode of vulvovaginitis from candida and 40-45% have had more episodes, of which 10-20% in complicated form. The kind of candida more frequently isolated in the vagina of symptomatic women is the Candida albicans: in the 10-20% of the cases the agent is present in absence of symptomatology, and we can almost consider it a saprophytic. On the other hand, always with greater frequency fetterses can be isolated of not albicans Candida, particularly the tropicalis and the glabrata kind, usually resistant to the common therapies. The classification of the vulvovaginal candidiasis proposed by Sobel, and by now universally approved, foresees 2 clinical forms of vulvovaginal candidiasis, the vulvovaginitis from not complicated candida (VVC) and the vulvovaginitis from complicated candida (VVCC): different for pathogenesis, elapsed clinical, symptomatology and frequency. They have to be considered in the substance 2 different nosological entities, and they request a diagnostic approach and a well different therapeutic appointment. In this study we will shortly reassume the principal characteristics of it, detaining us on the most recent acquisitions in theme of therapy. The base medicines of ac. boric, to parity of effectiveness, seem to introduce the most contained cost and the best compliance, and they offer him to a complementary use or, in some cases, alternative to the more you consolidate therapies with azoli.

Serum levels and biochemical characterization of oestradiol-17 beta dehydrogenase in umbilical cord blood.

The properties of the enzyme oestradiol-17 beta dehydrogenase from human umbilical cord serum have beem compared with those of oestradiol-17 beta dehydrogenase present in the maternal peripheral blood. On the basis of studies on stability, specificity, optimum pH, rate of enzymic reaction and Km determinations it can be concluded that oestradiol-17 beta dehydrogenase in the umbilical cord arteries has an activity between 5 and 15 times higher than in the umbilical cord vein and about 65% of the activity of the enzyme present in the maternal peripheral blood. The present results strongly suggest that in pregnancy the enzyme oestradiol-17 beta dehydrogenase is elaborated not only by the placenta but also by the foetus.

[Electromyography of the perineum. Demonstration of the method]. / Elettromiografia del perineo. Messa a punto del metodo.

The Authors, by means of surface E.M.G. have investigated the perineal potentials. The choice of surface E.M.G. is due to the good acceptance of the method by the patients, as it does not interfere with muscular activity and mental concentration, which are fundamental for a good application of R.A.T.

[Results of electromyography of the perineum of women in labor prepared and unprepared by the respiratory autogenic training method]. / Risultati elettromiografici del comportamento del perineo in travaglio di parto in donne preparate e non preparate con il metodo R.A.T.

The Authors, by means of surface E.M.G. of perineum, have analyzed statistically the potentials registered in two groups of pregnant women in labor, the first prepared according to the R.A.T. method, the second utilized as a control group. The complete automatization of the analysis was allowed to exclude any bias. The differences of the perineal potentials registered in the groups were statistically significant.

[Mitral valve prolapse and pregnancy]. / Il prolasso della mitrale e la gravidanza.

13 cases of MVP in pregnancy were examined and compared with a control group. No significant differences were found in the various parameters assessed in the two groups nor did there appear to be any significant increase in obstetric or neonatal risk.

[Cetyltrimethylammonium naproxenate as vaginal lavage in the therapy of vulvovaginal dystrophies in the postmenopause]. / Il naprossenato di cetiltrimetilammonio lavanda vaginale nella terapia delle distrofie vulvo-vaginali in post-menopausa.

A peculiar aspect of the postmenopausal period is atrophy of the lower genital tract, vagina and vulva. This is due to estrogen deficiency and is accompanied by vaginal pH elevation, lower number of lactobacilli and increased incidence of aspecific vulvovaginitis. We tested a new vaginal douche with an antibacterial-anti-inflammatory (non antibiotic-nonsteroidal) principle, cetyltrimethylammonium naproxenate 0.223% as an adjunct to classical estrogen topical replacement therapy. We treated 34 menopausal patients (mean age 67 yrs) in a double parallel controlled (15 A only estrogen topical therapy vs 19 B topical estrogen plus cetyltrimethylammonium naproxenate douches uid) study for 30 days. A significant reduction of symptoms was obtained in both groups although a faster reduction has been seen in the group treated with both drugs (= B). In conclusion a better replacement of physiological pH with reappearance of lactobacilli, a selective action on vaginal pathogens, a faster symptom remission and an higher psychophysical welfare can be attributed to the vaginal douche used in adjunct to classical estrogen topical therapy.

[Quaternary ammonium salts in gynecology and obstetrics]. / I sali quaternari di ammonio in ginecologia ed ostetricia.

We have summarized chemical, physical, and microbiological characteristics of Quaternary Ammonium Salts: particularly, benzalchromium chloride and didecyl-dimethyl-ammonium chloride characteristics were analyzed. These compounds may act as antimicrobial agents in different way: 1) they are surface-active agents and will denature protein or cause dissociation of an enzyme from its prosthetic group; 2) they may alter the cell permeability of bacteria and yeasts; 3) they may stimulate the glycolysis reaction and 4) may inhibit oxidation of lactate. These latest activities may play a role in maintenance of physiologic microbial ecology of vagina or in the re-establishment of the vaginal ecosystem after vaginitis or vaginosis. We have also summarized the physiologic variation of vaginal ecosystem during the different phases of women's life and the microbiology of vagina during vaginitis and vaginosis. The results of more recent studies about the therapeutic role of quaternary ammonium compounds in vulvo-vaginal infections an in vaginosis are synthetically reported. We concluded that quarternary ammonium compounds are efficacious, handy and safe, in obstetrics and gynecology. A very good compliance and low costs of these compounds suggest that they may be used alone as well in association with specific antimicrobial agents in the treatment of most of gynecological infections, and particularly in bacterial vaginosis.

[Autoimmune thrombocytopenia and pregnancy]. / Trombocitopenia autoimmune e gravidanza.

Immune thrombocytopenic purpura (ITP) is an autoimmune disorder with its highest frequency in young women in the reproductive years. An antepartum diagnosis of maternal thrombocytopenia has become more common because platelet counts are now included with routine complete blood cell counts. Sometimes platelet autoantibodies facilitate increased platelet destruction by the reticuloendothelial system especially the spleen. These autoantibodies (IgG) can cross the placenta and place the fetus at risk for thrombocytopenia and, sometimes, serious bleeding problems such as intracranial hemorrhage can occur. The treatment is performed by corticosteroids (prednisone) or intravenous immune gammaglobulin. Four patients with thrombocytopenia during pregnancy underwent medical treatment (prednisone 1 mg/kg/die). The results were successful. In one case only we did not have a clinical response after corticosteroid therapy. There were no intracranial hemorrhages; however the risk for the patients and fetal or neonatal hemorrhage is much lower than thought. Corticosteroid treatment is the first choice, but sometimes it can give a clinical negative response.

[Pregnancy in users of heart valve prostheses]. / La gravidanza nella portatrice di protesi valvolare cardiaca.

The observation of pregnancy in women with a mitral and aortic valvular prosthesis, allows the authors to point out the high maternal and fetal risk and to show the therapeutical treatment chosen. The obtained results, confirm the effectiveness of the anticoagulant treatment by heparin and of delivery by cesarean section.

[Maternal concentration of serum digoxin and concentration in the amniotic fluid and neonatal serum]. / Concentrazioni materne di digossina sierica e concentrazione nel liquido amniotico e siero neonatale.

Digoxin was assayed in maternal and neonatal sera and in the amniotic fluid in 14 pregnant patients chronically digitalized for mitral stenosis. Neonatal serum levels of digoxin are linearly correlated with maternal concentrations of the drug, and all are inversely related to maternal creatinine clearance. Amniotic fluid levels of the drug are not related to serum levels, but relate to amniotic fluid creatinine concentration. Fetal serum levels are identical to maternal ones for all practical purposes, but bear no relation to amniotic digoxin concentration. Digoxin was assayed with a commercial kit showing very little cross-reactivity with endogenous digoxin-like cross-reacting compounds. Pitfalls in commercial digoxin assays and clinical implications are discussed.