Ultrasound diagnosis of heterotopic pregnancy with viable fetuses.

Combined pregnancy is an under-estimated and increasing clinical condition. Its recognition is usually made post-operatively. Ultrasound findings are not specific. Diagnosis is possible only when the cardiac activity of the extrauterine and intrauterine fetus can be detected. In the literature, 18 pre-operative sonographic demonstrations of such cases are reported. A correct echographic assessment can show a definite diagnosis or indicate a diagnostic laparoscopy minimizing maternal morbidity and mortality and improving the prognosis of the intrauterine fetus. In this report, ultrasound diagnostic aspects are discussed.

Expression of AgNORs in serous ovarian tumors.

The nosological nature of the borderline ovarian tumor has been investigated by several methodological approaches. The aim of our research was to verify how the study of the nucleolar organizer regions (AgNOR) may offer its contribution on this subject. We studied 18 cases of ovarian serous tumours, respectively 6 benign, 6 borderline and 6 malignant. A separate calculation for clusters (> 1 mu) and total NORs was performed on fifty neoplastic cells chosen at random from every tumour. The findings recorded were the following: 1) the quantity and shape of clusters, dots and total NORs were significantly increasing from benign to borderline to malignant tumours; 2) the number of the dots and total NORs was higher in the case of borderline tumour stage III than in other cases limited to the ovary; 3) the clusters of the poorly differentiated carcinomas were much less numerous than the clusters of those well differentiated; instead the dots and the total NORs were more numerous. These data suggest a correlation between the number of the NORs and the biological activity of the tumours. The borderline serous tumours of the ovary showed a median position between benign and malignant tumours.

Evaluation and comparison of hemocoagulation parameters both in serum and in ascites from patients with gynecologic malignancies.

The authors report the results obtained investigating PT - PTT - Fbg - Alcohol test - FDP - AT III in the serum and FDP in the ascitic fluid of 18 patients with ovarian cancer, 2 patients with pelvic relapse of cervical cancer and 10 patients with cirrhosis of the liver. It is pointed out the presence of FDP in the ascitic fluid in large amounts, so it not seems to be an ovarian cancer specific marker, but an aspecific marker of malignancy.

Secondary tumors of the ovary. III. Tumors of the gastrointestinal tract and other sites.

16 cases of secondary ovarian tumors observed from 1977 to 1986, and in which the primary neoplasms involved other organs outside the genital tract or the breast, are studied. The observations concerned 13 metastases of the gastro-intestinal tract cancer (6 typical Krukenberg tumors, 3 "tubular" Krukenberg tumors, and 4 non-Krukenberg tumors), 1 urinary bladder cancer, 1 pancreatic cancer, and 1 tumor of unknown origin (probably an amelanotic melanoma). The histological diagnosis was very difficult in patients with no evidence of the primary malignancy, or in patients in whom the metastases simulate a concomitant primary ovarian tumor. The characteristic histological findings, histochemistry, and immuno histochemistry may suggest a correct diagnosis in most of situations.

Multiparametric discrimination of serous ovarian tumors by analytical morphometry.

In order to enhance the discrimination power in the field of serous ovarian tumors, we applied the software system SAM (Shape Analytical Morphometry) to the analytic studies of biological forms. Besides the usual dimensional evaluations (perimeter, area, maximum diameter and shape index), this procedure permits the description of the nuclear form using analytical parameters: 1) extraction of nucleus fundamental curve; that is a functional curve giving the "smoothing" of the original contour by two parametric equations (separately for x and y values as independent variables); 2) evaluation of nuclei contour irregularities by Fourier analysis; 3) evaluation of shape asymmetry by SAE (Shape Asymmetry Evaluator); that is the ratio between the length of a segment of a parabola interpolating the original curve points, and a straight line joining its extremities for a 180 degrees barycentric rotation according 10 degrees steps. All parameters resulted to be independent and were submitted to multivariate discriminant analysis. We studied 180 nuclei from 18 cases of serous ovarian tumors, (6 benign, 6 borderline and 6 malignant tumors). With respect to the dimensional parameters, the application of analytical morphometry permitted us to reduce the minimum percentage error in the discrimination of the different classes. In fact, in the distinctions of benign and malignant nuclei, the minimum percentage error was 13.30%, against the 18.3% error when using dimensional morphometry. Furthermore, in the comparison of malignant and borderline nuclei there was a reduction of error from 23.3% to 22.5%, and in the comparison of benign and borderline nuclei, the error was reduced from 37.5% to 30%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Partial anterior hypopituitarism caused by toxoplasmosis congenita. Description of a clinical case]. / Ipopituitarismo anteriore parziale da toxoplasmosi congenita. Descrizione di un caso clinico.

A case of incomplete anterior hypopituitarism due to congenital toxoplasmosis is reported. The rare pituitary involvement in congenital toxoplasmosis and the uncommon remark of associated endocrine symptomatology support this description.

[Laurence-Moon-Bardet-Biedl syndrome. Physiopathological aspects and description of a clinical case]. / La sindrome di Laurence-Moon-Bardet-Biedl. Aspetti fisiopatologici e descrizione di un caso clinico.

After some general introductory remarks, a case of Laurence-Moon-Bardet-Biedl syndrome is reported. The main physiopathological aspects of the syndrome and some elements of differential diagnosis are discussed.

[Ultrasonic assessment of the state of the cervical canal at the term of pregnancy]. / Determinazione ecografica delle modificazioni del canale cervicale a termine di gravidanza.

BACKGROUND: To assess if ultrasonic measurement of the cervical canal has carries, at term of pregnancy, a relationship with the onset of labour. To assess if cervical length identifies women at risk to deliver beyond 42 completed weeks of gestation (287 days). METHODS: Prospective case-control study, carried out between 37 and 40 weeks of gestation in uncomplicated, singleton, cephalic presentation, pregnant women. SETTING: outpatient ultrasound Department of a tertiary referral centre, serving > 1000 pregnancies. Weekly measurements of the cervical canal by transvaginal ultrasound probe. RESULTS: Inverse relationship between sonographic measurements and advancing gestational age. At 38 weeks of gestation, significant difference in the ultrasonic recordings between patients delivered before and beyond 41 completed weeks. CONCLUSIONS: It is possible to identify as early as 38 weeks of gestation those women that will deliver beyond 41 weeks. There is a subgroup of nulliparous patients that will probably be candidates to induction of labour.

Analgesic properties of electromagnetic field therapy in patients with chronic pelvic pain.

AIM: Demonstration of analgesic effects of electromagnetic field treatment in cases of chronic refractory pelvic pain. STUDY DESIGN: Prospective non-controlled trial, 64 women complaining about pelvic pain of at least 6 months duration, resistant to standard therapies, submitted to electromagnetic field applications on both iliac regions by Thelf Systems apparatus by two applications daily lasting 2 hours each for 20-40 days. Control visit after 3 months. RESULTS: Complete subsidence of pain in 39 cases (61%), in 15 patients (23%) relief during treatment, then mild endopelvic tension after a 3-month control; in 10 cases (16%) symptoms reduced only during application hours, unchanged at follow-up. Outcome of treatment appears to be independent of pre-existent psychosocial variables. CONCLUSION: Magnetic therapy shows a real analgesic effect on pelvic pain, and seems to contribute to resolution of complex interactions between somatic nociceptive stimuli and psychosocial implications affecting pain perception in these patients.

Antibiotic prophylaxis for abdominal hysterectomy.

Three different regimens of antibiotic treatment have been employed in order to evaluate their efficacy as a profilaxis for abdominal hysterectomy. Two short term administrations (Cephtriaxone and Cephamandole plus Tobramycine) and a conventional full dose treatment (Cephazoline) have been compared over a group of homogeneous patients. No significant differences, except a reduction in postoperative time spent in hospital, have been found among the groups. A reduction in urinary tract infection has also been reported with a single-dose antibiotic prophylaxis.

Maternal complications associated with cesarean section.

OBJECTIVE: To assess the prevalence of cesarean section (CS) related maternal complications and to evaluate post-CS complications in relationship with relative risk factors. METHOD: 3010 patients who had a CS in the University Hospital of Bari during the period 1988-98 were retrospectively included into the study and 1007 women delivered vaginally at the same institution and in the same period of time, were randomly selected as the control group. For each single patient delivered by CS, the following risk factors were taken into account: age, parity, pre-pregnancy body mass index (BMI), and any disease antedating pregnancy or diagnosed during pregnancy. Additionally, therapeutic procedures such as blood transfusion, number of days in hospital, and admission into intensive care were followed. The prevalence of puerperal complications was assessed for vaginal deliveries and CS by Student's t-test and a correlation of CS complications with risk factors was performed by multivariate analysis. RESULTS: In the cohort of abdominal delivery, puerperal complications were significantly more frequent compared with those following vaginal delivery (p < 0.05). In the group of CS, obese women have higher prevalence of maternal complications, particularly hypertension and intestinal complications (p < 0.05). CONCLUSION: Compared with vaginal delivery, CS delivery carries a higher number of postpartum complications, and the higher rate is mainly related to obesity.