Factors associated with climacteric symptoms in women around menopause attending menopause clinics in Italy.

OBJECTIVE: To obtain data on correlates of climacteric symptoms in women around menopause attending menopause clinics in Italy. METHODS: Since 1997 a large cross sectional study has been conducted on the characteristics of women around menopause attending a network of first level menopause outpatient's clinics in Italy. A total of 66,501 (mean age 54.4 years) women are considered in the present paper. RESULTS: The odds ratios of moderate and severe hot flashes/night sweats were lower in more educated women and (for severe symptoms only) in women reporting regular physical activity. Depression, difficulty to sleep, forgetfulness and irritability tended to be less frequent in more educated women and (depression only) in women reporting regular physical activity. Parous women reported more frequently these symptoms. CONCLUSIONS: This large study confirms in Southern European population that low education, body mass index and low physical activity are associated with climacteric symptoms. Parous women are at greater risk of psychological symptoms.

Effect of peritoneal fluid on sperm motility and velocity distribution using objective measurements.

The aim of this study was to analyze in vitro the effect(s) of peritoneal fluid (PF) on sperm motility. Seventy PFs obtained during laparoscopy were tested on motile-rich sperm suspensions. Proportion of motile sperm and velocity distribution were evaluated by multiple-exposure photography technique. At time (t) = 0, PFs increased both sperm parameters as compared with control (P less than 0.01). Maximum effect was observed at t = 5 hours: 32 (45%) PFs increased and 5 (7%) decreased the proportion of motile sperm, while 8 (11%) PFs increased and 4 (6%) decreased sperm velocity. No correlation was found between a particular infertile group and a definite negative effect. However, 70% of PFs from fertile women maintained or increased the proportion of motile sperm at t = 5 hours, compared with 36% in the total infertile group. Comparison of the sperm motility effect(s) of a given PF on different ejaculates revealed that the effects observed also were influenced by the sperm sample tested. In conclusion, PFs can maintain or increase the motility of spermatozoa as function of time. However, some PFs can inhibit sperm motility and these effect(s) can be influenced by the sperm sample.

Measurement of fetal surfactant production by fluorescence polarization of amniotic fluid in complicated pregnancies.

The results are presented of fluorescence polarization as a method for measurement of surfactant production in 159 specimens of amniotic fluid collected from pregnant women with diabetes, hypertension, Rh immunization, premature rupture of membranes (for more than 48 h prior to delivery) and intrauterine growth retardation (IUGR). The predictability of the development of respiratory distress syndrome has been assessed by this assay. Its specificity, sensitivity and overall accuracy were similar to the lecithin/sphingomyelin (L/S) ratio. The influence of the conditions detailed on fetal lung maturation was determined, lung development being enhanced until near term by Rh immunization, rupture of membranes and hypertension with IUGR.

Post-coital contraception by estrogen/progestagen combination or IUD insertion.

Five-hundred-thirty-eight patients received a complete follow-up to the first menses after post-coital contraception (PCC). Hormonal contraception (pill) was used in 436 women and mechanical contraception (IUD) was used in 102 women. No pregnancies were observed in the IUD group, while 8 pregnancies were found in the hormonal group. A comparative evaluation of the effectiveness and side effects of the two methods was made. The usefulness of PCC after an unprotected intercourse in order to avoid a pregnancy is confirmed.

Hysteroscopy and transvaginal ultrasonography in postmenopausal women with uterine bleeding.

OBJECTIVE: To evaluate the accuracy of hysteroscopy and transvaginal ultrasonography (TU), based on a histopathological report from endometrial specimens, in diagnosing endometrial pathology in menopausal women with uterine bleeding. METHODS: Four-hundred and nineteen postmenopausal women with uterine bleeding underwent TU, hysteroscopy and endometrial biopsy. Hysteroscopic and sonographic findings have been evaluated on the basis of the final diagnosis established by histologic examination. Sensitivity, specificity and positive predictive value of TU at an endometrial thickness cut-off point of 4 and 8 mm (double layer technique) and of panoramic hysteroscopy have been detected. RESULTS: Normal and abnormal endometrium was found in 222 and in 197 women, respectively. TU showed sensitivity of 95.1%, specificity of 54.8% and positive predictive value of 63.7% at a cut-off limit of 4 mm. With a cut-off limit of 8 mm the corresponding figures were 83.8%, 81.3% and 79.4%. Hysteroscopy demonstrated a sensitivity of 96.5%, specificity of 93.6% and positive predictive value of 92.6%. The combination of the two diagnostic tools showed a 100% sensitivity, 94.8% specificity and 93.3% positive predictive value. CONCLUSIONS: With cut-off limit of 4 mm, TU can be considered the first choice modality of endometrial investigation in women with postmenopausal uterine bleeding to select patients at risk to carry endometrial pathology. Hysteroscopy is a more accurate technique than TU because of better specificity and must be indicated for all patients showing an endometrial strip more than 4 mm. When an endometrial thickness below 4 mm is detected by ultrasound, hysteroscopy may be indicated on clinical background because of the possibility to miss infrequent (2.5% in our series), but relevant endometrial pathologies. Endometrial sampling should follow hysteroscopic view in all cases showing abnormal or suspicious lesions as well as in all cases with irregularly shaped endometrial lining and/or suboptimal endoscopic vision.

A study of cellular immunity in newborns after prevention of respiratory distress syndrome (RDS).

Cellular immune responsiveness against infections was evaluated in four groups of newborns. The first group was composed of preterm newborns whose mothers had received betamethasone for prevention of RDS, the second group of preterm newborns whose mothers had received ambroxol for prevention of RDS, the third group of preterm newborns whose mothers had not received any drug enhancing surfactant production, and the fourth group were healthy-term infants. A reduction of OKT4+ cells and functional deficits of neutrophils were found in preterm infants born to mothers treated with steroids, whereas no functional abnormalities of immune-competent cells were observed in preterm infants born to mothers treated with ambroxol.

Accelerations in "intra-partum" cardiotocographic record. III. Correlation with meconium staining of amniotic fluid.

The Authors examined perinatal outcome and presence of accelerations in cardiotocographic records in a group of patients showing meconium staining of amniotic fluid in labor, in comparison with the data of a control group. The first group showed an average Apgar between 1' and 5' and an average number of accelerations every 30' significantly lower than those of the control group. Moreover the study of accelerations confirmed that an average of more than 5 accelerations every 30' is a clear indicator of fetal well-being.

Accelerations in "intra-partum" cardiotocographic record. IV. Correlation with the presence of a funiculus pathology.

The Authors compare the presence of accelerations and variable decelerations in a group of cases showing funiculus anomalies and in a control group. The group with funiculus pathologies showed a lower average frequency of accelerations and a higher frequency of variable decelerations than the control group. Furthermore, it was confirmed that an average of more than 5 accelerations is a clear indicator of fetal well-being.

Accelerations in "intra-partum" cardiotocographic recording II. Present contemporaneously to prognostically unfavourable cardiotocographic aspects.

The Authors examine 1994 cardiotocographic recordings during labour, equivalent to 89% of all deliveries of the same period. They evaluate the acceleratory activity in the tract of recording presenting alterations considered expression of foetal distress (bradycardia, severe tachycardia, loss of cyclic variations, variable and late decelerations), and compare both parameters with the perinatal outcome. The presence of accelerations seems to allow a more oculate evaluation of the cardiotocogram and, in particular, a decreased incidence of hurried instrumental foetal extractions.

Accelerations in greater than intra-partum greater than cardiotocographic recording I. Correlation with perinatal outcome.

The authors examine 1994 cardiotocographic recordings during labour, equivalent to 89% of all deliveries of the same period. They evaluate the tendency of the acceleratory activity in the single recordings during their whole lenght, comparing it with the perinatal outcome, evaluated by the perinatal mortality and the Apgar score at 1' and 5'. They conclude that the presence of accelerations could be considered, when present in a certain degree, a sure index of foetal well-being or of good possibility of foetal reactions to hypoxic stimuli, allowing a more cautious evaluation of the cardiotocogram.

Risk factors for type 2 diabetes in women attending menopause clinics in Italy: a cross-sectional study.

OBJECTIVE: To analyze risk factors for type 2 diabetes among women attending menopause clinics in Italy for counselling about the menopause. SUBJECTS: Women attending a network of first-level outpatient menopause clinics in Italy for general counselling about menopause or treatment of menopausal symptoms. METHODS: Cross-sectional study with no exclusion criteria. Type 2 diabetes was defined according to National Diabetes Data Groups Indications and the fasting blood glucose at an oral glucose tolerance test within the previous year. RESULTS: Out of the 44 694 considered in this analysis, 808 had a diagnosis of diabetes type 2 (1.8%). In comparison with women aged < 50 years, the multivariate odds ratios (OR) of type 2 diabetes were 1.31 (95% confidence interval (CI), 0.99-1.74) for women aged 50-52 years, 1.66 (95% CI, 1.27-2.17) at 53-56 years and 2.84 (95% CI, 2.20-3.67) in women aged > or = 57 years. Type 2 diabetes was less frequently reported in more educated women (OR high school/university vs. primary school = 0.44 (95% CI, 0.36-0.55)). Being overweight was associated with an increased risk of type 2 diabetes. In comparison with women reporting a low level of physical activity, the multivariate OR of type 2 diabetes was 0.67 (95% CI, 0.54-0.84) for women reporting regular physical activity. In comparison with premenopausal women, the multivariate OR of type 2 diabetes was 1.38 (95% CI, 1.03-1.84) in women with natural menopause. This finding was present also after allowing for the potential confounding effect of age. The multivariate OR of diabetes for users of hormonal replacement therapy was 0.58 (95% CI, 0.46-0.73). CONCLUSIONS: This large cross-sectional study suggests that postmenopausal women are at higher risk of type 2 diabetes after allowance for the effect of age. Other main determinants of risk of type 2 diabetes in women around menopause were low socioeconomic status and being overweight. Diabetes was found less frequently in those taking hormone replacement therapy.

Simultaneous laparoscopic cholecystectomy and laparoscopically assisted vaginal hysteroadnexectomy.

As a consequence of the wide applications of operative laparoscopy and thoracoscopy, simultaneous surgical procedures have been carried out endoscopically. We report a 51-year-old woman treated by simultaneous laparoscopic cholecystectomy and celioscopically assisted vaginal hysteroadnexectomy for hydropic calculous gallbladder, uterine myomas, and bilateral ovarian policystosis. These procedures were carried out using six abdominal trocar sites, and the gallbladder was removed through the colpotomic access. The patient had an uncomplicated postoperative course and was discharged on postoperative day 5. In our opinion, the multidisciplinary laparoscopic approach, with the original technical solutions, represents an effective, minimally invasive method of treatment that gives new perspective about the indications and the treatment of similar cases.

Accuracy of hysteroscopy in predicting histopathology of endometrium in 1500 women.

STUDY OBJECTIVE: To estimate the accuracy of hysteroscopy in predicting endometrial histopathology. DESIGN: Retrospective analysis (Canadian Task Force classification II-2). SETTING: Public hospital. PATIENTS: One thousand five hundred women undergoing diagnostic hysteroscopy for suspected endometrial pathology, mostly because of abnormal uterine bleeding. INTERVENTIONS: Hysteroscopy and endometrial biopsy. MEASUREMENTS AND MAIN RESULTS: Hysteroscopy imaging was matched with histology. Functional, dysfunctional, and atrophic endometrium were considered normal findings; endometritis, endometrial polyps, hyperplasia, and carcinomas were considered abnormal. Sensitivity, specificity, and negative (NPV) and positive (PPV) predictive values of hysteroscopy in detecting normal or abnormal endometrium were calculated. These figures were defined to assess hysteroscopic accuracy in estimating pathologic conditions. Histology showed normal endometrium in 927 patients. Endometritis, polyps, hyperplasia, and malignancies were found in 21, 265, 185, and 102 patients, respectively. Hysteroscopy showed sensitivity, specificity, NPV, and PPV of 94.2%, 88.8%, 96.3%, and 83.1%, respectively, in predicting normal or abnormal histopathology of endometrium. Highest accuracy was in diagnosing endometrial polyps, with sensitivity, specificity, NPV, and PPV of 95.3%, 95.4%, 98.9%, and 81.7%, respectively; the worst result was in estimating hyperplasia, with respective figures of 70%, 91.6%, 94.3%, and 60.6%. All failures of hysteroscopic assessment resulted from poor visualization of the uterine cavity or from underestimation or overestimation of irregularly shaped endometrium. CONCLUSION: Hysteroscopy was accurate in distinguishing between normal and abnormal endometrium. Nevertheless, better knowledge of relationship between hysteroscopic imaging and pathophysiologic states of endometrium is necessary to improve its accuracy. Endometrial sampling is recommended in all hysteroscopies showing unevenly shaped and thick endometrial mucosa or an anatomically distorted uterine cavity, and when endouterine visualization is less than optimal.

An alternative to steroids for prevention of respiratory distress syndrome (RDS): multicenter controlled study to compare ambroxol and betamethasone.

The results are reported of a multicenter randomized study of the effectiveness of maternal administration of betamethasone versus ambroxol, a substance of the group of the benzylamines, for prevention of RDS in preterm infants. Women of 27 to 34 weeks gestation with threatened premature delivery or planned premature delivery were admitted to the trial. Between September 1981 and November 1984 a total of 288 randomized patients delivered 315 neonates. The incidence of RDS was assessed in 169 viable neonates born before the 37th week. Of these 86 were born of 76 mothers treated with beta-methasone and 83 of 76 mothers treated with ambroxol. The overall incidence of RDS was significantly (P less than 0.05) higher in the betamethasone group (31%) than the ambroxol group (13%). Ambroxol was significantly more effective than betamethasone in twin births, in infants born before the 31st week, when ROM to delivery time was more than 48 hours, when treatment to delivery time was between 2 and 7 days and in female infants. The neonatal infection rate was significantly higher (P less than 0.05) in the group of betamethasone treated infants (18% with four fatalities) than in the group of ambroxol treated infants (9% with one fatality). These results suggest that ambroxol may be a valid alternative to steroids for prevention of RDS.

ELISA antibodies to cytomegalovirus in pregnant patients: prevalence in and correlation with spontaneous abortion.

Prevalence of seroimmunity to cytomegalovirus (CMV) infection was tested by detecting ELISA IgG antibodies in 230 pregnant subjects from low socioeconomic backgrounds. Seroimmunity increased from 64.3% to 92.0% between the ages 15-20 and 35-40. Furthermore, ELISA IgM antibodies were detected during hospitalization in a group of 56 women whose pregnancies ended in spontaneous abortion and in a paired matched-control group. The overall percentage of IgM-positive reactions was 5.35% in the group with abortion. The percentage for only second trimester abortions amounted to 18.75%. There was no IgM-positive reaction in the control group.