[Rokitamycin in the treatment of female genital Chlamydia and Mycoplasma infections. Comparative study vs josamycin ]. / Trattamento delle infezioni genitali da Chlamydia e Mycoplasma con rokitamicina. Studio controllato vs josamicina.

BACKGROUND: The macrolides are among the most effective antibiotics against infections due to Chlamydia and Mycoplasma. The drug in such cases must have marked antibacterial activity, good oral bioavailability, and high intracellular diffusion--indispensable for instance with Chlamydia infection. Rokitamycin, a macrolide with a 16-atom lactone ring, has the features for use in the treatment of genital infections caused by Chlamydia or Mycoplasma, penetrating the cell and reaching considerably higher concentrations than other drugs of the same class. The aim of this trial was to gain further knowledge of rokitamycin in genital infections, including cases infected with Mycoplasma hominis, comparing the efficacy and safety of this drug with josamycin, another macrolide widely employed in clinical practice. METHODS: Patients of either sex, over the age of 18 years, with infections due to Chlamydia trachomatis and Mycoplasma hominis, were admitted. The trial was conducted in accordance with the Declaration of Helsinki and amendments. Fifteen patients were given rokitamycin, one 400 mg tablet every 12 h, and another fifteen received josamycin, one 500 mg tablet every 8 h, for 14 days. Before starting treatment, after the 14 days and after 42 days' follow-up the severity of the following symptoms was assessed: pruritus, burning, erythema, pollakiuria, dysuria, using a four-point rating scale (0 = absent, 1 = mild, 2 = moderate, 3 = strong). The presence or absence of leukorrhea was noted. Patients entered the severity of subjective symptoms daily in a diary. At the end of the trial overall assessments were made on the clinical response, microbiological outcome and efficacy. RESULTS: Thirty patients of both sexes were admitted, age 21-43 years, with genital infections due to Chlamydia trachomatis and/or Mycoplasma hominis. Fifteen were given rokitamycin, 800 mg/day, and 15 josamycin, 1500 mg/day, for 14 days. In 13 cases in each group an antibiotic was prescribed for the partner too. At the start of the trial microbiological samples were taken; in 13 cases a urethral swab was taken (six in the josamycin and seven in the rokitamycin group), and 17 cervical swabs were taken (respectively nine and eight). At the end of the trial 93% of patients gave a negative microbiological result. Mycoplasma hominis was isolated from one patient treated with rokitamycin, and Chlamydia trachomatis from one patient given josamycin. Symptoms improved at a similar rate in both groups, with no significant differences between the drugs. Safety was excellent in both groups, with no complaints of adverse reactions. CONCLUSIONS: This trial demonstrates the excellent activity of macrolide antibiotics against genital infections due to Mycoplasma hominis and Chlamydia trachomatis. Rokitamycin and josamycin both gave good or excellent clinical and microbiological outcomes in more than 90% of the cases. Both were extremely well tolerated. These findings confirm and extend the indications for rokitamycin, found in earlier trials to be extremely effective in the treatment of urethritis due to Chlamydia trachomatis and--as a whole--in infections caused by this microrganism.

Primary carcinoma of the fallopian tube.

BACKGROUND: Because of the rarity of fallopian tube cancer, clinical approaches have changed during the last 18 years. METHODS: Twenty-nine patients with fallopian tube cancer were treated at the Gynecologic Oncology Department of Milan University from 1970 to 1988. The mean patient age was 59 years. Parity, symptomatology and histology were considered. Distribution by stage was as follows: I, 11 (37%); II, 10 (34%); III, 8 (27%) according to the Dodson classification. Twenty patients (69%) underwent surgery followed by pelvic irradiation. Adjuvant chemotherapy was performed in the treatment of 5 women with stage I disease, 6 with stage II, and all 8 with stage III. RESULTS: Five-year overall survival was 41.38%: 47.6% at stages I and II, 25% at stage III. Radiotherapy has not been replaced by cisplatin-based multiagent chemotherapy. Optimal surgical debulking combined with accurate lymph node sampling are not followed by systematic use of repeat laparotomy. CONCLUSIONS: The procedures described in this work improve the clinical assessment and patient survival, and make different series comparable.

[Clinical effectiveness and safety of Seaprose S in the treatment of complications of puerperal surgical wounds]. / Efficacia clinica e tollerabilità del Seaprose S nel trattamento delle complicanze delle ferite chirurgiche in puerperio.

The aim of the study was the assessment of the efficacy and safety of Seaprose S in women out patients from the maternity ward with infiltrated surgical wounds subsequent to vaginal birth or caesarean section. The semialkaline proteolithic enzyme Seaprose S, available in 30 mg tablets was administered at a dosage of 3 tablets a day for a period of 8 days. Thirty-two puerpera with a mean age of 31 years +/- 0.9 SE were admitted to the study with an episiotomic wound in 13 cases and a laparotomic wound consequent on caesarean section in the remaining 19 cases. The clinical situation deriving from the surgical wound resolved on average on the 4th day, in particular the swelling and the congestion of the wound had already diminished in the first days of treatment (p less than 0.01). Safety of Seaprose S was good considering that in no cases were side effects attributable to the treatment observed. In conclusion, from the data obtained in this study one may confirm the validity of Seaprose S in the treatment of laparotomic and episiotomic wounds.

Efficacy of topical oxatomide in women with pruritus vulvae.

Pruritus vulvae is a very common condition. The patient's scratching often worsens the situation and makes diagnosis by the clinician difficult. A clinical trial to assess the safety and efficacy of a topical antihistaminic drug (oxatomide) was carried out. The first stage aimed to determine the best formulation and concentration: eleven patients were admitted in the study, conducted openly. Two preparations (cream and gel) and two concentrations (2.5% and 5%) were tested. A second stage was performed to assess the efficacy of oxatomide gel 5% versus placebo: thirty patients entered a double-blind, cross-over, placebo-controlled study. Results of the first stage demonstrated good local tolerability of the medication, good patient acceptance and no side effects. During the second stage better anti-itching action of topical oxatomide than placebo was obtained. Safety and acceptability were confirmed. In general topical oxatomide showed good tolerability and efficacy in women with vulvar itching of various natures.

[Prognosis factors in epithelial tumors of the ovary]. / Fattori di prognosi nei tumori epiteliali dell'ovaio.

87 patients treated for epithelial ovarian carcinoma between 1975 and 1986 were evaluated intensively. In all cases the original operation was followed by surgical reassessment to evaluate the result of adjuvant therapy and to study the cases without apparent disease. The actuarial survival rate after 3 years, by Kaplan-Meier calculation, demonstrated 73.5% survival in patients with negative second-look versus 32% in presence of positive reassessment (P less than 0.01). Surgical reexploration and histologic study were negative in 34 cases (39%). Original stage, histotype, histological grading, peritoneal washing and age of patients were considered for prognostic evaluation of the tumor. The absence of residual tumor (RT) at first surgery resulted in complete response after adjuvant therapy in 70.8% of women, versus 25.8% with RT greater than 2 cm (P less than 0.01). Negative second-look appears the most important prognostic factor for the evaluation of epithelial ovarian cancer (P less than 0.001).

[Prevention of acute neonatal respiratory insufficiency. A method of conditioning the baboon lung during cesarean section]. / La prevenzione dell'insufficienza respiratoria acuta neonatale. Metodica di condizionamento del polmone del babbuino in corso di taglio cesareo.

Preterm baboons at 140 +/- 3 day gestation (term 182 +/- 7 days) have been subjected to lung conditioning, consisting of a series of prolonged inflations of the lungs at 35 cm H2O, followed by approximately 10 min of application of continuous positive airway pressure (CPAP) equal to 15-20 cm H2O, before umbilical cord interruption. The aim of this study was to evaluate, in a primate experimental model, the safety and efficacy in the prevention of neonatal RDS of a technique so far experimented on only in ovine models. Thoraco-pulmonary compliance exceeded the value of 0.2 ml (cm H2O)-1.kg-1 in only 1 animal out of 5 (20%), which didn't develop illness, versus 69% of positive results achieved with the same technique in lambs at 128-130 day gestation, an experimental model considered in the literature as equivalent to a 140 +/- 3 day gestation baboon as far as it concerns incidence and severity of RDS. The application of lung conditioning was easy and safe (as previously reported), but its effectiveness in a primate model is still to be defined.

[Comparison among perineometric, radiologic and electromyographic parameters in patients with urinary stress incontinence]. / Confronto tra parametri perineometrici, radiologici ed elettromiografici nelle pazienti affette da incontinenza urinaria da sforzo.

In order to increase our knowledge of the physiopathology of urinary stress incontinence related to pelvic relaxation, the Authors examined 20 women suffering from SUI (Stress Urinary Incontinence) almost always characterized by concomitant slight or moderate urethrocystocele and 20 women without urological problems. They analyzed and compared the measurement of perineal descent with radiological and electromyographic parameters in order to detect if a suffering of some fibers of the pudendal plexus can be related to the pathology of SUI. They pointed out that patients affected by SUI show a perineal position, either at rest and under switch, below the ischial tuberosities plane. Furthermore the anterior angle at rest is always more than 30 degrees and electromyographic records are pathological in 90% of cases.

[Perineometry and stress incontinence]. / Perineometria e incontinenza urinaria da sforzo.

The authors have examined 20 patients with genuine stress incontinence and urogenital prolapse and 20 control subjects searching a difference between static and dynamic condition of the pelvic floor. They used a simple device to study the mean position of the perineal plane both at rest and under switch. In incontinent patients the perineal plane is always below the bituberal plane (+1.17 cm at rest and +1.32 cm straining). These values are on a higher plane in the control subject (-0.64 cm at rest and +0.48 cm upon straining). These differences have an highly significant statistical value (P = 0.0002 and P = 0.001).

[Congenital hypofibrinogenemia and labor: description of a clinical case]. / Ipofibrinogenemia congenita e parto: descrizione di un caso clinico.

The authors describe a case of Congenital Hypofibrinogenaemia which was revealed by the haemorrhagic complication occurred immediately after delivery.