Intracerebral haematoma following spinal anaesthesia for caesarean section: case report.

Several complications are known to occur with spinal anaesthesia and all of them are easily recognizable. We report the case of a 25 year old woman presenting with intracerebral hemorrhage secondary to spinal anaesthesia for caesarean section. She underwent surgical evacuation of the haematoma with complete recovery. The relevant literature is also reviewed.

Interactions between heme and tau-derived R1 peptides: binding and oxidative reactivity.

The interaction of hemin with the first 18-amino acid repeat in tau protein has been investigated at both the N-terminal free-amine (R1τ) and N-acetylated (AcR1τ) forms for its potential relevance in traumatic brain injury and possibly other neurodegenerative diseases. The binding properties of hemin-R1τ and hemin-AcR1τ were compared with those of the hemin complex with amyloid-ß peptide fragment 1-16 (Aß16) and synthetic hemins. AcR1τ and R1τ bind with moderate affinity to both monomeric and dimeric hemin to form 1 : 1 complexes, but for the acetylated peptide, the affinity is one order of magnitude larger (K1 = 3.3 × 10(6) M(-1)). The binding constants were similar to that of Aß16 for hemin, but unlike the latter, neither of the two R1τ peptides forms a 2 : 1 complex with hemin. This is mostly due to electrostatic repulsion between R1τ chains, and in particular the C-terminal proline-15 kink, while structural features of the hemin-R1τ complexes do not seem to play a role. In fact, the same features are observed for the interaction between ferric heme and peptide R1τ*, where the P15 residue is replaced by an alanine. Imidazole neither binds to [hemin(R1τ)] nor [hemin(AcR1τ)], whereas small ligands such as CN and CO easily bind to the ferric and ferrous forms of the complexes, respectively. A detailed comparative study of the peroxidase activity of [hemin(R1τ)] and [hemin(AcR1τ)] shows that such activity is very low. Thus, the association between heme and unfolded neuronal peptides does not, per se, involve a significant gain of toxic pseudo-enzymatic activity. However, under conditions of heavy heme release occurring on traumatic brain injury or when this activity is prolonged for long time, it can contribute to neuronal oxidative stress. In addition, the presence of hemin increases the aggregation propensity of R1τ.

Insulin, C-peptide, androgens, and beta-endorphin response to oral glucose in patients with polycystic ovary syndrome.

We examined the effects of an oral glucose load on plasma insulin, androgens, and beta-endorphin (beta EP) concentrations in patients carefully selected as having polycystic ovary syndrome (PCOS) and normal glucose tolerance. Our aim was to verify whether insulin resistance is a common feature of PCOS and to differentiate the metabolic abnormalities related to PCOS from those associated with obesity. Plasma immunoreactive insulin (IRI), C-peptide (C-PR), testosterone, androstenedione, dehydroepiandrosterone sulfate, ACTH, and beta EP responses to a 3-h oral glucose tolerance test (OGTT) were evaluated in 10 obese (OB-PCOS) and 10 nonobese (NO-PCOS) patients with PCOS and in 7 obese and 7 nonobese ovulatory controls. OB-PCOS and NO-PCOS did not differ significantly from weight-matched controls in the IRI response, but had a significantly higher C-PR response in terms of mean postglucose load levels and mean incremental areas. During OGTT, mean plasma levels of testosterone, androstenedione, and dehydroepiandrosterone sulfate declined in both PCOS groups as well as in controls, and no significant correlation between the plasma androgen and IRI or C-PR responses was found. The ACTH response in OB-PCOS and NO-PCOS was similar to that in controls, with a progressive decrease until 180 min. A similar decline in plasma beta EP was found in controls, whereas no change in plasma beta EP was observed in OB-PCOS and NO-PCOS. These findings indicate that independently of the presence of obesity, PCOS patients have enhanced insulin secretion in response to OGTT and show a peculiar pattern of changes in plasma beta EP.

Hormone receptors and enzymatic activities in human endometrial adenocarcinoma.

The hormone sensitivity of endometrial carcinoma is related to the presence of steroid hormone receptors. The determination of progesterone receptors has been proposed in order to predict clinical prognosis and to aid treatment selection. The integrity of the hormone receptor system and postreceptoral events in tumors is essential to endocrine therapy response. Nevertheless, although hormone receptors are present in a large number of endometrial carcinomas, only 30% of cases respond to hormone therapy. In some neoplasms the receptors can be present, but not functioning, or else neoplastic transformation could have induced alterations in processes after hormone-receptor interaction.

Prognostic role of laparoscopic salpingoscopy of the only remaining tube after contralateral ectopic pregnancy.

OBJECTIVE: To evaluate the prognostic value of laparoscopic salpingoscopy in detecting patients who are at increased risk for a repeat ectopic pregnancy (EP). DESIGN: Patients with secondary infertility after a previous contralateral salpingectomy for EP were evaluated by laparoscopy with tubal perfusion and salpingoscopy of the only remaining tube. Subsequent reproductive outcome was evaluated and correlated to laparoscopic and salpingoscopic findings. SETTING: Department of Obstetrics and Gynecology of the Catholic University, a tertiary care university center in Rome, Italy. PATIENTS: Eighteen patients submitted to laparoscopy and salpingoscopy after a previous salpingectomy for EP. INTERVENTION: A two- to three-puncture laparoscopy with tubal perfusion and salpingoscopy. MAIN OUTCOME MEASURE: Reproductive outcome after a mean follow-up of 42.6 months. RESULTS: Salpingoscopy revealed a normal tubal mucosa in 13 patients (72%) and intra-ampullary adhesions in 5 patients (28%). Eight of the 13 patients with a normal mucosa conceived an intrauterine pregnancy. In the 5 patients with intra-ampullary adhesions, there were 3 repeat EPs, with one patient having first a term pregnancy and then a repeat EP. The presence of peritubal adhesions at laparoscopy was not of prognostic significance. CONCLUSION: Direct visualization of the ampullary mucosa by salpingoscopy can allow the detection of intraluminal adhesions that put the patient at increased risk for a repeat EP.

Salpingoscopy in patients with contralateral ectopic pregnancy.

Patients who experience a tubal pregnancy have a poor prognosis in terms of reproductive potential and are at increased risk of a repeat EP. Salpingoscopy is a new endoscopic technique that allows the detection of abnormalities of the tubal mucosa. In seven patients with a follow-up longer than 6 months, an IUP occurred only in patients with a normal ampullary mucosa, whereas a recurrent tubal pregnancy occurred in the patient that conceived with an abnormal tubal mucosa. These preliminary results suggest that salpingoscopy may constitute an important prognostic factor in these patients.

Effects of interferon-beta on steroid receptors, prostaglandins and enzymatic activities in human endometrial cancer.

Steroid receptors, prostaglandin output and enzymatic activities were determined in explants derived from human endometrium exposed to natural interferon-beta (IFN-beta). Receptors and cell metabolism were evaluated before culturing the tissue fragments and after a 3-day treatment with varying concentrations of IFN-beta. Total steroid receptor levels were unchanged when explants were set up, but there was a redistribution of both estrogen and progesterone receptors (ER and PR). A decrease in cytoplasmic receptors corresponded to an increase in receptor molecules within the nucleus. Treatment with low concentrations of IFN-beta caused a significant enhancement (p < 0.05) of ER and PR in neoplastic endometrium. In basal conditions the ratio between prostaglandin F2 alpha (Pgf2 alpha) and prostaglandin E2 (PgE2) was higher in normal than in neoplastic endometrium. The addition of low concentrations of IFN-beta to the culture medium determined a significant increase (p < 0.02) in PgF2 alpha and a parallel increase in the above ratio in neoplastic tissue, while no variation was found in normal endometrium. Analysis of the results concerning the variations in hormone-related enzymatic activities due to IFN-B revealed a significant increase (p < 0.05) in 17 beta-hydroxy-steroid-dehydrogenase (17 beta-HSD) activity. The data presented here indicate that treatment with IFN-beta modifies those biological characteristics of neoplastic cells which are involved in hormone-responsiveness.

Ovarian and peripheral plasma levels of progestogens, androgens and oestrogens in post-menopausal women.

Ovarian and peripheral plasma concentrations of oestrone (E1), oestradiol (E2), androstenedione (A), testosterone (T), progesterone (P) and 17 alpha-hydroxy-progesterone (17 alpha OH-P) were assayed in 20 healthy post-menopausal women undergoing hysterectomy because of uterine fibromatosis. Significant differences were found between the ovarian and peripheral levels of E1 (P less than 0.01), E2 (P less than 0.001), A (P less than 0.01), T (P less than 0.001) and P (P less than 0.001). Analysis of the possible relationships between peripheral and ovarian levels of the six steroids considered and the patients' clinical characteristics revealed a positive correlation in only three cases, viz. between body weight and peripheral levels of E1 and E2, between E1 and E2 peripheral levels and between body weight and the E1/A ratio. The ovarian-peripheral gradient was calculated for each patient and was considered significant only if the ovarian peripheral difference exceeded the sum of each concentration multiplied by twice the maximal coefficient of variation of the assays used (12%). This gradient was significant in 75% of patients for T, in 45% for A, in 35% for E2, in 25% for E1, in 35% for P and in 30% for 17 17 alpha OH-P. Our findings confirm that circulating oestrogens in post-menopausal women originate mainly from the peripheral conversion of ovarian and adrenal androgens and that the ovary still continues to produce androgens. They also provide evidence that the ovary, at least in some post-menopausal subjects, can be a potential source of oestrogens and progestogens.

Ovarian and peripheral androgen and oestrogen levels in post-menopausal women: correlations with ovarian histology.

Ovarian and peripheral plasma levels of oestrone (E1), oestradiol (E2), androstenedione (A) and testosterone (T) were assayed in 58 post-menopausal women who underwent hysterectomy and oophorectomy (35 for endometrial carcinoma and 23 for benign gynaecological diseases). No significant difference between the two groups was seen when they were matched for percentage of ideal weight. However, significant differences were found between the ovarian and peripheral levels of the four steroids investigated. To facilitate analysis of the data, 40 of these women were classified into three groups (1, 2 and 3) according to degree of stromal hyperplasia of the ovary. Group 1 comprised those with atrophic ovaries, group 2 those with slight stromal hyperplasia and group 3 those with moderate or marked stromal hyperplasia. Ovarian levels of A and T were significantly higher than peripheral levels in all three groups, but the ovarian/peripheral oestrogen differences were significant only in groups 1 and 2. The ovarian steroid levels in group 3 were significantly higher than those in groups 1 and 2 in the cases of E1 (P less than 0.01), E2 (P less than 0.001) and A (P less than 0.001), but not in that of T. It was concluded that ovaries showing marked stromal hyperplasia can produce significant amounts not only of androgens but also of E2, and hence that any evaluation of the hormonal pattern in post-menopausal women must also take into account the microscopic characteristics of the ovary.

Preventive treatment of cortical bone loss with salmon nasal calcitonin in early postmenopausal women.

Thirty early postmenopausal women having risk factors for osteoporosis entered and 23 completed a six months double-blind placebo controlled study of the effect of nasal salmon calcitonin (SCT) (100 IU daily) plus oral calcium on bone turnover, cortical bone mass and sex-steroids. After the double-blind study SCT treatment was continued for six months in 20 women in both groups. A six months nasal SCT treatment was found to be effective in significantly increasing cortical bone mass and the gain was maintained following a 12 months treatment. The nasal SCT treatment was effective in significantly reducing parameters of bone turnover, as indicated by osteocalcin pBGP and urinary hydroxyproline levels, while during placebo administration an increasing trend of pBGP suggested a state of increasing bone remodeling. During the study, a small decrease in plasma testosterone not related to cortical bone mass and bone turnover was observed.

Serum CA-125 levels in the diagnosis and management of endometriosis.

The value of CA-125 for the diagnosis and management of endometriosis (EN) was investigated by assaying the marker in the serum and peritoneal fluid (PF) from patients with the disease in comparison with control subjects. Of women who underwent 270 consecutive laparoscopies, 81 with various stages of EN (18 stage I, 13 stage II, 35 stage III and 15 stage IV) and 38 with normal pelvic findings were studied. CA-125 serum values increased progressively in relation to the severity of the disease. The levels in stages III and IV EN were significantly higher (P less than .01) than in stages I and II or control patients. The latter two groups did not differ from each other. High CA-125 PF values were found in all the patients investigated. Twenty-two patients with EN were treated with a gonadotropin releasing hormone agonist for six months before second-look laparoscopy or laparotomy. CA-125 values decreased significantly after one month of medical treatment and remained unchanged during the course of therapy. No significant relationship was found in the outcome after therapy.

[The role of laparoscopy in the evaluation of chronic pelvic pain]. / Il ruolo della laparoscopia nella valutazione del dolore pelvico cronico.

Chronic pelvic pain, defined as cyclic or acyclic pain reported for a minimum of six months, is one of the most common gynecological symptoms and one of the most important in terms of social costs. From January 1987 to December 1991, 127 patients suffering from chronic pelvic pain were submitted to diagnostic laparoscopy at the Department of Obstetrics and Gynecology of the Università Cattolica del Sacro Cuore in Rome. The mean age of the patients was 30 years, ranging from 14 to 46. All patients were submitted to bimanual pelvic examination upon hospital admission, and most of them (No. = 99, 78%) to pelvic ultrasonographic examination. In 117 patients (92%) samples for the isolation of Chlamydia trachomatis in 5-iodo-2-deoxiuridine treated McCoy cell cultures were obtained from the cervix, the endometrium and the cul-de-sac peritoneal fluid. At laparoscopy, in 25 patients (20%) the exam showed normal pelvic anatomy, whereas in 102 patients (80%) some pelvic pathology was found. The most frequent conditions observed were: pelvic adhesions in 55% (No. = 70), endometriosis in 29% of the cases (No. = 37), and other pathologies (non-endometriotic ovarian cysts, hydrosalpinges, myomas, etc.) in 25% of the cases (No. = 32). At the comparison of bimanual examination and laparoscopic findings, out of 71 patients with normal findings at bimanual examination, 75% (No. = 53) were found to have abnormal findings at laparoscopy; out of 55 patients with abnormal bimanual examination, 11% (No. = 6) were found to have normal laparoscopic findings.(ABSTRACT TRUNCATED AT 250 WORDS)

[Endometriosis of the abdominal wall after cesarean section]. / Endometriosi della parete addominale dopo taglio cesareo.

The finding of endometriosis of the abdominal wall is a rare event; we describe three cases observed after cesarean section. The first case is an endometriosis of the rectus abdominis, first occurrence in literature. The second case describes a localization limited to the subcutaneous tissue. The third case describes the involvement of the entire abdominal wall. Only two patients complained about excruciating abdominal pain during menstrual bleeding. In one case pain was only an occasional event.

[Salpingoscopy: a new method for the evaluation of the tubal factors in sterility]. / La salpingoscopia: una nuova metodica per la valutazione del fattore tubarico di sterilità.

Salpingoscopy is a new endoscopic procedure that allows the direct vision of the tubal mucosa. Therefore, it is able to identify and evaluate intraluminal lesions not detected by hysterosalpingography or laparoscopy. The endoscopic evaluation of the tubal mucosa can predict the possibility of an intrauterine pregnancy or laparoscopic tubal surgery, permitting the selection of patients with the most favourable prognosis. This technique may also have a role in identifying patients at risk for a repeat ectopic pregnancy and patients with silent endosalpingitis.

[Sexuality and neoplastic disease]. / Sessualità e malattia neoplastica.

Authors review principles and occurrence of sex-impairment correlated with neoplasia and related treatments. Main altering effects appear due to chemotherapy and hormone manipulation, but even surgery and radiotherapy, as well as supportive care are able to induce sex dysfunctions, either physically or psychologically. A specific grading scale (with increasing intensity from 0 to 4) is proposed, following general WHO suggestions in medical oncology, with the aim of recording and prospectively evaluating clinical data in a reproducible fashion.

[Benign prostatic hypertrophy. Optimized diagnosis]. / Ipertrofia prostatica benigna. Diagnostica ottimizzata.

The optimal diagnostics of B.P.H. must be efficient, cheap and of spare invasiveness either physical than psychological. The optimization of diagnosis is the obtainment of high quality in the services provided, matched to a correct and shrewd utilisation of resources. To optimise a diagnosis efficiency is necessary, which means the largest degree of standardization of diagnostical procedures, with responsible management of economical factors. A course of standardization, cause his excessive simplification, cannot shared to a lot of Urologists, because in their opinion there is a risk to lose informations in every single patient, but is essential to use a universal language that make easy the comparison with patients and with results whether in order to clinics or trails. The standardisation of diagnostics consists to obtain the maximum of informations from present methodology and that is possible to realize in two way: improving the technique of execution and including the diagnostic test in the appropriate point of algorithm.

[External devices: for which patients?]. / Dispositivi esterni: a quali pazienti proporli?

Vacuum therapy is a reversible, non-invasive form of treatment for partial impotence, with great success in USA. The story of vacuum therapy begins about 1960, when Osbon developed a vacuum tumescence device which he personally used for more than 20 years. The device was made commercially available many years ago and has been marketed under several names. The newer systems have incorporated a negative pressure pump to achieve vacuum. Osbon's system was patented in 1983, sale is permitted by the U.S. Food and Drug Administration, and it is available by prescription only. More than 10,000 units have been sold. There are four different types of vacuum therapy: 1) loading cone + constriction band; 2) external splint + negative pressure; 3) Negative pressure + constriction band; 4) Negative pressure + intracavernous injections, without the use of constriction band. Each basic system will be described. The authors make a comparison between the use of negative pressure devices plus tension band and the use of negative pression devices without tension band (plus C.I.D. with vaso-active agents). In the second case there's a sort of synergistic action between vaso-active agents and vacuum therapy, representing a sort of "vaso-active exercise" of the erectile tissue. There are no absolute contraindications to use of external penile devices and potential contraindications are few. The external penile devices described represent a reversible therapeutic modality that can augment an inadequate erection and they should prove useful in any man who needs erectile enhancement. These devices appear to be particularly effective in men with partial impotence in whom only erectile enhancement is needed.

[Orthotopic ileal neobladder of the Emikock type: technical points and functional results]. / La neovescica ileale ortotopica tipo Emikock: attualità tecniche e risultati funzionali.

Ileal orthotopic neobladder represents, nowadays, the best urinary diversion after cystectomy. Emikock procedure was performed, in our institution, in 26 patients with bladder cancer T2-T4. At 6-60 months of follow-up 3 pts were died with local or at distance neoplastic recurrence, 2 were alive with neoplasms and 21 were NED. Nocturnal continence was good in 22 cases (88%) and only 3 patients were obstructed because of pseudodyssynergia in 2 and stricture in 1. Emikock neobladder even if needs a longer surgical time than other procedure and a long ileal tract is almost free from severe metabolic disorders. This technique offers a good protection of high urinary tract because of antireflux nipple and avoid the uretero-intestinal stricture. It not feasible, now, to know the functional trend of this reservoir on the long term. Adequate postoperative training is recommended to avoid the pseudodyssynergia and functional obstruction of reservoir.

[Iatrogenic obstructive azoospermia]. / Azoospermie ostruttive iatrogene.

Obstructive azoospermia is a common cause of sterility in men. In the past infection played an important role in the aetiology of obstructive azoospermia. Recently, however, the aetiology of obstructive azoospermia appears to be changing. So iatrogenic obstructive azoospermia has reached an important role in the field of obstructive azoospermia. In this work we show international literature about iatrogenic obstructive azoospermia. Unfortunately it is poor, in spite of an interesting item. We divided iatrogenic obstructive azoospermia into six groups, considering the possible anatomical site of obstruction. So we show the possible damages at the different levels: testis, epididymis, vas deferens, seminal vesicles, prostate and ejaculatory ducts.

[Urethral and prostatic urologic endoscopic surgery in day hospital]. / Chirurgia endoscopica urologica uretrale e prostatica in Day Hospital.

We evaluated urethral and prostatic urological endoscopical surgery in Day Hospital, following rules proposed by Veneto Region in 1996. We made surgical treatments for urethral strictures, BPH obstruction, and sclerosis of the bladder neck in 44 patients (age: 67-84). Laser therapy and classical surgical techniques were used. Our results were good: complete resolution of obstruction, lack of bleeding, early catheter removal, and acceptable costs.