Is it possible to predict postnatal depression? Research into the origin of blues and depression. The role of the gynaecologist.

PURPOSE OF INVESTIGATION: the authors investigated the role of the gynaecologist in trying to predict postnatal depression. Women suffering from postnatal depression (PND) are the expression of a failure to adapt to the unjust demands that society makes on them. Isolation and the lack of social support during and after the pregnancy are very strong factors of risk for postpartum depression. The problem is serious and it develops rapidly, within two weeks of childbirth. It requires immediate and continuous treatment. There is also some risk of infanticide or suicide. METHODS: submission of a questionnaire based on the EPDS (Edinburgh Postnatal Depression Scale) to 222 pregnant women between 28 and 40 weeks of gestation. RESULTS: 28.4% of the patients resulted positive to the test (score > 12 points) and the hypothesis would seem to be that there is a continuum between depression suffered pre- and postpartum, and that the depression begins during pregnancy and then becomes more acute or less latent at the time of confinement. CONCLUSIONS: the gynaecologist must have a role in helping to achieve an early diagnosis of the depression, because the earlier the problem is recognised the greater are the possibilities of therapy and preventing any consequences for the entire family group.

Non-immune foetal hydrops: a case report.

Foetal hydrops occurs when a certain amount of interstitial fluid, produced by capillary ultrafiltration, overcomes the amount of interstitial fluid that returns to the blood circulation through the lymphatic system. Hydrops is classified as immune (IH) due to the presence of circulating maternal antibodies against the foetal red blood cell's antigens, and non-immune (NIH) that includes all the other causes of hydrops. This classification is still valid, but only under a clinical point of view because they differ in aetiology and management. In this article the management of a case of non-immune foetal hydrops is described, in which, unlike most other cases of non-immune foetal hydrops, the foetus survived.

Antiestrogenic therapy in breast cancer and endometrial modifications.

The aim of this retrospective study was to detect endometrial lesions in tamoxifen breast cancer users (menopausal state related). The meaning of genital bleeding during the treatment and the actual incidence of benign and malignant pathology of the endometrium related to length of treatment was also evaluated. Tamoxifen (TMX) is a nonsteroidal triphenylene derivate with clear antiestrogenic properties on the breast which is used as adjuvant treatment for breast cancer; potential adverse effects include endometrial lesions. Three hundred and sixty-six breast cancer patients were enrolled in this study; 292 patients were treated with 20 mg/daily of TMX as adjuvant therapy and the remaining 74 did not receive therapy. All patients were subdivided in premenopausal and postmenopausal, asymptomatic and symptomatic groups. All patients underwent ultrasound scans (to examine endometrial thickness) and hysteroscopic examinations before treatment and after one, three and five years. Endometrial biopsy under direct hysteroscopic vision was systematically performed. The pathological histology reports were classified under polyps, simple hyperplasia, complex hyperplasia, atypical hyperplasia, and carcinoma. A higher incidence of endometrial pathology was found only in symptomatic postmenopausal TMX treated patients (27.2% vs 19.5%) between the third and fifth year of treatment.

Preparation for childbirth in different cultures.

Anthropologically childbirth is an enigma because every woman experiences an identical physiological and biological process, wherever the event takes place: from a hut in the jungle to a modern hospital in the United States. Differences are due to the way that pregnancy, birth and the postnatal period are treated. For most women in developing countries, being a woman means being a mother: a female is not a woman until she has given birth to a child. Therefore during pregnancy she has to follow precise rules and regulations with ritual meanings for her protection and that help her get into the role of a mother. Medicine offers important technological resources for the prevention, diagnosis and treatment of pathology during pregnancy, but with a lack of attention to emotional support. Modern society must try to give pregnant women the trust in their bodies in order to reach the harmony necessary to give birth "willingly" and "with joy".

Transcervical hysteroscopic myomectomy: long-term effects on abnormal uterine bleeding.

OBJECTIVE: To evaluate the effectiveness of hysteroscopic myomectomy in the treatment of symptomatic submucous leiomyomas and long-term outcomes. STUDY DESIGN: A total of 107 patients with abnormal uterine bleeding (n = 84) and/or infertility (n = 23) were submitted to hysteroscopic resection. MAIN OUTCOME MEASURES: control of menorrhagia and reproductive outcome. RESULTS: Abnormal uterine bleeding was controlled in 68 out of 84 patients with one procedure; 15 needed a second procedure for incomplete resection. Five patients had menorrhagic pathology relapse. Among 23 patients with associated infertility pregnancy was achieved in eight cases, seven went to term and one miscarried; one patient needed a second procedure. The mean follow-up was 36 months (24-60). Three patients were lost at follow-up. CONCLUSIONS: Transcervical hysteroscopic resection of submucous myomas is effective for control of abnormal uterine bleeding. Further studies are needed to define the value of such procedure in the treatment of infertility. Short and long-term results are strictly correlated to the possibility of obtaining a complete resection, which is conditioned by degree (0, 1, 2) and number of myomas.

Hormonal replacement therapy and evaluation of intrauterine pathology in postmenopausal women: a ten-year study.

BACKGROUND: To evaluate the role of hormonal replacement therapy (HRT) in determining: a) abnormal uterine bleeding (AUB); b) increased endometrial thickness at transvaginal sonography (TVS); c) the correct indication for outpatient hysteroscopy (HS) and biopsy in diagnosing intrauterine pathology. METHODS: Between April 1991 and April 2001 a group of 3,400 postmenopausal women was referred to the Department of Obstetrics and Gynecology of Rome University "La Sapienza"; 16.7% of them had received HRT. 587 out of the 3,400 women were recruited for a comparative study, including four groups. To assess statistical significance of HRT in determining AUB, and/or endometrial thickness related to malignant disease the chi-square test was used; p < 0.05 was considered significant. Histology was considered the true result (control). RESULTS: An increase in the endometrial thickness occurred significantly more often in women on HRT (p < 0.03); as well as the percentage of AUB (p < 0.0001). No difference in the incidence of endometrial adenocarcinoma was reported between the HRT and the non HRT groups. CONCLUSIONS: In postmenopausal women using HRT we can confirm that a higher incidence of signs (AUB, endometrial thickness > or = 5 mm) does not coincide with a higher incidence of malignant pathology. The data obtained from the recruited patients was arranged and evaluated by the most suitable methods for screening endometrial adenocarcinoma. According to our experience, we believe a cut-off point of 8 mm to be significant (p < 0.001) to perform an hysteroscopy and biopsy except for asymptomatic patients on HRT.

Introducing colposcopy and vulvovaginoscopy as routine examinations for victims of sexual assault.

Victims of sexual assault require appropriate care, follow-up and information regarding their legal rights. Clinicians are faced with the challenging responsibility of identifying victims and providing effective interventive and preventive counselling. The most pressing medical task is to confirm the assault and to undertake correct documentation and exhibition of biological traces. Performing colposcopy and vulvovaginoscopy does not allow us to diagnose a sexual assault trauma, but it can help us to identify those microscopic lesions (due to the enhanced visualization and the higher resolution under which the genital areas are examined) that may not be seen during a normal clinical examination. The colposcopic and vulvovaginoscopic examination starts from the vulvar region looking for superficial lacerations and ecchymosis; the labia majora and minor are examined scrupulously, then the posterior forchette, the perineum and the hymen where it is possible to report microulcerations, contusions and even possible scars due to a precedent defloration. Recent advances in clinical forensic medicine show that trained examiners using colposcopy obtain evidence of genital trauma in 87% to 92% of rape victims. Colposcopy and vulvovaginoscopy must be performed within 48 hours from the sexual assault, because most of the lesions heal rapidly. Colposcopy and vulvovaginoscopy may be seen as a stressful invasion of a woman who is already vulnerable and at risk of the rape trauma syndrome. Prior information about colposcopy may reduce the level of anxiety experienced by many women undergoing this procedure. Incorporating colposcopy and vulvovaginoscopy into the routine assessment of sexual assault victims could be a valid way of identifying genital injuries; moreover the medical report will be more detailed and precise.

Preoperative evaluation of ovarian masses: ultrasound and biochemical screening.

OBJECTIVE: The preoperative study of an ovarian mass, with a negative dosage of plasmatic BhCG, mainly has the purpose of discriminating between a benign neoplastic mass and a malignant mass. The aim of our work was to evaluate the validity of preoperative screening including a pelvic ultrasound examination and the dosage of some plasmatic tumor markers. METHODS: This is a retrospective study conducted on 78 patients who were referred to the III Division of the Department of Gynaecological Sciences, Perinatology and Puericulture of Rome University "La Sapienza" from January 1st 2001 to December 31st 2001 with a diagnosis of ovarian tumefaction whose origin was still to be determined. These patients underwent both a transabdominal and transvaginal ultrasound scan and biochemical examination of serum levels of Ca-125, Ca 19-9 and CEA. Subsequently these patients underwent surgery or medical therapy according to the suspected diagnosis. We then compared our suspected diagnosis with the precise histological diagnosis. Finally, following this comparison, we judged the validity of the proposed screening. RESULTS: Ultrasound examination is on its own an excellent method for preoperative screening in cases of adnexal tumefactions. However, its association with plasmatic dosages of Ca 125, Ca 19-9 and CEA improves the validity of the screening. CONCLUSION: The use of pelvic scanning, both transabdominal and transvaginal, associated with plasmatic dosages of Ca 125, Ca 19-9 and CEA, represents an excellent method of preoperative screening for the evaluation of benign or malignant ovarian tumefactions and for directing the surgeon towards the best therapy.

[Use of the eutectic ointment EMLA (Eutectic Mixture of Local Anesthetics) in the surgical treatment of inguinal hernia under local anesthesia]. / L'uso della crema eutettica EMLA nel trattamento chirurgico dell'ernia inguinale in anestesia locale.

The use of EMLA eutectic cream is very effective and well tolerated in superficial anaesthesia. It is particularly indicated in surgical treatment of inguinal hernia by local anaesthesia, to achieve the analgesia of superficial layers. This allows to reduce the total dose of anaesthetics administrated by infiltration, reducing the risk of overdose, eliminating the pain due to injection, and is very agreeable for the patients.

The palliative treatment of bronchial carcinoma with lasertherapy and stent.

The obstruction of the airways represents a severe complication in bronchial neoplasia. Endoscopic laser resection associated with the positioning of a stent represents a therapeutic praesidium that ensures the potency of the airways. The authors describe a case of bronchial carcinoma treated with endobronchial laser resection and positioning of a Dumon stent.