Defect of a subpopulation of natural killer immune cells in Graves' disease and Hashimoto's thyroiditis: normalizing effect of dehydroepiandrosterone sulfate.

BACKGROUND: The study of the natural killer (NK) immune compartment could provide important findings to help in the understanding of some of the pathogenetic mechanisms related to autoimmune thyroid diseases (Graves' disease (GD) and Hashimoto's thyroiditis (HT)). Within this context, it was suggested that alterations in NK cell cytotoxicity (NKCC) and NK production of cytokines might occur in subjects with GD and HT, whereas the normalization of NK functions could potentially contribute to the prevention of the onset or the progression of both diseases. OBJECTIVE: Due to the hypothesis of alterations in NK in autoimmune thyroid diseases, we were interested to evaluate NKCC in GD and HT patients and to modulate NK function and secretory activity with cytokines and dehydroepiandrosterone sulfate (DHEAS) in an attempt to normalize NK cell defect. DESIGN: We studied 13 patients with recent onset Graves' disease, 11 patients with Hashimoto's thyroiditis at first diagnosis and 15 age-matched healthy subjects. METHODS: NK cells were concentrated at a density of 7.75x10(6) cells/ml by negative immunomagnetic cell separation and validated by FACScan as CD16+/CD56+cells. NK cells were incubated with interleukin-2 (IL-2) and interferon-beta (IFN-beta) and co-incubated with DHEAS at different molar concentrations for measuring NKCC and the secretory pattern of tumor necrosis factor-alpha (TNF-alpha) from NK cells. RESULTS: Lower spontaneous, IL-2- and IFN-beta-modulated NKCC was demonstrated in GD and HT patients compared with healthy subjects (P<0.001). A decrease in spontaneous and IL-2-modulated TNF-alpha release from NK cells was also found in both groups of patients (P<0.001). The co-incubation of NK cells with IL-2/IFN-beta+DHEAS at different molar concentrations (from 10(-8) to 10(-5) M/ml/NK cells) promptly normalized NKCC and TNF-alpha secretion in GD and HT patients. CONCLUSIONS: A functional defect of a subpopulation of NK immune cells, involving both NKCC and the secretory activity, was demonstrated in newly-diagnosed GD and HT patients. This defect can be reversed by a dose-dependent treatment with DHEAS. The impairment of NK cell activity in autoimmune thyroid diseases could potentially determine a critical expansion of T/B-cell immune compartments leading to the generation of autoantibodies and to the pathogenesis of thyroid autoimmunity.

[Minilaparoscopy and open laparoscopy: prevention of laparoscopic complications]. / Minilaparoscopie e "open-laparoscopy". Prevenzione delle complicanze laparoscopiche.

BACKGROUND: The study aimed to compare laparoscopy, open-laparoscopy and mini-laparoscopy and to correlate the results of each technique with the respective percentages of laparotomic conversion. METHODS: A total of 101 laparoscopies were performed between November 1997 and April 1999: 18.8% were diagnostic and 81.2% operative. The latter included 54 traditional laparoscopies (65.9%), 18 open-laparoscopies (21.9%) and 10 minilaparoscopies (12.2%). RESULTS: Laparotomic conversion was required in 5.5% of laparoscopies. No laparotomic conversion was necessary for the open-laparoscoples and for mini-laparoscopies. CONCLUSIONS: The possibility of resorting to open-laparoscopy and mini-laparoscopy may represent a valid tool when the patient has previously undergone laparoscopic or laparotomic surgery, with the supposition of pelvo-abdominal adherences that would increase the risk of traditional laparoscopy.

[Ureaplasma urealyticum vaginosis and premature rupture of membranes. What is its role?]. / Vaginosi da ureaplasma urealyticum e rottura prematura delle membrane. Quale ruolo?

BACKGROUND: The aim of this study was to evaluate a correlation between PROM and genital infections. METHODS: A total of 308 vaginal swabs were made in randomized study group composed by 184 pregnant women aged between 26 and 32 years with an extreme age of 19 (one) and 40 years (one). Three vaginal swabs and one cervical swab (searching for Chlamydia) were made for every patient. Sixteen patients were excluded during this study, because they decided to have their babies in other hospitals. Therefore, the patients totally included in the study were 166: 109 at the first pregnancy, 33 at the second pregnancy and 5 at the third pregnancy. No one of them had any spontaneous abortion in the past. All possible other factor which ca be considered responsible and/or inductive of premature ruptures, such as cervical incontinence, cigarette smoke and coitus were excluded. RESULTS: 280 vaginal swabs were made in this study: 134 were positive, with a global positivity percentage of 47.85%. Premature rupture of membranes (PROM) was observed in 38 cases with an incidence of 23.03%: 26 were PROM and 12 were pPROM. The extreme pPROMs occurred, respectively, at the 21st and at 34th gestational week; 29 of the 38 cases of PROM, were associated with positive cultures. The results obtained show an evident correlation between PROM and Ureaplasma urealyticum vaginosis: this fact is improved by the high incidence percentage of this mycobacter in pregnant women and also by an absolute predomination of Ureplasma urealyticum in PROM cases (72.41%). CONCLUSIONS: These data obtained confirm the importance of this microorganism in PROM genesis, according to some recent studies. It is suggested that Ureaplasma urealyticum infection can contribute to a premature start of labour.

[Cure of female sterility. Treatment of hydrosalpinx]. / Cura della sterilità femminile. Trattamento dell'idrosalpinge.

BACKGROUND: The aim of this study was to show how a laparoscopic salpingectomy can positively modify infertile patients pregnancy rate after a diagnosis of hydrosalpinx, obtaining, through successive assisted procreation programs, a pregnancy rate equal to the pregnancy rate obtained in good conditions. METHODS: A group of 19 women under infertility treatment was evaluated: of these women, 11 were included less than three times in an assisted procreation program and 8 were included three or more times in these programs, for a total of 41 cycles of assisted reproduction: all these cycles were characterized by a negative result. All 19 patients were treated by diagnostic-operative laparoscopy: a salpingectomy was carried out after a hydrosalpinx in all these cases. RESULTS: All patients were treated with 2 assisted reproduction cycles, which were made with a variable range of time from 3 to 6 months after laparoscopic surgery, totalizing 38 cycles. At present, 4 pregnancies have been obtained (pregnancy rate = 22%): this value is comparable to the values obtained in the best assisted reproduction programs. CONCLUSIONS: Many studies showed that hydrosglpinx presence reduces very much FIVET procedures. There are many cases showing that the hydrosalpinx become worse, if it has not been preventively treated, during assisted reproduction programs. Moreover complications during FIVET programs in the presence of hydrosalpinx are observed. Even if this study is based on data related to a small number of patients, it's clear that surgical treatment of severe tubarian pathology can give the best results where an assisted reproduction program will be surely unsuccessful.

[Estrogen-progestin contraception and biohumoral response of new markers of the atheroma risk. Behavior of lipoprotein(a) and apolipoproteins A and B]. / Contraccezione estroprogestinica e risposta bioumorale di nuovi marcatori del rischio ateromasico. Comportamento della lipoproteina(a) e delle apolipoproteine A e B.

A homogeneous group of 45 patients, aged between 19 and 37 years was considered in relationship to metabolic response during oral contraceptive use. A free endocrinological-metabolic pathology control group, formed by 30 patients, aged between 22 and 35, who were not treated with any therapy in the six months before, was also considered. We also considered any other factors like smoking, height, and weight in all women of our study. Study-trial was comprehensive of a 12 months follow-up, with some periods of study at 0, +6, +12 months. Metabolic responses of lipoprotein(a) and apolipoprotein A and B during the different follow-up steps were determined. Total and fractionated cholesterol and triglycerides were also determined. Positive correlations were shown between Lipo(a) and Apo B and also between total cholesterol and LDL. Negative correlations were shown between Lipo(a) vs HDL and Apo A. Lipoprotein(a) was determined by the ELISA technique and turbidimetric technique. The aim of our study was to verify the importance of the new markers of atheroma risk; even if the oral estrogen-progestin contraception little interferes with this biohumoral marker synthesis, it improves atheroma risk protection through the lipidic metabolism complexity.

[Bacterial vaginosis and premature membrane rupture: an open study. Preliminary data]. / Vaginosi batterica e rottura prematura delle membrane: open study. Dati preliminari.

We tried to identify a correlation between bacterial vaginosis and PROM with the aim of proposing a future screening for pregnant women at risk for premature rupture of membranes. We made two vaginal bacteriological tests on women pregnant at 24th and 34th week, and we repeated the same test when it proved positive for infection after therapy. We did 375 tests and our study group was composed of 249 pregnant women, aged between 24 and 35. We also evaluated some variable factors as ultrasonographic gestational age redetermination, number pregnancies of oral contraceptives or IUD use, presence of risk factors presence (recurrent abortion, previous PROM, glucose metabolism alteration, immunosuppression, condylomatosis). 171 tests proved positive (total positivity percentage: 47.2%). The most common micro-organism was Ureaplasma urealyticum (49.1%) that was related to PROM in 66.7%. This result contracts with affirmations of some England authors who think that Ureaplasma hasn't an important role in PROM. This fact, if related to the other data we obtained with our study, actually current, shows a strict correlation between PROM and bacterial vaginosis, but also a different distribution of vaginal infections in our country in comparison with English countries.