Preoperative diagnosis of 221 consecutive ovarian masses: scoring system and expert evaluation.

OBJECTIVE: The aim of our work was to assess the diagnostic accuracy of a scoring system versus subjective assessment of the risk of malignancy of pelvic masses achieved by gynecologist/sonologists in the preoperative triage of a busy gynecology department. METHODS: One hundred and eighty-two consecutive patients who underwent surgical removal of ovarian neoplasms were examined. In 39 patients pelvic masses were bilateral. The total number of neoplasms analyzed in this series was 221. Lesions were examined and scored according to the sonographic characteristics. Gynecologist/sonologists also recorded a subjective evaluation of the adnexal masses defining them as "probably benign", and "suspicious/probably malignant". Preoperative ultrasound risk assessment was compared to the final pathologic report and diagnostic accuracy was calculated. CA125 was obtained in all patients and its independent and combined accuracy was calculated. RESULTS: The sensitivity of the scoring system and subjective evaluation was 86% and 95% respectively, specificity was 79% and 91% with a positive predictive value of 41% and 53%. The frequency of positive diagnoses for CA125 was 44% due to the high prevalence of endometrosis in this series (48%). In premenopausal patients (75%) the specificity was 93% and 89% for scoring and subjective evaluation, respectively. The combined use of morphological scoring and CA125 achieved higher specificity and positive predictive values both for the whole series and in premenopausal patients. CONCLUSIONS: These results confirmed that the experience of gynecological surgeons with ultrasound skills, outperforms the morphological indexing assessment of ovarian masses. Nonetheless an easy sonographic descriptive scoring system is not significantly lower in accuracy than the expertise achieved by gynecologists with sonographic skills.

Regulation of the proliferative potential of cord blood long-term culture-initiating cells (LTC-IC) by different stromal cell lines: implications for LTC-IC measurement.

BACKGROUND AND OBJECTIVE: Long-term culture-initiating cells (LTC-IC) are the best available approximation to an in vitro assay of stem cells in humans although they still represent a heterogeneous population in terms of proliferative capacity and sensitivity to different growth factors. Human umbilical cord blood (CB) is rich in hemopoietic progenitor cells, as measured by clonogenic assays and contains stem cells capable of reconstituting the marrow after ablation in clinical transplantation. We evaluated the influence of culture conditions on the in vitro behavior of LTC-IC from CB. DESIGN AND METHODS: LTC-IC were evaluated in long-term cultures, comparing two types of murine stromal cell lines: M2-10B4 and M2-10B4 transfected with cDNAs for human G-CSF and IL-3. RESULTS: Two and five fold higher numbers of terminally differentiated cells were produced during nine weeks of culture of CB mononuclear or CD34+ cells respectively, in cultures containing a M2-10B4 IL-3 G-CSF cell line compared to cultures containing the parental cell line. Likewise, a higher number of colony-forming cells (CFC) were detected in the supernatant of cultures with the transfected cell line. In contrast, the number of CFC generated within the stromal layer, after 5 or 9 weeks of culture, was significantly higher in cultures on M2-10B4 cells than those on M2-10B4 IL-3 G-CSF. INTERPRETATION AND CONCLUSIONS: Our results show that the proliferative capacity of CB LTC-IC can be strongly influenced by culture conditions and that the frequency of LTC-IC estimated using these cell lines as stromal support is not identical.

[Metabolic compensation and malformations in pregnancy complicated by diabetes]. / Compenso metabolico e malformazioni in gravidanze complicate da diabete.

Congenital malformations are considered the more frequent perinatal complications affecting offsprings of diabetic mothers; they represent the main cause of mortality of these neonates. Since diabetes is strictly controlled, the incidence and the seriousness of its complications are reduced from 8-10% to 2-3%. In this study we followed 56 pregnancies complicated by diabetes. There were 3 case of malformations. We correlate these with the metabolic maternal balance and with the HbA1c values. We could confirm the relationship between malformation and metabolic imbalance and also the absence of fetal malformations in women with metabolic compensation since the beginning of the pregnancy.

[Prevalence of RDS in diabetic pregnancy]. / La prevalenza di RDS del neonato nella gravidanza diabetica.

The offspring of the diabetic mother is more significantly affected by RDS (Respiratory Distress Syndrome) than the healthy pregnancy's one in the same conditions. The RDS is one of the most important cause of perinatal morbidity and mortality. The etiology of this syndrome is recognized in the modified carbohydrates metabolism, in the apposite effect of insulin versus the cortisol action, and in the slower adsorption of the alveolar fluid following the Cesarean section. In fact the diabetic mother is frequently submitted to this intervention to end the pregnancy and especially in last years when the CS was of first choice at 35 weeks in the diabetic mothers. Actually the RDS appears in the 13% of the offspring of mothers affected by pregestational diabetes and in the 5% of the offspring of gestational diabetic mothers. Here we refer about the prevalence of RDS in a population of 55 diabetic mothers.