Spatial variations in feeding habits and trophic levels of two small pelagic fish species in the central Mediterranean Sea.

Trophic ecology of adults of European sardine (Sardina pilchardus) and anchovy (Engraulis encrasicolus) was examined and compared among various regions of central Mediterranean Sea. Carbon and nitrogen stable isotope analyses (δ(13)C and δ(15)N) were adopted as a tool to determine changes in feeding behaviour of adults of sardines and anchovies. In the study period (summer) a clear geographical pattern was recognized in the isotopic composition of both species, with an increasing trend northward. The highest variations in isotopic signal were linked to the geographical positions of the samples and, especially, between pairs of areas: South Sicily/South Campania and Gulf of Gaeta/South Elba. Higher isotope values were found in the anchovies and sardines caught in northern Tyrrhenian Sea, while lower values were mostly estimated in the southern region. Higher carbon and nitrogen isotopes may reflect a more coastal behaviour of both species, being (13)C-enriched source from benthic primary producers in addition to phytoplankton. Variations in the nitrogen isotope ratio may reflect not only differences in the trophic level of prey species, but also variations in the baseline level of food webs. Our results support the hypothesis that feeding behaviour of both species is directly or indirectly influenced by local factors, or by resource partitioning based on zooplankton size. Findings can supply knowledge needed for improving fish stock management and promoting plans able to take into account also local ecosystem analysis.

A case of Sertoli-Leydig cell tumor in a postmenopausal woman.

Sertoli-Leydig cell tumor belongs to the group of sex cord-stromal tumors of the ovary. These neoplasms account for less than 0.5% of all ovarian tumors and are more often encountered in young women between the ages of 20 and 30 years who usually become virilized. We described an unusual case of Sertoli-Leydig cell tumor in a postmenopausal women who presented with a solid right pelvic mass, a large amount of ascites, and laboratory tests revealing an elevated CA125, all suggesting a pelvic malignancy. Although five similar cases of postmenopausal women with Sertoli-Leydig cell tumor of ovary have been reported in the literature, we believe that this is an useful addition to the literature.

Benign metastasizing leiomyoma in the lung: a case report.

The authors report a rare case of leiomyomatosis of the lung diagnosed in a women with uterine leiomyomatosis not previously treated. The absence of mitosis with nuclear atypism in all histological samples opens the question of whether the origin of the tumor in the lung was from uterine leiomyomas metastasizing or multifocal amarthomas, synchronous or metachronous. Hamartomas or real metastasis of uterine leiomyomas? The response to GnRH analogue treatment was evaluated.

Socio-demographic factors and indications in second trimester voluntary abortion.

BACKGROUND: According to Italian Law, second trimester termination of pregnancy is allowed for life threatening conditions or for severe psychological distress, linked or not to prenatal diagnosis of foetal abnormalities. Socio-demographic factors related to this condition have been analysed. METHODS: Clinical records of 330 patients admitted during the years 1988-1997 to the Obstetrics and Gynaecology Department, University of Bari, Italy, for voluntary second trimester abortion, were examined. Maternal psychiatric indications have been given in nearly all of the cases. In 123 cases the indications were secondary to the women suffering a psychiatric disorder due to foetal pathologies. In 205 cases--where poor social conditions were more frequent--the indication was given on the ground of a psychiatric disorder linked to the pregnancy itself. RESULTS: Significantly higher incidence of teenagers (23.3%) and singles (50%) in women who underwent a late abortion. Students were 16.4% in this group. In primary psychiatric indication singles prevail (74.4%) and students represent 23.6% while in secondary psychiatric indication the married were 84.7%, students only 4.8%. In primary psychiatric indication 32.5% of women aged nineteen or less, while in secondary psychiatric indication this percentage was 8%. CONCLUSIONS: Among patients who have a late abortion, teenagers students and singles are prevalent, these patients have significantly more primary psychiatric indications, not linked to foetal abnormalities. The high percentage of teenagers with primary psychiatric indication could depend on inadequate information and social service. Reduction of mid-trimester terminations of pregnancy can be significantly achieved intervening in this group of young women. On the other hand, in secondary indications earlier diagnosis of foetal abnormalities must be encouraged (villocentesis instead of amniocentesis) and abortion discouraged when the foetal pathology is minor, treatable or unlikely to significantly impair the future quality of life.

Prognostic factors and selective use of vaginal hysterectomy in early stage endometrial carcinoma.

INTRODUCTION: Endometrial cancer represents the fourth most frequent malignancy in women of any age, tending to become the most common gynaecological tumor in developed Countries. A retrospective analysis has been conducted on the prognostic factors of endometrial neoplasm during 15-years experience (1977-1991). MATERIAL AND METHODS: 321 patients affected by stage I and II endometrial carcinoma have been treated surgically first hand. Surgical-pathological staging and prognostic factors were reviewed and related to follow-up and 5-year survival rate. RESULTS: The age-peak of patients was 50-70 years; prevalent histologic type was adenocarcinoma (95.6%); 269 patients were in stage I and 52 in stage II. In stage I disease overall 5-year survival rate resulted to be 81.4%, while in stage II it fell to 59.6%. DISCUSSION: Myometrial involvement by adenocarcinomatous cells is probably the most important prognostic factor, considering its reliability and non-contradictory evaluation. Our data confirm there is no difference in impact on 5-year survival between abdominal and vaginal routes in clinical stage I and occult stage II endometrial carcinoma.

[Clinical experience with uterine sarcoma]. / Esperienza clinica sui sarcomi uterini.

BACKGROUND: To report and compare personal experience with international literature on uterine sarcomas. METHODS: 17 cases of uterine sarcomas diagnosed during seven years in our Institute, have been clinically histopathologically, prognostically and therapeutically analyzed. RESULTS: 10 cases of LMS, 6 of MMT, and 1 of ESS have been found. Women affected were mostly 42 to 84 years old. Most of the youngest patients were affected by LMS, while the oldest by MMT. Almost all of them were in menopause and pluriparae. The symptomatology consisted mainly of vaginal bleeding (58.9%). The diagnosis was preoperative for MMT and ESS; in 8 cases it was adopted for stage I, surgery and RT for stage II, surgery, RT and chemotherapy for a woman of stage III, and for the last two surgery and chemotherapy. The patients of stage III and IV survived respectively 8 and 10 months; three patients in stage I still have a 5 years survival and the other are still in follow-up. CONCLUSION: This work is a clinical contribution since the rarity of these neoplasms does not allow the standardization of a diagnostical and therapeutical iter and consequently the improvement of prognosis.

Sexuality in the climacterium.

A retrospective study on 421 women who spontaneously attended the Menopausal Center of Physiopathology of Human Reproduction at Bari University has been carried out to evaluate the incidence of the decrease of libido in climacterium and factors that affect it. The results show a high incidence of decreased libido (46%) and a correlation with age, dyspareunia and housewife status.

Climacteric syndrome and body-weight.

A retrospective study on 181 women who attended the menopausal out-patient clinic of Physiopathology of Human Reproduction at Bari University Hospital throughout 1995, has been carried out to evaluate the relation between body-weight (valued as BMI) and the climacteric syndrome. From the data we have discovered that hot flushes and sweating are more common in women with greater body-weight. Also, women with BMI > 23.8 were found to have a lower level of education.

Smoking and menopause.

A retrospective study on 293 women who attended the Physiopathology of Human Reproduction menopausal out-patient clinic at Bari University Hospital throughout 1995, has been carried out to evaluate correlations between smoking and climacteric syndrome. From the data we have discovered an earlier onset of menopause in the smokers. Fewer smokers were married and they worked more, drank more, and were more educated. The incidence of climacteric syndrome did not differ between smokers and non-smokers.

[Incidence of climacteric syndrome]. / Incidenza della sindrome climaterica.

A retrospective study on 300 women who attended the menopausal out-patient clinic of Physiopathology of Human Reproduction at Bari University Hospital from 1994 to 1995, was carried out to evaluate the incidence of climacteric syndrome in premenopause together with its correlations with the social and cultural environment. The results don't show differences between spontaneous and surgical menopause, and minor differences with premenopause. No relationship has been discovered between the onset of the menarche and the onset of spontaneous menopause. The hot flushes are more frequent in women with low level of learning.

Fetal malformations in an epileptic pregnant woman treated with carbamazepine.

We report a case of an epileptic pregnant woman at 20 weeks of gestation treated with carbamazepine, whose fetus was affected by major malformations probably due to the drug teratogenicity. After a therapeutic abortion minor malformations were also found. After seven months the patient was pregnant again, at 14 weeks of gestation she aborted spontaneously a fetus with no malformations. During this pregnancy the patient took a reduced dosage of carbamazepine.

Ultrasound diagnosis of heterotopic pregnancy with viable fetuses.

Combined pregnancy is an under-estimated and increasing clinical condition. Its recognition is usually made post-operatively. Ultrasound findings are not specific. Diagnosis is possible only when the cardiac activity of the extrauterine and intrauterine fetus can be detected. In the literature, 18 pre-operative sonographic demonstrations of such cases are reported. A correct echographic assessment can show a definite diagnosis or indicate a diagnostic laparoscopy minimizing maternal morbidity and mortality and improving the prognosis of the intrauterine fetus. In this report, ultrasound diagnostic aspects are discussed.

Clinical evaluation of an oral contraceptive containing Ethinyl-Oestradiol (30 mcg) and Gestoden (75 mcg).

At the Family Planning Center AIECS in Bari, 383 women have been treated for 6 cycles with an estroprogestinic combination containing Ethinyl-Oestradiol (30 mcg) and Gestoden (75 mcg). We evaluated the following parameters: contraceptive efficacy, cycle control, side effects and acceptability. At the end of the treatment, 346 women (90.4%) decided to continue the treatment while only 22 expressed a negative opinion. The clinical experience has been positively considered by the physician, considering the high contraceptive efficacy, even if 12% of women forgot to take the pill (Pearl Index 0.00) side effects profile and cycle control.

Grading colposcopic appearance: paired comparison between two methods for differentiating benign papillomaviral infection from high-grade dysplasia of the uterine cervix.

Histologic features of 134 cases of human papilloma virus (HPV) cervical infection and cervical intraepithelial neoplasia (CIN) were reviewed and correlated with colposcopic diagnosis on the basis of two different grading methods: International Nomenclature for Colposcopy showed 79.1% predictive accuracy and Reid's improved colposcopic index 86.6% of accurate predictions (significant difference at P less than 0.05). Overestimation difference was the most significant, with 23 overestimates in International Classification and 11 in Reid's score (P less than 0.01).

Use of intra-amniotic, intramuscular or intravaginal prostaglandins for mid-trimester termination of pregnancy.

PIP: 277 terminations of 2nd trimester pregnancies performed at the University Department of Obstetrics and Gynecology of Bari, Italy, during 1985-1990 with intraamniotic administration of hypertonic saline and 35 mg of PGF2alpha (Dinoprost) was the method used initially; more than 90% of cases (84 out of 91) were carried out before 1987. From the end f 1986, intramuscular Sulprostone was used at the dose of 500 mg every 3 hours, for a maximum of 3 injections in 87 cases. Vaginal administration of 1 mg Gemeprost suppository every 3 hours was introduced in 1988 and almost completely replaced the previous techniques (99 cases were reviewed). The mean age of patients was 26.3 years (range 15-47), and gestational age varied from 15 to 24 weeks. 169 (61%) were nulliparous, 97 (35%) had 1 to 3 children, and 11 patients had more than three. 139 (50.2%) were married. Regarding previous terminations of pregnancy, 235 patients (84.8%) had had none, 23 had had one, and 19 more than one. 128 (46.2%) patients came from low socioeconomic class, 105 (37.9%) were middle class, and 44 were high class. The statistical analysis ANOVA showed abortion induction interval of 24.02, 24,28, and 14.24 hours, respectively for the intraamniotic, the sulprostone, and the Gemeprost methods. The days of hospitalization were 9.57, 8.50, and 11.18, respectively. Psychological evaluation indicated that Gemeprost was preferred by the patients, while the intraamniotic method was perceived negatively. Side-effects were significantly milder, thus Gemeprost is considered the first choice for induction of mid-trimester abortion after evaluation of possible contraindications to prostaglandins. In those cases where severe stenosis of the cervical canal arises, laminaria pretreatment followed by either Gemeprost or Sulprostone is highly effective.^ieng

Multifocal extraovarian serous carcinoma. A histochemical and immunohistochemical study.

Three cases of multifocal extraovarian serous carcinoma are presented. This rare, interesting tumor is characterized by a peritoneal carcinosis with ascites and by a histological pattern similar to one of the ovarian serous carcinoma without primary involvement of the ovaries. The pathological criteria for a differential diagnosis between this condition and a localization of ovarian carcinoma are discussed. Histochemical studies show the presence of mucins and the absence of ialuronic acid in the neoplastic cells. The positivity to the low molecular weight cytokeratins is strong in the normal mesothelial cells, and weak in the hyperplastic and neoplastic cells. The meaning of these findings in the tumoral histogenesis is discussed.

Direct lymphadenography of the cervix: personal data.

The results obtained by an experimental clinical study about the lymphatic drainage of the uterine cervix by direct intraparenchymal injection of Lipiodol are reported. This study suggests a new approach to the evaluation of cervical carcinoma staging complementary to the peripheral lymphangiography.

Evaluation and comparison of hemocoagulation parameters both in serum and in ascites from patients with gynecologic malignancies.

The authors report the results obtained investigating PT - PTT - Fbg - Alcohol test - FDP - AT III in the serum and FDP in the ascitic fluid of 18 patients with ovarian cancer, 2 patients with pelvic relapse of cervical cancer and 10 patients with cirrhosis of the liver. It is pointed out the presence of FDP in the ascitic fluid in large amounts, so it not seems to be an ovarian cancer specific marker, but an aspecific marker of malignancy.

Epidemiological factors and prophylaxis of ovarian tumors.

PIP: 2 theories explaining the common epithelial ovarian carcinoma are: 1) regular ovulations without interruptions can make the epithelium susceptible to a malignancy, and 2) when a carcinogen is introduced into the vagina, it reaches the surface ovarian epithelium through the uterus and the open tubes within 25 minutes. Premalignancy consists of 2 basic concepts, the transformation and the following spread. Important risk factors are: 1) dietary habits, especially a high fat intake; 2) presence of selected families with a familial development of epithelial ovarian tumors; 3) the lesions which are at the limits of malignancy; and 4) the cellular dysplasia of the ovarian epithelium. There is also a good relationship between socioeconomic situations, nutritional state, and increased ovarian carcinoma occurrence. Occurrence is also higher in white women which can be related to a connection between habits of living involving the socioeconomic state and the rate of ovarian neoplasms. The most frequent factors among common ovarian epithelial carcinomas are thought to be early menopause (under age 45), delayed menarche (over age 14), and a lower number of pregnancies. Pregnancy, even if not carried to its full-term, must be considered a factor decreasing the risk of a malignant ovarian neoplasm. Among the most important environmental factors studied are estrogens and viral agents. Prophylactic factors are: 1) histological and surgical diagnosis of any solid of cystic adnexal tumefaction, 2) investigation and control of any cystic mass, 3) detection and control of all cystic adnexal masses increasing their size during the observation of the group of patients in fertile age, 4) detection and control of any unilateral cystic ovarian neoplasm with a diameter lower than 10 cm, 5) control of all palpable ovaries in postmenopausal women, 6) control of all patients with adenomatoid hyperplasia of the endometrium, 7) removal of roughly pathological ovaries in women under age 35 during pelvic surgery for malignant or benign disease, 8) possible hysterectomy and bilateral ovariosalpingotomy in women having 2 or more close relations affected by ovarian neoplasm, and 9) ovaries ablation in women 35 or older who undergo pelvic surgery for a benign or malignant disease.^ieng