Endometrial response in sequential cyclic therapy assessed with associated hysteroscopy and histology.

A morphologic study was performed on the endometrium in 37 asymptomatic postmenopausal women under effects of cyclically administered oestrogens. Eighty-seven postmenopausal women were taken as control group. Medroxyprogesterone acetate (MPA), 10 mg daily, was administered in association with two types of oestrogen replacement therapy: conjugated equine oestrogens 0.625 mg (CEE) or transdermal 17 beta-oestradiol 0.05 mg (E2-TTS). Endometrial biopsies were taken under hysteroscopic control before treatment and on days 8-12 of combined therapy at the 6th month. Follow-up at 12 and 18 months was only performed in 8 and 5 patients, respectively, with transdermal 17 beta-oestradiol treatment. Various types of endometrial response were identified from atrophy to hyperplasia and secretory patterns. No atypical hyperplasia was found. All cases of simple or complex hyperplasia showed a regression after increased MPA dosage treatment (20 mg). This work is aimed at investigating the endometrial response during sequential cyclic therapy by using morphologic criteria based on hysteroscopy and histology. A large number of patients with hyperplasia can be detected with target biopsy under hysteroscopy, thus playing an important role in the management of patients during replacement therapy in research protocols.

Uterine sarcomas: a clinicopathologic study.

A series of 48 cases with initial diagnosis of uterine sarcoma was reviewed to evaluate the validity of histologic criteria. The influence of pathologic and clinical prognostic factors and treatment modalities were examinated. The 32 patients included in this retrospective study after pathologic review had 5-year overall survival rate of 13.1%. Surgical pathological staging was demonstrated to be a significant prognostic factor, since patients with FIGO stage I-II disease had 33.5% actuarial survival rate whereas no patient with stage III-IV disease was alive at 37 months. Histological type, age and menopausal status did not significantly influence survival. Presence of heterologous elements and lymphovascular invasion were associated with a poor prognosis in the subgroup of patients with mixed mesodermal tumors. Median survival for patients receiving adjuvant treatment was 25 months compared to 19 months for those undergoing no adjuvant therapy.

High dose cisplatin after failure of polychemotherapy containing cisplatin in ovarian cancer. Preliminary results.

A substantial percentage of patients with advanced ovarian cancer will progress or relapse after platinum-based front therapies and will require salvage chemotherapy. In order to evaluate feasibility and effectiveness of high dose platinum (HD-CDDP) nine patients with ovarian cancer were treated with HD-CDDP while progressing after conventional doses of the same drug. Cisplatin 40 mg/M2 d. 1----5 q. 28 days, was administered with forced chloruresis for a total of fifteen cycles. Preliminary results show a promising 44.4% response rate with acceptable toxicity: only one patient had to discontinue treatment because of severe combined toxicity including infection, mucositis, shaking tremors, ototoxicity and palmar hyperkeratosis.

Cisplatin, methotrexate, and 5-fluorouracil combination chemotherapy for advanced ovarian cancer.

A combination chemotherapy including cisplatin, 25 mg/m2 on Days 1,8; methotrexate, 30 mg/m2 on Day 1; and 5-fluorouracil, 600 mg/m2 on Day 1 has been evaluated in 28 previously untreated and 10 pretreated patients with advanced ovarian cancer after debulking surgery when feasible. The pathological response rates (complete + partial responses) were 69.2 and 50% in untreated and pretreated patients, respectively. Overall 24-month survival and progression-free survival (PFS) are 19.2 and 10.9%, respectively. A significant difference in survival and PFS is evident between patients with less and more than 2 cm residual disease and between responders (CR + PR) versus nonresponders. No renal toxicity was induced and no cycles had to be delayed because of hemathologic toxicity.

Junctions on the maternal blood surface of the human placental syncytium.

Terminant chorionic villi of the human placenta at 8, 9, 12, 14 weeks' gestation and at full term have been studied in freeze-fracture replicas and in thin sections. In replicas, maculae occludentes of different size have been detected in all placental samples on the cleaved plasma membrane of the free (maternal) surface of the syncytiotrophoblast. In thin sections they are located in narrow invaginations of the syncytium luminal plasma membrane. These invaginations are in turn similar to flattened vesicles (also associated with junctions) located in the underlying syncytioplasm. Possible origin and function of the junctions on the syncytium free surface are discussed.

A three-dimensional study of the normal human placental villous core. I. The Hofbauer cells.

In order to study the three-dimensional ultrastructure of the Hofbauer cells, human placentae from the 6th to the 21st week of gestation and also from the end of pregnancy were cryofractured and observed by scanning electron microscopy. Hofbauer cells were found in the villous core at all the gestation stages examined. Their surface morphology was characterized by lamellipodia, funnel-like structures, blebs and microplicae. This pleomorphic aspect was probably related to functional or environmental conditions. In addition, thin cytoplasmic processes connected the Hofbauer cells with each other and with the components of the villous stroma. Fractured Hofbauer cells revealed large vacuoles in the cytoplasm; the vacuoles were smaller in size both at the beginning and at the end of pregnancy. This study further attests to the macrophagic nature of these cells.

[Biological and clinical aspects of legal abortion]. / Aspetti biologici e clinici dell'aborto legalizzato

PIP: The timing of the beginning of individual life in the embryo is discussed. It is noted that modern techniques make possible to detect vital signs at a very early stage, although a certain time elapses before the embryo assumes a clearly human form. However, a decision on the legitimacy of abortion should be based primarily on the consequences of pregnancy and childbirth for the mother, considering not only the imminent risk of death, now very rare, but her general physical and mental health and social adjustment. Abortion can be justified in case of genetic anomalies of the fetus which would seriously and permanently impair the life of the child. The available methods of induced abortion appropriate to the various stages of pregnancy, the precautions to be taken in each case, and the possible complications and risks are described and discussed.^ieng

[Colpocytological patterns caused by hormonal contraceptives]. / Quadri colpocitologici determinati da contraccettivi ormonali

PIP: The effects of estrogen-progestin combinations on vaginal cytology were studied using colpocytological smears from 598 women aged 18-45 years who had used oral contraception for from 3 months to 6 years. In general, combined preparations resulted in decreased estrogen levels, fewer superficial cells, and a prevalence of intermediate cells; inflammation and mycosis were much more common. Changes produced by minipills were of the same type but were less pronounced. With sequential preparations, the maturation of vaginal epithelium is not blocked, and mycosis is not so frequent. In 8% of cases, serious morphological abnormalities characterized by dyskarayosis were observed, and dysplasia was seen in 15%. Cytological checkups are recommended every 6 months because of these anomalies.^ieng

[Hormonal contraception with associated estrogenoprogestational agents]. / La contraccezione ormonale con estroprogestinici associati

PIP: Estrogen-progestogen combination drugs are the most effective contraceptives, and constitute the best method for most healthy women. There are, however, contraindica and side effects, although some of the latter are without clinical significance. The effects of these drugs are summarized, the risks involved are discussed, and are classified. The symptoms that may indicate an excess or deficiency of estrogen or progestogen. The selection of the proper drug for each individual case is discussed, but it is pointed out that only the reuslts of the 1st few cycles of treatment can show whether the initial decision was correct or a change is required. If the treatment proceeds normally and test results remain normal, it is still advisable to interrupt the treatment for 2 or 3 months after 2 years. The need for medical supervision of the treatment is emphasized.^ieng