Use of a preventive sling surgery for the simultaneous correction of latent stress urinary incontinence during the cystocele repair: two year follow-up.

AIM: The aim of this paper was to assess the feasibility and utility of adding a preventive trans obturatory tape (TOT) during the same intervention for anterior prolapse repair, in patients with masked urinary incontinence and massive cystocele. METHODS: A retrospective trial was conducted in a Tertiary care University Hospital. Ninety-nine women with a massive cystocele (Ba ≥2 cm of pelvic organ prolapse quantification) and an occult stress urinary incontinence were recruited from 2004 to 2010: 53 women were subjected to an anterior fascial reconstruction alone while 46 underwent the same intervention with the addition of TOT. Patients were also asked to rate their overall quality of life, using the International Consultation on Incontinence Modular Questionnaire-Lower Urinary Tract Symptoms Quality Of Life (ICIQ-LUTSqol). All patients were assessed at one, six, twelve and twenty-four months of follow-up. Statistical analysis was performed with SPSS 15.0 software; SPSS inc., Chicago IL, USA was performed using the Chi-square test with Fisher's post-hoc correction. RESULTS: At 24 month follow-up the rate of appearance of stress urinary incontinence at the urogynecological examination, was higher in the group without TOT (81% vs. 19%, P=0.004). In terms of overall quality of life, significantly higher rates of satisfaction have been reported by the group treated with additional TOT (P=0.006). CONCLUSION: The addition of TOT during the anterior prolapse correction seems to give a greater durability to the correction, resulting, in the long term, in a lower rate of urinary symptoms onset (first latency) and in a better quality of life compared to the traditional anterior colporrhaphy alone.

Monitoring bone effect of transdermal hormone replacement therapy by ultrasound investigation at the phalanx: a four-year follow-up study.

OBJECTIVE: A controlled 4-year follow-up study was conducted on a population composed of 112 healthy early postmenopausal women to evaluate the ability of ultrasound technology in detecting the effects of hormone replacement therapy (HRT) on bone. At the end of the study, 47 untreated and 25 treated women had been evaluated. Cyclic sequential estrogen/progestogen therapy, 50 microg/day of transdermal 17beta-estradiol (Rotta Research Laboratorium) plus 5 mg/day of medrogestone (Wyeth-Ayerst) was used. DESIGN: Ultrasound transmission through the distal metaphysis of hand phalanxes was measured by DBM Sonic. Beside amplitude-dependent speed of sound (AD-SoS), three new parameters could be calculated: pure speed of sound (pSOS), bone transmission time (BTT), and ultrasound bone profile index (UBPI). Ultrasound measurements were taken at baseline and after 1, 2, and 4 years. RESULTS: Among untreated women a significant decrease of all ultrasound parameters was observed at follow-up measurements. In the HRT-treated group we observed a significant increase of AD-SoS, pSoS, and BTT. We qualified as "responders" women in the treated group for whom AD-SoS, pSoS, and BTT increased by more than 2.77 times the coefficient of variation of the measurement, i.e., 95% variability. Women in the treated group were identified as responders at 4 years of follow-up by AD-SoS (56%), pSOS (56%), and BTT (60%). Ultrasound bone profile index declined in both groups, although to a lower extent among HRT-treated subjects. CONCLUSIONS: The 4-year data confirm the results obtained at 1 and 2 years of follow-up. This study demonstrates that bone tissue investigation by ultrasound at the phalanx can be used to monitor the effect of HRT, and thus it should be considered a potential technology for the management of menopause by gynecologists.

[Postmenopausal osteoporosis in the Emilia-Romagna region. Extent of the problem]. / L'osteoporosi postmenopausale nella regione Emilia-Romagna. Dimensioni del problema.

BACKGROUND: The purposes of this paper are to summarise the epidemiological data concerning the frequency of postmenopausal osteoporosis and its related fractures in Emilia-Romagna, a province of northern Italy, and to determine the future impact of this disease. METHODS: To evaluate how many people suffer from postmenopausal osteoporosis it was decided to calculate the number of hospital admissions due to this disease or to its related fractures in postmenopausal women--included and excluded according to the ICD9-CM codes relative to the hospital discharges--during the years 1994 and 1995. RESULTS: The results show that incidence rates of these hospital admissions increase with age, as well as the number of osteoporotic fractures. Hip fractures, which represent a major problem due to their costs and consequences, are the more frequent osteoporotic fractures which need hospital admission, while it is possible that a large part of other fractures (which do not need hospitalisation or have been treated in private structures) has not been calculated. CONCLUSIONS: When projected to the population of women living in Emilia-Romagna in the future decade, also keeping the age-specific fracture rates constant, these data suggest that the occurrence of postmenopausal osteoporosis and of osteoporotic fractures will increase, with a dramatic escalation of economic and human costs. Finally, direct costs related to postmenopausal osteoporosis have been calculated for the decade 1995-2004.

Bone effects of transdermal hormone replacement therapy in postmenopausal women as evaluated by means of ultrasound: an open one-year prospective study.

OBJECTIVES: To evaluate the effectiveness of transdermal oestrogen replacement therapy plus medrogestone (HRT) in postmenopausal bone loss prevention by means of US. METHODS: We enrolled 112 healthy postmenopausal women in an open, prospective study. These women, after a gynaecological evaluation and an US assessment of the skeletal status, were advised to take cyclic sequential oestrogen/progestagen therapy: 50 microg/day of transdermal 17beta-oestradiol (Rotta Research Laboratorium) plus 5 mg/day of medrogestone, for 12 days per cycle (Wyeth-Ayerst). After 1 year we recalled these women: only 32 of them were taking HRT, while 49 had declined HRT without taking alternative therapies. The remaining women were excluded from the study as they were either unavailable for the check-up or they were taking prohibited therapies. We used DBM Sonic 1200 (Igea, Italy) to assess US parameter changes at phalanxes at enrollment and after 1 year. This device enabled us to evaluate US transmission velocity (AD-SoS) and US attenuation pattern (UBPS). In a previous study we had evaluated the intra- and inter-observer reproducibility of AD-SoS measurements (0.4 and 1.0% respectively). Using the same data we evaluated the intra- and inter-observer precision of UBPS. RESULTS: The UBPS intra-operator reproducibilities were 5.3% and 6.1% (for the 1st and the 2nd operator, respectively), while inter-observer precision was 8.8%. Both AD-SoS and UBPS significantly decreased in the non-user group(-0.7%, P < 0.001 and -14.3%, P < 0.001 respectively). In the user group AD-SoS showed a significant increase (+0.7%, P < 0.01), while a slight but significant decrease was observed for UBPS (-2.8%, P < 0.05). CONCLUSIONS: Our findings show that the effectiveness of transdermal HRT in slowing or even arresting postmenopausal bone loss can be monitored by quantitative US studies. The trend difference observed between AD-SoS and UBPS with and without therapy is at least partially explained by a different response to HRT with regard to bone density as well as structure.

Effects of cyclic therapy with intranasal carbocalcitonin in healthy spontaneous postmenopausal women.

Carbocalcitonin spray administered for 12 months at a daily dosage of 80 U MRC according to five schedules has been tested on 150 normal spontaneous postmenopausal women for its influence on bone mineral density (BMD), bone metabolism and osteoarticular pain. BMD was monitored before and at the end of treatment in comparison with BMD of untreated control women. Metabolic markers (serum alkaline phosphatase, serum osteocalcin and urinary hydroxyproline) were also evaluated before and during treatment (at the 9th or 10th month of treatment). Osteoarticular pain was assessed by an analogic visual scale. Intranasal carbocalcitonin, administered according to cyclic schedules at a high frequency dosage, was able to maintain bone mass only in the earlier postmenopausal women. BMD percent increase after 12 months of treatment was 1.10 and 1.31 in women with low (< 0.870 mg/cm2) and high baseline BMD (> or = 0.870 mg/cm2), respectively. In advanced menopause the maintaining effect of carbocalcitonin on BMD seemed evident only if the baseline bone mass was lower than the BMD of the age matched control group. At least six months of treatment/year is necessary for effective therapy. Both systemic and local tolerance were optimal. No significant side-effects were detected.

Premenopause-dependent changes.

The authors retrospectively evaluated 1,773 climacteric outpatients in order to establish: (a) criteria able to distinguish different conditions in the transitional phase before menopause (advanced fertile age and premenopause) and (b) premenopause-related changes during the transition from one to the other of several clinical and laboratory parameters. Results showed an increase in gonadotropin plasma levels, a decrease in estrogen plasma levels and a greater frequency of women complaining of hot flushes in premenopause compared to advanced fertile age, as an expression of the progressive decline of ovarian function. Premenopause-related changes were a decrease in thyroid function and an increase in the body mass index, the beginning of bone loss, an increase in glucose, total cholesterol and triglyceride serum levels and a greater frequency of women complaining of hypertension and urinary stress incontinence. An increase in total proteins, uric acid and aminotransferase serum levels was also noted.

Ultrasound velocity changes at the proximal phalanxes of the hand in pre-, peri- and postmenopausal women.

We evaluated the bone tissue modifications which occur in pre-, peri- and postmenopausal women by means of an ultrasound (US) device which measures US propagation velocity in the distal metaphysis of the proximal phalanxes of the hand. Before starting the study, two operators assessed the in vivo short-term precision of the device in 12 volunteers, each measured 10 times (5 times by each operator). Then the US velocity in the dominant (DO) and non-dominant (ND) hand was measured in 228 women to evaluate whether there was a difference between US values measured at these sites. Finally, another selected group of 417 healthy pre-, peri- and postmenopausal women, aged from 40 to 65 years, was studied to evaluate the physiological climacteric changes in the US parameter measured: amplitude-dependent speed of sound (AD-SoS). In the 12 volunteers, intra- and inter-observer short-term precision (CV) was 0.4% (for both the operators) and 1.0%, respectively. DO and ND hand AD-SoS values (2074.1 +/- 63.8 m/s and 2077.1 +/- 65.5 m/s, respectively) proved to be highly correlated (r = 0.96, p < 0.0001) in the 228 women studied. AD-SoS distribution (417 subjects) was correlated with age, climacteric condition (premenopause with regular or irregular cycles and natural postmenopause) and body mass index (BMI). In premenopause (253 subjects) the US velocity was higher among women with regular cycles (2107.2 +/- 48.5 m/s) than among those with irregular cycles (2074.7 +/- 44.1 m/s) (p < 0.0001). In postmenopause (164 subjects) an inverse correlation between AD-SoS and the time elapsed since menopause was found (r = -0.42, p < 0.0001). Furthermore, age and BMI were shown to be inversely related to AD-SoS (r = -0.47, p < 0.0001 and r = -0.30, p < 0.0001, respectively) when evaluated in the whole study group. The results obtained confirm that US transmission at the phalanxes is sensitive to pre-, peri- and postmenopausal bone changes. Further studies are needed to evaluate its ability to predict osteoporotic fracture risk.

Climacteric symptoms and control of the cycle in women aged 35 years or older taking an oral contraceptive with 0.150 mg desogestrel and 0.020 mg ethinylestradiol.

In a multicenter prospective trial, 58 healthy women aged between 35 and 49 years were studied for one year (639 cycles) while taking an oral contraceptive (OC) containing desogestrel 0.150 mg and ethinylestradiol (EE) 0.020 mg. Efficacy, control of the cycle, side effects, complaints, and climacteric symptoms were monitored after 3, 6, 9 and 12 cycles. No pregnancies occurred during the study period. Spotting gradually decreased from 29.3% in cycle 1 to 4.2% in cycle 12, while breakthrough bleeding (BTB) disappeared after cycle 7. One case of superficial thrombophlebitis and 3 cases of minor side effects were registered. With regard to the complaints, breast tenderness, headache, and depression gradually decreased during the study (basal vs. 12-month data: 50.9% vs. 31.2%, 48.3% vs. 18.7%, 39.6% vs. 20.8%, respectively), while nausea disappeared after three months. A significant treatment-dependent reduction of climacteric symptoms was obtained after cycle 3 and this tendency was maintained up to cycle 12. No changes were registered in body mass index (BMI) or blood pressure.

Effects of an oral contraceptive combination containing 0.150 mg desogestrel plus 0.020 mg ethinyl estradiol on healthy premenopausal women.

Twenty-six healthy premenopausal outpatients from the Menopause Clinic of the University of Bologna were treated with a combination pill containing 0.020 mg of ethinyl estradiol and 0.150 mg of desogestrel for one year. Throughout the treatment period, clinical and laboratory monitoring was periodically performed, and women were asked about the occurrence of climacteric symptoms. This formulation relieved climacteric symptoms, and did not adversely affect lipids and clotting factors, except for a slight increase in serum triglycerides. Laboratory data also suggest a beneficial effect on bone metabolism.

[Italian multicenter study for the verification of the efficacy and tolerability of short-term substitution hormone therapy using conjugated estrogens and progestagens administered orally in the postmenopausal a period]. / Studio multicentrico italiano di verifica in merito all'efficacia ed alla tollerabilità della terapia ormonale sostitutiva a breve termine con estrogeni coniugati e progestinici per via orale nella postmenopausa.

Three hundred and sixty-three postmenopausal women received 6 months of cyclic hormone replacement therapy with conjugated estrogens in differing doses (0.625 mg and 1.25 mg) associated in a sequential pattern lasting 12 days with progestagens (medroxyprogesterone acetate or medrogestone) in 16 italian health centres. The results of the multicentre study confirm the efficacy of this conjugated estrogen-progestogen regimen in resolving climacteric syndrome, offering cardiovascular protection and vaginal trophic effect and preventing postmenopausal osteoporosis, as well as confirming its tolerability in relation to blood pressure, body weight, breast, endometrium, blood coagulation and hepato-renal function.

Analysis of the climacteric syndrome.

The climacteric syndrome (CS) was investigated in a large sample of women (over 4000) who spontaneously attended the Menopause Clinic at the University of Bologna between 1976 and 1986. The participants selected had received no hormonal replacement therapy for at least 6 mth or any other drug for at least 3 mth previously. They were all free from any disease that could influence any of the CS symptoms. The frequency of 12 symptoms considered typical of the CS was investigated. The interrelationships between these symptoms were determined as well as the frequency of the occurrence of individual symptoms in association with various climacteric complaints. The results indicated (a) that the CS is not uniform but both variable and individual, (b) that the frequency of its constituent symptoms remains high in advanced fertile age and the advanced postmenopause, (c) that the symptoms are preferentially interlinked, (d) that many, but not all, symptoms exhibit a differentiated pattern during the course of the natural and surgical menopause/age progression, and (e) that hot flushes and sweating, and to some extent insomnia and headache, are menopause-dependent.

Body mass index distribution in climacteric women.

Body Mass Index (BMI) was calculated in 2481 climacteric women selected from among the outpatients attending the Menopause Clinic at Bologna University in absence of hormonal replacement therapy and diseases that could cause weight gain. Analysis of variance of the W/H2 (weight/height squared) distribution in different age and climacteric situations demonstrates that the pre-menopause is a weight-gain inducing state and that ageing seems to cause a progressive increase in W/H2.

Non-invasive 24-hr monitoring of high blood pressure in climacteric outpatients.

Blood pressure (BP) monitoring was carried out over a period of 24 hr in 28 hypertensive women selected among the outpatients attending the Menopause Clinic at Bologna University. Seven (7) of the women (mean age 50 +/- 1 yr) were in the pre-menopause, 7 had undergone a natural menopause at 6 to 36 mth previously (mean age 52 +/- 4 yr) and a further 7 had had a natural menopause 37-120 months previously (mean age 56 +/- 5 yr). The control group was made up of 7 women in late fertile age (mean age 47 +/- 1 yr). It was found that: high blood pressure was not confirmed in all patients; there was a significant increase in systolic and diastolic BP values in natural post-menopause subjects (P less than 0.01) temporarily related to ovarian failure, but BP reached a steady state in elderly women when a new hormonal balance is established; 24-hr monitoring made it possible to identify a group of climacteric outpatients at higher cardiovascular risk whose suitability for antihypertensive treatment could thus be assessed.

Use of Org OD 14 for the treatment of climacteric complaints.

The effects of treating climacteric complaints in post-menopausal women were studied in an open trial in which Org OD 14, a placebo and no treatment were compared. In addition to the symptomatic effects, clinical and laboratory parameters were also studied. One hundred and twenty-four women who had undergone a natural or surgical menopause completed 4 mth of randomized treatment; 35 received Org OD 14 (2.5 mg/day, per os), 46 a placebo, and 43 no treatment. The mean ages and time in years since menopause were comparable for each group. The parameters were assessed before treatment and after 4 mth. The results in the group treated with Org OD 14 were compared statistically with those for the other two groups using the chi 2 test, Student's t test or analysis of variance. A beneficial effect on clinical parameters was seen following Org OD 14 treatment. The results as regards hot flushes and sweating were significantly better statistically than those in the other groups. Org OD 14 was found to have no effect on the endometrium, breasts, body weight or blood pressure, while vaginal atrophy was slightly improved. Serum levels of total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides and phosphate were slightly reduced by Org OD 14. Liver function tests, clotting factors and the other routine laboratory parameters were not affected by Org OD 14 treatment. It was concluded that Org OD 14 is an effective and safe compound for the treatment of climacteric syndrome.

High blood pressure and 'ischaemic' ECG patterns in climacteric women.

A study to evaluate the prevalence of high blood pressure (HBP) and resting 'ischaemic' electrocardiogram (ECG) patterns in the climacteric was carried out in 494 outpatients aged up to 65 yr. The study group was made up of 91 pre-menopausal women, 235 natural post-menopausal women, 91 surgical post-menopausal women and 77 women of advanced reproductive age, who comprised the control group. High systolic and/or diastolic blood pressure values were seen in 26.6% of the overall climacteric group (C), i.e. in 23.1% of the pre-menopausal women (PM); 28.9% of the natural post-menopausal women (NMt); and 24.2% of the surgical post-menopausal women (SMt), these frequencies being statistically significant compared to that in the control group (K) (6.5%). 'Ischaemic' ECG patterns (according to the Minnesota Code definition) were observed in 20.3% of the C group, in 22.0% of the PM group and in 27.5% of the SMt group, these rates being statistically significant compared to that in the control group (9.1%). Minnesota Code 4:1 and 5: 1-2 patterns were present in 5.7%, and 4:2 and 5:3 patterns in 14.6% of the C group. A significant correlation was found between HBP (systolic and diastolic) and 'ischaemic' ECG patterns.

Physiopathological aspects of body overweight in the female climacteric.

The correlation between overweight and the climacteric was studied in 550 menopause clinic patients by investigating certain clinical and sociocultural parameters (age, marital status, educational level, occupation and type of work, calorie intake, smoking habits, parity, blood pressure, previous hormonal therapy and climacteric symptoms), evaluating plasma levels of various hormones (17 beta-oestradiol, follicle-stimulating hormone (FSH), luteinizing (LH), testosterone, hydrocortisone, adrenocorticotrophic hormone (ACTH), triiodothyronine (T3), thyroxine (T4), growth hormone (GH) and insulin), glucose and various lipid fractions (total lipids, total cholesterol, nonesterified fatty acids (NEFA), triglycerides and phospholipids) and exploring the blood-clotting pattern ( Owren 's test, euglobulin lysis time, antithrombin III and prothrombin agglutination time (PAT). The subjects were classified as normal weight or overweight by reference to Broca's Index, as modified by Brusch , and the degree of overweight was determined by means of the Body Mass Index (BMI). Of the subjects examined, 49% were overweight and, in successive years following the menopause, there was a growing bipolarization of the weight increase. The correlation between overweight in the climacteric and the parameters considered was found to be significant only in regard to calorie intake, age and educational level. Post-menopausal gonadotrophin levels in blood were significantly lower in the overweight than in the normal-weight women. With the onset of menopause, the plasma level of testosterone fell in the normal-weight women, while it increased, along with that of hydrocortisone, in the overweight women. In the normal-weight women at menopause, it was found that there was a tendency towards a substantial increase in lipid fractions and glycaemia, as well as a state of hypercoagulability. In the overweight women, the tendency was towards an even more marked increase in both glycaemia and the various lipid fractions, and, besides the hypercoagulative state, there was an associated reduction in fibrinolytic activity. It is concluded that the menopause not only causes metabolic changes but also aggravates the metabolic and endocrine tendencies which characterize overweight subjects and thus, clinically, constitutes an obesity risk factor in those women who already demonstrate a tendency towards overweight in the pre-menopausal phase.

A study of thyroid function in the pre- and post-menopause.

Serum levels of thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), free triidotthyronine (FT3), free thyroxine (FT4) and thyroxine-binding globulin (TBG) were measured in 382 healthy women who were attending a menopause clinic. Of these women, 140 were in the pre-menopausal phase, 162 had been post-menopausal for less than 3 yr and 60 had been post-menopausal for greater than 3 yr. Analysis of the results as a function of climacteric situation, revealed that the only significant difference was a lower serum concentration of FT3 in the women who had been post-menopausal for over 3 yr than in the women who were in the pre-menopausal phase. Statistical analysis of the results as a function of both climacteric situation and age showed that the serum level of TBG increases with age, while serum levels of circulating thyroid hormones decrease, and that although the menopause does not bring about marked changes in thyroid function, it nevertheless tends to reduce that function, especially when menopause occurs at the expected time. Finally, by correlating values with T4 values on an individual basis, it was possible to ascertain that when physiological changes in thyroid function do occur in the climacteric, they are not caused by primary changes in TSH secretion.

The clinical use of arginine aspartate in male infertility.

130 male subjects (61 with asthenospermia, 69 with oligoasthenospermia) classified according to spermiologic patterns have been treated with different therapeutic outlines (gonadotrophins, antibiotica, arginine aspartate high levels, their associations); 89 subjects have been undergone with arginine aspartate, 41 without arginine aspartate. The results have been critically examined in order to different therapeutic outlines, to spermiogram, to diagnosis, to use of arginine aspartate in different spermiologic alterations, to use of arginine aspartate with respect to control groups, to arginine aspartate levels.

[Establishment, characteristics and experience of an abortion clinic]. / Istituzione, caratteristiche ed esperienza di un servizio per l'interruzione volontaria di gravidanza.

PIP: Abortion became legal in Italy in May 1978; since then the abortion services at the Institute of Obstetrics and Gynecology of the University of Bologna, Italy were able to comply with over 90% of requests for abortion; waiting time between the presentation of the request and the intervention is usually 7 days. Abortion seekers are treated on an outpatient basis; only 1.7% of patients require hospitalization. Only 6 interventions a day are done by the same doctor, who performs abortions 20 days/month. The choice of anesthesia is left to the patient, and abortion is done by vacuum aspiration. The patients are checked prior to discharge, and contraception is discussed and the patient is invited to come back after 1 month. Between June 1978 and September 1979 there were 1852 interruptions of pregnancy. 52.7% of women receive their certificate for abortion at one of the public family health centers, and only 33.4% by a private doctor. The majority of interventions takes place before the 11th week of pregnancy; 33.6% first pregnancies, and only a very limited number of requests are for medical reasons. Most women are in the age group 21-30, 40% are unmarried, most belong to the low middle class, 17.3% are students, and most come from Bologna. 41.6% of women have no children, 27.4% have 1 child, 22.3% have 2 children, and only 8.7% have more than 2 children. Clearly, at least from this study, the choice of abortion is a very conscious one, and it shows that women choose to become mothers only when they so desire.^ieng