Peripheral parenteral nutrition in protracted hyperemesis gravidarum--report of two cases and a literature review.

Hyperemesis gravidarum is defined as severe nausea and vomiting during the first trimester of pregnancy. It is characterized by dehydration, electrolyte imbalance, ketonuria and weight loss of more than 5% of body weight and it usually requires hospitalization. Traditionally, total parenteral nutrition has been used when patients with hyperemesis gravidarum fail to respond to conservative measures, including dietary manipulation and antiemetics. Total parenteral nutrition has been shown to be an effective method of nutritional support during pregnancy but it is expensive and has potentially serious complications. Peripheral parenteral nutrition reduces the risk of complications, but caloric intake is limited. A small number of investigators have suggested using enteral nutrition as an alternative to total parenteral nutrition. Herein we report two cases of hyperemesis gravidarum successfully treated with an effective regimen of peripheral parenteral nutrition.

Reproductive outcome in patients treated by oral methotrexate or laparoscopic salpingotomy for the management of tubal ectopic pregnancy.

OBJECTIVE: To determine the reproductive outcome of women who have received methotrexate or been treated by laparoscopic salpingotomy (LS) for ectopic tubal pregnancy. STUDY DESIGN: The study consisted of 123 participants, all women with tubal pregnancies, who had been treated either by methotrexate per os or by laparoscopic salpingotomy. The reproductive outcome of these women was estimated after a follow-up time-period of ten years. RESULTS: In the methotrexate group, consisting of 34 women, the fertility rate was 82% with a mean interval time to conceive of 9.4 months after the treatment. In the group treated by LS, consisting of 89 women, the fertility rate was 82.6% and the mean interval time to conceive was 11.7 months. CONCLUSION: The reproductive outcome of the women who received either per os treatment of methotrexate or LS for tubal pregnancy, remains high. Both therapeutic methods constitute reliable solutions for managing ectopic pregnancy.

Serum leptin and erythropoietin during menstruation.

OBJECTIVE: The potential influence of leptin and erythropoietin on the angiogenesis and bleeding of the endometrium during normal menstrual cycles and possible correlations between them. STUDY DESIGN: Serum concentrations of leptin and erythopoietin were measured at menstrual days 20, 1 and 3 or 4 in healthy, non-obese, normal menstruating women. RESULTS: Mean leptin and erythropoietin concentrations showed no significant alteration over time (F = 0.588, p = 0.563 and F = 0.654, p = 0.528, respectively). There was, however, a strong negative linear relationship between the concentration of the two substances on days 1 and 3 or 4 (p = 0.018 and p = 0.028, respectively). CONCLUSIONS: If the two substances affect endometrial angiogenesis, they may do this in a locally limited way, so that peripheral concentration changes cannot be observed. Their inverse correlation prompts further study with receptor determination.

Ectopic missed abortion after laparoscopic sterilization with the harmonic scalpel.

A case of a patient who presented with ectopic pregnancy and subsequent missed abortion one year after laparoscopic sterilization with the harmonic scalpel is reported. According to our knowledge of the relevant literature, this is the first time that a case of ectopic pregnancy after sterilization with a harmonic scalpel has been reported.

Recombinant human erythropoietin in mildly anemic women before total hysterectomy.

UNLABELLED: The purpose of this study was to investigate the efficacy of preoperative recombinant human erythropoietin (rHuEPO) treatment in a group of mildly anemic women. METHODS: This randomized controlled study included 50 healthy, mildly anemic women who underwent total hysterectomy for leiomyomas. The study group (Group A) included 23 women who received rHuEPO 600 U/kg once weekly for three weeks, plus iron supplementation. The control group (Group B) included 27 women who received only iron supplementation. Blood samples were obtained on days -14, -7, 0, +3, +7 and +14. RESULTS: An increase in preoperative mean hemoglobin concentration was noted in both groups; however, the increase was significantly higher in Group A throughout the study period. Mean reticulocyte count was also significantly higher in this group, whereas mean ferritin level was significantly lower. No postoperative transfusion was needed in Group A, whereas five women were transfused in Group B. CONCLUSION: Rapid and persistent improvement of hematologic parameters makes the use of rHuEPO for preoperative treatment of mildly anemic women with benign uterine pathology a very interesting approach.

Unicornuate uterus and uterus didelphys indications and techniques for surgical reconstruction: a review.

Unicornuate uterus and uterus didelphys consist of miscellaneous congenital malformations of the female genital system. These anomalies can cause many gynecological and obstetrical complications including infertility, ectopic pregnancy, recurrent abortions and preterm deliveries. Laparoscopy and hysteroscopy are two helpful operative procedures in establishing an accurate diagnosis and treating effectively. A case of a patient with unicornuate uterus and longitudinal vaginal septum, who presented at our hospital suffering from infertility, is reported.

Recurrent bacterial vaginosis in a virgin adolescent: a new method of treatment.

Bacterial vaginosis (BV) is a polymicrobial infection of the vagina and should not be considered an exclusively sexually transmitted disease. We describe the case of a 17-year-old female virgin adolescent with recurrent malodorous vaginal discharge for 6 months. Before referral to us she had been treated unsuccessfully with conservative treatment options. Our investigation revealed Gardnerella vaginalis as the responsible factor for the vaginal infection. Because metronidazole treatment had failed as monotherapy, a new method was applied. Repeated vaginal washings with 3% H(2)O(2), 15% NaCl and 10% providone iodine were initiated. At the end of each washing, vaginal walls were thoroughly cleaned up with a small gauze. After 10 days of treatment the odor and the vaginal discharge had ceased and 12 months later no relapse had occurred. It seems to be reasonable to use this kind of treatment in recurrent BV.

Early pregnancy termination with vaginal misoprostol before and after 42 days gestation.

BACKGROUND: Misoprostol is a prostaglandin E(1) analogue that has been used for medical abortion. We conducted this prospective study to compare the efficacy of vaginal misoprostol for abortion in women at a gestational age of <42 days and in women at a gestational age of 42-56 days. METHODS: A total of 160 women seeking medical termination of a pregnancy of <56 days were enrolled in the study. Medical termination was performed using 800 micro g of vaginal misoprostol, repeated every 24 h for a maximum of three doses. RESULTS: The overall complete abortion rate was 91.3%. In group A (gestation <42 days) complete abortion occurred in 96.3% of women, whereas in group B (gestation = 42-56 days) complete abortion occurred in 86.3% of women (P < 0.025). The two groups did not differ significantly with respect to side-effects (incidence of pain, bleeding, nausea, diarrhoea, fever and headache). Women who had aborted successfully were significantly more satisfied with the method compared with women who did not (P < 0.001). CONCLUSIONS: The vaginal misoprostol-alone regimen is highly effective for women seeking medical abortion of pregnancies of

Bacteriological cultures of removed intrauterine devices and pelvic inflammatory disease.

Intrauterine devices (IUDs) are highly effective, long-term methods of contraception. Although evidence of a direct association between IUD use and pelvic inflammatory disease (PID) is scarce, concerns about PID related to IUDs use has limited their use throughout the world. We designed this study to examine the effect of IUDs on PID. For the study, we recruited 200 participants from among women who requested an IUD as a means of contraception. The IUDs were removed 36 months later or in case of PID. No PID cases were recorded during the follow-up period. Prior to IUD insertion, 121 women (60.5%) had symptoms and/or signs of lower genital tract infection, whereas during the follow-up period 179 women (89.5%) had symptoms and/or signs of lower genital tract infection. The Papanicolaou smears were negative for Actinomyces throughout the study period. Also, cultures for sexualy transmitted disease microorganisms were negative throughout the study period. Following IUD removal, 189 IUD cultures (94.5%) were positive. The bacterial flora of the removed IUDs consisted of common aerobic and anaerobic microorganisms that do not account for PID. The most common microorganisms identified were Staphylococcus coagulase negative, Eschericia coli, and Enterococcus faecalis. IUDs are a very effective and safe method of contraception if potential recipients are selected carefully. Culture of the removed IUDs and therapeutic management of women with positive cultures are not recommended when women are asymptomatic for PID.

Polycystic ovarian syndrome and thrombophilia.

BACKGROUND: Polycystic ovarian syndrome (PCOS) is associated with insulin-induced plasminogen activator inhibitor-1 (PAI-1) elevations. Since thrombophilic states correlate with high miscariage rates, as does PCOS, this study aimed at looking for thrombophilic predisposition in PCOS women compared with non-PCOS controls. METHODS: The prevalence of antithrombin III, protein S and protein C deficiencies, as well as factor V Leiden, prothrombin G20210A factor and methylene tetrahydrofolate reductase (MTHFR) mutations, was compared between two different groups of women, one with PCOS (n = 30) and one without PCOS (n = 45). RESULTS: Median proportions of activated protein C, S and antithrombin III as well as the activated protein C ratios were within normal ranges in both samples. There was no evidence that the genetic analysis for factor V Leiden or prothrombin factor differed between the two samples. The odds ratio (OR) of bearing a mutation on the MTHFR gene was 1.2-fold higher [95% confidence interval (CI) 0.470-3.065] in women with PCOS than in women without (P = 0.83). Although this difference is not statistically significant, it might indicate a slightly higher prevalence of heterozygous genotypes in women with PCOS (OR = 1.197, 95% CI 0.473-3.034). CONCLUSIONS: Molecular risk factors of hereditary thrombophilia do not show increased prevalence in women with PCOS in comparison with women in the general population. The existence of a possible trend towards higher prevalence of MTHFR mutation in women with PCOS needs further study, particularly regarding homocysteine levels.

Effective treatment of beta-thalassemia intermedia during pregnancy with rHuEpo. A case report.

The anemia of pregnancy in presence of beta-thalassemia intermedia usually aggravates pregnancy procedure. In the present study we investigated whether the administration of recombinant human erythropoietin (rHuEpo) recombinant human erythropoietin in combination with iron and folic acid may ameliorate blood indices as an alternative choice to blood transfusion.

Hepatocyte-like cells in the pancreatic islets: study of the human foetal pancreas and experimental models.

OBJECTIVE: To determine the existence of hepatocyte-like cells in the human foetal pancreas. STUDY DESIGN: Foetal pancreas was examined in parallel with two experimental models involving pancreatic tissue regeneration. Foetal pancreases (n = 20; 10 to 18 weeks) were obtained from spontaneous abortions and were histologically examined using haematoxylin-eosin and PAS staining. Tissues from food-deprived and copper-deficient female Wistar rats were studied following D-penicillamine administration, and tissue from female hamsters was evaluated following administration of a pancreatic carcinogen. Histological examination in animal studies included haematoxylin-eosin staining, and diaminobenzidine histochemistry. RESULTS: The presence of a characteristic cell-type whose morphology was distinct from islets cells and exocrine pancreas cells was observed in human foetal pancreatic islets. These cells were morphologically similar to hepatocyte-like cells and were compatible to those observed in the experimental models. Topographical relationships suggest that these originate from stem cells which are related to the pancreas duct cells. CONCLUSION: We conclude that hepatocyte-like cells or precursors exist in the human foetal pancreas.

[Fertility and pregnancy after conization]. / Fertilità e gravidanza dopo conizzazione.

Conization is frequently used as a diagnostic and curative method for the prevention of the cervical cancer on women of the fertile age. Conization was performed on 408 women up to 40 years in our Clinics during the years 1967 to 1989. The percentage of attested postoperative pregnancies among these women amounts to 13.51% and declines with age; it is high among women up to 25 years of age (29%) and low (3%) among women between 36 and 40 years. The percentage with premature births before the operation was 15.25%; after the operation the percentage declined to 13.31%. Preventive cerclage was used on one part (8.1%) of the latter percentage and no cerclage on the remaining 5.4%. It is concluded that there is not high danger of premature birth after conization and therefore performance of the operation does not seem to necessitate preventive cerclage.

[Effect of epidural anesthesia via catheter on the mother and her fetus]. / Influenza dell'anestesia epidurale con catetere sulla madre e sul feto.

The present study describes the effects of lumbar epidural anaesthesia performed on a group of pregnant women (group A) during the period 1986-1988. The overall behavior of the women of group A is compared to that of another group of 990 women on whom no epidural anaesthesia was performed (group B). No serious hyperventilation was observed on any of the women of group A and no PO2 drop in the intervals between contractions of the uterus. Metabolic acid production of both mother and foetus was lower than that observed in group B. Comparisons of multiparas of group A to those of group B showed a higher percentage normal cardiotocographic records among the former. Newborns in group A showed better Apgar scores. No serious complications were observed among women of group A.