[Phytoestrogens and menopause]. / Fitoestrogeni e menopausa.

Menopause is the interruption of menstrual and reproductive capacity, therefore, that occurs naturally in all women between 48 and 55 years, due to a lower production of gonadal steroids. The period becomes progressively irregular and lack of ovulation and menstrual flow decrease, and finally disappears. The time between the first symptoms and the cessation of the menstrual cycle is called menopause. With the onset of menopause the woman undergoes a series of changes related to estrogen deficiency, which occur in all tissues of the body. In this period one can distinguish an early stage, characterized by hot flashes, mood swings, night sweats and insomnia, and a late phase in which we highlight more symptoms related to the interruption of hormonal such as osteoporosis, obesity, at urogenital and increased incidence of cardiovascular disease. In Italy, only 5.2% of women aged 45-64 years used hormone replacement therapy, and only 20-30% follow a therapy for more than two years, both for psychological reasons, and for fear of side effects. Not surprisingly, therefore, phytoestrogens are given a high importance, as they are considered a natural alternative tank to to their plant origin. Interest in phytoestrogens was born from the observation that postmenopausal women who live in the East have a lower incidence of symptoms, cardiovascular disease, cancer and osteoporosis hormone use, compared to Western women.

[Comparison of 100 of hysterectomy laparoscopic against 100 cases hysterectomy laparotomy]. / Confronto di 100 casi isterectomia laparoscopica vs 100 casi isterectomia laparotomica.

OBJECTIVE: The aim of our study is to obtain the parameters for assessment of patient, so that policy guidelines for surgical procedures to choose from (laparoscopy or laparotomy). This way you get a chance to prefer the choice of surgical approach over another. Moreover, the ultimate goal is to determine if there is any superiority of one surgical technique over another according to clinical parameters. METHODS: This was a randomized observational study, using the comparison between a first sample of 100 patients treated with hysterectomy by laparotomy and a second sample of 100 patients treated with hysterectomy laparoscopy (THL). A comparison of results obtained in the short term whereas the biennium 2007/2008, using as a method of patient selection, the system of systematic randomization. RESULTS: The results of this work reveals the superiority of laparoscopic hysterectomy over abdominal hysterectomy by taking into account the parameters of evaluation and risk factors. CONCLUSION: In conclusion it is important to a precise preoperative evaluation according to specific parameters that impinge on efficacy and safety of laparoscopic surgery. If you made a careful preoperative evaluation of the patient is able to make it even safer laparoscopic surgical technique with a clear superiority in terms of efficacy, safety and less invasiveness of laparoscopy compared to laparotomy.

A new uterine suture technique for postpartum hemorrhage.

At present, postpartum hemorrhage is still an important cause of maternal mortality and morbidity. When medical therapy has no success, conservative surgical procedures are applied before making a hysterectomy. Three transverse sutures are applied to the entire uterine wall both to the right and the left side of the uterus. Our technique has been applied to 4 women with postpartum hemorrhage secondary to uterine atony. Bleeding was stopped immediately by compressive sutures. The four patients had normal menstruation cycles after delivery and had new pregnancies. No woman had postoperative complications. Uterus compressive suture is an effective alternative to hysterectomy to treat postpartum hemorrhage secondary to atony. This is a simple and quick procedure that preserves fertility.

Effects of soy isoflavones on menopausal neurovegetative symptoms.

AIM: Dietary soy supplementation may reduce the incidence of hot flushes in postmenopausal women due to the presence of phytoestrogens in soy foods. The aim of this study was to assess the effects of a 3-month administration of different doses of either oral or transdermal soy isoflavones on climacteric complaints in postmenopausal women. METHODS: Sixty postmenopausal women were assigned randomly to one of the following groups: groups A and B received 50 mg/day or 75 mg/day of oral isoflavones respectively, while groups C and D received 6 mg/day or 12 mg/day of transdermal isoflavones. A control group (group E) was composed of 15 patients that did not receive any treatment. Hot flushes, Kupper-man index and vaginal dryness at baseline and then after 5, 9 and 13 weeks were evaluated. RESULTS: The isoflavone treatment led to a progressive significant (p<0.01) reduction of the number of hot flushes in the groups A, B and D with a dose-related effect in group D. At week 13, the Kupperman index and hot flush score decreased significantly in all the treated groups, while vaginal dryness score was reduced only in group B. CONCLUSION: Our findings suggest that both oral and transdermal soy isoflavones are effective to attenuate slight to moderate menopausal neurovegetative symptoms with a dose-related effect.

AGUS and ASCUS: different incidence in pre- and postmenopausal women.

PURPOSE OF INVESTIGATION: The aim of this study was to determine the incidence of AGUS (atypical glandular cells of undetermined significance), ASCUS (atypical squamous cells of undetermined significance) and SIL (squamous intraepithelial lesion) in the cytologic diagnosis in pre- and postmenopausal women. METHODS: We did a retrospective study selecting 183 patients who were screened for cervical pathology. Ninety-six patients were in postmenopausal age. We determined the incidence of cytologic abnormalities defined as ASCUS, SIL, and AGUS in pre- and postmenopausal women. RESULTS: We expected a marked incidence of low-grade SILs in the fertile population, while the postmenopausal group was thought to be affected more by AGUS and ASCUS. We obtained different results. In our population study, premenopausal women presented more AGUS and ASCUS; the two subgroups presented the same incidence of low-grade SILs; postmenopausal women were more affected by high-grade SILs. CONCLUSIONS: The significance of the new categories introduced by the Bethesda System is still uncertain for different authors. As we look to the future new markers that more specifically identify individuals at-risk can be expected.

Utilisation of hydrogen peroxide in the treatment of recurrent bacterial vaginosis.

AIM: The authors have evaluated the real efficacy of using hydrogen peroxide for previously treated recurrent bacterial vaginosis that is resistant to other forms of treatment. METHODS: The study included 58 women aged between 18 and 42 years old. Vaginal irrigations with 30 ml of hydrogen peroxide (3%) were prescribed in the evening for a week. The follow-up was carried out 3 months after the end of treatment. RESULTS: The results clearly show that the use of hydrogen peroxide in vagina can eliminate the main symptoms of bacterial vaginosis, and in particular the malodorous leucoxanthorrhea in 89% of cases at 3 months after the end of treatment, a result that is comparable to that obtained using metronidazole or clindamycin as a vaginal cream. Moreover, hydrogen peroxide facilitates the restoration of normal vaginal bacterial flora (represented by H202-producing lactobacillus) in 100% of cases and normal acid pH (pH<4.5) in 98% of cases; it also fosters the disappearance of clue cells from vaginal smears and anaerobic pathogenic flora from vaginal secretions in 100% of cases. The amine test became negative in 97.8% of cases. All results underwent statistical analysis and were found to be statistically significant. CONCLUSION: Hydrogen peroxide represents a valid alternative to conventional treatments for recurrent bacterial vaginosis, and associates the absence of collateral effects with low costs, excellent tolerability and real therapeutic efficacy.

[Role of intestinal resection in primary cytoreduction of ovarian cancer]. / Il ruolo della resezione intestinale nella citoriduzione primaria del cancro dell'ovaio.

BACKGROUND: The aim of this study is to define the role of the intestinal removal for the therapy of ovarian cancer in advanced stadium. METHODS: We have examined 247 females with epithelial ovarian cancer in advanced stadium, that had intestinal removal. RESULTS: The survival in the females that had a very good intestinal removal is greatest than in the females that hadn't a very good intestinal removal.

[Cytoreductive surgery in patients with stage IV ovarian carcinoma]. / La chirurgia citoriduttiva nelle pazienti con carcinoma dell'ovaio allo stadio IV.

BACKGROUND: The aim of this study is to evaluate the efficacy of cytoriductive surgical in females with ovarian carcinoma in advanced stadium, and to define the role of this surgical for the survival of females with hepatic metastases. METHODS: This is a retrospective study. 164 females with ovarian cancer in IV stadium was examined. 64 females had hepatic metastasis. All patients had cytoriductive surgical. RESULTS: The survival in the patients without hepatic metastasis was 38 months if the cytoreduction was very good; it was 18.3 months if there is residual disease. The survival in the patients with hepatic metastasis was 50.1 months if the cytoreduction was very good; it was 27 months if there is residual disease. CONCLUSIONS: A very good surgical is very important for the survival of patients with ovarian cancer in advanced stadium. This is true also in the patients with hepatic metastases.

[Meigs' syndrome and "Meigs' pseudo-syndrome." Report of 2 cases]. / Sindrome di Meigs e "pseudo-sindrome di Meigs". Descrizione di due casi.

BACKGROUND: The aim of this study is to investigate similitudis and differences between the Meigs' syndrome and Meigs' pseudosyndrom. The Meigs' syndrome is an uncommon disease that is characterized by benign ovarian tumor, ascites and pleural effusion. The Meigs' pseudosyndrom is a serious disease that is characterized by malignant ovarian tumor, ascites, pleural effusion. METHODS: We have examined two cases: a case of Meigs' syndrome that is characterized by vomit, abdominal pain, ascites, height serum Ca 125 level; a case of Meigs' pseudosyndrom that is characterized by ovarian adenocarcinoma that is diagnosticated owing to ascites and pleural effusion. CONCLUSIONS: This study suggest that the surgical therapy have a very important role for the complete remission of the disease in the Meigs' syndrome and for the remission of ascites and pleural effusion in the Meigs' pseudosyndrom.

[HPV infection. Clinical features and treatment]. / Infezione da HPV. Aspetti clinici e trattamento.

The aspecific and exiguous symptoms and the lacking information are among the reasons of the diffusion of the vulvo-vaginal papillomatosis. We carried out the present study between 1995 and 1999 in the outpatient clinic of cervico-vaginal pathology of the Second University of Naples. 680 patients (aged between 18 and 56 years) underwent vulvoscopic and colposcopic examination. The did not show any relevant symptoms specific for HPV infection. Among the viral strains, HPV-16 and HPV 18 are able to induce a cervical cancer. To eliminate the pathology the primary prevention is necessary: it consist of both an adequate information about the micro-condilomatosis, the role of the activator agent, the modality of the infection, and the annual screening examinations such as pap-test and colposcopy. As first line treatment during secondary prevention, we utilize Roferon A, and perform diathermocoagulation according with the local diffusion and the degree of the disease (mild, moderate, severe). At the end of the therapy with Roferon A we observed that the infective focus was eliminated in about 60% of the cases and, only for moderate and severe micro-condilomatosis a diathermocoagulation was necessary.

[Second-look in ovarian cancer: laparoscopy or laparotomy?]. / Second-look per cancro dell'ovaio: laparoscopia o laparotomia?

BACKGROUND: The aim of the present study was to compare the laparoscopic second-look with laparotomic second-look as regards the consistency of diagnosis of residual tumoral disease after first step treatment in patients affected by ovarian cancer, and to evaluate the feasibility of the laparoscopic second-look. METHODS: Twenty-one patients affected by ovarian cancer underwent laparoscopic second-look followed by laparotomic second-look. Six months after the first surgical intervention all the patients showed no contraindications to laparoscopic second-look. All the surgeries were performed with the same procedure: after the introduction of the trocars the lysis of adherences was carried out, the whole abdominal cavity was explored, 18 abdominal-pelvic sites were examined, direct biopsies were performed and samples for the cyto- and histological analysis were obtained. RESULTS: Positive predictive value for laparoscopy was 100% (6 out of 6 cases), while negative predictive value was 84% (2 false negative cases out of 12). The complete abdominal-pelvic examination was possible in 95% of cases with laparotomy while in 41% of cases with laparoscopy, because of post-operative severe adherences. CONCLUSIONS: Laparoscopic second-look has a good consistency as regards the diagnosis of residual tumoral disease, but its feasibility is lower than laparotomy owing to the presence of severe adherences and the high risk of intra- and post-operative compliances.

Time length of negativization of hCG serum values after either surgical or medical treatment of ectopic pregnancy.

OBJECTIVE: The aim of this study was to compare the time length until the human chorionic gonadotropin titer became negative after medical or surgical treatment of ectopic pregnancy. EXPERIMENTAL DESIGN: Prospective, randomized study. PARTECIPANTS AND INTERVENTIONS: We compared time to resolution in 30 cases of tubal pregnancies successfully treated, 15 underwent laparoscopic linear salpingostomy (group 1) and 15 medical treatment with single-ose methotrexate (group 2). The patients of both groups had no meaningful differences of age, gestational age and human chorionic gonadotropin mean values. MEASURES: During the follow-up human chorionic gonadotropin serum values were obtained every two days until the titer was negative. RESULTS: The time to resolution was 33.6 +/- 6.6 days in group 1, 31.5 +/- 7.8 in group 2 with no statistically meaningful differences. CONCLUSION: The data, comparable with results obtained by laparoscopic treatment, suggest that human chorionic gonadotropin value becomes negative independently of type of treatment and residual trophoblast.

[Psychological consequences in women with symptomatic HPV infection]. / Conseguenze psicologiche in donne con infezione sintomatica da HPV.

OBJECTIVE: Evaluation of psychological and social aspects of women with diagnosed genital HPV-infection. EXPERIMENTAL DESIGN: A retrospective study of 40 women with a diagnosis of HPV-genital infection has been made. INTERVENTIONS AND MEASURES: A questionnaire for gathering information on social life, sexuality and emotional relationship with the partner was submitted to the patients. RESULTS: There is a high percentage of sexual impairments after diagnosis of HPV-infection. CONCLUSIONS: HPV infections, as many genital pathologies, lead to problems with sexuality as well as hypochondriac fears.

[Diagnosis and therapy of CIN in pregnant women]. / Diagnosi e terapia della CIN in donne gravide.

BACKGROUND: CIN is the most frequent neoplasm in pregnancy. At present, in Italy, Pap test and colposcopy are not included in routine examinations in prenatal visits. METHODS: In this study, we submitted 560 pregnant women to Pap test during prenatal visits. In case of abnormal or doubtful smears a colposcopy and target biopsy were performed. RESULTS: Of the 560 women studied, 124 had genital bleeding and the other 436 were asymptomatic. Six cases of CIN symptomatic women and 5 cases in the asymptomatic ones. In no cases we thought necessary a therapeutic operation. We limited the therapy to a follow-up. CONCLUSIONS: In our opinion, it is necessary to treat CIN during pregnancy.

Bone density in women with endometriosis.

OBJECTIVE: To evaluate the impact of endometriosis on bone metabolism. MATERIALS AND METHODS: We compared bone mineral density and biochemical markers (plasma osteocalcin, bone alkaline phosphatase, fasting urinary hydroxyproline, urinary excretion of cross-linked N-telopeptide of type I collagen) of bone turnover in forty-nine perimenopausal women undergoing laparotomy because of benign gynecologic pathology: in twenty-four of them (group A) endometriosis was diagnosed, the remaining twenty-five represented the control group (group B). Statistical analysis was performed by means of Student "t"-test; significance was set at p < 0.05. RESULTS: Bone density of the lumbar spine (0.898 +/- 0.325 vs 0.940 +/- 0.350) and bone markers failed to show statistically significant differences between the two groups. No significant correlation was observed between any bone density measurement and severity of endometriosis. CONCLUSION: Endometriosis does not seem to induce even in advanced stages, a reduction of bone density.

[Authors' experience in the treatment of cervical intraepithelial neoplasia]. / Neoplasia intraepiteliale cervicale. Nostra esperienza di trattamento.

BACKGROUND: During the last ten years, after the destroying intervention for the treatment of cervical intraepithelial uterine neoplasia (CIN = Cervical Intraepithelial Neoplasia) was abandoned, space has been given to the conservative treatment, both destructive and excisional. In this study, conducted at the Department of Gynaecology and Obstetrics of Eboli Hospital (ASL Salerno 2) in collaboration with the Gynaecological and Obstetrical Department of the Second University of Naples, the authors compared the various therapy techniques of the conservative excisional type, using 5 different methods. METHODS: One hundred and fifty-seven women, all with lesions of the neck of the uterus of varying degrees of severity, underwent the treatment. Cytologic and colposcopical controls (follow-up) were carried out at intervals over a period of time. RESULTS: In 5 of the 95 patients (5.3%) who underwent surgical conisation, the presence of invading carcinoma was noted. Of the 19 women treated with diathermical loop, 3 cases of mature squamous metaplasia, 3 cases of CIN I, 8 cases of CIN II, and 4 cases of CIN III were observed. In the 32 patients treated with laser-therapy a complete recovery, equal to 100% was obtained although with slight margins of under-estimation and over-estimation; the same result was verified in the 3 patients treated with electroresection with high frequency radio waves and in the 8 patients treated with microneedle. CONCLUSIONS: On the basis of these results it is concluded that lasertherapy and electroresection with high frequency radio waves (3.8 MHz) using electrodes with "bands" or with "linears" (microneedle) gave the best results for both the therapeutical advantages with anatomical and functional integrity of the cervix and for economic reasons.

[Incidence of CIN in HIV-positive women]. / Incidenza della CIN in donne HIV-positive.

BACKGROUND: The aim of this study was to evaluate the incidence of CIN in HIV-seropositive women. METHODS: A group of 23 women with a mean age of 28 years was recluted. Three of them were clinically affected, and 20 were non-AIDS HIV-seropositive. The patients underwent cervical cytology, colposcopically directed biopsy and T-cell studies. In addition, HPV using the in vitro hybridization, was investigated. RESULTS: Eight of 23 patients (24.78%) had CIN. Patients with CIN had significantly lower CD4 cell counts and CD4/CD8 ratios than those without CIN. Patients with AIDS had higher grade lesions than those non-AIDS HIV-sero-positive. CONCLUSIONS: The data obtained suggest that abnormal cervical pathology is common among HIV seropositive women, and so cervical colposcopy should be part of the routine management of HIV-seropositive women.

[Authors' experience with medical therapy of herpes genitalis in pregnancy]. / Nostra esperienza nella terapia medica dell'Herpes genitalis in gravidanza.

BACKGROUND: Neonatal risk in herpes infections is very high: in the USA it is 1:2,000, in Japan 1:15,000 and in England 1:65,000. These differences seem to be due mostly to the different risk factors associated to the mother infection. The best strategy to cure herpes infection is to examine every patient during pregnancy and to identify the high risk ones. METHODS: In this study, 1,860 pregnant women have been submitted to a colposcopic and cytologic screening for the research of HSV. RESULTS: HSV was found in twenty (1.07%) women. Two groups have been made: the first with 14 HSV positive women at 3-6 months of pregnancy and second with 6 HSV positive women at eight months of pregnancy. Both groups were treated with acyclovir per os. The 14 women of the first group underwent vaginal delivery. The women of the second group underwent cesarean section. Only in 1 case a neonatal infection has been observed.