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.

Effects of long-term high dose testosterone administration on vaginal epithelium structure and estrogen receptor-α and -ß expression of young women.

To date, the effects of long-term testosterone (T) administration on the human vagina are not completely understood. Thus, the aim of this study was to investigate the effects of long-term T treatment on vaginal tissue histology, estrogen receptor alpha (ERα) and beta (ERß) expression and proliferation in female to male transsexual subjects (FtM). We compared vaginal samples from FtM subjects with those of premenopausal women (PrM) and postmenopausal women (M) not receiving any hormonal treatment for at least 2 years. Vaginal tissue samples from 16 FtM subjects treated with T (intramuscular injections of 100 mg Testoviron Depot/7-10 days for at least 1 year), undergoing sex reassignment surgery, and 16 PrM and 16 M subjects undergoing a vaginal hysterectomy for prolapse, were collected. For each sample, morphology, glycogen content, proliferation (ki-67), ERα and ERß expression were evaluated. Vaginal samples from FtM showed a loss of normal architecture of the epithelium, intermediate and superficial layers were completely lost, and glycogen content was depleted. T administration resulted in a strong proliferation reduction when compared with both M and PrM subjects. Stromal and epithelial ERα as well as ERß were significantly decreased in FtM when compared with PrM subjects. In conclusion, our data suggests that systemic T administration at supraphysiological dosage, determines profound changes in histomorphology and reduces ERs expression and proliferation of vaginal epithelium.

Doppler flow analysis of the palmaris superficial branch of the radial artery in postmenopausal women with acroparesthesia: the role of hormone therapy. A pilot study.

METHOD: Twenty-three patients with acroparesthesia were submitted to clinical evaluation and color Doppler analysis of the uterine artery and palmaris superficial branch of the radial artery. Thirteen women (Group I) were submitted to hormone treatment with drospirenone 2 mg + estradiol emidrate 1 mg. Ten patients refused the treatment and served as controls (Group II). The patients were studied at baseline and after 6 months' therapy. RESULTS: After 6 months of hormone therapy, the resistances of the uterine artery and palmaris superficial branch of the radial artery significantly decreased in Group I patients. This was associated with the complete disappearance of paresthesic symptoms in 12/13 (92%) of the treated patients. In patients belonging to Group II, the paresthesia remained unchanged. CONCLUSION: Hormone therapy with drospirenone may increase the forearm/hand blood flow, and favor the amelioration of paresthesia.

Abnormalities of somatic peptide-containing nerves supplying the pelvic floor of women with genitourinary prolapse and stress urinary incontinence.

OBJECTIVES: To test the hypothesis that genital prolapse may be related to peripheral nerve abnormalities, we examined the changes occurring to peptide-containing nerve processes supplying the periurethral muscles in women with stress urinary incontinence associated with prolapse. METHODS: Thirty patients with genital prolapse and 10 age-matched control subjects entered the study. All patients were evaluated by urodynamic investigations. Ten of 30 patients had pure stress urinary incontinence; none of the control subjects was incontinent. During surgery, four biopsy samples were obtained from each woman from the periurethral and perirectal muscles. The muscle sections were processed for immunohistochemistry using specific antibodies to glial (S-100 protein) and general neuronal markers (neuron-specific enolase) and neuropeptides, including neuropeptide Y, vasoactive intestinal polypeptide, and substance P. The evaluation of immunolabeled nerves was based on a semiquantitative analysis that allowed for a four-point ordinate scale score. RESULTS: S-100 and neuron-specific enolase immunoreactive nerve fibers, running either singly or in small bundles, along with a dense network of neural processes containing neuropeptide Y, vasoactive intestinal polypeptide, and substance P, were found throughout the connective tissue and striated muscle of the control specimens. In contrast, in the muscle specimens from those with genitourinary prolapse, both the density and the intensity of neuropeptide Y, vasoactive intestinal polypeptide, and substance P immunoreactive nerves were markedly reduced compared with the control specimens. CONCLUSIONS: The evidence of a reduced peptide-containing nerve supply to the perineal muscles provides a morphologic basis suggesting that neural abnormalities contribute to the pathogenesis of genital prolapse and urinary incontinence.

A histological and immunohistochemical study of neuropeptide containing somatic nerves in the levator ani muscle of women with genitourinary prolapse.

BACKGROUND: To evaluate the changes occurring in the somatic innervation throughout the levator ani muscle in women with genitourinary prolapse and stress urinary incontinence (SUI). METHODS: Thirty-four patients with genital prolapse entered the study and ten subjects with non-malignant pathologies acted as a control group. All patients were evaluated by urodynamic investigation and an electromyographic study of pelvic floor muscles to define the type of urinary incontinence. Biopsy samples were obtained from both groups of patients: the site of muscle biopsies were left and right part of perirectal pubococcygeus muscle. The evaluation of immunoreactivity was semiquantitative and based on staining intensity and distribution. RESULTS: In all cases, S-100 protein and NSE immunoreactivities were found in nerve fascicles running throughout the striated muscle. NPY and VIP positivities were more intense and diffuse, whereas SP immunoreactivity was quite scanty. The different patterns of NPY and VIP expression changed in relation to degree of genital prolapse and to the presence of SUI. CONCLUSIONS: Our immunohistochemical study shows the presence in the pelvic floor of neurons that are able to synthesize neuropeptides. The lower immunoreactivity score of same neuropeptides (VIP, NPY) observed among patients with third degree genital prolapse and with SUI could be related to biochemical damage of the neurons with subsequent lower production of chemical messengers.

Systemic interferon therapy for female florid genital condylomata.

A prospective randomized study comparing systemic interferon therapy with placebo in women with florid genital condylomata was carried out. A first group of 22 patients received alpha-interferon (Alfaferone: Alfa-Wassermann Bologna, Italy). 3 x 10(6) IU by i.m. injection every other day for four weeks (total of 12 injections). A second group of 20 patients was treated with a placebo. All patients, before therapy, were submitted to a colposcopic and vulvoscopic examination, a Pap smear and biopsy, in order to confirm the clinical diagnosis. Controls were carried out on all patients as a distance of three, six and twelve months from the end of treatment using colpocytologic, colposcopic and vulvoscopic examinations. One year after the termination of the therapy with interferon 45.4% of patients had a complete recovery compared with 10% of spontaneous recovery in the control group (p = 0.028). The systemic side effects of alfa-interferon, though very frequent, did not limit the use of the product. Our results suggest that systemic alfa-interferon treatment is effective in female genital condylomata, above all in those patients with multifocal florid lesions, both in terms of complete remission and number of relapses.

Cervical intraepithelial neoplasia in HIV seropositive patients.

In order to assess the frequency of cervical intraepithelial neoplasia (CIN) in a high risk population, 32 women infected with human immunodeficiency virus (HIV), with no AIDS-related symptoms, underwent colposcopic, cytologic and histologic examinations of the uterine cervix. In seven cases (21.9%) cervical smears showed dysplasia and in nine cases (28.1%) histologic evaluation indicated CIN. No invasive carcinomas were observed. In seven of the nine women CIN was associated with lesions due to human papillomavirus infection (HPV). These data confirm that HIV-positive women are at increased risk for developing neoplasias in the lower genital tract and are in need of regular and careful cytologic and, in particular, colposcopic and histologic examinations.

Prophylaxis of venous thrombosis after gynaecological surgery: a controlled pilot study of defibrotide.

BACKGROUND: Defibrotide (Def), a new antithrombotic drug, has been proposed as a prophylactic agent in postoperative DVT. Most of the studies to date, however, have either not been controlled or have used unverifiable systems for asymptomatic DVT diagnosis. This randomized pilot study compared Def versus standard low-dose calcium heparin (CH) prophylaxis after gynaecological surgery, using objective criteria for DVT diagnosis. METHODS: Forty-one pts received 400 mg Def intramuscularly twice a day starting the day before surgery; 40 pts received 5000 IU CH s.c. twice daily beginning 2h before surgery. The two groups were well matched for all relevant risk factors. DVT was diagnosed by means of the 125I fibrinogen uptake test (FUT) and venography. Blood coagulation and fibrinolysis tests were also carried out perioperatively. RESULTS: Isotopic DVT (FUT-positive for two consecutive days) was recorded in 6 (14.6%) of the Def and 5 (12.5%) of the CH groups. In cases where FUT was positive for at least three consecutive days (4 in Def and 1 in CH), venography confirmed DVT in 3 cases (all in the Def group). No side-effects were recorded in either group and the amounts of transfused blood were not different. No significant differences in blood coagulation or fibrinolysis tests were recorded, except for higher fibrinogen levels on the 8th post-operative day in the Def group. CONCLUSIONS: These results do not indicate any trend suggesting that Def, as a prophylactic agent in gynaecological surgery, offers any clinical or practical advantages over standard low-dose heparin prophylaxis.

Immunosuppression and human genital papillomavirus infection.

A group of 39 patients who underwent iatrogenic immunosuppression for renal transplant were evaluated by means of colposcopic, cytologic, and histologic investigations. Evidence of human papillomavirus (HPV) infection was found in 30.7%, more frequently in the cervix. Biopsy specimens of the most atypical areas showed the presence of cervical intra-epithelial neoplasia in one case. The high incidence of HPV infection in this group suggests that immunodeficient patients should have close monitoring of the entire ano-genital tract.

Evaluation by means of radius bone densitometry of the fracture risk due to osteoporosis in post-menopause.

The aim of this work is to establish the predictive value of radius bone density with reference to the risk of fracture in postmenopausal women. Our data confirm a significant predictability of the radius for limb and rib fractures, but not for vertebral bones.

Estudo comparativo da prevençäo de aderências em microcirurgia experimental com o emprego de fármacos e de métodos de barreira / Comparative study of prevention of post-operative adhesions in experimental microsurgery using drugs and barrier-methods

Experimentamos a eficácia anti-aderencial da hidrocortisona, do dextran 70 e da celulose oxidada na intervençäo de microanastomose término-terminais do corno uterino de rato. Os melhores resultados foram obtidos no grupo de animais tratados com hidrocortisona observados com o dextran 70. A celulose oxidada demonstrou-se ineficaz na prevençäo de aderências

An enzyme-linked immuno sorbent assay for salivary estriol during normal pregnancy.

It has been recently demonstrated that the concentration of Estriol in saliva increases in the course of pregnancy, similarly to the plasmatic concentration of unconjugated and total Estriol. As an alternative to RIA, which is an expensive method and requires a highly specialized laboratory, there is now available a competitive, sensitive and rapid enzyme-linked immuno sorbent assay (ELISA) for Estriol in saliva and plasma. Aim of this study is to compare the levels of Estriol concentration, measured by RIA and by ELISA in saliva and plasma in seven women tested every week from the 30th week to the term of pregnancy.

ELISA for salivary and plasma estriol in pregnancy.

A competitive, sensitive, and rapid enzyme-linked immunoadsorbent assay (ELISA) was developed for the determination of estriol in saliva and in plasma. Horseradish peroxidase (HRP) was used as the label enzyme; separation between free and bound steroid was carried out by insolubilized antibody prepared by adsorbing purified IgG of rabbit anti-6-oxoestriol-6-(O-carboxymethyl)oxime-BSA on polystyrene balls. The enzyme activity was measured by a colorimetric reaction using o-phenylenediamine dihydrochloride and hydrogen peroxide as substrate. The sensitivity of the assay was 12 pg/tube. In order to compare ELISA to RIA estriol estimations in different biological fluids, we selected six women during normal pregnancy, from the 30th to the 40th week of gestation. Salivary estriol was assayed by direct and extraction methods, while the corresponding plasma samples of the same subjects were analyzed only for unconjugated estriol by an extraction method. A good agreement was found between the results obtained by RIA and ELISA: r = 0.897, p less than 0.001 between direct RIA and direct ELISA in saliva; r = 0.909, p less than 0.001 between extraction RIA and direct ELISA in saliva; and r = 0.916, p less than 0.001 between extraction RIA and extraction ELISA in plasma. A good correlation (r = 0.793, p less than 0.001) was present between plasma samples by RIA and saliva samples by ELISA (direct method). These results indicate that: ELISA is a reliable method for the determination of estriol in plasma and saliva. Saliva samples can be used for the assay of estriol and therefore for the assessment of fetal conditions during pregnancy.

Behavior of some steroids in endometrial adenomatous and atypical hyperplasia.

Endometrial adenomatous and atypical hyperplasia are the histopathological pictures that more frequently may develop into an adenocarcinoma. It is believed that a hormonal action may favour the genesis of endometrial cancer. We studied the plasmatic levels of some steroids, considered to be responsible for neoplastic changes, in patients with adenomatous and atypical hyperplasia. With this object we measured plasmatic levels of estrone, estradiol, androstenedione, DHEA-S and testosterone in postmenopausal patients with adenomatous and atypical hyperplasia and in fertile women, both in proliferative and secretory phases. We didn't find any difference in the steroid pattern in the two groups.

Behaviour of some steroids in postmenopausal women with coelomic ovarian tumors.

In order to study the hormonal pattern in ten postmenopausal women with coelomic ovarian tumors we measured Estrone, Androstenedione, DHEA-S and Testosterone plasmatic levels before and after surgery. Estrone and Androstenedione plasmatic levels were significantly higher in patients with coelomic ovarian tumors than in the control group and they showed a rapid and constant decrease after surgery. Nevertheless we didn't find any ovarian histological picture to explain the hormonal increase.

[Clinical and therapeutic aspects of pelvic inflammatory disease in IUD users]. / Aspetti clinico-terapeutici dell'infezione pelvica in donne portatrici di IUD.

PIP: The author evaluated some parameters in 20 female IUD users who, in 1978, recovered from a diagnosis of pelvic inflammation at the Primera Clinic of Obstetrics and Gynecology, University of Bologna. Young, nulliparous patients and the long lapse of time (14 months), from the date of the introduction of the spiral, proved to be factors in the high incidence of pelvic inflammation. In addition, the author emphasizes the importance of specific antibiotic therapy administered over the longterm to assure female fertility. Of the 18 females treated only with antibiotics, 2 presented bilateral impervious tubes evaluated with tubal insufflation 10 months after the acute pelvic inflammation episode. (author's modified)^ieng

[Androgenic treatment with depot mesterolone in dyspermia].

The clinical use of testosterone, and more recently of orally administered mesterolone in disorders of male fertility is of limited therapeutic efficacy, as shown by data found in the literature. On the basis of these considerations, the authors have tested mesterolone cyclopentylproprionate in 15 subjects suffering from sperm disorders. The drug, which is slowly released in the tissues has been parenterally administered at a total dose of 1,200 mg (100 mg per week). During the therapeutic trial the following aspects have been studied: spermiologic and hormonal patterns, general conditions, libido, principal organic functions and the possible side effects. Results are critically evaluated.

[Cyproterone acetate - ethinylestradiol treatment of hirsutism, acne, seborrhea and alopecia].

Twenty-five female patients, aged 14 to 49, and suffering from syptoms of virilization (hirsutism, acne, seborrhea and alopecia) were treated with an estrogen-progestogen combinantion, i.e. cyproterone acetate and ethinylestradiol, having antiandrogenic and antiovulatory action. Patients were submitted to monitoring by means of a series of laboratory tests in order to detect any toxic or hormonal effects that might occur. In most cases symptoms of virilization were significantly reduced, while untoward side effects were not noted.