Immunological variations in women suffering from ovarian cancer. Influence of radical surgical treatment.

BACKGROUND: The immune system includes all the innate or acquired mechanisms, that the organism uses for protecting itself from the aggression of external pathogens or neoplasia. About the control of the tumor growth, the immune mechanisms implicated are quite a lot: the cytotoxicity against the tumor cells by cytotoxic T lymphocyte, macrophages, NK cells; simil-NK cells (ADCC). Tumors have generally antigenic marked potential, for which numerous antigens have been identified, but none of these has revealed a correlated specificity to the neoplasia. Only a glycoprotein at elevated molecular weight, the CA125, presents an elevated specificity and sensibility. The objective of this study was to examine immunological variations in the peripheral blood of patients with ovarian carcinoma before and after radical surgical treatment. METHODS: In the Institute of Obstetrics and Gynaecology of Second University of Studies of Naples the immunological variations in 8 women (mean age: 59.5; range: 49-70 years) suffering from ovarian cancer, have been evaluated before and after radical surgical treatment (when the stage of the tumor made possible the surgery) and compared to 8 normal volunteers of comparable age (control group), in the period January 1994-June 1998. The patients were followed in average for two years and subjected to a immunological screening with blood drawings effected at the hospitalisation and later 1, 6, 12, 18, 24 months from surgical treatment. The immune evaluation were effected with: proliferation tests on the monocytes of the peripheral blood, evaluation of the production of Interleukin 1 and 2 with the leukocyte phenotyping, evaluation of NK cells activity. The patients were followed in average for two years. RESULTS: The radical surgery decidedly improves the immune response. The ability to produce IL-1 by the lymphocytes of the patients object of our study, appeared constantly falling (with reduction of about 50%) before the surgery and it meaningfully increases in the post-surgery period. The surgery doesn't modify the lymphocytes T helper and T inducer. The surgery delays the diminution of the NK cells in a little meaningful way. The periodic dosage of the CA125 does not give the same results: in the 60% a progressive increase was realised and in the 40% it remained constant. CONCLUSIONS: The surgery constantly improved the physical state of the patient, determining an increase of the immune response toward the neoplasia, and therefore achieving a meaningful increase of survival.

Ovarian cancer screening by transvaginal color Doppler ultrasonography.

BACKGROUND: The need for the early detection of ovarian cancer continues to be one of the most important issue in women's health care. The ovarian neoplasia characteristically have a scarce symptomatology for which it tries to create a sensitive and specific screening test so that the diagnosis could precociously be made and, consequently, improve the prognosis with a timely therapy. Our purpose was to assess the performance of transvaginal color Doppler ultrasonography in ovarian cancer screening. METHODS: In the Institute of Obstetrics and Gynaecology of Second University of Studies of Naples, in the period between January 1997 and December 1998, 60 women, divided into two groups (the 1st group included 30 women in fertile age with standard uterine dimensions, the 2nd group included 30 menopausal women), were submitted to transvaginal color Doppler ultrasonography. Color Doppler ultrasonography was performed with an ESAOTE ANSALDO AU5 HARMONIC ultrasound machine provided with a 6.5 MHz real-time sector electronic array endovaginal probe with a 5 MHz pulsed Doppler system and equipped with the color velocity imaging system for the color blood flow codification. The score used in the evaluation of the ovary are us follows: volume of the adnexa (from 1 to 5); presence of papillas and septa (from 1 to 5); wall thickness (from 1 to 5). An high score (> 12) corresponds to probability of presence of neoplasia. For the flow modifications the following parameters were considered: RI (Index of resistance); PI (Pulse Index); Vmax (Maximum Speed). CD was considered as suspicious when flow was detected and the lowest RI found was < or = 0.45, PI < or = 0.58 Vmax < or = 60. RESULTS: Sonographic morphology evaluation and CD were suspicious in 11 cases and 9 of these were positive on histopathological analysis (true positive = 15%, false positive = 5%). All the women that had morphologically normal ovaries observed on ultrasound examination and were not suspicious on CD analysis, were also negative on histopathological analysis (true negative = 80%). CONCLUSIONS: The color Doppler ultrasonography revealed a decidedly valid method of screening of the first level, being non-invasive examination, painless, therefore well accepted by the patients, even if in some women, especially if in fertile age, the physiological modifications calls for repeated investigations and compare its parameters.

Contraception with the latest estroprogestagens in women suffering from systemic lupus erythematosus.

BACKGROUND: This study was performed to evaluate, in women suffering from Systemic Lupus Erythematosus (SLE), the relationship between the assumption of oral contraceptives and the evolution of the disease. METHODS: In the Institute of Obstetrics and Gynaecology in collaboration with the Institute of Dermosyphilopathical Clinic of Second University of Studies of Naples, 20 women in fertile age suffering from SLE with specific cutaneous manifestations were studied for the year 1999. All the patients requested to take, at contraceptive purpose, low-dosage estroprogestagens. The contraceptives we prescribed have, as active substance, the gestodene at the dose of 0.075 mg and the etinilestrdiol at the dose of 0.02 mg per day. Patients' group in object was compared for a year with a similar control group of women suffering from SLE not subjected to any pharmacological therapy. RESULTS: Only 5 patients out 20 have had to suspend therapy after 4 or 5 months, because a relapse of the illness was experienced while the others 15 patients did not lament a relapse of the illness. In the control group a more or less similar percentage of patients, during the months of the observation, spontaneously had episodes of relapse of the illness. CONCLUSIONS: The results of our brief study have shown that the administration of hormonal contraceptives in reality doesn't constantly produce immediate and remarkable exacerbations of the illness in women suffering from SLE. In our opinion the contraception with the latest estroprogestagens can comfortably be effected under strict medical control, probably because the medicines at low dosage are quickly metabolized and in the majority of the cases they don't have capacity to influence the course of such chronic connectivitis.

Induced abortion and contraception: survey of 576 young women in Naples.

The aim of the study was to investigate the link between induced abortion and contraceptive methods. Five hundred and seventy-six women who underwent induced abortions at the Obstetrics and Gynecology Institute of the Second University of Naples were interviewed. They were asked about their knowledge of contraception methods; age, school attendance rate and marital status were also considered. The women were 27.8 (mean age) years old, high school educated (58.5%), married (41%), nulliparous (63%). Twenty-four percent of the women admitted a previous induced abortion. Withdrawal (176 women), condoms (104) and oral contraceptives (74 women) were the most widely used contraceptive methods. Withdrawal (37%) resulted in being the most utilized method during the cycle in which conception occurred; no method had been employed by 31% of the women. We found that 35% of the women had used their contraceptive method in a regular way but become pregnant nevertheless. Another group of 40% had forgotten to use their contraceptives for a few days and became pregnant by accident. In the last group of 25% of the women had not used any contraceptive methods. The diffusion of modern methods of fertility regulation influences the number of induced abortions as shown by its reduction since 1982. Our data confirm that induced abortion is the consequence of an insufficient use of modern contraceptives. Therefore more information is necessary to get women and men to use contraceptive methods regularly.