Junctions on the maternal blood surface of the human placental syncytium.

Terminant chorionic villi of the human placenta at 8, 9, 12, 14 weeks' gestation and at full term have been studied in freeze-fracture replicas and in thin sections. In replicas, maculae occludentes of different size have been detected in all placental samples on the cleaved plasma membrane of the free (maternal) surface of the syncytiotrophoblast. In thin sections they are located in narrow invaginations of the syncytium luminal plasma membrane. These invaginations are in turn similar to flattened vesicles (also associated with junctions) located in the underlying syncytioplasm. Possible origin and function of the junctions on the syncytium free surface are discussed.

Endometrial response in sequential cyclic therapy assessed with associated hysteroscopy and histology.

A morphologic study was performed on the endometrium in 37 asymptomatic postmenopausal women under effects of cyclically administered oestrogens. Eighty-seven postmenopausal women were taken as control group. Medroxyprogesterone acetate (MPA), 10 mg daily, was administered in association with two types of oestrogen replacement therapy: conjugated equine oestrogens 0.625 mg (CEE) or transdermal 17 beta-oestradiol 0.05 mg (E2-TTS). Endometrial biopsies were taken under hysteroscopic control before treatment and on days 8-12 of combined therapy at the 6th month. Follow-up at 12 and 18 months was only performed in 8 and 5 patients, respectively, with transdermal 17 beta-oestradiol treatment. Various types of endometrial response were identified from atrophy to hyperplasia and secretory patterns. No atypical hyperplasia was found. All cases of simple or complex hyperplasia showed a regression after increased MPA dosage treatment (20 mg). This work is aimed at investigating the endometrial response during sequential cyclic therapy by using morphologic criteria based on hysteroscopy and histology. A large number of patients with hyperplasia can be detected with target biopsy under hysteroscopy, thus playing an important role in the management of patients during replacement therapy in research protocols.

[Current clinical problems of contraception]. / Problemi clinci della moderna contraccezione.

PIP: Modern contraceptive methods are discussed, with special emphasis on oral contraceptives, which are regarded as the most effective. They are also regarded as generally safe, although there are contraindications and the drugs should only be prescribed after careful examination. The need for selecting the drug most suitable for the individual patients, mainly on the basis of the characteristics of the menstrual cycle (suggesting a predominance of estrogen or progestin, within safety limits, such as 50 mcg of estrogen), is emphasized. The examinations required include a general clinical, gynecological, and breast examination, cytology tests, evaluation of the menstrual flow pattern, measurements of arterial pressure, weight, glucose, cholesterol and triglyceride levels, and urine tests. They should be repeated at 6-month intervals, or 3-month intervals in the case of high-risk patients (varicose veins, obesity, heavy smokers, high cholesterol and triglyceride levels, history of jaundice, slight heart condition, clinical or potential diabetes, porphyria or predisposition to uterine myoma). Oral contraceptives are contraindicated in cases presenting a history of thromboembolism, phlebitis, cerebral apoplexy; sickle cell anemia, which indicates a predisposition to thromboembolic accidents; serious liver disease or recent hepatitis; serious heart disease; hormone-dependent neoplasia (breast cancer); predisposition to uterine cancer; erythematous lupus; metorrhagia of unknown origin; psychic disorders, especially of a depressive type. They should also be avoided for 3-4 years after puberty, in order to avoid interfering with the development of the hypothalamus and with growth. A carcinogenic effect of the pill and an increase in the risk of giving birth to abnormal children can be ruled out, although the incidence of abortions due to chromosome anomalies after suspending treatment is rather high (due to the previous inhibition of ovulation, a situation similar to repeated pregnancies at short intervals, which involve the same risk).^ieng

[Hormonal contraception with associated estrogenoprogestational agents]. / La contraccezione ormonale con estroprogestinici associati

PIP: Estrogen-progestogen combination drugs are the most effective contraceptives, and constitute the best method for most healthy women. There are, however, contraindica and side effects, although some of the latter are without clinical significance. The effects of these drugs are summarized, the risks involved are discussed, and are classified. The symptoms that may indicate an excess or deficiency of estrogen or progestogen. The selection of the proper drug for each individual case is discussed, but it is pointed out that only the reuslts of the 1st few cycles of treatment can show whether the initial decision was correct or a change is required. If the treatment proceeds normally and test results remain normal, it is still advisable to interrupt the treatment for 2 or 3 months after 2 years. The need for medical supervision of the treatment is emphasized.^ieng

[Colpocytological patterns caused by hormonal contraceptives]. / Quadri colpocitologici determinati da contraccettivi ormonali

PIP: The effects of estrogen-progestin combinations on vaginal cytology were studied using colpocytological smears from 598 women aged 18-45 years who had used oral contraception for from 3 months to 6 years. In general, combined preparations resulted in decreased estrogen levels, fewer superficial cells, and a prevalence of intermediate cells; inflammation and mycosis were much more common. Changes produced by minipills were of the same type but were less pronounced. With sequential preparations, the maturation of vaginal epithelium is not blocked, and mycosis is not so frequent. In 8% of cases, serious morphological abnormalities characterized by dyskarayosis were observed, and dysplasia was seen in 15%. Cytological checkups are recommended every 6 months because of these anomalies.^ieng