Ovarian cancer after kidney transplantation.

Malignancies are one of the major causes of morbidity and mortality in transplant patients. The incidence is progressively increasing either because of the increased age transplant patients and the increase of immunosuppressive therapy or the increased follow-up range post-transplantation. The main causes of increased tumor incidence in transplant patients with respect to the general population are the reduced immunosurveillance and the high incidence of infections due to oncogenic viruses. This problem might become more and more serious in the near future due to the introduction of new immunosuppressive strategies that significantly extend allograft survival. A case of ovarian cancer in a kidney transplant patient is described. Attention is focused on the potential dual role of immunosuppressive therapy in the development of malignancies in transplant patients.

Study of pubertal development in Abruzzo (Italy) and analysis of factors implicated in puberty variability.

The aim of the study was to confirm whether there is a secular trend towards the early onset of puberty without an early onset of menarche. The study included a total of 1,266 subjects, 771 females and 495 males, with an age range between 5.9 and 18.2 years. In all subjects height, percentile of height, weight, percentage of overweight, bone age and pubertal stages were evaluated. On the basis of pubertal stage the population was subdivided into Tanner's corresponding classes. The obtained data for the female population showed a stabilized onset of puberty compared to the last decades and prolonged length of the pubertal period. Pubertal development in males, instead, did not appear to have changed over the last decades. The study is in line with American studies; the earlier onset of puberty verified in the last decades has slowed prolonging the length of the pubertal period. The specific mechanisms implicated in sexual maturation are not yet well known and need further studies.

Silicone gel mammary prostheses: immune pathologies and breastfeeding.

Augmentation mammoplasty is the most frequent request among esthetic surgery procedures but numerous controversies have been raised about the security of the silicone gel prostheses. Today a new question needs an answer: is the prosthesis a risk factor for pregnancy? In this paper the results of a hematochemical study performed on a group of patients with term pregnancies and silicone gel breast implants (group A) compared with a control group without implants (B) are described. For laboratory screening the valuation of antibody (TRIM) and silicone concentrations in blood and maternal milk and in neonate blood was performed.

Endometriosis: rare localizations in two cases.

Endometriosis is a disease in continuous evolution due to its various aspects and atypical localizations. Every year many women all over the world are affected by it. In typical localizations the diagnosis is simple; the symptoms include pelvic pain and in most of cases sterility. In rare localizations the symptoms are non-specific and the diagnosis is difficult. In particular an intestinal isolated localization is often asymptomatic or can cause non-specific pelvic pain, irregular intestinal activity and in such case, a subocclusive condition often with a diagnosis of inflammatory bowel disease. Two cases of rare localizations of endometriosis are described in the intestinal wall and a cesarean section scar. An analysis of the etiopathogenesis and diagnostic approach in these rare localizations is presented.

Gorlin syndrome associated with basal cell carcinoma of the vulva: A case report.

Gorlin syndrome, also known as nevoid basal cell carcinoma syndrome (NBCCS), is a hereditary condition transmitted as an autosomal dominant trait with high penetrance and variable expressivity. The syndrome is characterized by numerous manifestations: basal cell carcinomas (BCCs) and odontogenic keratocysts (OKCs) are the leading ones. In this article a typical Gorlin syndrome case associated with basal cell carcinoma of the vulva is described.

Management of ovarian cysts in pregnancy: a case report.

According to recent epidemiological studies on ovarian cysts during pregnancy one out of 600 are, in most cases, benign neoformations. The most frequent histological type reported is mature cystic teratoma (50% of the cases), followed by functional cysts (13%), benign cystadenomas (20%) and ovarian cancer (0.6%). Most adnexal masses are asymptomatic and spontaneously resolve before the 16th week of amenorrhoea. On the other hand, some cases are persistent forms which can cause complications for the mother and fetus. The objective of this work was to review the existing literature from an epidemiological point of view, with an emphasis on diagnostic and therapeutic management. We have paid particular attention in our review to the use of diagnostic techniques and non surgical therapies such as laparoscopy, which in expert hands and adopting particular skills, can be considered as on approach to ovarian cysts in pregnancy. We present the case of a patient with an ovarian cyst during pregnancy that was a successfully treated with laparoscopy.

Malignant vulvar melanoma: colposcopic evaluation and review of the literature. A case report.

Because of the rarity of this kind of vulvar neoplasia, the diagnostic difficulties (clinical and histopathological) conditioning the therapeutic approach and the missing iconographical material, we report a case of vulvar melanoma seen at the Department of Obstetrics and Gynecology of the University of L'Aquila in April 2001, together with a review of the literature. Owing to radical vulvectomy and bilateral inguinal lymphadenectomy with the Byron three-incision approach the histological report was: epithelioid cell apigmented melanoma radially spreading (MMSS), a tumor-free margin of at least 1.7 cm with sufficient lympholitic infiltration.

[Isolated inguinal endometriosis. Report of a clinical case]. / Endometriosi inguinale isolata. Descrizione di un caso clinico.

The case of a patient with inguinal isolated endometriosis in whom laparoscopy revealed no evidence of pelvic endometriosis is presented. Following the observation of this case and the published reports by other authors on frequency, pathogenesis, diagnosis and therapy, the article supports the hypothesis that inguinal endometriotic lesions are likely associated with lymphatic spread of endometrial cells.

[Bacterial vaginosis during chemotherapy for gynecological neoplasms. A therapeutic proposal]. / La vaginosi batterica in corso di chemioterapia per tumori ginecologici. Proposta terapeutica.

Bacterial vaginosis (BV) is a well characterized disease, defined Amsel's criteria, whose incidence is significantly increased during chemotherapy for gynecologic malignancies, as previously reported by the authors. Nine patients out of 14 (64%) who were receiving adjuvant chemotherapy for gynecologic tumors showed a clinical and laboratory evidence of bacterial vaginosis and were treated with cetyltrimethilammonium naproxenate vaginal douches. Results were analyzed up to the completion of oncologic chemotherapy: a high efficacy and tolerability for the topical treatment was demonstrated in all cases.

[Evaluation of the endometrium by vaginal ultrasonography]. / Valutazioni vaginoecografiche dell'endometrio.

A group of 131 women aged between 35 and 70 years old were examined using endo-vaginal ultrasonography. Of the patients examined, 45 had been in menopause for at least 2 years and 86 were pre-menopause. 48.9% of the post-menopause patients reported loss of blood and 69.8% of pre-menopause patients reported alterations in the menstrual cycle. Ultrasonography was performed using an endo-vaginal 5 MHz (Ansaldo 600) probe with the patient in a dorsosacral position. During the course of ultrasonography the appearance of the endometrium, in particular its thickness, dyshomogeneity and, in pre-menopause women, its correspondence with the stage of the ovarian cycle, were examined. Taking these parameters into account, the type of endometrial echo patterns were classified, separating the cases into pre- and post-menopause groups. Of the women in menopause, 22 underwent curettage due to symptoms, independently of endometrial thickness which was over 4 mm in 50% of cases, 3 women underwent curettage following ultrasonographic indications, whereas the remaining 20 underwent hysterectomy due to other pathologies. Of the pre-menopausal group, 10 underwent curettage following ultrasonographic indications and 42 due to symptoms; the remaining patients underwent hysterectomy due to pathologies not related to the endometrium. A clearly defined role of endovaginal ultrasonography in the diagnosis of endometrial pathologies emerges if ultrasonographic findings are correlated with histological ones. In the group of post-menopausal women (45), all those cases which were histologically classified as endometrial carcinoma (4) were associated with an endometrial thickness over or equal to 4 mm.(ABSTRACT TRUNCATED AT 250 WORDS)

[Fetal malformations and chromosome abnormalities diagnosed at the Center of Prenatal Diagnosis of the University of Aquila in the 1995-1998 triennium]. / Malformazioni e cromosomopatie fetali diagnosticate presso il centro di diagnosi prenatale dell'Università dell'Aquila nel triennio 1995-1998.

BACKGROUND: Over the past few years numerous techniques have been developed, allowing an evaluation of fetal physiopathology that was unthinkable until recently. The authors describe 20 cases of fetal malformations and chromosomal abnormalities diagnosed by scan and amniocentesis at the Centre for Diagnosis and Obstetric Prophylaxis at L'Aquila University. METHODS: Between January 1995 and April 1998 a total of 1180 amniocentesis and 4000 obstetric scans were performed in a group of 1650 pregnant women. RESULTS: Of the patients examined using ultrasound scan, 8 presented manifest fetal pathologies, of which 5 were associated with chromosome abnormalities: 1) left ventricular hypoplasia, common atrium, tricuspid dysplasia; 2) omphalocele; 3) Morgagni-Stewart-Morel syndrome; 4) plurilobate cystic hygroma; 5) duodenal atresia; 6) Dandy-Walker syndrome; 7) cystic hygroma and hydrops; 8) cystic hygroma, hydrops, cardiopathy and Dandy-Walker syndrome. Among the pregnant women undergoing amniocentesis without a prior diagnosis of fetal malformation, 12 presented pathological fetal karyotypes: 2 cases of Turner's syndrome; 2 cases of Edward's syndrome; 2 cases of Klinefelter's syndrome, of deletion of a stretch of chromosome 8; 1 case of Down's syndrome; 2 cases of supernumerary marker chromosome; 1 twin pregnancy with Klinefelter's syndrome in one twin and paracentric inversion of chromosome 13 in the other; 1 twin pregnancy with a small supernumerary marker chromosome in both twins. CONCLUSIONS: Ultrasonography often enables the diagnosis of congenital abnormalities not associated with chromosome pathologies. However, karyotype studies play an essential role in pregnancies with a high genetic risk.

[Cervical maturation and induction of labor with PgE2 gel. Authors' experience]. / Maturazione del collo uterino e induzione del travaglio di parto con PgE2 gel. Nostra esperienza.

BACKGROUND: To evaluate the efficacy and safety of intracervical prostaglandin E2 gel applications (PgE2) for cervical ripening and induction of labor in relation to parity and admission cervical score. MATERIALS AND METHODS: One hundred and thirty-nine hospitalized patients with an unfavorable cervix (Bishop score < or = 4) received a dose of commercially available endocervical dinoprostone gel 0.5 mg. On the basis of cervical scores, the gel was reapplied at a 12-hour interval for a maximum of two doses. If cervical ripening was successful (Bishop score > 4) but labor did not start within 12 hours from the last dose of gel, labor was induced with oxytocin infusion or with 1 or 2 doses of intravaginal dinoprostone. RESULTS: Intracervical gel was effective for preparing an unfavorable cervix in 87.1% of patients. In 53.1% of nulliparous with admission Bishop < or = 2 the interval between the first application of gel and delivery was higher than 24 hours whereas in all patients with parity > or = 1 and initial Bishop score between 3 and 4 delivery was achieved within 24 hours. The cesarean delivery rates in the two groups were 23.9% and 43% respectively. CONCLUSIONS: The interval from the first application of gel to delivery is strongly influenced by parity and initial cervical score. Vaginal delivery can be expected in four fifths of patients with an unfavorable cervix who undergo pre-induction cervical ripening with prostaglandin E2 gel.

[Malignant gynecologic neoplasms during menopause. Authors' experience]. / Neoplasie ginecologiche maligne in menopausa. Nostra esperienza.

From January 1991 to December 1993 409 post-menopausal women were observed at the Center for the Study of Climateric Disorders of the Department of Obstetrics and Gynecology of the University of L'Aquila. The aim of the study was to evaluate the incidence of gynecologic neoplasm among this group of women. A total of 48 women at risk for malignant tumors were detected. The relationship between the climateric age and the oncologic risk is discussed.

[Pelvic floor rehabilitation in women affected with stress urinary incontinence. Authors' experience]. / La rieducazione del pavimento pelvico nelle donne affette da incontinenza urinaria da stress. Nostra esperienza.

BACKGROUND: This study evaluated pelvic floor rehabilitation as a possible treatment for urinary stress incontinence: a challenge to tradition. METHODS: In this study 20 female subjects with urinary stress incontinence had rehabilitation therapy, at first in the outpatients clinic with motivated physiotherapists and afterwards by home exercises. RESULTS: At the end of 3 months of training, stress incontinence had disappeared in 7 patients (35%), while an improvement was recorded in 13 (65%). CONCLUSIONS: In summary, pelvic floor rehabilitation program can be an effective alternative to surgical approach in reducing the frequency of urinary leakage. Further studies are needed to identify factors predicting success and to improve the techniques of pelvic floor rehabilitation.

[Lifestyle and drinking habits during pregnancy]. / Stile di vita ed abitudini voluttuarie in gravidanza.

BACKGROUND: It has been reported that a high consumption of alcohol during pregnancy is correlated to fetal alcohol syndrome and other perinatal problems. Less is known about the effects linked to moderate and limited drinking during pregnancy. METHODS: A study was carried out in 140 pregnant women: the mean age was 33.05 +/- 5.22, whereas the gestational age was 28.56 +/- 12.1 weeks (range 5-42). Each woman was asked to compile a form giving personal details and details of psychosocial behaviour, a lifestyle questionnaire (CAGE) and a form entitled "How much do you drink" based on SQQ. RESULTS: 22.2% of women reported that they had drunk alcohol during the month prior to the interview. Of these, 15% had not altered their habits, 0.8% had increased their alcohol consumption and 6.4% had reduced it. Wine was the form of alcohol most frequently consumed. Only one woman was positive to the SQQ test, and only one pregnant woman was positive to CAGE. CONCLUSIONS: This study shows that dietary behaviour was correct in the majority of cases.

[Vulvo-cervico-vaginal inflammatory pathologies in childhood and adolescence. Our experience]. / Patologia flogistica vulvo-cervico-vaginale nell'infanzia e nell'adolescenza. Nostra esperienza.

One hundred and twenty-seven pediatric and adolescent patients suffering from vulvo-vaginitis underwent clinical and instrumental tests. The results of bacterioscopic and cultural test were negative in 39 (31.7%) patients due to the probable intervention of local hormonal, allergic and/or irritative factors. The tests used by the authors revealed phlogosis in 88 patients (68.3%) which was aspecific in 58 cases (65.9%) and specific in 30 (34.1%). While aspecific phlogosis were basically caused by germs of intestinal origin, typical of childhood and the prepuberal period, mycetes, gardnerella vaginalis, protozoa and chlamydia trachomatis were identified as the causes, in order of importance, of specific phlogosis, the exclusive hallmarks of adolescence.

[Apropos of a case of Dandy-Walker syndrome associated with chromosome abnormalities]. / A proposito di un caso di sindrome di Dandy-Walker associata ad anomalia cromosomica.

A case of Dandy-Walker syndrome associated with chromosome abnormalities (46,XX,-21, +der(13)t(13;21)(q22;q11), diagnosed during pregnancy is reported. This is a pathology characterized by malformations of the central nervous system, mainly of the cerebellum. Due to several aspects and different prognosis between classic Dandy-Walker and its variants, many clinical and therapeutic problems may raise.

[Antibiotic prophylaxis of infective complications after cesarean section. Our experience]. / Profilassi antibiotica delle complicanze infettive dopo taglio cesareo. Nostra esperienza.

BACKGROUND: The efficacy of a single dose of antibiotic vs multiple doses of the same drug, in reducing maternal infections following the cesarean section, is evaluated. METHODS: A total of 206 pregnant women undergoing elective or emergency cesarean section from 1st June 1998 to 30 June 1999, at the Department of Obstetrics and Gynecology of the University of L'Aquila, were included in a randomized study to compare the efficacy of prophylaxis with a single dose of piperacillin sodium (2 g i.v. after the umbilical cord clamping; group A) vs triple doses of the same antibiotic (2 g i.v. at 6 hourly intervals, beginning from the umbilical cord clamping; group B). RESULTS: The incidence of infective morbidity in group A was 7.3%, with a 2% wound infections, 1% urinary infections and 4.16% febrile morbidity. The incidence of infective morbidity in group B was not much higher (9%), with 2.7% wound infections, 1.8% urinary infections and 4.5% febrile morbidity. CONCLUSIONS: In order to obtain a useful antibiotic prophylaxis in cesarean sections, the single-dose seems to be preferable to the multiple-doses, since the single-dose not only has equal efficacy, but also less cost, smaller risk of super-infections by resistant organisms and it involves smaller care from the-medical and nursing staff.

[Chlamydia trachomatis infection and its correlation with cervical preoncogenesis]. / Flogosi da Chlamydia trachomatis e sua correlazione con la preoncogenesi cervicale.

Among 612 patients included in this open study, serologic detection of Chlamydia infection was compared with cervical cytologic, histologic and colposcopic abnormalities. Serologic and cytologic evidence of elevated exposure to Chlamydia among patients with squamous intraepithelial lesions was found. Nevertheless, whether the Chlamydia infection represents a non casual association resulting from the correlation with sexual activity or it plays independent or supporting etiologic roles is an issue that warrants further investigations.

Genital tuberculosis in a menopausal woman. A case report.

We have analysed the role played by genital tuberculosis (TBC) in Italy today, and in particular in L'Aquila, in the light of a worrying recrudescence. We report the case of a 64-year-old patient, in menopause for the past 11 years or so, referred to the Gynecology and Obstetrics Clinic of the University of L'Aquila, with an anamnesis of menometrorrhagia since the age of 55. The patient was studied from a gynecological and internist profile including the following procedures: gynecological examination and pap-test, colposcopy, transvaginal scan, chest X-ray, abdominal and pelvic CAT, laboratory tests and Mantoux reaction. The uterus was found to be fibromatous during the gynecological examination and scan, whereas colposcopy revealed a small ectropion and the presence of very adherent yellowish mucus. The Mantoux test was positive. CAT showed cicatricial sequelae in the pulmonary parenchyma. It was decided to perform curettage, but this was prevented by the presence of pyometra. The patient was treated with specific chemotherapy and then underwent total laparohysterectomy with bilateral adnexectomy. The histological findings confirmed genital TBC. Genital TBC is now undergoing a worrying recrudescence. We need to have a full knowledge of the pathology, the diagnostic means with which to discover it and the correct therapeutic instruments to overcome it.