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Background There are no data regarding the management of advanced soft-tissue sarcoma (STS) in elderly patients. Patients and methods We retrospectively reviewed the charts of patients ≥75 years old diagnosed with metastatic or unresectable STS between 1991 and 2011 in 11 French and American centers. Results The study included 361 patients. Of these, 223 patients (62%) received systemic therapy, whereas 123 patients (34%) were managed with best supportive care (BSC) only. Patients who received BSC were more likely to be ≥80 years, with performance status (PS) ≥ 2, Charlson comorbidity score ≥ 10, and metastatic disease. The median progression-free survival of patients treated with systemic therapy was 4 months (95% CI: 2.9–5.1). Thirty-six patients (16%) stopped chemotherapy because of toxicity. Median overall survival (OS) of patients managed with specific therapy was 10.9 months (95% CI: 8.3–13.5) versus 5.3 months (95% CI: 3.6–7.1) for patients managed with BSC (P = 0.001). On multivariate analysis, age ≥ 80 years, PS ≥ 2, and number of metastatic sites were the only independent factors associated with OS. Conclusion A high proportion of elderly patients with advanced STS were denied chemotherapy. Further efforts are needed to define better the optimal care for fit and unfit elderly patients with STS.

Background It has been suggested that withdrawal of inhaled corticosteroids (ICS) in COPD patients on maintenance treatment results in deterioration of symptoms, lung function and exacerbations. The aim of this real-life, prospective, multicentric study was to investigate whether withdrawal of ICS in COPD patients at low risk of exacerbation is linked to a deterioration in lung function and symptoms and to a higher frequency of exacerbations. Methods 914 COPD patients, on maintenance therapy with bronchodilators and ICS, FEV1>50% predicted, and

The authors analyse the results of direct (cervical, urethral, tubal) and serological research of Chlamydia trachomatis in a sample population of 420 women undergoing celioscopy due to sterility and pelvic pain, paying particular attention to a group of 193 who were found to be suffering from PID (acute, sequelae). In terms of absolute numbers the correlation between chlamydial contact-PID-sterility is confirmed, whereas in an analysis of the levels of direct positivity it is only significant for acute PID, and in cases of sequelae and in sterility with chronic infection with or without tubal damage the direct identification of Chlamydia trachomatis does not differ much from controls. Salpingo-peritoneal isolation was found to be completely lacking in significance.

The Authors have analyzed the results obtained by treating 60 patients affected by HPV lesions of the lower female genital tract (flat vulvar, vaginal and cervical condylomatosis) with beta-interferon. At vulvovaginal level, the action of the drug is independent from the colposcopic aspect of the lesion but is closely correlated to its extension. The drug proved to be more efficacious at cervical level in case of condylomatous cervicitis rather than ANTZ with a reduction in the size of the lesion and disappearance, if present, of the dysplasia. The positive action of the beta-interferon has never occurred before 2-6 months from the end of the farmacologic treatment. The best results have been obtained in case of condylomatous cervicitis with complete remission in 58% of the cases, and in vaginal condylomatosis (CR at 6 months: 45%). On the basis of these results we may conclude that in these HPV lesions priority should be given to medical treatment whereas in vulvar condylomatosis (especially if extended greater than 1/3) where results are not very satisfactory (not more than 20% of CR) physical therapy is advisable.

Bovine brain cortex phospholipids (BC-PL) have a partially dopaminergic effect on the human CNS. This leads to modifications in gonadotropins (FSH, LH and prolactin) pituitary incretion in normal subjects. The Authors have developed an acute test for phospholipids (300 and 600 mg by fast i.v. injection) to be performed in patients suffering from secondary normoprolactinemic amenorrhea possibly of diencephalic origin (hypothesis: hypothalamus function test). In these subjects no change in FSH and LH incretion was observed, whereas blood prolactin levels appeared remarkably reduced. In a small group of patients affected by hyperprolactinemia brain cortex phospholipids produced a more rapid and more marked reduction in blood prolactin (similar to that caused by bromocriptine) in functional conditions in comparison to the organic ones.

The results of a research on Chlamydia T. (direct survey of both the antigen in the uterine cervix and plasmatic antibodies) in a group of subjects suffering for cervico-vaginitis are provided. The incidence of the Chlamydia infection (proved by either the presence of this bacterium or antibody positivity) is not different from the values reported in literature. Conversely, the presence of neither specific cytological or colposcopic patterns nor of priviledged comites at vaginal level could be demonstrated. Our data, however, confirm a greater incidence of this infection in women reporting early sexual life and a high number of partners. As for the relationship between Chlamydia and contraceptives a slightly higher incidence of positivity in the cervix of patients using oestro-progestinics was registered, whereas no significant difference was noted in the use of other contraceptives IUD included.Physicians examined 173 sexually active, non pregnant women suffering from lower genitalia inflammation. They responded to questions pertaining to their past and recent obstetric/gynecological history, to their partner's possible urogenital inflammations, the age of 1st intercourse, number of partners, and contraceptive use. 27.2% of the patients tested positive using immunoenzymatic techniques for Chlamydia trachomatis (CT). No specific symptoms of CT were observed. A correlation exists between early sexual intercourse and a large number of partners and a greater incidence of CT infections. Almost 98% of all CT positive patients reported 1st sexual intercourse between 16 and 21 years. Antibody positivity ranged from 33% (1st intercourse before 15 years) to 24% (1st intercourse between 16-21 years) and decreased to 5.89% when 1st intercourse occurred 21 years. In addition, CT positive patients had many partners. A greater positivity in the cervix occurred in those using oral contraceptives, however. On the other hand, no positivity was noted for those who used IUDs. Those women who used several contraceptives, such as oral contraceptives, IUD, and barrier methods, had a higher incidence of CT positivity (53.2%) than other groups. Perhaps this is due to clinical cervicovaginitis symptoms prompting the women to change techniques. Specific colposcopy patterns and cytological alterations which some physicians believe indicate CT infections did not identify patients with Chlamydia. These data suggest that it is impossible to make a diagnosis based on symptoms, past sexual history, and contraceptive use. Therefore the data indicate that immunoenzymatic tests are needed.

The exact cause of amenorrhea during the puerperium is still a matter of debate. PRL might inhibit primarily the release of FSH and LH or their stimulating effects on the ovary. In the study presented here, 28 healthy women were investigated, 13 of them lactating puerperae. In the other 15, lactation was prevented by drugs (metergoline in 9, bromocriptine in 6). The women's serum PRL, FSH, LH, beta-HCG and 17 beta-estradiol as well as their FSH and LH response to LHRH (100 micrograms i.v.) were tested 1, 3, 7 and 14 days after vaginal delivery. Serum PRL levels remained elevated in the lactating puerperae and dropped in the puerperae treated with metergoline or bromocriptine. The pattern of FSH, LH and beta-HCG levels as well as the FSH and LH response to LHRH were superimposable in lactating and in nonlactating women. 17 beta-estradiol levels dropped in all puerperae from day 1 to 7, but rose from day 7 to 14 only in the puerperae treated with metergoline or bromocriptine and not in the lactating women. These data indicate that PRL directly affects the ovarian response to FSH and LH, whereas the release of FSH and LH remains unaffected. A stimulatory effect of metergoline and bromocriptine on the ovarian steroidogenesis cannot be excluded.

Objective. To analyse the association between use of oral contraception and risk of pelvic endometriosis. Design. We compared use of oral contraception in women with and without endometriosis. Participants. Eligible for the study were women with primary or secondary infertility (n = 393) or chronic pelvic pain (n = 424), requiring laparoscopy, consecutively observed between September 1995 and January 1996 in 15 obstetrics and gynaecology departments in Italy. Results. Out of the 817 women included in the study, 345 had a diagnosis of endometriosis; 164 (47.5%) women with endometriosis and 139 (29.4%) without the disease reported ever using oral contraception. In comparison with never users the estimated odds ratios (OR) of endometriosis were 1.8 (95% CI 1.0-3.3) in current users and 1.6 (95% CI 1.1-2.4) in ex-users. No clear relation emerged between duration of oral contraceptive use and risk of endometriosis. In comparison with never users, the OR was 1.8 (95% CI 1.1-3.0) for women reporting their last use of oral contraception < 5 years before interview and 1.5 (95% CI 0.9-2.5) for those reporting their last use ≥ 5 years before interview. Conclusions. The study suggests that oral contraception is associated with an increased risk of endometriosis but this finding is based on a selected population and cannot generalised to all women with endometriosis.

OBJECTIVE: The objective of the study was to analyse the relationship between selected characteristics and risk of pelvic endometriosis. STUDY DESIGN: Eligible for the study were 817 women with primary or secondary infertility or pelvic pain requiring laparoscopy. Of these, 393 were included for infertility and 424 for pelvic pain. RESULTS: A total of 345 (42.2%) had a diagnosis of endometriosis and 472 did not have the disease. Multiparous women had endometriosis less frequently than nulliparous, the estimated odds ratios (OR) were respectively 0.9 (95% confidence interval, CI, 0.5-1.6) and 0.4 (95% CI 0.2-0.7) in women reporting one and two or more births. In comparison with women reporting no spontaneous abortion, the estimated OR was 0.3 (95% CI 0.2-0.5) in those who reported > or =1 miscarriage. In comparison with women reporting menstrual cycles lasting > or =25 days subjects with totally irregular menstrual cycles had a reduced risk of endometriosis (OR 0.6, 95% CI 0.3-0.9). No significant association emerged between smoking, age at menarche and risk of endometriosis. CONCLUSIONS: this study confirms, with a different methodological approach to previously published studies, that multiparity, a history of abortion and lifelong irregular menstrual pattern decrease the risk of endometriosis in women with pelvic pain and infertility.