Search

The aim of the study was to describe the recent trends in antiretroviral treatment in late pregnancy and the sociodemographic changes among pregnant women with HIV over the last 6 years. Data from the National Program on Surveillance on Antiretroviral Treatment in Pregnancy in Italy were grouped per calendar year, and changes in antiretroviral treatment, population characteristics, maternal immunovirologic status and newborn clinical parameters were analyzed. A total of 981 HIV-infected mothers who delivered between 2002 and 2008 were evaluated. The proportion of women receiving at least three antiretroviral drugs at delivery increased significantly from 63.0% in 2002 to 95.5% in 2007-2008, paralleled by a similar upward trend in the proportion of women who achieved complete viral suppression at third trimester (from 37.3 in 2002 to 80.9 in 2007-2008; p < 0.001). The co-formulation of zidovudine plus lamivudine remained the most common nucleoside backbone in pregnancy, even if a significant increase in the use of tenofovir plus emtricitabine was observed in more recent years. Starting from 2003, nevirapine prescription declined, paralleled by a significant rise in the use of protease inhibitors (PI), which were present in more than 60% of regimens administered in 2007-2008. Nelfinavir was progressively replaced by ritonavir-boosted PIs, mainly lopinavir. No significant changes in preterm delivery, Apgar score, birth weight, and birth defects were observed during the study period, and the rate of HIV transmission remained below 2%. These data demonstrate a significant evolution in the treatment of HIV in pregnancy. Constant improvements in the rates of HIV suppression were observed, probably driven by the adoption of stronger and more effective regimens and by the increasing options available for combination treatment.

Intrauterine transmission of HHV-6 is well established in immunocompetent women while few data are available on infections in babies born to HIV-positive mothers. To assess the rate of HHV-6 vertical transmission in comparison to CMV, we analyzed cord blood spots dried on cards (Dried Blood Spots, DBS) collected during a multi-center study on HIV congenital infections in Italy. DBS were tested by PCR for HHV-6 and CMV footprints. HHV-6 amplimers were sequenced and characterized. As control group, cards taken from babies born to HIV-negative mothers were analyzed. DBS of 187 babies born to HIV-positive and 372 to HIV-negative mothers were analyzed. The prevalence of HHV-6 was 3.2% in babies born to HIV-positive mothers. CMV was found in the HIV-positive group with a prevalence rate of 1.6%. In newborns of control pregnant women, HHV-6 prevalence rate was 1.1% (p=0.09), while CMV was not detected (p=0.04). Sequence analysis could distinguish between HHV-6 A and B variant in both groups and one A/B coinfection was found in a baby born to a HIV-positive mother. HIV-infected mothers transmit HHV-6 and CMV viruses to their babies more frequently than uninfected women.

Background: Few studies have assessed the determinants of birthweight in newborns from HIV-positive mothers in analyses that adjusted for different gestational age at delivery., Method: We calculated gestational age-adjusted birthweight Z-score values in a national series of 600 newborns from women with HIV and in 600 newborns from HIV-negative women matched for gender and gestational age. The determinants of Z-score values in newborns from HIV-positive mothers were assessed in univariate and multivariate regression analyses., Results: Compared to newborns from HIV-negative women, newborns from HIV-positive women had significantly lower absolute birthweight (2799 vs. 2887 g; p = .007) and birthweight Z score (-0.430 vs. -0.222; p < .001). Among newborns from mothers with HIV, the maternal characteristics associated with significantly lower Z-score values in univariate analyses were recent substance use (Z-score difference [ZSD] 0.612, 95% CI 0.359-0.864, p < .001), smoking >10 cigarettes/day (ZSD 0.323, 95% CI 0.129-0.518, p = .001), absence of pregnancies in the past (ZSD 0.200, 95% CI 0.050-0.349, p = .009), no antiretroviral treatment in the past (ZSD 0.186, 95% CI 0.044-0.327, p = .010), and Caucasian ethnicity compared to Hispanic (ZSD 0.248, 95% CI 0.022-0.475, p = .032). Body mass index (BMI) at conception and maternal glycemia levels during pregnancy were also significantly related to birthweight Z scores. Glycemia, BMI, and recent substance use maintained a significant association with Z-score values in multivariate analyses. In the multivariate analysis, the only factors significantly associated with Z-score values below the 10th percentile were recent substance use (adjusted odds ratio [AOR] 3.17, 95% CI 1.15-8.74) and smoking (AOR 2.26, 95% CI 1.13-4.49)., Discussion: We identified several factors associated with gestational age-adjusted birthweight in newborns from women with HIV. Smoking and substance use have a significant negative impact on intrauterine growth, which adds to an independent HIV-related effect on birthweight. Prevention and information on this issue should be reinforced in women with HIV of childbearing age to reduce the risk of negative outcomes in their offspring.

Background: In pregnant women taking antiretroviral treatment at conception treatment may be transiently stopped for safety concerns. Limited data are available on the consequences of such discontinuations., Methods: We used data from a national study to compare different treatment pathways during pregnancy. Overall, 321 women were evaluated and classified into three groups: women not on treatment at conception and who started treatment during pregnancy (starters; n=91); women on treatment at conception who temporarily discontinued treatment during first trimester (discontinuers; n=114); and women on treatment at conception who maintained treatment (continuers; n=116)., Results: At conception, the three groups had similar CD4+ T-cell counts (499, 495 and 470 cells/mm3, respectively; P>0.10); starters had significantly higher median HIV RNA levels at conception (5,690 copies/ml) compared with both continuers (58 copies/ml, P<0.001) and discontinuers (49 copies/ml, P<0.001). Continuers maintained undetectable HIV RNA at all pregnancy trimesters, while discontinuers showed at first and second trimester transient negative effects on HIV (4,776 and 386 copies/ml, respectively) and CD4+ T-cell levels (376 and 392 cells/mm3, respectively), which were reversed at last trimester (52 copies/ml and 432 cells/mm3, respectively). No significant differences were observed among the groups in HIV RNA and CD4+ T-cell counts at third trimester, preterm delivery, low birth weight or mode of delivery. The number of cases of HIV transmission and birth defects were too limited to allow comparisons., Conclusions: Early discontinuation of antiretroviral treatment in pregnancy produces transient virological and immunological effects without precluding the achievement of a good viral suppression at the end of pregnancy; no clinical consequences were observed.

Lipid values were measured during pregnancy in HIV-infected, treatment-experienced women. A previous history of lipodystrophy was associated with significantly higher triglyceride values at all pregnancy trimesters. In multivariate analyses lipodystrophy independently increased the risk of hypertriglyceridemia by threefold at the first trimester, and by eightfold at the second and third trimesters. Protease inhibitor treatment was also independently associated with hypertriglyceridemia.

Objective: In our study we evaluated the frequency of three SNPs (-52 G/A, -44 C/G; -20 G/A) in the 5' UTR of DEFB-1 gene, in a cohort of 130 HIV-1 infected mothers and their children, collected by the Italian group SIGO in Obstetrics and Gynecology., Methods: The three SNPs (-52 G/A, -44 C/G; -20 G/A) in the 5' UTR of DEFB-1 gene were genotyped by direct sequencing of PCR products., Results: The C allele at position -44 was shown to be significantly different in both HIV-1 positive mothers and their children when compared to the healthy controls. The odds ratio for -44 C allele in children born to HIV-1 infected mothers is 7.09 (confidence interval 3.38-15.3) while the odds ratio for this allele in HIV-1 infected mothers is 6.42 (confidence interval 3.14-13.4)., Conclusions: Our results evidence a high frequency of the -44 CC allele in HIV-1 infected mothers and their children with augmented potential risk of maternal fetal transmission. This potential vertical transmission risk has been successfully prevented by antiretroviral drug treatment and cesarian section of the HIV-1 positive mothers.

Objective: Studies that mostly were conducted before the widespread use of combination antiretroviral treatments have reported that antenatal invasive procedures markedly increase the risk of human immunodeficiency virus vertical transmission. We aimed to evaluate the vertical transmission rate and other maternal and neonatal complications among women who were infected with human immunodeficiency virus who underwent antenatal invasive procedures during the second trimester of pregnancy and who were delivered after the advent of antiretroviral regimens., Study Design: We conducted a multicenter case series of women who were infected with human immunodeficiency virus who underwent amniocentesis or chorionic villus sampling or cordocentesis during the second trimester of pregnancy and who were delivered after January 1, 1997., Results: Sixty-three of 775 recruited women (8.1%) had performed early invasive diagnostic techniques . This rate has improved progressively from 4% in 1997 to 14%. Two of 60 viable infants (3.3%; 95% CI, 0.6%-10.1%) were infected with the human immunodeficiency virus. This rate did not differ significantly from the transmission rate that was observed in women who did not undergo antenatal invasive techniques (1.7%; P = .30)., Conclusion: The current risk of human immunodeficiency virus vertical transmission that is associated with early invasive diagnostic techniques is lower than previously reported.

Objective: We investigated genetic polymorphisms of MBL2 gene, in a cohort of 90 Italian HIV-1 pregnant seropositive women and their children in order to understand whether the MBL2 genotype of HIV-1 positive mothers might be related to their ability to transmit the virus to their children., Materials and Methods: DNA was extracted from Iso Code Stix cards, and MBL2 genotyping was performed by Melting Temperature Assay., Results: The frequency of the MBL2 0/0 homozygotes was higher in HIV-1 positive mothers than in healthy controls, the MBL2 0/0 genotype was more frequent in children born from HIV positive mothers than healthy subjects., Conclusions: We have confirmed the association of polymorphisms involving a gene of the innate immunity with an increased risk of being infected by HIV. These polymorphisms were also evidenced in children born from HIV+ mothers, but the risk of infection was strongly reduced by cesarean delivery and by antiretroviral treatment.

Objective: To evaluate the incidence of gestational diabetes in our population and verify costs of universal screening. To assess neonatal and obstetrical outcomes with respect to maternal epidemiological characteristics., Methods: Eight hundred and fifty-six pregnant women between 24th and 28th weeks of gestation were examined in this observational study. Universal screening with glucose challenge test was used to screen the group for gestational diabetes. History, obstetrical and neonatal outcomes were collected and then analyzed., Results: Gestational diabetes was diagnosed in 6.6% of cases. Patients with at least one risk factor had a cesarean section in 50% of cases and a spontaneous vaginal delivery in 23.59% of cases (p < 0.001). The absence of any risk factor was found in 73.7% of positive glucose tolerance test and in 62.5% of affected patients. The cost of universal screening in our study, was 57,60 Euros per case identified., Conclusions: Given the high prevalence of diabetes, the high proportion of patients potentially not identified with a selective screening in this study and the relatively low cost, universal screening for gestational diabetes seems the best way to identify patients and prevent adverse obstetrical and neonatal outcomes.

Objective: To generate reference ranges for bioelectrical impedance indices throughout pregnancy and to investigate whether a relationship exists between these indices and the neonatal birth weight., Study Design: Pregnant women with a singleton gestation, gestational age lower than 12 weeks, and absence of medical diseases before pregnancy were enrolled. Patients with pregnancy complications, such as hypertensive disorders, diabetes, and antiphospholipides syndrome were excluded. Antrophometric maternal parameters and bioelectrical impedance measurements were performed during the first, second, third trimester of pregnancy, at delivery and 60 days after delivery. Height(2)/resistance (cm(2)/Omega) and height(2)/reactance (cm(2)/Omega) were utilized to estimate the total and extracellular body water amounts, respectively. Spearman rank correlations and cox proportional hazard modelling were used for statistical purposes., Results: 169 patients completed all measurements. Total and extracellular water amounts significantly increase as pregnancy advances and return to the pre-pregnancy values within 60 days after delivery. After adjustment for gestational age at delivery, fetal sex, and smoking habits, height(2)/resistance at 25 weeks (hazard=1.04, 95% confidence interval (CI) 1.02-1.06, P<0.005), height(2)/resistance at 30 weeks (hazard=1.03, 95% CI 1.01-1.05, P<0.005), height(2)/reactance at 20 weeks (hazard=1.03,95% CI 1.01-1.05, P<0.005), and height(2)/reactance at 25 weeks (hazard=1.03, 95% CI 1.01-1.04, P<0.01) were found to be independent predictors of birth weight., Conclusion: We have provided reference ranges for bioimpedance analysis during pregnancy, an easy, fast and non invasive method to estimate the body water composition during pregnancy. Bioelectrical impedance indices during the second trimester of pregnancy are independently related to the birth weight.

Objective: Our purpose was to examine the efficacy of a topical long-term treatment with boric acid versus an oral long-term treatment (itraconazole) in the cure and prevention of recurrent vulvovaginal candidiasis., Study Design: A prospective, nonrandomized study of patients affected by recurrent vulvovaginal candidiasis was undertaken. In 3 years we recruited 22 consecutive patients who underwent therapy with itraconazole (group 1) or boric acid (group 2). Women were followed up for 1 year, with clinic and microbiologic controls after 1, 3, 6, and 12 months after the first visit., Results: During the treatment, the positive culture results (15.1% vs 12.1%) and the signs and symptoms (33.3% vs. 24.2%) were similar within the 2 groups, with no significant statistical difference. With the withdrawal, after 6 months relapses were common in the 2 groups (54.5%)., Conclusions: Boric acid seems to be a valid and promising therapy both in the cure of the vaginal infection and in the prevention of relapses of recurrent vulvovaginal candidiasis, but its efficacy ends with the suspension of the therapy.

Aim: Gravidic cholestasis is a syndrome that is usually manifested during the third trimester of pregnancy and regresses in puerperium. It is characterized by the onset of itch, with or without associated jaundice and alterations of hepatic functional parameters. Its incidence varies according to geographical area., Methods: A retrospective analysis was made regarding the frequency of this pathology in pregnant patients attending the Gynecology and Obstetrics Clinic of Trieste from 1-1-1980 to 31-7-1997. The epidemiological and clinical characteristics were studied relating to the course of pregnancy and neonatal outcome. Patients were identified on the basis of diagnosis on admittance and anamnestic and laboratory data, generalised itch and increased transaminase, biliary salts and alkaline phosphatase. Patients suffering form active-phase viral hepatitis were excluded, as were those in whom symptoms appeared after the start of alpha methyldopa administration., Results: The frequency of gravidic cholestasis in this series was 0.36%. No significant differences were recorded in terms of age, parity and weight increase in these patients compared to the general population of pregnant women. Birth was spontaneous in 66% and by cesarean section in 34%. The frequency of premature births was 12%. The Apgar score at 5 min was satisfactory in all neonates., Conclusions: Careful monitoring of pregnancy associated with suitable obstetric care enabled a zero rate neonatal and maternal mortality to be achieved.

Cryoglobulins are a group of proteins with the common property of precipitating from cooled serum. Cooled cryoglobulinemia is a classic disease caused by immune complexes which subside on vessel walls and produce a clinical picture represented by recurrent purpura, asthenia, arthralgias, Raynaud's phenomenon, glomerulonephritis and sensorimotor neuropathy. The authors describe a case of a patient C.M., 37 years old, with cryoglobulinemia, chronic hepatitis C and gravidic cholestasis at 28 weeks' gestation. The clinical picture worsened with the appearance of mild hypertension with proteinuria and hypochromic anaemia. At 31 weeks' the arthralgic symptomatology and pruritus revealed degeneration with an alteration of glycemic profile values and treatment with rapid human insuline was started. The cardiotocography began to be pathologic and a cesarean section was performed; the newborn weighted 1570 g. Cooled cryoglobulinemia is a pathology which worsens in a gravidic state and can impair the outcome of pregnancy.

Objective: To establish the physiologic changes in the coagulation and fibrinolytic systems during normal pregnancy and puerperium., Study Design: One hundred and seventeen normal pregnant women were investigated in a longitudinal study involving five measurements: blood samples were collected at 10, 20, 30, 36 weeks and on the second day puerperium and were assayed for prothrombin time (PT expressed in INR), activated partial thromboplastin time (PTT), fibrinogen (FBG), antithrombin III activity (AT III), protein C activity (PC), protein S activity (PS), prothrombin fragments 1+2 (F1+2), type 1 plasminogen activator inhibitor activity (PAI) and tissue-plasminogen activator antigen (t-PA). Student t-test, One Way Analysis of Variance (ANOVA) and Bonferroni test were used for statistical analysis. P<0.05 (two tails) was assumed to indicate a significant difference., Results: Fibrinogen concentrations were always increased with respect to controls (P<0.001), while protein S was always decreased, with values averaging 60% of those of controls from the 10th week of pregnancy onwards (P<0.001). Variance analysis showed a statistically significant increase with gestational age for procoagulant factors (INR: P<0.001; FBG: P<0.001), a reduction for anticoagulants (PC: P<0.0001; PS: P<0.0001), and a rise for F1+2 (P<0.0001). With regard to fibrinolysis, there was an increase both for t-PA (P<0.0001) and PAI-1 (P<0.0001) during pregnancy. The t-PA values were always comprised in the normal range. PAI-1 were increased with respect to control values starting from 31st week. The most significant variations in the procoagulants (expressed by PT and FBG) were recorded up to the 20th week (P<0.001); from the 30th week onwards, they remained stable until after the delivery. The same was true for protein S levels (P<0.001), except that the difference between the 10th and the 20th weeks was not statistically significant. The level of F1+2 gradually increased throughout pregnancy (P<0.001), and then fell in the puerperium (P<0.001)., Conclusions: The parameters showing the greatest variation during pregnancy were PT, FBG, PS, F1+2 and PAI-1. The existence of a hypercoagulable state in pregnancy was suggested by the increased levels of F1+2.

Particular conditions exist at the end of some pregnancies which cause an increase in maternal and fetal risk. A valid alternative for these pregnancies is represented by the administration of prostaglandins, in order to obtain labor induction. The goal of our study was to define the eligibility criteria and the epidemiological characteristics that correlate most with a favorable obstetrical outcome. The study was conducted on 133 informed, consenting patients subjected to labor-induced delivery with prostaglandins E2. The mode of delivery in relationship to parity demonstrated that the pluriparous patients had fewer difficulties in labor and in its induction: of the 43 pluriparous cases, none had a cesarean section for failed induction and 95.3% delivered vaginally. One hundred percent of the patients with a Bishop score of more than 4 went into labor, as opposed to 81% of the patients with a score of less than 4. Therefore, taking into consideration the cost of the method, we retain that choosing an active position is valid, respecting the eligibility criteria for the induction of labor described above.

The prediction of spontaneous abortion in the first trimester is made possible owing to the use of two diagnostic procedures: maternal assay of some biochemical parameters and ultrasonography. However, the diagnostic value of ultrasound is greater than the former procedure since it enables the embryo to be visualized directly, measuring crown-rump length (CRL), together with the gestational sac whose diameter can also be measured (DSG). The present study aimed to verify the prediction of abortion given by the ratio between DSG and CRL measured using ultrasound in the first trimester of pregnancy, namely with signs of embryonic vitality already present. A prospective longitudinal study was performed in a population of 59 pregnant women attending the Obstetric and Gynecology Clinic of Trieste University during the period between April 1990 and April 1991. On enrollment in the study all patients had a gestational age of 8 +/- 2 weeks of amenorrhea. A preliminary measurement of DSG and CRL (t0) was then obtained and these measurements were repeated after four weeks (t1). The data obtained were first compared to each other for the same time (DSG0/CRL0 and DSG1/CRL1) and the relationship between the two ratios was then calculated ((DSG1/CRL1)/(DSG0/CRL0)). This method provides a sensitive method of analysing variations in the ratio between the two measurements taken at different moments. Inferential statistical principles were then applied. At the end of the first trimester the evolution or otherwise of pregnancy was assessed by examining and separating two groups of women: those who had had spontaneous abortions and those who had continued their pregnancies.(ABSTRACT TRUNCATED AT 250 WORDS)

The KBB acid elution test is used to assess the presence and extent of transplacental passage of fetal cells into the maternal circulation both as a diagnostic aid in detecting hemorrhage before birth and in monitoring pregnancies at risk for hemolytic disease of the newborn. However the technique is ineffective when an hereditary Hb-pathy with associated increase in HbF is present in the mother, like the HPFH, delta-beta thalassemia and other hereditary abnormal hemoglobins. A mother with HPFH and another mother with delta-beta thalassemia with false positive result of the acid-elution test are described and the need for an extension of the clinical and laboratory study in families with hereditary HbF disorder is stressed.

The treatment of hypertension in pregnancy is justified by the need to reduce blood pressure in order to avoid the onset of preeclampsia, eclampsia, retarded intrauterine growth and even neonatal, perinatal and maternal death. The value of using drugs to treat slight-moderate hypertension in pregnancy is, however, not clearly defined in the literature. In fact, from an etiopathogenetic point of view, the significance of increased blood pressure in pregnancy has not yet been satisfactorily explained, and above all the positive significance of increased blood pressure not be forgotten since, up to diastolic levels of 90 mmHg, it is accompanied by an increase in birth weight. The aim of the present study was to verify the efficacy of pharmacological treatment in cases of slight-moderate hypertension during pregnancy in a population of 121 pregnant women attending the Obstetrics-Gynecological Clinic of the "Istituto per l'Infanzia" in Trieste during the period from 14-11-1984 to 24-4-1991. Data for this retrospective study were extrapolated from an analysis of medical records and then memorized in a data-base file. The degree of hypertension was classified as slight, moderate and severe according to blood pressure levels measured on hospitalisation. Clinical signs taken into account included: edema, proteinuria and hypoprotidemia. Anti-hypertensive therapy was selected between one or more associated drugs belonging to the following classes: central action and peripheral action anti-adrenergic drugs, beta-blockers, calcium channel blockers, vasodilators, diuretics, ACE-inhibitors and sedatives. Moreover, patients also received non-pharmacological treatment in the form of low sodium diets and bed-rest.(ABSTRACT TRUNCATED AT 250 WORDS)

A clinical report concerning a severe idiopathic thrombocytopenia during pregnancy (minimal platelet count 3000/mm3 is described). Corticosteroids and immunoglobulins were administered in preparation to elective cesarean delivery. Since the platelet count not improve significantly, 3 units of platelets from a single donor were adjunctively given using diapheresis. An elective cesarean delivery was performed at 34 weeks, without further complications. The newborn weighed 2550 g and the postnatal course was uneventful.

The Authors examine the correlation between hypertensive disorders of pregnancy and fetal growth. The results of a study of 342 pregnancies, confirm a significant correlation between hypertension and fetal growth retardation. These findings, so evident in moderate and severe hypertension, have also been confirmed in cases of mild hypertension. The medical treatment also in the pregnancies with mild hypertension, and a larger utilisation of operative deliveries, determined a decrease in perinatal mortality and morbidity.

The frequency of the Pap test and the incidence of dysplastic and neoplastic lesions of the uterine cervix in the province of Trieste from 1/7/85 to 30/6/88 have been analysed. Over this period, the annual frequency of screening was 11% of the resident female population, with considerable differences from one age class to another. In the age group between 15 and 29, in which CIN 1 incidence is at its maximum, the frequency of screening is much lower than it is among subjects of average age. It is considered that it would be more advisable to detect the cervical lesion in the earliest stage and so bring forward performance of the first Pap test to a younger age.

A computerized system for colpocytologic data collection and filing, is presented. A descriptive and easy to elaborate recording of anamnestical data and examination findings is achieved using two correlated files. Step by step filing is obtained by multichoice scheme which progressively appears on the screen.

A retrospective analysis of the ultrasonic charts of 150 pregnancies with a birth weight below the tenth percentile is presented. In all cases the first scan was carried out before the 20th week of gestation to assess gestational age measuring crown to rump length or biparietal diameter (BPD). Subsequent scans every 4 weeks measured BPD or abdominal circumference. Birth weight was below the fifth percentile in 70 cases and between the fifth and tenth percentiles in 80 cases. A risk condition was found in 32.26%. The first observation of an abnormal parameter was widely spread throughout the latter half of the pregnancy. The management of IUGR included close observation and often required planned delivery. Cesarean section was required in 30.75% of the cases. Acute fetal distress has been the indication in 17.6% of cases and chronic fetal distress in 41.3%. Perinatal mortality was 6.66%. The need for criteria that will accurately detect the fetus most at risk from complications of IUGR is stressed.

The authors report 172 cases of patients who had to undergo a curettage of the uterine cavity and an endometrial sampling with Vabra Curettage. In 80.8% of the cases, the histologic diagnosis of the material removed with Vabra Curettage was comparable with that of the uterine curettage. In 8.7% of the sampling, the histologic diagnosis of the tissue removed with the "suction technique" was easier. In 10.5% of the cases, the diagnosis was more reliable in the samplings taken away with uterine curettage. In this last group, nevertheless, the endometrial tissue removed with Vabra curettage allowed us to exclude the presence of an adenocarcinoma or of an atypical hyperplasia. Only in 1.2% of the specimens, the Vabra Curettage did not allow us to exclude an endometrial pathology (for lack of material). On account of the increased incidence of endometrial carcinoma, the tolerability of the method proposed, its low cost, the Authors advocate a large-scale use of this method for a prevention program directed at the high-risk population for this carcinoma.

With the aim of evaluating the correlation between dysplastic lesions of the uterine cervix associated or not with condylomatosis and Chlamydia T. infection, we carried out a serological study of anti-Chlamydia species-specific antibodies and a direct and/or a cultural investigation on a sample of 320 women who performed a Pap-test. The serological examination showed positivity (titer greater than or equal to 1:32) in 49 control subjects (with negative cytology) (23.7%); in 27 cases (43.5%) with actual diagnosis of condylomatosis/CIN associated or not with condylomatosis and in 28 cases (54.9%) with previous diagnosis of condylomatosis/CIN associated or not with condylomatosis. The cultural investigation did not show any significant difference among the groups above mentioned. Finally, the frequency of positive cases for anti-Chlamydia antibodies was estimated for each grade of actual or previous CIN: a greater frequency of positivity was noted in cases with CIN 3 (75%).

Ovarian cancer has high rate of mortality among malignant gynecologic tumors. Because of its aggressiveness and low rate of 5 year survival of patients treated, it is important to realise a screening program for its early diagnosis. Today, immunologic research is directed to the study of tumoral markers that allow us to detect the presence of still clinically silent ovarian neoplasms. Some tumoral markers such as CEA and CA 125 are available for post-surgical monitoring of patients treated for ovarian cancer. The Authors have carried out a study to evaluate the possibility of their use in the depistage of ovarian neoplastic pathology. A blood sample was taken for the evaluation of serum CEA and CA 125 in a series of 520 patients older than 45 years, who did not complain signs or symptoms of pelvic pathology. A pathologic value for CEA was considered higher than 7.3 ng/ml and for CA 125 greater than 37 U/ml. For CEA 2.5% (13 cases) presented pathologic values compared to 2.88% (15 cases) for CA 125. One third of cases (0.5%) with high levels of CEA had repeated blood samples. 3 of them had confirmed high levels of CEA but echotomography performed in these patients was negative for pathologic ovarian masses. 15 patients had CA 125 high levels. 3 out of 15 cases repeated the blood sample that resulted normal. On 11 of these cases an echotomography was also performed that diagnosed a uterine myomatosis in 4 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

The authors made a review of the last 100 cases who underwent a conization of the cervix during the period 1980-1986. Cyto-histological evaluation was compatible in 78% of the cases with a cervical intraepithelial neoplasia of third degree and in 22% with a CIN of first and second degree. Early post-operative complications consisted of a hemorrhage in 3% of the cases, easily stopped with a vaginal packing. In 2% of the cases a risuture under general anaesthesia was required. In 1 case the stitches loosened and in another a urinary infection was present. Twenty-six patients underwent total hysterectomy after conization for different indications; only one patient had a relapse after six months as there was a moderate dysplasia localized in the vaginal vault. During the follow-up, 14 patient became pregnant. Among these, 5 underwent legal termination during the first trimester and 9 delivered at term without any complication. During these follow-up of 7 years in the older cases and 6 months in the more recent ones, 6 cases displayed a persistence of the disease after 3 months, (CIN of variable degree) and 2 cases relapsed at the second colpocytological control. These patients, according to the age and the presence of clinical indications, underwent total hysterectomy or diathermic coagulation with resolution of the disease. A relapsing invasive tumor was never observed.)

The Authors have carried out a cyto-hystologic study on 533 cervical intraepithelial neoplasias (CIN) devoted to identifying the association frequency between cervical dysplastic lesions and cervico-vaginal infections caused by Trichomonas vaginalis, Chlamydia Trachomatis, Herpes Simplex virus and Human Papilloma virus. HPV lesions have revealed the pathology found more frequently in CIN lesions (33.2%) compared to 0.19% in the normal population, while the other infections have not shown significant differences between dysplastic lesions and normal control. In patients with CIN, the assumption of the estro-progestinic pill does not seem to contribute to the increase of frequency of cervico-vaginal infections.

The Authors report the results of a study on the diffusion of CIN and of invasive carcinoma of the portio in the Trieste population over the 1977-1986 decade. In order to achieve this aim all the bioptical specimens analyzed in the Institute of Pathological Anatomy and Histology of Trieste University were reviewed. Over this period 313 cases of CIN 1-2, 314 cases of CIN 3 and 289 of invasive carcinoma were diagnosed. The average age for CIN 1-2 lesions was 33.5 (range 17-78), for CIN 3 39.9 (range 18-81) and for invasive carcinoma 58.6 (range 26-89). The distribution by age group was markedly different in the three types of lesion dealt with, showing a substantial presence of preinvasive lesions under the age of 50. During the period considered a significant decrease in the incidence of invasive carcinoma was not recorded, in contrast with other reports. This datum may be explained by the fact that the number of women undergoing cyto-oncological screening has not increased over the last decade.

The authors report the incidence of endometrial adenocarcinoma and atypical hyperplasia in 245 women who had undergone uterine curettage for post-menopausal bleeding. In 4 cases a stenosis of the cervix precluded the curettage. Of the remaining 241 patients, 71.3% had negative histology; in 24.4% histology was compatible with adenocarcinoma or atypical endometrial hyperplasia; in a third group of 10 patients a different type of gynecological neoplasia was diagnosed. Obese, nulliparous women were more significantly affected by endometrial adenocarcinoma. The highest incidence was noted among women over 60 years of age. The authors describe some epidemiological and clinical characteristics of the population under study.

1103 cases of endometrial hyperplasia were diagnosed between January 1, 1978 and December 31, 1987 at the Department of Anatomy and Pathological Histology of the University of Trieste. Of these, 58% were cases of cystic glandular hyperplasia, 38% of adenomatous hyperplasia and 4% of atypical hyperplasia. Subdividing the period examined into two five-year periods, it was found that the rate of incidence of endometrial hyperplasias was more than doubled, this increase having been caused above all by cases of cystic hyperplasia. Distribution by age classes of subjects suffering from different hyperplastic forms suggests that cystic glandular hyperplasia is not a precursor of the adenomatous form, whereas the latter and atypical hyperplasia might constitute a continuous spectrum of potentially precancerous lesions.

The data resulting from an epidemiological and anatomopathological study on ovarian tumours in the Trieste province are presented. 970 cases of ovarian neoplasms diagnosed in the Institute of Pathological Anatomy and Histology of Trieste University over the 1969-1985 period were analyzed: 66.7% were benign and 33.3% were malignant. The crude incidence of benign ovarian tumours was 24.2/100,000 and that of malignant tumours was 12.1/100,000. The incidence rate of the latter standardized on the world population was 6.5/100,000. It is a low level, which does not increase over time. Benign ovarian tumours affect all age groups, while malignant tumours are more frequent among elderly women. In addition, the distribution by age group varies according to the histological type. Among benign tumours, the most frequent are the epithelial ones (over 50% of the total), followed by tumours of germinal origin (27.5%), tumours of the ovarian stroma (21.6%) and those of ovarian non-specific tissues (0.8%). Among malignant neoplasms, epithelial ones are 94.4%, germinal tumours 2.8%, stromal tumours 1.8% and sarcomas 0.9%.

Ovarian cancer is the first cause of death from gynaecological malignancy. The poor over-all five year survival rate requires a specific procedure for early detection of ovarian carcinoma. An evaluation of ultrasonography as a screening test in early ovarian cancer is currently used in our Institute. A group of 500 volunteers without clinical symptoms, older than 45 years, and/or in postmenopausal period, were submitted to the procedure. We used a real-time mechanical sector scanner with 3 mHz transducer. The morphology and size of both ovaries were assessed. Abnormal results were obtained in 11 women. Four (4) postmenopausal patients underwent surgery. At the moment our study proves that ultrasonography is a valid procedure in the investigation of the ovaries in postmenopausal women. We need further evaluations to assess the real effectiveness of ultrasound examination as a screening test for early detection of ovarian cancer.

Flow cytometry is used to screen gynaecologic specimens for Cervical Intraepithelial Neoplasia (CIN) and its precancerous lesions, possibly associated with human papilloma virus (HPV), in order to investigate the role of aneuploidy as a biological marker in HPV and CIN lesions. A total of 299 cervical samples was collected by scraping and the cellular DNA content was measured using the propidium iodide staining procedure. Two groups of patients were studied; a group of 142 negative controls for cytology and groups of patients assigned to mild, moderate or severe dysplasia, carcinoma in situ diagnosed by histologic classification according to the Papanicolaou staining technique. Pathological samples showing an alteration of the DNA index or perturbation of the cellular phase S compartment ranged from 6.4% to 41.9%. Our results confirm those obtained by other authors and suggest the hypothesis that aneuploidy is present with permanence of viral DNA in early stages of carcinogenesis, which can be used as a marker in the transition from benign to malignant cells. This work is of potential interest for the possible follow-up of patients having condyloma and could aid the early diagnosis of cervical carcinoma.