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The reproductive history of 19 women with a diagnosis of unicornuate uterus confirmed by laparoscopy or laparotomy is analyzed. The patients were followed for 2 to 10 years. One patient had a cavitary communicating rudimentary horn, four a cavitary noncommunicating rudimentary horn, seven a noncavitary rudimentary horn, and seven no rudimentary horn. Six of the patients presented with primary infertility. The other 13 women had a total of 29 pregnancies, 1 (3.4%) in a rudimentary horn determining rupture; abortions occurred in 17 (58.6%), premature labor in 3 (10.3%), and term births in 8 (27.6%), with a live birth rate of 38%. Of the 11 births, 6 (54.5%) were breech presentations, and 9 (81.8%) were cesarean sections. In five cases the rudimentary horn was removed, with associated salpingooophorectomy in three patients. Cervical cerclage was not performed in any of the patients.

Chronic pelvic pain (CPP) in adolescent women is a frequent complaint. We assessed the value of laparoscopy in the differential diagnosis of CPP in 47 adolescents 11-19 years old after six months or more of cyclic or acyclic pelvic pain. No pelvic abnormalities were detected in 19 patients (40.4%), endometriosis was detected in 18 (38.3%) (frequently with nonpigmented or "nonclassic" lesions), partially obstructive genital tract malformations were found in 4 (8.4%), and other types of pathology were discovered in 6 (12.8%). Nearly 60% of the patients had a treatable pelvic disease. Laparoscopy is an invaluable tool in the diagnosis of CPP in adolescents and should be performed before starting a psychiatric evaluation or prescribing long-term medical treatment.

GnRH agonists, synthetic peptide analogs of GnRH, desensitize pituitary receptors for the native molecule, thus causing reversible hypogonadotropic hypogonadism. Numerous clinical studies have suggested that these compounds are efficacious in the treatment of endometriosis, but it is not clear whether they are superior to the other drugs used in treatment of this disease. The frequency of recurrence of pain symptoms at the end of treatment is high and the data on recovery of fertility are conflicting. Long-term administration of GnRH agonists is a safe and well tolerated treatment but its role in the management of endometriosis is still not well defined.

The placental morphology in 22 cases of induced abortion performed one to three months after the Seveso disaster is described. In 15 cases no gross histological or ultrastructural alterations were observed. In seven cases there were many prominent microprecipitates beneath the trophoblastic basement membrane at various distances from the fetal capillaries. Intermediate patterns between simple dense bodies, already well known, and complex pluri-stratified giant structures not previously reported have been described. Combined ultrastructural and x-ray investigations (EDAX analysis) have recorded calcium- and iron-related emissions from these structures. The significance of these findings and their possible relationship to dioxin poisoning has been discussed.

Ca 125 levels in serum and peritoneal fluid were measured in 39 patients with endometriosis and 18 patients with normal pelvic anatomy at laparoscopy, and the presence of this antigen in endometriotic tissue and endometrial mucosa was also investigated. Serum CA 125 concentrations were elevated in patients with Stage III or IV endometriosis compared with control subjects (32.9 +/- 11.2 versus 16.4 +/- 8.9 U/ml, means +/- SD; p less than 0.001). CA 125 values were greater than 35 U/ml in 36.8% of women with Stage III or IV endometriosis and in none of the control subjects. No significant differences in CA 125 levels in peritoneal fluid were found between patients with endometriosis and control subjects. The immunohistochemical studies found CA 125 in 10% of the endometriotic lesions and 37.5% of the endometrial samples of patients with endometriosis and in 33.3% of the endometrial samples of control subjects.

In the 12 subsep uteri the endometrium covering the septum was studied using light microscopy, electronic scanning microscopy and electronic transmission microscopy for the purpose of determining if it should be considered a reason for inadequate implantation and therefore justify an anomalous evolution of pregnancy. The results show that compared with a normal endometrium there is only a slight difference with the basal state. This alteration could however negatively influence the stages of development following implantation and particularly the structure of the maternal-fetal relationships which preclude placentation.

C57Bl/6 J mice (6-8 weeks old) were given single i. p. doses (1, 2, 6 and 30 micrograms/kg) of 2,3,7,8-tetrachloro-dibenzo-p-dioxin (TCDD) and macrophage-mediated and natural killer (NK) cell-mediated cytotoxicity was evaluated at different times after treatment. Peritoneal macrophage cytolytic activity was measured as 3H-thymidine release from prelabelled mKSATU5 target cells in a 48 hours assay; macrophage-mediated cytostasis was assessed in terms of inhibitions of 3H-thymidine uptake by SL2 lymphoma cells. Spleen NK activity was measured using 51Cr-labelled YAC-1 lymphoma cells as targets. TCDD did not modify spontaneous macrophage-mediated and NK cell-mediated cytotoxicity per unit number of effector cells nor did it affect the macrophages' capacity to express increased cytolytic and cytostatic activity in the presence of endotoxin. Lower numbers of peritoneal macrophages and splenocytes were recovered from TCDD treated mice. Thus the total numbers of lytic units recovered from animals exposed to TCDD were lower than controls. Impairment of these cellular effector mechanisms, due to cell loss rather than inhibition of function, might play a role in the lowered resistance to bacterial infection of mice given TCDD and in the carcinogenic and cocarcinogenic activity of this chemical.

The results of second-look laparoscopy were compared with subjective symptomatology and findings at pelvic exploration in 36 patients who had received conservative treatment for endometriosis. In the 14 patients given pharmacologic treatment, second-look laparoscopy demonstrated active endometriosis in 57.1%, whereas pelvic pain was present in 64.3% and gynecologic examination was positive in 28.6%. In the 22 patients who underwent surgery, active endometriosis was detected by second-look laparoscopy in 31.8%, whereas 40.9% reported pelvic pain and pelvic examination was positive in 31.8%. Thus clinical signs and symptoms were unreliable in the diagnosis of endometriosis recurrence, whereas laparoscopy was indispensable. It should be programmed for 6 months from the end of medical treatment and 12 months after surgery; however, if the pain symptomatology recurs, then laparoscopy is performed immediately.

Circadian and circatrigintan profiles of prolactin (PRL) in young normally cycling women at 4 well characterized times of the ovulatory cycle have been compared. Circadian patterns of PRL (collected at 2-h intervals for 24h at each phase selected) change during the 4 phases, being higher in the luteal phase. In a consistent percentage of individuals, serum PRL rises notably during the night; in one half of the subjects a peak is located also in the afternoon or early evening. The statistically significant circatrigintan rhythm of PRL shows the acrophase approximately in the mid-luteal phase.

The short-term reproductive prognosis of recurrent miscarriage for which no cause was found has been evaluated in 95 couples investigated between 1980 and 1986 at the First Obstetric and Gynaecological Clinic of the University of Milan. The actuarial overall 3-year livebirth delivery rate was 64%, increasing constantly with time. The reproductive success rate decreased with the number of previous miscarriages from 80% in women with two, to 60% with three and 46% with four or more miscarriages. No effect of age and socio-economic status emerged. There was a positive association between the number of previous miscarriages and the risk of miscarriage in the next pregnancy. Compared with women with two miscarriages the relative risk of another miscarriage was 2.3 for those with three previous miscarriages and 5.0 for those with four or more (chi 2 1 for trend adjusted for age = 5.2, P = 0.02).

176 cases of cervical stump cancer have been reviewed. "Coincident cancer" and "True cancer" distinction has been made. Histological features, therapeutic plane and survival have been reported.

In the period 1979-1983, 102 patients with endometriosis underwent conservative surgery at Ia Clinica Ostetrica e Ginecologica, Milan University. Treatment indications, techniques and results are presented. 34.3% of the women were in stage I, 51% in stage II and 14.7% in stage III of the American Fertility Society classification. Postoperatively, the incidence of dysmenorrhea fell from 63.7% to 15.7%, deep dyspareunia from 53.3% to 17.6% and chronic pelvic pain 21.6% to 11.8%. In 1-6 years' follow-up of the 53 women wanting children, the postoperative birth-rate was 68.3% in stage I patients, 59% in stage II and 37.5% in stage III. Endometriosis treatment is still only symptomatic, and conservative surgery, using atraumatic procedures, should aim at restoring fertility and resolving pain symptomatology.

Spontaneous abortion is the commonest complication of pregnancy. Its reported incidence appears to be constant in developed countries but the frequency of subclinical fetal loss is largely unknown. There is a well known relationship between fetal loss and advancing maternal age. Trisomic fetuses occur more commonly in older women and most are aborted but old women are also at greater risk of aborting a chromosomally normal fetus. Recent epidemiological data have demonstrated a significant association between maternal cigarette smoking and spontaneous abortion. A role of gravidity, early age at menarche, alcohol and methylxanthine consumption has been recently claimed, but epidemiological evidence is scanty and largely controversial. The present paper reviews the epidemiological data on spontaneous abortion.

The Authors report survival data concerning 40 patients affected by cervicocarcinoma who, between 1970 and 1979, underwent exploratory laparotomy after pelvic radiotherapy, with detection of paraaortic lymphnode metastases. The patients subjected to laparotomy only (21 cases) have a 9-month average survival, which increases to 24 months in those with lymphadenectomy and complete pelvic surgery. While all the patients in the first group have died, in the second 3 survive at 5 years and 3 show no evidence of disease at 52,46 and 35 months from surgery. Hysterectomy with pelvic and lomboaortic lymphadenectomy, whether therapeutical or palliative, seems to be in patients with paraortic metastases provided surgery is feasable.

To investigate ultrastructural modifications in the endometrium of women receiving clomiphene citrate (CC) treatment, we performed endometrial biopsies in the preovulatory phase in 17 patients with anovulatory infertility and 16 normo-ovulating women with tubal or male sterility. Histology, scanning and transmission electron microscopy (SEM and TEM) revealed midproliferative phase aspects in 11.7% of the treated group and 6% of the controls, late proliferative aspects in 76.4% and 82%, and postovulation days 1-3 characteristics in 11.7% and 12% respectively. No significant differences were observed between the patients and controls; our data indicate that CC taken in a dose not exceeding 100 mg/day from day 3 of the cycle can induce endometrial maturation that is almost identical with that of a spontaneous preovulatory phase. This type of endometrium should therefore allow implantation of a fertilized egg and maintain unmodified the complex biohumoral relations with the embryo.

Eighty-nine patients were examined by ultrasound during the second phase of the menstrual cycle. The operators were not aware of the patients' history or results of previous ultrasonographic or radiologic investigations. The operators' aim was to diagnose uterine malformations graded as normal, suspected, or abnormal. Ultrasound identified 7 of 9 patients with a didelphic or complete septate uterus and 2 out of 3 with a bicornuate or partial septate uterus. Two other cases were suspected (one with a unicornuate, the other with a didelphic uterus). One false-positive case occurred, and 10 patients were not identified as having a malformed uterus (sensitivity, 42.9%; specificity, 97.8%). False-negatives involved mainly minor malformations.

By interview with several women a dramatic problem for the doctors: how to give doomed patients something more than mere medical help.

We describe a method, based on Selye's granuloma pouch, for establishing reproducible Bacteroides fragilis infections in both mice and rats starting from rather low inocula. The infected pouches resemble abscesses and phlegmons. This model is promising for studies of antibiotic therapy in that both bacterial kinetics and antibiotic levels can be followed in the exudates.

A hysteroscopic second look has been performed following sixteen intracavitary myomectomies, twenty-nine metroplasties and thirty-four intra-uterine adhesiolyses. This control has been performed three months after laparotomic operation and after forty-five days of sequential estro-progestogen treatment in cases of transcervical operation. The hysteroscopic second-look proved to be an excellent follow-up method after uterine conservative surgery and it avoids the use of X-rays, allows a detailed morphological evaluation of the uterine cavity and offers the possibility of complementary surgery, when necessary.

One case of left fallopian tube prolapse following vaginal hysterectomy is reported. Modifications of the endosalpinx at S.E.M. show a mucosa relatively resistant to biological assault.

One hundred twelve cases of female urinary incontinence were studied. The bladder was stable in 53 patients and detrusor instability was detection in 59 of the incontinent women. Cystometry performed in the supine position cannot be relied upon to be sufficiently useful in the complete evaluation of various forms of instability. Involuntary detrusor contractions occurring during one or more provocative tests represent an abnormal bladder behavior pattern. An isometric contraction develops when the stream is interrupted and stable incontinent women show only a small isometric rise in 35 cases (66%). Fifty-six patients with unstable bladders presented a large isometric detrusor contraction (95%). Urodynamic studies combined with voiding stop tests can increase the clinical information of female urinary incontinence.

Through sonographic sections with mid-empty bladder it is possible to evaluate all uterine biometric data. This technique was evaluated in thirty-four cases of uterine malformations and satisfactory results were obtained in thirty-two of them. If further studies on randomized patients confirm the specificity of this technique, it could become a basic non invasive investigation for the screening of uterine malformations.

Fourteen infertile women with hysterographic diagnoses of unicornuate uterus underwent pelvic ultrasonography and, subsequently, laparoscopy to evaluate the ability of ultrasound to diagnose the subclasses of this malformation. Seven women underwent laparotomy to remove a rudimentary horn. Ultrasound demonstrated a sensitivity of 85.7% and a specificity of 100% in diagnosing the presence of a rudimentary horn, and a sensitivity of 80% and a specificity of 100% in diagnosing the presence of a cavity in the rudimentary horn. Urography confirmed the supplementary information on the urinary tract provided by ultrasound. Ultrasound appears to have a role in the clinical management of women with unicornuate uterus.

In vitro exposure to saccharin (0.1-2 mg/ml) did not affect the tumoricidal activity of macrophages and natural killer (NK) cells from mice and rats. In contrast saccharin at doses of 0.5-2 mg/ml significantly and consistently depressed the blastogenic response of rat lymph node cells to phytohemagglutinin (PHA). Similarly mouse splenocytes showed impaired responsiveness to PHA and bacterial lipopolysaccharides n the presence of 2 mg/ml saccharin. Compared with murine lymphoid cells, human peripheral blood lymphocytes were relatively resistant to the immunodepressive activity of saccharin, a low but significant, depression (21%) of the response to PHA being observed only at the highest concentration (2 mg/ml) in 1 of 3 normal healthy donors tested.

Endometrial biopsies were obtained in 12 volunteers between 18 and 35 years old who had used SHB 209 AE oral contraceptive during the previous six months. Three main types of endometrial patterns were observed: proliferative, very similar to a normal proliferative phase; early secretory: similar to early postovulatory endometrium; late secretory: characterized by diffuse predecidual changes in the stroma. At SEM after one week a great prevalence of nonciliated cells was observed. During the 2nd and the 3rd week, the endometrial surface appears still flattened with scanty glandular outlets.

Spontaneous or Bacillus Calmette Guérin (BCG)-stimulated macrophage cytotoxicity was investigated in the peritoneal cavity of BALB/c x DBA/2 treated with various chemotherapeutic agents. The SV40-transformed mKSA TU5 (TU5) line and the mFS6 sarcoma were used as targets. Cytolytic activity of macrophages from individual mice (4-6 per experimental group) was measured as release of [3H methyl]thymidine from prelabelled target cells. Treatment with azathioprine (a single injection 100-400 mg/kg or 5 daily doses of 10-80 mg/kg s.c.) and dimethyltriazenoimidazole carboxamide (a single injection of 45-180 mg/kg or 5 daily doses of 3-30 mg/kg i.v.) resulted in marked dose-dependent inhibition of spontaneous macrophage cytotoxicity against TU5 tumor cells 2 days later. By 7 days after drug treatment spontaneous cytotoxicity of macrophages had returned to normal levels. In contrast adriamycin (a single dose of 5-10 mg/kg or 5 daily doses of 0.6-2.5 mg/kg i.v.) and cyclophosphamide (a single dose of 50-200 mg/kg or 5 daily doses of 6-25 mg/kg i.v.) did not affect spontaneous cytolytic activity of murine macrophages. BCG-stimulated macrophage cytotoxicity was investigated using mFS6 target cells which were relatively resistant to the spontaneous levels of macrophage-mediated cytolysis; the same pattern of effects was observed, azathioprine and dimethyltriazenoimidazole carboxamide inhibiting cytolytic activity levels in contrast to adriamycin and cyclophosphamide. These results are discussed in terms of the known effects of these agents on other functions of mononuclear phagocytes and on other immune reactivities.

From January, 1973, to June, 1976, 226 patients with palpable ovarian masses were evaluated preoperatively by lymphography. Histology showed 166 cases of malignant epithelial tumors, 26 benign tumors, and 34 malignant special tumors (not included in this report). Furthermore, the group of patients included 99 recurrences of ovarian epithelial cancer and 24 patients who underwent restaging diagnostic procedures without clinical evidence of disease. Lymphography was negative in all patients with benign tumors. In the 289 cases of epithelial cancer, lymphangiography gave evidence of nodal metastases in 88 (30%). When the histological subtype was considered, the highest incidence of metastases was in undifferentiated carcinoma (50%) and the lowest, in mesonephroid carcinoma (14%). According to the stage before lymphography, nodal metastases were found in 8% of Stage I, 0% of Stage II, 29% of Stage III, and 53% of Stage IV cases. The incidence of metastases was 46% in patients studied for recurrent disease and 17% in patients studied for restaging. Fifty-four percent of patients had metastases only in the pelvic nodes and 18% only in the para-aortic chains; in 28% both chains were involved simultaneously. Bilateral involvement was found in 63% of the positive cases. Retroperitoneal node biopsies were performed in 68 patients (36%). The radiologic/histologic correlation was 100% in the lymphangiographically positive cases; 81% in the negative cases, with nine false-negative reports; and 87% in all cases.

Endometrial reconstruction after hysteroscopic metroplasty of a septate uterus was studied by light microscopy and scanning electron microscopy when the uterus was removed 13 days after metroplasty for a histologic diagnosis of leiomyosarcoma. We observed a retraction of the margins of the incised septum, which could prevent the formation of intrauterine adhesions. Reepithelialization of the cut surface seemed to proceed both centripetally, by proliferation of the surrounding normal endometrium, and centrifugally from the bottom of the glands present at the base of the septum.

A total of 18 infertile patients with hysterosalpingographic diagnosis of bifid uterus underwent magnetic resonance imaging (MRI) and subsequent laparoscopy or laparotomy to evaluate the capability of MRI to differentiate among the various classes of the malformation. Magnetic resonance imaging identified both bicornuate uteri correctly, both didelphic uteri, nine of the 12 partial septate uteri, and both complete septate uteri. The method demonstrated a sensitivity of 100% and a specificity of 78.6% in demonstrating cervical prolongation of the spur. Compared with laparoscopy, MRI is less expensive and less invasive, and can also be performed in patients with extensive adhesions. However, it has the disadvantage of not providing information on tubal conditions or on the presence of minimal and mild endometriosis.

Authors report the endosalpingeal scanning electron microscopy (S.E.M.) findings in eleven tubes removed for ectopic pregnancies. The first aim of this study is to verify whether there is a corresponding morphological common aspect in all cases. The second aim is that of locating, with the aid of S.E.M. findings, some prognostic indications for predicting the future fertility of the patient.

The association between spontaneous abortion and ectopic pregnancy was evaluated in a case-control study conducted on 161 women (cases) with recurrent spontaneous abortions (two or more consecutive spontaneous abortions) and 170 control subjects who delivered normal infants. The risk of ectopic pregnancy in women with a history of recurrent spontaneous abortion was about fourfold that of controls (relative risk adjusted for age and number of pregnancies = 4.3; 95% confidence interval 1.4-14.7). This association was confirmed by comparing the observed number of extrauterine pregnancies in women with recurrent spontaneous abortions with the expected number computed from regional data on the frequency of ectopic pregnancies; the estimated relative risk was 3.7, with a 95% confidence interval of 2.2-7.0. The present report found an association between spontaneous abortions and ectopic pregnancies, suggesting some common risk/etiologic factors for these two reproductive failures.

A total of 43 infertile patients with hysterosalpingographic diagnosis of bifid uterus underwent sonography and subsequent laparoscopy/hysteroscopy to evaluate the capacity of ultrasound to demonstrate the peritoneal profile of the malformed uteri correctly. Sonographic visualization was adequate in 39 cases (90.7%) and the following were identified correctly: 1 of 2 didelphic uteri, all of 11 bicornuate uteri, all of 4 complete septate uteri, and all of 22 partial septate uteri. The sensitivity of ultrasound in detecting the presence of a perimetrial fundal notch was 92.3% and its specificity 100%. Thus, a precise differential diagnosis of "double" uteri was possible with this technique, which may in some clinical situations provide an alternative to laparoscopy.

Sonography was used to study the site of uterine implantation of 12 pregnancies in eight patients with complete septation of the uterus. The purpose was to determine the incidence of septal implantation in these patients and its relation to the outcome of the pregnancies. The live-birth rate in the 12 pregnancies was 33%. Three pregnancies (25%) went to term and ended in live neonates. One (8%) resulted in a premature delivery and the neonate survived. Eight (67%) ended in abortion. Sonograms showed that in all four pregnancies that were not aborted, implantation was in the lateral wall of the uterus. In comparison, in the eight pregnancies that terminated in abortion, implantation was septal in six, mixed in one, and undetermined in one. Our experience with this small group of patients suggests that pregnancies in septate uteri have a poor prognosis and that abortion is related to septal implantation.