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Background: Osteoporosis is the most wide-spread metabolical illness in the world, affecting from 30-40% of white women and 13% of white men over 50 years of age. Recently, the DEXA technique (Dual Energy X-ray Absortiometry) has proven to be a method, which is accurate, precise, low-cost, low-risk in terms of exposition to radiation and fast in terms of execution times., Methods: The results obtained by comparing 54 DEXA examinations with the same number of conventional X-ray examinations are presented. 54 women in menopause were submitted to a computerized bone mineral evaluation with a 2.0 version DEXA EUROMOX TBS at the level of the lumbar region (L1-L5) and the left femur, at the Gynecology and Obstetrics Clinic of the University of L'Aquila. During the same session the women were subjected to X-rays of the lumbar column, pelvis and femurs., Results: A diagnosis of osteoporosis was reported in 59% of the women in both the lumbar and femoral regions with DEXA, while conventional radiography showed osteoporosis in 33% of the examinations of the spinal column and in 51% of the femurs., Conclusions: Thus, it was demonstrated that the presence of a disorder at the level of the spinal column can lead to an interference in the diagnosis, while the association of the femoral region, which is less subject to related disorders leads to a more accurate diagnosis of osteoporosis in doubtful cases.

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.

Background: AUB (abnormal uterine bleeding) is one of the most common pathologies. It is therefore important to use a method that is easy to carry out in order to ensure a rapid and reliable diagnosis. Hysteroscopy may represent the elective method for the study of the uterine cavity., Methods: A total of 222 women suffering from AUB were studied between January 1996 and June 1997 at the Department of Surgery, Gynecology Clinic of L'Aquila University. Their age ranged between 30 and 74 years old. The exclusion criteria for the study were as follows: presence of a genital infection in active or latent phase, pregnancy in progress or abortion. All patients underwent operative hysteroscopy with targeted biopsy accompanied, when necessary, by endometrial ablation. All biopsies underwent histological analysis and the results of hysteroscopic diagnosis and histological diagnosis were then compared., Results: There was a 85% correspondence between results. The main difficulties were encountered in the identification and selection of the characteristics of hyperplasia. Moreover, during the study it was found that hysteroscopy was both diagnostic and also therapeutic since it enabled the removal of polyps and intracavitary fibroma or endometrial ablation if required., Conclusions: Hysteroscopy was therefore found to be a totally reliable method for the study of abnormal uterine bleeding compared to the histological tests carried out.

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.

Objective: To compare colposcopic findings to cytologic and histological diagnoses in women with colposcopic reports of ANTZ and/or HPV infection., Methods: Among 791 hospitalized women referred for colposcopic examination, colposcopy showed ANTZ grade 0-2 and/or HPV infection in 271 patients (34.26%). Only 153 were fully investigated by colposcopy, cytology (under colposcopic observation) and histology (target punch biopsy: 109 patients; surgical specimens of hysterectomy: 42 patients; conization: 2 patients). Cytological and histological diagnoses were reported according to the Bethesda System., Results: 132/153 Pap smears were estimable for sampling adequacy; 44/63 resulted as normal and were histologically positive for LSIL [1]. Five LSIL-positive Pap tests were negative on histology (false negative and false positive rate of 33.33% and 3.78%). The pap test was diagnostic for intraepithelial neoplasia in 34/65 cases (53.3%) and for invasive cancer in 6/11 cases (54.5%). In 67/132 cases (50.8%) adequate-for-sampling Pap smears could not predict the exact diagnosis. On the other hand, 108/141 patients with colposcopic evidence of ANTZ/cancer showed histological SIL or invasive neoplasm (76.59%): ANTZ 1 was associated to LSIL and HSIL in 74.1% and 2.4%; ANTZ 2 to LSIL, HSIL and invasive cancer in 41%, 30.76% and 10.3%. Colposcopic suspicion of invasive cancer in 8 patients was histologically demonstrated in 7 (87.5%); colposcopic diagnosis of HPV infection was confirmed in 10/12 (83.4%)., Conclusion: A better correspondance was shown between colposcopy and histology than between cytology and histology in the diagnosis of SIL. We suggest a routine colposcopy investigation for all patients admitted to a gynecological clinic and we believe it is very important to take Pap smears under colposcopic observation if colposcopy and cervical smears are performed in the same sitting.

Objective: This study aimed to evaluate the risk of preterm delivery in the asymptomatic obstetric population of L'Aquila by means of fetal fibronectin immunoassay in cervicovaginal secretions., Methods: In this prospective study, 60 asymptomatic pregnant women at low-risk for preterm delivery were followed-up. Fetal fibronectin cervical swabs from the esocervix and posterior vaginal fornix were obtained every second week from 24 to 36 weeks of gestation. Fetal fibronectin concentrations were measured by an enzyme-linked immunosorbent assay with a cutoff level set at 50 ng/ml., Results: Twelve patients (20%) had at least one positive fetal fibronectin test result. Six women in our study group (10%) were delivered spontaneously < 37 weeks; 4 of these (66%) had at least one positive fetal fibronectin test result (positive predictive value: 33%; sensitivity: 66%) and 3 of these women (75%) had a positive test result between 24 and 26 weeks. The remaining 8 patients with at least one positive fetal fibronectin test were delivered at term or post-term. Forty-eight women always had negative tests and 46 (95.8%) of these were delivered at term (specificity 82%), whereas 2 (4.2%) were delivered prematurely. The negative predictive value of fetal fibronectin as a predictor of term delivery in this low-risk population in 95% with odds ratio = 11.5 (95% confidence interval 1.44 to 110.4), relative risk = 8 (95% confidence interval 1.38 to 59.2) and Fisher Exact Test p < 0.024., Conclusion: In a population of asymptomatic patients at low risk for prematurity, the occurrence of a positive cervical or vaginal fetal fibronectin test result defines a subgroup at increased risk for preterm delivery, mostly at low gestational age.

Purpose: To evaluate activity and tolerability of intramuscular administration of 17-alpha-hydroxyprogesterone caproate (Lentogest-Amsa) in hormone replacement therapy in menopause., Patients and Methods: Intramuscular slow releasing 17-alpha-hydroxyprogesterone caproate was given to 30 postmenopausal women. Patients were divided into two groups according to the number of monthly doses (1 or 2)., Results: In both groups of patients a regular monthly bleeding was obtained. Echographic assessment did not show abnormal endometrial thickness., Conclusions: The results of this study have pointed out the efficacy of intramuscular progesterone-caproate administration with a better compliance in the single dose group.

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.

Background: To evaluate the triple screen serum test as a noninvasive screening test for expectant mothers > 35 years old, who are not usually considered for invasive screening for trisomy 21., Methods: 1784 tri-tests (triple serum screening tests) were performed on expectant mothers between their 15th and 18th week of pregnancy, using the radioimmunological Ria-Kodak with an Alpha program (Logical Medical System LTD) with a cut-off value of 1:350., Results: 244 positive equal to 13.60%. The percentage of false positives was respectively 12.9% (age < 35) and 28% (age > 35). Only in two of these cases did we have a positive response in amniocentesis for a fetus affected with Down syndrome. Of the 1540 patients with a negative tri-test, one woman gave birth to a fetus with Down syndrome., Conclusions: Our study revealed a sensitivity of 66%. The elevated number of false positives has led us to decide on a variation on the cut off in the future: from 1:350 to 1:300.

Background: Hormonal replacement therapy (HRT) is always of major employ in the practice. Unfortunately, a high percentage of women interrupt therapy after a few months., Methods: Two hundred menopausal women with intact uterus were studied. During the first consultation, they received an informative booklet regarding the menopause, without any verbal information. During the second visit, the gynaecologist discussed with the patient the information acquired and prescribed the HRT (50 mcg/die of transdermal estradiol, as continuous therapy, and 5 mg medroxyprogesterone acetate/os for 10 days/months) to those who required it. The compliance to treatment at 3, 6 and 12 months has been recorded., Results: Of the 200 women studied, 153 referred to have read the informative booklet: 112 requested further informations to their family doctor; 97 discussed the contents with the partner; 130 expected HRT. The 3 months, 6 months and 12 months compliance has been of 110 (84%), 97 (74%) and 68 women (52%) respectively. Causes of drop out: breast tension (12%); water retention and/or increase of weight (20%); headache (7%); vaginal blood loss (22%); others [fear of cancer, etc.] (54%)., Conclusions: According to personal opinion, three factors may condition the compliance to the HRT: 1) circumstantial information, not only verbal before the onset of therapy; 2) treatment protocols with low incidence of side effects; 3) frequent follow-up.

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.

Objective: To evaluate colposcopy in the monitoring of patients affected by locally advanced cervix cancer treated with primary chemotherapy., Materials and Methods: Eight patients (42-54 years old) affected by squamous cervical cancer locally advanced (stage FIGO IIa "bulky"/IIb/III) were treated with primary chemotherapy (cisplatin 50 mg/m2 vincristin 1 mg/m2 bleomicin 30 UI in 24 hours continuous infusion q 7 days for 3 cycles). Colposcopy was performed before chemotherapy, after the second cycle and at the end of chemotherapy., Results: Two pathological complete responses, 5 partial responses and one case of stable disease were observed. Patients with complete and partial response were treated with radical hysterectomy. In responding patients we observed a typical sequence of colposcopic findings. Regression of distinctive malignancy feature, reduction of atypical vessels, gradual disappearance of peripheral lesions and centripetal reepilization of the cervix were sequentially registered. At the end of treatment the cervix appeared with a colposcopy imaging as well as a centripetal squamous complete or incomplete metaplasia, open--for most part--glandular exit and weak acid-iodic positivity., Conclusion: In responding patients we observed a typical sequence of colposcopy finding, useful in order to evaluate the effects of chemotherapy and to programme the surgical approach.

Background: Abnormal uterine bleeding is the most common symptom of endometrial pathology. In the past, D and C (Dialation and Curettage) was the best way for both diagnosis and therapy. We used hysteroscopy in the study of endometrial pathology. The purpose of this study was to evaluate transvaginal ultrasound testing compared to hysteroscopy., Methods: 288 women with abnormal uterine bleeding underwent transvaginal tests and hysteroscopies with biopsy and curettage., Results: The study reported a 0.91 sensitivity and 0.89 specificity of the transvaginal probe. The authors consider the transvaginal examination a good to evaluate endometrial pathology., Conclusions: Furthermore, they have found the endometrial thickness and pattern with the TVG probe of value as the first step in any endometrial diagnosis, with or without bleeding.

Parvovirus B19 is a small, heat-stable, single-strained DNA virus (5.5 kb), with 23 nm icosahedral capsid discovered in 1975. Since its discovery, the virus has been shown to be a causative agent of erythema infectiosum (fifth disease). Under specific circumstances it can cause transient aplastic crisis, chronic anemia, arthritis and fetal death. Laboratory diagnosis of recent or past B19 infection usually relies on the demonstration of virus-specific IgM or IgG antibodies in patient's serum. The aim of this study was to evaluate the prevalence of Parvovirus B19 infection among 87 pregnant patients. Our study on anti-B19 antibody prevalence indicates that about 64% of pregnant women in our country lack specific antibodies and are at risk of B19 infection. One intrauterine death was encountered in a patient with specific IgM antibodies. The authors suggest the detection of IgG and IgM anti-B19 antibodies as a routine screening practice during pregnancy.

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.

A total of 53 patients were included in this study, aged between 21 and 72 years old and hospitalised with the diagnosis of ovarian tumour. All patients underwent a clinical examination, ultrasonography and NMR prior to surgery. The findings of ultrasonography and NMR were correlated with histological results in order to evaluate the value of these methods in the differential diagnosis of benign and malignant ovarian tumours. Histological tests revealed 46 benign tumours, 3 borderline cases and 4 malignant growths. Transvaginal ultrasonography revealed precisely 47 out of 53 ovarian tumours, and NMR 49 out of 53. The main limitation of both techniques was the tendency to overestimate ovarian lesions (specificity: ultrasonography 89%, NMR 93%). As far as concerns the identification of malignant lesions NMR does not appear to offer significant advantages in comparison to ultrasonography (sensitivity 85% ultrasonography = NMR).

Preoperative staging is fundamentally important in endometrial carcinoma. The presence of lymph node metastasis and the risk of tumour recidivation are correlated to the degree of myometrial invasion by the tumour. The preoperative diagnosis of the absence of myometrial invasion may render pelvic lymphadenectomy superfluous. A group of 24 patients suffering from endometrial carcinoma underwent transvaginal ultrasonography and nuclear magnetic resonance prior to surgery in order to evaluate possible myometrial invasion. The study was integrated by computerised tomography (CT) to obtain a clearer image of the retroperitoneum. The authors aim to ascertain the accuracy, sensitivity and specificity of these methods in the preoperative evaluation other degree of myometrial infiltration.

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.

The Authors carried out an open, non-controlled clinical trial in order to evaluate the clinical efficacy of estriol administered by the vaginal route (0.0125% cream) in cystourethropathic diseases caused by estrogenic insufficiency. All the 45 patients recruited (mean age 51.6 years) had been in menopause from 6 to 24 months; all of them have been treated with 0.5 mg estriol daily for 2 weeks; furthermore the treatment has been continued with the same dose of the hormone for the following 4 weeks but using an alternating daily administration. Among the parameters taken into consideration for the evaluation of the patients, a urodynamic examination has been also included. The final results have been considered very satisfactory showing a very significant improvement concerning every urodynamic test. Similar results have been obtained considering the symptomatologic point of view. On the basis of these results, the Authors concluded that estriol vaginal cream formulation represents a valuable therapeutical possibility in the treatment of patients affected by urogynecological diseases caused by estrogenic insufficiency in post-menopausal conditions.

Changes in lymphocyte subsets in whole blood of normal pregnant women were examined by flow cytometry. From the first trimester and throughout pregnancy, the count of B cell subset remain unchanged. On the contrary, the percentage of "helper" lymphocytes decreased in the first trimester, increase in the third. These changes of lymphocyte subsets may indicate suppression of immunological activity during pregnancy.

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)

The aim of this work is the use of decisional analysis for the clinical diagnosis of Chlamydia trachomatis, to verify the utility of making a routine direct immunofluorescence test with a strategy of no routine direct immunofluorescence test with a strategy of no routine test in women during gynecologic escannations. Patients eligible for this analysis were sexually active woman, who are not pregnant, woman in reproductive age who do not have evidence of a clinical syndrome associated with or known to be caused by Chlamydia trachomatis. Our results show that the decision as to the use of the test involves 0.87 utility, while the decision of no routine test involves a 0.80 utility. We can therefore deduce that the best strategy for a woman who subjects herself to routine gynecologic care is to use this test, because the Chlamydia trachomatis has been implicated as the etiologic agent of acute salpingitis, chronic and tubal infertility.

The Authors report their findings concerning the synchronous associations of tumours involving pelvic organs in the female genital tract observed at the Gynecological Clinic, Aquila. From January 1980 to December 1991, 9 cases (4.28%) of synchronous tumours were found in a total of 210 cases of womb, ovary and vagina tumours. The paper examines the clinical problems and questions of anatomopathological characterisation raised by these associations.

This paper assesses the effect of estradiol on the in vitro growth of fibroblast taken from human breast skin. It was observed that estrogens stimulate the proliferation of phenotypically adult fibroblasts; that there is a threshold increase of hormonal concentration which can trigger off this process; and that the size of the single dose is more important than the number of doses of hormone received.

Personal experience of sero-vaccino-prophylaxis for the purposes of vertical interruption of hepatitis B transmitted by mother carriers of HBsAG to their children is reported. Special attention is paid to the problem of the failure of such immunitary strategy in high-risk newborns (children of HBsAg, HBeAg and HBV-DNA positive mothers) and some suggestions are made to reduce the risk of this infection.

This study focuses on cervical cancer and the importance of establishing a suitable screening programme. The results of a study carried out in the Abruzzo region during a 10-year sample period are reported. A Population of 36,663 patients, of which 3,372 had never been screened, was included in the study. All patients were attending the Centre of Cytology and Colposcopy at the Clinic of Obstetrics and Gynecology in L'Aquila. In order to make progress in both the diagnosis and treatment of this pathology, it is necessary not only to obtain an interdisciplinary approach with constant cooperation between professional colleagues (cytologist, colposcopist and histologist), but also an increased sensitivity of the population to the need for screening.

The study included two different sized groups of patients suffering from various degrees of valvular microcondylomatosis. A group of 40 patients was treated using combined therapy while a second group of 20 patients received immunomodulating therapy alone with Sintomodulin. In particular, possible changes in the T-cell line of the immune system and correlations between the viral lesion and variations in serum levels of lymphocyte subpopulations were assessed. Results were analysed up to one year after the end of therapy.

The circadian rhythm of serum angiotensin-converting enzyme (ACE) activity was investigated in pregnant women with normal and pre-eclamptic gestation. The chronobiological approach was able to document the occurrence of a circadian rhythm for serum ACE activity in normal pregnancy. Such a rhythm is characterized by a decreased mesor and amplitude and a shifted crest. The circadian rhythm for serum ACE activity was not detectable in pre-eclamptic pregnancy. Such an abrogation is accompanied by a negligible decrease of mesor suggesting the occurrence of a relative hyperACEemia. This disorder could play a role in pregnancy-induced hypertension.

The topographical distribution of cholinergic nerve fibres in the uterus was studied in normal as well as chemically sympathectomized mice. Our analysis was performed using both transverse sections and whole mounts, in order to analyse the distribution of cholinergic nerves within the various layers of the uterus and to study the morphology of nerve plexuses that supply the organ. Cholinergic nerve fibres were found chiefly around the uterine artery and its primary ramifications. Nerve fibres coming from arterial plexuses are distributed to the myometrium and more infrequently to the endometrium. Groups of acetylcholinesterase positive ganglion cells were located in the cervix. The distribution pattern of the cholinergic innervation of mouse uterus shows important topographical differences. In the tubal end of uterine horn the innervation is poor and cholinergic nerve fibres are organized in a sparse plexus. The number and the density of uterine nerves increase gradually proceeding toward the cervix. The cervix shows the richest innervation. The findings that observed nerve fibres are unaltered by chemical sympathectomy and are revealed using short incubation times suggest their parasympathetic nature.