[Vaginal delivery following previous cesarean section].

Background And Aim: The increased use of cesarean section (CS) over the past 30 years has raised a problem which has been much debated in obstetric practice: is it always necessary to repeat CS in women who have previously undergone cesarean section? The aim of this study was to establish whether women previously undergoing CS can start trial labour?

Methods: The authors examined 195 pregnant women who had previously undergone 1 or 2 CS. Medical history, clinical examination and maternal and fetal monitoring techniques were used to select the women who could start trial labour.

[Treatment of benign uterine hemorrhage and simple endometrial hyperplasia by endometrial ablation].

Background And Aims: The technique of endometrial resection by resectoscope represents a valid alternative to hysterectomy in patients with a high operating risk suffering from benign uterine bleeding and simple endometrial hyperplasia refractory to medical treatment or uterine curettage. The aim of this study was to demonstrate the validity of the resectoscopic technique of endometrial ablation.

Methods: The authors performed endometrial ablation using a loop and roller resectoscope in a group of 24 women with refractory menorrhagia which failed to respond to other techniques of first choice.

[Ultrasonic monitoring as a method of preventing risks of ovarian hyperstimulation during drug therapy].

Background And Aims: Ultrasonographic monitoring represents the most immediate method for an early confirmation of the onset of the worst complication of the pharmacological induction of ovulation: ovarian hyperstimulation. The aim of this study was to evaluate the incidence of this complication in a sample group of anovulatory patients receiving pharmacological treatment and undergoing repeated ultrasonographic monitoring.

Methods: The authors analysed the controls performed during 1996-1997 in which a total of 413 cycles were stimulated.

[Estrogen and progestin treatment in postmenopause. Effects on the endometrium].

Background And Aims: It has been well demonstrated that menopausal disorders resulting from the lack of estrogens may be delayed and partly eliminated by appropriate hormone replacement therapy. The aim of this study was to demonstrate the absolute innocuity of the association of estrogen and progestin.

Methods: The authors used an association of conjugated equine estrogens and medroxi-progesterone acetate to treat menopausal syndrome in 80 women aged between 48 and 55 years old.

[Abnormal uterine hemorrhage in climacteric. Medical management].

Following a review of the literature, the authors examine the drugs which are currently used to treat anomalous uterine bleeding during menopause, illustrating their aims and justifying the rationale underlying their use. They conclude by stating that a satisfactory treatment often does not exist, but it is the task of the specialist to gauge the level and sequence of treatments in order to achieve the hoped-for result.

[Abnormal uterine hemorrhage in the climacteric. Diagnostic approach].

Having made a detailed list of the invasive and non-invasive diagnostic techniques used to evaluate anomalous uterine bleeding in menopause, the authors conclude by affirming that hysteroscopy undoubtedly represents the most reliable diagnostic technique and that echography should be the preferred first diagnostic step since it allows the adnexa to be examined and is less invasive and cheaper.

[Anomalous uterine hemorrhages in the climacteric. Their etiopathogenesis].

Anomalous uterine bleeding accounts for approximately two-thirds of the causes of outpatient gynecological check-ups for women in menopause. The high incidence of this pathology raises considerable problems from a clinical and social point of view. In this paper the authors outline the main causes of both organic and functional bleeding.

[Menopause. Hormone substitution therapy and prevention of cardiovascular risk].

Background And Aims: Cardiovascular disease is the major cause of death in over 60-year-old women. The mean age of onset is about 10 years later in women compared to men, a difference which can be explained by the end of physiological estrogen production in menopause.

Methods: The authors treated a group of 68 menopausal patients with HRT for a period of 5 years.

[Clinical efficacy of tamoxifen in the treatment of premenstrual mastodynia].

Background: Premenstrual syndrome (PMS), which was first described by Frank in 1931, is a clinical condition that is not easy to classify in terms of either symptoms or from a diagnostic and therapeutic point of view.

Aims: The aim of this study was to evaluate the efficacy of tamoxifen, an antiestrogen drug, using a double-blind study with placebo in the treatment of mastodynia, one of the most frequent symptoms of PMS, given that an absolute or relative increase in estrogens is one of the most controversial etiopathogenetic hypotheses.

Methods: The study included a group of 88 outpatients aged between 22 and 40 with regular menstrual cycles and intense mastodynia.

[Use of a GnRH analogue (leuprorelin) in the therapy of endometriosis].

Background: Endometriosis is undoubtedly an extremely complex disease from both a diagnostic and therapeutic point of view. The finding that the continuous administration of GnRH analogs suppresses gonadotropin release by the hupophysis, thus blocking ovary function, has promoted researchers to use these drugs in the treatment of endometriosis.

Aim: Having reviewed the data reported in the literature, the authors selected from the numerous drugs used to resolve implants (oestroprogestogens, danazol, progestogens, clomiphene citrata, GnRH analogs), a GnRH analog with a depot action known as leuprorelin (D-Leu6-Pro9-NH-Ethylamide).

[Dysspermia due to inflammation. The evaluation of sperm cultures].

The study evaluates 160 cases of positive spermioculture taken from 522 sterile individuals examined by the authors at the Couple Sterility Outpatient unit in Department A of the Institute of Gynecology and Obstetrics at Turin University during the period between January 1984 and December 1993. The germs responsible for infection were assayed in order to evaluate the strains which showed the highest incidence every year. Whereas there was no significant change in the absolute number of cases of sterility over the period, the number of cases caused by infection increased significantly during the second five-year period.

Asymptomatic bacteriuria in pregnancy: maternal and fetal complications.

From an analysis of the data reported in the literature it is clear that pregnancy is a predisposing factor for urinary tract infection and that pregnant women with this pathology are exposed to dangerous risks which may influence maternal wellbeing and fetal prognosis. Authors do not concur on the specific risks to the mother and fetus, one reason being that the statistics reported to date reveal discrepancies relating to the presence of disorders prior to pregnancy and the environmental, working and socio-hygienic conditions of the populations studied. The apparently paradoxical finding of a higher incidence of perinatal problems in pregnant women with asymptomatic bacteriuria compared to manifest forms can be attributed to the fact that the latter are treated with adequate therapies whereas asymptomatic bacteriuria, which is difficult to diagnose, may persist throughout pregnancy.

Asymptomatic bacteriuria in pregnancy: a diagnostic and therapeutic approach.

Pregnancy is a predisposing factor for urinary tract infection and pregnant women suffering from this pathology are exposed to dangerous risks which may condition maternal wellbeing and fetal prognosis. The apparently paradoxal finding of a higher incidence of perinatal problems in pregnant women with asymptomatic bacteriuria compared to those with manifest infections may be explained by the fact that the latter are adequately treated, whereas asymptomatic bacteriuria, which is difficult to diagnose, may continue in a subtle form for the entire duration of pregnancy. This emphasises the importance of the early diagnosis of infection using a protocol based on urine tests and urine culture and the adequate treatment of all cases of asymptomatic bacteriuria in order to reduce the incidence of maternal and fetal complications (acute pyelonephritis, increased fetal morbidity and mortality).

[Intramuscular beta-interferon in the treatment of cervical intraepithelial neoplasia (CIN) associated with human papilloma virus (HPV) infection].

In an attempt to find less aggressive and more efficacious tools for the treatment of cervical neoplasia (CIN) associated with genital HPV infection, the authors have examined a therapeutic approach based on the strengthening of natural defences. For this purpose, a group of 10 patients diagnosed with CIN associated with HPV infection received beta-IFN therapy at a dose of 300,000 UI/die i.m.

[Ovarian hyperstimulation syndrome (OHS): borderlines between physiology and pathology].

The use of gonadotropins in therapy has led to the appearance of a complication due to hyperstimulation, referred to as "syndrome due to ovarian hypertension" (SOH). There are three clinical stages of SOH: slight, moderate and severe, caused by a pathogenetic mechanism which is thought to involve the action of prostaglandins and the renin-angiotensin system leading to an alteration in capillary permeability with increased ovarian diameter. SOH can be prevented using a protocol to evaluate clinical conditions during therapy mainly based on hormone assays and echographic monitoring.

Danazol in the treatment of endometrial hyperplasia.

The paper reports the results of a study performed in 62 menorrhagic women with endometrial hyperplasia treated with Danazol. The efficacy and tolerability of the above drug was found to be satisfactory.

Antineoblastic activity of antioxidant vitamins: the role of folic acid in the prevention of cervical dysplasia.

The authors made a study on 90 patients affected by various degrees of uterine cervix dysplasia searching for folic acid plasmatic concentrations. The team members affected by CIN have been compared with a test team consisting of women with normal pap-test and vaginoscopy. The study proved that the average levels of folic acids have significantly decreased in cases of dysplasia compared with the test team.

Perinatal mortality and morbidity in premature birth.

In a study carried out in 100 cases of premature birth in Section "A" of the Department of Gynecology and Obstetrics of the University of Turin, the authors report a perinatal mortality rate of 5.4%. Perinatal morbidity was found to be very high (68.

[Cholestasis in pregnancy].

The authors report the main morphological and functional alterations of the liver during the course of pregnancy. The size of the organ does not change and there is a slight (20%) reduction of hepatic flow. Hepatic function is partially modified in view of the following factors: reduced protein synthesis (in particular the albumin component), increased serum levels of cholesterol and triglycerides mediated by steroid hormones, inhibition of canalicular secretion and consequent diminution of the liver's excretory function, variations in serum levels of many markers of cholestasis so much so that they become unreliable due to pregnancy.