In the present article the authors have carried out a statistical investigation on data relative to the caesarean sections performed in the Departments of Obstetrics and Gynaecology of the University of Rome "La Sapienza" since 1986 to 1990. Particular object of this study is to evaluate data regarding fetal bistoury lesions incidentally caused while performing the incision of the uterine wall during a caesarean section. To our knowledge, this topic has never been taken into account by the world's literature, nevertheless it is important also for its legal and insurance implications. Throughout the mentioned period 13787 deliveries occurred, 3117 of which were caesarean sections: this is equal to a frequency of 22.6%, with an increase rate of 37.5% during the whole 5 years time. 58 cases of fetal bistoury lesions have been found to occur since 1986 to 1990: this equal to 1.8% of all the performed caesarean sections. Even if their gravity was usually scarce, and only 7 cases needed a specific treatment, 25.8% of these lesions involved areas such as forehead, cheek bone, cheek, mostly related to possible aesthetic damages with their connected legal consequences. In order to evaluate what factors can contribute to the occurrence of these lesions and taking account of the large number of factors that may be involved (such as conditions at which the operation is performed, skill and experience of the surgeon etc.), the authors focus their attention to those which, for their clinical significance and possibility of detection, suit more than others such a statistical investigation.(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Injuries↗

PubMedDate not supplied

[Intrahepatic cholestasis in pregnancy].

Intrahepatic cholestasis of pregnancy (ICP) is a syndrome usually manifesting during the third trimester of pregnancy and disappearing after delivery. Multiple factors seem to be involved in pathogenesis of the syndrome; however, ICP appears to take place in women congenitally hypersensitive to estrogens. Typical is pruritus, which may be followed by jaundice and associated with other less common symptoms. The biochemical parameters are characteristically altered: an increase in the levels of aminotransferases (AST, ALT), total bile acids and alkaline phosphatase is observed; while serum GGT are normal. Maternal prognosis is benign. By contrast, a higher risk of acute fetal distress and prematurity has been reported. Various drugs are used in the treatment of ICP. We present the case of a patient treated with S-adenosyl-L-methionine (SaMe). SaMe therapy has proved to be effective in improving the altered biochemical parameters, whose normalization was obtained before delivery.

Adult↗

PubMedDate not supplied

[The role of the pineal body in the endocrine control of puberty].

The pineal gland plays an important role in reproductive endocrinology. The epiphysis regulates seasonal variations in reproductive function of seasonally breeding animals. In humans, even if they are not seasonal breeders, the role of the pineal in reproductive endocrinology seems to be important as well. It appears to be of particular importance the endocrine control of the gland on pubertal sexual maturation. Even if not all researchers agree, several data suggest that elevated melatonin levels-characteristic of prepubertal age-keep the hypothalamic-pituitary-gonadal axis in quiescence: thus, an inhibitory effect on pubertal development is exerted. Subsequently, the decreasing serum melatonin with advancing age would result in activation of the hypothalamic pulsatile secretion of GnRH- and therefore of the reproductive axis-with consequent onset of pubertal phenomena. The production rate of melatonin does not change with age and no growth in pineal size from 1 to 15 years of age has been demonstrated by nuclear magnetic resonance (NMR) studies. Therefore the decrease of serum melatonin concentrations has been proposed to be due to the increase in body mass or, according to another hypothesis, to be also temporally linked to sexual maturation. Furthermore, recently, it has been suggested in rats that the pineal influences not only the pubertal sexual maturation, but even the gonadal and genital development and function of offspring, already during intrauterine life. Investigations are needed to evaluate this hypothesis in humans.

Adolescent↗

PubMedDate not supplied

[Use of GnGH (GnRH-A) in gynecology].

GnRH-agonist therapy is used in the management of many gynaecological pathologies: uterine fibroids, endometriosis, ovarian cystic pathology, breast cancer, dysfunctional uterine bleeding and, in males, prostatic cancer. In the case of uterine fibroids, this therapy can be used as a pre-treatment before conservative or demolitive surgery or as an alternative to hysterectomy. At the Centre for Therapy of Uterine Pathologies (I Institute of Obstetrics and Gynaecology of the University of Rome "La Sapienza") the use of Gn-RH-A therapy in uterine fibroids has been investigated and results consistent with those of many other groups of study have been obtained. The two most important results are: 1. the decrease of both the myoma's size and the uterine volume; 2. the block of menometrorrhagiae symptoms, with improvement of the haematic crasis and possibility to convert a demolitive surgery to a conservative surgery. GnRH-agonists can represent a definitive treatment for patients with symptomatic uterine fibroids and in perimenopausal age.

Female↗