The pineal gland and reproduction

The hormonal activity of the pineal gland is influenced by boththe dark-light cycle and the seasonal cycle, causing it to playan important role in the neuroendocrine control of reproductivephysiology. This is especially evident in seasonally breedinganimals, in which reproductive function is clearly influencedby seasonal variations in the duration of night and day. Humansare not seasonal breeders. Nevertheless, seasonal fluctuationshave been described in human reproduction, and the pineal glandalso appears to exert an important role in the neuroendocrineregulation of human reproductive physiology. There is evidencethat the epiphysis is involved in the control of sexual maturation.In rats, the maternal pineal appears to influence the gonadaland genital development and function of offspring; this hypothesishas yet to be confirmed in humans. The pineal apparently influenceshuman reproductive function not only at the hypothalamic-pituitarylevel, by inhibition of the hypothalamic pulsatile secretionof gonadotrophin-releasing hormone, but also at the gonadallevel, where melatonin receptors have also been found. In addition,melatonin is reported to increase serum prolactin concentrationsin both rats and humans. It has been suggested that melatoninis involved in the control of menstrual cyclicity.     

Destructive cesarean section: hysterectomy for obstetric reasons and post-abortive hysterectomy. Analysis of 35 cases

The Authors examined surgical case studies for the 20-year period from February 1968 to February 1988 concerning hysterectomies performed for obstetric reasons at the "La Sapienza" University of Rome, Obstetrics and Gynaecology Department; these numbered 35 out of 69,677 births. They also considered hysterectomies carried out during caesarean sections, during birth or the postpartum period, during the puerperium and after miscarriage. They also analyzed reasons for the action taken, the type of operation, the length of the gestation period, the mother's age, and transfusions given.     

Current epidemiologic features of septic abortion

BACKGROUND: This article deals with the current epidemiological features of septic abortion. METHODS: Forty-two of 431 abortions (9,74%) were diagnosed as septic abortions during 1998 at the I and II Institute of Obstetrics and Gynecology, University of Rome La Sapienza , and are retrospectively analyzed. RESULTS: Thirty-four women (81%) came from an EEC country, whereas 8 (19%) from a developing country. Their mean age was 31,4 years (range: 18-43 years). Eighteen patients (43%) were nulliparous; 24 (57%) multiparous; 14 (33%) had previous abortions, none had previous septic abortions. Among risk factors, premature rupture of membranes was found in 5 cases (12%); whereas amniocentesis, HIV positivity, diabetes, positive urine culture and illegal pregnancy termination procedures were found in 5 further cases. No risk factors were found in 76% of patients. CONCLUSIONS: It is observed that, due to medical-scientific advances, previously unknown risk factors have emerged during the last three decades in Western Countries, such as invasive procedures of prenatal diagnosis, IUD contraception and AIDS immunodepression. However, other previously frequent risk factors, such as sepsis from illegal abortion, may emerge again in Countries where abortion is legal (such as Italy), due to massive immigration of clandestine women from developing Countries.     

Immune tolerance in pregnancy. Maternal-fetal interactions

The conceptus may be considered as a sort of semi-allogenic graft for the maternal organism, since it shares a half of genomic complement with the father. Nevertheless, its rejection does not take place physiologically during a pregnancy. The mechanisms resulting in the maternal immune tolerance versus the conceptus are not yet completely clarified. Such mechanisms are probably multiple and interacting with each other. In animal and in vitro studies provide evidence suggesting that the following factors are important in producing the maternal immune tolerance: the anatomical position of the fetus; the absence of expression of the class I and II Major Histocompatibility Complex (MHC) molecules in trophoblast tissues; the activity of blocking antibodies; a modification of the immune response; the fetal-placental production of immunosuppressive hormones and substances. Amongst pregnancy-related changes in the immune response, a reduced Natural Killer (NK) cell activity and an increased synthesis of Th2 cytokines (which inhibit the cell-mediated immunity) with an altered Th1/Th2 balance appear to be remarkably important. With regard to fetal-placental hormones, progesterone seems to exert an important immunosuppressive influence mediated by the protein named "Progesterone Induced Blocking Factor" (PIBF). Nevertheless, the real contribution of each of the above mentioned mechanisms still remains to be elucidated in humans.     

Contraception after heart transplantation

It was observed that fertility and menstrual function in heart-transplanted women, impaired before the operation, become normal with a new heart. The restoration of reproductive function is also confirmed by many cases of pregnancy in heart-transplant recipients, reported in the literature. Twenty-four cases were published worldwide up to 1997, out of which eighteen had a positive result. Also a case personally treated was successful. The outcome of a pregnancy after heart transplantation is, then, generally positive. Nevertheless, such a pregnancy involves important maternal and fetal risks. Thus, the gynecologist has to provide correct information about both such risks and the most suitable contraceptive methods, for these patients. Oral contraceptives are very effective and, in the new low-dose formulations, free from serious adverse effects. No adverse effects have been observed in our patient, who represents the only case, reported in the literature, in which an estroprogestinic contraception was utilized before a pregnancy. In conclusion, during an oral contraception or after a tubal sterilization, pregnancy is really unlikely to occur. Thus, when the couple either has completed the familial nucleus or does not desire offspring, a doubt is at least justified as to whether these safer methods of contraception are advisable in such women.     

Magnetic resonance imaging evaluation of bone marrow changes in obstructive sleep apnoea syndrome in adults

PURPOSE: The aim of this study was to evaluate bone marrow reconversion in patients with obstructive sleep apnoea syndrome (OSAS) by means of magnetic resonance imaging (MRI). To our knowledge, no explicit correlation between OSAS and such parameter has been documented in the literature. MATERIALS AND METHODS: During a 35-month period, 33 patients with a clinical diagnosis of OSAS, obese but without restrictive or obstructive ventilatory defects, were evaluated with MRI during wakefulness in all patients with T1-, PD- and T2-weighted sequences in the sagittal and axial plane within 1 week after polysomnography. RESULTS: MRI showed bone marrow reconversion in 33.3% of patients. Patients with bone marrow reconversion showed higher mean haematocrit (HT) values, lower mean nocturnal oxyhaemoglobin saturation, higher percentage of sleep time with oxygen saturation (SaO2) <90%, lower nadir, as well as greater neck adiposity and soft-palate lengthening compared with patients without bone marrow reconversion. Furthermore, in patients with bone marrow reconversion, haematocrit (HT) was negatively correlated with daytime arterial oxygen partial pressure (PaO2) and positively with arterial carbon dioxide partial pressure (PaCO2). CONCLUSIONS: In patients with OSAS, bone marrow reconversion is probably correlated with the severity of nocturnal desaturation. As bone marrow reconversion is, for unknown reasons, greater in adults younger than 40 years, MRI evidence of bone marrow reconversion could be useful in young individuals for the early diagnosis of sleep-disordered breathing and prevention of associated cardiovascular diseases.     

Laparoscopic surgery in treatment of stage IIb cervical cancer after neoadjuvant chemotherapy. A case report and review of the literature

BACKGROUND: A detailed operative procedure of laparoscopic radical hysterectomy (type III) with pelvic and aortic lymphadenectomy after neoadjuvant chemoterapy in treatment of Stage IIb cervical cancer is described. CASE REPORT: A 50-year-old patient with Stage IIb squamous cell carcinoma of the uterine cervix, who initially was not surgically resectable, received three courses of neoadjuvant chemotherapy that included ifosfamide 5 g/m2, cisplatin 50 mg/m2 and paclitaxel 175 mg/m2 (TIP). Following a partial clinical response to chemotherapy, the patient underwent laparoscopic type III radical hysterectomy with bilateral salpingo-oophorectomy and pelvic and paraaortic lymphadenectomy. The surgical procedure lasted 250 minutes. Blood loss was 310 ml. The patient was discharged on postoperative day 4. The mean length of the resected parametria and paracolpia was 4.1 cm and 2.0 cm, respectively. The number of dissected lymph nodes was 48:29 pelvic and 19 paraaortic nodes. No major intraoperative or postoperative complications occurred. The patient also underwent adjuvant radiation therapy. Follow-up was performed at six months so far. CONCLUSIONS: This experience suggests that such a surgical procedure is safe. Laparoscopic radical hysterectomy potentially allows for decreased perioperative morbidity and blood loss, faster recovery and better cosmetic results. Large studies with long term follow-up are needed to confirm that this approach may be proposed as an alternative to conventional surgery.     

Hysterectomy in obstetrics. Analysis and comparison of a group of cases from the Italian and the international literature (536 cases)

The Authors made a comparison between the frequency of obstetric hysterectomies carried out at the "La Sapienza" University Obstetrics and Gynaecology Departments and of those reported in international publications regarding Great Britain, USA, Australia, Saudi Arabia and Libya. Data obtained covered the 462 hysterectomies effected out of the 442,174 births from 1972 to 1895. Results were compared as under: general frequency per number of births, reasons for surgery, type of operation carried out, age of the patient, gestation period, obstetrical history and complications.