S. Ferrero

Maternal arrhythmias during pregnancy.

Introduction.An increased incidence of maternal cardiac arrhythmias is observed during pregnancy and they can range from clinically irrelevant isolated premature beats to debilitating supraventricular and ventricular tachycardias.Discussion.Management of arrhythmias during pregnancy is similar to that in non-pregnant patients. However, the presence of the foetus and the risk of teratogenicity, the haemodynamic changes, the effect of therapy on labour, delivery and lactation must be evaluated. Antiarrhythmic drug selection depends on the specific arrhythmia being treated and the cardiac condition of the mother. Although no drug is completely safe, most are well tolerated and can be given with relatively low risk. Some antiarrhythmic agents, such as propranolol, metoprolol, digoxin and quinidine, have been extensively tested during pregnancy and have proved to be safe; they should therefore, whenever possible, be used as a first-line. For supraventricular tachycardia, intravenous adenosine may be used to terminate the arrhythmia if vagal manoeuvres fail. If possible, drug therapy should be avoided during the first trimester of pregnancy. When drug treatment fails or is not indicated because of the haemodynamic instability of the patient, direct current cardioversion can be used.Conclusion.Most patients with arrhythmias during pregnancy can be treated with an excellent result.

Post-operative complications after caesarean section in HIV-infected women

Abstract.nThis retrospective study evaluated complications associated with caesarean section in HIV-infected women. For each HIV-positive patient (n=45) a control group of ten seronegative women (n=450) was matched for age, number of foetuses, gestational age, indication for caesarean section, status of the membranes and kind of anaesthesia. All women delivered in the same hospital using a uniform protocol. We evaluated the duration of stay in hospital after operation, the need for antibiotics after caesarean section, the incidence of minor postoperative complications (mild anaemia, mild temperature or fever 24xa0h after surgery, wound haematoma or infection, urinary tract infection, endometritis) and major postoperative complications (severe anaemia, pneumonia, pleural effusion, peritonitis, sepsis, disseminated intravascular coagulation, thromboembolism). Most HIV-positive women (64.5%) had a complicated recovery after surgery. A higher incidence of major and minor postoperative complications were observed in the HIV-positive group than in the control group. There was a statistically significant greater incidence of mild anaemia, mild temperature or fever, urinary tract infection and pneumonia in the HIV-positive group. HIV-positive women with less than 500×106 CD4+ lymphocytest/l had higher post-caesarean section morbidity than HIV-positive women with more than 500×106 CD4+ lymphocytest/l. The median duration of hospital stay was significantly higher in the HIV-positive group (median 7xa0days) than in the HIV-negative group (median 4xa0days). The rate of HIV vertical transmission was 8.8%. Higher post-caesarean section morbidity was found in HIV-positive women than in controls. Unfortunately, the HIV-positive women (with low CD4 lymphocytes counts), whose infants theoretically will benefit most from caesarean delivery, are also the women who are most likely to experience post-operative complications.

Proteomics technologies in endometriosis

Endometriosis is a common disorder that is associated with infertility and pelvic pain. Diagnosis is based on the visualization of endometriotic lesions during surgery as no reliable serum marker is currently available. The etiology of endometriosis is largely unknown. Over the last 20 years, several proteomics technologies have been used to research novel proteins with a potential etiological role in endometriosis, and to identify candidate serum markers for this condition. While some molecules identified by proteomics technologies may have a relevant role in the pathogenesis of endometriosis, the research of potential serum markers for this condition is still far from any clinical application. This review summarizes the state of the art and potential applications of proteomics in endometriosis research.

Lateral distribution of benign ovarian cysts

0020-7292/

O475 PROGESTOGEN-ONLY CONTRACEPTIVE PILL COMPARED WITH COMBINED ORAL CONTRACEPTIVE IN THE TREATMENT OF PAIN SYMPTOMS CAUSED BY ENDOMETRIOSIS IN PATIENTS WITH MIGRAINE WITHOUT AURA

see front matter D 2005 International Federation of G All rights reserved. doi:10.1016/j.ijgo.2004.11.029 T Corresponding author. Department of Obstetrics and Gynecology, San Martino Hospital, University of Genoa, Largo B. Benzi 1, Genoa 16132, Italy. Tel./fax: +39 010511525; mobile: +39 3477211682, +44 7984980950. E-mail address: simone.ferrero@fastwebnet.it (S. Ferrero). URL: http://www.simoneferrero.com (S. Ferrero). December 2003. Information was abstracted from a continuously updated database. Functional follicular and luteal cysts were not considered in the present study. Women with cysts of different histologic origin in the same ovary or bilaterally, and those who had undergone abdominal surgery for reasons other than appendectomy, were also excluded from the study. Institutional review board approval was not requested because this was a retrospective study. Statistical analysis was performed using analysis of variance, one-way analysis of variance on ranks, the Mann—Whitney U test, and the v-test. Dermoid cysts were present bilaterally in 8.6% of the women. Among women with unilateral dermoid cysts, the numbers of left-sided cysts (55.0%) and right-sided cysts (45.0%) were similar (P=0.159). Unilateral endometriotic cysts were more frequent on the left than on the right ovary (Pb0.001). Bilateral cysts were more frequent in women with endometriotic cysts (19.3%) than in those with nonendometriotic cysts (7.2%) (odds ratio, 3.11; 95% confidence interval, 2.15—4.50; Pb0.001). Serous, mucinous, and paraovarian International Journal of Gynecology and Obstetrics (2005) 89, 150—151

Peritoneal fluid macrophages in endometriosis: correlation between the expression of estrogen receptors and inflammation.

Objective: Evaluate patient satisfaction at 6-month treatment in women with symptomatic rectovaginal endometriosis and migraine without aura with (progestogen-only contraceptive pill, POP versus sequential combined oral contraceptives, COC) Study Design: A patient preference trial including 144 women (82 in the group COC and 62 in the group POP). Main outcome measure was the degree of patient satisfaction by using a Likert scale. Secondary objectives were to evaluate differences in endometriosis-related pain and changes in migraine features during the treatment. Results: In group POP, 38/62 women (61.2%) were satisfied or very satisfied after treatment, compared to 31/82 women (37.8%) in group COC (p = 0.005). The intensity of chronic pelvic pain and dyspareunia significantly decreased at 6-month treatment in both the groups. At 6-month treatment, the number of migraine attacks was lower than at baseline in group POP (p = 0.002), while it was not reduced in group COC (p = 0.521). The intensity of migraine attacks was significantly different between baseline and 6month treatment in group POP (p < 0.001) but not in group COC (p = 0.078). Conclusions: POP is better tolerated than COC and it seems to ameliorate migraine attacks compared to COC in symptomatic patients with rectovaginal endometriosis and migraine without aura. Both drugs efficaciously relieve endometriosis-related pain symptoms. This study supports the use of the POP in women with rectovaginal endometriosis and coexisting migraine without aura. a 2014 Elsevier Ireland Ltd. All rights reserved.