No abstract

SummaryObjectives: the aims of the present study were to compare the haemodynamic effects of oxytocin and carbetocin and to assess the efficacy of these two drugs in terms of blood loss and the additional uterotonic needed in caesarean section at high risk of primary post-partum haemorrhage. Methods: women in the carbetocin group (group A) received a bolus of 100 µg IV; women in the control group (group B) received 20 IU of oxytocin in 1000 ml of 0,9% NaCl solution IV (150 mL/ hour). The main parameter evaluated was the haemodynamic effects of drugs and the need for additional uterotonic agents. In addition we compared the drop in haemoglobin level, the uterine tone, the uterine fundal state and the diuresis. Results: regarding the haemodynamic effects, both drugs have a hypotensive effect, but we found a greater reduction in blood pressure within the oxytocin group. Significantly more women needed additional uterotonic agents in the oxytocin group (23,5% vs 0%, p<0.01), though there was no significant difference in estimated blood loss and in the drop haemoglobin level (p>0.05). There was a significant difference in the diuresis, higher in carbetocin group (1300 ml ± 450 ml vs 1100 ml ± 250 ml, p=0.01). Conclusions: a single injection of carbetocin appears to be more effective than a continuous infusion of oxytocin to prevent the PPH, with a similar haemodynamic profile and minor antidiuretic effect.

This is the first study evaluating the clinical, metabolic, and hormonal effects of the ethinylestradiol-chlormadinone acetate (EECMA) combination in hirsute women with polycystic ovary syndrome (PCOS). Ultrasonographic pelvic examination, hirsutism score, and hormone profile evaluation were performed at baseline and after 3 and 6 cycles of treatment. Oral glucose tolerance test, euglycemic-hyperinsulinemic clamp, and assessment of lipid profile were carried out at baseline and after 6 cycles of treatment. A significant improvement in hirsutism was evident at the end of treatment. From the third cycle onward, plasma levels of sex hormone binding globulin significantly increased when compared to baseline. Free androgen index, androstenedione, and 17-hydroxyprogesterone significantly decreased after 6 cycles. The treatment did not affect glucose and insulin homeostasis. Total cholesterol, triglycerides, and high-density lipoprotein (HDL) plasma levels remained unvaried, whereas low-density lipoprotein (LDL) concentrations showed a significant reduction. A significant increase in very-low-density lipoprotein (VLDL) levels was seen at the sixth cycle of therapy. In conclusion, EE-CMA combination ameliorates clinical and hormonal features of PCOS women, with no detrimental effects on glucose, insulin, and lipid metabolism.

The movement and the distribution of water, sodium, potassium, chloride, magnesium and calcium have been studied in slices prepared from rabbit placentae at different periods of gestation, incubated in condition of depressed metabolism (0-1 degree C). In these conditions the tissue takes up water from the external medium up to a maximum of about 2.0 kg/kg d. wt., which represents 30 per cent of the initial H2O content of the fresh tissue. The extracellular compartment swells progressively and proportionally to the age of the placenta. The sodium and chloride content of the tissue increases while that of potassium decreases and their intracellular concentration reaches, after 120 min, that of the external medium. Magnesium does not show appreciable changes and calcium, too, despite its extreme variability, does not seem to undergo significant variations during the cold incubation. The results obtained show that placenta, like most of other mammalian cell systems, possesses specific metabolism-dependent mechanisms responsible for the maintenance of water distribution and ion gradients among the different tissue compartments. The characteristics and the regulation of these mechanisms are discussed in detail.

No abstract

No abstract

No abstract

L’autorizzazione della commercializzazione, in Italia, del Norlevo - prodotto a base di levonorgestrel - come contraccettivo d’emergenza (Decreto AIC/UAC n. 510/2000 del 26.09.2000) ha sollevato un intenso dibattito sul comportamento del medico che non vuole prescrivere per ragioni deontologiche ed etiche, sostanze che possano ostacolare il proseguimento dello sviluppo del concepito. Ci si chiede, inoltre, se questa decisione possa rientrare nella fattispecie prevista dall’art. 9 della Legge 194/78 in materia di obiezione di coscienza. Per dare una risposta a questo interrogativo, è stato necessario studiare, innanzitutto, il meccanismo di azione del levonorgestrel: solo qualora si fosse riscontrata la possibilità di un effetto abortivo, sarebbe stato possibile appellarsi alla suddetta legge. Poiché si è giunti alla conclusione che, accanto all’unico effetto contraccettivo (inibizione/ritardo dell’ovulazione) dimostrato, sono presenti anche e soprattutto effetti in fase post-fertilizzazione, è stata presa in esame la riflessione giuridica in materia. Alla luce dell’ordinamento italiano e delle decisioni della Corte Costituzionale, il rifiuto di prescrivere/somministrare il Norlevo rientra nelle previsioni dell’art. 9 della Legge 194/78, ma anche qualora questo non venisse riconosciuto, si rende sempre configurabile - a fronte del bene “vita umana” - anche una sorta di “clausola di coscienza” in base alla quale il medico ha diritto ad agire secondo i propri convincimenti interiori.