Mother-to-child transmission of human immunodeficiency virus in Italy : temporal trends and determinants of infection

In order to analyse temporal trends in vertical transmission rates of human immunodeficiency virus (HIV) and determinant of congenital HIV infection in Italy, we have considered data from a network of hospitals co-operating in the Italian Collaborative Study on HIV infection in pregnancy, conducted between 1988 and 1995. A total of 1040 women entered the study. The HIV-1 status of the babies was known in 848 cases (81.5%). Transmission rates were highest in the period 1988\u20131991, then tended to decrease and in 1995 the rate was 9.7 per 100 children (this finding, however, was based on only six infected children and the trend was not statistically significant). Considering the overall series, the risk of vertical HIV transmission was higher in women with low CD4 count in pregnancy [odds ratio (OR) <400 versus \u2a7e400 1.8, 95% confidence interval (CI) 1.1\u20132.9]. In comparison with vaginal delivery the risk of transmission was 0.3 (95% CI 0.1\u20130.5) and 0.6 (95% CI 0.3\u20131.2) respectively for elective and emergency delivery. In comparison with women who delivered at term (\u2a7e37 gestation weeks) the OR of HIV infection of the babies for the whole series was 2.2 (95% CI 1.3\u20133.6) in women who delivered preterm. Similar findings emerged when the analysis was conducted considering, separately, subjects observed in the period 1988\u20131991 and 1992\u20131995. The frequency of Caesarean section increased from 26.5% of deliveries in 1988\u20131991 to 36.2% in 1992\u20131995. Consequently, most temporal differences disappeared after standardization for mode of delivery, but the rate in 1995 was still lower than in 1988\u20131994

Prognostic value of pelvic lymphadenectomy in surgical treatment of apparent stage I endometrial cancer.

BACKGROUND: The role of pelvic lymphadenectomy in early endometrial carcinoma is still being debated. MATERIALS AND METHODS: We retrospectively analyzed a total of 131 patients with FIGO stage I endometrial cancer undergoing surgery without (Group 1) or with (Group 2) pelvic lymphadenectomy. Kaplan-Meier and Cox analyses were used to calculate crude and adjusted survival rates. Moreover, the overlap of pre- and post-surgical staging was analyzed. RESULTS: Overall survival rate at 5 years was 90.1%. The difference in crude survival rates of the two groups is not statistically significant (p-value= 0.3777, log rank test). Five patients of Group 2 presented positive pelvic nodes. Therefore our results showed a pre-surgical understaging, referring to nodal involvement, in 9.1% of cases (5/55). CONCLUSION: Pelvic lymphadenectomy is a useful procedure for prognostic and staging purposes, but does not improve survival in FIGO stage I endometrial carcinoma

Diagnostica prenatale e "management" ostetrico

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Sonographic diagnosis of congenital anomalies during the first trimester

Current ultrasound technology allows an examination of fetal anatomy and the detection of anomalies at 12-15 weeks. Studies assessing the accuracy of early sonographic diagnosis prior to 15 weeks of pregnancy were reviewed. In expert hands the detection rate is about 40 per cent for major extra-cardiac anomalies and 65 per cent for major cardiac defects. However, due to technical and practical limitations, sonographic assessment of fetal anatomy in the first trimester cannot replace the midtrimester scan and should be restricted to couples whose fetus is at increased risk for malformation