Minerva ginecologica (Minerva Ginecol)

Journal description

A Journal on Obstetrical and Gynecological Pathophysiology, Clinical Medicine and Therapy. Frequency: Bi-Monthly.

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Website Minerva Ginecologica website
Other titles Minerva ginecologica
ISSN 0026-4784
OCLC 1696021
Material type Periodical
Document type Journal / Magazine / Newspaper

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: In this study we evaluated the short term effects of vaginal erbium laser (VEL) in the treatment of postmenopausal women (PMW) suffering from genitourinary syndrome of menopause (GSM). Sixty-five PMW were evaluated before and after VEL treatment (1 treatment every 30 days, for 3 months). GSM symptoms were evaluated either with subjective (Visual Analog Scale, VAS) and objective (Vaginal Health Index Score, VHIS) measures. In addition, in 21 of these PMW suffering from mild-moderate stress urinary incontinence (SUI), the degree of incontinence was evaluated with the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF) before and after VEL treatments. VEL treatment induced a significant decrease of VAS of both vaginal dryness, dyspareunia (P<0.01) and a significant (P<0.01) increase of VHIS). In addition, VEL treatment induced a significant (P<0.01) improvement of ICIQ-SF scores in PMW suffering from SUI. VEL was well tolerated with less than 2 % of patients discontinuing treatment due to adverse events. VEL treatment significantly improves vaginal dryness, dyspareunia and mild-moderate SUI. Larger and long-term studies are needed to investigate the role of laser treatments in the management of GSM.
    Minerva ginecologica 04/2015; 67(2):97-102.
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    ABSTRACT: The aim is to investigate the relationship between post--partum pain and personality considered as Personal Meaning Organization (PMO). Pain diseases, not related to organic disorders, frequently occur in post--partum and may lead to severe consequences for women and their functions of caregiving. Emotions are usually experienced in the body and their expression is strictly related to individual personality. Considering personality as a process, each symptom expresses a need to maintain the sense of oneness and historical continuity. 105 women were enrolled from the Department of Obstetrics and Gynaecology and after delivery they presented post partum pain not related to organic diseases. Women filled out a general information questionnaire assessing age, employment, marital status, education level, parity, type of delivery, attendance to a pre--partum course, week of gestation. Their personality, as PMO, was evaluated using the Mini Questionnaire of Personal Organization (MQPO). Controller PMO perceived more pain compared to the Principle Oriented PMO (95% CIs [--0.09, --1.98]; Wald Z = --2.28;; p<.02), slightly more than Contextualized patients (95% CIs [--0.09, --1.15]; Wald Z = --1.81, p<.06) and more than those with a Detached PMO (95% CIs [--0.09, --2.10]; Wald Z = --1.84, p<.06). The results suggest a role of PMO in influencing the perception of post--partum pain and no relation with the other general information assessed, particularly, within the Controller women group in which the experience of physical pain might be a way to represent a subjective discomfort.
    Minerva ginecologica 02/2015;
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    ABSTRACT: To describe the robotic nerve--sparing technique and review the most recent data in the literature on this surgical approach. Presentation of anatomical aspects regarding the nerve--sparing technique, besides discussion of the surgical steps as performed in our institution. Robotic--assisted nerve--sparing radical hysterectomy is a feasible approach for the treatment of cervical cancer patients, with remarkable advantages in terms of ergonomy, articulated movements and image magnification. All these features contribute for identification and preservation of the pelvic innervation, reducing the risk of surgical sequelae. Robotic nerve--sparing technique can be incorporated as a standard care without compromising radicality.
    Minerva ginecologica 02/2015;
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    ABSTRACT: TO evaluate the concentration of Nerve Growth Factor (NGF) in follicular fluid of women affected by Polycystic Ovarian Syndrome (PCOS) undergoing to In Vitro Fertilization cycle. I n vivo study. A sample of 52 women was considered, 20 without pathology (male infertility - Control group) and 32 affected by PCOS. All patients received a long stimulation protocol and the oocytes obtained by pick--up were fertilized with standard procedures of Intracytoplasmatic Sperm Injection (ICSI). Samples of follicular fluid (FF) were collected at oocyte pick--up. After centrifugation at 560 × g for 3 min, follicular fluid samples were frozen at -80 °C. After thawing the values of NGF in FF were determined by enzyme immunoassay ELISA using commercially available NGF enzyme--linked immunosorbent assay kits. The results of study were analyzed statistically with Student's T Test. The content of NGF was higher in FF of PCOS patients (2023,30 ± 587,09 pg/ml) in comparison with control group (1704,09 ± 326,8 pg/ml; p < 0,05). The levels of serum estrogen (E2) were higher in patients with PCOS (1724,24 ± 635,79 pg/ml) than in control group (1305,3 ± 298,12 pg/ml; p<0,05). The number of retrieved oocytes was more in PCOS patients (9,7±4,6) than in control group (8±4,4), but oocytes in metaphase II were similar in two groups (6,2±2,4 vs 6,09±4). The present results show that ovaries of PCOS patients produce more NGF than non--PCOS patients; it confirms that an excess of ovarian NGF might be an abnormality contributing to Polycistic Ovarian Morphology and PCOS.
    Minerva ginecologica 02/2015;
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    ABSTRACT: The aim of this study was to investigate the contribution of the gonadal steroid receptors expression to the pathophysiological pathways of pelvic organ prolapse (POP) and urodynamic stress urinary incontinence (USUI) after menopause. This was a prospective closely matched controlled clinicopathological study. Immunohistochemistry for estrogen receptor isoform α (ER--α) and β (ER--β), as well as for progesterone receptor (PR), was performed on formaline fixed and paraffin embedded sections of specimens coming from the pubocervical fascia of postmenopausal women who were allocated into three Groups: patients with synchronous POP and USUI (Group A), patients diagnosed with only POP (Group B), and patients without POP or USUI who underwent gynecological surgery for another benign indication (control group, Group C). There was no statistically significant difference among the three groups for age, parity, body mass index, or smoking. The expression of ER--α receptors was found significantly reduced among samples of Group B when compared with control group. Statistically significant reduction not only for ER--α, but for ER--β, as well, was noticed among samples of Group A, compared to the other two groups. No remarkable differences concerning the density of PR receptors were observed among the three groups. Alterations of ER--α in the pubocervical fascia and around the urethra in postmenopausal women may play an important role in the pathophysiology of POP. In addition, the risk for developing USUI among POP patients seems to be strongly associated with the reduction of both estrogen receptors (ER--α and ER--β) expression.
    Minerva ginecologica 02/2015;
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    ABSTRACT: Cryopreservation techniques play today a central role in assisted reproduction, as they enhance the overall efficacy of in vitro fertilization (IVF) treatments by allowing the banking of supernumerary embryos obtained in these treatments, and their later use. The transfer of frozen/thawed embryos was established nearly 30 years ago, and although it has been clinical routine for a long time, the importance of freezing embryos has been newly emphasized. As recognized downsides of IVF treatment include the high prevalence of perinatal complications due to multiple births, the recommended practice of transferring fewer embryos in the fresh IVF treatment cycle, with the goal of performing single embryo transfer and the cryostorage of remaining embryos for their later use in frozen--thawed cycles, one at a time, is currently the trend. Also of great importance, cryopreservation techniques for spermatozoa and oocytes have additionally permitted gamete storage for long--term and the implementation of several new treatment modalities for assisted reproduction. Most of these methods are applied today in clinical programs of fertility preservation and third--part reproduction, such as sperm-- and egg donor programs. Use of frozen thawed sperm has been in clinical use for over 50 years and banking sperm has been routinely offered to men, usually before gonadotoxic treatments, but also in many cases, practised as a "safety policy" previously to a vasectomy. Freezing methods for women's egg have required a much longer time to achieve a comparable effective clinical standard. Only recently, with the development of vitrification of oocytes, the clinical standard was recognized and since 2013 when the label "experimental" was removed, the freezing of oocytes could be regarded as an established method, and its use extended into clinical practice for fertility preservation but also performed after personal requirements, so called, "social freezing".
    Minerva ginecologica 02/2015;
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    ABSTRACT: Laparoscopy is the gold standard in gynecologic surgery. Single port laparoscopic surgery, has been developped in order to improve minimally invasive surgery. We reviewed single--port approach in benign gynecologic pathology. A bibliographic research on Pubmed and Medline was realized from january 2000 to january 2015. Single--port laparoscopy can be used for salpingostomy or salpingectomy to treat tubal ectopic pregnancy, benign adnexal disease ( ovarian cystectomy, salpingo--oophorectomy) , and for hysterectomy. We don't have enough data for complex procedures like myomectomy or hysteropexy. Robotic Single--port laparoscopy seems to be a very attractive perspective. The use of Single--port laparoscopy in benign gynecology surgery is expanding. More and more ergonomics limitation of Single port laparoscopy are corrected by developpement of articulated or flexible instruments and camera. Beyond these preliminary results, more ample propective studies with an adapted and standardized instrumentation are thus essential to highlight real profits.
    Minerva ginecologica 02/2015;
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    ABSTRACT: The progressive and chronic nature of this disease can have a substantial impact on both quality of life and functioning of women who suffer from the disease. While medical treatment can be sufficient therapy for many women with endometriosis, medical therapies are often inadequate for the severest cases. The anatomic changes of adhesions/fibrosis and smooth muscle metaplasia that are associated with endometriosis, however, can be substantial and surgery for this disease can be technically challenging. Historically, the severest cases of endometriosis were managed using a laparotomy approach. Traditional laparoscopy has gained popularity for the management of this disease but has limitations in the surgical treatment of the most difficult cases of endometriosis. With the introduction of the robotic surgical platform, experience has gradually accumulated regarding its application for surgical management of DIE. It has been suggested that the robotic platform enables more complex dissections and may be the ideal modality for the surgical management of endometriosis. As both experience and technology expand, the robotic platform is being utilized by an increasing number of surgeons and for increasingly complex minimally invasive pelvic surgery. The literature analyzing its actual performance in the management of DIE, however, is only just manifesting. This review focus on the surgical management of endometriosis by robotic laparoscopy. Specifically we describe the unique surgical challenges of this disease. We also highlight the current state of the literature that analyzes the application of robotic laparoscopy to the various anatomic and clinical manifestations of endometriosis and critique outcomes as they apply to the safety, efficacy and cost of this modality for the management of endometriosis.
    Minerva ginecologica 02/2015;
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    ABSTRACT: Endometriosis is present in up to one--third of infertility patients. In a subset of these patients, workup will reveal the presence of an endometrioma. When the endometrioma is causing pelvic pain or dysmenorrhea, removal can greatly improve pain and quality of life. However, in the patient preparing for an IVF cycle removal of an endometrioma can delay treatment. It is critical to know the benefits and risk of such a procedure prior to proceeding with surgical endometrioma removal. A great deal of literature had been published on the effect of endometriomas on fertility and IVF outcomes. In this review, we will summarize the current literature addressing the effects of endometrioma removal on ovarian response and pregnancy rates following IVF.
    Minerva ginecologica 02/2015;
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    ABSTRACT: The last decade has been characterized by a careful review of the risks and benefits of hormone replacement therapy (HRT). Various types and doses as well as different combinations, may offer different advantages in different groups of women. Women with premature or early menopause may benefit from HRT, at least until the age at which natural menopause usually occurs. The most favorable benefits of HRT is in symptomatic younger women (50--59 years) within 10 years since menopause. Beside the effect on symptoms, these patients have additional benefits such as reduction in cardiovascular disease (CVD), osteoporotic fractures, and overall mortality. In older women low--dose or ultra--low--dose HRT may have a better safety profile than standard dose oral combinations. Currently, available evidence does not support the use of HRT for the sole osteoporosis or CVD and cognition decline prevention.
    Minerva ginecologica 02/2015;
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    ABSTRACT: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women in fertile age. It is an endocrine and metabolic disorder characterised by oligo-an ovulation, hyperandrogenism and insulin-resistance. Various therapeutic approaches have been attempted in PCOS, including diet and the use of pharmacological agents such as oral contraceptives (OCs) or [12] anti-androgens Recently, the introduction of inositol in the treatment plan has proved to be as reasonable as useful in countering the endocrine-metabolic disorders of this syndrome. The aim of our study is to compare the clinical, endocrine and metabolic response after 6 months of therapy in 137 PCOS women characterized by oligomenorrhea and/or acne and/or mild hirsutism and insulin-resistance. The patients were treated with Myo-inositol or with D-Chiro-Inositol or with Placebo. Our study showed that both Myo-Inositol and D-Chiro Inositol treatments are able to significantly improve the regularity of the menstrual-cycl, the Acne Score, the endocrine and metabolic parameters and the insulin-resistence in young, overweight, PCOS patients. Definitely, we assumed that both treatments with Myo-inositol and with D-Chiro inositol could be proposed as a potential valid therapeutic approach for the treatment of patients with PCOS. Additionally, further examination and for a longer period of treatment are needed.
    Minerva ginecologica 02/2015;
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    ABSTRACT: Our objectives were to evaluate the efficacy of the PerigeeTM transoburator (TOT) mesh kit [American Medical Systems (AMS)-Minnetonka, MN, USA] in the treatment of ≥ stage 2 symptomatic AVP following a 2-year follow up and to discuss the role of the pre-, peri- and postoperative measures taken to prevent complications. A total of 50 patients were eligible and were subjected to AVP surgical treatment with the use of the PerigeeTM system. All patients were followed-up at 4 weeks, 2, 6, 12 and 24 months. Our primary objective was treatment success and efficacy after anatomical examination of the patient at the 24- month follow-up. Efficacy was defined as ≤ stage I AVP. All patients completed the 24-month follow-up. Our secondary objective was to examine the complication rates in relation to the use of preventative measures. The proportion of patients with II to III stage significantly decreased postoperatively (p<0.001). A significantly improvement was found in all POP-Q measures (p<0.05) while mean vaginal length was similar to the preoperative values. At 24-month follow up, 45 women were defined as ≤stage I, indicating a 90% objective success rate (95% CI: 81.4% - 98.6%). The treatment of AVP with the use of Perigee TOT system can be both effective and safe. It is crucial for POP procedures to be performed by high-volume surgeons in this field, with extensive knowledge of the pelvic floor anatomy and the mesh's characteristics.
    Minerva ginecologica 02/2015;
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    ABSTRACT: Conventional controlled ovarian stimulation (cCOS) can cause significant discomfort, including ovarian hyperstimulation syndrome (OHSS). Clearly, management of OHSS and poor responder patients requires new strategies to overcome these problems and facilitate the birth of a healthy child with the fewest stimulation cycles. Several alternative methods have been developed. Non-conventional controlled ovarian stimulation (non-cCOS) is based on low-dose stimulation regimens and is often termed "light", "soft", "mini", "minimal", "mild", "low cost", or "low dose IVF". Non-controlled ovarian stimulation therapies (non-COS) include natural cycle IVF or a mixture between non-controlled and non-cCOS, termed "modified natural IVF" or "anti-estrogen/aromatase inhibitor/low dose FSH-cycles", in which cycles are monitored but not controlled. These approaches promise to reduce the physical, emotional, and financial burden of IVF therapy while maintaining acceptable pregnancy rates. Such approaches might reduce the risk of OHSS. However, the overall cost per baby increases due to the higher number of stimulation cycles required, and the inconvenience of ovum pick-up still remains. The primary focus should be to obtain several good quality blastocysts after a single cCOS cycle. Thus, adequate numbers of mature oocytes are mandatory. What is more difficult and expensive for patients: several non-COS/non-cCOS cycles to obtain a baby or a single cCOS cycle with a high probability to obtain more than one child? Classic cCOS using the GnRH agonist long protocol followed by single embryo transfer (SET) at the blastocyst stage and aseptic vitrification of surplus embryos optimizes the IVF outcome. This strategy, combined with outpatient management in the case of OHSS, minimizes inconvenience and risks of OHSS. Accumulation cycles (AC) by repeated COS with subsequent freezing of blastocysts, combined with preimplantation genetic screening (PGS), is a promising new approach for low responders, especially in cases of advanced maternal age (AMA).
    Minerva ginecologica 02/2015;
  • Minerva ginecologica 02/2015;
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    ABSTRACT: The risk of an individual woman to develop breast cancer over a 5-year period can be estimated using the Gail Model. The risk factors included in this model effectively classify patients into two different subgroups. One subgroup comprises patients at increased risk because of increased exposure to estrogen.These women are more likely to benefit from endocrine chemopreventive therapies, namely selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs). The second subgroup comprises women who have inherited genetic mutations that predispose them to breast cancer. Chemoprevention in these patients is more likely to be achieved by novel agents, such as lapatinib, gefitinib, fenretinide, rexinoids and poly(ADP-ribose) polymerase (PARP)-inhibitors.
    Minerva ginecologica 02/2015;
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    ABSTRACT: The aim of this study was to evaluate the effect of Beta--glucan in women with ASCUS or L-SIL, as detected by cervical cytologic screening. A total of 356 women with ASCUS or L--SIL were enrolled and divided into two groups: 1) 176 patients, treated with topical Beta--glucan and 2) 180 patients who were only followed-up. The treatment consisted of two cycles of topical Beta--glucan applied once a day for 20 consecutive days and treatment separated by ten days. The effect of Beta-glucan was evaluated comparing Pap cytology results and colposcopic findings between treated patients and controls after 6 and 12 months of follow up. After 6 months from enrollment, 63.1% (111/176) of patients treated with Beta-glucan had a negative Pap smear versus 45.0% (81/180) of controls (P<0.001), and 43.4% (36/83) of treated patients versus 18.2% (14/77) of controls experienced the disappearance of colposcopic lesions (P=0.001). At the end of the 12-month follow up, 83.5% (147/176) of treated patients versus 60.0% (108/180) of controls had a negative Pap smear (P<0.001), and 55.4% (46/83) of treated patients versus 24.7% (19/77) of controls experienced the disappearance of colposcopic lesions (P<0.001). No side effects were observed in treated patients. Beta--glucan increases the spontaneous regression rate of low-grade cytologic abnormalities as well as cervical findings.
    Minerva ginecologica 02/2015;
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    ABSTRACT: While diminished ovarian reserve (DOR) predicts decreased ovarian response to stimulation, it does not necessarily foretell about the cycle fecundity. According to Bologna's criteria laid down by the European Society of Human Reproduction and Embryology (ESHRE), old age, abnormal ovarian reserve tests such as antral follicle count (AFC) and anti--mullerian hormone (AMH) as well as prior suboptimal response to stimulation are the main factors representing DOR. Unfavorable response to maximal stimulation on two previous occasions may also represent DOR. Among the ovarian reserve tests, AMH and AFC are the most predictive values for DOR. Factors which may give rise to DOR include environmental factors, autoimmune or metabolic disorders, infections, genetic abnormalities, and iatrogenic causes (such as smoking, chemotherapy, radiation and gynecologic surgeries). Besides, studies have proposed endometriosis as a key contributor to DOR and hence emphasized on its proper management to prevent additional damages leading to compromised fertility. In summary, DOR is found to be a clinical challenge in the practice of fertility care with controversial countermeasures to prevent or treat the condition. Nevertheless, some promising measure such as: oocyte, embryo and tissue cryopreservation, ovarian transplantation, dietary supplementation and the transfer of mitochondria have offered hopes towards ameliorating the burden of DOR. This review attempts to discuss DOR from different perspectives and summarize some existing hopes in clinical practice.
    Minerva ginecologica 02/2015;