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ABSTRACT: The imaging techniques have a fundamental role in the diagnosis of endometriosis. Ovarian endometriosis (endometrioma) and deep endometriosis can be recognized using transvaginal ultrasound and/or magnetic resonance imaging (MRI). Although transvaginal ultrasound is the first choice of imaging modality when investigating women with pelvic pain, MRI have a role for the wider field of visions. The reproducibility of both techniques has been investigated. The three-dimensional ultrasonography has been proposed. Also studies regarding unusual localizations are reported in the literature. New insights are present about the role of imaging in the detection of the malignant transformations. This review summarizes the current evidence on the diagnostic accuracy of these two techniques in the pre-surgical assessment of endometriosis.
Minerva ginecologica 04/2013; 65(2):143-166.
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V Mais,
R Angioli,
E Coccia,
A Fagotti,
S Landi, G B Melis,
M Pellicano,
G Scambia,
E Zupi,
S Angioni,
S Arena,
R Corona,
F Fanfani,
C Nappi
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ABSTRACT: Adhesions are the most frequent complication of abdominopelvic surgery, causing important short- and long-term problems, including infertility, chronic pelvic pain and a lifetime risk of small bowel obstruction. They also complicate future surgery with considerable morbidity and expense, and an important mortality risk. They pose serious quality of life issues for many patients with associated social and healthcare costs. Despite advances in surgical techniques, the healthcare burden of adhesion-related complications has not changed in recent years. Adhesiolysis remains the main treatment although adhesions reform in most patients. There is rising evidence, however, that surgeons can take important steps to reduce the impact of adhesions. A task force of Italian gynecologists with a specialist interest in adhesions having reviewed the current evidence on adhesions and considered the opportunities to reduce adhesions in Italy, have approved a collective consensus position. This consensus paper provides a comprehensive overview of adhesions and their consequences and practical proposals for actions that gynecological surgeons in Italy should take. As well as improvements in surgical technique, developments in adhesion-reduction strategies and new agents offer a realistic possibility of reducing adhesion formation and improving outcomes for patients. They should be adopted particularly in high risk surgery and in patients with adhesiogenic conditions. Patients also need to be better informed of the risks of adhesions.
Minerva ginecologica 02/2011; 63(1):47-70.
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A Daemen,
L Valentin,
R Fruscio,
C Van Holsbeke, G B Melis,
S Guerriero,
A Czekierdowski,
D Jurkovic,
W Ombelet,
A Rossi,
I Vergote,
T Bourne,
B De Moor,
D Timmerman
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ABSTRACT: The aim of this study was to establish when a second-stage diagnostic test may be of value in cases where a primary diagnostic test has given an uncertain diagnosis of the benign or malignant nature of an adnexal mass.
The diagnostic performance with regard to discrimination between benign and malignant adnexal masses for mathematical models including ultrasound variables and for subjective evaluation of ultrasound findings by an experienced ultrasound examiner was expressed as area under the receiver-operating characteristics curve (AUC), sensitivity and specificity. These were calculated for the total study population of 1938 patients with an adnexal mass as well as for subpopulations defined by the certainty with which the diagnosis of benignity or malignancy was made. The effect of applying a second-stage test to the tumors where risk estimation was uncertain was determined.
The best mathematical model (LR1) had an AUC of 0.95, sensitivity of 92% and specificity of 84% when applied to all tumors. When model LR1 was applied to the 10% of tumors in which the calculated risk fell closest to the risk cut-off of the model, the AUC was 0.59, sensitivity 90% and specificity 21%. A strategy where subjective evaluation was used to classify these 10% of tumors for which LR1 performed poorly and where LR1 was used in the other 90% of tumors resulted in a sensitivity of 91% and specificity of 90%. Applying subjective evaluation to all tumors yielded an AUC of 0.95, sensitivity of 90% and specificity of 93%. Sensitivity was 81% and specificity 47% for those patients where the ultrasound examiner was uncertain about the diagnosis (n = 115; 5.9%). No mathematical model performed better than did subjective evaluation among the 115 tumors where the ultrasound examiner was uncertain.
When model LR1 is used as a primary test for discriminating between benign and malignant adnexal masses, the use of subjective evaluation of ultrasound findings by an experienced examiner as a second-stage test in the 10% of cases for which the model yields a risk of malignancy closest to its risk cut-off will improve specificity without substantially decreasing sensitivity. However, none of the models tested proved suitable as a second-stage test in tumors where subjective evaluation yielded an uncertain result.
Ultrasound in Obstetrics and Gynecology 01/2011; 37(1):100-6. · 3.01 Impact Factor
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ABSTRACT: evaluate the efficacy of an estroprogestin EP containing 20 mcg ethinilestradiol (EE) and 3 mg drospirenone (DRSP) in the treatment of hyperandrogenism.
In this study, twenty hyperandrogenic patients were treated with an EP containing EE 20 mcg and DRSP 3 mg in 24+4 regimen for three months. Skin evaluation was performed both quantitatively and qualitatively.
This EP combination showed, after a short-term treatment (three months) to decrease significantly seborrhea, acne, and circulating androgens (testosterone, deidroepiandrosterone sulphate, and androstenedione), while increased sex hormone binding globulin levels. Moreover, this EE 20 mcg/DRSP 3mg EP combination changed some parameters of skin quality, increasing corneometry (a parameter related to skin hydration), and reduced trans epidermal water loss (TEWL, a parameter related to skin evaporation), and erythema (a parameter related to skin inflammation). These results could be taken into account in individualizing the treatment of hyperandrogenic patients.
Minerva ginecologica 12/2010; 62(6):509-13.
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L Ameye,
D Fischerova,
L I Valentin,
E Epstein,
F Leone, G B Melis,
S Guerriero,
C Van Holsbeke,
J Veldman,
L Savelli,
R Fruscio,
A Lissoni,
A Testa,
I Vergote,
S Van Huffel,
B Van Calster,
D Timmerman
Ultrasound in Obstetrics and Gynecology 10/2010; 36(S1):41-42. · 3.01 Impact Factor
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B Van Calster,
A Czekierdowski,
R Fruscio, G B Melis,
S Guerriero,
L Savelli,
C Van Holsbeke,
W Ombelet,
S Van Huffel,
I Vergote,
L I Valentin,
T Bourne,
D Timmerman
Ultrasound in Obstetrics and Gynecology 10/2010; 36(S1):42-43. · 3.01 Impact Factor
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C Van Holsbeke,
B Van Calster, G B Melis,
A Testa,
S Guerriero,
R Fruscio,
A A Lissoni,
A Czekierdowski,
L Savelli,
S Van Huffel,
L I Valentin,
D Timmerman
Ultrasound in Obstetrics and Gynecology 10/2009; 34(S1):8. · 3.01 Impact Factor
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Ultrasound in Obstetrics and Gynecology 10/2009; 34(S1):282. · 3.01 Impact Factor
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Ultrasound in Obstetrics and Gynecology 10/2009; 34(S1):160-161. · 3.01 Impact Factor
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Ultrasound in Obstetrics and Gynecology 10/2009; 34(S1):236. · 3.01 Impact Factor
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Ultrasound in Obstetrics and Gynecology 10/2009; 34(S1):141. · 3.01 Impact Factor
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S Guerriero,
J Alcazar,
S Ajossa,
M Angiolucci,
N Garau,
M Pilloni,
R Galvan,
M Garcia-Manero,
G Lopez Garcia,
C Laparte, G B Melis
Ultrasound in Obstetrics and Gynecology 10/2009; 34(S1):7. · 3.01 Impact Factor
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Ultrasound in Obstetrics and Gynecology 10/2009; 34(S1):285-286. · 3.01 Impact Factor
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Ultrasound in Obstetrics and Gynecology 10/2009; 34(S1):24. · 3.01 Impact Factor
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Ultrasound in Obstetrics and Gynecology 10/2009; 34(S1):238-239. · 3.01 Impact Factor
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D Timmerman,
L Ameye,
D Fischerova,
E Epstein, G B Melis,
S Guerriero,
C Van Holsbeke,
L Savelli,
R Fruscio,
A A Lissoni,
A Testa,
J Veldman,
I Vergote,
S Van Huffel,
T Bourne,
L I Valentin
Ultrasound in Obstetrics and Gynecology 10/2009; 34(S1):7. · 3.01 Impact Factor
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Ultrasound in Obstetrics and Gynecology 10/2009; 34(S1):38. · 3.01 Impact Factor
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ABSTRACT: Chorioamnionitis is an inflammation of the placental membranes induced by microorganisms which reach the endometrial cavity from the vagina and uterine cervix. Premature labor frequently depends on infections. In patients with premature rupture of membranes (PROM) antibiotic treatment can prevent intra-amniotic inflammation if it is absent at admission. In spite of antibiotic treatment started immediately after the PROM in 218 patients, the chorioamnionitis did not prevent delivery in 41 patients within 48 hours of PROM. In the presence of a previous chorioamnionitis, antibiotic treatment cannot prevent premature labor, whereas it can prevent infection and lead to a longer duration of pregnancy if PROM does not depend on previous infection.
Journal of chemotherapy (Florence, Italy) 11/2007; 19 Suppl 2:17-9. · 1.08 Impact Factor
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A M Fulghesu,
S Angioni,
E Frau,
C Belosi,
R Apa,
R Mioni,
N Xamin,
G P Capobianco,
S Dessole,
F Fruzzetti,
V Lazzarini,
L Minerba, G B Melis,
A Lanzone
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ABSTRACT: The introduction of transvaginal approach in ultrasound (US) has enabled the accurate evaluation of the structure of the ovary and stroma. Stroma represents an acknowledged US marker for polycystic ovary syndrome (PCOS). The proportion revealed between the stroma and the ovary surface in the median section (S/A ratio) had been indicated as a reliable marker for hyperandrogenism. In order to verify the feasibility of this determination in routine use and to confirm the efficacy of S/A ratio in predicting hyperandrogenism in PCOS, a multicentric study was performed in association with five Italian research groups.
A total of 418 subjects of fertile age presenting oligomenorrhoea or secondary amenorrhoea, enlarged ovaries measuring >10 cm(3) and/or >12 follicles measuring 2-9 mm in diameter took part in the study. Clinical, US and hormonal evaluations were performed in the early follicular phase or on random days in amenorrhoeic subjects. US assessment included ovarian volume, follicle number, ovarian and stroma area in median section. The hormonal study included a baseline plasma determination of LH, FSH, estradiol (E(2)), androstenedione (A), testosterone (T), dehydroepiandrosteronesulphate, 17-hydroxy-progesterone, sex hormone-binding globulin and prolactin. Correlations and receiver operator curves were used in statistical analysis of data.
S/A was found to be the best significant predictor of elevated A and T levels. In order to ascertain significant cut-off values in relation to A and T levels Youden indexes were calculated and indicated 0.32 as the best cut-off for the S/A ratio.
This work underlines the importance of stroma measure in improving US diagnosis of PCOS and suggest that this parameter may be used in routine clinical practice. In fact, multicentre study demonstrated the easy feasibility of such procedure without need of sophisticated machines or intensive training for operators.
Human Reproduction 10/2007; 22(9):2501-8. · 4.47 Impact Factor
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Ultrasound in Obstetrics and Gynecology 09/2007; 30(4):368 - 369. · 3.01 Impact Factor
