[Show abstract][Hide abstract] ABSTRACT: The purpose of this study is to evaluate the menstrual profile in users of the etonogestrel (ENG)-releasing implant (Nexplanon®) and the possible correlation with anthropometric variables.
Ninety-two healthy women, desiring long-term contraception with the ENG implant were enrolled in a prospective observational study. Anthropometric variables were measured at baseline and after 3, 6, 9, and 12 months. Patients recorded daily the occurrence of any bleeding or spotting. The bleeding/spotting pattern was evaluated over consecutive 90-day intervals ("Reference Periods" - RPs). Patients who showed a favourable bleeding profile (amenorrhoea, infrequent, or normal bleeding) for 50% or more of the RPs were assigned to group A, while patients with a favourable bleeding profile for less than 50% of the RPs were assigned to group B.
Sixty-eight women (79%) were assigned to group A; 18 (21%) to group B. Group B had a lower baseline body mass index (BMI) than group A (24.84 ± 4.95 kg/m(2) versus 20.75 ± 4.41 kg/m(2); p < 0.005).
The ENG sub-dermal implant is a well-tolerated contraceptive method, with a high proportion of women experiencing a favourable bleeding profile. The lower basal BMI in Group B in comparison with Group A may account for the higher percentage of irregular bleeding.
[Show abstract][Hide abstract] ABSTRACT: A relationship between urinary incontinence and hypermobility of the urethrovesical junction (UVJ) during pregnancy has been described. The aim of the study was to compare the effects of vaginal delivery (VD) and caesarean section (CS) on UVJ mobility.
The retrovesical angle (RVA) and the anterior angle between the UVJ and the pubic bone, the pubovesical angle (PVA), were evaluated ultrasonographically in controls and pregnant women during their first pregnancy between 38 and 40 weeks, and then re-evaluated 6 weeks and 6 months after delivery. All patients completed a validated questionnaire (ICIQ-SF). Differences between and within groups were assessed with Student's t test, the chi-squared test for trend, and one-way two-tailed analysis of variance with Scheffé's post-hoc test. The correlation between PVA and RVA was evaluated using the Spearman R correlation. The positive predictive value, negative predictive value, sensitivity and specificity for the prediction of stress urinary incontinence (SUI) symptoms were also determined.
Included in the study were 42 controls and 217 pregnant women. PVA at rest, during cough and Valsalva manoeuvre was significantly higher in pregnant women than in controls and in women 6 weeks after VD in comparison with women who had undergone CS. Patients affected by SUI showed a significantly higher PVA. RVA did not differ between subjects affected or not by SUI symptoms. PVA and RVA were not correlated with each other.
PVA and RVA are increased in pregnant women in comparison with controls. In patients undergoing VD, PVA is restored significantly later than in those undergoing CS. The change in RVA after pregnancy and delivery seems to persist longer than the change in PVA.
International Urogynecology Journal 05/2015; DOI:10.1007/s00192-015-2736-3 · 2.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cervical stenosis, defined as cervical scarring of variable degree, represent a significant anatomical impediment to hysteroscopic procedures. Acquired cervical stenoses are more common then congenital forms and they are mainly associated with aging, estrogen-progesteron drugs, cervical trauma or carcinoma. The overcoming of cervical stenosis at office hysteroscopy is challenging and it often fails requiring the scheduling of the patient for an in-patient treatment under general anesthesia. We report the office hysteroscopy treatment of a vanishing external uterine orifice in a postmenopausal woman with ultrasonographic report of a heterogeneous and thick endometrium suggestive of endometrial pathology, focusing the main surgical steps to perform an adequate management.
[Show abstract][Hide abstract] ABSTRACT: The "Triangle of Death" is an area of southern Italy highly polluted due to the presence of numerous illegal waste sites. To assess whether environmental contamination could produce an increased intake of harmful chemicals, we determined the serum levels of the 12 polychlorinated biphenyls (PCBs) indicated as "dioxin like" by the World Health Organization (WHO) in both maternal blood serum and umbilical cord blood serum of people residing in that area. The study was performed on 32 pregnant women and cord serum of their 32 newborn babies. Maternal serum concentrations ranged from 0.019 to 10.426 ng/mL (mean 1.590 ± 2.002 ng/mL), while umbilical serum concentrations ranged from 0.018 to 16.980 ng/mL (mean 1.858 ± 3.558 ng/mL). To normalize the toxic impact of the different congeners, the levels were expressed as WHO-TEQ, i.e., toxic equivalent concentrations. Total PCB concentrations (ΣPCBs WHO-TEQ 1998) were 0.297 TEQ-ng/mL in maternal serum and 0.663 TEQ-ng/mL in cord blood. These levels are significantly higher not only than those found in subjects resident in other areas but also in comparison to those reported in other published studies. This suggests that the exposure of both pregnant mothers and their fetuses to environmental pollution could produce a high intake of PCBs. The study may be important for the public health authorities to evaluate the level of exposure to environmental pollutants in human residents in the Triangle of Death.
[Show abstract][Hide abstract] ABSTRACT: Small non coding RNAs (sncRNAs) represent a heterogeneous group of <200nt-long transcripts comprising microRNAs, PIWI-interacting RNAs (piRNAs) and small-nucleolar-RNAs (snoRNAs) involved in physiological and pathological processes such as carcinogenesis and tumor progression. Aberrant sncRNA expression in cancer has been associated with specific clinical phenotypes, grading, staging, metastases development and resistance to therapy. Aim of the present work is to study the role of sncRNAs in endometrial carcinogenesis. Changes in sncRNA expression were identified by high-throughput genomic analysis of paired normal, hyperplastic and cancerous endometrial tissues obtained by endometrial biopsies (n = 10). Using smallRNA sequencing and microarrays we identified significant differences in sncRNA expression pattern between normal, hyperplastic and neoplastic endometrium. This led to the definition of a sncRNA signature (129 microRNAs, 2 of which not previously described, 10 piRNAs and 3 snoRNAs) of neoplastic transformation. Functional bioinformatics analysis identified as downstream targets multiple signaling pathways potentially involved in the hyperplastic and neoplastic tissue responses, including Wnt/β-catenin, and ERK/MAPK and TGF-β-Signaling. Considering the regulatory role of sncRNAs, this newly identified sncRNA signature is likely to reflect the events leading to endometrial cancer, which can be exploited to dissect the carcinogenic process including novel biomarkers for early and non-invasive diagnosis of these tumors.
[Show abstract][Hide abstract] ABSTRACT: Introduction: Bisphenol A (BPA) is a weakly estrogenic compound that has been detected in a wide va-riety of food products and biological matrices (saliva, blood, urine, etc). Despite the potential risk of human exposure to BPA, little information exists concerning maternal and fetal exposure to BPA during pregnancy. The aim of this study is to evaluate the correlation between placental BPA concentration, infant birth weight and calculated birth weight centile, and several other maternal and infant parameters. Methods: Placental sample were collected from 200 subjects. BPA levels were measured by isotope dilution GCeMS. Additional maternal and infant data were gathered from medical charts and were potential correlates with placental BPA levels. Results: Placental BPA concentrations ranged from 4.4 ng/g to 273.9 ng/g in oven-dried tissue (average 103.4 ± 61.8 ng/g). There was a significant negative correlation between calculated birth weight centile and levels of placental BPA (p < 0.05). Low birth weight and small for gestational age infants also had significantly greater placental BPA concentrations as compared to normal weight infants and average/ large for gestational age infants. Infants born to African American mothers also had greater placental BPA concentrations as compared to infants born to Hispanic mothers. Discussion: Placental BPA concentrations are correlated with the growth potential of the fetus and may play a role in reduced fetal growth.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study is to evaluate and compare sexual satisfaction with the use of three types of hormonal contraceptives. We have evaluated the sexological profile of 23 patients, treated with a subdermal hormonal contraceptive containing 68 mg etonogestrel. We have compared this profile to that of other two groups of previously studied patients: one consisting of 26 women treated with a vaginal ring releasing 120 A mu g/day of etonogestrel and 15 A mu g/day of ethinylestradiol (EE) and one consisting of 25 women treated with an oral contraceptive containing 20 A mu g of EE and 150 A mu g of desogestrel. A further group of 25 women, not in treatment with any type of hormonal contraceptive, has been studied as control group. The Interviewer Rating of Sexual Function (IRSF) has been completed by the patients at the beginning of the study and after cycles of 3 and 6 months of contraceptive usage. All three types of hormonal contraceptives have increased positive indicators of patients' sexual life (sexual interest and fantasies, of orgasm number and intensity and satisfaction) and decreased negative ones (anxiousness, discomfort). Subdermal contraception is slower than both intravaginal and oral hormonal contraceptives in giving these effects, but is more effective after a cycle of 6 months of usage.
Archives of Gynecology and Obstetrics 07/2014; 290(6). DOI:10.1007/s00404-014-3323-4 · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We present an overview of the current pharmacological treatment of urinary incontinence (UI) in women, according to the latest evidence available. After a brief description of the lower urinary tract receptors and mediators (detrusor, bladder neck, and urethra), the potential sites of pharmacological manipulation in the treatment of UI are discussed. Each class of drug used to treat UI has been evaluated, taking into account published rate of effectiveness, different doses, and way of administration. The prevalence of the most common adverse effects and overall compliance had also been pointed out, with cost evaluation after 1 month of treatment for each class of drug. Moreover, we describe those newer agents whose efficacy and safety need to be further investigated. We stress the importance of a better understanding of the causes and pathophysiology of UI to ensure newer and safer treatments for such a debilitating condition.
Journal of Pelvic Medicine and Surgery 07/2014; 20(4):185-202. DOI:10.1097/SPV.0000000000000076
[Show abstract][Hide abstract] ABSTRACT: Abstract Despite the easy access to contraception today, the rate of unintended pregnancies is still high because of scarce education among women on the methods available and of non-adherence to indications or discontinuation of the contraceptive method chosen. Adherence to contraception can be implemented through counseling programs intended to provide potential users with information regarding all contraceptive options available and to address women's concerns in line with their lifestyle, health status, family planning, and expectations. In here, we evaluate a multi-step decisional path in contraceptive counseling, with specific focus on potential users of long-acting release contraception etonorgestrel. We propose an algorithm about the management of possible issues associated with the use of subcutaneous contraceptive implant, with a special focus on eventual changes in bleeding patterns. We hope our experience may help out health-care providers (HCPs) to provide a brief but comprehensive counseling in family planning, including non-oral routes of contraceptive hormones. Indeed, we believe that a shared and informed contraceptive choice is essential to overcome eventual side-effects and to improve compliance, rate of continuation and satisfaction, especially with novel routes of administration.
[Show abstract][Hide abstract] ABSTRACT: Factors related to bacterial virulence and/or to the host have been implicated in the pathogenesis of recurrent urinary tract infections (rUTI), but in most cases the cause is unknown. Mannose binding lectin (MBL) is an acute phase glycoprotein that exerts immunological functions by binding to the surface of a variety of pathogens. Some human gene variants reduce MBL activity thereby predisposing the host to bacterial and viral infections. The aim of this study was to investigate MBL2 gene variants in relation to rUTI risk. Six MBL gene variants and seven haplotypes were analyzed by PCR and direct sequencing in rUTI patients (n=83) and in healthy subjects from southern Italy (n=642). The frequencies of the L allele (-550) and the HYPA haplotype were higher in controls than in patients stratified according to sex (p<0.05). Our data indicate that the HYPA haplotype in the MBL2 gene could be associated with a minor risk of developing rUTI in males.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 12/2013; 19(1). DOI:10.1016/j.ijid.2013.10.019 · 2.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Accumulating evidence shows an association between deregulation of miRNAs and exposure to environmental chemicals; miRNAs play a unique regulatory role in gene expression. Among environmental pollutants, dioxins are a family of compounds that are known to have multiple hazardous effects. Also, in utero exposure of the fetus to dioxins has been shown to cause impaired psychomotor development, decreased immune function and skin disease. miR-191 is a microRNA that has been found to be up-regulated by dioxin in hepatocellular carcinoma cells in vitro. Our study provides the first molecular evidence in vivo of a positive relationship between levels of polychlorinated biphenyls (PCBs) and miR-191 expression in human peripheral blood mononuclear cells. miR-191 expression was significantly correlated with blood concentrations of total PCB and, in particular, of 3,3',4,4',5,5'-hexachlorobiphenyl (PCB 169, a coplanar congener). Blood concentrations of PCB 169 correlated significantly with miR-191 expression in pregnant women living in a PCB-polluted area, who underwent therapeutic abortion due to fetal malformations. These data suggest that miRNAs could be potential biomarkers to clarify the mechanisms of environmental disease.
Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis 03/2013; 753(1). DOI:10.1016/j.mrgentox.2012.12.018 · 4.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: STUDY OBJECTIVE: To describe the hysteroscopic findings in patients complaining of menorrhagia to establish any significant association between menorrhagia and benign/malignant intrauterine disorders. DESIGN: Prospective cohort study (Canadian Task Force classification II). SETTING: University La Sapienza, Rome, Italy. PATIENTS: One hundred eighteen premenopausal women undergoing office hysteroscopy for menorrhagia (group A) and 344 premenopausal patients undergoing office hysteroscopy for other indications (noncyclic abnormal uterine bleeding, infertility, ultrasonographic abnormalities, etc) (group B). INTERVENTIONS: Office hysteroscopy. MEASUREMENT AND MAIN RESULTS: Data on the prevalence of hysteroscopic findings (cervical polyps, endometrial polyps, submucous myomas, low-grade hyperplasia and high-grade hyperplasia/endometrial carcinoma) were compared between group A and group B. The total prevalence, as well as the prevalence of type 0 and type I myomas (totally or >50% intracavitary, respectively), and the mean number per patients with submucous myomas was significantly higher in group A compared with group B (p = .0001, p = .024, and p = .017, respectively). Multivariable logistic regression analysis showed a statistically significant association between age (odds ratio 4.15, 95% confidence interval 1.55-11.1 in the 40- to 49-year age group), presence of submucous myomas (odds ratio 2.76, 95% confidence interval 1.52-5.00), and menorrhagia. CONCLUSIONS: Menorrhagia seems to be associated with aging, the presence and number of submucous myomas, and with the degree of their intracavitary development.
[Show abstract][Hide abstract] ABSTRACT: We report the case of a yolk sac tumor of the ovary in a 26 years old woman. The laparoscopic approach and the BEP chemotherapy were fundamental to have a minimally invasive treatment and to preserve fertility.
[Show abstract][Hide abstract] ABSTRACT: Besides life-style changes, electrical stimulation or surgery, pharmacological treatment is becoming the first-choice approach in women suffering from lower urinary tract symptoms (LUTS), including urge urinary incontinence (UUI) and overactive bladder (OAB). Several drugs for the treatment of bladder storage and voiding disorders are currently available and, in the near future, novel compounds with higher specificity for the lower urinary tract receptors will be accessible. This will bring optimization of therapy, reducing side effects and increasing compliance, especially in patients with comorbidities and in women. The purpose of this paper is to give an overview on the pharmacotherapy of two common inter-correlated urological conditions, UUI and OAB. The study was conducted by analyzing and comparing the data of the recent international literature on this topic. Advances in the discovery of pharmacological options have dramatically improved the quality of life of patients affected by incontinence, but further studies are needed to increase the effectiveness and safety of the therapies used in this field.
European journal of obstetrics, gynecology, and reproductive biology 01/2013; 174. DOI:10.1016/j.ejogrb.2013.12.024 · 1.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We did a double-blind, randomized, placebo-controlled study to assess the incidence of infectious complications and the protective effect of antibiotic administration during operative hysteroscopic procedures in an office setting. A total of 1046 consecutively enrolled women with intrauterine lesions were randomly allocated to the reference group (523 patients administered with 1 g of cefazolin intramuscularly) and the study group (523 patients administered with 10 mL of isotonic sodium chloride solution), and treated in office setting by operative hysteroscopy for endometrial polypectomy, uterine septa, submucosal myomas, and intrauterine adhesions. The primary outcome measure was the computation of difference between groups in postsurgical infectious complications occurring in the 5 days after the procedures. The time spent in performing the various procedures did not differ significantly (P > .05) between the groups. With respect to the overall rate of postsurgical infection, we found that 12 (1.15%) of 1046 patients referred with symptoms related to infective complications, 7 (1.3% of 523 women) in the study-untreated-group and 5 (1.0% of 523 women) in the reference group. Such incidences did not differ significantly between the groups (P > .05). Antibiotics were prescribed in all cases of postsurgical infection and the infective process resolved in few days. None of these patients developed serious infections with adnexal involvement, as confirmed by clinical and ultrasounds evaluation. The results of the current study would support the American College of Obstetricians and Gynecologists recommendation not to prescribe routine antibiotic administration in the case of hysteroscopic surgery.