G L Bracco

University of Florence, Florens, Tuscany, Italy

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Publications (22)27.85 Total impact

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    ABSTRACT: Laparoscopic approaches to giant ovarian cysts, particularly in adolescents, have critical management concerns as follows: risk of malignancy, risk of cyst rupture, and limited working space. A 15-year-old girl presented with a giant (>25 cm) ovarian serous cyst adenoma containing 7 L of fluid. At open laparoscopy, a giant, entirely cystic, smooth mass originating from the right ovary and lying between the symphysis and the xiphoid was observed. After intraabdominal fluid aspiration, open conservative cystectomy was performed, avoiding spillage. The patient made an uneventful postoperative recovery and was discharged on the second postoperative day. To our knowledge, this is the largest ovarian cyst treated conservatively in an adolescent. Minimal access surgery, laparoscopy and open cystectomy, can be safely proposed in this group of patients. Conservative surgery should always be evaluated for preservation of ovarian function in cases of giant ovarian cysts in adolescents.
    Journal of Pediatric Surgery 07/2009; 44(6):E5-8. · 1.38 Impact Factor
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    ABSTRACT: Laparoscopy is considered the gold standard for treatment of endometriosis. In vitro fertilization and embryo transfer (IVF-ET) is often used to treat women with infertility associated with endometriosis. The objective of the study was to evaluate the pregnancy rate after surgical treatment and to assess whether a combined approach with laparoscopic surgery followed by IVF-ET can improve the "overall" pregnancy rate. A retrospective observational study was carried out on 107 infertile patients who underwent laparoscopic surgery for endometriosis and came at follow-up for a period of time between 1 and 11 years. Sixty-seven patients who did not become pregnant after surgery subsequently underwent IVF-ET. The pregnancy rate achieved after the integrated laparoscopy-IVF approach was 56.1%. The pregnancy rate after surgery, was significantly lower (37.4%). The fecundity rate for spontaneous conceptions within 6 months of laparoscopy (23.2%) was significantly higher (P<0.05) than for the following intervals. The cumulative fecundity in women older than 35 years was significantly lower than in younger women. In patients with endometriosis-associated infertility, surgery followed by IVF-ET is more effective than surgery alone. When patients fail to conceive spontaneously, after a maximum of 1 year from laparoscopic surgery, IVF should be suggested.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 05/2008; 138(1):54-9. · 1.84 Impact Factor
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    ABSTRACT: Ovarian stimulation is an important step in the success rate of in vitro fertilization (IVF) allowing multiple follicular growth, several oocytes and consequently more embryos. The combination of GnRH-antagonists (GnRH-ant) and gonadotrophins is now available for clinical use and represent a valid alternative to classical protocol with GnRH agonist. GnRH-antagonists induce a direct block of GnRH receptor with a rapid decrease in LH and FSH, preventing LH surge. Two protocols has been designed for assisted reproduction technology (ART) treatment: multiple-dose protocol and a single-dose. Both protocols are simply, efficacious, started in the late follicular phase and do not have side effects. A review of GnRH-antagonist applications in ART cycles are presented. Smaller doses of gonadotrophins, shorter stimulation period and lower ovarian hyperstimulation syndrome (OHSS) incidence are reported in literature using GnRH-antagonist compared to agonist. Triggering of ovulation, the use in polycystic ovarian syndrome (PCOS) and poor reponders patients are other interesting indication. Regarding to pregnancy rate and potentially adverse effects of drugs on endometrium or implantation needed more data.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 08/2004; 115 Suppl 1:S44-56. · 1.84 Impact Factor
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    ABSTRACT: To present pressure lavage under ultrasound guidance (PLUG) as a new therapeutic procedure for selected cases of intrauterine adhesions (IUA). An open clinical investigation with no control group. Teaching hospital. Seven consecutive patients referred to our department for secondary amenorrhea due to IUA. A newly developed technique based on sonohysterography was used to monitor the effects of intrauterine injections of saline solution on the continuous accumulation of saline in the uterine cavity for the mechanical disruption of IUA. Lysis of intrauterine adhesions, restoration of menses, and increased pregnancy rate in infertile patients. Five patients with mild IUA obtained satisfactory lysis of adhesions by the use of the PLUG technique. A second-look hysteroscopy after 1 month showed that filmy adhesions persisted in two patients with moderate IUA. These adhesions were removed successfully during hysteroscopy. Restoration of menses was obtained and has continued in all patients. Two of the three infertile patients became pregnant. This technique is safe and ideal as an in-office procedure. PLUG allows complete lysis in mild IUA cases, and the need for therapeutic, and possibly follow-up hysteroscopy, can be avoided. In moderate IUA cases, the procedure may represent a useful initial step in reducing the need for operative hysteroscopy.
    Fertility and Sterility 04/2001; 75(3):601-6. · 4.17 Impact Factor
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    ABSTRACT: To evaluate the efficacy and safety of ultrasound (US) guidance as compared to laparoscopic monitoring during operative hysteroscopy. Prospective, open study including 81 patients undergoing operative hysteroscopy under US guidance for uterine septum and submucous myoma. Clinical and surgical outcomes were compared with those in an historical control group of 45 patients undergoing the same operation under laparoscopic guidance. US guidance proved satisfactory in all patients, and there were no complications due to insufficient visualization of the pelvic structures; in no case was conversion to laparoscopic guidance required. US scanning was most useful in determining the outer limit of the intramural component of submucous partial intramural myoma, allowing complete resection. During metroplasty, US guidance allowed extension of the resection beyond the normal limit conventionally defined by hysteroscopy; none required reintervention. By comparison, in the control group, a second attempt was required because the operation was insufficiently radical in four patients. US guidance was used successfully as the only visual aid for hysteroscopic surgery, comparing favorably with laparoscopy in terms of efficacy and safety.
    The Journal of reproductive medicine 06/2000; 45(5):413-8. · 0.75 Impact Factor
  • Annals of the New York Academy of Sciences 02/2000; 900:253-9. · 4.38 Impact Factor
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    ABSTRACT: To assess the true incidence of vaginal vault prolapse after hysterectomy. The records of 2,670 patients who had undergone hysterectomy between 1983 and 1987 were reviewed. From this population, 448 patients were selected for follow-up study. The mean follow-up phase was 11 years (range, 9-13). Patients were divided into two groups according to the presence or the absence of genital prolapse at hysterectomy. Pelvic examination was performed in order to identify the presence of vault prolapse. Pelvic support was assessed using Baden and Walker's "halfway description." Five of the 2,670 patients who had undergone hysterectomy at our institution returned on their own initiative for surgical correction of vault prolapse. Using the modalities in the literature, the incidence of vault prolapse was 0.4%. Instead, on pelvic examination, the incidence of vault prolapse was 4.4% (20 patients in a group of 448). Fourteen of the 20 with vault prolapse had previously undergone vaginal hysterectomy for genital prolapse: six had had abdominal hysterectomy for benign disease, excluding genital prolapse. Therefore, the incidence of vaginal vault prolapse was 11.6% (14/120 patients) when hysterectomy had been performed for genital prolapse and 1.8% (6/328) when hysterectomy had been performed for other benign diseases. In the latter group (328 patients), all the cases of vault prolapse developed after abdominal hysterectomy: the incidence was 2% (6/308 patients); no case (0/20 patients) of vault prolapse developed after vaginal hysterectomy that had been performed on patients without genital prolapse. The primary risk factor for vaginal vault prolapse in this study, was obesity. Obese subjects were significantly more susceptible to developing the condition when compared to nonobese (P < .001). Our data show that there is a low incidence of vaginal vault prolapse when hysterectomy is performed in the absence of defects in pelvic support. A comparison of our method and those described in the literature to determine the incidence of vaginal vault prolapse showed that this event is often underevaluated if long-term follow-up after hysterectomy is not carried out.
    The Journal of reproductive medicine 08/1999; 44(8):679-84. · 0.75 Impact Factor
  • Minerva ginecologica 06/1998; 50(5):217-9.
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    ABSTRACT: We report a case of acute abdomen due to puncture of a dermoid cyst during oocyte aspiration, which required laparotomy. A woman who had undergone an in-vitro fertilization and embryo transfer required hospitalization due to onset of an acute abdomen. An ultrasonographic scan showed a pelvic mass with the features of dermoid cyst. The patient required diagnostic laparotomy which confirmed the presence of a ruptured dermoid cyst with subsequent peritonitis.
    Human Reproduction 10/1996; 11(9):1897-9. · 4.67 Impact Factor
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    ABSTRACT: In the past, most cases of osseous metaplasia of the endometrium were diagnosed following removal of bone from the endometrium by dilatation and curettage and frequently subsequently treated by hysterectomy. Nowadays, management involves a suggested diagnosis by transvaginal ultrasound examination, confirmation by hysteroscopy and hysteroscopic removal of ectopic intrauterine bone. This is usually carried out under laparoscopic guidance. However, the degree of visual control provided by combined transabdominal and transrectal ultrasonography may prove sufficiently accurate for hysteroscopic guidance. In this report we describe a case of endometrial osseous metaplasia successfully managed by ultrasound-guided hysteroscopy. The advantages of our approach include reduced invasiveness, reduced costs and simultaneous visualization of the abdominal and intrauterine cavities. One limitation, however, is represented by the greater operator dependence of ultrasound guidance as compared to laparoscopy, the former requiring extensive training and state-of-the-art equipment. We suggest that ultrasound guidance for hysteroscopic removal of extensive osseous metaplasia may represent a potentially safer and more effective alternative to laparoscopy and would therefore encourage further clinical evaluation of this technique.
    Ultrasound in Obstetrics and Gynecology 09/1996; 8(2):134-6. · 3.56 Impact Factor
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    ABSTRACT: To evaluate the biocompatibility, adhesion prevention properties and ability to preserve reproductive capacity of polytetrafluoroethylene surgical membrane in ovarian surgery on the rabbit. In two groups of female rabbits a standard lesion was made on each ovary. In group 1, one ovary was partially covered with a flat sheet of the surgical membrane, and the other was left uncovered so that each rabbit served as its own control. In group 2, one ovary was again left uncovered to serve as an internal control, and the other was completely covered with a "cap" of the surgical membrane. Laparotomies were performed several weeks postoperatively after the rabbits were mated with fertile males; adhesions were evaluated, and the number of cornual pregnancies was determined. In group 1, 67.9% of the control ovaries and 7.1% of the partially covered ovaries had adhesions (P < .001); in the uterine horn on the control side, 32.1% of the rabbits exhibited cornual pregnancies (1.14 +/- 1.72 [mean +/- SD] pregnancies per rabbit), whereas on the experimental side, 89.3% of the rabbits exhibited cornual pregnancies (3.89 +/- 1.58 per rabbit). In group 2, 83.3% of the control ovaries and 11.1% of the covered ovaries had adhesions (P < .001); in the uterine horn on the control side, 23.5% of the rabbits exhibited cornual pregnancies (2 +/- 1.1 per rabbit), whereas on the experimental side, 100% of the rabbits exhibited cornual pregnancies (4.8 +/- 0.9 per rabbit). The surgical membrane is an excellent device for preventing the formation of adhesions to the ovary after surgery in rabbits, preserving the reproductive capacity of the ovary.
    The Journal of reproductive medicine 03/1996; 41(2):73-8. · 0.75 Impact Factor
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    ABSTRACT: To evaluate the possible effects of topical testosterone as maintenance therapy after clobetasol propionate treatment. Thirty-two patients with biopsy-proven vulvar lichen sclerosus (LS), after 24 weeks of treatment with 0.05% clobetasol propionate cream, were randomly distributed into two groups of 16 each and treated for a further length of time (24 weeks) with testosterone 2% ointment or a cream-based preparation (placebo). The patients were examined before and after treatment for symptoms, gross aspects and histologic features. With clobetasol propionate all patients had a marked improvement (P < .001) in both clinical and histologic parameters. After clobetasol propionate therapy, the 16 testosterone-treated patients had significant worsening of their symptoms (P < .05%) and no evident changes in gross aspects (P = NS). The placebo-treated group had good symptomatic control of their disease, with no significant changes in symptoms or gross aspects (P = NS). After the good results obtained with clobetasol propionate, treatment with testosterone appeared to have a negative effect, while a regularly provided emollient cream was useful in symptom control.
    The Journal of reproductive medicine 03/1996; 41(2):99-102. · 0.75 Impact Factor
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    ABSTRACT: We report a case of acute abdomen due to puncture of a dermoid cyst during oocyte aspiration, which required laparotomy. A woman who had undergone an in-vitro fertilization and embryo transfer required hospitalization due to onset of an acute abdomen. An ultrasonographic scan showed a pelvic mass with the features of dermoid cyst The patient required diagnostic laparotomy which confirmed the presence of a ruptured dermoid cyst with subsequent peritonitis.
    01/1996;
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    ABSTRACT: Bilateral vulvar edema associated with severe ovarian hyperstimulation syndrome is described for the first time. A 28-year-old woman underwent gonadotropin-releasing hormone analogue and gonadotropin treatment for in vitro fertilization and embryo transfer. On day 18 of the cycle, the patient reported mild abdominal discomfort that became severe during the following four days. One the 22nd day of the cycle, bilateral ovarian enlargement and ascites were present. The vulva showed massive edema and fissures. Ovarian hyperstimulation syndrome (OHSS) therapy consisted of human albumin, lactated Ringer's solution and heparin. The vulvar edema was treated with topical hydrocortisone ointment, ice packs and topical gentamycin twice a day. After one week of treatment, the vulva was normal. We think that the vulvar edema in this case was the result of decreased oncotic pressure and increased hydrostatic pressure, as occur during OHSS.
    The Journal of reproductive medicine 10/1995; 40(9):659-60. · 0.75 Impact Factor
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    ABSTRACT: In 20 women with vulvar lichen sclerosus (LS) we analyzed the immunohistologic features of the dermal lymphoid infiltrate and the number of epidermal CD1a+ cells (Langerhans cells). Activated (HLA-Dr+) T cells, associated with CD1a+ accessory cells, were found in the dermis in all cases. The number of CD1a+ epidermal cells was increased, and the cells expressed strong HLA-DR+ staining. These findings suggest activation of the skin immune system in vulvar LS lesions. Conventional 2% testosterone therapy failed to modify the immunohistologic features. Clobetasol, 0.05%, application seemed more effective in down-regulating the skin's immune system activation profile.
    The Journal of reproductive medicine 03/1994; 39(2):110-4. · 0.75 Impact Factor
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    ABSTRACT: A randomized study was conducted on 79 patients with vulval lichen sclerosus who were treated for three months with four topical drugs including testosterone (2%), progesterone (2%), clobetasol propionate (.05%) and a cream based preparation. To evaluate the efficacy of the treatments, patients were examined before and after therapy for symptoms, gross appearance of the lesions and histopathologic features. Patients treated with clobetasol had a better response than responses recorded in the other groups. Remission of symptoms occurred in 75% of patients treated with clobetasol compared to 20% treated with testosterone, 10% treated with progesterone and 10% treated with a cream based preparation. The clobetasol group was the only group with gross changes and histologic evaluations before and after treatment, that showed a highly significant difference (P < .001). In a condition characterized by epidermal atrophy, we observed a significant reduction in epidermal atrophy after treatment. This study suggests that clobetasol propionate (.05%) (a very potent topical steroid) is the therapy of choice in vulval lichen sclerosus.
    The Journal of reproductive medicine 01/1993; 38(1):37-40. · 0.75 Impact Factor
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    ABSTRACT: The paper describes a study carried out in 40 patients affected by lichen sclerosus (LS) of the vulva. The mean age of patients was 60.9 years (range 27-83) and 31 were in menopause. Patients were divided randomly into two groups of 20. The symptoms (itching, burning, pain, dyspareunia), clinical aspects (atrophy, hyperkeratosis, sclerosis) and histological alterations (atrophy of the epithelium, edema, inflammatory infiltrate, fibrosis) were quantified in each patient by a score. The mean scores relating to the three parameters examined were then calculated for each group. One group was treated with testosterone propionate 2% and the other with a strong synthetic corticosteroid, clobetasol dipropionate 0.05%. After 24 weeks of treatment patients were again evaluated in relation to clinical (symptoms and clinical aspects) and histological parameters, following the procedure used before the start of treatment. The mean scores obtained were then compared with those before the start of treatment. Statistical analyses were performed using Student's t-test. Testosterone was found to be effective in relation to symptoms but no significant change was observed in relation to clinical aspects and histological alterations. It also caused major secondary effects which led to the suspension of treatment in one patient. Clobetasol was shown to be highly effective both in relation to symptoms and in terms of clinical aspects and histological alterations, and did not cause any noteworthy collateral effects, especially contact dermatitis. In the context of the objective parameters examined in this study, sclerosis and hyperkeratosis were easily modified by corticosteroid treatment in comparison to atrophy, especially in those patients with a longer duration of disease.(ABSTRACT TRUNCATED AT 250 WORDS)
    Minerva ginecologica 12/1992; 44(11):567-71.
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    ABSTRACT: One hundred thirty-eight cases of nonneoplastic epithelial disorders of the vulva treated with medical therapy from 1984 to 1988 were evaluated at the University of Florence, Florence, Italy. The 67 cases of lichen sclerosus were treated with testosterone propionate or progesterone ointment for 32 weeks. The 31 cases of squamous hyperplasia were treated with corticosteroid ointment for 16 weeks. The 40 patients with lichen sclerosus associated with squamous hyperplasia were treated with corticosteroid ointment for 12 weeks and then with testosterone propionate ointment for another 20. To evaluate the efficacy of the treatments, the patients were examined before and after therapy. The evaluation took into account the symptoms and gross appearance of the lesions, which were given a score of 1-3. Considering all the cases evaluated, a total regression of symptoms occurred in 82 patients (59.4%), while a partial regression occurred in 37 (26.8%). Furthermore, there was a total regression of gross changes in 68 cases (49.3%) and a partial one in 43 (31.1%). The best results were obtained with squamous hyperplasia, which lichen sclerosus, alone or associated with squamous hyperplasia, yielded less successful results.
    The Journal of reproductive medicine 05/1991; 36(4):301-5. · 0.75 Impact Factor
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    ABSTRACT: Biopsies taken from vulvar lesions in 12 women affected by vulvar lichen sclerosus et atrophicus (LSA) have been processed for immunohistological study. Activated (HLA-Dr+) T cells, associated with CD1a+ accessory cells, were found in the dermis in all cases, with architectural patterns varying in relation to the histological phase (early, well developed, old) of the lesion. Interestingly, the number of epidermal CD1a+ Langerhans cells (LCs) was increased in all cases, without any correlation with the amount of the dermal infiltrate and with the histological phase of the lesions. In fact, also in old lesions the number of epidermal CD1a+ LCs was increased, and the sparse dermal lymphoid cells showed a persistent HLA-Dr antigen expression. These data, indicating the persistent activation of epidermal antigen-presenting cells and lymphoid cells in all the evolutive phases of vulvar LSA, suggest a possible involvement of the skin immune system in the pathogenesis of LSA.
    Dermatologica 02/1991; 182(1):18-22.
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    ABSTRACT: Since the last century, epidemiological studies of cervical carcinoma have shown a close link with sexual activity and in particular with promiscuity starting at an early age. Aetiological research has therefore concentrated on identifying sexually transmitted pathogens. In recent years studies have focused on the apparently significant role of HSV and particularly HPV in the aetiopathogenesis of this tumour. After the first cytohistological findings the HPV-cervical cancer link has been confirmed by electron microscopy, immunohistochemical studies and hybridisation of viral DNA. The identification of different HPV types presenting varying degrees of oncogenic risk offers the prospect of reaching a reliable prognosis on the basis of the particular virus identified in the lesion. The hypothesis that the virus has a decisive influence on the biology of th tumour is also intriguing: findings on the incidence and course of cervical cancer in the youngest women seems to suggest tha HPV may be a fundamental tumour growth factor.
    Minerva ginecologica 02/1989; 41(1):9-15.