[show abstract][hide abstract] ABSTRACT: To assess the effects of the combination of pelvic floor rehabilitation, intravaginal estriol and Lactobacillus acidophli administration on stress urinary incontinence (SUI), urogenital atrophy and recurrent urinary tract infections in postmenopausal women.
136 postmenopausal women with urogenital aging symptoms were enrolled in this prospective randomized study. Patients: randomly divided into two groups and each group consisted of 68 women. Interventions: Subjects in the triple therapy (group I) received 1 intravaginal ovule containing 30 mcg estriol and Lactobacilli acidophili (50 mg lyophilisate containing at least 100 million live bacteria) such as once daily for 2 weeks and then two ovules once weekly for a total of 6 months as maintenance therapy plus pelvic floor rehabilitation. Subjects in the group II received one intravaginal estriol ovule (1 mg) plus pelvic floor rehabilitation in a similar regimen. Mean outcome measures: We evaluated urogenital symptomatology, urine cultures, colposcopic findings, urethral cytologic findings, urethral pressure profiles and urethrocystometry before, as well as after 6 months of treatment.
After therapy, the symptoms and signs of urogenital atrophy significantly improved in both groups. 45/59 (76.27 %) of the group I and 26/63 (41.27 %) of the group II referred a subjective improvement of their incontinence. In the patients treated by triple therapy with lactobacilli, estriol plus pelvic floor rehabilitation, we observed significant improvements of colposcopic findings, and there were statistically significant increases in mean maximum urethral pressure, in mean urethral closure pressure, as well as in the abdominal pressure transmission ratio to the proximal urethra.
Our results showed that triple therapy with L. acidophili, estriol plus pelvic floor rehabilitation was effective and should be considered as first-line treatment for symptoms of urogenital aging in postmenopausal women.
Archives of Gynecology 09/2013; · 0.91 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of this study was to assess the long-term efficacy and complication rates of posterior intravaginal slingplasty (IVS) in women suffering from genital prolapse.
Posterior IVS or infracoccygeal sacropexy is a minimally invasive procedure for suspension of the vagina with the goal of creating new uterosacral ligaments through the insertion of a polypropylene tape. Forty-four patients were enrolled: 25 patients, affected by uterovaginal prolapse, were subjected to vaginal hysterectomy and posterior IVS; and 19 patients, diagnosed with vaginal vault prolapse, were subjected to posterior IVS alone. The primary outcome for posterior IVS was 12-month, 24-month and annual 9-year postoperative efficacy that is based on a Pelvic Organ Prolapse Quantitative score of -5 at point C, which describes the vaginal apex.
Of the 44 patients who underwent posterior IVS, none required blood transfusions with an average reduction of perioperative hemoglobin of 1.2 ± 0.4 g/dl, and the average time of hospitalization was 4.3 ± 0.6 days. The rate of success was 93.18% (41/44) at 9 years' follow-up. We had only one case of extrusion (2.27%) and three cases of recurrence (6.82%), such as two cases of cystocele and of rectocele.
Most patients interviewed confirmed that their quality of life improved after surgery, 86.36% of the operated patients reported that their sexual performance improved and that they would recommend this surgery for their friends. Posterior IVS was a minimally invasive surgical procedure with a high success rate for genital prolapse.
Journal of Obstetrics and Gynaecology Research 09/2013; · 0.84 Impact Factor
[show abstract][hide abstract] ABSTRACT: Early and certain diagnoses of endometriosis are mandatory to begin the correct treatment and to exclude the risk of endometriosis-associated ovarian carcinoma (EOC) and endometrial stromal sarcoma (ESS).
To assess the immunohistochemical expression of Ber-Ep4, an epithelial antigen, and CD10 in endometriosis.
Forty-eight women underwent laparoscopic surgery for endometriosis and endometriotic samples were recovered for histology. In all surgical specimens Ber-Ep4 and CD10 were searched by an immnohistochemical method. The authors evaluated the correlations among the immunohistochemical positivity and the location of endometriosis.
Most cases (40/48 83.34%) were represented by ovarian endometriotic cyst. Among the eight remaining cases, three (3/48, 6.25%) were pelvic endometriotic lesions, two (2/48, 4.17%) peritoneum of vesico-uterine pouch, one vaginal lesion (2.08%), one salpinx lesion (2.08%), and one inguinal location (2.08%). Ber-Ep4 and CD10 were expressed in 90% and in 100% of the ovarian lesions, respectively. In pelvic lesions Ber-Ep4 and CD10 showed both 66.67% of positivity and had the same pattern in peritoneal, salpinx, vaginal, and inguinal lesions (50%, 100%, 100%, 100%, respectively). Ber-Ep4 was negative in 6/48 (12.5%) cases whereas CDO10 was negative in 2/48 (4.17%) cases of endometriosis. The sensitivity of Ber-Ep4 and CD10 for endometriosis diagnosis were 87.50% and 95.83%, respectively. Immunohistochemistry for Ber-Ep4 showed positivity in all cases of endometriosis with typical cubic epithelium, whereas CD10 was positive in 1/2 (50%) atypical case.
Immunohistochemical expression of Ber-Ep4 and CD10 was positive in most cases of endometriosis and was useful in differential diagnosis with mesothelial cysts. Ber-Ep4 was negative in cases of hyperplastic epithelium or cytological atypia; these cases are not well-differentiated and could be optimally treated by surgery and not by hormonal therapy because of the risk of cancer degeneration.
European journal of gynaecological oncology 01/2013; 34(3):254-6. · 0.58 Impact Factor
[show abstract][hide abstract] ABSTRACT: The cellular tumor suppressor protein pl61NK4a (p16) has been identified as a biomarker for transforming human papilloma virus (HPV) infections. P16 is a cyclin-dependent kinase inhibitor that regulates the cell cycle and cell proliferation by inhibiting cell cycle G1 progression.
To confirm the role of p16 as biomarker for transforming HPV infections and possible clinical applications in histological samples from the uterine cervix.
The subject of this study included 56 biopsies of the cervical canal collected from January 2012 to September 2012 in the Institute of Pathology of the University of Sassari. The search for HPV immunohistochemistry was performed with the monoclonal antibody DAKO 1:25, while for the detection of p16 was used CINtecTM p16 (INK4a) histology kit.
In 56 biopsies performed in women aged between 23 and 69 years, the authors highlighted, by histological analysis, 24 cases of low-grade squamous intraepithelial lesion (LSIL) - cervical intraepithelial neoplasia (CIN1) and 31 cases of high-grade squamous intraepithelial lesion (HSIL) - CIN2/3); 15 CIN2, 14 CIN3, and two cervical squamous cell carcinoma in situ (SCIS). One case was an infiltrating squamous cell carcinoma (ISC). In 24 CIN1, there was a 16.67% positivity for p16 and an equal percentage occurred for HPV. In 15 cases of CIN2 the percentage of positivity for p16 was considerably increased (73.33%), unlike the search for HPV which had a positivity rate of 20%. Finally, in 14 cases of CIN3, and in three carcinomas, the positivity for p16 was equal to 100%, however the search for HPV positivity was between 0% and 7.14%.
These results demonstrated that p16 was a highly sensitive marker of cervical dysplasia. The authors have shown that p16 overexpression increased with the severity of cytological abnormalities and that had a greater ability to identify the viral infection compared to the classical immunohistochemical staining for HPV.
European journal of gynaecological oncology 01/2013; 34(3):227-30. · 0.58 Impact Factor
[show abstract][hide abstract] ABSTRACT: To assess the immunohistochemical expression of BerEP4, a new epithelial antigen in ovarian cancer.
We studied 62 cases of ovarian cancer in which BerEP4, CEA and CA-125 were investigated by an immunohistochemical method. We evaluated the correlations among immunohistochemical positivity and the grading, histotype and stage of disease.
BerEP4 was positive in 45 out of 62 cases (72.58%), CA-125 in 36 out of 62 cases (58.06%) and CEA in ten out of 62 cases (16.13%). BerEP4 was present both in serous and in mucinous tumors (80.96% vs. 80.77%). CA-125 was mainly expressed in serous vs mucinous tumors (66.67% vs. 57.69%). CEA was more prevalent in mucinous vs. serous tumors. Ber-EP4 was mainly expressed in G1 (75%) and G2 (77.27%). CA-125 was more present in G1 and G3 (both 62.50%) than G2 (50%), whereas CEA showed positivity in G1: 12.50%, G2: 22.73% and G3: 12.50%. There were no differences among the three antigens studied with regard to clinical stage.
In our study Ber-EP4 was positive in 45 out of 62 cases (72.58%) of primary epithelial ovarian cancers. The presence of this antigen seemed to be related to the histotype and grading but not to clinical stage.
European journal of gynaecological oncology 01/2012; 33(1):90-2. · 0.58 Impact Factor
[show abstract][hide abstract] ABSTRACT: Endometrial stromal sarcomas (ESSs) are rare neoplasms, which are currently treated by surgery, whereas effective adjuvant therapies have not yet been established. Recently, epidermal growth factor receptor (EGFR) expression has been described in ESS, and a potential role of EGFR-targeted adjuvant therapies has been proposed. The aim of this study was to analyze EGFR status in an ESS series and to evaluate their potential role as molecular targets.
EGFR status was investigated in a total of ten cases of ESS, which included seven low-grade ESS and three undifferentiated ESS cases. EGFR expression levels were assessed by immunohistochemistry, and gene amplification analysis was performed with dual-color fluorescence in situ hybridization (FISH).
Nine out of ten ESS cases showed positive immunostaining, whereas FISH analysis demonstrated constantly negative results.
This study confirmed that EGFR is frequently overexpressed in ESS. FISH analysis did not show EGFR amplification in any of the tumors, therefore EGFR expression in ESS should be related to different genetic mechanisms.
European journal of gynaecological oncology 01/2012; 33(6):629-32. · 0.58 Impact Factor
[show abstract][hide abstract] ABSTRACT: Vulvar cancer (VC) is a rare disease, usually diagnosed in a stage still amenable to potentially curative treatments, including surgery and/or radiation therapy with or without chemotherapy. Several patients however present at diagnosis with metastatic disease and another 30-50% will relapse. Prognosis of metastatic or recurrent disease not amenable to salvage surgery or radiotherapy is very poor. Evidence about the efficacy of chemotherapy in this setting is limited and its role still remains unclear. At present there is no standard treatment for advanced VC and patients are usually treated with schedules adopted for chemoradiation or extrapolated from cervical cancer. We report our experience using a cisplatin-gemcitabine regimen in two cases of metastatic squamous cell VC. No response was obtained with this schedule. No other data are available in the literature about the choice of a cisplatin-gemcitabine regimen in this patient subset. The paucity of evidence about the role of palliative chemotherapy in metastatic VC justifies any effort to implement knowledge. For this reason we think it is notable to also report a negative experience. It is not possible for us to conclude that this chemotherapy would be unable to provide any benefit in a larger sample of patients; nonetheless we think that new agents, rather than combinations of older drugs, could hopefully provide more benefit.
European journal of gynaecological oncology 01/2012; 33(4):421-2. · 0.58 Impact Factor
[show abstract][hide abstract] ABSTRACT: To assess the effects of the combination of pelvic floor rehabilitation and intravaginal estriol administration on stress urinary incontinence (SUI), urogenital atrophy and recurrent urinary tract infections in postmenopausal women.
Two-hundred-six postmenopausal women with urogenital aging symptoms were enrolled in this prospective randomized controlled study. Patients were randomly divided into two groups and each group consisted of 103 women. Subjects in the treatment group received intravaginal estriol ovules, such as 1 ovule (1 mg) once daily for 2 weeks and then 2 ovules once weekly for a total of 6 months as maintenance therapy plus pelvic floor rehabilitation. Subjects in the control group received only intravaginal estriol in a similar regimen. We evaluated urogenital symptomatology, urine cultures, colposcopic findings, urethral cytologic findings, urethral pressure profiles and urethrocystometry before, as well as after 6 months of treatment.
After therapy, the symptoms and signs of urogenital atrophy significantly improved in both groups. 61/83 (73.49%) of the treated patients, and only 10/103 (9.71%) of the control patients referred a subjective improvement of their incontinence. In the patients treated by combination therapy with estriol plus pelvic floor rehabilitation, we observed significant improvements of colposcopic findings, and there were statistically significant increases in mean maximum urethral pressure (MUP), in mean urethral closure pressure (MUCP), as well as in the abdominal pressure transmission ratio to the proximal urethra (PTR).
Our results showed that combination therapy with estriol plus pelvic floor rehabilitation was effective and should be considered as a first-line treatment for symptoms of urogenital aging in postmenopausal women.
Archives of Gynecology 06/2011; 285(2):397-403. · 0.91 Impact Factor
[show abstract][hide abstract] ABSTRACT: Breast conservation is a major goal of cancer treatment. Many different minimally invasive options have been considered such as cryoablation. This technique is the best visualized of all ablation techniques due to the phase change during ice formation. We describe a case of breast cancer with lymph node axillary metastasis treated by CT-guided cryoablation. Cryoablation may have unique benefits for cost-effective outpatient breast cancer therapy using only local anesthesia and/or mild sedation.
European journal of gynaecological oncology 01/2011; 32(2):224-5. · 0.58 Impact Factor
[show abstract][hide abstract] ABSTRACT: We describe the first case of a perimortem cesarean section on a patient who committed suicide during labor by jumping from the fourth-floor window of the labor ward. The cesarean section was performed 30 minutes after the death of the woman, and a child of 3037 g was born with an Apgar score of 0 at 1 minute. Today, 4 years later, the baby is well and has no apparent neurological problems.
American journal of obstetrics and gynecology 02/2008; 198(1):e15-6. · 3.28 Impact Factor
[show abstract][hide abstract] ABSTRACT: Alobar holoprosencephaly is a rare and severe brain malformation due to early arrest in brain cleavage and rotation.
We report a congenital anomalous fetus with alobar holoprosencephaly, prenatally diagnosed by two-dimensional (2D) sonography at the 40 weeks of gestation. The mother was affected by gestational diabetes mellitus and was obese (BMI > 30 kg/m(2)). 2D Ultrasound depicted the cerebral malformation, cyclopy, proboscis, cardiac defects (atrial septal defect, hypoplastic left heart, anomalous communication between right ventricle and aorta) and extremities defects. The newborn died just after delivery. External examination confirmed a mobile proboscis-like nose on the normal nose position. The fetus had both claw hands. The right and left feet showed to be equine. Autopsy confirmed the ultrasound diagnosis and chromosome analysis revealed trisomy 13 (47,XY,+13). Fetopathologic examination showed cyclopy, proboscis and alobar holoprosencephaly of the fetus, which was consistent with Patau syndrome.
The teratogenic effect of diabetes on fetus has been described, but no previous clinical case of a congenital anomalous fetus with trisomy 13 and maternal gestational diabetes has been reported. This case report is the first to describe 2D ultrasound diagnosis of alobar holoprosencephaly and trisomy 13 with maternal gestational diabetes mellitus.
Archives of Gynecology and Obstetrics 06/2007; 275(5):385-7. · 1.33 Impact Factor
[show abstract][hide abstract] ABSTRACT: We describe a case of right axillary lymph node metastasis of an occult infiltrating lobular carcinoma arising from accessory mammary gland of the left upper anterior chest wall. Ultrasonography and mammography were normal bilaterally. Magnetic resonance imaging (MRI) revealed a 3.34 cm inhomogeneous lesion. Then, core biopsy under ultrasound guidance demonstrated a typical infiltrating breast lobular carcinoma. To our knowledge, this is the first case reported in the literature of an axillary lymph node metastasis from an occult contralateral infiltrating lobular carcinoma of the accessory breast tissue. MRI was useful for assessing the lesion of the accessory breast tissue.
The Breast Journal 04/2007; 13(3):305 - 307. · 1.83 Impact Factor
[show abstract][hide abstract] ABSTRACT: Paget's disease of the breast is a rare manifestation of breast carcinoma.
The patient presented with a red lesion of the left nipple-areola complex. Breast physical examination, ultrasonography and mammography were normal bilaterally. Magnetic resonance imaging (MRI) correctly depicted Paget's disease of the nipple. Before surgery the patient underwent biopsy of the lesion that showed Paget's disease of the breast associated with an underlying ductal carcinoma in situ. The patient underwent left mastectomy and unilateral axillary lymph node dissection. The patient refused the breast-conserving surgery because she was afraid that she could have a recurrence of the carcinoma. Microscopy of the lesion confirmed the MRI diagnosis.
MRI was very useful and accurate to diagnose Paget's disease of the breast without palpable mass, ultrasonographic and mammographic findings.
Archives of Gynecology and Obstetrics 09/2006; 274(5):316-8. · 1.33 Impact Factor
[show abstract][hide abstract] ABSTRACT: The purposes of this study were to assess the risk of malignant cell dissemination into the peritoneal cavity through the fallopian tubes in patients with endometrial carcinoma undergoing sonohysterography and to evaluate the accuracy of sonohysterography in the estimation of myometrial invasion by the tumor and its role in the preoperative staging.
This was a prospective study that was conducted at the Sassari University hospital. Thirty-two patients with endometrial carcinoma underwent sonohysterography during laparotomy for hysterectomy. The fluid that spilled from the fallopian tubes and was collected into graduated plastic tubes was analyzed by a pathologist. The presence of malignant endometrial cells in the fluid that was spilled from the fallopian tubes was assessed. The depth of myometrial invasion by tumor was assessed by gross and sonohysterographic examinations and compared with histopathologic findings.
Malignant cells were reported in the fluid that spilled from the fallopian tubes in 2 patients (6.25%). The occurrence of suspected cells in the fallopian fluid was reported in 6 women (18.75%); thus, the presence of malignant or suspicious cells in the fluid that spilled from the fallopian tubes was reported in 8 of 32 cases (25%). Sonohysterography correctly evaluated the depth of myometrial invasion in 27 of 32 cases (84.37%).
Sonohysterography was useful to assess the depth of myometrial invasion and may have a role in preoperative staging, but sonohysterography should not be performed in women with suspicious diagnosis of endometrial carcinoma.
American journal of obstetrics and gynecology 03/2006; 194(2):362-8. · 3.28 Impact Factor