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

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    ABSTRACT: Inositol has been reported to improve insulin sensitivity since it works as FSH second messenger achieving insulin-like effects on metabolic enzymes. The aim of this study was to evaluate myo-inositol (MY) effectiveness on FSH levels in postmenopausal women. In order to assess this issue, 32 outpatient postmenopausal women with FSH levels lower than 35 mIU/ml were enrolled for a 6-month observational study. All women were treated with 2 g of MY twice a day and the FSH reduction was evaluated. MY administration induced a decrease of FSH levels after three months of treatment, as well as during the second trimester of supplementation in respect to baseline. Therefore, MY might be considered as a valid insulin-sensitizing molecule for the menopausal disorder management.
    No preview · Article · Oct 2015 · Minerva ginecologica
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    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.
    No preview · Article · Apr 2015 · Minerva ginecologica
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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.
    No preview · Article · Feb 2015 · Minerva ginecologica
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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".
    No preview · Article · Feb 2015 · Minerva ginecologica
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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.
    No preview · Article · Feb 2015 · Minerva ginecologica
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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.
    No preview · Article · Feb 2015 · Minerva ginecologica
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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.
    No preview · Article · Feb 2015 · Minerva ginecologica
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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.
    No preview · Article · Feb 2015 · Minerva ginecologica
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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.
    No preview · Article · Feb 2015 · Minerva ginecologica
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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.
    No preview · Article · Feb 2015 · Minerva ginecologica
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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).
    No preview · Article · Feb 2015 · Minerva ginecologica

  • No preview · Article · Feb 2015 · Minerva ginecologica
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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.
    No preview · Article · Feb 2015 · Minerva ginecologica