[Show abstract][Hide abstract] ABSTRACT: Neuroendocrine carcinomas (NEC) of the female genital tract are aggressive and rare tumors that usually involve the cervix and ovary, and are seen rarely in the endometrium in perimenopausal or postmenopausal women. We presented a case of a73 year-old postmenopausal woman with vaginal bleeding and abdominal pain. A subsequent computerized tomography (CT) scan of pelvis showed an enlarged uterus (20,0 × 12,0 cm) with para-aortic and pelvic lymph node metastases. She underwent surgical debulking and staging of an endometrial tumor with omental metastasis and positive lymph nodes. The pathological diagnosis was primary small cell carcinoma (SCC) combined with endometrioid carcinoma of uterine corpus. Her final FIGO stage was IVB. Three months after surgery CT-total body showed a metastasis to left lung of SCC. Because the small-cell component of endometrial tumor showed a strong positivity for TTF1 as pulmonary counterpart a differential diagnosis with a primary small cell carcinoma of the lung should be made. Identifying an appropriate therapeutic management for SCC of endometrium is challenging since these are extremely rare tumors. An optimal initial therapeutic approach to this rare disease, especially at an advanced stage, has not yet been clearly defined. However, in these a multidisciplinary therapy, including surgery, chemotherapy, and radiotherapy represent until this time the only therapeutic option.
Preview · Article · Feb 2016 · Annals of Medicine and Surgery
[Show abstract][Hide abstract] ABSTRACT: Aim:
To assess the safety and efficacy of cold loop myomectomy applied to bipolar resectoscope to perform "one-step" myomectomy of submucosal myomas with intramural involvement.
Seventy-two patients with at least one symptomatic G1 or G2 myoma (Wamsteker's classification) underwent cold loop myomectomy from January 2011 to January 2013. All surgical procedures were performed using a 26Fr resectoscope and bipolar energy source. At one month after the procedure, all patients underwent an office hysteroscopy check-up. A subgroup of seven infertile patients underwent an office hysteroscopy every two-weeks to evaluate recovery time of the myometrial fovea.
Resectoscopic myomectomies were successfully performed in one surgical step in 70 out of 72 patients without any significant complications. Overall, the mean diameter of resected myomas was 32.2 ± 9 mm. Median operative time was 34.2 ± 24.1 min. Median fluid deficit was 761.22 ± 480.34 ml. The fovea was almost completely restored (>80%) six weeks after surgery in six of the seven infertile patients who underwent repeated follow-up office hysteroscopies every two weeks.
Data from the present study show that the use of cold loops applied to bipolar resectoscope represent an effective, safe technique for "one-step" myomectomy of G1-G2 myomas, allowing rapid recovery of the myometrial fovea.
Full-text · Article · Nov 2015 · Journal of Obstetrics and Gynaecology Research
[Show abstract][Hide abstract] ABSTRACT: Background:
Bisphenol A (BPA) is an environmental compounds is known to possess endocrine disruption potentials. Bisphenol A has epigenetic effects as deregulated expression of microRNAs; such epigenetic marks can induce up/down alterations in gene expression that may persist throughout a lifetime. Bisphenol A (BPA) exposure has been documented in pregnant women, but consequences for development of offspring after BPA exposure during pregnancy are not yet widely studied. Therefore, the aim of this study was to gain a comprehensive understanding of microRNAs changes in the placenta transcriptome from pregnant women subjected to therapeutic abortion for fetal malformation and correlate the impact of gestational exposure to BPA on these developmental changes.
We performed a comparative analysis of genome wide miRNA expression in placentas from pregnant women exposed to BPA using microarray technology to identify miRNAs which were aberrantly expressed in placentas from malformed fetuses. The expression changes of differential expressed miRNAs in the samples used for microarray were confirmed by qPCR . Beside, we applied various bioinformatics tools to predict the target genes of the identified miR-146a and explore their biological function and downstream pathways.
We found that miR-146a was significant overexpressed and correlated significantly with BPA accumulation in the placenta from pregnant women living in a polluted area and undergoing therapeutic abortion due to fetal malformations. Beside, we applied various bioinformatics tools to predict the target genes of miR-146a and explore their biological function and downstream pathways.
For the first time, we found, in humans, that miR-146a was significant over-expressed and correlated significantly with BPA accumulation in the placenta. Our results lead to the suggestion that miRNAs could be potential biomarkers to clarify the mechanisms of environmental diseases.
Full-text · Article · Sep 2015 · BMC Medical Genomics
[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.
No preview · Article · Jun 2015 · Gynecological Endocrinology
[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.
Full-text · Article · May 2015 · International Urogynecology Journal
[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.
No preview · Article · Mar 2015 · Environmental Monitoring and Assessment
[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 variety 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.
Placental sample were collected from 200 subjects. BPA levels were measured by isotope dilution GC-MS. Additional maternal and infant data were gathered from medical charts and were potential correlates with placental BPA levels.
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.
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: 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.
Full-text · Article · Jul 2014 · Journal of Pelvic Medicine and Surgery
[Show abstract][Hide abstract] ABSTRACT: Purpose:
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 µg/day of etonogestrel and 15 µg/day of ethinylestradiol (EE) and one consisting of 25 women treated with an oral contraceptive containing 20 µg of EE and 150 µg 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.
Full-text · Article · Jul 2014 · Archives of Gynecology and Obstetrics
[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.
Full-text · Article · Dec 2013 · International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases
[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.