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Sesto Fiorentino, Italy

Litta P.,University of Padua | Nappi L.,University of Foggia | Florio P.,UOC Obstetrics and Gynecology | Mencaglia L.,Centro Oncologico Fiorentino | And 2 more authors.
Gynecological Surgery

The aim of this study is to evaluate the feasibility, efficacy, safeness, and patients' acceptability of a modified transcervical endometrial resection (TCER) technique for the treatment of menorrhagia. Eighty-four premenopausal women with menorrhagia after careful investigation and 2 months therapy with GnRHa underwent a modified TCER. It was performed with a standard dual channel, 26 French irrigating resectoscope (Karl Storz, GmbH, Germany) after cervix dilatation to 10 mm and sorbitol mannitol solution used as distension medium. The modified technique was based on the resection of the endometrium and of the first myometrial layers only on the anterior and posterior walls, without treating fundus and cornual areas as usually performed. Endometrial resection was performed to a depth of 4 to 5 mm. Clinical and hysteroscopic follow-up was performed for 60 months. Early and late complications, changing in bleeding patterns, and patients' satisfaction were recorded. Sixty-four out of 73 patients that completed the 60 months improved. Eumenorrhea was achieved in 68.5 %, hypomenorrhea in 5.5 %, and amenorrhea in 13.7 %. Most of the patients (86.3 %) showed satisfaction at the follow-up interview. Control hysteroscopy showed that post modified TCER uterine cavity maintained the possibility of macroscopic and histopathology investigation during follow-up. Modified TCER is a technique easy to perform and effective in the long-term resolution of menorrhagia. In particular, it avoids the formation of synechiae and the shrinkage of the uterine cavity that may be the cause of various long-term complications, such as the delay in the diagnosis of endometrial carcinoma onset. © 2014 Springer-Verlag. Source

Lococo F.,Catholic University of the Sacred Heart | Cesario A.,Catholic University of the Sacred Heart | Cardillo G.,Unit of Thoracic Surgery | Filosso P.,University of Turin | And 9 more authors.
Journal of Thoracic Oncology

INTRODUCTION: Available data on the malignant solitary fibrous tumor of the pleura (mSFTP), a very rare neoplasm with unpredictable prognosis, are scarce. The aim of this study is to collectively analyze the aggregated data from the largest series in the English literature to date, a multicenter, 10-year study of 50-cases. METHODS: We retrospectively reviewed the clinical records of patients who underwent surgical resection for mSFTP in the period between January 2000 to July 2010. Long-term survival (LTS) and 5-year disease-free survival were analyzed in detail. RESULTS: There were 24 men and 26 women (median age, 66 years; age range, 44-83 years). Thirty-two patients (64%) were symptomatic. A malignant pleural effusion was diagnosed in 12 cases. Surgical resection included isolated mass excision in 13 patients and extended resection in 35. In the remaining two cases only biopsies were undertaken. The resection was complete in 46 cases (92%). Adjuvant treatment was administered to 15 patients. Median follow-up was 116 months (range, 18-311 months). Overall LTS and disease-free survival were 81.1% and 72.1%, respectively. Fifteen patients (30%) experienced a relapse of the disease. Complete resection yielded much better LTS than partial resection (87.1% versus 0%; p < 0.001). At the Cox regression analysis, incomplete resection (hazards ratio [HR]: 39.02; 95% confidence interval [CI]:4.04-380.36; p = 0.002) and malignant pleural effusion (HR: 3.44; 95%CI: 0.98-12.05; p = 0.053) were demonstrated to be risk factors for earlier death. At multivariate analysis, chest-wall invasion and malignant pleural effusion increased the risk of recurrence (HR: 4.34; 95%CI: 1.5%-12.6%; p = 0.007 and HR: 3.48; 95%CI: 1.1%-11.0%; p = 0.038, respectively). CONCLUSIONS: Surgical resection remains the treatment of choice for mSFTP. Relapse is common (approximately 30%). Incomplete resection and malignant pleural effusion at diagnosis impact LTS negatively. Copyright © 2012 by the International Association for the Study of Lung Cancer. Source

Nappi L.,University of Foggia | Sardo A.D.S.,University of Naples Federico II | Spinelli M.,University of Naples Federico II | Guida M.,University of Salerno | And 6 more authors.
Reproductive Sciences

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. © The Author(s) 2012. Source

Florio P.,University of Siena | Puzzutiello R.,University of Siena | Filippeschi M.,U.O.C. of Obstetrics and Gynecology | D'Onofrio P.,University of Siena | And 6 more authors.
Journal of Minimally Invasive Gynecology

Study Objective: To estimate the efficacy and tolerability of low dose spinal anesthesia during operative hysteroscopy in a group of patients with high surgical risks. Design: Case series study (Canadian Task Force Classification II-2). Setting: Tertiary centers for women health care. Patients: A total of 47 women affected by endometrial polyps (n = 32), myomas (n = 8), and abnormal uterine bleeding (n = 7) scheduled for inpatient operative hysteroscopy. Interventions: Transvaginal ultrasonography; office diagnostic hysteroscopy; preoperative evaluation of American Society of Anesthesiologist (ASA) classification; inpatient operative hysteroscopy; low-dose spinal anesthesia with hyperbaric bupivacaine; compilation of a questionnaire. Main Outcome Measures: Practicability and patients' subjective experiences with spinal anesthesia; duration of cervical dilation and for operative hysteroscopy; infusion volume needed; incidence of surgical complications. Results: Resectoscopy was performed in all patients, with the exception of 1 woman (2.1%) in which spinal anesthesia was unsuccessful. No statistically significant differences were noted among groups in terms of intra- and peri-operative findings. Sensory block induced by spinal anesthesia was suitable for surgery in all patients, and side effects occurred far less frequently than mentioned in the literature. Data reported in the questionnaire revealed that 93.5% of women would choose a spinal anesthesia again for a potential operative hysteroscopy in the future, since for 89.1% of them long lasting anesthesia is of relevance. Conclusions: Low-dose spinal anesthesia is a feasible technique in the inpatient setting for operative hysteroscopy in women with high surgical risks. © 2012 AAGL. Source

Santarpia L.,University of Texas M. D. Anderson Cancer Center | Santarpia L.,Translational Research Unit | Calin G.A.,University of Texas M. D. Anderson Cancer Center | Adam L.,University of Texas M. D. Anderson Cancer Center | And 10 more authors.
Endocrine-Related Cancer

MicroRNAs (miRNAs) represent a class of small, non-coding RNAs that control gene expression by targeting mRNA and triggering either translational repression or RNA degradation. The objective of our study was to evaluate the involvement of miRNAs in human medullary thyroid carcinoma (MTC) and to identify the markers of metastatic cells and aggressive tumour behaviour. Using matched primary and metastatic tumour samples, we identified a subset of miRNAs aberrantly regulated in metastatic MTC. Deregulated miRNAs were confirmed by quantitative real-time PCR and validated by in situ hybridisation on a large independent set of primary and metastatic MTC samples. Our results uncovered ten miRNAs that were significantly expressed and deregulated in metastatic tumours: miR-10a, miR-200b/-200c, miR-7 and miR-29c were down-regulated and miR-130a, miR-138, miR-193a-3p, miR-373 and miR-498 were up-regulated. Bioinformatic approaches revealed potential miRNA targets and signals involved in metastatic MTC pathways. Migration, proliferation and invasion assays were performed in cell lines treated with miR-200 antagomirs to ascertain a direct role for this miRNA in MTC tumourigenesis. We show that the members of miR-200 family regulate the expression of E-cadherin by directly targeting ZEB1 and ZEB2 mRNA and through the enhanced expression of tumour growth factor b (TGFb)-2 and TGFb-1. Overall, the treated cells shifted to a mesenchymal phenotype, thereby acquiring an aggressive phenotype with increased motility and invasion. Our data identify a robust miRNA signature associated with metastatic MTC and distinct biological processes, e.g., TGFb signalling pathway, providing new potential insights into the mechanisms of MTC metastasis. © 2013 Society for Endocrinology. Source

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