Carrara L.,University of Brescia |
Gadducci A.,University of Pisa |
Landoni F.,Italian National Cancer Institute |
Maggino T.,Unit of Gynaecology and Obstetrics |
And 6 more authors.
International Journal of Gynecological Cancer | Year: 2012
Objective: To determine current practice and to assess the value of routine follow-up procedures for endometrial cancer surveillance. To discuss whether such procedures are feasible and effective to identify asymptomatic recurrences and describe the pattern of relapse detected by procedures. Methods: The records of 282 consecutive women with recurrent endometrial cancer treated from 1986 to 2005 were retrospectively collected in 8 Italian institutions. Primary disease, clinical history, and recurrence features and data were analyzed. Results: Thirty-five (12.4%) of 282 patients had recurrence in vaginal vault, 51 patients (18.0%) had recurrence in central pelvis, 14 patients (4.9%) had recurrence in pelvic wall, and 39 patients (13.8%) had recurrence in lymph nodes. One-hundred twenty-eight patients (45.3%) showed a distant relapse, whereas 15 patients (5.3%) developed both distant relapse and local relapse. The site of relapse influenced survival because the patients with vaginal vault recurrences lived significantly longer than the patients with recurrences in other sites. Eighty (28.4%) of the 282 patients became symptomatic and anticipated the scheduled visit, 37 (13.1 %) of the patients reported their symptoms during the follow-up meeting, and 165 (58.5 %) of the patients were asymptomatic and the diagnostic path was introduced by a planned visit or examination. Among the asymptomatic patients, the first procedure that led to further examinations was clinical visit alone for 60 (36.4%) of 165 patients, imaging for 103 patients (62.4%), and cytologic examination for 2 patients (1.2%). Symptoms at recurrence can predict survival: patients with an asymptomatic recurrence had a median survival time from relapse of 35 months versus 13 months if they had a symptomatic repetition (P = 0.0001). Conclusions: Follow-up after endometrial cancer treatment varies in Italy. In this retrospective study, women with asymptomatic recurrence have shown a better clinical outcome compared with those with symptomatic relapse. The optimal approach is actually unknown, and guidelines comparing follow-up protocols have not been established. Prospective costeffectiveness studies are needed. Copyright © 2012 by IGCS and ESGO.
Palomba S.,Unit of Gynecology and Obstetrics |
De Wilde M.A.,University Utrecht |
Falbo A.,Unit of Gynecology and Obstetrics |
Koster M.P.H.,University Utrecht |
And 3 more authors.
Human Reproduction Update | Year: 2015
Background: The great majority of studies performed so far concerning women diagnosed with polycystic ovary syndrome (PCOS) have focused on diagnosis, menstrual cycle abnormalities, hirsutism and infertility. Although progress has been made in developing methods for achieving a pregnancy and reducing multiple gestations in women with PCOS, little attention has been paid to pregnancy complications and subsequent child outcomes. This review aims to summarize current knowledge regarding the clinical and pathophysiological features of pregnancy and children in women with PCOS. Methods: A literature search up to April 2015 was performed in PubMed, Medline, the Cochrane Library andWeb of Science without language restriction. All articles were initially screened for title and abstract and full texts of eligible articles were subsequently selected. Systematic reviewswith meta-analysis were initially included for each specific subject. Recent randomised controlled trials (RCTs), which were not included in the systematic reviews, were also included. In addition to evidence from meta-analyses or RCTs, we used non-randomized prospective, uncontrolled prospective, retrospective andexperimental studies.Whenspecific data for patientswithPCOSwere lacking, results fromgeneral populationstudieswere reported. Results: Women withPCOSexhibit a clinically significant increased risk of pregnancycomplicationscompared with controls.Data whichwere not adjusted for BMI or otherconfounders demonstrated inPCOSa 3-4-fold increased risk of pregnancy-induced hypertension and pre-eclampsia, a 3-fold increased risk of gestational diabetes and 2-fold higher chance for premature delivery. Features characteristic of PCOS, such as hyperandrogenism, obesity, insulin resistance and metabolic abnormalities, may contribute to the increased risk of obstetric and neonatal complications. Limited available data suggest that offspring ofwomen with PCOS have an increased risk for futuremetabolic and reproductive dysfunction. Underlying pathophysiological mechanisms of pregnancy complications along with its association with health of offspring remain uncertain. To date, the strategies for prevention and management of pregnancy complications in women with PCOS, and whether long-term health of these women is influenced, and to what extent, by pregnancy and/or pregnancy complications, remain to be elucidated. Conclusions: Women with PCOS show an increased risk of pregnancy complications. Heterogeneous aetiological factors involved in PCOS and associated co-morbidities may all be involved in compromised pregnancy and child outcomes. In women with PCOS, a possible relationship with genetic, environmental, clinical and biochemical factors involved in this complex condition, as well as with pregnancy complications and long-term health for both mother and child, remains to be established. © The Author 2015. Published by Oxford University Press.
Conservative treatment in rupture of the uterus outside labor at 22 weeks of pregnancy: Case report [Trattamento conservativo nella rottura d'utero fuori travaglio a 22 settimane di gravidanza: Case report]
Rossetti D.,Unit of Gynecology and Obstetrics |
Trezzi G.,Unit of Gynecology and Obstetrics |
Carnelli M.,Unit of Gynecology and Obstetrics |
Frigerio L.,Unit of Gynecology and Obstetrics
Italian Journal of Gynaecology and Obstetrics | Year: 2012
Spontaneous rupture of the uterus during pregnancy is considered a rare complication of obstetric emergency with important implications for maternal and fetal outcome. The main risk factors mentioned in the literature are the uterine scar from previous cesarean section, the myomectomy, the metroplastic and great multiparity. Uterine rupture is a very rare event, especially outside of labor and in patients without apparent uterine scars. Are not described in the literature cases of uterine rupture occurred in the second trimester of pregnancy treated conservatively, postponing childbirth beyond the 32nd week. Background. The rupture of uterus is a sudden and dramatic event in which only the presence of a timely diagnosis, the stabilization of the patient, the evaluation of the fetal-placental conditions and the quick access in the operating room can avoid the maternal death, the hysterectomy, and, in the fetuses below the threshold of vitality, the death. Case. In the Unit of Obstetrics and Gynecology of the "Ospedali Riuniti" in Bergamo an exceptional clinical event allowing a young mother to complete her pregnancy, put to risk by a rare condition, occurred: the spontaneous rupture of the uterus at the 22nd week of pregnancy. The patient, hospitalized in the department of Obstetrics, was submitted then to caesarian cut with maintenance of the uterus at the 32nd week of pregnancy with favorable results both for the mother and for the child. The new born had a weight of 2,120 grams and was in good general conditions. Conclusions. In the scientific literature regarding obstetrics, this is the first clinical case of rupture of uterus surgically mended in progress of pregnancy at the 22nd week, with favorable evolution for the mother and the baby. For the first time in Italy we can describe the positive result of this rare condition thanks to the coordination of a multidisciplinary équipe inside a highly specialized hospital. © 2012, CLC Edizioni Internazionali, Rome.
Joham A.E.,Monash University |
Joham A.E.,Diabetes and Vascular Medicine Unit |
Palomba S.,Unit of Gynecology and Obstetrics |
Hart R.,University of Western Australia |
Hart R.,Bethesda Hospital
Seminars in Reproductive Medicine | Year: 2016
Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting up to one in five reproductive-aged women. It is underpinned by insulin resistance and hyperandrogenism and is associated with metabolic, reproductive, and psychological features. Women with PCOS have higher rates of obesity and central adiposity compared with women without PCOS, and weight strongly influences prevalence and clinical severity of PCOS. Women with PCOS may have subfertility and women should be aware of factors affecting fertility, in particular the impact of obesity and age. Once pregnant, women with PCOS have significantly increased risk of pregnancy-related complications including gestational diabetes, hypertensive disorders, premature delivery, and delivery by cesarean section. The offspring of women with PCOS may have increased risk of congenital abnormalities and hospitalization in childhood. Clinicians should be aware of the increased risk and screen, prevent, and manage accordingly. Copyright © 2016 by Thieme Medical Publishers, Inc.
Ansaloni L.,Unit of General Surgery i |
Agnoletti V.,Unit of Anaesthesiology |
Amadori A.,Unit of Gynecology and Obstetrics |
Catena F.,Morgagni Pierantoni Hospital |
And 13 more authors.
International Journal of Gynecological Cancer | Year: 2012
Objective: Although standard treatment for advanced epithelial ovarian cancer (EOC) consists of surgical debulking and intravenous platinum- and taxane-based chemotherapy, favorable oncological outcomes have been recently reported with the use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of the study was to analyze feasibility and results of CRS and HIPEC in patients with advanced EOC. Materials/Methods: This is an open, prospective phase 2 study including patients with primary or recurrent peritoneal carcinomatosis due to EOC. Thirty-nine patients with a mean (SD) age of 57.3 (9.7) years (range, 34Y74 years) were included between September 2005 and December 2009. Thirty patients (77%) had recurrent EOC and 9 (23%) had primary EOC. Results: For HIPEC, cisplatin and paclitaxel were used for 11 patients (28%), cisplatin and doxorubicin for 26 patients (66%), paclitaxel and doxorubicin for 1 patient (3%), and doxorubicin alone for 1 patient (3%). The median intra-abdominal outflow temperature was 41.5-C. The mean peritoneal cancer index (PCI) was 11.1 (range, 1Y28); and according to the intraoperative tumor extent, the tumor volume was classified as low (PCI G15) or high (PCI <15) in 27 patients (69%) and 12 patients (31%), respectively. Microscopically complete cytoreduction was achieved for 35 patients (90%), macroscopic cytoreduction was achieved for 3 patients (7%), and a gross tumor debulking was performed for 1 patient (3%). Mean hospital stay was 23.8 days. Postoperative complications occurred in 7 patients (18%), and reoperations in 3 patients (8%). There was one postoperative death. Recurrence was seen in 23 patients (59%) with a mean recurrence time of 14.4 months (range, 1Y49 months). Conclusions: Hyperthermic intraperitoneal chemotherapy after extensive CRS for advanced EOC is feasible with acceptable morbidity and mortality. Complete cytoreduction may improve survival in highly selected patients. Additional follow-up and further studies are needed to determine the effects of HIPEC on survival. © 2012 by IGCS and ESGO.
PubMed | University of Modena and Reggio Emilia and Unit of Gynecology and Obstetrics
Type: | Journal: Trends in endocrinology and metabolism: TEM | Year: 2016
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age and affects fertility and pregnancy in cases of oligoanovulation. Ovulation induction is often used to treat anovulatory patients with PCOS, but many of these women fail to conceive and resort to assisted reproductive technologies. Alterations in oocyte competence (OC) are considered potential causative factors for subfertility in women with PCOS. In this review we present and critically assess all recent clinical and experimental data regarding OC in women with PCOS. Our analysis demonstrates that the contribution of OC to reproductive potential in women with PCOS varies and largely depends on the PCOS phenotype and comorbidities associated with PCOS.