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Items: 7

1.
Pol J Radiol. 2018 Dec 30;83:e519-e523. doi: 10.5114/pjr.2018.81441. eCollection 2018.

Corona mortis variant of the obturator artery: a systematic study of 300 hemipelvises by means of computed tomography angiography.

Author information

1
Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Verona, Italy.

Abstract

Purpose:

The purpose of the present study is to systematically assess the prevalence and characteristics of the corona mortis (CM) variant of the obturator artery by means of computerised tomography angiography (CTA).

Material and methods:

A total of 150 consecutive patients (112 males, average age 73 years) referred to CTA for lower limb arterial evaluation were included in this retrospective study. Patient demographics, anastomosis incidence, artery diameter, distance from the symphysis pubis, Kellgren-Lawrence score, and pelvic size were evaluated.

Results:

In this study 40.6% of patients presented at least one competent CM arterial anastomosis. In the 300 evaluated arteries, 90 arterial anastomoses were found (30%), 40 on the right side (average diameter 1.63 mm) and 50 on the left side (1.78 mm). In 32 cases there was only one anastomosis, while in 29 cases the CM was bilateral. No anastomoses were detected in 89 patients. Mean distance from the symphysis was 50 mm. No relevant association with hip osteoarthrosis was found for CM. Mean pelvic size was 213 mm.

Conclusions:

The evidence from this study suggests that CM is a common variant that needs to be acknowledged before pelvic intervention.

KEYWORDS:

computerised tomography angiography; corona mortis; variant anatomy

Conflict of interest statement

The authors report no conflict of interest.

2.
Climacteric. 2019 Aug;22(4):329-338. doi: 10.1080/13697137.2018.1549213. Epub 2019 Jan 10.

Endometriosis: seeking optimal management in women approaching menopause.

Author information

1
a Department of Obstetrics and Gynecology , Civico Hospital , Palermo , Italy.
2
b Department of Surgical Sciences , University of Cagliari , Cagliari , Italy.
3
c Department of Obstetrics and Gynecology , Azienda Ospedaliera Perugia , Perugia , Italy.
4
d Gynecology Department , IRCCS San Raffaele Scientific Institute , Milan , Italy.
5
e Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Integrata , Verona , Italy.
6
f Department of Clinical Sciences and Community Health , Università degli Studi di Milano , Milan , Italy.
7
g Gynaecology Unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy.
8
h Department of Gynecology, Obstetrics and Urology , ' Sapienza' University of Rome , Rome , Italy.
9
i Department of Molecular and Developmental Medicine, Obstetrics and Gynecology , University of Siena , Siena , Italy.
10
j Department of Clinical and Experimental Medicine, Obstetrics and Gynecology , Università degli Studi Magna Graecia , Catanzaro , Italy.
11
k Department of Biomedicine and Prevention , Università degli studi di Roma 'Tor Vergata' , Rome , Italy.
12
l Department of Obstetrics and Gynecology , Asola Hospital , Mantova , Italy.
13
m Division of Genetics and Cell Biology , IRCCS San Raffaele Scientific Institute , Milan , Italy.
14
n Department of Obstetrics and Gynecology , San Giovanni Addolorata Hospital , Roma , Italy.
15
o Academic Unit of Obstetrics and Gynaecology , Ospedale Policlinico San Martino , Genoa , Italy.
16
p Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , University of Genoa , Genoa , Italy.
17
q Department of Minimally Invasive Gynaecological Surgery , Centre Tuscany USL , Florence , Italy.
18
r Department of Experimental, Clinical and Biomedical Sciences, Obstetrics and Gynaecology , University of Florence , Florence , Italy.
19
s Department of Obstetrics and Gynecology , University of Milan, Macedonio Melloni Hospital , Milan , Italy.
20
t Gynecology and Physiopathology of Human Reproductive Unit , University of Bologna, S. Orsola-Malpighi Hospital of Bologna , Bologna , Italy.
21
u Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine , University of Naples Federico II , Naples , Italy.

Abstract

The incidence of endometriosis in middle-aged women is not minimal compared to that in the reproductive age group. The treatment of affected women after childbearing age to the natural transition toward menopause has received considerably poor attention. Disease management is problematic for these women due to increased contraindications regarding hormonal treatment and the possibility for malignant transformation, considering the increased cancer risk in patients with a long-standing history of the disease. This state-of-the-art review aims for the first time to assess the benefits of the available therapies to help guide treatment decisions for the care of endometriosis in women approaching menopause. Progestins are proven effective in reducing pain and should be preferred in these women. According to the international guidelines that lack precise recommendations, hysterectomy with bilateral salpingo-oophorectomy should be the definitive therapy in women who have completed their reproductive arc, if medical therapy has failed. Strict surveillance or surgery with removal of affected gonads should be considered in cases of long-standing or recurrent endometriomas, especially in the presence of modifications of ultrasonographic cyst patterns. Although rare, malignant transformation of various tissues in endometriosis patients has been described, and management is herein discussed.

KEYWORDS:

Perimenopause; endometriosis; endometriosis malignant transformation; endometriosis treatment; management; middle-aged women

3.
J Obstet Gynaecol Res. 2018 Feb;44(2):292-297. doi: 10.1111/jog.13523. Epub 2017 Nov 2.

Defining probabilities of bowel resection in deep endometriosis of the rectum: Prediction with preoperative magnetic resonance imaging.

Author information

1
Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
2
Department of Radiology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.

Abstract

AIM:

Deep endometriosis of the rectum is a highly challenging disease, and a surgical approach is often needed to restore anatomy and function. Two kinds of surgeries may be performed: radical with segmental bowel resection or conservative without resection. Most patients undergo magnetic resonance imaging (MRI) before surgery, but there is currently no method to predict if conservative surgery is feasible or whether bowel resection is required. The aim of this study was to create an algorithm that could predict bowel resection using MRI images, that was easy to apply and could be useful in a clinical setting, in order to adequately discuss informed consent with the patient and plan the an appropriate and efficient surgical session.

METHODS:

We collected medical records from 2010 to 2016 and reviewed the MRI results of 52 patients to detect any parameters that could predict bowel resection. Parameters that were reproducible and with a significant correlation to radical surgery were investigated by statistical regression and combined in an algorithm to give the best prediction of resection.

RESULTS:

The calculation of two parameters in MRI, impact angle and lesion size, and their use in a mathematical algorithm permit us to predict bowel resection with a positive predictive value of 87% and a negative predictive value of 83%.

CONCLUSIONS:

MRI could be of value in predicting the need for bowel resection in deep endometriosis of the rectum. Further research is required to assess the possibility of a wider application of this algorithm outside our single-center study.

KEYWORDS:

conservative surgery; deep infiltrating endometriosis; laparoscopic bowel resection; magnetic resonance imaging

PMID:
29094417
DOI:
10.1111/jog.13523
[Indexed for MEDLINE]
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4.
J Minim Invasive Gynecol. 2016 May-Jun;23(4):476-88. doi: 10.1016/j.jmig.2015.12.017. Epub 2016 Jan 6.

Adenomyosis: What the Patient Needs.

Author information

1
Department of Obstetrics and Gynecology, Macedonio Melloni Hospital, University of Milan, Milan, Italy.
2
Department of Obstetrics and Gynecology, Civico Hospital, Palermo, Italy.
3
Department of Obstetrics and Gynecology, Santa Maria della Misericordia Hospital, Perugia, Italy.
4
Department of Obstetrics and Gynecology, University of Verona, Verona, Italy.
5
Department of Obstetrics and Gynecology, Istituto Luigi Mangiagalli, University of Milan, Milan, Italy.
6
Department of Obstetrics and Gynecology, San Raffaele Hospital, University of Milan, Milan, Italy.
7
Department of Obstetrics and Gynecology, University of Siena, Siena, Italy.
8
Department of Obstetrics and Gynecology, University of Magna Graecia, Catanzaro, Italy.
9
University of Tor Vergata, Rome, Italy.
10
Department of Gynecology, Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy.
11
Department of Obstetrics and Gynecology, University of Genova, Genova, Italy.
12
Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy.
13
Department of Obstetrics and Gynecology, Santa Maria Goretti Hospital, Latina, Italy.
14
Department of Obstetrics and Gynecology, University of Florence, Florence, Italy.
15
Department of Gynecology, Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy. Electronic address: mariagrazia.porpora@uniroma1.it.
16
Infertility Unit, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.

Abstract

A panel of experts in the field of endometriosis expressed their opinions on management options in a 28-year-old patient, attempting pregnancy for 1 year, with severe cyclic pelvic pain and with clinical examination and imaging techniques suggestive of adenomyosis. Many questions this paradigmatic patient may pose to the clinician are addressed, and all clinical scenarios are discussed. A decision algorithm derived from this discussion is also proposed.

KEYWORDS:

Adenomyosis; Diagnosis; Pelvic pain; Pregnancy desire; Treatment

PMID:
26772777
DOI:
10.1016/j.jmig.2015.12.017
[Indexed for MEDLINE]
Icon for Elsevier Science
5.
Hum Reprod. 2016 Feb;31(2):339-44. doi: 10.1093/humrep/dev313. Epub 2015 Dec 18.

Comparison between the stripping technique and the combined excisional/ablative technique for the treatment of bilateral ovarian endometriomas: a multicentre RCT.

Author information

1
Department of Obstetrics and Gynaecology, 'Sapienza' Università di Roma, Rome, Italy ludovico.muzii@uniroma1.it.
2
Department of Obstetrics and Gynaecology, 'Sapienza' Università di Roma, Rome, Italy.
3
Department of Obstetrics and Gynaecology, Università degli Studi di Verona, Verona, Italy.
4
Department of Obstetrics and Gynaecology, Università San Raffaele, Milan, Italy.
5
Department of Obstetrics and Gynaecology, Università di Siena, Siena, Italy.
6
Department of Obstetrics and Gynaecology, Ospedale Civico, Palermo, Italy.
7
Department of Obstetrics and Gynaecology, Ospedale Santa Maria Goretti, Latina, Italy.
8
Department of Obstetrics and Gynaecology, Università Cattolica del Sacro Cuore di Roma and ISI Paolo VI, Rome, Italy.
9
Department of Obstetrics and Gynaecology, Università di Bologna, Bologna, Italy.
10
Department of Obstetrics and Gynaecology, Università degli Studi di Milano, Milan, Italy.

Abstract

STUDY QUESTION:

Is the combined excisional/ablative technique for the treatment of ovarian endometriomas better than the traditional stripping technique in terms of recurrence rate?

SUMMARY ANSWER:

There is no evidence that the combined excisional/ablative technique is better than the traditional stripping technique, as similar recurrence rates were observed for the two techniques.

WHAT IS KNOWN ALREADY:

The stripping technique is associated with better results compared with ablative, non-excisional techniques for the treatment of ovarian endometriomas. Excisional techniques, such as stripping, have, however, been associated with reduced ovarian reserve as evaluated with anti-Mullerian hormone, and surgical techniques that better preserve the ovarian reserve are needed.

STUDY DESIGN, SIZE, DURATION:

A prospective, multicentre, randomized blinded clinical trial was carried out on 51 patients with bilateral endometriomas larger than 3 cm. For each patient, serving as her own control, one ovary was randomized to the stripping technique and the contralateral to the combined excisional/ablative technique. Patients were enrolled between January 2013 and April 2014.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Patients of reproductive age with pelvic pain and/or infertility affected by bilateral endometriomas larger than 3 cm were included (n = 51). The patients underwent laparoscopic removal of endometriomas with two different surgical techniques performed at either side after random assignment: complete removal by stripping on one side versus the combined technique, consisting of partial excisional cystectomy followed by completion with ablative surgery using bipolar coagulation, on the other side. Post-operative follow-up was performed at 1, 3 and 6 months after surgery for the evaluation of endometrioma recurrence (primary outcome) and of antral follicle count (AFC) and ovarian volumes (OVs) to assess ovarian reserve (secondary outcome).

MAIN RESULTS AND THE ROLE OF CHANCE:

Recurrence rates were 5.9% for the stripping technique versus 2.0% for the combined technique (odds ratio 3.00; 95% confidence interval: 0.24-157.5; P = 0.62). AFC in the ovaries treated with the stripping technique did not differ significantly from AFC in ovaries treated with the combined technique at all follow-up visits, whereas OV was significantly lower after the combined technique at the 6-month follow-up visit (P = 0.04).

LIMITATIONS, REASONS FOR CAUTION:

A major limitation of this study is the small sample size and particularly for ovarian reserve, the secondary outcome, for which no formal sample size calculation was performed. The lower-than-expected recurrence rates in the present series may be related to the shorter follow-up in our study compared with most studies in the literature. Further studies with larger sample sizes and longer follow-up are needed to confirm the findings of this study. The combined technique using CO2 laser energy instead of bipolar coagulation should also be evaluated.

WIDER IMPLICATIONS OF THE FINDINGS:

The traditional excisional technique, i.e. the stripping technique, should still be considered the gold standard approach for the surgical treatment of endometriomas.

STUDY FUNDING/COMPETING INTERESTS:

No commercial funding was received. The authors report no relevant conflict of interest.

TRIAL REGISTRATION NUMBER:

ANZCTR number ACTRN12614000653662.

TRIAL REGISTRATION DATE:

23 June 2014.

DATE OF FIRST PATIENT'S ENROLMENT:

1 January 2013.

KEYWORDS:

antral follicle count; endometrioma; endometriosis; ovarian reserve; ovarian surgery

PMID:
26682578
DOI:
10.1093/humrep/dev313
[Indexed for MEDLINE]
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6.
J Minim Invasive Gynecol. 2015 May-Jun;22(4):517-29. doi: 10.1016/j.jmig.2015.01.021. Epub 2015 Feb 10.

How to Manage Bowel Endometriosis: The ETIC Approach.

Author information

1
Department of Obstetrics and Gynecology, Macedonio Melloni Hospital, University of Milan, Milan, Italy.
2
Department of Obstetrics and Gynecology, Civico Hospital, Palermo, Italy.
3
Department of Obstetrics and Gynecology, Santa Maria della Misericordia Hospital, Perugia, Italy.
4
Department of Obstetrics and Gynecology, University of Verona, Verona, Italy.
5
Department of Obstetrics and Gynecology, Isituto Luigi Mangiagalli, University of Milan, Milan, Italy.
6
Department of Obstetrics and Gynecology, San Raffaele Hospital, University of Milan, Milan, Italy.
7
Department of Obstetrics and Gynecology, University of Siena, Siena, Italy.
8
Department of Obstetrics and Gynecology, University of Magna Graecia, Catanzaro, Italy.
9
University of Tor Vergata, Rome, Italy.
10
Department of Obstetrics and Gynecology, University of Genova, Genova, Italy.
11
Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy.
12
Department of Obstetrics and Gynecology, Santa Maria Goretti Hospital, Latina, Italy.
13
Department of Obstetrics and Gynecology, University of Florence, Florence, Italy.
14
Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy.
15
Infertility Unit, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
16
Department of Obstetrics and Gynecology, University of Siena, Siena, Italy. Electronic address: ezupi@libero.it.

Abstract

A panel of experts in the field of endometriosis expressed their opinions on management options in a 35-year-old patient desiring pregnancy with a history of previous surgery for endometrioma and bowel obstruction symptoms. Many questions that this paradigmatic patient may pose to the clinician are addressed, and various clinical scenarios are discussed. A decision algorithm derived from this discussion is proposed as well.

KEYWORDS:

Bowel endometriosis; Diagnosis; Previous surgery; Treatment

PMID:
25678420
DOI:
10.1016/j.jmig.2015.01.021
[Indexed for MEDLINE]
Icon for Elsevier Science
7.
Oncologist. 2013;18(12):1307-14. doi: 10.1634/theoncologist.2013-0138. Epub 2013 Oct 22.

Anti-Müllerian hormone and antral follicle count reveal a late impairment of ovarian reserve in patients undergoing low-gonadotoxic regimens for hematological malignancies.

Author information

1
Department of Life and Reproduction Sciences, Section of Obstetrics and Gynecology and.

Abstract

The impact of cancer therapy on the reproductive potential of patients is increasingly recognized because survival rates of patients have clearly improved in recent years. Different fertility preservation methods, either generally accepted or still experimental, are currently available, and counseling of patients requires a delicate balance between the efficacy and side effects of the proposed method and the characteristics of both the tumor and the therapy. Deeper knowledge of the effects of cancer therapy on the reproductive potential of patients over time is required to identify the most appropriate fertility preservation method. In this paper, we report a case-control study in which female patients who were diagnosed with hematological malignancies and treated with chemotherapy and/or radiotherapy were compared with age-matched controls in terms of ovarian reserve, as measured by ultrasound examination and hormonal status. By stratifying patients for gonadotoxicity of the therapy received and time elapsed from the end of the therapy, we report that patients treated with low gonadotoxic therapies, while being similar to age-matched controls in their ovarian reserve when evaluated within a few years from the end of the therapy, show a clear impairment over longer times. We also report that anti-Müllerian hormone is the most sensitive hormonal parameter in detecting changes in ovarian reserve when compared with follicle-stimulating hormone or inhibin-B. This study stresses the importance of accurate counseling at the time of diagnosis of cancer and emphasizes the risks of infertility with low gonadotoxic therapies that may reduce the reproductive window of survivors.

KEYWORDS:

Anti-Müllerian hormone; Antral follicle count; Fertility preservation; Hematological malignancies

PMID:
24149138
PMCID:
PMC3868425
DOI:
10.1634/theoncologist.2013-0138
[Indexed for MEDLINE]
Free PMC Article
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