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E M Messalli

Publications and source records attributed to E M Messalli.

At least 19 recordsLinked to original sources
PubMed2006

Third stage ovarian carcinoma--case report: the necessity of a multidisciplinary approach to treatment.

Ovarian carcinoma, part of a heterogeneous group of tumours, is the main cause of death by gynaecological neoplasms. The diagnosis, in general, is delayed. Multiorgan diffusion, the necessity of a surgical operation and strong chemotherapy, and the eventual pathology due to patient age are all factors that require a multidisciplinary approach. In fact the case, here reported, refers to a patient who came under our observation for a bilateral ovarian mass discovered casually during an abdominal ultrasound exam carried out for renal colic. Excellent cytoreduction with peritoneal cytology, total abdominal hysterectomy, bilateral salpingo-oophorectomy (Figure 2), bilateral pelvic lymphadenectomy, total omentectomy, removal of nodules from the mesentery, the colon and three nodules in the abdominal wall thickness was executed. The histological report was G3, angioinvasive bilateral ovarian endometrioid adenocarcinoma. Metastasis was found only in one left obturator lymph node out of 17 lymph nodes removed. All of the removed abdominal, mesenteric and intestinal nodules were neoplastic. It is concluded that the complexity of similar cases always requires a multidisciplinary approach as in our case, involving an oncologist, hematologist, surgeon, gynaecologist, radiologist, anaesthesiologist, and nursing staff in the management of third stage ovarian cancer patients to obtain the best treatment thus guaranteeing a higher survival rate and better quality of life.

Aged↗
PubMed2006

A therapeutic algorithm for early-stage endometrial cancer: indications, patient selection, and feasibility.

Endometrial cancer is the most widely spread gynaecologic neoplasm in industrial countries. Mode of spread includes direct extension, lymphatic and haematic diffusion. Lymphatic involvement, particularly, is a topic of wide debate due to the strong therapeutic implications associated with it. In this regard, anatomic-surgical staging is better in that it corresponds to real conditions whereas clinical-instrumental staging is still today incomplete.

Algorithms↗
PubMed2005

Local estrogen replacement therapy in postmenopausal atrophic vaginitis: efficacy and safety of low dose 17beta-estradiol vaginal tablets.

PURPOSE OF INVESTIGATION: To verify the effectiveness and safety of low-dose 17beta-estradiol vaginal tablets in the treatment of the postmenopausal atrophic vaginitis. PATIENTS AND METHODS: 325 postmenopausal women with atrophic vaginitis in estrogenic replacement therapy with 0.025 mg 17beta-estradiol vaginal tablets, one application each day for two weeks, and a single application two times a week for the following 22 weeks (total treatment period: 24 weeks). RESULTS: Most of the women reported an improvement of symptoms just after two weeks and minimal incidence of adverse reactions. No patients showed abnormal endometrial thickness and no one had to interrupt the treatment for abnormal uterine bleeding because of systemic absorption. CONCLUSION: Low-dose 17beta-estradiol vaginal tablets in the treatment of the postmenopausal atrophic vaginitis constitutes an extremely valid approach in terms of effectiveness and safety.

Administration, Intravaginal↗
PubMed2004

Pelvic lipomatosis complicating ovarian cyst removal: a case report.

Pelvic lipomatosis consists of an abdominal capsulated mass containing lipidic tissue, generally with remarkable dimensions, responsible for urinary tract disturbances. Here we describe the first case to our knowledge of accidental intraoperative diagnosis associated to an ovarian cyst in absence of objective symptoms and signs.

Adult↗
PubMed2003

[Indications for hormone replacement therapy].

BACKGROUND: The purpose of the present study is to evaluate indications and contraindications, advisability and compliance of hormone replacement therapy (HRT) in women in the climacteric who, owing to the cessation of ovarian activity, face loss of the state of present and future wellbeing. METHODS: A series of 602 women who have attended the Menopause Centre of the II Division of the Department of Gynaecology and Obstetrics of the Second University of Naples in the period from 1/12/1998 to 10/4/2001. The diagnostic methodology adopted is outlined and the reasons for the prescription of HRT indicated. Patients who do not present contraindications were assessed in relation to the gravity of the climacteric syndrome and the likelihood of a future pathology bound up with the lack of estrogens. The intensity of the symptomatology was assessed on the basis of Kuppermann's nomogram. RESULTS: The cessation of ovarian activity occurred between the ages of 40 and 45 in 16.9% of cases while the percentage was 5.9% prior to the age of 40. Cases in which a climacteric syndrome was present numbered 147, or 24.2%. Women who present a cardiovascular risk represent a noteworthy percentage (27.1%). A high number of women are at osteoporotic risk: 223, or 37.0%. Although it has a great number of indications, HRT is only prescribed in about half the patients. Stress is laid on the caution exercised by physicians in prescribing HRT and the diffidence of women in accepting it. Of the well-known contraindications to HRT the most common are those relative to the mammary risk. CONCLUSIONS: HRT was only prescribed for about half the women who came to our attention both as a result of the caution of the physicians who consider even relative contraindications peremptory, and because of the diffidence of a percentage of women with regard to such therapy. Alternative therapies to HRT are in fact a second valid choice, especially in the prevention of osteoporosis.

Adult↗
PubMed2003

Ovarian hyperstimulation syndrome: distinction between local and systemic disease.

The ovarian hyperstimulation syndrome (OHSS) is an iatrogenic, unpredictable and potentially life-threatening complication in patients submitted to pharmacological ovarian stimulation. Information on risk factors, etiopathogenetic mechanisms, prevention strategies and therapeutic management is continuously updated. The present study retrospectively analyzed 123 women affected by different grades of OHSS as a result of pharmacological ovulation induction. Hospital admission was suggested in 14 patients with severe OHSS, whereas patients with moderate or mild OHSS were followed in the out-patient section of our department. The results confirmed the efficacy of the therapeutic scheme adopted. The syndrome is localized to the ovaries at the time that the condition is triggered; when organs different from the ovaries become involved, OHSS assumes systemic aspects. The different clinical signs are the basis of a proposal of a local and systemic classification.

Adult↗
PubMed2003

Alcohol sclerosis of endometriomas after ultrasound-guided aspiration.

AIM: We investigate the possibility to use ultrasound-guided aspiration and alcohol sclerosis in patients with endometrioma. METHODS: Ten patients with endometriotic ovarian cysts, mean diameter <70 mm, CA125 <35 UI, persistence of cyst after medical therapy and refusal of surgical therapy have been studied. The patients were submitted to ultrasound-guided aspiration of endometriomas. Fifty per cent of aspirated fluid was replaced with pure ethanol, which was left in situ for 10 to 20 minutes. No medical therapy was employed after aspiration and ethanol treatment. RESULTS: In 9 patients no recurrence was observed at ultrasound after 21.2+/-6.62 months of follow-up. In 1 case only, after 6 months, a recurrence of the endometrioma in the same site was observed. CONCLUSION: Ultrasound-guided alcoholic sclerotherapy of the endometriotic ovarian cysts is effective and safe. We speculate that this procedure could be indicated in patients refusing standard surgical therapy.

Adolescent↗
PubMed2003

Premature ovarian failure. Clinical evaluation of 32 cases.

AIM: Premature menopause, also termed premature ovarian failure (POF), is characterized by cessation of menstruation before the age of 40 years. Pathogenetic mechanisms are not so clear, particularly genetic implications of cellular apoptosis. Diagnostic approach is multifactorial and therapy depends on the pregnancy wish. METHODS: Eight hundred and thirty patients approached the Menopausal Center of the University Department of Gynaecological, Obstetrical and Reproductive Sciences of the Second University of Naples between October 1998 and October 2002. All patients were clinically investigated and selected on the basis of menopausal age, pregnancy wish and menopausal syndrome. RESULTS: Menopausal mean age was 48.31+/-4.62 years and 32 patients (4%) were affected by premature ovarian failure because of menopausal appearance before the age of 40. Three of these patients were treated to have a pregnancy; the remaining 29 required medical treatment to reduce menopausal symptoms. The osteoporosis risk for premature menopause patients was similar to the other women. The cardiovascular risk was increased because of an increase in risk factors in premature ovarian failure patients. No breast or endometrial pathology was revealed and therapy compliance was satisfactory without any drop-out. CONCLUSION: Premature ovarian failure has a varied etiology, pathogenetic aspects, clinical evolution and therapeutical approach. Adequate treatment of premature menopause women presents good compliance, resolution of infertility when required and a successful resolution of menopausal symptoms.

Adult↗
PubMed2003

Methotrexate treatment for tubal pregnancy. Criteria for medical approach.

AIM: The purpose of this retrospective study is to underline the indications for the use of systemic methotrexate (MTX) in tubal pregnancies. METHODS: One hundred and four (n=104) consecutive women were treated in our Department for tubal pregnancy. The database analysis showed that after careful respect for inclusion criteria, the treatment chosen was the intravenous administration of MTX in 68 patients, whereas laparoscopy constituted the primary treatment in 36 patients. A single dose of MTX was intravenously administered, diluted in saline solution, with a dosage of 50 mg/m2 of body surface. Close serum beta-hCG monitoring was performed, and in the case of a short fall, a 2nd dose of methotrexate was submitted. RESULTS: The overall success rate of MTX treatment was 91%; the 2nd dose of MTX was used in 12% of patients, whereas in only 6 out of 68 patients included in the medical treatment group a surgical approach for suspected tubal rupture was necessary. CONCLUSION: Treatment with methotrexate is effective and safe in the presence of these criteria: patient hemodynamically stable, absence of tubal rupture sign and hemoperitoneum, an adnexal mass with a diameter < or = 5 cm, an amenorrhea < or = 6 weeks and HCG levels < or = 10,000 mIU/ml. Laparoscopy is indicated in diagnostic uncertainty, when MTX is not suggested, when adnexal mass is > 5 cm, or in patients in which beta-hCG levels was > 10,000 mIU/ml.

Abortifacient Agents, Nonsteroidal↗
PubMed2002

[Vena cava filter in patients with gynecologic cancer complicated by pulmonary embolism and progressive hypercoagulability].

The aim of the study was to verify the validity of placement of a vena cava filter in patients with gynecologic cancer complicated by pulmonary embolism and progressive persistent hypercoagulability. The authors discuss two patients with pulmonary embolism. In this study, a gynecologic tumor was diagnosed, one presented endometrial carcinoma and the other ovarian papillary carcinoma, after the position of vena cava filter and treatment with urokinasi (2.800.000 UI/ml) it was possible to do surgery followed by radiation therapy in the first case and chemotherapy in the second. In these cases there are indications for the placement of a vena cava filter. This has enabled surgery and anticoagulation therapy and has prevented the movement of any other emboli, which were later dissolved by fibrinolytic agents, and the effectiveness result was the arrest of progressive hypercoagulability moved by tumor cell. The serious conditions that were related to prior embolism and to a persistent thrombotic state characterized by progressive hypercoagulability did not make it possible to perform surgery or any other type of therapy because of absolute contraindications. The decision to place the filter could thus become the first step towards subsequent improvements, that are also tied to the possibility of performing surgery for removing tumor, arrest of progressive hypercoagulability due to tumor cell, allow chemotherapy or radiation treatment.

Carcinoma, Adenosquamous↗
PubMed2002

Restitutio ad integrum of myometrium after myomectomy. Different results in pregnant and non-pregnant patients.

BACKGROUND: The aim of this study is to check whether there exists a difference in restitutio ad integrum of the uterus after myomectomy performed during Caesarean section and out of pregnancy. METHODS: Two different groups are considered: Group A (n=8) that underwent myomectomy during Caesarean section; Group B (n=10) in which myomectomy was performed out of pregnancy. All patients were followed with serial scan evaluations. RESULTS: The results showed a much more complete and faster absorption of hyperplasia and hypertrophy surrounding fibroid nodules when myomectomy was performed during Caesarean section. CONCLUSIONS: A later pregnancy in patients who underwent myomectomy during Caesarean section might have a favourable outcome, possibly reaching a term gestation and vaginal delivery.

Adult↗
PubMed2002

[Pelvic actinomycosis and sub-acute abdomen].

An interesting case of pelvic actinomycosis with paculiar clinical manifestation is presented. A 42 years-old patient came to our emergency service for an abdominal pelvic pain and fever. Past history showed IUD in situ for over 15 years. The patient was submitted to a ultrasonographic scan and a complete hematological screening was performed. The diagnosis was of subacute abdomen, and an exploratory laparotomy was carried out. During laparotomy an atypical reactive tissue and a suppurative cavity were found. The histological finding of tissue biopsy showed pelvic actinomycosis. On the basis of these findings the conclusion is drawn that a better prevention of pelvic actinomycosis is necessary of its diffusion in the last years due to sexual habit changes.

Abdomen, Acute↗
PubMed2001

Pelvic actinomycosis in menopause: a case report.

OBJECTIVE: To examine the association between the use of intra uterine device (IUD) and the risk of actinomycosis in postmenopausal women. METHODS: We report a case of pelvic actinomycosis in a postmenopausal woman who was wearing an IUD for 14 years until 20 months after the beginning of menopause. In the last 5 years the patient had been suffering occasionally from pain, abdominal tension and rectal tenesmus. The disease was revealed clearly 18 months after removing the intrauterine device. RESULTS: The diagnosis of pelvic actinomycosis was only possible after hysterectomy, bilateral oophorectomy and multiple biopsies. At histological features a focus with actynomycetes colonies was evident. CONCLUSIONS: This study supports the previously reported association between the pelvic location of actinomycosis and the use of the IUD. The removal of IUD should be mandatory in postmenopausal women.

Actinomyces↗
PubMed2001

[Ovarian function after total simple hysterectomy].

BACKGROUND: The aim of this prospective study is to evaluate the ovarian function and its duration after total simple hysterectomy. METHODS: This research was carried out on thirty regularly menstruating patients who underwent simple hysterectomy. Ovarian function has been evaluated by measuring FSH, E2, PP at 6 and 24 months from hysterectomy or from the first observation at the beginning of the study. RESULTS: None of the patients showed ovarian failure at 6 months. Nine patients (average age: 48,8 years) showed ovarian failure at 24 months. CONCLUSIONS: The conclusion is drawn that the cessation of ovarian activity is not influenced by hysterectomy: it rather depends on the age of the patient.

Adult↗
PubMed2001

[A case of atypical bicornate unicollis uterus treated with metroplasty according to Jones].

The aim of the study is to report on the result achieved on uterus bicornate unicollis that after hysterosalpingography proved atypical in the isthmic section of the left horn because it was filiform and had irregular walls. The metroplasty technique was performed, applying the Jones technique, on a patient affected by infertility for six years, with uterine malformation. Hysterosalpingography evidenced an atypical malformation: a unicollis-bicornis uterus that was atypical in the isthmic section of the left horn, treated with the technique of Jones because it was filiform. Diagnostic laparoscopy visualized two symmetrical and separated horns. Metroplasty was performed applying Jones technique, by removing the isthmic miometrium of the left horn in order to widen the communication with the upper part. The result of postoperative hysterosalpingography, performed 10 months after intervention, showed a single uterine cavity with irregular walls that allowed the evolution of a pregnancy that was prematurely concluded after thirty-two weeks on the birth of a live, vital fetus. Infertility is probably associated with the complexity of uterine malformation. We can, therefore, underline that laparotomic metroplasty is an effective technique that can be performed in particular cases.

Adult↗
PubMed2001

[Cesarean section according to Stark].

BACKGROUND: The aim of this paper is to compare cesarean section according to Stark to cesarean section according to conventional technique in order to evaluate advantages and limits. METHODS PLACE: Second University of Study of Naples, Department of Obstetrics and Gynaecology, during the period from March 1996 to March 1999. PATIENTS: One hundred and two cesarean sections according to Stark were performed. These interventions have been compared with others performed, during the same period, according to the conventional technique. INTERVENTION: Comparison between cesarean section according to Stark and cesarean section according to conventional technique. RESULTS: For each case, several parameters have been compared: extraction time, total time, number of suture threads, canalization time, blood loss and fetal Apgar. CONCLUSIONS: Cesarean section according to Stark is an evolution of the conventional surgical technique, which can be applied for particular indications such as maternal, fetal and anesthesiologic conditions.

Cesarean Section↗
PubMed2000

Contribution to the choice of therapy in abdominal pregnancy.

The goal of our study was to offer our contribution to the selection of the most suitable therapy to treat abdominal pregnancy. We discuss three patients affected with this pathology, which was diagnosed early by laparoscopy. The patients were treated with 50 mg/m2 of methotrexate administered intravenously. The abdominal pregnancy was terminated in all three patients. Since the outcome involved termination of the pregnancy, it is important to emphasize that methotrexate therapy, must be considered elective. Operative laparoscopy can be limited only to cases in which the ovum has not become implanted in the intestinal interstices and is not near sites susceptible to complications.

Adult↗