PubMed Health⌕ Search

Biomedical subjects

N Pansini

Publications and source records attributed to N Pansini.

9 recordsLinked to original sources
PubMed1998

Paracervical anesthesia for hysteroscopy and endometrial biopsy in postmenopausal women. A randomized, double-blind, placebo-controlled study.

OBJECTIVE: To evaluate the efficiency of paracervical anesthesia in reducing pain and the incidence of vasovagal reactions during diagnostic hysteroscopy with endometrial biopsy in postmenopausal women. STUDY DESIGN: A randomized, placebo-controlled, double-blind study. Seventy-two postmenopausal women underwent diagnostic hysteroscopy and endometrial biopsy. Hysteroscopies were performed by using a lens-based endoscope with a diameter of < 4 mm and endometrial biopsies by using a 3-mm Novak's curette. Ten milliliters of 1.5 mepivacaine or saline solution was injected at the junction of the cervix and vagina (at the 4 and 8 o'clock positions) by means of an appropriate needle before performing the intrauterine procedures. Referred pain was evaluated by means of a visual analogue scale; continuous monitoring of heart rate and blood pressure was also performed. RESULTS: Paracervical anesthesia significantly reduced pain at hysteroscopy and biopsy. The incidence of vasovagal reactions was also significantly lower in the anesthetized group. CONCLUSION: Paracervical anesthesia is effective for hysteroscopy and endometrial biopsy in postmenopausal women and may be indicated particularly for patients with cervical stenosis, for very anxious subjects and in all situations where pain stimulation could trigger threatening side effects due to systemic pathologies.

Anesthesia, Local↗
PubMed1996

Diagnostic accuracy of hysteroscopy in endometrial hyperplasia.

OBJECTIVES: To determine the diagnostic accuracy of hysteroscopy in the diagnosis of endometrial hyperplasia in women with abnormal uterine bleeding. METHODS: From 1993 through 1995, 980 women referred to our institution for abnormal uterine bleeding underwent diagnostic hysteroscopy with eye direct biopsy of the endometrium in case of macroscopic abnormalities. Hysteroscopic features were compared with pathologic findings in order to detect the reliability of the endoscopic procedure. Statistical analysis was performed with the McNemar test. RESULTS: Positive predictive value of hysteroscopy in the diagnosis of endometrial hyperplasia accounted for 63%. In fact hysteroscopic diagnosis of endometrial hyperplasia was confirmed at pathologic examination in 81 out of 128 patients. Sensitivity and specificity of the endoscopic procedure accounted for 98% and 95%, respectively. Negative predictive value accounted for 99%, as only two cases of atypical hyperplasia were missed at hysteroscopy. Positive predictive value was higher in postmenopausal patients compared to women in the fertile age (72 vs. 58%). CONCLUSIONS: Overall, results appear encouraging, since no case of endometrial hyperplasia was missed by hysteroscopy. The high diagnostic accuracy, associated with a minimal trauma, renders hysteroscopy the ideal procedure for both diagnosis and follow-up of conservative management of endometrial hyperplasia.

Adult↗
PubMed1996

The role of contact hysteroscopy.

Contact hysteroscopy has been replaced by a new technique based on the use of a special hysteroscope. The instrument was designed to study the squamocolumnar junction and the lesions of the portio. A new technique, endometrial dating, uses the Hamou hysteroscope to study endometrial physiology. We improved endometrial dating and discovered a new pattern, the pseudofunctional dysvascular endometrium (PFDE), that seemed to pertain to uterine bleeding. We also studied the PFDE syndrome in the presence of dysfunctional uterine bleeding. In this study we reviewed the three procedures and assessed their results. We conclude that contact microhysteroscopy is a reliable diagnostic procedure, and should be considered part of diagnostic hysteroscopy, not an independent technique.

Diagnosis, Differential↗
PubMed1996

Hyperplastic Human Endometrium

Endometrial hyperplasia is considered to be a frequent cause of menorrhagia. Traditionally, this pathology was diagnosed from specimens obtained by uterine curettage or after hysterectomy for benign disease. With hysteroscopy one can visualize the uterine cavity directly and perform guided biopsies of the endometrial mucosa. We assessed the reliability of hysteroscopic procedures in the diagnosis of endometrial hyperplasia. We performed 980 hysteroscopies in 3 years for menorrhagia and found endometrial hyperplasia in 128 women. We compared the results with histologic findings. Statistical analysis was performed according to McNemar test. On the basis of the results, hysteroscopy diagnoses and monitors endometrial hyperplasia.

Journal Article↗
PubMed1996

Hysteroscopic Polypectomy in the Office without Anesthesia

Hysteroscopy is a reliable procedure not only for diagnosis, but also for office treatment of uterine pathologies that, until recently, required general or at least topical anesthesia. The vaginoscopic approach without a speculum and tenaculum avoids discomfort to patients and ensures complete compliance. We treated 253 endometrial and cervical polyps with 5F instruments and an office hysteroscope with operative sheath. All polyps were removed on diagnosis, and the women were able to resume their normal activity soon after the procedure. Pretreatment with danazol or gonadotropin-releasing hormone analogs was necessary only for polyps larger than 2 cm. Recurrence at follow-up was 5%.

Journal Article↗
PubMed1996

Anatomic Impediments to the Performance of Hysteroscopy

Infertility and menorrhagia in menopausal women are the most frequent indications for hysteroscopy. Often, however, the procedure turns out to be difficult or impossible due to stenosis and reduction in the size of the cervical canal. With the availability of more and more atraumatic endoscopic instrumentations and improvements in the technique, hysteroscopy can be performed in all women, whatever the obstacle. In our 5-year experience of 1500 hysteroscopies, we often found anatomic conditions that, besides being obstacles to performing the examination, increased patient discomfort. With the office hysteroscope with a 5F operative sheath one can rapidly overcome the obstacles and complete the examination without discomfort to the patient.

Journal Article↗
PubMed1992

Mitoxantrone and continuous infusion of cytosine arabinoside in refractory and relapsed acute lymphoblastic leukemia.

Twenty adult patients with relapsed or refractory acute lymphoblastic leukemias (ALL) received a regimen employing two courses of mitoxantrone 12 mg/m2 by rapid intravenous infusion on days 1, 2 and 3 and cytosine arabinoside (ARA-C) 200 mg/m2/day by continuous infusion on days 1-7. Complete remission (CR) was achieved in 10 of 20 (50%) patients (3 refractory and 7 relapsed). Median duration of CR was 5 months (range 2-9). The treatment was associated with minimal extrahematologic toxicity, with no cardiac toxicity. Our results are nearly in line with therapeutic responses obtained with regimens employing megadose therapy (HD ARA-C). Because of acceptable toxicity, mitoxantrone plus continuous infusion of a standard dose of ARA-C could be considered for relapsed of refractory ALL patients eligible for an intensive therapeutic approach (bone marrow transplantation) after a second CR.

Adolescent↗