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Biomedical subjects

P Vercellini

Publications and source records attributed to P Vercellini.

At least 55 records · Page 3Linked to original sources
PubMed1996

Endometrial Ablation with a Vaporizing Electrode in Women with Regular Uterine Cavity or Submucous Leiomyomas

To verify the technical feasibility and safety of endometrial ablation with a vaporizing electrode (Vaportrode), we performed operative hysteroscopy in a consecutive series of 40 women (mean ± SD age 45.3 ± 4.7 yrs) with established menorrhagia and uterine volume less than 12 weeks' gestation. The results in 26 women with a regular uterine cavity were compared with those in 14 patients who had submucous myomas with less than 50% intramural extension. Surgery was undertaken after 2-month treatment with a depot gonadotropin-releasing hormone agonist. Pure cutting current was set at 200 W. Mean ± SD operating time was 8.6 ± 2.4 minutes in women with a regular cavity and 14.4 ± 5.2 in those with submucous myomas (mean difference 5.8 minutes, 95% CI 3.4-8.3). Corresponding values for distention fluid absorption were, respectively, 76 ± 103 and 227 ± 138 ml (mean difference 151 ml, 95% CI 73-229). A significant correlation was observed between operating time and distention fluid deficit (Spearman r = 0.47, p = 0.002). No complications occurred and all the procedures were performed as day surgery. After a mean follow-up of 4 months, no recurrence of menorrhagia was reported. Endometrial ablation with the Vaportrode is rapid, effective, and safe. Fluid deficit, although significantly greater in women with submucous myomas than in those with regular cavities, always remained within safety limits and below the usual values observed after resection with the wire loop.

Journal Article↗
PubMed1996

Goserelin Depot Treatment Before Endometrial Resection

To ascertain whether treatment with a gonadotropin-releasing hormone agonist before endometrial resection reduces absorption of distention fluid and operating time, facilitates the procedure, and improves long-term bleeding pattern, 71 menorrhagic women were allocated to 8 weeks of goserelin depot treatment before operative hysteroscopy or immediate surgery in the early proliferative phase of the cycle. Eight patients withdrew from the study after randomization, leaving 33 in the goserelin arm and 30 in the immediate surgery arm. Mean (SD) operating time was 15.1 (9.0) minutes in the goserelin group versus 16.9 (9.5) minutes in the controls (mean difference 1.8 min, 95% CI -2.9-6.4). Mean (SD) distention medium deficit was, respectively, 422 (287 ml) and 564 ml (291 ml; mean difference 142 ml, 95% CI -4-288). Considering only the 29 women with adenomyosis, the mean (SD) fluid deficit was considerably less in the 19 goserelin-treated group than in the 10 controls, 299 (206) versus 597 (135) ml (mean difference 298 ml, 95% CI 149-447). The surgeons classified intraoperative difficulties as none in 6, minimal in 20, moderate in 7, and severe in no cases in the goserelin group; corresponding figures in the group without pretreatment were 2, 14, 13, and 1 (p = 0.02). At 12-month follow-up 35% of women in the goserelin group were amenorrheic, 23% hypomenorrheic, 42% eumenorrheic, and none hypermenorrheic. Corresponding figures in the immediate surgery group were, respectively, 20%, 30%, 37%, and 13%. Goserelin administration before endometrial resection may reduce absorption of fluid at surgery in some patients and may facilitate intrauterine operating conditions. Effects on long-term bleeding patterns were limited.

Journal Article↗
PubMed1996

Leuprolide in a 3-monthly versus a monthly depot formulation for the treatment of symptomatic endometriosis: a pilot study.

An open-label randomized pilot study was conducted to evaluate the efficacy and acceptability of 6 months treatment with leuprolide in a 3-monthly versus a monthly i.m. depot injection for the relief of chronic pelvic pain in women with endometriosis. A total of 30 women aged 18-38 years were allocated to the 3-monthly depot arm (n = 15) or to the monthly depot arm (n = 15) after laparoscopic diagnosis of pelvic endometriosis. Mean (SD) deep dyspareunia scores according to a 0-3 point verbal rating scale decreased from 1.8 (0.9) at baseline to 1.3 (0.7) at the end of treatment in the 3-monthly depot group and from 2.1 (1.2) to 1.3 (0.7) in the monthly depot group. Corresponding values in non-menstrual pain scores fell from 2.1 (0.6) to 1.1 (0.3), and from 2.1 (0.8) to 1.2 (0.4) respectively, without statistically significant differences between the groups. Serum luteinizing hormone (LH) and 17 beta-oestradiol concentrations were significantly suppressed at 12 and 24 weeks compared with baseline values, without differences between the groups. The monthly depot caused a slightly more marked inhibition of serum follicle stimulating hormone (FSH) levels with respect to the 3-monthly preparation. Mean (SD) endometriosis scores at baseline and at 6-month follow-up laparoscopy were respectively 32.8 (25.1) and 12.2 (9.3) in the 3-monthly depot group and 29.0 (22.7) and 13.1 (15.3) in the monthly depot group (paired t-test, P < 0.05). Mean percentage decrease in lumbar spine bone mineral density was 5.2% in the former and 4.9% in the latter subjects. In the 3-monthly depot group, 13 women graded the tolerability of their treatment schedule as "good' compared with seven in the monthly depot group (chi 2 = 5.40, P = 0.02).

Adolescent↗
PubMed1996

Treatment with a gonadotrophin releasing hormone agonist before endometrial resection: a multicentre, randomised controlled trial.

OBJECTIVES: To ascertain whether treatment with a gonadotrophin releasing hormone agonist before endometrial resection reduces absorption of distension fluid and operating time and facilitates the procedure. DESIGN: A multicentre, prospective, randomised controlled study. PARTICIPANTS: Seventy-one premenopausal women with established menorrhagia. INTERVENTIONS: Eight weeks of goserelin depot treatment before endometrial resection of immediate surgery in the early proliferative phase of the cycle. MAIN OUTCOME MEASURES: Irrigation fluid deficit, operating time and degree or difficulty of the procedure. RESULTS: After randomisation eight women withdrew from the study, leaving 33 women in the goserelin arm and 30 in the immediate surgery arm. Mean (SD) operating time was 15.1 (9.0) min in the goserelin group versus 16.9 (9.5) min in the controls; mean difference + 1.8 min, 95% CI, -2.9 to + 6.4. Mean (SD) distension medium deficit was, respectively, 422 (287) ml versus 564 (291 ml); mean difference + 142 ml, 95% CI -4 to + 288. The goserelin effect was restricted to the 29 women with adenomyosis as the mean (SD) fluid deficit was considerably less in the 19 treated women than in the 10 controls (299 (206) ml versus 597 (135) ml; mean difference + 298 ml, 95% CI + 149 to + 447). The surgeons classified the intraoperative difficulties as none in 6, minimal in 20, moderate in 7, and severe in no cases in the goserelin group; corresponding figures in the group without pretreatment were 2, 14, 13, and 1. CONCLUSIONS: Goserelin administration before endometrial resection may reduce absorption of fluid at surgery in women with adenomyosis and may facilitate intrauterine operating conditions.

Absorption↗
PubMed1996

Hysterectomy for benign gynecologic disorders: when and why?

Controversy continues to swirl around hysterectomy-particularly about when and why it is appropriate for benign disorders. In the United States, one woman in three undergoes hysterectomy by age 65. The rate in the European Union nations ranges from 6% to 20%. In this review, the most recent epidemiologic data on hysterectomy are summarized, and the generally accepted indications for this procedure for benign gynecologic diseases are presented and discussed.

Endometriosis↗
PubMed1996

Endometriosis and pelvic pain: relation to disease stage and localization.

OBJECTIVES: To determine whether prevalence and severity of pain symptoms are related to endometriosis stage and site, with particular reference to deep infiltrating vaginal lesions. DESIGN: Systematic assessment of chronic pelvic pain symptoms. SETTING: University hospital endometriosis center. PATIENTS: A total of 244 consecutive symptomatic patients with endometriosis diagnosed at laparoscopy or laparotomy. INTERVENTIONS: Assessment of dysmenorrhea and nonmenstrual pain by means of a 10-point linear analog scale, a 7-point multidimensional rating scale, and a 3-point verbal scale; evaluation of deep dyspareunia with the first and third systems only. MAIN OUTCOME MEASURES: Prevalence and severity of pain symptoms in relation to endometriosis stage and site of lesions. Correlation between revised American Fertility Society score and symptoms severity, as well as between two pain scales to assess dysmenorrhea and nonmenstrual pain. RESULTS: Eighty-eight women had stage I and II disease and 156 had stage III and IV disease. Only ovarian endometriosis was present in 108 patients, only peritoneal implants were present in 37, combined ovarian and peritoneal lesions were present in 57, and histologically confirmed vaginal endometriosis was present in 42. The frequency and severity of deep dyspareunia and the frequency of dysmenorrhea were less in patients with only ovarian endometriosis than in those with lesions at other sites. Patients with vaginal endometriosis had a significantly increased risk of deep dyspareunia compared with those whose lesions were at other sites (odds ratio, 2.55; 95% confidence interval, 1.21 to 5.39). Stage per se, independent of lesion site, was not correlated with frequency and severity of dysmenorrhea and nonmenstrual pain. The severity of deep dyspareunia was related inversely to the endometriosis score (Spearman correlation coefficients for linear analog and verbal rating scales, respectively, -0.22 and -0.20). Kendall test by ranks revealed a correlation between linear analog and multidimensional pain scales in the rating of both dysmenorrhea and nonmenstrual pain (respectively, tau-b, 0.59 and tau-b, 0.68). CONCLUSIONS: Endometriosis stage in the current classification was not related consistently to pain symptoms. The presence of vaginal lesions was associated frequently with severe deep dyspareunia. Dysmenorrhea and nonmenstrual pelvic pain were assessed with equal accuracy by a linear analog and a multidimensional scale.

Adolescent↗
PubMed1996

Laparoscopic uterine biopsy for diagnosing diffuse adenomyosis.

OBJECTIVE: To investigate the possibility of diagnosing diffuse adenomyosis with the uterus in situ. STUDY DESIGN: Myometrial needle biopsy was performed on a prospectively evaluated series of 72 women undergoing laparoscopy for infertility and/or chronic pelvic pain. Before surgery the patients completed a questionnaire on the presence and severity of dysmenorrhea according to a linear analog and verbal rating scale. A single specimen was taken from along the median line in the upper third of the posterior uterine wall using a 14-gauge Tru-cut needle inserted through the anterior abdominal wall under laparoscopic guidance. RESULTS: No complications occurred. Adenomyosis was diagnosed in 8 of the 42 subjects with menstrual pain and 5 of the 30 asymptomatic ones (19% versus 17%) and pelvic endometriosis in 27 and 10, respectively (64% versus 33%, P = .02). The frequency of moderate or severe dysmenorrhea was greater in women with adenomyosis than in those without adenomyosis or endometriosis, but the difference was not statistically significant. Conversely, menstrual pain was significantly more frequent and severe in patients with endometriosis as compared with women who had neither endometriosis nor adenomyosis. CONCLUSION: Uterine needle biopsy is simple, rapid and safe, but its overall clinical importance, as well as the predictive value of a normal histologic result, requires further investigation.

Adult↗
PubMed1996

GnRH agonists before surgery for uterine leiomyomas. A review.

OBJECTIVE: To clarify whether preoperative treatment with gonadotropin-releasing hormone (GnRH) agonists offers substantial advantages to patients undergoing conservative or definitive surgery for uterine leiomyomas. STUDY DESIGN: A review of data from the most recent English-language literature. RESULTS: Inducing amenorrhea in patients with heavy menorrhagia and severe sideropenic anemia before both conservative and definitive surgery for uterine fibroids raises hemoglobin and hematocrit values to within the normal range, limits homologous blood transfusions and enables operations to be scheduled with the patients in better condition. A temporary 30-50% reduction in mean uterine volume theoretically may convert an abdominal into a vaginal hysterectomy in "borderline" cases or sometimes allow a transverse instead of longitudinal abdominal incision. No trial has yet demonstrated "clinically" significant reductions in operating time, operative blood loss or postoperative morbidity in patients undergoing myomectomy or hysterectomy after a course of GnRH agonists as compared with those operated on immediately. There seems insufficient scientific evidence to justify the routine use of GnRH agonists before myomectomy at laparotomy, except possibly in the case of extremely bulky uteri. GnRH agonist treatment before hysteroscopic myomectomy induces endometrial thinning, reduces bleeding and mucous debris, and decreases the diameter of submucous leiomyomas, improving visibility and limiting operating time and fluid intravasation. CONCLUSION: The available data seem to support the use of GnRH agonist treatment before surgery for uterine leiomyomas in selected circumstances. Administration of GnRH agonist for only two or three months preoperatively seems to achieve all the advantages of this treatment, limiting side effects and cost.

Adult↗
PubMed1995

The value of cyst puncture in the differential diagnosis of benign ovarian tumours.

A prospective collection of serum samples and ovarian cyst fluid was used to assess the use of different tumour markers and cyst fluid cytology in combination with serum tumour markers for the differential diagnosis of benign ovarian cysts. A consecutive series of 108 women of median age 30 years (range 15-75) undergoing laparotomy or operative laparoscopy for presumedly benign ovarian cyst(s) were studied at a teaching hospital at the University of Milan, Italy. The main outcome measures were tumour markers CA 125, CA 19.9 and carcino-embryonic antigen (CEA) in serum and ovarian cyst fluid, oestradiol and progesterone concentrations in cyst fluid, and cytology of the sediment. The studied cysts were endometriotic (55 subjects), dermoid (16), mucinous (12), serous (10) or of miscellaneous histotype (15, including four follicular and one luteal). Serum CA 125 concentrations were significantly higher in the endometrioma patients than in the other groups. The sensitivity of CA 125 in the differentiation of endometriomas from other adnexal tumours was 61.8% and the specificity 94.3%; combining CA 125 and CA 19.9 assays yielded a sensitivity of 83.6% and specificity of 62.3%. Cyst fluid tumour markers values were extremely scattered with ample overlap between different cyst types. Oestradiol and progesterone concentrations were similar in the histological subgroups. Cyst fluid cytology was non-specific. We concluded that the aspiration of fluid from presumedly benign ovarian cysts appears to contribute little to the differential diagnosis of various tumours. The use of combining serum CA 125 and CA 19.9 assays in the diagnosis of endometriomas needs further confirmation.

Adolescent↗
PubMed1995

Adenomyosis at hysterectomy: a study on frequency distribution and patient characteristics.

To evaluate the prevalence and risk factors for adenomyosis, the clinical records of consecutive women undergoing hysterectomy during a 3 year period were retrieved. Data were collected on indication for the intervention, general sociodemographic characteristics of the patients, age at menarche, parity, abortions, and menopausal status at surgery. Adenomyosis was diagnosed in 332 of the 1334 cases (24.9%). The condition was present in 146 of the 627 patients (23.3%) with fibroids and menorrhagia, 68 of the 265 (25.7%) with prolapse, 21 of the 98 (21.4%) with ovarian cysts, 19 of the 100 (19%) with cervical cancer, 31 of the 110 (28.2%) with endometrial cancer, 16 of the 57 (28.1%) with ovarian cancer, and 19 of the 77 (24.7%) with miscellaneous indications. These differences were not statistically significant (chi 2(6) = 11.14). In comparison with nulliparous women, the odds ratio was 1.3 and 1.5 respectively in women with one and > or = two births (chi 2(1) trend = 5.76 P < 0.05). No relationship was found between age at surgery, age at menarche, indications for surgery, menopausal status at intervention, and presence of endometriosis. Our findings do not support the notion that adenomyosis is more frequently related to particular clinical conditions, and suggest that parity may be associated with an increased frequency of adenomyosis.

Adult↗
PubMed1995

Conservative surgery for severe endometriosis: should laparotomy be abandoned definitively?

According to current opinion, surgery at laparotomy for conservative treatment of endometriosis is obsolete. The debate on the indications, modalities and results of surgical treatment for the most severe forms has recently been rekindled. Although some expert endoscopists propose advanced techniques to deal with the most problematic pelvic lesions, various authors wonder if such interventions have been demonstrated as efficacious and safe enough to justify abandoning the standard reference treatment. We have reviewed the data, comments and proposals recently published on the topic. The available scientific evidence appears insufficient to recommend laparoscopy instead of surgery at laparotomy, even for the most severe forms of endometriosis. Intestinal, vesical, periureteral, retroperitoneal, and vaginal lesions and large endometriomas associated with extensive dense adhesions may still benefit from classical surgery at laparotomy. However, the lack of comparative studies prevents a correct comparison of the methods in terms of pregnancy rate, resolution of pain and incidence of recurrences.

Endometriosis↗
PubMed1994

Gonadotropin releasing hormone agonist treatment before hysteroscopic endometrial resection.

OBJECTIVES: To evaluate the effects of treatment with the gonadotropin releasing hormone (GnRH) agonist goserelin before endometrial resection on absorption of distension medium fluid and technical feasibility of the surgical procedure. METHODS: Fifty-five patients reporting menorrhagia underwent endometrial resection after 2 months of goserelin depot therapy (33 cases) or during the proliferative phase of the cycle (22 controls). RESULTS: In the cases, the mean distension medium deficit +/- S.D. was 511 +/- 196 ml versus 647 +/- 245 ml in controls (P = 0.03), and the operating times were, respectively, 14 +/- 4 versus 18 +/- 5 min (P = 0.002). The intrauterine operating conditions were considered excellent or good in 64% of the cases versus 27% of the controls (chi 2 = 5.60, P = 0.02). CONCLUSIONS: GnRH agonists induce endometrial thinning, so that when administered before intrauterine interventions, mucus cellular debris and bleeding should be reduced during surgery and hysteroscopic visibility increased; the operating time may thus be shorter and fluid absorption decreased. However, more data are needed before considering GnRH agonists a proven effective means of facilitating endometrial resection.

Adult↗
PubMed1994

Serum and Cyst Fluid Tumor Marker Levels in the Differential Diagnosis of Benign Ovarian Cysts

Serum and cystic fluid levels of CA 125, CA 19.9, carcinoembryonic antigen (CEA), and alpha-fetoprotein (AFP) were assayed in 74 consecutive women of median age 30 years (range 15 to 74 years) undergoing surgery for adnexal cysts of presumed benign nature. Median (range) serum levels of CA 125, CA 19.9, CEA and AFP were 46.5 IU/ml (4.3-406), 28.5 IU/ml (1-96.3), 1.4 ng/ml (0.5-3.5) and 2.4 ng/ml (1-9.9) in 44 endometriotic cysts; 22.5 (4.7-82), 4.9 (1-226),1.3 (0.7-4.8) and 4 (0.5-10.5) in 11 dermoid cysts, 14 (8.6-25.1), 3.2 (1-6), 1 (0.3-2.8) and 3.7 (1.9-6) in 9 mucinous cysts, and 6.9 (0.5-104), 18 (1-132), 0.8 (0.1-1.9) and 2.1(1-5.4) in 10 cases with mixed histotypes. Corresponding cystic fluid levels were 342,864 (1,418-3,404,682), 228,000 (117-2,500,000), 106 (0.5-2,908) and 1.3 (0.4-51) in endometriomas; 843,895 (10,842-1,676,948), 740,039 (77-1,280,000), 470 (61-880) and 2.5 (1-4) in dermoids; 3,485 (27.2-149,804), 9,007 (36.4-153,475), 1,631 (402-11,096) and 1 (0.5-2.5) in mucinous cysts, and 13,068 (5,300-43,767), 412 (1-142,700), 0.8 (0.4-5.3) and 2.3 (1-4) in the mixed histotype group. No significant between group differences were detected in serum marker levels. Patients in the mucinous cyst group had significantly lower CA 125 cystic fluid levels compared with women with endometriomas and dermoids (P<0.05). Fluid aspirate tumor marker measurements did not aid in the differential diagnosis of benign ovarian cysts, mainly due to the extremely wide scattering of values.

Journal Article↗
PubMed1994

Analysis of p53 and ras gene mutations in endometriosis.

No activating mutations in codons 12, 13 and 61 of ras genes nor inactivating mutations in exons 5-9 of the p53 tumor suppressor gene were detected by polymerase chain reaction and single-strand conformation polymorphism methods in either eutopic or ectopic endometrium from 10 women with severe endometriosis.

Adult↗
PubMed1994

A modified technique for correction of the complete septate uterus.

When correcting a complete uterine septum, it is recommended that one should spare the cervical portion to avoid the possible risk of cervical incompetence. However, it may be difficult to create a communication between the uterine cavities above the internal os. In seven patients with complete septate uterus we incised the cervical portion with Metzenbaum scissors and the corporal portion with microscissors under hysteroscopic guidance. The operating times were shorter and the distension fluid deficit smaller compared with nine historical controls in whom the cervical septum was spared. No intraoperative or obstetric complications were associated with cervical septal section. This modified technique is simple, rapid, safe, inexpensive, and may be considered among the alternative treatments to correct a complete septate uterus.

Abortion, Habitual↗
PubMed1994

Very low dose danazol for relief of endometriosis-associated pelvic pain: a pilot study.

OBJECTIVES: To evaluate the efficacy and safety of very low dose danazol in improving pelvic pain in women with endometriosis, the benefit of preceding the treatment by a short course of a GnRH agonist, symptoms recurrence after drug withdrawal, and variations in menstrual pattern. DESIGN: Open-label, randomized study. SETTING: University hospital endometriosis center. PATIENTS: Forty-two women with moderate or severe pelvic pain and laparoscopically diagnosed endometriosis. INTERVENTIONS: Treatment with oral danazol, 50 mg/d, for 9 months (group I, n = 21) or leuprolide depot for 3 months followed by oral danazol, 50 mg/d, for 6 months (group II, n = 21), and a 6-month follow-up. MAIN OUTCOME MEASURES: Variations in severity of symptoms during treatment and at the end of follow-up as shown by a linear analog scale and a verbal rating scale; menstrual blood loss as assessed by a pictorial chart. RESULTS: Four patients withdrew from the study, one in each group at the fifth month of treatment (for persistent pain) and one in each group during follow-up (they requested additional therapy); one woman in group I was lost to follow-up. Significant improvements were obtained in dysmenorrhea, deep dyspareunia, and nonmenstrual pain in both treatment schedules without differences between the groups. Also menstrual blood loss was significantly reduced in both groups. A temporary fall in high and rise in low density lipoprotein cholesterol was observed in the study population. At the end of follow-up symptoms recurred without significant differences in median pain scores with respect to baseline. CONCLUSION: Very low dose danazol may be an alternative for temporary relief of endometriosis-associated pain. Ovulation is not always inhibited and barrier contraception is needed. Side effects occur but are rarely severe. Further data are required to evaluate the influence of long-term administration on the lipid profile.

Adolescent↗