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Biomedical subjects

P Vercellini

Publications and source records attributed to P Vercellini.

At least 73 records · Page 4Linked to original sources
PubMed1994

Paracervical anesthesia for outpatient hysteroscopy.

One hundred seventy-seven women aged 41 +/- 8 (mean +/- SD) years, referred for evaluation of excessive uterine bleeding, were enrolled in an open-label randomized trial to evaluate the efficacy of local anesthesia before hysteroscopy in an outpatient population. The patients underwent hysteroscopy and endometrial biopsy with paracervical block by 10 mL of 1% mepivacaine hydrochloride solution (n = 87) or no local anesthesia (n = 90) and assessed lower abdominal and pelvic pain according to a 10-point linear analog scale. The mean +/- SD pain score was 4.5 +/- 2.0 at hysteroscopy and 5.2 +/- 2.1 at endometrial biopsy in the 87 subjects given a paracervical block versus 4.9 +/- 2.2 and 5.7 +/- 2.4 in the 90 women not given local anesthesia, without statistically significant differences. Paracervical anesthesia for routine outpatient hysteroscopy in premenopausal women may be superfluous.

Adult↗
PubMed1994

Veralipride for hot flushes induced by a gonadotropin-releasing hormone agonist: a controlled study.

OBJECTIVES: To evaluate the efficacy of veralipride, a benzamide derivative, in the treatment of hot flushes induced by GnRH agonists (GnRH-a) and to study peripheral blood mononuclear cell beta-endorphin concentrations during drug administration. DESIGN: Randomized, placebo-controlled, double-blind trial. SETTING: Academic department of obstetrics and gynecology. PATIENTS: Forty women of mean age 43 +/- 5 years who experienced disturbing hot flushes during a 4-month course of tryptorelin depot for myoma-associated menorrhagia. INTERVENTIONS: Treatment with oral veralipride 100 mg/d (20 subjects) or matching placebo (20 subjects) during the third month of GnRH-a administration. MAIN OUTCOME MEASURES: Modifications of frequency and severity of hot flushes as shown by a 0 to 6-point vasomotor scoring system and variations of beta-endorphin levels in peripheral blood mononuclear cells. RESULTS: Two subjects in each group dropped out of the study. The median (range) vasomotor score at the end of the second month of treatment was 4 (3 to 6) in both the veralipride and placebo group. At the end of the third and fourth months the median (range) scores were, respectively, 2 (0 to 6) versus 4 (1 to 6) and 2 (0 to 5) versus 4 (1 to 6). No significant variations in mononuclear cell beta-endorphin concentrations were recorded. Serum PRL levels rose from 11.7 +/- 5.7 to 132.3 +/- 65.0 ng/mL (conversion factor to SI unit, 1.0) during veralipride administration and returned to 10.6 +/- 3.7 ng/mL after drug withdrawal. CONCLUSION: Veralipride reduced vasomotor symptoms induced by a GnRH-a. Transient hyperprolactinemia was the main side effect observed. The mode of action of the drug in GnRH-a-treated patients and possible interactions with endogenous opioid peptides need further elucidation.

Adult↗
PubMed1993

Endometriosis and ovarian cancer.

In 556 patients undergoing surgery for ovarian cancers the frequency of endometriosis ranged from 3.6% to 5.6% in serous, mucinous, and miscellaneous neoplasms versus 26.3%, 21.1%, and 22.2%, respectively, in endometrioid, clear cell, and mixed subtypes; the differences were statistically significant (chi 2 heterogeneity 50.0, p < 0.001) and consistent in strata of age, parity, menopausal status, and disease stage.

Adenocarcinoma↗
PubMed1993

Pregnancy at forty and over: a case-control study.

We compared obstetric prognosis in 327 women > or = 40 years old (148 nulliparas, 279 multiparas) with 20-30-year-old matched controls who delivered at our department between 1988 and 1990. Gestational diabetes and chronic hypertension were the only more frequent antepartum complications in cases than controls (2.4% vs. 0.3% and 3.4% vs. 0.3%, respectively). There were more premature deliveries in cases than controls (19% vs. 8%) but no difference in postdate deliveries. Cesarean section was more frequent in cases than controls in both nulliparas (64% vs. 30%) and multiparas (43% vs. 12%). Incidence of abdominal delivery for acute obstetrical indications was not increased in older gravidas. Significant differences were observed in low birthweight (17% vs. 5%) and 5-min Apgar score < 7 (8% vs. 2%). Most of the abnormal Apgar scores were recorded after cesarean section; values for vaginally-delivered infants were comparable in older and younger women. Perinatal mortality was similar in the two groups.

Adult↗
PubMed1993

Does contraception modify the risk of endometriosis?

Long episodes of regular, prolonged, abundant menstrual flows are generally agreed to increase the risk of endometriosis. Since oral oestrogen-progestogen combinations reduce and intra-uterine contraceptive devices increase menstrual flow, an effect on the risk of development of endometriosis in women utilizing these forms of contraception could be expected. Analysis of the most recent epidemiological observations shows no consensus on a possible relationship between use of cyclic oral contraceptives and endometriosis, with an increase, a decrease, and no effect on the risk of developing the disease all being reported. A lower relative risk of endometriosis in previous users of the intrauterine contraceptive device was only found in two series, most of the other data suggesting a rise in risk or no effect. Further studies on the relationship between type of contraception and endometriosis are needed to demonstrate whether the risk of development of the disease could be influenced, and whether well tolerated, relatively inexpensive, long-term treatment might be available for symptomatic patients not desiring offspring.

Contraceptives, Oral↗
PubMed1993

Tumor necrosis factor in plasma and peritoneal fluid of women with and without endometriosis.

To determine whether in vivo levels of tumor necrosis factor a in plasma and peritoneal fluid differ in infertile subjects with and without endometriosis, peripheral blood and peritoneal fluid samples were collected in 94 women undergoing laparoscopy for infertility. Quantitative determinations of tumor necrosis factor a were performed by an enzyme immunoassay test. Tumor necrosis factor a levels were below the detection limit (10 pg/ml) in plasma and peritoneal fluid of 42 (91%) and 30 (90%) patients with endometriosis and 40 (83%) and 31 (91%) subjects without the disease, respectively. In our series, plasma and tumor necrosis factor a levels were not different in infertile women with and without endometriosis.

Adult↗
PubMed1993

Gonadotropin releasing hormone agonist treatment before hysterectomy for menorrhagia and uterine leiomyomas.

OBJECTIVE: To investigate the effect of gonadotropin releasing hormone agonist (goserelin) treatment before hysterectomy for leiomyomata-associated menorrhagia. DESIGN: Prospective, comparative, nonrandomized study. SETTING: A teaching hospital of Milano University. PATIENTS: Anemic women requiring hysterectomy for myoma-associated menorrhagia. INTERVENTION: Six months' preoperative goserelin treatment (41 cases) or immediate surgery (92 controls). MAIN OUTCOME MEASURES: Abdominal/vaginal hysterectomy rate, number of transfusions, operating time, blood loss, complications, febrile morbidity, and days in hospital. RESULTS: In the goserelin group mean hemoglobin rose (8.5 versus 13.3 g/dl) and mean uterine volume decreased (528 versus 251 ml). At preoperative pelvic exploration abdominal hysterectomy was indicated in 22 (54%) cases and 74 (80%) controls and vaginal hysterectomy in 19 (46%) and 18 (20%) (relative risk 3.6, 95% confidence interval 1.6 to 7.7; p = 0.001). No case required a transfusion whereas 51% of controls needed a total of 127 packed red cell units. CONCLUSIONS: In anemic women with menorrhagia and leiomyomas, gonadotropin releasing hormone agonist treatment before hysterectomy limited transfusion requirements and increased the vaginal procedure rate.

Adult↗
PubMed1993

Multifocal endometriosis. A case report.

Disseminated endometriosis of the urinary, genital and intestinal systems was treated successfully with conservative surgery. We hypothesize that this unusual presentation may have derived from retrograde menstruation, pooling of endometrial cells in the dependent anterior and posterior cul-de-sacs with subsequent passage across the peritoneal mesothelium, and dissemination by clockwise intraabdominal currents.

Adult↗
PubMed1993

Adenomyosis: a déjà vu?

Adenomyosis is a relatively frequent finding in series of hysterectomies performed for menorrhagia and dysmenorrhea. Evident selection biases of the available studies on adenomyosis have always limited the possibilities of defining the real clinical importance of the condition. Until now the only certain diagnoses have been made by histopathologists on uteri removed at surgery, but recently various sufficiently accurate techniques have been suggested which allow diagnosis on the uterus in situ. With the these methods it might be possible to obtain correct information on the epidemiologic characteristics of adenomyosis and to clarify whether it has a pathogenic role in unexplained ovulatory menorrhagia and juvenile dysmenorrhea. Furthermore, resectoscopic treatment has been proposed in some mild forms of adenomyosis to avoid hysterectomy, whereas it seems improbable that medical treatment can offer a definitive solution. The adoption of standard histologic criteria for adenomyosis seems important. Until this is done, it will be difficult to establish whether adenomyosis is really a disease or merely a paraphysiologic condition.

Adult↗
PubMed1993

Abnormal uterine bleeding associated with iron-deficiency anemia. Etiology and role of hysteroscopy.

We reviewed the clinical and histologic records of 61 consecutive premenopausal women with abnormal uterine bleeding and moderate to severe iron-deficiency anemia investigated in a tertiary care and referral center. Excessive bleeding was caused by benign lesions in 67% of the cases and by anovulation in 25% and was unexplained in 8%. Hysteroscopy revealed an organic intrauterine lesion (submucous myomas in 38%, endometrial polyps in 13%, submucous adenomyomas in 3%) that could be treated endoscopically in more than half the patients. In populations without nutritional deficiencies, a woman of reproductive age with sideropenic anemia and no other evident cause of blood loss or systemic disease should be considered menorrhagic until proven otherwise. Hysteroscopy should be included in evaluations of abnormal uterine bleeding.

Adenomyoma↗
PubMed1993

Minimal and mild endometriosis. Is there anything new under the sun?

Research on endometriosis in patients with minimal or mild lesions is marred by our ignorance of the prevalence of limited stages in the asymptomatic female population of reproductive age. Laparoscopic studies performed on women undergoing tubal sterilization suggest that 2-8% are affected. However, the estimates may be unreliable because the studies were retrospective and misdiagnosis of subtle endometriosis cannot be excluded. In a recent prospective study of 86 asymptomatic women, more than 40% had minimal or mild lesions at laparoscopy. The data available do not support the suggestion that limited forms must always be treated to prevent disease progression, nor do they demonstrate worsening in all cases of minimal and mild endometriosis. Furthermore, there is no definitive evidence that the medical and surgical cytoreductive treatments available are effective in preventing eventual progression of the disease in some of the patients. We still do not know the prevalence of minimal and mild endometriosis in the healthy population, the percentage of progression towards severe stages or the risk factors of evolution of the disease. The hypothesis to test is that minimal endometriosis is partly a paraphysiologic condition that is frequently self-limited or resolves spontaneously.

Endometriosis↗
PubMed1993

Gonadotropin releasing hormone agonist for chronic anovulatory uterine bleeding and severe anemia.

Twenty-three women with chronic heavy anovulatory uterine bleeding and severe iron-deficiency anemia received six months' treatment with goserelin, a gonadotropin releasing hormone agonist, administered as a monthly subcutaneous depot. After two months of treatment, all patients were amenorrheic and subsequent spotting was reported on only nine occasions. Laboratory results showed the following values: mean hemoglobin before treatment, 7.9 g/dL-13.8 g/dL at six months (+75%); mean hematocrit, 26.3%-41.6% (+58); mean serum iron, 19.8 micrograms/dL-63.3 micrograms/dL (+134%) and mean serum ferritin, 6.2 ng/mL-35.3 ng/mL (+469%). The endometrial hyperplasia observed in 11 subjects showed regression at follow-up suction biopsy. Gonadotropin releasing hormone agonists administered in a depot formulation for a few months in highly selected patients with severe anemia associated with heavy anovulatory uterine bleeding are practical, safe and effective, may avoid blood transfusions and could be used as a first line of treatment.

Adult↗
PubMed1993

Reproductive prognosis after hysteroscopic metroplasty in 102 women: life-table analysis.

OBJECTIVE: To evaluate reproductive prognosis after hysteroscopic metroplasty. DESIGN: The cumulative proportions of women who became pregnant and gave birth, subdivided according to previous obstetric history, were calculated by the product limit method and compared using the log rank test. SETTING: Outpatient infertility clinic of Milan University. PATIENTS: One hundred two consecutive patients with complete (n = 23) or partial septate uterus (n = 79) referred because of infertility or repeated abortion. INTERVENTION: Hysteroscopic metroplasty performed by microscissors (n = 80), argon laser (n = 10), or electroresectoscope (n = 12). MAIN OUTCOME MEASURES: Postoperative cumulative pregnancy and birth rates. RESULTS: At 36 months the cumulative pregnancy and birth rates were 89% and 75%, respectively, in the septate uterus group and 80% and 67% in the subseptate uterus group. CONCLUSIONS: Reproductive prognosis after hysteroscopic metroplasty was favorable and not influenced by the malformation subclass.

Adolescent↗
PubMed1993

Hysteroscopic metroplasty with resectoscope or microscissors for the correction of septate uterus.

During 1990, we performed hysteroscopic incision of uterine septum in 23 women with repeated abortion. The patients were allocated randomly to metroplasty with resectoscope (12 patients in group 1) or microscissors (11 patients in group 2) to compare surgical feasibility and anatomic results with these instruments. The uterine cavity was distended by instillation of sorbitol and mannitol solution under manometric control. Two patients in group 1 and three in group 2 had a complete septum. In group 1, the mean operating time, plus or minus standard deviation (S.D.), was 22 +/- 6 minutes compared with 17 +/- 5 minutes in group 2 (p = 0.06). The mean amount of distension medium used, plus or minus S.D., was 890 +/- 153 milliliters in group 1 versus 671 +/- 170 milliliters in group 2 (p = 0.003). One woman in group 1 with complete uterine septum had a uterine perforation that was managed conservatively. Postoperative morbidity for the entire series was negligible. At follow-up ultrasonography and hysteroscopy performed two months postoperatively, a residual fundal notch > or = 1 centimeter deep was detected and corrected in four patients in group 1 and two in group 2. Our findings indicate that, in terms of operating time and efficacy, the resectoscope and microscissors are equally valid instruments to correct a septate uterus, with a feasibility rate of 100 percent.

Abortion, Habitual↗
PubMed1993

A gonadotropin-releasing hormone agonist versus a low-dose oral contraceptive for pelvic pain associated with endometriosis.

OBJECTIVES: To evaluate the efficacy of goserelin versus a low-dose cyclic oral contraceptive (OC) in improving pelvic pain in women with endometriosis and to compare recurrence of symptoms during follow-up. DESIGN: Open-label, randomized trial. SETTING: University hospital endometriosis center. PATIENTS: Fifty-seven women with moderate or severe pelvic pain and laparoscopically diagnosed endometriosis. INTERVENTIONS: Six-month treatment with goserelin depot (n = 29) or a low-dose cyclic OC (n = 28) followed by 6-month follow-up. MAIN OUTCOME MEASURES: Variation 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. RESULTS: At 6 months of treatment, a significant reduction in deep dyspareunia was observed in both groups, with goserelin superior to the OC at linear analog scale assessment. Nonmenstrual pain was diminished on both scales without differences between treatments. Women taking the OC experienced a significant reduction in dysmenorrhea. At the end of follow-up, symptoms reappeared without differences in severity between the groups. CONCLUSIONS: Low-dose cyclic OCs may be a valuable alternative for the treatment of dysmenorrhea and nonmenstrual pain associated with endometriosis. Symptoms recurred in most subjects 6 months after drug withdrawal.

Adolescent↗
PubMed1992

Gonadotropin releasing hormone agonist treatment for severe menorrhagia in patients with contraindications to surgery.

Four patients with heavy menorrhagia, severe iron-deficiency anemia and contraindications to surgery were treated with a gonadotropin-releasing hormone agonist in a depot formulation. At 2 months of therapy they were all amenorrheic, and at 6 months the hematologic values had improved markedly. Gonadotropin-releasing hormone agonists may obviate emergency surgery in patients at high surgical risk or could constitute the first line of sequential therapeutic regimens, once general health conditions have improved.

Adult↗