Intra-abdominal spread of malignant cells following hysteroscopy.
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Abdominal Neoplasms↗
Biomedical subjects
S Bettocchi
Publications and source records attributed to S Bettocchi.
A vaginoscopic approach to reduce the pain of office hysteroscopy.
We developed a new approach to diagnostic hysteroscopy that reduces patient discomfort and increases the possible applications of hysteroscopy. Between February 1992 and March 1996, 1200 hysteroscopies were performed at our institution. Of these, the last 680 were done using the vaginoscopic approach without preselection. Discomfort was reduced in all patients, including those with moderate stenosis of the internal cervical os. Vaginoscopy is easy to perform and incurs no additional cost for the patient. It is ideal for office hysteroscopy and in patients who otherwise might require general anesthesia, such as virgins and older women with somewhat stenotic vaginas.
Ambulatory Surgical Procedures↗
Missed hysteroscopic detection of uterine carcinoma before endometrial resection: report of three cases.
Endometrial ablation or resection using hysteroscopy appears to be an effective treatment for menorrhagia resistant to medical therapy. Three patients with endometrial adenocarcinoma missed in the preoperative hysteroscopic and histological assessment and subjected to endometrial resection were collected in a multicenter study. One case was an early adenocarcinoma in the background of late proliferative endometrium in a 39-year-old woman. In the other two patients, ages 51 and 68, the adenocarcinoma developed in a polyp in a background of simple hyperplasia. Since hysteroscopy with endometrial biopsy might not be able to exclude the presence of an early intrauterine cancer, appropriate selection and accurate evaluation of patients are imperative before ablative surgery. Endometrial resection is preferred over endometrial laser ablation since it provides additional tissue for histologic examination.
Adenocarcinoma↗
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↗
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↗
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↗
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↗
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↗
New Era of Office Hysteroscopy
One of the major problems of early office hysteroscopy was patient discomfort and pain due to the diameter of the scope. We overcame this handicap by using a small-diameter hysteroscope. We also developed a new way to access the cervix, the vaginoscopic approach, that permits hysteroscopy to be performed without speculum, tenaculum, or local anesthesia. We also perform operative procedures with this hysteroscope, including polypectomy and septum resection, always without anesthesia in an office setting.
Journal Article↗
Hormonal sensitivity of adenylate cyclase from human endometrium: modulation by estradiol.
In human endometria, a membrane-bound adenylate cyclase is present, which is recovered in high yield in a low-speed particulate fraction. Neither the specific activity of the enzyme nor the response to modifiers that act through the regulatory subunit of the complex, are modified during the proliferative or secretory phase of the cycle. Surprisingly, we found that in vitro treatment of secretory endometrial membranes with 17 beta-estradiol stimulates 3- to 4-fold the activity of adenylate cyclase. However this response does not occur on proliferative membranes. The activation by estradiol is independent of the presence of guanylylimidodiphosphate and is additive to that of the nucleotide. Possibly, as the consequence of the phenomenon, the concentration of cyclic AMP is significantly higher in curretage samples obtained from patients during the secretory rather than in the proliferative phase of the cycle. To our knowledge this is the first evidence of a target-cell membrane-directed effect of sex steroids in humans.
Adenylyl Cyclases↗
Influence of acute estrogenic withdrawal on blood calcitonin.
As a model to investigate the pathogenesis of postmenopausal osteoporosis and the involvement of calcitonin in the bone alterations, we chose surgical menopause, studying the influence of castration on blood calcitonin. After surgery, the hormone and calcemia were raised significantly over preoperative values in castrated women, but not so in a control group of patients undergoing hysterectomy without oophorectomy. The elevated concentration of calcitonin was maintained during at least 4 months. It is speculated that this mechanism of control of calcitonin secretion by gonadal hormones might be activated in the pathogenesis of postmenopausal osteoporosis.
Adult↗
Short-term effect of oophorectomy on lipoprotein metabolism.
The influence of steroid hormones on lipoprotein metabolism has been investigated in menstruating women undergoing oophorectomy; indeed, by this procedure, it is possible to alter selectively the secretion of the hormones and thus to determine the influence of their withdrawal on blood lipids. Within 3 months of surgery we observed significant rapid changes in cholesterol levels of total and HDL-bound components (early decrease and subsequent increase) without alteration of the triglyceride component of the lipoproteins. Similar biphasic changes were observed for the apolipoproteins A and B, determined by immunological methods. These results are suggestive of an action of sex hormones on the lipoprotein metabolism, both on the lipid and the protein moieties. They can be explained by a primary action of the hormones on the apolipoprotein metabolism and a secondary apoprotein-mediated effect on the lipid component of the lipoproteins.
Adult↗
Sex steroid hormones influence the cAMP content in human endometrium during the menstrual cycle.
The measurement of the tissue concentrations of cyclic adenosine monophosphate (cAMP) in human endometrium shows that the levels of the nucleotide vary during the menstrual cycle, being 11.4 +/- (SE) 2.5 and 37.7 +/- (SE) 10.1 pmol/mg protein in the proliferative and secretory phase, respectively. The individual determinations of cAMP are significantly correlated to the estradiol/progesterone blood concentration ratio: by this means we obtained a superimposable distribution with the results of histologic examination suggesting that the hormones have a direct action in determining the cAMP levels in this tissue. The relevance of these observations for the physiology of the endometrium is discussed.
Cyclic AMP↗
[Effect of maternal anxiety (unrest) on the health status of the fetus].
The aim of our study was to clarify the question, to what extent the anxiety of the gravida during gestation is capable to influence the fetal condition.--For that reason, besides of a statistical analysis of a standardized interview the basal heart frequency and the reaction in a non-stress CTG over 20 min has been examined. The data of 101 women between the 36th and 42nd week of gestation were included. The age of our patients ranged from 20 to 30 years.--For assessment of the degree of anxiety we used the STAI X-1 test (questionnaire for self-assessment of anxiety as condition and characteristically personal property, resp.). Cases of pathologic gestation were excluded by history and a carefully clinical examination. No significant correlations between the level of anxiety and fetal condition could be demonstrated. We detected only a slight tendency of decreasing heart-rate variability and increasing frequency of accelerations in the CTG, as well as an increase of active fetal movements with a raising maternal level of anxiety.
Adult↗
Phenotypic immaturity of T and B lymphocytes in cord blood of full-term normal neonates. Analysis of cell surface markers by using conventional techniques and monoclonal antibodies.
We examined mononuclear cell subsets in cord blood of normal newborns by surface marker analysis. The percentages of T lymphocytes (E-rosetting and T3+ cells) were lower in cord blood than in peripheral blood (PB) from adults, while the percentage and absolute number of T6+ cells were higher in cord blood. As the sum of T4+ and T8+ cells exceeded the values of E-rosetting lymphocytes in cord blood, we suggest that immature lymphocytes with the phenotype of 'common' thymocytes (T6+, T4+, T8+) are present in cord blood of full-term newborns. Higher percentage and absolute number of B lymphocytes were detected in cord blood. More than 50% of B cells in cord blood formed rosettes with mouse erythrocytes, a surface marker of functional immaturity. Finally, cells bearing receptors for IgG-Fc fragments or C3 and expressing Ia-like and M1 antigens were uniformly increased in cord blood, suggesting higher percentages of cells of the monocytic lineage.
Adult↗
Analysis of mononuclear cell subsets in pregnancies with intrauterine growth retardation. Evidence of chronic B-lymphocyte activation.
We have examined the mononuclear cell (MC) subpopulations of 5 pregnant women: Three of them had a previous history of IUGR, whereas two were primiparae and presented IUGR at the term of gestation. IUGR was confirmed after delivery in three women. The analysis of MC subsets was performed by rosetting and immunofluorescence techniques; both heterologous antisera specific for human immunoglobulins and monoclonal antibodies specific for T cell antigens and for M1 and Ia-like antigens were used. The three patients with IUGR confirmed at birth presented numbers of circulating lymphoid cells positive for cytoplasmic IgM, IgG and IgA and with morphologic features of plasmablasts or plasma cells at least tenfold higher than in normal pregnant women at the term of gestation. Our data suggest that chronic activation of the lymphoid system occurs in pregnant women with IUGR. Maternal abnormal reactivity to fetal antigens or to undiagnosed chronic infections may be likely explanations for this phenomenon. Further studies are clearly needed to clarify the relationship between B-lymphocyte activation and pregnancy and to examine the hypothesis of an altered balance of the immunoregulatory T lymphocyte subsets in patients with IUGR.
B-Lymphocytes↗
Use of cis-platinum in the treatment of ovarian carcinoma. Clinical results and evaluation of nephrotoxicity.
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Altretamine↗
Behaviour of immune complexes and the complement system in normal pregnancy and pre-eclampsia.
A quantitative study of the circulating immune complexes (IC) was carried out on women during normal pregnancy (286) and the post-partum period (20) and women with pre-eclampsia (30). Furthermore, the behaviour of the complement (C) system was followed. Results showed that IC were low in the first trimester of normal pregnancy (25.3%) and decreased in the following trimesters, whereas they were always present in pre-eclampsia. A very significant difference (p less than 0.0001) was seen when we compared the incidence of IC in normal pregnancy at the third trimester and the pre-eclamptic patients. The follow-up study of the IC, carried out on 4 pre-eclamptic women, showed an increase in the IC levels associated with the exacerbation of the pre-eclamptic picture and a decrease after delivery. The study of complement in normal pregnancy showed a decrease in C1-INH, C1s and C1q, whereas C3, C5, C9 and the properdin factor B increased during the following weeks of gestation; CH50 did not vary excepting during the 1st trimester. In the puerperium all values increased. There was no significant difference between the serum levels of the C components in the 3rd trimester of normal pregnancy and pre-eclampsia. High levels of C3d were observed in normal pregnancy at the 3rd trimester and in pre-eclampsia. The study of this split product of C3 showed that there is activation of the C system, but, since the synthesis of the C components is increased, activation could be masked. Alloantibodies and circulating IC could be the factors responsible for this activation in normal pregnancy and in pre-eclampsia, respectively.
Adult↗