Biomedical subjects
Publications and source records attributed to Stefano Bettocchi.
The use of ultrasound guidance has proven to be a key factor in performing embryo transfer in a gentle and atraumatic manner. However, despite the lower incidence of brusque maneuvers, bladder distension has not shown any positive impact on the IVF success rate.
PURPOSE OF REVIEW: The main aim in investigating post-menopausal women is to exclude endometrial cancer. The purpose of this review is to define up-to-date clinical guidelines for the management of all post-menopausal women (asymptomatic as well as symptomatic). RECENT FINDINGS: Thanks to improvements in both the technology and the technique, hysteroscopy has become a simple and painless procedure that can easily be performed in an office or outpatient setting without any particular discomfort for the patient. The new, easier procedure, well tolerated by patients, has excellent diagnostic and surgical accuracy. Assuming that office hysteroscopy could offer a better visualization of the uterine cavity without increasing patient discomfort if compared to ultrasound, various authors have recently proposed the use of hysteroscopy as a first-line procedure in the approach to the menopausal patient. This could be defined as a change in strategy that has yielded very interesting results in terms of a better understanding of the appearance of the uterine cavity and the clinical value of small intra-cavitary pathologies (and their related treatment), particularly in asymptomatic women. SUMMARY: Hysteroscopy can be considered a routine outpatient method providing immediate results and causing minimal discomfort, especially when performed with the vaginoscopic approach. This technique has ushered in a new era of very-low-cost hysteroscopy, because only the hysteroscope is required in the outpatient procedure, with no need for additional instruments, medication, extra personnel or dedicated theatre. The time taken is comparable to that required for transvaginal sonography.
The indications for hysteroscopic procedures in gynecologic practice are ample and clearly charted: hysteroscopy is considered the gold standard not only for visualizing the cervical canal and the uterine cavity, but also for treating many different kinds of benign pathologies localized to that region. This article summarizes the authors' experience with this technique during the last 14 years, which have been devoted to improving the procedure by creating new instruments and modifying the technique.
We evaluated the efficacy of office hysteroscopic treatment of benign intrauterine pathologies using 5F mechanical instruments (scissors, grasping forceps). Subjects were 4863 women who underwent the procedure without analgesia or anesthesia. We treated cervical and endometrial polyps (0.2-3.7 cm), intrauterine adhesions, and anatomic impediments. At 3 months postoperatively, pathology persisted in 364 women (5.6%). Many operative procedures may be performed in the office setting with simple instruments, provided that correct indications are observed.
A 28-year-old woman with severe right lower abdominal pain and vaginal bleeding at 7 weeks' (+/- 2 days') gestation was seen in the emergency room of our institution. The pregnancy was the result of natural conception after ovarian stimulation with gonadotropins. Transvaginal sonography revealed five intrauterine gestational sacs containing five live embryos. A positive fetal heartbeat was detected in the fallopian tube on the right. Laparoscopic findings disclosed the enlarged uterus with the unruptured right ectopic pregnancy in the ampullary region and an extrauterine pregnancy in the left tube as well. A linear salpingotomy was performed on the right tubal pregnancy. We decided to perform salpingectomy on the left tube because it was impossible to preserve the tube, and exploration of it showed the existence of another gestational sac. It is necessary to decry inappropriate and injudicious use of assisted reproductive technologies, especially by individuals with little or no training in monitoring the agents and treatments prescribed. In 2003, still waiting for official legislation from the Italian Parliament on assisted reproductive technology, we have to face dramatic situations, such as this very unique case of heterotopic pregnancy.
STUDY OBJECTIVE: To assess the diagnostic accuracy of office hysteroscopy by comparing hysteroscopic findings with histologic findings on hysterectomy specimens in postmenopausal women with breast cancer treated with tamoxifen. DESIGN: Retrospective clinical study (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Thirty-three women. INTERVENTION: Record review. MEASUREMENTS AND MAIN RESULTS: Compared with histologic diagnoses of uteri, hysteroscopic findings showed diagnostic sensitivity of 97%, specificity of 100%, positive predictive value of 100% and negative predictive value of 96%. The diagnostic accuracy of hysteroscopy is the same in patients taking tamoxifen as in the general population. CONCLUSION: Hysteroscopy is a powerful method for diagnosing endometrial disease because it provides a direct view of the uterine cavity, reveals focal lesions, and enables targeted biopsies to be performed at the same time.
BACKGROUND: To compare amoxicillin-clavulanic acid with cefazolin as ultra-short-term prophylaxis in laparotomic gynecologic surgery. MATERIALS AND METHODS: A prospective randomized study was conducted to compare two antimicrobial regimens in surgical prophylaxis of laparotomic surgery. Patients were randomly allocated to receive amoxicillin-clavulanic acid (2.2 g) [Group A] or cefazolin (2 g) [Group B] as a single dose 30 min before surgery. Each patient was assessed daily until discharge to evidence febrile status and the presence of infections at the operative site, urinary tract, and respiratory tract. RESULTS: In the amoxicillin-clavulanic acid (Group A) and cefazolin (Group B) groups, overall 346 and 352 patients, respectively, were evaluable for prophylactic efficacy at hospital discharge. Infectious complications were infrequent in both arms. Febrile morbidity occurred in 21 (6.1%) and 26 (7.4%) patients, respectively, in the amoxicillin-clavulanic acid and cefazolin groups. Wound infection and urinary tract infection were also higher, but not significantly in the cefazolin group (0.5% vs. 1.1% and 2.0% vs. 2.5%, respectively). There was one respiratory tract infection (0.2%) in Group B, and no septic death in either groups. CONCLUSION: Ultra-short-term prophylaxis with both amoxicillin-clavulanic acid and cefazolin is safe in elective laparotomic gynecologic surgery.
BACKGROUND: Apoptosis may operate the 'selection' between follicles destined for atresia and follicles that will remain available for ovulation. The aim of this study is to assess the expression of apoptosis in quiescent follicles. METHODS: Ovarian cortex samples from women of reproductive age, fixed in formalin, were used for immunohistochemical and terminal deoxynucleotidyl transferase-mediated deoxy-UTP nick end labelling (TUNEL) methods. In histological sections the follicles were classified as primordial, primary, secondary and antral. Follicle density was defined as the total number of follicles/0.5 cm(2) of ovarian cortical tissue. Mab DO-7 (anti-p53) and Mab 124 (anti-bcl-2) were used in the immunohistochemical study. RESULTS: TUNEL was positive in 23.4% of the primordial follicles, and in 23.2% of the primary follicles, both in oocytes and granulosa cells, whereas all secondary follicles were negative. Bcl-2 activity was expressed in 75% of secondary follicles. p53 was negative in all samples. CONCLUSIONS: Apoptosis could be the process responsible for atresia of quiescent follicles and hence depletion of the ovarian germ stockpile. Follicular cells expressing Bcl-2 may therefore be the viable cells that escape the apoptotic process. Negative p53 patterns may be a favourable prognostic finding showing genome integrity in the replicating follicular cells of women of reproductive age.
PURPOSE OF REVIEW: Visual examination of the uterine cavity and contextual operative facilities have provided the gynecologist with the perfect 'diagnostic' tool, making it possible to examine the cavity and biopsy suspected areas under direct visualization. RECENT FINDINGS: The approach used to insert the scope, together with the diameter of the hysteroscope and the distention of the uterine cavity, are of extreme importance in reducing patient discomfort to a minimum during an outpatient examination. The vaginoscopic approach (without speculum or tenaculum) has definitively eliminated patient discomfort related to the traditional approach to the uterus. One of the major problems for endoscopists is passing through the internal cervical os; the new generation of hysteroscopes, with an oval profile and a total diameter between 4 and 5 mm, are strictly correlated to the anatomy of the cervical canal. Miniaturized instruments have enabled the physician not only to perform targeted hysteroscopic biopsies, but also to treat benign intrauterine pathologies, such as polyps and sinechiae, without any premedication or anesthesia. This has been defined as a 'see & treat' procedure: there is no longer a distinction between the diagnostic and operative procedures, but a single procedure in which the operative part is perfectly integrated in the diagnostic work-up. SUMMARY: Diagnostic hysteroscopy has long paid the price of being a purely visual method of investigation. Today, thanks to recent advances in instrumentation and to modified techniques related to the simultaneous use of the scope and of instruments, hysteroscopy is finally achieving the full accuracy that has been awaited for the last 20 years.
BACKGROUND: Abdominal pregnancy is a rare event, and the concomitant presence of an intrauterine pregnancy is very exceptional. CASE: A case of concomitant abdominal and intrauterine pregnancy following in vitro fertilization and embryo transfer (IVF-ET) occurred in a woman with bilateral salpingectomy. The abdominal pregnancy was successfully treated surgically, with preservation of the intrauterine pregnancy. CONCLUSION: A careful ultrasound examination should be performed on women who have undergone IVF-ET, and the possibility of abdominal pregnancy should be kept in mind in the differential diagnosis of acute abdomen.
OBJECTIVE: To assess the diagnostic accuracy of office hysteroscopy by comparing the hysteroscopic findings with the histologic findings on the hysterectomy specimens. DESIGN: Retrospective clinical study. SETTING: University-affiliated hospital. PATIENT(S): Review of the hospital records of 443 patients who underwent office hysteroscopy and, within 2 months, hysterectomy. INTERVENTION(S): We compared the hysteroscopic findings (including targeted biopsies) with the histologic findings that were obtained after hysterectomy. The results of this study were then compared with those of a previous study in which we examined the diagnostic accuracy of dilatation and curettage (D&C). MAIN OUTCOME MEASURE(S): We evaluated the diagnostic accuracy of office hysteroscopy. RESULT(S): When compared with the histologic diagnosis of the uterus, the hysteroscopic findings showed a diagnostic sensitivity of 98%, a specificity of 95%, a positive predictive value (PPV) of 96%, and a negative predictive value (NPV) of 98%. Hysteroscopy was found to have a greater diagnostic accuracy than D&C: the sensitivity and the NPV of the two diagnostic procedures were statistically different. CONCLUSION(S): Office hysteroscopy is confirmed as a powerful diagnostic tool, but targeted biopsies, performed with a small diameter operative hysteroscope, must be performed in cases of suspect endometrium to confirm the image-based diagnosis.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.