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  1. A New Hysteroscopic Risk Scoring System for Diagnosing Endometrial Hyperplasia and Adenocarcinoma
    Autor*in: Ianieri, Manuel Maria ; Staniscia, Tommaso ; Pontrelli, Giovanni ; Manzi, Federica Stella ; Recchi, Maristella ; Liberati, Marco ; Ceccaroni, Marcello ; DI SPIEZIO SARDO, ATTILIO
    Erschienen: 2016

    STUDY OBJECTIVE: To develop a new hysteroscopic morphologic scoring system that helps physicians, especially those who have less experience, to make a differential diagnosis among normal endometrium (NE), endometrial hyperplasia, and endometrial... mehr

     

    STUDY OBJECTIVE: To develop a new hysteroscopic morphologic scoring system that helps physicians, especially those who have less experience, to make a differential diagnosis among normal endometrium (NE), endometrial hyperplasia, and endometrial carcinoma. DESIGN: A retrospective study (Canadian Task Force Classification II). SETTING: An office hysteroscopy service. PATIENTS: A total of 435 endometrial biopsies were included in the study: 201 NE, 160 endometrial hyperplasia without atypia (EH), 30 atypical endometrial hyperplasia (AEH), and 44 endometrial cancer (EC). INTERVENTIONS: The authors retrospectively evaluated all videos of diagnostic hysteroscopies performed before endometrial biopsies to note endometrial morphologic parameters suggestive of pathology. Principal significant variables were selected by means of the chi-square test (p < .05) and integrated into an ordinal multivariate analysis. Through the estimate of the beta coefficient, a score was obtained to be appointed to each of the selected variables, and characteristic intervals of each of the endometrial lesions were created. MEASUREMENTS AND MAIN RESULTS: The scoring system showed a sensitivity and specificity of 71.1% and 80%, 48.7% and 82.5%, 63.3% and 90.4%, and 95.4% and 98.2% regarding NE, EH, AEH, and EC, respectively. The positive predictive values and negative predictive values, respectively, were 76.8% and 80% for NE, 62% and 73.5% for EH, 32.7% and 97% for AEH, and 85.7% and 99.5% for EC. CONCLUSIONS: The proposed scoring system showed good diagnostic performance, especially in relation to endometrial cancer, and may represent a useful diagnostic tool, mainly for operators with less experience.

     
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    Quelle: BASE Fachausschnitt Germanistik
    Sprache: Englisch
    Medientyp: Aufsatz aus einer Zeitschrift
    Format: Online
    Schlagworte: Endometrial cancer; Endometrial hyperplasia; Hysterscopy; Obstetrics and Gynecology
  2. Adhesions and endometriosis: challenges in subfertility management: (An expert opinion of the ANGEL-The ANti-Adhesions in Gynaecology Expert PaneL-group)
    Autor*in: De Wilde, R. L ; Alvarez, J. ; Brölmann, H. ; Campo, R. ; Cheong, Y. ; Lundorff, P. ; Pawelczyk, L. ; Roman, H. ; Wallwiener, M. ; DI SPIEZIO SARDO, ATTILIO
    Erschienen: 2016

    There is molecular evidence that endometriosis has a negative impact on the ovaries, although the exact pathophysiology concerning endometriosis-associated subfertility is not known. The negative impact on the tubo-ovarian unit can be directly by... mehr

     

    There is molecular evidence that endometriosis has a negative impact on the ovaries, although the exact pathophysiology concerning endometriosis-associated subfertility is not known. The negative impact on the tubo-ovarian unit can be directly by distorting the anatomy, indirectly by invoking inflammation or by oxidative damage with poorer-quality oocytes. Endometriosis even seems to have a negative effect on pregnancy outcome after in vitro fertilization.

     
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    Quelle: BASE Fachausschnitt Germanistik
    Sprache: Englisch
    Medientyp: Aufsatz aus einer Zeitschrift
    Format: Online
    Schlagworte: Adhesion prophylactic agent; Adhesion; Endometriosi; Subfertility management; Medicine (all); Obstetrics and Gynecology
  3. Challenging the cervix: Strategies to overcome the anatomic impediments to hysteroscopy: Analysis of 31,052 office hysteroscopies
    Autor*in: Bettocchi, Stefano ; Bramante, Silvia ; Spinelli, Marialuigia ; Ceci, Oronzo ; Fascilla, Fabiana Divina ; BIFULCO, GIUSEPPE ; DI SPIEZIO SARDO, ATTILIO
    Erschienen: 2016

    OBJECTIVE: To report our experience on 10,156 cases of cervical stenosis (CS) diagnosed at office hysteroscopy. DESIGN: Retrospective study. SETTING: Ambulatory clinics of diagnostic and operative hysteroscopy of two university teaching hospitals... mehr

     

    OBJECTIVE: To report our experience on 10,156 cases of cervical stenosis (CS) diagnosed at office hysteroscopy. DESIGN: Retrospective study. SETTING: Ambulatory clinics of diagnostic and operative hysteroscopy of two university teaching hospitals (Naples and Bari). PATIENT(S): A total of 31,052 patients undergoing office hysteroscopy. INTERVENTION(S): All of the paper and electronic reports of the office hysteroscopies performed from January 1996 to September 2014 were reviewed. Hysteroscopies were classified as successful (i.e., when access to and visualization of the entire uterine cavity was possible during the same procedure), incomplete (i.e., when access to uterine cavity was possible, but the entire uterine cavity could not be examined), or failed (i.e., when access to uterine cavity was not possible). CS was classified on the basis of localization: stenosis of external cervical ostium (ECO; type I); stenosis of distal third of cervical channel and the internal cervical ostium (ICO; type II); stenosis of the ICO (type III), and combined stenosis of ECO and ICO (type IV). MAIN OUTCOME MEASURE(S): The success rate at overpassing CS (including both successful and incomplete hysteroscopies) was the primary outcome measure. Secondary outcome measures were frequency and localization of CS in fertile and postmenopausal women and the frequency of use of technical maneuvers and/or miniaturized mechanical or bipolar instruments to overcome them. RESULT(S): All hysteroscopies were performed with the use of a 5- or 4-mm rigid continuous-flow office operative hysteroscope by operators with different levels of expertise. The hysteroscopy technique used was standardized between the two centers and among all of the surgeons throughout the years. An access to the uterine cavity with a complete evaluation of the whole endometrial surface was possible in 93.9% of cases (29,152 patients). The main reasons of the 1,320 (4.3%) incomplete and 580 (1.9%) failed hysteroscopies were pain and CS, respectively. CS was identified in ...

     
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    Quelle: BASE Fachausschnitt Germanistik
    Sprache: Englisch
    Medientyp: Aufsatz aus einer Zeitschrift
    Format: Online
    Schlagworte: Anatomic impediment; Cervical stenosi; Miniaturized instrument; Office hysteroscopy; Obstetrics and Gynecology; Reproductive Medicine
  4. The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies
    Autor*in: Grimbizis, Grigoris F ; Saravelos, Sotirios H. ; Gordts, Stephan ; Exacoustos, Caterina ; Van Schoubroeck, Dominique ; Bermejo, Carmina ; Amso, Nazar N. ; Nargund, Geeta ; Timmerman, Dirk ; Athanasiadis, Apostolos ; Brucker, Sara ; De Angelis, Carlo ; Gergolet, Marco ; Li, Tin Chiu ; Tanos, Vasilios ; Tarlatzis, Basil ; Farquharson, Roy ; Gianaroli, Luca ; Campo, Rudi ; DI SPIEZIO SARDO, ATTILIO
    Erschienen: 2016

    STUDY QUESTION: What is the recommended diagnostic work-up of female genital anomalies according to the European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) system? SUMMARY ANSWER: The... mehr

     

    STUDY QUESTION: What is the recommended diagnostic work-up of female genital anomalies according to the European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) system? SUMMARY ANSWER: The ESHRE/ESGE consensus for the diagnosis of female genital anomalies is presented. WHAT IS KNOWN ALREADY: Accurate diagnosis of congenital anomalies still remains a clinical challenge because of the drawbacks of the previous classification systems and the non-systematic use of diagnostic methods with varying accuracy, some of them quite inaccurate. Currently, a wide range of non-invasive diagnostic procedures are available enriching the opportunity to accurately detect the anatomical status of the female genital tract, as well as a new objective and comprehensive classification system with well-described classes and sub-classes. STUDY DESIGN, SIZE, DURATION: The ESHRE/ESGE CONgenital UTerine Anomalies (CONUTA) Working Group established an initiative with the goal of developing a consensus for the diagnosis of female genital anomalies. The CONUTA working group and imaging experts in the field have been appointed to run the project. PARTICIPANTS/MATERIALS, SETTING, METHODS: The consensus is developed based on: (i) evaluation of the currently available diagnostic methods and, more specifically, of their characteristics with the use of the experts panel consensus method and of their diagnostic accuracy by performing a systematic review of evidence and (ii) consensus for the definition of where and how to measure uterine wall thickness and the recommendations for the diagnostic work-up of female genital anomalies, based on the results of the previous evaluation procedure, with the use of the experts panel consensus method. MAIN RESULTS AND THE ROLE OF CHANCE: Uterine wall thickness is defined as the distance between the interostial line and external uterine profile at the midcoronal plane of the uterus; alternatively, if a coronal plane is not available, the mean anterior and ...

     
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  5. Rare case of giant cystic adenomyoma mimicking a uterine malformation, diagnosed and treated by hysteroscopy
    Autor*in: Pontrelli, Giovanni ; Bounous, Valentina Elisabetta ; Scarperi, Stefano ; Minelli, Luca ; Florio, Pasquale ; DI SPIEZIO SARDO, ATTILIO
    Erschienen: 2015

    We describe a case of giant cystic uterine adenomyoma that was diagnosed and treated by hysteroscopy. In a 27-year-old woman with menometrorrhagia, severe dysmenorrhea, and chronic pelvic pain, pelvic ultrasonography revealed an enlarged uterine... mehr

     

    We describe a case of giant cystic uterine adenomyoma that was diagnosed and treated by hysteroscopy. In a 27-year-old woman with menometrorrhagia, severe dysmenorrhea, and chronic pelvic pain, pelvic ultrasonography revealed an enlarged uterine cavity filled with homogeneous low echogenic fluid content. A large cornual hematometra of 8.0 cm in diameter in a bicornuate uterus was suspected, and this hypothesis was also supported by magnetic resonance imaging findings. On the contrary, hysteroscopy revealed a bilocular huge cystic lesion of the posterior uterine wall that was removed by means of monopolar loop resection. The operative finding and the histopathologic examination confirmed the diagnosis of cystic adenomyoma of the uterus. Hysteroscopy may represent a valid tool for diagnosis and minimally invasive treatment of cystic adenomyoma, including those of large volume. Its use is helpful in differential diagnosis between cystic adenomyoma and uterine malformations as a possible cause of pelvic pain.

     
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    Quelle: BASE Fachausschnitt Germanistik
    Sprache: Englisch
    Medientyp: Aufsatz aus einer Zeitschrift
    Format: Online
    Schlagworte: adenomyoma; adenomyosi; endometriosi; giant cystic adenomyoma; hysteroscopy; Obstetrics and Gynecology
  6. Ultrasonographic evaluation of urethrovesical junction mobility: correlation with type of delivery and stress urinary incontinence
    Autor*in: Cosimato, Cosimo ; Cipullo, Lucio M. A. ; Troisi, Jacopo ; DI SPIEZIO SARDO, ATTILIO ; Tommaselli, Giovanni Antonio ; Oro, Rosa Rita ; Zullo, Fulvio ; Altieri, Vincenzo
    Erschienen: 2015

    A relationship between urinary incontinence and hypermobility of the urethrovesical junction (UVJ) during pregnancy has been described. The aim of the study was to compare the effects of vaginal delivery (VD) and caesarean section (CS) on UVJ... mehr

     

    A relationship between urinary incontinence and hypermobility of the urethrovesical junction (UVJ) during pregnancy has been described. The aim of the study was to compare the effects of vaginal delivery (VD) and caesarean section (CS) on UVJ mobility. The retrovesical angle (RVA) and the anterior angle between the UVJ and the pubic bone, the pubovesical angle (PVA), were evaluated ultrasonographically in controls and pregnant women during their first pregnancy between 38 and 40 weeks, and then re-evaluated 6 weeks and 6 months after delivery. All patients completed a validated questionnaire (ICIQ-SF). Differences between and within groups were assessed with Student's t test, the chi-squared test for trend, and one-way two-tailed analysis of variance with Scheff,'s post-hoc test. The correlation between PVA and RVA was evaluated using the Spearman R correlation. The positive predictive value, negative predictive value, sensitivity and specificity for the prediction of stress urinary incontinence (SUI) symptoms were also determined. Included in the study were 42 controls and 217 pregnant women. PVA at rest, during cough and Valsalva manoeuvre was significantly higher in pregnant women than in controls and in women 6 weeks after VD in comparison with women who had undergone CS. Patients affected by SUI showed a significantly higher PVA. RVA did not differ between subjects affected or not by SUI symptoms. PVA and RVA were not correlated with each other. PVA and RVA are increased in pregnant women in comparison with controls. In patients undergoing VD, PVA is restored significantly later than in those undergoing CS. The change in RVA after pregnancy and delivery seems to persist longer than the change in PVA.

     
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  7. The comprehensiveness of the ESHRE/ESGE classification of female genital tract congenital anomalies: A systematic review of cases not classified by the AFS system
    Autor*in: DI SPIEZIO SARDO, ATTILIO ; Campo, R. ; Gordts, S. ; Spinelli, M. ; Cosimato, C. ; Tanos, V. ; Brucker, S. ; Li, T. C. ; Gergolet, M. ; De Angelis, C. ; Gianaroli, L. ; Grimbizis, G.
    Erschienen: 2015

    STUDY QUESTION How comprehensive is the recently published European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) classification system of female genital anomalies? SUMMARY ANSWER The... mehr

     

    STUDY QUESTION How comprehensive is the recently published European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) classification system of female genital anomalies? SUMMARY ANSWER The ESHRE/ESGE classification provides a comprehensive description and categorization of almost all of the currently known anomalies that could not be classified properly with the American Fertility Society (AFS) system. WHAT IS KNOWN ALREADY Until now, the more accepted classification system, namely that of the AFS, is associated with serious limitations in effective categorization of female genital anomalies. Many cases published in the literature could not be properly classified using the AFS system, yet a clear and accurate classification is a prerequisite for treatment. STUDY DESIGN, SIZE AND DURATION The CONUTA (CONgenital UTerine Anomalies) ESHRE/ESGE group conducted a systematic review of the literature to examine if those types of anomalies that could not be properly classified with the AFS system could be effectively classified with the use of the new ESHRE/ESGE system. An electronic literature search through Medline, Embase and Cochrane library was carried out from January 1988 to January 2014. Three participants independently screened, selected articles of potential interest and finally extracted data from all the included studies. Any disagreement was discussed and resolved after consultation with a fourth reviewer and the results were assessed independently and approved by all members of the CONUTA group. PARTICIPANTS/MATERIALS, SETTING, METHODS Among the 143 articles assessed in detail, 120 were finally selected reporting 140 cases that could not properly fit into a specific class of the AFS system. Those 140 cases were clustered in 39 different types of anomalies. MAIN RESULTS AND THE ROLE OF CHANCE The congenital anomaly involved a single organ in 12 (30.8%) out of the 39 types of anomalies, while multiple organs and/or segments of Müllerian ducts (complex ...

     
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