Alberto Marabini

Acceptability and Pain of Outpatient Hysteroscopy

STUDY OBJECTIVE To investigate the pain and acceptability of diagnostic hysteroscopy performed without local anesthesia. DESIGN Prospective, observational study (Canadian Task Force classification II-2). SETTING University-associated department of obstetrics and gynecology. PATIENTS The 1144 consecutive women who underwent diagnostic hysteroscopy. INTERVENTIONS Diagnostic hysteroscopy and endometrial biopsy as indicated. MEASUREMENTS AND MAIN RESULTS Patients were asked to rate the pain experienced on a 10-cm visual analog scale and to state if they were willing to repeat the procedure. The mean pain score was 4.7 +/- 2.5; 398 patients (34.8%) experienced severe pain. No risk factors for painful hysteroscopy were found, although abnormality of the cervical canal was associated with high pain scores. Acceptance of the procedure was high, 83.0% (950 women). CONCLUSION Diagnostic hysteroscopy is a painful procedure even when performed with atraumatic technique by experienced surgeons. Most women, however, stated they were willing to have a second procedure under the same conditions.

Fibrin sealant in laparoscopic adhesion prevention in the rabbit uterine horn model

OBJECTIVE To assess the effects of fibrin sealant on adhesions after laparoscopic surgery. DESIGN Standardized surgical trauma was induced in 60 female rabbits. The animals were randomized in three groups for different adhesion prevention treatment. SETTING University research laboratory. INTERVENTIONS After standardized trauma was induced, group 1 (n = 20) received no treatment, group 2 animals (n = 20) were injected in the abdominal cavity with 60 mL of Ringers lactate, and human fibrin sealant was applied on the surgical lesions under laparoscopic vision in group 3 (n = 20). MAIN OUTCOME MEASURES Five weeks after laparoscopy, a laparotomy was performed, and the adhesions were scored. RESULTS Fourteen of 20 rabbits in the control group (70%) presented postoperative adhesions, 11 of 20 (55%) in the Ringers group, and 5 of 20 (25%) in the fibrin sealant group. High-score adhesions were seen in 15% of cases in control and Ringers group and in 5% of cases in the fibrin sealant group. CONCLUSIONS When used during laparoscopic surgery, fibrin sealant has a preventive effect on de novo postsurgical adhesions. To assess the efficacy in reproductive surgery, a trial on recurrent postsurgical adhesions is required.

A case of retroperitoneal liposarcoma in pregnancy: Case Report

Retroperitoneal liposarcoma is a rare malignancy. We report a case of retroperitoneal myxoid liposarcoma in pregnancy. The patient died of the disease eight months after surgery.

A multifaced DNA ploidy analysis to determine ovarian carcinoma aggressiveness

A microfluorometric DNA study was conducted on isolated cells from 64 fragments of ovarian epithelial tumors. Data analysis considered the DNA content of the main stemline and the prevalence of cells in the different compartments of the DNA ploidy histogram in relation to the mitotic activity index and the histologic architecture. Main stemlines were found remarkably stable in different parts of the same tumor. Peridiploid (1.8c to 2.2c) stemlines were found both in well‐differentiated and in poorly differentiated tumors. However, low aneuploid (2.2c to 3.0c) stemlines were mostly found in nonsolid tumors and high ploidy (3.2 to 5.04 c) stemlines were prevalent in solid tumors. A comparative analysis between DNA ploidy parameters and mitotic activity was useful to evaluate the expanding modalities of neoplastic cell populations. This analysis revealed that several tumors accumulate an excessive amount of heteroploid cells and others an excessive amount of G2 cells. Yet, most neoplastic cell populations vary from slow to rapidly growing patterns without relevant abnormalities in their ploidy graphic profiles. No relationship was found between stemline ploidy and histologic architecture compared with expanding modalities. These findings indicate that multifaced criteria combining features such as main ploidy, graphic profile, mitotic rate, and histologic architecture measured on one or more microsamples of the same tumor may help to objectively estimate the aggressiveness reached by the neoplastic cells at the time of clinical presentation.

Treatment of Endometrial Hyperplasia with Cyproterone Acetate Histological and Hormonal Aspects

A regime of cyproterone acetate (CPA) (300 mg/‐day by the oral route for 30 days) has been used in 10 postmenopausal women with endometrial hyperplasia (8 atypical and 2 adenomatous). Androstenedione (A), estrone (E1), testosterone (T) and estradiol (E2) plasma levels were determined before and at the end of treatment. The regression of endometrial hyperplasia was ascertained histologically in all patients after 30 days of therapy. All steroids showed a significant decrease (p<0.05) as compared with their corresponding basal values. Moreover, the E1A ratio was significantly lowered (p<0.01) following CPA administration (5.9+2.9% to 2.5+0.6%). From these data it is evident that CPA can not only act as a progestin, but may also reduce the endogenous estrogen production, lowering either the adrenal production of A (the most important estrogen precursor in the post‐menopause) or the A to E1 peripheral conversion.

CA-125 monitoring during chemotherapy for ovarian cancer.

Serum CA-125 was determind in 60 patients with variously extended ovarian cancer and monitored during and after chemotherapy. The study indicates that: 1) prechemotherapy CA-125 shows the presence of an active disease with an accuracy > 85%. The antigen is elevated in 97% of patients with > 2 cm disease, but sensitivity is low (67%) in patients with minimal residual disease (< 2 cm); 2) changes in CA-125 correspond well with the response to chemotherapy. CA-125 becomes negative in every patient having clinical CR and increases in every patient with progressive disease. These changes can indicate the type of response some months ahead of time; 3) CA-125 indicates in advance the recurrence of the disease after an objective remission: 4) In the conditions studied CA-125 basal levels do not seem to have prognostic value as regarding either response or survival.

99mTc-Ca-gluconate renal scintigraphy in patients with chronic renal failure.

SummaryFrom use of99Tc-Ca-Sn-gluconate in patients with various degrees of renal failure the following conclusions were drawn: 1. a good relationship exists between the parenchymal and vascular patterns in scintigraphy and the functional renal impairment; 2. the morphological definition is good, since in most cases a differential diagnosis can be made between diffuse parenchymal disease and space-occupying lesions even at very low glomerular filtration rate values; 3. this technique is supplementary to i.v. pyelography in patients with relatively good glomerular filtration rate values and is a reliable alternative to i.v. pyelography in those with low creatinine clearance values.

Evaluation of the scintigraphic technique for detecting bone metastases in 100 breast cancer patients.

In an attempt to evaluate the utility of bone scintigraphy for the diagnosis and follow-up of skeletal metastases, radioisotopic scan (total body) by 99mTc has been performed on 100 patients suffering from breast cancer in various stages. The radiographic control followed the scan on the basis of clinical or scintigraphic suspicion of bone lesions. Twenty-one patients showed metastases by scan, and in all but 2 the radiography was concordantly positive; in 22 subjects scintigraphy and radiology demonstrated non-malignant lesions. Both scan and radiology were used to explore 169 metastatic localizations, with concordant results in 45% of the sites; however, 7% of the sites with discordant results became positive for metastasis by radiology some months after the scan positivity. The false–negative results were more frequent in the radiographic study (27%) than with the scintigraphic scan (21%). The latter technique was unable to detect osteoblastic lesions in particular. The scintigraphic test also gave reliable results in the follow-up procedure, frequently anticipating the radiological modifications of metastatic lesions. In conclusion, bone scan often appears to be more accurate and precocious than the roentgengraphic test in the detection and the follow-up of skeletal metastatic lesions; it suggests the utility of the bone scan as a preliminary test, which allows a more rational use of the radiology.

Use of the radioiodinated Rose Bengal in the study of icterogenic hepatopathies

SummaryStudies are described on the practical use of radioiodinated Rose Bengal and scintiphotography with the gamma-camera in the differential diagnosis of jaundice. The main scintiphotographic aspects of the various types of jaundice are discussed with special reference to the possibility of making a diagnosis. Special attention is paid to the investigation of ‘major cholestasis’ cases and particularly the possibility of differentiating intra-hepatic and extra-hepatic jaundice.

L’angioscintifotografia con radiotecnezio nello studio della vascolarizzazione renale

RiassuntoL’angioscintifotografia con gamma-camera e99mTcO4 permette di: 1) studiare le modificazioni della vascolarizzazione renale nelle stenosi delle arterie renali, 2) di raccogliere elementi utili per una diagnosi differenziale delle masse renali. Questo metodo ha fornito dati di notevole interesse che hanno consentito nella maggior parte dei casi di formulare un preciso indirizzo diagnostico. L’atraumaticità, l’assenza di rischi di sorta per il paziente e la rapidità di esecuzione fanno di questa indagine un valido test discreening da adottare prima di ricorrere ad altre indagini più complesse.SummaryAngioscintiphotography with gamma-camera and99mTcO4 allows: 1) study of the renal vascularization in the stenosis of renal arteries, and 2) provides very useful informations for a differential diagnosis of renal space occupying lesions. The method gives very interesting data for a correct diagnostic approach. The absence of traumatic risk, the low dose of radiation and the short time of execution indicate angioscintiphotography as an important screening test to be programmed before other more complicated procedures.