Angela Borghero

Comparison between transvaginal sonography, saline contrast sonovaginography and magnetic resonance imaging in the diagnosis of posterior deep infiltrating endometriosis

To compare clinical evaluation, transvaginal sonography (TVS), saline contrast sonovaginography (SCSV) and magnetic resonance imaging (MRI) in the diagnosis of posterior deep pelvic endometriosis (DPE).

Hysteroscopic Enucleation in Toto of Submucous Type 2 Myomas: Long-Term Follow-Up in Women Affected by Menorrhagia

STUDY OBJECTIVE To evaluate long-term efficacy of type 2 myoma enucleation in toto. DESIGN Longitudinal retrospective study (Canadian Task Force classification II-2). SETTING University obstetrics and gynecology clinic. PATIENTS One hundred twelve women with menorrhagia and at least 1 type 2 submucous myoma who underwent hysteroscopic myoma enucleation in toto. INTERVENTION Clinical long-term follow-up. MEASUREMENTS AND MAIN RESULTS Success of the procedure and influence of myoma characteristics on recurrence of menorrhagia were evaluated. Mean (SD) follow-up was 58.4 (19.1) months. The success of the procedure was 88.4% (99 patients). Seventeen patients (15.2%) underwent a 2-step procedure. Among patients with relapsed menorrhagia, 10 (8.9%) underwent a repeat operation. Statistical analysis showed that number and diameter of myomas did not influence the outcome. Localization in the posterior wall of the uterus, compared with other sites, was associated with a higher percentage of resolution of menstrual symptoms (p = .03). There was no significant relationship between myomas features and risk of symptom recurrence during follow-up. The 2-step myomectomy was performed in patients with myomas >30 mm in diameter (p < .001). CONCLUSION Hysteroscopic enucleation in toto of type 2 myomas is a safe and effective technique in long-term management of premenopausal women with menorrhagia.

Evaluation of the impact of endometriotic lesions on patient's pelvic pain symptoms

PurposeTo verify if different endometrial lesions determine the diagnostic symptom panel for a specific symptom.MethodsWe recruited 537 women with endometriosis who underwent laparoscopic surgery. Data on patient characteristics, severity of pelvic pain symptoms, disease stage and anatomical characteristics of endometriotic lesions were collected and analyzed by univariate analysis, followed by multiple logistic regression.ResultsWe observed a strong inverse relationship between pain symptoms and, respectively, the age of women at surgery (OR 0.885; p<0.05) and nulliparity (OR 5.6; p<0.05). A significant association between dysmenorrhea and nulliparity (OR 10.1; p< 0.01) and dysmenorrhea and rAFS stage (OR 4.7; p<0.05) was also confirmed. Finally a strong relationship was found between the presence of a rectovaginal endometriotic nodule and pain symptoms: dyspareunia (OR 13.8, p<0.001) and dysmenorrhea (OR 2.3, p<0.05). Significant relationships were found between the presence of peri-annexial adherences ...

Obstetric outcomes in patients treated for deep pelvic endometriosis

Purpose The aim of this study was to assess obstetric outcomes and symptoms during and after pregnancy in women submitted to surgical treatment for deep pelvic endometriosis. Methods We evaluated 123 women who underwent surgery for severe deep pelvic endometriosis-related symptoms. Interventions were excision of rectovaginal septum nodule with or without rectal or vaginal resection, or excision of nodule of uterosacral ligaments. On the basis of pregnancy desire, patients were submitted to a telephone interview and asked if there had been a pregnancy and its outcome. They were also asked to describe their pain symptoms before, after and during the pregnancy. Results From the 123 patients, we selected 43 women desiring pregnancy after surgery, who answered the telephone interview. Twenty-four patients (55.8%) got pregnant. We recorded 34 pregnancies a mean 21.8 ± 17.9 months after surgery. In the group of 25 full-term pregnancies, 14 women (56%) had a vaginal delivery without complications, and 11 (44%) underwent a cesarean section. In only 3 cases, was the indication of cesarean section related to previous surgery. Seventy-one percent of women treated without rectal or vaginal resection delivered vaginally. We also registered 1 case of uncomplicated vaginal delivery in a patient with vaginal resection and another 1 in a patient with rectal resection. In the patients who complained of pain before pregnancy, we observed a resolution of pain symptoms during pregnancy, but after delivery these symptoms reappeared. Conclusions In patients submitted to surgery for deep pelvic endometriosis, even in cases of vaginal or rectal resection, a cesarean section is not always mandatory.

Maspin expression, subcellular localization and clinicopathological correlation in endometrial hyperplasia and endometrial adenocarcinoma.

Maspin expression in endometrial hyperplasia and endometrial endometrioid adenocarcinomas was assessed and its correlation with p53 and Ki67 expressions and clinical outcome, as well as its potential to distinguish typical from atypical endometrial hyperplasia, were assessed in this study. Histological sections from 114 cases of endometrial endometrioid adenocarcinoma, 75 cases of endometrial hyperplasia (typical and atypical), and 23 normal endometrial tissue samples were examined. The most representative hematoxylin-eosin slides were selected and 2-3 micron-thick sections were cut for immunohistochemical staining with maspin, p53, and Ki67 antibodies. While there was no maspin expression in normal endometrial cells, it was present in 14.5% of the patients with endometrial hyperplasia without atypia. Staining for maspin was positive in atypical hyperplasia and endometrial adenocarcinoma in, respectively, 45% and 49.1% of the cases studied. No statistically significant correlations were found between maspin and Ki-67 antibodies or p53 expression. Our findings showed that maspin expression, which generally correlates with a less aggressive behavior, is significantly higher in atypical hyperplasia and in endometrial endometrioid adenocarcinoma. Maspin positivity in endometrial hyperplasia could be used to identify pseudo-atypical hyperplasia and could be considered a potentially useful prognostic parameter in those cases in which adenocarcinomas are well differentiated.

OC11.02: Determining the best diagnostic approach for deep infiltrating endometriosis

Objectives: To generate physical fetal models using images obtained by 3-dimensional ultrasound (3DUS), magnetic resonance (MR) and computed tomography (CT) to guide additive manufacturing (AM) technology. Methods: Images from 45 fetuses, including 4 sets of twins, were used. Twenty-three fetuses were normal and evaluated only by 3DUS. Twenty-two cases had complications such as conjoined twins; tumors; aneuploidy; skeletal; central nervous system; facial or thoracic defects. Scans were performed using high-resolution 3DUS. In cases of abnormalities, MR and CT were performed on the same day as 3DUS. The images obtained with 3DUS, MR or CT, were exported to a workstation in Digital Imaging and Communications in Medicine format. A single observer performed slice-by-slice manual segmentation using a digital high definition screen. Software that converts medical images into numerical models was used to construct virtual 3D models, which were physically realised using AM technologies (SLA Viper, Objet Connex 350, ZCorp 510 or FDM Vantage). Results: The main outcomes presented were the possibility to create 3D virtual and physical models from 3DUS, MRI or CT both separately and also in various combinations. AM systems allow the conversion of a 3D virtual model to a physical model in a fast, easy and dimensionally accurate process. They were remarkably similar to the postnatal appearance of the aborted fetus or newborn baby. Conclusions: This study introduced the innovative use of AM models into fetal researches. The results suggest a new possibility for educational purposes or better interaction between parents and their unborn child during pregnancy. Normal fetus (29 weeks): Virtual and physical model built in a powder-based system.