Angelo Licameli

Syphilis Infection during Pregnancy: Fetal Risks and Clinical Management

Congenital syphilis is still a cause of perinatal morbidity and mortality. Untreated maternal infection leads to adverse pregnancy outcomes, including early fetal loss, stillbirth, prematurity, low birth weight, neonatal and infant death, and congenital disease among newborns. Clinical manifestations of congenital syphilis are influenced by gestational age, stage of maternal syphilis, maternal treatment, and immunological response of the fetus. It has been traditionally classified in early congenital syphilis and late congenital syphilis. Diagnosis of maternal infection is based on clinical findings, serological tests, and direct identification of treponemes in clinical specimens. Adequate treatment of maternal infection is effective for preventing maternal transmission to the fetus and for treating fetal infection. Prenatal diagnosis of congenital syphilis includes noninvasive and invasive diagnosis. Serological screening during pregnancy and during preconception period should be performed to reduce the incidence of congenital syphilis.

Transvaginal ultrasonography and magnetic resonance imaging for assessment of presence, size and extent of invasive cervical cancer

To prospectively assess the diagnostic performance of transvaginal ultrasound and magnetic resonance imaging (MRI), using histology as the gold standard, with regard to the presence, size, and extent of invasive cervical cancers and the detection of metastatic lymph nodes.

Ovarian cancer arising in endometrioid cysts: ultrasound findings

To describe sonographic characteristics of malignant transformation in endometrioid cysts.

Pegylated liposomal doxorubicin in the management of ovarian cancer.

Among the pharmaceutical options available for treatment of ovarian cancer, much attention has been progressively focused on pegylated liposomal doxorubicin (PLD), whose unique formulation, which entraps conventional doxorubicin in a bilayer lipidic sphere surrounded by a polyethylene glycol layer, prolongs the persistence of the drug in the circulation and potentiates intratumor drug accumulation. These properties enable this drug to sustain its very favorable toxicity profile and to be used safely in combination with other drugs. PLD has been already approved for treatment of advanced ovarian cancer patients failing first-line platinum-based treatment. Moreover, phase III trials have been already completed, and results are eagerly awaited, which hopefully will expand the range of PLD clinical application in this neoplasia both in front-line treatment, and in the salvage setting in combination with other drugs. Moreover, attempts are continuing to enable this drug to be combined with novel cytotoxic drugs and target-based agents. This review aims at summarizing the available evidence and the new perspectives for the clinical role of PLD in the management of patients with epithelial ovarian cancer.

Treatment of cervical cancer in Italy: Strategies and their impact on the women

Treatment of cervical cancer greatly varies according to the stage of the disease. Laparoscopic surgical staging is emerging as a valid approach, compared to clinical and imaging staging, to better identify the treatment plan. Minimally invasive surgery plays the greatest role in the treatment of early cervical carcinoma (ECC). Laparoscopically assisted radical vaginal hysterectomy (LARVH) is an alternative surgical strategy in this subset of patients. Interest has been increasing in using conservative fertility-sparing surgery such as laparoscopic vaginal radical trachelectomy (LVRT) or chemo-conization, options to be preferred in selected patients, with early-stage disease and asking for future fertility. Chemoradiotherapy currently represents the gold standard in the treatment of patient with locally advanced cervical cancer (LACC). In Italy, neoadjuvant chemotherapy (NACT) followed by radical surgery is today emerging as a valid alternative to the standard chemoradiation and the paclitaxel, ifosfamide and cisplatin (TIP) regimen is one of the most active neoadjuvant chemotherapeutic treatments. Moreover, the combination of different strategies to maximize local control should be considered. Among different approaches to this issue the use of a three-modality treatment, including radiotherapy, chemotherapy and surgery has been investigated. Our data on a large single-institutional series of LACC patients treated with chemoradiation followed by radical surgery confirm that this three-modality treatment can achieve overall survival (OS) and Disease Free Survival (DFS) rates at least comparable to chemoradiation alone, with an acceptable rate of complications. Tailoring of radical surgery, on the basis of intraoperative findings, such as lympho-nodes status, might play an important role in diminishing the overall rate of complications and eventually improve quality of life (QoL) of these patients. Cervical cancer generally has an aggressive impact on relatively young women and, as we experienced, the relevance of psychosocial aspects in gynaecologic oncology has become a main issue.

Imaging in gynecological disease (7): clinical and ultrasound features of Brenner tumors of the ovary.

To describe clinical and ultrasound features of Brenner tumors of the ovary.

Screening and management of maternal colonization with Streptococcus agalactiae: an Italian cohort study

Abstract Introduction: Streptococcus agalactiae (Group B streptococcus [GBS]) is the most common cause of sepsis and meningitis in infants <3 months of age. Intrapartum antibiotic prophylaxis (IAP) is effective in preventing the transmission of GBS to newborns. The Centers for Disease Control and Prevention (CDC) guidelines suggest vaginal and rectal cultures to assess GBS colonization between 35 and 37 weeks’ gestation. Methods: Between July and December 2013, we identified 535 women admitted to the Obstetric and Gynecology Unit of Cardarelli Hospital (Campobasso, Italy) for delivery. We evaluated the indications for IAP, complete execution of IAP, and neonatal outcomes. Results: Our sample included 468 women and 475 live births. Correct screening for GBS was executed in 241 cases (51.5%), the number of women colonized was 96 (30.2%), and 136 women had indications to receive IAP, but only 68 (50%) received adequate treatment. Conclusions: GBS colonization status should be determined by collecting both vaginal and rectal specimens at 35–37 weeks’ gestation. Inadequate screening for GBS and incorrect IAP led to an increased incidence of early-onset disease in newborns. Local public health agencies should promote surveillance and educational programs to prevent neonatal GBS infections.

Listeria Infection in Pregnancy: A Review of Literature

Listeria monocytogenes, a Gram-positive bacterium, is responsible for human listeriosis. Infection with Listeria has been associated with the consumption of contaminated and/or inadequately cooked food, particularly dairy products, leafy vegetables, fish, and meat. The main clinical manifestations include diarrhea, nausea and vomiting, which are usually followed by fever and flu-like symptoms. Listeriosis affects pregnant women in about one in seven (14%) cases. They are approximately 10 times more likely to catch the disease than the general population. Although Listeria infection during pregnancy is usually uncomplicated for the mother, fetal and neonatal infection can be severe and fatal. Animal studies have shown a dose-response relationship between L. monocytogenes bacterial load and adverse pregnancy outcome, mainly pregnancy loss. Fetal and neonatal infection occurs through the transplacental passage of the bacterium or through exposure in the perinatal period. In pregnant women Listeria infection was associated with fetal loss, preterm birth, neonatal infection or neonatal death. Blood culture is the principal diagnostic tool and the antibiotic of choice for the treatment of listeriosis is penicillin, with high doses injected intravenously for at least 14 days. In case of suspected or confirmed maternal listeriosis, a program of fetal surveillance should be implemented. Common fetal ultrasound findings in listeria infection include non-immune hydrops, intracranial calcifications, and intrauterine fetal demise. Strategies for the prevention of listeriosis, including avoiding unpasteurized dairy products, uncooked food and leftover food, have significantly decreased the number of cases of infection. Prevention in pregnant women can be achieved by sticking to prophylactic measures and strict diet recommendations.

Pegylated Liposomal Doxorubicin in the Management of Ovarian Cancer

Despite the cytoreductive efforts, and the high responsiveness to standard carboplatin/pacllitaxel front-line treatment, ovarian cancer (OvCa) remains the most lethal gynaecological malignancy with a 5-yr overall survival of only 25%–30% in advanced stage disease. Among the pharmaceutical options available for treatment of OvCa, much attention has been dedicated to pegylated liposomal doxorubicin (PLD) (Doxil® in the US; Caelyx® in Canada and Europe); this drug has a unique formulation which has entrapped conven- tional doxorubicin in a bilayer lipidic sphere surrounded by a polyethylene glycol layer, which prolongs the persistence of the drug in the circulation and potentiates its intratumor accumulation. These properties represent the winning resource for this drug in that sustain its very favourable toxicity profile and the safe combination with other drugs. PLD has already been approved for treatment of advanced ovarian cancer patients failing first line platinum-based treatment. Moreover, Phase III trials have been completed, which will hopefully bring PLD to front-line treatment, and in salvage setting in combination with platinum agents. This concise review will focus on the clinical role of PLD in the management of patients with epithelial OvCa.

Chronic exposure to high doses of selenium in the first trimester of pregnancy: Case report and brief literature review

Obstetricians usually prescribe supplements during pregnancy without actual indication. The use of selenium during pregnancy has increased, due to its function in several antioxidant mechanisms.