Elena Greco

Effects of an oral contraceptive containing drospirenone on bone turnover and bone mineral density.

OBJECTIVE: To compare the effects of a new 21-day combined oral contraceptive containing 30 μg ethinyl/estradiol plus 3 mg drospirenone with a 21-day preparation containing 30 μg ethinyl/estradiol plus 75 μg gestodene on bone turnover and bone mineral density in young fertile women. METHODS: A randomized, controlled trial was conducted with healthy fertile women treated with 30 μg ethinyl/estradiol plus 3 mg drospirenone (group A; n = 24), 30 μg ethinyl/estradiol plus 75 μg gestodene (group B; n = 24) and healthy controls (group C, n = 23). At 3, 6, 9, and 12 months of the study, serum and urinary calcium, osteocalcin, urinary pyridinoline, and deoxypyridinoline were measured. At baseline and after 12 months, lumbar bone mineral density was determined by dual-energy X-ray absorptiometry. RESULTS: In groups A and B, urinary pyridinoline and deoxypyridinoline at 6, 9, and 12 months were significantly reduced in comparison with basal values and group C (P < .05). Pyridinoline and deoxypyridinoline levels were lower in group A than in group B throughout the study, but not significantly. In group A serum calcium levels were significantly increased after 6 months. At 12 months, no significant difference was detected in lumbar bone mineral density values among the 3 groups and in comparison with basal values. CONCLUSION: Both combined oral contraceptives exert a similar positive influence on bone turnover and bone-sparing effect in young postadolescent women. LEVEL OF EVIDENCE: II-1

Efficacy of a polyethylene oxide-sodium carboxymethylcellulose gel in prevention of intrauterine adhesions after hysteroscopic surgery.

STUDY OBJECTIVES To assess the efficacy of a polyethylene oxide-sodium carboxymethylcellulose gel (Intercoat; Gynecare, division of Ethicon, Inc., Somerville, NJ) in preventing the development of de novo intrauterine adhesions (IUAs) after hysteroscopic surgery and to rate the patency of the internal uterine ostium at 1-month follow-up diagnostic hysteroscopy. DESIGN Randomized controlled study (Canadian Task Force classification I). SETTING University hospital. PATIENTS One hundred ten patients diagnosed during office hysteroscopy as having single or multiple lesions suitable for surgical treatment or resistant dysfunctional uterine bleeding requiring endometrial ablation. INTERVENTIONS Patients were randomized to 2 groups. Group 1 underwent hysteroscopic surgery plus intrauterine application of Intercoat gel, and group 2 underwent hysteroscopic surgery only (control group). Follow-up office hysteroscopy was performed at 1 month after surgery to assess the rate and severity of IUA formation and to rate the patency of the internal uterine ostium after the surgical intervention. MEASUREMENTS AND MAIN RESULTS Compared with the group 2, group 1 demonstrated a significant reduction in the incidence (6% vs 22%; p <.05) of de-novo IUAs. Application of the gel seemed to reduce the severity of IUAs, with fewer moderate and severe IUAs at follow-up in group 1 in comparison with group 2 (33% vs 92%). Furthermore, group 1 demonstrated significant improvement in the degree of patency of the internal uterine ostium (41.9% of cases) in comparison with diagnostic office hysteroscopy performed at enrollment (p <.05). In contrast, in group 2, worsening of patency of the internal uterine ostium was recorded in 18.2% of cases (p <.05). CONCLUSIONS Intercoat gel seems to prevent de novo formation of IUAs and to improve the patency of the internal uterine ostium at follow-up hysteroscopy. However, larger studies are needed to confirm these findings.

The use of an oral contraceptive containing estradiol valerate and dienogest before office operative hysteroscopy: a feasibility study.

To investigate the impact of a 3 months preoperative administration of an oral contraceptive, containing dienogest (DNG) and estradiol valerate (E2V) on the outcome of office operative hysteroscopy (OOH). One-hundred and forty-two patients diagnosed at office hysteroscopy as having an asynchronous endometrium associated with either a broad-base sessile endometrial polyp (>1.5, <2.5 cm) or a uterine septum (>1/3 uterine cavity) or scheduled for tubal sterilization were enrolled into a prospective case-control study at University “Federico II” of Naples. 86/142 patients accepted the preoperative hormonal treatment (Group A), while 56/142 refused, thus becoming controls (Group B). Group A underwent OOH during the 10th–20th days of the third cycle of treatment. In Group B OOH was performed at enrolment, together with the diagnostic procedure. The study outcomes were: endometrial pattern, success rate, operating time, degree of surgical difficulty and pain score. An overall improvement of the endometrium was reported in 100% of cases in Group A. A statistically significant difference in success rate could not be demonstrated between two groups. Operative procedures were performed significantly quicker and easier in Group A than Group B (p < 0.001 and p < 0.05, respectively). The mean Visual Analog Scale (VAS) score was significantly lower in Group A (p < 0.001). A short pretreatment with combined oral contraceptive (COC) containing E2V/DNG seems to have a favorable impact on endometrium which in turn may result in an improvement of the overall outcomes of OOH.

Do serum leptin levels have a role in the prediction of pregnancy outcome in case of threatened miscarriage

Objective  To determine whether maternal serum leptin levels can predict pregnancy outcome in cases of threatened miscarriage.

Prenatal sonographic diagnosis of Rubinstein-Taybi syndrome.

Rubinstein-Taybi syndrome (RSTS; Online Mendelian Inheritance in Man 180849, http://www.ncbi.nlm.nih.gov/sites/entrez?db=omim) is a rare genetic multisystem disorder characterized by mental retardation, broad and often angulated thumbs and halluces, and distinctive facial features. 1 Congenital heart abnormalities, including a patent ductus arteriosus, septal defects, and aortic coarctation, have been reported in up to 33% of affected patients. 2 In a minority of cases, other systemic anomalies involving the skin, eye, ear, central nervous system, urinary tract, and musculoskeletal system, as well as an increased risk of developing tumors, have also been described. 3 The reported incidence of this condition ranges from 1 per 100,000 to 1 per 125,000 live births. 3 Although RSTS is categorized as an autosomal dominant disorder, most reported cases are sporadic, deriving from de novo mutations at a locus on band 16p13.3, which encompasses the gene for the transcription cofactor cyclic adenosine monophosphate response element-binding protein-binding protein. 4 This protein is ubiquitously expressed as a coactivator in cyclic adenosine monophosphate-regulated gene expression, which explains the multisystem problems described in affected individuals. The psychosocial prognosis of the syndrome is quite poor because of mental retardation, varying from a moderate to severe degree, and the considerable morbidity due to associated congenital abnormalities. The diagnosis of RSTS is usually made at birth or during infancy and is still essentially clinical. In fact, even with modern molecular genetic testing, a cytogenetic or molecular abnormality can be found in about 55% of affected individuals, thus leaving the diagnosis to rest on clinical features only in most cases. 4 Despite the fact that the acral abnormalities featured in these individuals might be detectable on sonography, as well as the abnormal profile due to the beaked nose, no prenatal description of RSTS has been reported in literature to the best of our knowledge. We report a case in which the diagnosis of RSTS was hypothesized prenatally after sonographic detection of highly suspicious findings in a family without any previous known risk for this condition.

Isolated Extrapelvic Endometriosis of the Gluteal Muscle

A 33-year-old woman with a 2-year history of swelling and pain in her buttock and left thigh fluctuating with her menstrual cycle who was becoming progressively disabled was referred to the department of orthopedics. Magnetic resonance imaging (MRI) detected a left buttock lesion of 3 x 2 cm that was initially diagnosed as muscular-fiber laceration with associated hematoma. The worsening of her symptomatology required an ultrasound-guided biopsy of the lesion that revealed endometriosis. Laparoscopy showed the pelvis to be free of gross disease. Hormonal suppression by means of gonadotropin-releasing hormone analog therapy proved adequate in temporarily alleviating symptoms. A year later the patient underwent surgical excision of the buttock lesion, which was effective in alleviating her symptoms for a short period of 10 months. A 1-year follow-up MRI revealed several small endometriotic foci, located among piriformis and obturator internus muscle fibers, which were considered not suitable for surgical removal. The patient is currently on a drug regime for pain management. However, she has experienced permanent muscular damage on her left buttock including significant omolateral gluteus strength reduction, functional impairment (inability to rotate laterally or bend her left leg), and the assumption of an antalgic gait while walking. Because of impairment in her deambulation capability, total physical invalidity was agreed for her by the National Health Care Services.

Pregnancy in a gerodermia osteodysplastica patient: A case report

Gerodermia osteodysplastica is a rare autosomal recessive connective tissue disorder included in the cutis laxa syndromes. We report the first case of pregnancy in a 26-year-old patient with gerodermia osteodysplastica, which terminated in successful cesarean delivery at term. The course, management, and potential concerns of such an extraordinary pregnancy are described.

Hysteroscopic identification of hydatidiform mole.

Fig. 2. Macroscopic appearance of hydatidiform mole, immediately after its removal from uterine cavity. The hydatidiform mole, a form of abnormal conception, affects 1 to 3 women in every 1000 pregnancies throughout reproductive age. In perimenopausal and postmenopausal age, it represents a rare cause of abnormal uterine bleeding (AUB). In these patients, the diagnosis is often accidental (i.e. missed execution of b-human chorionic gonadotropin dose) after diagnostic curettage performed for AUB or thickened endometrium at transavaginal ultrasound scanning. Very few reports describe the hysteroscopic detection of such uncommon lesion. We report such a case in a 51-year-old multiparous woman, who was referred to our department with severe

“Tubal Ostium Sunshine”: Hysteroscopic Sign of Chronic Salpingitis

Fallopian tube abnormalities including tubal occlusion, acute and chronic salpingitis, hydrosalpinx, peritubal adhesions, and salpingitis isthmica nodosa are major causes of female infertility, accounting for 30% to 40% of all cases. A tubemay be obstructed as a result of inflammation or a previous surgery. Most commonly, fallopian tube occlusion is due to an infection such as pelvic inflammatory disease, typically caused by a sexually transmitted agent such as Chlamydia trachomatis or Neisseria gonorrhoeae. Occlusion may occur at any site along the course of the tube. When the blockage involves the ampullary portion, the tube may dilate, thus forming a hydrosalpinx. Currently, hysterosalpingography and laparoscopy are the criterion standard in assessment and management of fallopian tube occlusion. However, several new techniques have been recently introduced. Several authors have investigated the role of hysteroscopy in assessing the status of the fallopian tubes. A recent