Filomenamila Lorusso

The Plasma Homocysteine Levels Are Increased in Polycystic Ovary Syndrome

Women with polycystic ovary syndrome (PCOS) have several cardiovascular disease risk factors. Since hyperhomocysteinemia is associated with early atherosclerosis, it was postulated that the homocysteine levels are higher in PCOS patients than in control subjects which, therefore, may explain the cardiovascular disease risk. Thirty-five women with PCOS and 20 healthy subjects were studied. Endocrine assays, lipid profile, homocysteine and insulin level determinations, and ultrasound evaluation were performed in all subjects. We found significantly higher mean plasma homocysteine concentrations in patients with PCOS as compared with controls (10.4 ± 4.4 vs. 7.2 ± 1.5 ng/dl; p < 0.003). These data show that in PCOS early atherosclerosis is not exclusively dependent on hyperinsulinemia and elevated lipid profile – PCOS patients are exposed to significantly higher homocysteine levels which might increase the cardiovascular disease risk.

Accuracy of transvaginal sonography and contrast‐enhanced magnetic resonance‐colonography for the presurgical staging of deep infiltrating endometriosis

To investigate the accuracy of transvaginal sonography (TVS) and contrast‐enhanced magnetic resonance‐colonography (CE‐MR‐C) for the presurgical assessment of deep infiltrating endometriosis (DIE).

Polycystic ovary syndrome: relationship between insulin sensitivity ,sex hormone levels and ovarian stromal blood flow

Polycystic ovary syndrome (PCOS) is the most common cause of menstrual disorders ,and is characterized by chronic anovulation ,hyperandrogenism and infertility. In recent years ,it has become apparent that PCOS is also associated with hyperinsulinemia that is probably central to the pathogenesis of PCOS. As a peculiar vascular pattern has been reported to be present in PCOS ,the aim of this study was to investigate intraovarian stromal vascularization in PCOS patients and its possible correlation with sex hormones ,gonadotropins and insulin levels. Twenty-eight oligomenorrheic or amenorrheic patients with PCOS and 14 eumenorrheic women with a PCOS-like ovarian pattern undergoing endocrine screening and ultrasound color Doppler intraovarian blood flow were recruited to the study. Ten healthy women with regular menses represented the control group. Hormonal assays (follicle-stimulating hormone (FSH) ,luteinizing hormone (LH) ,androstenedione ,testosterone ,sex hormone-binding globulin (SHBG) and estradiol), oral glucose tolerance test (OGTT) ,baseline and glucose-induced insulin levels ,and transvaginal ultrasonographic and color Doppler analysis (pulsatility index (PI) ,resistance index (RI) and velocity (Vmax) of ovarian stromal flow) were performed in all participants in the early proliferative phase. Endocrine values showed significant differences in PCOS patients compared with PCOS-like women and controls ,while PI and RI indices were significantly higher in controls. PCOS patients were divided into hyperinsulinemic (n = 16) and normoinsulinemic (n = 12). Androstenedione was significantly higher (p < 0.01) in the hyperinsulinemic than in the normoinsulinemic patients and controls ,while SHBG was significantly (p < 0.01) lower in the hyperinsulinemic group. Analysis of color Doppler intraovarian vascularization showed a significantly lower RI and a higher Vmax in the hyperinsulinemic subjects than in the normoinsulinemic PCOS patients and controls. An increased stromal blood flow was observed in the PCOS and PCOS-like patients by transvaginal color Doppler evaluation ,but this technique is not able to differentiate these two similar ovarian patterns. However, hyperinsulinemic PCOS patients had an increased vascularity of the ovarian stroma. A strong correlation between hyperinsulinemia ,hyperandrogenism and low SHBG levels was evidenced ,and a hyperinsulinemia-induced mechanism for ovarian stromal angiogenesis is discussed.

Do uterine fibroids affect IVF outcomes

The effect of myomectomy on implantation and pregnancy rates prior to assisted reproduction treatments is controversial. This study was designed to assess clinical outcomes of IVF cycles in women with uterine fibroids. A retrospective single-centre assessment of clinical outcomes of IVF/intracytoplasmic sperm injection (ICSI) treatments in infertile women in a 4-year span was carried out. All patients underwent detailed transvaginal ultrasound and hysteroscopy to precisely identify presence, location and intracavitary growth of uterine fibroids. Cumulative pregnancy, ongoing pregnancy and live birth rates were considered primary outcome measurements. Fifty-one women with fibroids (97 treatment cycles), 63 patients with previous myomectomy (127 cycles), and 106 infertile women who did not demonstrate fibroids anywhere in the uterus (215 cycles) were considered for the analysis. No significant difference was found for pregnancy and live birth rates between groups. Women with fibroids>4 cm required an increased number of cycles to obtain an ongoing pregnancy, compared with the other groups. The data do not support pre-IVF myomectomy in women with small-to-moderate uterine fibroids, regardless of their location. This represents valuable information in the counselling of women with fibroids before reproductive assisted cycles.

Office hysteroscopy in an in vitro fertilization program

Objective. In the present paper we evaluate the incidence of intrauterine pathologies in a population undergoing in vitro fertilization (IVF) treatment. Moreover, we compare the IVF outcome between patients with normal and abnormal uterine findings to determine if office hysteroscopy (OH) is of any clinical significance. Methods. The hysteroscopic findings in 866 consecutive patients were analyzed. The study group included 555 patients at the first IVF attempt and 311 patients with two or more failed IVF cycles. Results. All hysteroscopic parameters were considered normal in 514 cases (59.4%); in 352 cases (40.6%) various pathological conditions were found. Patients were divided into two groups according to the hysteroscopic findings. The implantation and pregnancy rates were similar between the groups. Comparing the clinical outcomes in patients with repeated IVF failure who had hysteroscopy with no pathology and with pathology, we did not find any statistical differences. Conclusions. This study suggests that hysteroscopy as a routine infertility examination should be performed in all patients, owing to the elevated incidence of hysteroscopic pathological findings (59.4%); hysteroscopy also seems to be the best way to repair the uterine cavity when pathological conditions are present. However, performing OH before IVF–embryo transfer is of no significant value in improving pregnancy outcomes.

Deep pelvic endometriosis: accuracy of pelvic MRI completed by MR colonography

PurposeThis study assessed the diagnostic accuracy of pelvic magnetic resonance (MR) imaging completed by MR colonography for the preoperative evaluation of deep pelvic endometriosis in patients undergoing laparoscopic surgery.Materials and methodsA total of 143 patients (mean age 34.3±5.1 years) with a clinical suspicion of deep pelvic endometriosis were assessed by pelvic MR and MR colonography. All patients underwent laparoscopic surgery 3–10 weeks after the MR examination. The presence, location, number and extent of endometriotic lesions were evaluated. Data obtained with MR were compared with surgical findings. MR sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and diagnostic accuracy values were calculated for each site by considering the laparoscopic and histological findings as the reference standard.ResultsLaparoscopy confirmed the presence of endometriosis in 119/143 patients (83%); in 76/119 (64%) deep pelvic endometriosis was diagnosed, whereas in the remaining 43/119 (36%), superficial peritoneal implants and endometriomas were found. In 32/119 (27%) patients, intestinal lesions were detected. MR had sensitivity, specificity, PPV, NPV and diagnostic accuracy values of 67–100%, 85–100%, 83–100%, 84–100% and 84–100%, respectively, in recognising lesions located in different pelvic sites.ConslucionsMR imaging combined with colonography is a highly accurate tool for characterising deep endometriotic lesions in patients scheduled for laparoscopic surgery. In particular, MR colonography has very high accuracy in detecting colorectal involvement.RiassuntoObiettivoScopo del presente lavoro è stato valutare l’accuratezza diagnostica della risonanza magnetica (RM) pelvica associata a colonografia-RM nella valutazione preoperatoria della endometriosi pelvica profonda in pazienti sottoposte ad intervento per via laparoscopica.Materiali e metodiCentoquarantatre pazienti (età media 34,3±5,1 anni) con sospetto clinico di endometriosi pelvica profonda sono state valutate mediante RM pelvica completata con colonografia-RM. Tutte le pazienti sono state sottoposte a laparoscopia con un intervallo di 3–10 settimane dall’esame RM. Sono stati valutati presenza, sede, numero ed estensione delle lesioni endometriosiche. I dati ottenuti dalla RM sono stati confrontati con quelli chirurgici. Sensibilità, specificità, valore predittivo positivo (VPP) e negativo (VPN) ed accuratezza diagnostica della RM sono stati calcolati per ciascuna sede esaminata, considerando i reperti laparoscopici e istologici quale gold standard.RisultatiLa laparoscopia ha confermato la presenza di endometriosi in 119/143 pazienti (83%); in 76/119 (64%) era evidente endometriosi pelvica profonda, mentre nelle rimanenti 43/119 (36%) erano presenti endometriomi e impianti peritoneali superficiali. In 32/119 (27%) pazienti, sono state riscontrate lesioni intestinali. La RM ha presentato valori di sensibilità, specificità, VPP, VPN e accuratezza diagnostica rispettivamente compresi tra 67%–100%, 85%–100%, 83%–100%, 84%–100%, 84%–100% nel riconoscimento delle diverse sedi di impianto della patologia.ConclusioniLa RM associata a colonografia rappresenta una metodica accurata per lo studio delle pazienti con endometriosi pelvica profonda da sottoporre ad intervento chirurgico laparoscopico e per la caratterizzazione delle lesioni endometriosiche. In particolare la colonografia-RM consente elevati valori di accuratezza nell’identificazione delle lesioni intestinali.

Follicular growth and oocyte maturation in GnRH agonist and antagonist protocols for in vitro fertilisation and embryo transfer

Background. The aim of this study was to evaluate the response to treatment in a group of patients undergoing IVF and randomised to receive GnRH-antagonist or the GnRH-agonist. The endpoints were the pattern of follicular growth, the maturity of the oocytes collected, the embryo quality and the pregnancy outcome. Methods. A total of 136 patients undergoing IVF were included. Sixty-seven patients were allocated to the GnRH antagonist and 69 patients to the GnRH agonist. GnRH antagonist was administered when the leading follicle reached a diameter of 12–14 mm. GnRH agonist was administered in a long luteal protocol. Results. The mean numbers of oocytes retrieved and mature oocytes were significantly higher in the agonist than in the antagonist group (p < 0.02 and p < 0.01, respectively). Embryo quality, implantation rate, clinical pregnancy rates, ongoing pregnancy rate and miscarriage rate were similar in both groups. Conclusions. Better follicular growth and oocyte maturation are achieved with GnRH agonist treatment. However, both regimens seem to have similar efficacy in terms of implantation and pregnancy rates. Further studies clarifying the effect of the GnRH antagonist on ovarian function are needed, as well as a clear definition of the best period of the follicular phase for the GnRH antagonist administration.

Is the occurrence of the empty follicle syndrome a predictor that a subsequent stimulated cycle will be an unfavourable one

Several hypotheses have been advanced to explain empty follicle syndrome (EFS) but it remains a controversial topic. This paper reports experience with three IVF cycles in which no oocytes were collected. In all cases, an additional IVF cycle was performed. The ovarian stimulation protocol, ultrasound and hormonal surveillance methods, human chorionic gonadotrophin timing and oocyte retrieval technique were similar in all patients. The assessment of additional cycles demonstrated a poor response in terms of oocyte quality, since the number of mature oocytes was low despite the high number of oocytes collected. Thus, the data suggest that in these patients, EFS should be considered as a borderline form of poor response to ovarian stimulation. If this is confirmed, EFS should be a recurrent event and an empty cycle could be a good predictor that a subsequent stimulated cycle will be an unfavourable.

Hepatic nodular regenerative lesions in patients with hereditary haemorrhagic telangiectasia: computed tomography and magnetic resonance findings

PurposeThis study was done to evaluate the prevalence of regenerative hepatic nodules in patients with hereditary haemorrhagic telangiectasia (HHT).Materials and methodsBetween February 2001 and December 2010, 171 consecutive HHT patients (95 men and 76 women) were studied with triphasic multidetector computed tomography (MDCT) in 91 cases, magnetic resonance imaging (MRI) in 34 cases and both in the remaining 46 cases. The presence of diffuse vascular abnormalities and focal liver lesions were recorded.ResultsHepatic arteriovenous malformations (HAVMs) were found in 126/171 (74%) patients. Arteriovenous shunts were found in 24/171 (14%) cases, arterioportal shunts in 52/171 (30%), mixed shunts in 26/171 (15%), telangiectases in 84/171 (49%) and transient hepatic attenuation differences (THADs) in 70/171 (41%). Hepatic nodular lesions were found in 6/171 (3.5%) patients (three men; three women). In 5/6 cases, vascular abnormalities were also evident. Two patients had a single lesion; four had multiple lesions. No lesion showed a central scar.ConclusionsHyperenhancing hepatic regenerative lesions have a high prevalence in HHT patients, representing the response of liver parenchyma to hypoperfusion caused by HAVMs. These lesions are often multiple and may lead to nodular regenerative hyperplasia.RiassuntoObiettivoScopo del presente lavoro è valutare la frequenza di lesioni nodulari rigenerative nei pazienti affetti da telangiectasia emorragica ereditaria (HHT).Materiali e metodiNel periodo compreso tra febbraio 2001 e dicembre 2010 sono stati arruolati consecutivamente 171 pazienti (95 uomini, 76 donne) affetti da HHT. La presenza di alterazioni epatiche è stata ricercata in 91 casi con TCMD trifasica (fase arteriosa precoce, tardiva e fase venosa) e in 34 con angio-risonanza magnetica (RM) dinamica, i rimanenti 46 pazienti sono stati sottoposti ad entrambi gli esami.RisultatiIn 126/171 (74%) pazienti sono state diagnosticate alterazioni vascolari epatiche costituite da fistole artero-venose (24/171, 14%), fistole artero-portali (52/171, 30%), fistole miste (26/171, 15%), telangiectasie (84/171, 49%) e disordini di perfuzione (THADs) (70/171, 41%). In 6/171 casi (3 donne e 3 uomini, 3,5%) sono state descritte lesioni nodulari epatiche ipervascolarizzate associate in 5 pazienti ad altre lesioni vascolari. Due pazienti erano portatori di una lesione singola mentre in quattro casi sono state dimostrate lesioni multiple. In nessun caso è stata riconosciuta una cicatrice centrale.ConclusioniLe lesioni epatiche rigenerative hanno un’elevata prevalenza nei pazienti affetti da HHT e costituiscono una risposta del fegato all’ipoperfusione determinata dagli shunt artero-venosi intraparenchimali. Tali lesioni si presentano spesso in forma multipla e possono determinare un quadro di iperplasia nodulare rigenerativa diffusa.

Gatrointestinal imaging with multidetector CT and MRI

Computed tomography (CT) and magnetic resonance imaging (MRI) are important diagnostic tools for evaluating gastrointestinal disorders. A rigorous examination protocol is needed to achieve the best results. This paper describes the technical issues of CT and MRI for the study of gastrointestinal tracts (esophagus, stomach, small and large bowel).