Franco Gorlero

Intramural pregnancy embedded in a previous Cesarean section scar treated conservatively

Figure 1 Cesarean scar pregnancy demonstrated by three-dimensional ultrasound showing the gestational sac implanted in the lower segment dehiscence of the anterior myometrium. In this gestational sac an embryo with its yolk stalk was also seen. A well-developed trophoblastic shell was depicted around the gestational sac. The residual myometrium was thin and bulged into the uterovesical fold (indicated by the arrow). CX, cervix; F, fundal endometrial cavity.

Metformin: risk-benefit profile with a focus on cancer.

Introduction: Epidemiological evidence suggests an increased incidence of cancer in obese, prediabetic, and diabetic patients and a reduced risk of cancer incidence and mortality in diabetic patients on metformin compared with other antidiabetic drugs. In vitro studies support the efficacy of metformin in cancer therapy and prevention. Although metformin seems to be promising as a cancer chemopreventive or therapeutic drug, the principal consideration is whether metformin will be effective in cancer clinical trials for nondiabetic subjects or only in diabetics or subjects with insulin resistance. Safety of metformin is even more important in treating nondiabetic patients. Areas covered: The present review focuses on epidemiological data and clinical trials testing the efficacy of metformin on cancer, the safety in nondiabetic patients and the future development of this promising drug. Expert opinion: Meta-analyses of epidemiological in which metformin treatment has been used for diabetic patients show a positive trend for benefit; nevertheless, clinical data outcomes are preliminary and the results of ongoing trials are awaited. The different types of cancer, heterogeneity of populations and presence of comorbidity make it difficult to determine the benefits of metformin in cancer prevention and treatment.

Gestational choriocarcinoma arising in a cornual pregnancy

A of a case of cornual pregnancy associated with initial transformation to choriocarcinoma is reported. Appropriate monitoring of HCG titers following conservative management of ectopic pregnancy is important not only to diagnose persistent ectopic gestation, but to avoid missing trophoblastic disease, albeit rarely.

Penetration of Prulifloxacin into Gynaecological Tissues after Single and Repeated Oral Administrations

AbstractObjective: This study aimed to evaluate the penetration into gynaecological tissues of ulifloxacin, the active metabolite of prulifloxacin, a once-daily fluoroquinolone administered once or in repeated doses. Methods: This was an open-label, randomised study that included 20 consenting female inpatients (age range 40–65 years) requiring total simple hysterectomy as a result of benign disease. Three groups of patients were enrolled: group A (four patients whose gynaecological tissue samples were used to set up the bioanalytical method); group B (eight patients treated 3 hours before surgery with one 600mg tablet of prulifloxacin); group C (eight patients treated with prulifloxacin 600mg once daily for 3 days and undergoing surgery 3 hours after the last dose). Patients to be treated with prulifloxacin were randomly allocated to group B or C. During surgery, samples of blood were collected jointly with healthy tissue removed from the endometrium, proximal fallopian tube, vaginal posterior fornix and portio vaginalis. Ulifloxacin concentrations in plasma and gynaecological tissues were determined by a liquid chromatography-tandem mass spectrometry (LC-MS/MS) bioanalytical method. An intrastudy assessment of the bioanalytical method performance was also conducted for plasma and tissues using calibration and quality control data (spiked samples). Results: Ulifloxacin mean concentrations were always higher in group C than in group B patients, both in plasma (0.76 vs 0.53 μg/mL) and in gynaecological tissues, namely fallopian tube (1.38 vs 0.81 μg/g), posterior fornix (1.48 vs 1.05 μg/g), portio vaginalis (1.46 vs 1.45 μg/g) and endometrium (2.20 vs 1.39 μg/g), as expected after repeated drug administrations. Tissue concentrations observed after repeated administrations were generally higher than the ulifloxacin minimum inhibitory concentrations for pathogens more frequently involved in gynaecological bacterial infections. The mean tissue/plasma ratios ranged between 1.5 and almost 3. Conclusion: The results of this study are promising but not fully predictive of clinical or microbiological efficacy for prulifloxacin. There is a need for appropriate clinical trials confirming that prulifloxacin is a useful therapeutic tool in patients with gynaecological bacterial infections.

Evaluation of the efficacy and tolerability of two different dosages of fenticonazole vaginal ovules (600 mg and 1000 mg) in patients with vaginal trichomoniasis: A controlled, double-blind, randomized clinical trial versus placebo

Abstract A double-blind clinical trial was performed in two clinical centers to evaluate the efficacy and the safety of two dose schedules of fenticonazole (one 600-mg or one 1000-mg ovule applied for 2 consecutive days) versus placebo in the treatment of vaginal trichomoniasis. Sixty-one patients were included in the study in the following three treatment groups: 600-mg ovules, 21 patients; 1000-mg ovules, 20 patients; and placebo, 20 patients. A vaginal swab was obtained before treatment and on day 7 for phase-contrast direct microscopic identification of Trichomonas species and a cultural examination was performed to exclude a possible mycotic or bacterial etiology. The severity of vaginal signs and symptoms (erythema, itching, discharge, edema, and burning) were evaluated with a semiquantitative scale (0 to 3). At baseline, all patients were positive for Trichomonas vaginalis on microscopic examination; on final evaluation the test was negative in 13 (65.0%) patients in the 600-mg group (one patient did not have a final examination performed), in 10 (58.8%) of the 1000-mg group, and in 3 (15.0%) of the placebo group. The difference between patients receiving active drug and placebo was highly significant (chi-square test, P ≤ 0.005), while no significant difference existed between the two groups of drug-treated patients. A highly significant reduction of the symptomatic scores was observed in both active-treatment groups as compared with placebo, but, as in the case of the microbiologic findings, no difference was found between the two groups of fenticonazole-treated patients. Side effects of mild or moderate intensity were present in three patients in the 1000-mg dose group. Two patients had a burning sensation and one had a burning sensation and discharge. One of the patients with a burning sensation interrupted the treatment. Such symptoms could also be part of the underlying disease.

Effect of terguride on prolactin levels in normal, puerperal and hyperprolactinaemic women

SummaryTerguride, is an 8 — alpha — ergoline derived from lisuride, acts as a partial dopamine (DA) agonist.The effect and tolerance of terguride has been investigated by an acute administration of 0.2 mg p.o. to 8 normal women, 8 patients with hyperprolactinaemia and 8 women with puerperal hyperprolactinaemia. Prolactin (PRL) levels were markedly suppressed in all subjects, with no significant differences between the groups.Treatment for 5 days with terguride 0.4 mg/day or 0.8 mg/day was studied as an inhibitor of lactation. PRL levels were suppressed in a dose-related manner. No untoward side-effects were noted.

Itraconazole Plasma and Vaginal Mucosal Levels in Patients with Chronic Vaginal Candidosis Treated with Itraconazole 200mg Once Daily for 3 Consecutive Days

Summary20 nonpregnant patients with chronic vaginal candidosis were divided randomly into 5 groups of 4 patients. They all received itraconazole 200mg once daily for 3 consecutive days. A blood sample and vaginal biopsy were obtained 1 hour after each administration as well as 25 and 50 hours after the last drug intake. The results show that the itraconazole levels in the vaginal mucosa are comparable with the corresponding blood levels, but that after the end of treatment, drug levels in the vagina remain elevated for much longer than the corresponding blood levels. These data suggest that a regimen of itraconazole 200mg once daily for 3 days results in therapeutic tissue levels at the site of infection for more than 5 days.

Unexpected pregnancies after tubal recanalization failure with selective catheterization**Supported by a grant from National Research Council (Consiglio Nazionale Ricerche), Targeted Project “Prevention and Control of Disease Factors,” subproject 05, “Human Fertility Control,” contract no. 01.00108.8F41, Chieti, Italy.

OBJECTIVE To evaluate selective salpingography sensitivity. DESIGN Retrospective study. SETTING Obstetrics and Gynecology Department, University of Genoa, Italy. PATIENTS One hundred seventeen patients previously submitted to selective salpingography because of unilateral or bilateral proximal tubal injection failure. RESULTS Seven pregnancies, one of which was ectopic, were obtained in 17 patients who had only recanalized tubes available for conception; 15 pregnancies were obtained in 39 patients who had one tube recanalized and one already patent; 3 tubal pregnancies were obtained in 12 patients who had only one tube already patent; 4 pregnancies, one of which was ectopic, were obtained in 19 patients who had neither patent nor recanalized tubes. CONCLUSIONS Selective salpingography can give false-positive results; therefore, it is possible to obtain a pregnancy even after selective salpingography failure.