Marco Angiolucci

Influences of melatonin administration on the circulation of women

The cardiovascular effects induced by the daytime administration of melatonin (1 mg) were compared with those of placebo in 17 young, healthy, early follicular-phase women. Compared with placebo, the administration of melatonin modified, within 90 min, the pulsatility index (PI), evaluated by color Doppler ultrasound, of the internal carotid artery, abdominal aorta, and axillary artery. The effect was linearly related to baseline PI, higher baseline PI being associated with greater PI declines. Melatonin administration significantly decreased mean PI of internal carotid artery ( P < 0.02), systolic and diastolic blood pressure ( P < 0.01), and norepinephrine levels evaluated after 5 min of standing position ( P < 0.02). Heart rate and supine catecholamine levels were not modified. These data indicate that in young, healthy women the administration of 1 mg of melatonin greatly influences artery blood flow, decreases blood pressure, and blunts noradrenergic activation. Clinical implications of present data are worthy to be fully explored.

Transvaginal ultrasonography in the diagnosis of cystic teratoma

Objective To assess prospectively the role of transvaginal ultrasonography in screening for cystic teratoma and in differentiating cystic teratoma from other ovarian masses. Methods Three hundred seventy-six premenopausal non-pregnant women underwent transvaginal ultrasonography 1 week before undergoing laparotomy or laparoscopy. The visualization of localized or diffuse echogenicity was chosen as the characteristic ultrasonographic finding of cystic teratoma. Endosonographic diagnosis was compared with surgical and pathologic findings. Results Sensitivity and specificity for the ultrasonographic screening were 57.9 and 99.7%, respectively, calculated for each visualized overy (n = 659), and 84.6 and 98.2%, respectively, for differentiating cystic teratoma from other ovarian masses, calculated for each visualized cyst (n = 123). Conclusion Transvaginal ultrasonography has a better predictive ability for differentiating cystic teratoma from other ovarian masses (kappa value 0.84) than in screening for cystic teratomas (kappa value 0.69).

Transvaginal ultrasonography combined with CA-125 plasma levels in the diagnosis of endometrioma

OBJECTIVE To assess the role of transvaginal ultrasonography combined with CA-125 plasma levels in the diagnosis of endometrioma. DESIGN Prospective study with pathological confirmation of the diagnosis. SETTING Department of Obstetrics and Gynecology of the University of Cagliari, Italy. PATIENTS One hundred one consecutive premenopausal nonpregnant women submitted to laparoscopy or laparotomy, from November 1993 to October 1994, because of the presence of an adnexal mass. INTERVENTIONS Within 2 days before surgery all patients underwent transvaginal ultrasonography and evaluation of CA-125 plasma levels. The ultrasonographic impression and the CA-125 value were then compared with the histopathological diagnosis. MAIN OUTCOME MEASURE The overall agreement between the test result and the actual outcome was calculated using the kappa index for the transvaginal ultrasonography used alone and for the combination of transvaginal ultrasonography and CA-125 values, for each chosen cutoff and range. RESULTS Transvaginal ultrasonography has a strong agreement between test and surgery (kappa value 0.76) whereas the combined use of the two methods is associated with a lower kappa index, ranging from 0.40 to 0.69. CONCLUSION Transvaginal ultrasonography used alone has a better predictive capacity in differentiating endometrioma from other adnexal masses than combined methods.

Tumor markers and transvaginal ultrasonography in the diagnosis of endometrioma

Objective To evaluate the accuracy of CA 19.9 plasma levels (with or without CA 125 levels) combined with transvaginal ultrasonography in the differential diagnosis of endometrioma. Methods One hundred eighteen consecutive premenopausal nonpregnant women had laparoscopy or laparotomy between November 1994 and November 1995 because of the presence of a persistent adnexal mass. They underwent transvaginal ultrasonography and measurement of CA 19.9 and CA 125 plasma levels within 2 days before surgery. The ultrasonographic impression and the tumor marker values were compared with the histopathologic diagnosis. The overall agreement between the test result and the actual outcome was calculated using the kappa statistic. Results Transvaginal ultrasonography had a strong agreement between test result and surgery (kappa value 0.84), whereas the combined methods were associated with a lower kappa value (range 0.24–0.80). Conclusion Transvaginal ultrasonography used alone is the most cost-effective method in the preoperative differential diagnosis of endometrioma.

Effect of exogenous melatonin on vascular reactivity and nitric oxide in postmenopausal women: role of hormone replacement therapy

Several effects of melatonin are modulated by gonadal steroids and are reduced in ageing women. Administration of melatonin reduces internal carotid artery pulsatility index (PI), and blood pressure in young individuals. Whether these effects are conserved in postmenopausal women and are influenced by hormone replacement therapy (HRT), was herein investigated.

Potentially beneficial cardiovascular effects of melatonin administration in women.

Cagnacci A, Arangino S, Angiolucci M, Maschio E, Longu G, Melis GB. Potentially beneficial cardiovascular effects of melatonin administration women. J. Pineal Res. 1997; 22:16–19. Munksgaard, Copenhagen

Epidemiology and Diagnosis of Endometriosis

Endometriosis is defined as the presence of ectopic endometrium with evidence of both cellular activity and progression, with formation of adhesions, or interference with normal reproductive processes.] Endometriosis is often associated with infertility, chronic pelvic pain and/or presence of adnexal masses, but typical lesions have also been found in asymptomatic women.* The diagnosis of endometriosis requires direct visualization of the lesions by laparoscopy or laparotomy. For this reason, data on the prevalence of endometriosis in the general population published so far are not conclusive. In fact, only few prospective have been undertaken, which report a prevalence range of 20-40% in infertile women, 4-65% in patients with chronic pelvic pain, and 1-22% in women submitted to gynecological surgery for other indications.2 Considering the high prevalence of the disease Friedman et ~ l . ~ have evaluated the reliability of a less invasive diagnostic method, ultrasonography, in all forms of pelvic endometriosis, and demonstrated a possible role only when endometriotic cysts are present. Other authors6.’ have also analyzed the spectrum of ultrasonographic transabdominal or transvaginal findings of surgically proved endometriomas, but they did not analyze the specificity of these techniques. Both medical and surgical treatment of endometriosis has greatly improved over the last 20 years,

Role of Transvaginal Sonography in the Diagnosis of Peritoneal Inclusion Cysts

and operative laparoscopy, alone or in combination with medical treatment, has emerged as an indispensable component of modern management of the disease.’ Therefore, the present study was performed to evaluate the prevalence of pelvic endornetriosis in premenopausal women submitted to laparoscopy and/or laparotomy for benign gynecological disease. In addition, the same subjects were submitted to transvaginal ultrasonography within one week before surgery to evaluate the accuracy of this less invasive technique in differentiating endometriomas from other ovarian cysts. Finally, the role of operative laparoscopy in the management of endometriosis was evaluated in those patients who underwent laparoscopy for benign ovarian cysts or chronic pelvic pain.

Association between different morphological types and abnormal karyotypes in early pregnancy loss

Objective. The aim of this prospective study was to investigate the accuracy of B‐mode transvaginal sonography alone and combined with color Doppler imaging and cancer antigen 125 (CA 125) plasma concentrations in differentiating peritoneal cysts from other adnexal masses. Methods. Between September 1999 and September 2003, 213 adnexal masses underwent transvaginal sonography combined with power Doppler evaluation. Plasma concentrations of CA 125 were measured before surgery. The sonographic suspicion of peritoneal cysts (the presence of a bizarre lump‐shaped cyst with a thin wall and fine internal septations with or without an ovary suspended among adhesions) was then compared with the surgical diagnosis. The overall agreement between the sonographic test results and the surgical findings was calculated by the κ index. The diagnostic value of each test was also evaluated with likelihood ratios (LRs). Results. Thirteen of 213 patients were found to have peritoneal cysts. Specificity and sensitivity of B‐mode sonography for differentiating peritoneal cysts from other adnexal masses were 96% (95% confidence interval, 94%–97%) and 62% (95% confidence interval, 35%–83%), respectively. The value of the negative LR (0.40) indicated a good clinical test, whereas the positive LR (15) indicated an excellent test. Power Doppler imaging did not seem to increase the accuracy of B‐mode transvaginal sonography (κ = 0.51 and 0.52, respectively), nor did the association of CA 125 plasma concentration (κ = 0.34). Conclusions. Transvaginal sonography alone is a useful method for detection of peritoneal cysts.

Different circulatory response to melatonin in postmenopausal women without and with hormone replacement therapy

To identify the abnormal transvaginal ultrasound (TVS) findings typical of aneuploidic pregnancies that end with early pregnancy loss (EPL).