Nicola Saliani

Laparoscopy vs Minilaparotomy in Women with Symptomatic Uterine Myomas: A Prospective Randomized Study

OBJECTIVE To compare outcomes in patients with symptomatic uterine myomas who underwent laparoscopic (LPS) or minilaparotomic (MLPT) myomectomy. DESIGN Prospective randomized study (Canadian Task Force classification II-2). SETTING University hospital. PATIENTS Eighty patients with no more than 3 uterine myomas of maximal diameter of 7 cm. INTERVENTION Either LPS or MLPT myomectomy. MEASUREMENTS AND MAIN RESULTS Mean blood loss, mean duration of postoperative ileus, and mean decrease in hemoglobin were significantly lower in the LPS compared with the MLPT group (p < .001). Mean operative time was not significantly longer in the LPS group compared with the MLPT group. Duration of hospitalization was significantly shorter in the LPS compared with the MLPT group (p < .001). No intraoperative complications were observed during MLPT. In 1 patient, conversion from LPS to MLPT was necessary because of difficulty in reconstructing the uterine wall. CONCLUSION Laparoscopic myomectomy is a suitable alternative to MLPT in women with 1 to 3 myomas. However, preoperative careful evaluation of the size and sites of the myomas is necessary to avert conversion and prevent complications.

Poor reliability of vaginal and endocervical cultures for evaluating microbiology of endometrial cavity in women with chronic endometritis.

Background: Chronic endometritis (CE) is a subtle pathology causing infertility and abnormal uterine bleeding. We evaluated the reliability of vaginal and cervical cultures for detecting infectious agents at the endometrial level. Methods: In a prospective diagnostic study, 181 women diagnosed with CE and 100 controls underwent vaginal, endocervical and endometrial sampling. Cultures for common bacteria, Neisseria gonorrhoeae, yeast and Ureaplasma urealyticum and PCR for Chlamydia trachomatis were performed. Results: The prevalent infectious agents at the endometrial level were common bacteria(59.7% of cases); U. urealyticum was detected in 11.0% and C. trachomatis in only 2.8%. The concordance rate between endocervical and endometrial specimens for common bacteria was 48.3%; 100% for C. trachomatis and 58.3% for U. urealyticum. The concordance rate between vaginal and endometrial cultures for common bacteria was 50.2%, only 16.7% for C. trachomatis and 48.8% for U. urealyticum. For common bacteria both vaginal and cervical cultures showed low sensitivities of 0.30 and 0.19, respectively. Conclusion: Common bacteria and U. urealyticum were the prevalent infectious agents in the uterine cavity of women diagnosed with CE. Both vaginal and endocervical cultures had low concordance with endometrial cultures. Only C. trachomatis test at cervical level had high concordance with endometrial findings.

Successful management of a cervical twin pregnancy: neoadjuvant systemic methotrexate and prophylactic high cervical cerclage before curettage.

OBJECTIVE To report our experience in managing a case of viable cervical twin pregnancy with systemic methotrexate and 2 weeks later with endocervical curettage after placing prophylactic high cervical cerclage. DESIGN Case report. SETTING University medical center. PATIENT(S) A 36-year-old woman, gravida 2, para 0, complaining of vaginal bleeding and pelvic pain, in whom cervical twin pregnancy was diagnosed at the sixth week of gestation. INTERVENTION(S) Systemic methotrexate was given as first-line treatment. Two weeks later because of persisting bleeding, endocervical curettage was performed after closing cervical arteries and placing but not tightening high cervical cerclage. MAIN OUTCOME MEASURE(S) Pregnancy termination, bleeding control, and preservation of fertility. RESULT(S) Notwithstanding the ligature of cervical arteries at curettage, heavy bleeding occurred, which was controlled rapidly by tightening the cerclage. Curettage then was completed successfully. Postoperative period was uneventful. Two years later the woman delivered vaginally. CONCLUSION(S) In case of cervical twin pregnancy methotrexate pretreatment and prophylactic placement of high cervical cerclage, but not ligature of cervical arteries, before curettage showed to be effective in terminating pregnancy ensuring effective bleeding control and preservation of fertility.