Nicoletta De Rosa

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.

High prevalence of human papillomavirus infection in Eastern European and West African women immigrants in South Italy.

Tornesello ML, Cassese R, de Rosa N, Buonaguro L, Masucci A, Vallefuoco G, Palmieri S, Schiavone V, Piccoli R, Buonaguro FM. High prevalence of human papillomavirus infection in Eastern European and West African women immigrants in South Italy. APMIS 2011; 119: 701–09.

Plasma leptin and adiponectin levels in hormone replacement therapy and contraception: effects of different progestogens.

OBJECTIVE To evaluate the impact of hormone replacement therapy and oral contraceptives containing different progestogens on adiponectin and leptin serum levels. DESIGN Prospective, longitudinal, semi-randomized study. SETTING General gynecology clinic of a university hospital. PATIENT(S) Forty-five healthy postmenopausal and 45 healthy premenopausal women. INTERVENTION(S) Thirty postmenopausal women were randomized to receive either drospirenone (DRSP) 2 mg + E(2) 1 mg (n = 15) or norethisterone acetate (NETA) 0.5 mg + E(2) 1 mg (n = 15). Thirty premenopausal women were randomized to receive either ethinilestradiol (EE) 0.020 mg + DRSP 3 mg (n = 15) or EE 0.020 mg + desogestrel 0.15 mg (n = 15). Furthermore, 15 postmenopausal and 15 premenopausal untreated women served as controls. MAIN OUTCOME MEASURE(S) Adiponectin and leptin serum levels before and after 6 months of hormonal therapy. RESULT(S) No significant differences in leptin levels were detected in any group after 6 months. Adiponectin levels were significantly reduced in the NETA + E(2) group and increased in the EE + DRSP group, while remaining unmodified in all other groups. CONCLUSION(S) Hormone replacement therapy with NETA, but not with DRSP, decreases serum adiponectin levels. Oral contraceptives containing DRSP increase serum adiponectin levels.

Comparison of bidirectional barbed suture Stratafix and conventional suture with intracorporeal knots in laparoscopic myomectomy by office transvaginal hydrolaparoscopic follow-up: a preliminary report.

OBJECTIVES To compare surgical outcomes of different types of intracorporeal sutures for laparoscopic posterior myomectomy, by a prospective randomized study. STUDY DESIGN Prospective randomized study on 47 patients with single posterior intramural myoma (4-7cm in diameter) undergoing laparoscopic myomectomy. The patients enrolled were divided into two groups, one operated using conventional suture in double strand, and the other with bidirectional barbed suture Stratafix. The main outcome measures were suturing time, peri-operative variables, and post-operative adhesions in both groups. RESULTS The mean operative time was shorter with the Stratafix™ than with the conventional suture (66.3±8.2 vs. 73±8min; p=0.005). Suturing time was significantly shorter in the Stratafix™ than in the control group (8.8±2.4 vs. 15.5±2.8min; p=0.001). Intraoperative bleeding was significantly less in the Stratafix group (p=0.0012). Conversely, there was no statistically significant difference for postoperative adhesions between the two groups (26.7% vs. 21.4% p=0.5). CONCLUSIONS The use of barbed suture may reduce operative time, suturing time, and blood loss. No difference in post operative adhesions was found.

Effects of estradiol valerate and dienogest on quality of life and sexual function according to age.

Abstract This is an observational study on 102 women aged 25–45 years to evaluate if the E2V/DNG pill has any impact on quality of life (QoL) and sexual function (FSF). Thirty-nine women were younger than 35 years (group A), and 63 women were 35 years old or older (group B). At baseline and after 6 months, patients received the Italian validated version of the Short Form-36 questionnaire and the Italian validated version of the Female Sexual Function Index questionnaire. Group A showed an overall higher perception in all QoL scores at baseline and after 6-months (p < 0.05). E2V/DNG treatment did not exert any significant effect on QoL perception in group A apart from an increase in the GH domain (general health). In group B we observed a significant improvement both in GH and in VT (vitality) scores. We found a significant reduction in “lubrication” after 6 months both in group A and B (p < 0.01) and a significant improvement in “satisfaction” and “pain” scores in group A and in “desire”, “satisfaction” and “total” score in group B (p < 0.01). The E2V/DNG pill is associated with a significant improvement of GH and VT and with an improvement in FSF with no difference between age groups. Chinese abstract 这是一项关于戊酸雌二醇/地诺孕素是否对年龄在25岁–45岁的102名女性生活质量（QOL）和性功能（FSF）有影响的观察性研究。39名女性小于35岁（A组），63名女性大于35岁或更大（B组）。在未用药和用药6个月后，患者接受意大利版的36个问卷调查和女性性功能指数问卷调查。未用药及用药6个月后（p<0.05），A组显示总体的生活质量评分更高。除了提高GH（一般健康状况）外，戊酸雌二醇/地诺孕素对A组生活质量没有任何明显影响。我们观察到B组GH和VT（体力）评分明显升高。我们发现6个月后A组和B组（p<0.01）“性润滑”作用明显降低，A组“性满意度”和“性交疼痛”评分明显升高；B组“性欲”、“性满意度”和“总”评分（p<0.01）明显升高。戊酸雌二醇/地诺孕素明显改善GH和VT，在不同年龄组中对性功能的改善没有显著差异。

Assessment of Chlamydia trachomatis infection among Eastern European and West African women immigrants in South Italy

Chlamydia trachomatis infection is the most common sexually transmitted bacterial infection with an estimated incidence of 50 million cases in the world.1 The infection may remain asymptomatic or, if not treated, can lead to severe clinical manifestations including acute urethral syndrome, urethritis, bartholinitis, cervicitis, upper genital tract infections and perihepatitis.2 Despite the recognised need for early diagnosis and treatment of C trachomatis and other curable sexually transmitted infections, the strategies for detection of these infections are currently limited, …

Impact of transvaginal hydrolaparoscopy ovarian drilling on ovarian stromal blood flow and ovarian volume in clomiphene citrate-resistant PCOS patients: a case-control study

Abstract Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in gynecology. In PCOS patients vascularization parameters are altered. Transvaginal hydrolaparoscopy (THL) is a mini-invasive approach for ovarian drilling in PCOS patients. In this study, we assessed the effect of ovarian drilling using THL on ovarian volume (OV) and vascularization index (VI) using 3D power Doppler ultrasonography in CC-resistant PCOS patients. A case-control study on 123 CC-resistant PCOS women who underwent THL ovarian drilling was performed. Patients underwent 3D ultrasound and power Doppler to measure VI, flow index (FI), vascularization flow index (VFI) and to evaluate OV before and after the procedure, at six months, and on the early follicular phase of the menstrual cycle. After THL ovarian drilling, OV and power Doppler flow indices were significantly reduced compared to pre-operative values (OV: 7.85 versus 11.72 cm3, p < 0.01; VI: 2.50 versus 4.81, p < 0.01; VFI: 1.10 versus 2.16, p < 0.01; FI: 32.05 versus 35.37, p < 0.01). In conclusion, THL ovarian drilling seems to reduce OV and 3D power Doppler indices, and could therefore be a viable alternative to LOD in PCOS patients resistant to medical therapy.

Operative transvaginal hydrolaparoscopy improve ovulation rate after clomiphene failure in polycystic ovary syndrome

Abstract Aim of our study was to assess the ovulation rate, with mid-luteal progesterone level and ultrasound follicles monitoring, in PCOS CC-resistant patients undergone transvaginal hydrolaparoscopy ovarian drilling. A prospective observational study was carried out in 123 PCOS, infertile, CC-resistant patients who undergone THL ovarian drilling. Each woman was evaluated by hormonal measurement, and ultrasound evaluation during 6 months follow-up. Progesterone serum levels were assessed on days 20–24 of the cycle after surgical treatment. Pg levels >3 ng/mL were considered as ovulation. Ovulation frequency and the highest mean follicular diameters during the monitoring were recorded. 117 patients complete the study, since six patients were lost to follow-up. Mean follicular diameter during ovulation monitoring was 16.37 mm. Ovulation rate at the follow up was 64.1% one month after treatment, 79.5% after three months and 82.9% after six months. 28 patients conceived during follow-up period. Pregnancy rate was 70.1%. Our study has shown that THL ovarian drilling improves ovulation and pregnancy rate in women with CC-resistant PCOS. We believe that this approach should be offered as second-line therapy at all PCOS CC-resistant women who fail the medical methods of ovulation induction.

Impact of Ospemifene on Quality of Life and Sexual Function in Young Survivors of Cervical Cancer: A Prospective Study

Background Cervical cancer (CC) treatments impact quality of life (QoL) and sexual function (SF) of survivors. Treatment options to reduce sexual dysfunction are limited. The aim of this study was to assess the effectiveness of ospemifene in CC survivors with clinical signs and symptoms of vulvovaginal atrophy (VVA) focusing on their QoL and SF. Materials and Methods Fifty-two patients with previous diagnosis of stage I-IIa CC suffering from VVA and treated with ospemifene were enrolled into a single arm prospective study. Patient underwent 6 months of therapy. At baseline and after 6 months all subjects performed Vaginal Health Index (VHI). The SF and QoL were measured by The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) and the Cervical Cancer Module (CXC-24). Results After treatment a significant improvement of each parameter of VHI has been demonstrated. Global health status and emotional and social functioning scores improved significantly. On the contrary, general symptoms scales did not show significant difference from baseline data. Sexual activity, sexual vaginal functioning, body image, and sexual enjoyment scores increased significantly. Conclusion Ospemifene seems to be effective in decreasing the VVA symptoms in CC survivors.

Endocervicoscopy: an important diagnostic tool in patients with cervical intraepithelial neoplasia undergoing LLETZ

Sir, We read with interest the report by Ott et al. (1) critically evaluating the role of a routine diagnostic hysteroscopy performed in addition to large loop excision of the transformation zone (LLETZ) for discovering intrauterine anomalies undetected by pre-operative ultrasound. The authors have shown that hysteroscopy is not so beneficial for these patients as to recommend its routine use before LLETZ; indeed, without specific medical indication, with hysteroscopy it was possible to discover only a few benign findings of questionable clinical relevance, and this also exposed patients to surgical complications. We are fully in agreement with Ott and his co-authors as we have had a similar clinical experience in our department. Nonetheless, we wish to focus attention on a recently developed technique for the diagnostic work-up of cervical intraepithelial lesions (2). This innovative imaging technique, named endocervicoscopy, combines the conventional hysteroscopic instrumentation with the colposcopic classification system for evaluation of the endocervical mucosa. The primary indication for endocervicoscopy is repeatedly positive cervico-vaginal cytology suggestive of a high-grade squamous intraepithelial lesion (H-SIL) and negative or unsatisfactory (i.e. non-visible squamocolumnar junction) colposcopy. Endocervioscopy can be performed in an office setting without anesthesia and/or analgesia, using the same instruments as used for traditional hysteroscopy (an office operative hysteroscope <5mm, a xenon light source, an irrigation-suction electronic device, a digital endocamera and a high resolution monitor, equipped with a videorecording system). Endocervicoscopy consists of four steps. The first step is the application of 2ml of 5% acetic acid onto the cervix (step I). The procedure continues with a panoramic view of both the cervix and the transformation zone aimed at recording the modifications induced by the application of the acetic acid, as described for the colposcopic criteria (step II: esocervicoscopy). In particular, the squamocolumnar junction should be clearly identified in its entire path and localized. Also Nabothian cysts, cervical polyps, and typical transformation areas should be identified and localized within the endocervix. The trophism, the vascularization, and the morphology of the endocervical mucosa should then be evaluated. The surgeon should be well acquainted with the physiological changes of this mucosa throughout the menstrual cycle and with aging (step III: endocervicoscopy). If clinically requested, endocervicoscopy may be completed by an examination of the uterine cavity (step IV: hysteroscopy). The endocervicoscopy report is based on colposcopic theoretic principles and visible lesions are classified under specific categories on the basis of their severity, according to the International Federation of Cervical Pathology and Colposcopy (3). Our results have shown that endocervicoscopy, when combined to target/orientated biopsy, had higher sensitivity, even if not statistically significant, than curettage for detecting endocervical lesions (79 vs. 66%) and comparable specificity, diagnostic accuracy, and positive predictive value. Our data have shown that 13% of endocervical abnormalities detected by endocervicoscopy were missed by blind endocervical curettage (2). Furthermore, endocervicoscopy allows the possibility to determine the precise topography of the cervical intraepithelial lesion, to detect ‘jump lesions’, and to perform an adequate surgical excision minimizing cone size. Indeed, in our study, women undergoing endocervicoscopy had a significant smaller volume of cone biopsy, with all presenting free cone margins. In conclusion, we believe that endocervicoscopy could represent an important diagnostic tool in the management of patients with cervical intraepithelial neoplasia undergoing LLETZ. Indeed, the correct identification and topography of the lesions allows for the cone excision to be tailored, thus potentially better preserving the future fertility of the woman.