Nicoletta Vendola

Endometriosis and ovarian cancer

In 556 patients undergoing surgery for ovarian cancers the frequency of endometriosis ranged from 3.6% to 5.6% in serous, mucinous, and miscellaneous neoplasms versus 26.3%, 21.1%, and 22.2%, respectively, in endometrioid, clear cell, and mixed subtypes; the differences were statistically significant (chi 2 heterogeneity 50.0, p < 0.001) and consistent in strata of age, parity, menopausal status, and disease stage.

Gonadotropin releasing hormone agonist treatment before hysterectomy for menorrhagia and uterine leiomyomas

Objective. To investigate the effect of gonadotropin releasing hormone agonist (goserelin) treatment before hysterectomy for leiomyomata‐associated menorrhagia.

Veralipride for Hot Flushes during Gonadotropin-Releasing Hormone Agonist Treatment

Hot flushes are the commonest symptom induced by gonadotropin-releasing hormone agonists (GnRHa). We performed an open observational trial to evaluate the efficacy of veralipride, an antidopaminergic drug, in reducing hot flushes in 25 premenopausal women treated with a GnRHa for endometriosis (8 subjects) or menorrhagia (17 subjects). The patients received goserelin depot for 6 months and veralipride was added for the third month. Hot flushes, severe in all women at 2 months, improved in both frequency and intensity in 92% of the subjects during veralipride administration. The benefit obtained persisted until the end of the GnRHa treatment.

Conservative surgical treatment for severe endometriosis in infertile women: are we making progress?

Conservative surgery for severe endometriosis in infertile women is one of the most challenging situations for the pelvic surgeon. The second half of the 1980s saw an increase in the supporters of laparoscopic treatment even for more extensive disease. Two opposing factions were thus created: traditional gynecologic surgeons who accuse endoscopists of imprudence and technical inadequacy and enthusiastic supporters of operative laparoscopy who consider laparotomy obsolete and its associated morbidity needlessly high for the patient and health service. In the present review of the literature data we analyze laparotomy and laparoscopy techniques and compare the postoperative results in terms of reproductive success in an attempt to clarify whether conservative endoscopic treatment of severe endometriosis is only an inappropriate proposal with no future or whether, due to its efficacy, it will eventually limit interventions via laparotomy to exceptional circumstances.

Ureteral drainage with double-J catheters in obstructive uropathy during pregnancy : a report of 3 cases

Acute dilatation of the upper urinary tract during pregnancy is a common cause of renal colics and urinary tract infections, leading, rarely, to renal insufficiency. We describe 3 cases with symptomatic hydronephrosis at 28 weeks of gestation who underwent placement of an internal urinary drainage by so-called double-J ureteral stents which rapidly reduced obstruction and symptoms and allowed pregnancies to continue to term. We conclude that double-J ureteral stenting is an effective, simple, safe, and economical method to treat acute hydronephrosis during pregnancy.

A gonadotropin-releasing hormone agonist versus a low-dose oral contraceptive for pelvic pain associated with endometriosis**This work was conducted within the framework of the Italian National Research Council Applied Project “Prevention and Control of Disease Factors,” subproject 5 (Fertility Control), grant no. 91.00131.PF41.115.05532, Milan, Italy.††Presented at the 48th Annual Meeting of The American Fertility Society, New Orleans, Louisiana, November 2 to 5, 1992.

OBJECTIVES To evaluate the efficacy of goserelin versus a low-dose cyclic oral contraceptive (OC) in improving pelvic pain in women with endometriosis and to compare recurrence of symptoms during follow-up. DESIGN Open-label, randomized trial. SETTING University hospital endometriosis center. PATIENTS Fifty-seven women with moderate or severe pelvic pain and laparoscopically diagnosed endometriosis. INTERVENTIONS Six-month treatment with goserelin depot (n = 29) or a low-dose cyclic OC (n = 28) followed by 6-month follow-up. MAIN OUTCOME MEASURES Variation in severity of symptoms during treatment and at the end of follow-up as shown by a linear analog scale and a verbal rating scale. RESULTS At 6 months of treatment, a significant reduction in deep dyspareunia was observed in both groups, with goserelin superior to the OC at linear analog scale assessment. Nonmenstrual pain was diminished on both scales without differences between treatments. Women taking the OC experienced a significant reduction in dysmenorrhea. At the end of follow-up, symptoms reappeared without differences in severity between the groups. CONCLUSIONS Low-dose cyclic OCs may be a valuable alternative for the treatment of dysmenorrhea and nonmenstrual pain associated with endometriosis. Symptoms recurred in most subjects 6 months after drug withdrawal.