Pier Luigi Cherchi

Efficacy of low-dose intravaginal estriol on urogenital aging in postmenopausal women

Objective To assess the efficacy and safety of intravaginal estriol administration on urinary incontinence, urogenital atrophy, and recurrent urinary tract infections in postmenopausal women. Design Eighty-eight postmenopausal women with urogenital aging symptoms were enrolled in this prospective, randomized, placebo-controlled study. Participants were randomly divided into two groups, with each group consisting of 44 women. Women in the treatment group received intravaginal estriol ovules: 1 ovule (1 mg) once daily for 2 weeks and then 2 ovules once weekly for a total of 6 months as maintenance therapy. Women in the control group received inert placebo vaginal suppositories in a similar regimen. We evaluated urogenital symptomatology, urine cultures, colposcopic findings, urethral cytologic findings, urethral pressure profiles, and urethrocystometry before as well as after 6 months of treatment. Results After therapy, the symptoms and signs of urogenital atrophy significantly improved in the treatment group in comparison with the control group. Thirty (68%) of the treated participants, and only seven (16%) of the control participants registered a subjective improvement of their incontinence. In the treated participants, we observed significant improvements of colposcopic findings, and there were statistically significant increases in mean maximum urethral pressure, in mean urethral closure pressure as well as in the abdominal pressure transmission ratio to the proximal urethra. Urethrocystometry showed positive but not statistically significant modifications. Conclusions Our results show that intravaginal administration of estriol may represent a satisfactory therapeutic choice for those postmenopausal women with urogenital tract disturbances who have contraindications or refuse to undergo standard hormone therapy.

Perimortem cesarean delivery 30 minutes after a laboring patient jumped from a fourth-floor window: Baby survives and is normal at age 4 years

We describe the first case of a perimortem cesarean section on a patient who committed suicide during labor by jumping from the fourth-floor window of the labor ward. The cesarean section was performed 30 minutes after the death of the woman, and a child of 3037 g was born with an Apgar score of 0 at 1 minute. Today, 4 years later, the baby is well and has no apparent neurological problems.

Umbilical Artery Pulsatility Index in Pregnancies Complicated by Insulin-Dependent Diabetes mellitus without Hypertension

Objective: In a group of diabetic pregnant women, the umbilical artery pulsatility index (PI) was compared with both pregnancy complications and perinatal outcomes. Method: We evaluated 67 women with pregnancies complicated by insulin-dependent diabetes mellitus (IDDM), without hypertension. For the study we took the last umbilical PI value before delivery into consideration. Doppler results were not used for patient management. Umbilical artery PI was correlated with the route of delivery and the following perinatal complications: intrauterine growth retardation; cesarean sections for acute fetal distress; respiratory distress syndrome (RDS); neonatal hyperbilirubinemia; hypocalcemia; hypoglycemia; macrosomia, and neonatal intensive care unit (NICU). Results: Among the 67 diabetic patients enrolled in this study, 44 (66%) had umbilical PIs ranging from the 5th to the 95th percentile (PI mean ± SD = 1.2 ± 0.3), while 23 (34%) had PIs above the 95th percentile (PI mean ± SD = 1.6 ± 0.3). Among the group with pathologic umbilical PIs, analysis of the data revealed a significantly higher incidence of both cesarean sections for acute fetal distress and perinatal complications: RDS; hyperbilirubinemia; hypoglycemia, and the need for NICU, respectively. Conclusion: In 34% of the diabetic pregnant women without hypertension, we found increased vascular resistances. Among these patients the incidence of perinatal complications was higher, and both closer maternal metabolic control and stricter care of fetal conditions are needed.

A Rare Case of Primary Actinomycosis of the Breast Caused by Actinomyces viscosus: Diagnosis by Fine-needle Aspiration Cytology under Ultrasound Guidance

Abstract:  We report the case of a 27‐year‐old woman with primary actinomycosis of the breast. Diagnosis was established by culture examination of specimen recovered by fine‐needle aspiration cytology (FNAC) under ultrasound guidance. To our knowledge, this is the first description in the literature of a case of primary actinomycosis of the breast caused by Actinomyces viscosus. Twenty‐nine previous cases of primary actinomycosis of the breast have been published, but these were caused by the more common species Actinomyces israelii. Targeted antibiotic therapy did not ameliorate the condition, thus drainage and excision of the mass were carried out. No other medical therapy was administered. Six years after surgery, no recurrence has been observed on both ultrasonographic and mammographic examinations. 

Lymph Node Axillary Metastasis from Occult Contralateral Infiltrating Lobular Carcinoma Arising in Accessory Breast: MRI Diagnosis

Abstract:  We describe a case of right axillary lymph node metastasis of an occult infiltrating lobular carcinoma arising from accessory mammary gland of the left upper anterior chest wall. Ultrasonography and mammography were normal bilaterally. Magnetic resonance imaging (MRI) revealed a 3.34 cm inhomogeneous lesion. Then, core biopsy under ultrasound guidance demonstrated a typical infiltrating breast lobular carcinoma. To our knowledge, this is the first case reported in the literature of an axillary lymph node metastasis from an occult contralateral infiltrating lobular carcinoma of the accessory breast tissue. MRI was useful for assessing the lesion of the accessory breast tissue.

Polycystic ovary syndrome, adipose tissue and metabolic syndrome

AbstractPurposePolycystic ovary syndrome (PCOS) is the most common endocrine disorder that affects women of reproductive age and is characterized by ovulatory dysfunction and/or androgen excess or polycystic ovaries. Women with PCOS present a number of systemic symptoms in addition to those related to the reproductive system. It has been associated with functional derangements in adipose tissue, metabolic syndrome, type 2 diabetes, and an increased risk of cardiovascular disease (CVD).MethodsA detailed literature search on Pubmed was done for articles about PCOS, adipokines, insulin resistance, and metabolic syndrome. Original articles, reviews, and meta-analysis were included.ResultsPCOS women are prone to visceral fat hypertrophy in the presence of androgen excess and the presence of these conditions is related to insulin resistance and worsens the PCO phenotype. Disturbed secretion of many adipocyte-derived substances (adipokines) is associated with chronic low-grade inflammation and contributes to insulin resistance. Abdominal obesity and insulin resistance stimulate ovarian and adrenal androgen production, and may further increase abdominal obesity and inflammation, thus creating a vicious cycle.ConclusionThe high prevalence of metabolic disorders mainly related to insulin resistance and CVD risk factors in women with PCOS highlight the need for early lifestyle changes for reducing metabolic risks in these patients.

Efficacy and 9 years' follow-up of posterior intravaginal slingplasty for genital prolapse

The aim of this study was to assess the long‐term efficacy and complication rates of posterior intravaginal slingplasty (IVS) in women suffering from genital prolapse.

Coexistence of a heterotopic pregnancy associated with a homolateral ovarian cyst in a patient submitted to elective abortion.

The authors describe the case of a right tubal pregnancy of delayed diagnosis in a 31-year-old nullipara, who was submitted to voluntary termination during the 7th week of pregnancy and who presented a homolateral ovarian cyst. Two weeks later the patient presented pelvic pain and intraperitoneal fluid layer, while plasma β-hCG was 1,262 IU/ml. The case history was complicated by recent termination surgery and presence of an ovarian cyst, but a plasma β-hCG assay and transvaginal ultrasonography oriented the diagnosis towards a previously unrevealed heterotopic pregnancy. The fallopian tube and the ovarian cyst were removed by laparoscopy. The case points out to the fact that, though rare, heterotopic pregnancy must always be considered one of the possible complications of spontaneous pregnancy.

Granular cell tumor of the breast.

Granular cell tumor of the breast is a rare, usually benign tumor that is encountered in women 30–50 years old, usually presenting as a palpable, painless mass. Ultrasonographic and mammographic findings are not specific for this tumor and histology is mandatory for certain diagnosis and to exclude malignancy.

Giant ovarian tumor complicating late pregnancy: A case report.

The incidence of benign ovarian tumors in pregnancy is onecase out of 112 deliveries (1). The most common pathologiclesions are benign cystic teratomas (45%) following by cystad-enomas (31.5%) (2).The reported malignancy rate of ovarian tumors during preg-nancy is about ten times lower than in the non-pregnant popu-lation and is not more than 8% (3).Benign teratomas generally do not grow beyond 15 cm indiameter unlike cystadenomas which more commonly achievelarger dimensions (2).We report the case of a pregnant woman in the 34th week ofher pregnancy affected by an ovarian mucinous cystadenomawhich, to our knowledge, is larger than anything described inthe literature up to now.