Sandro Razzi

Treatment of severe recurrent endometriosis with an aromatase inhibitor in a young ovariectomised woman

Endometriosis is a chronic and progressive disease manifested by chronic pelvic pain and infertility and which may affect 2–10% of women of reproductive age. Because it is an oestrogen-dependent disease, the goal of current medical therapy is to induce hypoestrogenism or to antagonise oestrogen action. Oestrogen biosynthesis in women of reproductive age takes place primarily in the ovary, while after spontaneous or surgical menopause, the adipose tissue and adrenal glands are the main source. Aromatase P450 catalyses the conversion of androstenedione of adrenal origin to oestrogens, endometriotic tissues express it – 4 and prostaglandins are the most potent known aromatase stimulator in endometriotic stromal cells.

Surgical scar endometriosis after Cesarean section: A case report

Background. Cutaneous endometriosis is a rare condition. Case report. A 37-year-old woman came to our observation 3 years after Cesarean section for a nodule under the scar that became spontaneously painful during menstrual bleeding. Transabdominal ultrasound examination, serum CA125 determination and histopathological analysis of the nodule were performed. Ultrasound revealed the presence of an oval-shaped hypoechogenic neoformation, while the serum CA125 level was slightly increased, and a diagnosis of endometriosis was confirmed by the histopathological analysis of a surgical specimen. Conclusion. This is an interesting case of surgical scar endometriosis, and the etiopathogenetic mechanism of this location may be explained by a dissemination of endometrial tissue during the Cesarean section.

Efficacy of vaginal danazol treatment in women with menorrhagia during fertile age

OBJECTIVE To evaluate the clinical efficacy and patient satisfaction of danazol delivered vaginally as treatment for young women with menorrhagia. DESIGN Prospective study. SETTING University of Siena, Siena, Italy. PATIENT(S) Women with menorrhagia (n = 55; age range 25-35 years) after ultrasound and hysteroscopy. INTERVENTION(S) Low-dose danazol (200 mg/day) was daily administered by vaginal route for 6 months. MAIN OUTCOME MEASURE(S) Before and every month during the treatment women were requested: 1) to keep a diary of menstrual bleeding and to rate blood loss on a visual analog scale from 0 (no blood loss) to 10 (gushing-type bleeding); 2) to record side effects and their satisfaction with the therapy. Transvaginal ultrasound, blood count, serum chemistries, and serum concentration of LH, FSH, E(2), TSH, FT(3), FT(4), and PRL were evaluated before and after 6 months. RESULT(S) The severity of blood loss was significantly reduced in all of the women after 2 months of treatment. Uterine volume was significantly reduced, and hematocrit, hemoglobin, and red blood cell count increased in all of the women after 6 months. The medical treatment did not affect hormonal parameters, and menstrual cycle remained unaffected; few local vaginal adverse effects were recorded. CONCLUSION(S) Vaginal danazol resulted in effective medical treatment in young women with menorrhagia, and, because of a lack of significant adverse effects, it may be proposed as an alternative treatment.

Serum Inhibin B Correlates with Successful Ovulation in Infertile Women

AbstractPurpose: To investigate whether inhibin B and activin A serum and follicular fluid levels in infertile women undergoing induction of superovulation correlate with successful ovulation. Methods: Infertile women (n = 16) (30–43 years of age) undergoing induction of superovulation for assisted reproduction were studied. A blood sample was collected before and days 3, 8, and 12 during the induction of superovulation. A follicular fluid sample at the time of ovarian pick up was also collected. Serum and follicular fluid were assayed for inhibin B, activin A, and estradiol. Results: According to the successful follicular development women were divided in two groups: (A) responders (n = 10) and (B) poor responders (n = 6). Women of group A showed mean follicular fluid inhibin B levels higher than in group B (P = 0.001), while no significant difference for activin A levels was found. During induction of superovulation serum activin A levels did not change in both groups of women, while inhibin B and estradiol levels significantly increase only in responder women (P < 0.001). Serum inhibin B and estradiol levels correlated with follicles developed ≥10 mm (P = 0.000). Conclusions: Serum inhibin B is an effective marker of follicular development in infertile women undergoing induction of superovulation, and may represent a further marker for ovarian follicular capacity.

Yolk sac tumor in a young girl: a case report.

Background. Yolk sac tumor is a rare neoplasm characterized by high malignancy given its premature metastasis, that is frequent in adolescence. Case report. A 21-year-old woman came to our observation for an ovarian cyst (13 cm in diameter). Following salpingo-oophorectomy, it was revealed as a yolk sac tumor by histological diagnosis. The patient exhibited a highly elevated level of α1-fetoprotein (AFP) (1156 UI/ml). She is now undergoing chemotherapy treatment. Conclusion. This is an interesting case of yolk sac tumor in a young girl, at an age typical for germ cell tumor. AFP represents a valid marker resulting in a useful diagnostic tool.

Non-hormonal targets for the medical treatment of endometriosis

Endometriosis is a chronic condition characterized by growth of endometrial tissue outside the uterus. Common symptoms include dysmenorrhoea, dyspareunia, non-cyclic pelvic pain, and infertility. Endometriosis is often treated surgically upon diagnosis but with a higher rate of recurrence, suggesting that a combination of surgical and medical management might provide better outcomes. The primary goal of medical treatment is to interrupt the growth and activity of endometriosis lesions. Because of the chronic nature of this disease, long-term or repeated courses of medication may be required to control symptoms. Increasing knowledge about the pathogenesis of endometriosis at the cellular and molecular levels may give us the opportunity to use new pharmaceutical agents affecting angiogenesis, inflammation, oxidative stress, proliferation or apoptosis to prevent or inhibit the development of endometriosis.

Predicting pregnancy after surgery for pelvic endometriosis: A multivariate analysis based on objective clinical data

BackgroundEndometriosis is a common disorder in women of reproductive age and is a major cause of pelvic pain and infertility. Counseling women with endometriosis about their reproductive future re...