Stefania Rossi

Tolerability, side effects, and complications of hysterosalpingocontrast sonography (HyCoSy)

OBJECTIVE To evaluate the tolerability, side effects and complications of hysterosalpingocontrast sonography (HyCoSy). DESIGN Prospective study. SETTING University hospital. PATIENT(S) 669 infertile women. INTERVENTION(S) All patients were examined with HyCoSy and monitored for 30 minutes after the procedure. A telephone interview was subsequently carried out to record possible late side effects and postprocedural complications. MAIN OUTCOME MEASURE(S) Tolerability to the procedure was evaluated by means of an 11-point (0 to 10) numeric rating scale of the pain experienced. Postprocedural fever, pelvic infections, peritonitis, hemorrhage were recorded. RESULT(S) Of 660 patients who completed the examination, 483 (73.2%) completed the telephone follow-up after a period of 14.7 +/- 9.9 months from the procedure. The mean patient age was 34.5 +/- 4.3 years, and mean infertility duration was 28.1 +/- 23.2 months. The mean numeric rating scale was 2.7 +/- 2.5, and 10 patients (2.0%) required postprocedural drug treatment for pain relief. Mild vasovagal reactions were experienced in 20 cases (4.1%), and four patients (0.8%) had a severe vasovagal reaction. No late complications were reported. No patients required hospital admission after the procedure. CONCLUSION(S) In our series, HyCoSy was a well-tolerated examination with a very low rate of side effects and no late complications that required no atropine or anti-inflammatory drugs. These data support the safety of HyCoSy when performed as described, but further work is needed to estimate the rate of late complications and side effects in other settings.

Vaginal Drug Delivery: The First Uterine Pass Effecta

In the past few years targeted drug delivery has been one of the prime objectives of pharmaceutical developers, who wish to maximize desired effects on a “target organ” while minimizing any adverse consequences linked to systemic activity. Recently, numerous independent investigators have reported higher accumulations of drugs in the uterus when they were administered vaginally. Higher concentrations were observed in the uterus even when levels in the blood were lower than those achieved by systemic administration (i.m., transdermal). Similar findings have been reported with substances other than progesterone, such as danazol’ and terbutaline.2 These observations support the hypothesis that there is a high degree of direct vagina-to-uterus transport or a “first uterine pass effect.” To test this hypothesis we used a human ex vivo uterine perfusion and we applied 3H-progesterone directly over the rim of vaginal tissue removed with the uterus at the time of surgery.

Financial impact in the Italian Health Service of laparoscopic versus laparotomic surgery for the treatment of ovarian cysts

To assess the cost of two procedures for the removal of ovarian cysts, 200 pre-menopausal women were recruited for the surgical removal of ovarian cysts by laparoscopy (n = 100) and laparotomy (n = 100) according to case-control criteria. Patients operated by laparoscopy (mean age +/- SD 32.22 +/- 9.98 years) and laparotomy (mean age +/- SD 29.57 +/- 6.62 years) for ovarian cysts (mean diameters +/- SD 4.98 +/- 3.62 and 4.83 +/- 2.78 cm) had a post-surgical hospital stay of 3.12 +/- 0.41 and 7.25 +/- 1.08 days (P < 0.001) respectively. The total rate of complications occurring in patients operated by laparoscopy was 9 versus 53% (P < 0.001) of those operated by laparotomy; body temperature > 38 degrees C was recorded in 52/100 of patients operated by laparotomy versus 6/100 of those operated by laparoscopy. The mean cost for each pure surgical treatment performed by laparoscopy was US

Recurrence of Endometrial Polyps

498.17 versus US

Uterine Contractility in Patients with Endometriosis

642.47 when it was performed by laparotomy (P < 0.001). The laparoscopic surgical approach is more expensive in the first 36 operations, thereafter becoming cheaper. The mean of the entire overall expenditure was US

High cytokine expression and reduced ovarian reserve in patients with Hodgkin lymphoma or non-Hodgkin lymphoma

1142.08 and US

New insights in the selection and management of cancer patients applicants for ovarian tissue cryopreservation

2138.72 for laparoscopy and laparotomy (P < 0.001) respectively. The entire expenditure for laparoscopy is higher than laparotomy only until eight operations. In conclusion, laparoscopy versus laparotomy has resulted in a saving of US

The Financial Impact of Laparoscopy versus Laparotomy in the Treatment of Uterine Leiomyomata

14,429.3 for 100 operations while the saving on entire costs was US

Transplantation of cryopreserved ovarian tissue in a patient affected by metastatic struma ovarii and endometriosis

99,664.8.

Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy

Aims: To estimate the recurrence rate of patients with endometrial polyps and to evaluate whether the recurrence can be correlated with the histopathologic features of the polyp. Methods: Two hundred and eighty-two women with endometrial polyps in both pre- or postmenopausal period and suffering from abnormal uterine bleeding or not were treated by resectoscopic surgery in a tertiary university hospital and were subsequently followed to check for polyp recurrence. Results: Polyp recurrence rate after hysteroscopic surgery and correlation between recurrence and main demographic, hysteroscopic and histopathologic characteristics were analyzed. During mean ± SD follow-up period of 26.3 ± 19.7 months, the overall recurrence rate was high (13.3%) and did not vary (p = NS) with age, parity, weight or other demographic characteristics of the patients or with the hysteroscopic appearance. On the contrary, the histopathologic features showed significant differences between patients with and without polyp recurrence. Recurrence rate was higher (p < 0.001) in women with histopathologically hyperplastic polyps without atypia and lower (p < 0.001) in women with benign polyps. Conclusion: The study shows that after resectoscopic polypectomy, the recurrence rate of endometrial polyps is high (13.3%). Moreover, the hyperplastic polyps without atypia recur more frequently than benign ones.