Stefano Floris

Evidence that treatment with monophasic oral contraceptive formulations containing ethinylestradiol plus gestodene reduces bone resorption in young women

The aim of the study was to evaluate if a pill containing the same dose of the same type of progestin compound (gestodene, GES, 75 microg) but different doses of ethinylestradiol (EE2) (20 or 30 microg) differently influences specific markers of bone resorption (urinary levels of pyridinoline (PYR) and dexoxypyridinoline (D-PYR)). During the 12 months of the study a significant decrease of urinary levels of PYR and D-PYR was found in 2 groups of young post-adolescent women taking the pills with 20 and 30 microg of EE2 in comparison with control women (subjects of the same age group with normal menstrual cycle who did not use contraception). In women taking pills with 20 or 30 microg EE2, the levels of sex hormone-binding globulin (SHBG) significantly increased during treatment in comparison with baseline, whereas in the same time period no changes occurred in control women. These findings suggest that similar to the pill containing 30 microg EE2, the lower dosage of the EE2 pill (20 microg) is also capable of reducing bone resorption. Twenty and 30 microg EE2 pills exert the same biological estrogenic effect. In fact, SHBG levels significantly increased with both pills. However, an additional effect of the progestin compound that could act directly on progestin or estrogen receptors of bone cannot be excluded. Since contraception with a pill containing the lowest estrogen dose is associated with the lowest incidence of side effects, these findings further suggest a pill containing 20 microg EE2 for young post-adolescent women would be the best choice.

Three-Dimensional Quantification of Tumor Vascularity as a Tertiary Test After B-Mode and Power Doppler Evaluation for Detection of Ovarian Cancer

The purpose of this study was to investigate the role of 3‐dimensional (3D) quantification of tumor vascularity in the differential diagnosis of pelvic indeterminate masses with a solid appearance or unilocular or multilocular cysts with a solid component showing central vascularization on 2‐dimensional power Doppler sonography.

Reproducibility of Endometrial Vascular Patterns in Endometrial Disease as Assessed by Transvaginal Power Doppler Sonography in Women With Postmenopausal Bleeding

Objective. The purpose of this study was to assess the intraobserver and interobserver agreement for identifying different endometrial vascular patterns using power Doppler sonography in women with postmenopausal bleeding and a thickened endometrium. Methods. Digitally stored sonographic images from a random sample of 65 patients with postmenopausal bleeding and a thick endometrium (>5 mm) on B‐mode sonography and evaluated by transvaginal power Doppler sonography for assessment of endometrial blood flow mapping were evaluated by 5 different examiners with different levels of expertise in Doppler sonography. Intraobserver and interobserver agreement according to the level of experience were assessed by calculating the κ index. Results. Intraobserver agreement was good or very good for all experienced examiners (κ = 0.78–0.96) and moderate (κ = 0.52) for the inexperienced examiner. Interobserver agreement was moderate among all experienced examiners (κ = 0.45–0.80). The inexperienced examiner showed fair or moderate interobserver agreement (κ = 0.32–0.45). Conclusions. Our results indicate that endometrial blood flow mapping using transvaginal power Doppler sonography is acceptably reproducible. More experience was associated with better intraobserver and interobserver agreement.

Efficacy and safety of oral and transdermal hormonal replacement treatment containing levonorgestrel

OBJECTIVES The oral combined formulation of levonorgestrel with estradiol valerate (LNG+EV) has demonstrated to be effective on some postmenopausal symptoms. The availability of a transdermal HRT in sequential formulation with 17-beta-estradiol plus levonorgestrel (TSE2+TSLNG) induced us to do this control-study with the aim to evaluate the efficacy and safety of both oral and transdermal treatments. METHODS At baseline, the psychological symptoms with the psychometric scale SCL-90, the bone resorption with the measurement of the urinary levels of pyridinoline and dexoxypirydinoline, and the insulin and lipid metabolism were assessed in 30 postmenopausal women (PMW) and in 18 premenopausal women. Then, the PMW women were randomly divided in three groups: group A (N=10) assumed EV+LNG, group B (N=10) did not assume any treatment, group C (N=10) was treated with TSE2+TSLNG. The length of the study was 12 months. The aforementioned assessments were repeated at different time-intervals up to the end of the study. RESULTS The total score of SCL-90, the bone resorption, the levels of LDL-cholesterol, total-cholesterol and the parameters of insulin metabolism were higher in PMW than in premenopausal women. During the study, the SCL-90, the bone resorption, total-cholesterol, and LDL-cholesterol levels significantly decreased only in the groups A and C. By contrast, in the group B bone resorption significantly increased at the 12th month. During the treatments, insulin metabolism did not change in the groups A and B. In the group C the secretion of C-peptide and the C-peptide:insulin ratio after OGTT were significantly higher at the 12th month than before treatment. In all groups the endometrium thickness did not change during the study. CONCLUSION A 12-month of either oral or transdermal HRT containing levonorgestrel seems to exert beneficial effects on the main postmenopausal symptoms without negative interferences on the endometrium.

Effect of chronic administration of cabergoline on uterine perfusion in women with polycystic ovary syndrome

OBJECTIVE To confirm whether patients with polycystic ovary syndrome (PCOS) have a reduction in uterine perfusion and to verify whether chronic administration of cabergoline can decrease this high vascular resistance. DESIGN Prospective randomized trial. SETTING Endocrinological Centre of the Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy. PATIENT(S) Thirty patients were enrolled in the study: 20 affected by PCOS and 10 healthy controls. Patients with PCOS were randomly assigned to one of two treatments for 3 months: oral administration of cabergoline (0.5 mg) every week or oral administration of placebo every week. INTERVENTION(S) All patients underwent transvaginal ultrasonography associated with Doppler flow measurement of the uterine artery, and serum hormone concentrations were determined during the early follicular phase. In women with PCOS, Doppler flow measurement and hormonal assessment were repeated in the early follicular phase of the third month of treatment. MAIN OUTCOME MEASURE(S) Pulsatility index of the uterine artery before and during treatment. RESULT(S) The mean pulsatility index of the uterine artery in patients with PCOS was significantly higher than that of the control group (3.29+/-0.5 and 2.01+/-0.2, respectively). Patients with PCOS treated with cabergoline showed a significant increase in uterine perfusion, with a pulsatility index of 3.14+/-0.6 before and 2.39+/-0.5 during the treatment. No difference was found in patients with PCOS treated with placebo. CONCLUSION(S) Patients with PCOS have high resistance in the uterine arteries, but chronic administration of cabergoline can increase uterine perfusion.

OC176: Three‐dimensional (3D) quantification of tumor vascularity as third step after B‐mode and power Doppler evaluation for detection of ovarian cancer

gadolinium injection. For the myometrial invasion, we used the FIGO classification: 1a (without myometrial invasion), 1b (< 50% myometrial invasion), 1c (> 50% myometrial invasion). Results: The pathological analysis showed that 15% of women were stage 1a, 31%, stage 1b and 54%, stage 1c. As far as the myometrial involvement is concerned, the sonographic report was correct in 9 out of 13 patients (69%). The MRI conclusion was concordant with the histology in 9 patients out of 11 (82%). The sonography found more overestimations, but recognized all stage 1c diseases. The MRI gave one overestimation and one underestimation, but was inaccessible for two patients (no place). Conclusion: In the extension staging of an early endometrial carcinoma, the endovaginal sonography, with all its potentialities, seems to be promising, as it seems to give nearly equivalent results has the MRI, with a lower cost and an easier access. This preliminary study stimulates us to extend the study on a larger scale.

OC07: Diagnosis of location of deep infiltrating endometriosis by transvaginal tenderness‐guided ultrasonography

variables could improve ultrasound prediction of fetal macrosomia over prediction which relies on the commonly used formulas for the sonographic estimation of fetal weight. Methods: The δ SVM algorithm was used for binary classification between two categories of weight estimation: > 4000 g and < 4000 g. Clinical and sononographic input variables of 100 pregnancies suspected of having LGA fetuses were tested. Results: Thirteen of 38 features were selected as contributing variables that distinguish birth weights of below 4000 g and of 4000 g and above. Considering 4000 g as a cut-off weight the pattern recognition algorithm predicted macrosomia with a sensitivity of 81%, specificity of 73%, positive predictive value of 81% and negative predictive value of 73%. The comparative figures according to the combined criteria based on two commonly used formulae generated from regression analysis were 88.1%, 34%, 65.8% and 66.7%. Conclusions: The δ SVM algorithm provides a prediction of LGA fetuses comparable to that of other commonly used formulae generated from regression analysis. The better specificity and better positive predictive value suggest potential value for this method and further accumulation of data may improve the reliability of this approach.

OP16.07: Intraobserver and interobserver agreement of B‐mode typical ultrasonographic patterns suggestive of presence of ovarian malignancy

Objectives: Neoadiuvant chemotherapy (NAC) has been proposed as a possible alternative to up-front debulking surgery in advanced ovarian cancer. We evaluated the response to NAC by transvaginal sonography (TVS). Methods: Twenty-six patients with histologically confirmed diagnosis of ovarian cancer underwent TVS before and during NAC (first, third and sixth cycle). We evaluated the regression of tumor size according to RECIST criteria, the regression of ascites according to a quantitative score (0: absence, 1:< 2 cm, 2:> 2 cm, 3:> 5 cm), the regression of peritoneal implants and intratumoral blood flow. After six cycles of NAC, interval debulking surgery (IDS) was performed in responder patients; non-responders had a second line of chemotherapy. We compared sonographic evaluation of response to NAC to pathological response. Results: Among 26 patients prospectively enrolled in the study (mean age 60), 13 were stage IIIC and 13 were stage IV; 19 patients had NAC and IDS and seven had second-line chemotherapy. Measurement of tumor size showed a regression> 90% in 5/26 patients, > 50% and< 90% in 16/26 patients and persistent disease in five patients. Before NAC ascites was seen in 23/26 (88.5%) patients and after treatment it disappeared in 17 patients. In 6/7 (85%) patients with persistent or progressive disease, ascites was found until the sixth cycle. Peritoneal implants were seen in 18/26 patients (69%); after NAC peritoneal implants disappeared in 14/18 (78%) patients. Intratumoral blood flow was found in 22/26 (84%) patients; after NAC vascularization was not detectable in 13 patients, while a persistent small venous vessel was observed in nine. Conclusions: TVS seems to be feasible and accurate in the evaluation of response to NAC, showing ascites pattern of evolution as the more accurate feature: persistence of ascites can be considered a pattern of non-responder patients to NAC.

OP16.03: Reproducibility of different patterns of benign ovarian masses assessed by transvaginal ultrasonography evaluated by several operators with different degree of experience

Mean birth weight was 2922 g (SD 316) versus 2474 g (SD 751) (P = 0.025). In MC twins, survival was 80.0% (4/5) in the first group versus 86.9% (20/23) in pregnancies managed conservatively (P = 0.7). Mean gestational age at birth was 35.2 (SD 2.9) weeks in the first group versus 32.7 (SD 3.4) weeks in the second group (P = 0.14). Preterm delivery (< 34 weeks) was reported in 50.0% (2/4) versus 68.2% (15/22) (P = 0.48). Mean birth weight was 2711 grams (SD 596) versus 1667 grams (SD 372) (P = 0.0001). Conclusions: This is the first systematic review on the management of twins discordant for anencephaly. In dichorionic twins, we found a significant increase in mean gestational age and weight at delivery, therefore supporting the use of selective feticide in these pregnancies. In monochorionic twins selective feticide also seems to be preferable but the lack of sufficient data and the complexity of this pathology make it hard to draw clear conclusions in this group.

OC198: Sonohistology: the use of simple findings to predict the histological diagnosis in more than 900 adnexal masses evaluated by a single center

I concentration. Cardiac troponin I (cTnI) is a specific marker of myocardial injury in adults and children. Perinatal asphyxia can cause cardiac dysfunction. Methods: Some 161 samples among fetuses from pathological pregnancies were collected. Twenty-two had an elevated level of cTnI (above 0.1 ng/mL). Disorders in pregnancy, date of gestation, Doppler flow velocimetry in the ductus venosus (DV) and umbilical artery (AU) and vein (DV), mode of delivery, Apgar score and respiratory status after birth were evaluated. cTnI was determined on a dimension clinical chemistry system. Results: There were 22 newborns with a raised level of TnI: seven (31.8%) with SGA, five (22.2%) with fetal cardiac problems (arrhythmia, structural and functional abnormalities), nine (40.9%) with abnormal biophysical test results (abnormal Doppler velocimetry, computerized cardiotocography, biophysical profile score) and six (27.2%) whose mothers who had disorders (diabetes mellitus, hypertension). Results are shown in the table. Median gestational age at delivery was 36.6 (range, 27–43) weeks. Seventeen (77.2%) patients had a Cesarean section. The range of TnI blood concentration was 0.11–6.66 ng/mL in this group. Five (22.7%) had umbilical pH below 7.25. Conclusions: A high level of cTnI was associated with several disorders that could have led to fetal asphyxia. More detailed fetal heart examination is necessary to prove that fetal asphyxia had an impact on heart function.