[Diagnostic hysteroscopy in abnormal uterine bleeding. Five-years' experience]. / L'isteroscopia diagnostica nel sanguinamento uterino anomalo. Cinque anni di esperienza.

BACKGROUND: Hysteroscopy has acquired a central role in the clinical diagnosis of intrauterine pathologies. This study evaluated the feasibility, procedure modality, tolerability, complications and diagnostic accuracy of hysteroscopy in the management of patients with abnormal uterine bleeding (AUB). METHODS: This retrospective study was carried out on 512 women (age range: 38-80 years, mean age: 63) with AUB who attended our hysteroscopy outpatient service from January 1996 to December 2001. After undergoing transvaginal sonography, the patients were referred for further diagnostic studies. Ambulatory hysteroscopy without premedication was performed using a Hamou hysteroscope and physiological solution or CO(2) as distension medium. Guided biopsy with a Novak cannula completed the examination. When focal lesions were found, the patients were referred for surgical treatment (hysteroscopic resection, hysterectomy, etc.). Hysteroscopic and histologic findings were then compared. RESULTS: Locoregional or general anaesthesia was required in only 9.3% of cases to complete the examination. Overall, the examination was well tolerated; one case of serious complications (vagal syndrome which resolved rapidly) and 18 cases of shoulder blade pain were recorded. The hysteroscopic picture was normal in 25% of cases, benign pathology was diagnosed in 58.6% and suspected malignant neoplasia in 16.4%. Correlation rates between hysteroscopic and histologic diagnoses are reported for the various hysteroscopic pictures. CONCLUSIONS: Ambulatory hysteroscopy was shown to be a simple, safe, well tolerated and reliable procedure in the diagnosis of AUB across all age groups. Its widespread use can drastically reduce the need for conventional curettage, thereby increasing patient satisfaction and lowering costs.

Endometrial lesions after tamoxifen therapy in breast cancer women.

Tamoxifen, a nonsteroidal antiestrogen with a partial estrogen-antagonist activity, is widely used as a hormonal adjuvant therapy for breast cancer in women with positive receptors for estrogens. Its prolonged administration has been associated with a series of collateral effects, among which the endometrial carcinoma is the most important. The aim of our study was to investigate an eventual correlation between a therapy with tamoxifen and the onset of endometrial lesions. We recruited 228 postmenopausal patients who had been operated on for breast cancer. They were divided into two groups according to the presence of positive or negative estrogen receptors. The group with positive receptors was subjected to hormonal adjuvant therapy by tamoxifen (20 mg/day for 5 years), while the group with negative receptors was not treated. All the patients underwent a hysteroscopic evaluation of the uterine cavity before and after treatment. The follow-up carried out 5 years later showed the presence of a statistically higher risk (p < 0.00001) of endometrial lesions, such as low glandular hyperplasia and polyps, than in the treated patients compared with untreated patients. On the other hand, because there was no onset of endometrial carcinoma, the risk of this kind of lesion turned out to be practically absent. In all the treated patients who did not evidence any endometrial lesions (n = 90) and in all those with negative receptors (n = 104) the endometrium seemed to have an atrophic aspect. In conclusion, according to these data, we believe that hormonal adjuvant therapy by tamoxifen (20 mg/day), associated with a periodic hysteroscopic evaluation, and eventually a directed biopsy of the endometrium in order to keep under control the frequent onset of benign endometrial lesions, does not absolutely seem to increase the risk of endometrial carcinoma.

[Ovarian pregnancy after intraperitoneal insemination (I.P.I.)]. / Gravidanza ovarica dopo intraperitoneal insemination (I.P.I.).

An observed case of ovarian pregnancy after intraperitoneal insemination (IPI) triggers a description of this new technique and a suggestion as to the possible dynamics of the ensuing ectopic pregnancy.

[The effects of lesions in several zones of the brain on cell multiplication in the glandular epithelium of the rat small intestine]. / Effets de lésions de quelques zones de l'encéphale sur la multiplication cellulaire dans l'épithélium des glandes de l'intestin grêle chez le rat.

Radio-frequency lesions of tubero-infundibular region of the hypothalamus are followed by a significant increase of the mitotic rate in the small intestine glandular epithelium in rats. This increase does not occur when radio-frequency lesions are located in the anterior and posterior hypothalamus, in the dorsomedial thalamus and in the cerebral hemispheres.