Antiestrogenic therapy in breast cancer and endometrial modifications.

The aim of this retrospective study was to detect endometrial lesions in tamoxifen breast cancer users (menopausal state related). The meaning of genital bleeding during the treatment and the actual incidence of benign and malignant pathology of the endometrium related to length of treatment was also evaluated. Tamoxifen (TMX) is a nonsteroidal triphenylene derivate with clear antiestrogenic properties on the breast which is used as adjuvant treatment for breast cancer; potential adverse effects include endometrial lesions. Three hundred and sixty-six breast cancer patients were enrolled in this study; 292 patients were treated with 20 mg/daily of TMX as adjuvant therapy and the remaining 74 did not receive therapy. All patients were subdivided in premenopausal and postmenopausal, asymptomatic and symptomatic groups. All patients underwent ultrasound scans (to examine endometrial thickness) and hysteroscopic examinations before treatment and after one, three and five years. Endometrial biopsy under direct hysteroscopic vision was systematically performed. The pathological histology reports were classified under polyps, simple hyperplasia, complex hyperplasia, atypical hyperplasia, and carcinoma. A higher incidence of endometrial pathology was found only in symptomatic postmenopausal TMX treated patients (27.2% vs 19.5%) between the third and fifth year of treatment.

[A case of double ectopic pregnancy dealed with a laparoscopic management]. / Un caso di duplice gravidanza ectopica trattato per via laparoscopica.

UNLABELLED: Uterine horn pregnancy is a very rare condition and is associate with a high rate of maternal morbidity and mortality. The standard treatment is laparotomy. CASE: A 40-year-old woman, previosly undegone laparotomy surgery for extrauterine pregnancy, was admitted to hospital "Casa di Cura Malzoni" because ectopic pregnancy was diagnosed. The patient was treated with laparoscopic surgery.

[A review of 445 cases of laparoscopic hysterectomy: benefits and outcome]. / Review di 445 casi di isterectomia laparoscopica: vantaggi e outcome.

Hysterectomy is a major procedure indicated for women with gynaecologic pathologies. After reporting the first laparoscopic hysterectomy (Reich 1989), this technique has recently been considered as a safe and efficient alternative to traditional abdominal hysterectomy in the management of benign uterine pathologies when vaginal route is contraindicated. The laparoscopic approach should not be held to compete with vaginal hysterectomy. From 1995 to 2001 in our institute, the proportion of laparoscopic hysterectomy has increased and laparotomic hysterectomy has decreased. Between January 1999 and January 2001 we carried out 445 total laparoscopic hysterectomies. There were 5 laparotomy conversions for large uterus. The average haemoglobin drop was 1,36 g/dl. Median operative time was 95 +/- 27 min. The mean in postoperative stay was 2.7 +/- 0.8 gg. The postoperative complications were minimal. Laparoscopic approach is less painful, is associated to less blood loss, shorter hospital stay, more rapid recovery and a better assumption by affected women. Some disadvantages are reported too, such as larger operating time, high rate of complication and experience required for performing laparoscopy including a learning curve. A training period is necessary to standardize the operating procedure, to put in place methods of avoiding complication and to reach a plateau of surgical skill. The purpose of this study was to show the role of total laparoscopic hysterectomy and how it can be performed safely with a minimal morbidity after a period of training in which we worked out shrewdness to get a standardized technique with the most effective outcome.

Laparoscopic surgery in treatment of stage IIb cervical cancer after neoadjuvant chemotherapy. A case report and review of the literature.

BACKGROUND: A detailed operative procedure of laparoscopic radical hysterectomy (type III) with pelvic and aortic lymphadenectomy after neoadjuvant chemoterapy in treatment of Stage IIb cervical cancer is described. CASE REPORT: A 50-year-old patient with Stage IIb squamous cell carcinoma of the uterine cervix, who initially was not surgically resectable, received three courses of neoadjuvant chemotherapy that included ifosfamide 5 g/m2, cisplatin 50 mg/m2 and paclitaxel 175 mg/m2 (TIP). Following a partial clinical response to chemotherapy, the patient underwent laparoscopic type III radical hysterectomy with bilateral salpingo-oophorectomy and pelvic and paraaortic lymphadenectomy. The surgical procedure lasted 250 minutes. Blood loss was 310 ml. The patient was discharged on postoperative day 4. The mean length of the resected parametria and paracolpia was 4.1 cm and 2.0 cm, respectively. The number of dissected lymph nodes was 48:29 pelvic and 19 paraaortic nodes. No major intraoperative or postoperative complications occurred. The patient also underwent adjuvant radiation therapy. Follow-up was performed at six months so far. CONCLUSIONS: This experience suggests that such a surgical procedure is safe. Laparoscopic radical hysterectomy potentially allows for decreased perioperative morbidity and blood loss, faster recovery and better cosmetic results. Large studies with long term follow-up are needed to confirm that this approach may be proposed as an alternative to conventional surgery.

[Laparoscopically assisted vaginal hysterectomy Gasless. Retrospective study in patients with uterine fibroids]. / Colpoisterectomia con assistenza laparoscopica Gasless. Studio retrospettivo per uteri voluminosi.

PURPOSE: To evaluate the feasibility to perform laparoscopically assisted vaginal hysterectomy in patients who were not suitable for vaginal hysterectomy. PATIENTS AND METHODS: LAVH Gasless was carried out on 31 patients with uterine fibroids. Uterine weight ranged of 420-800 gr. RESULTS: There were 2 laparotomy conversion (6%) for uterus 800 gr; median operating time was 79 +/- 18 minutes (range 75-89); the average haemoglobin drop was 1.7 +/- 0.9 g/dl; the mean in postoperative stay was 3.7 +/- 0.7 days (range 3-5). Febrile morbidity > 38 degrees C were found in 3 cases. CONCLUSIONS: Laparoscopic assistance has advantages in performing transection of round and infundibolo-pelvic ligaments in vaginal steps and in controlling post-operative blood loss.

[Recovery of cervical portio epithelial integrity using radiofrequency: preliminary results]. / Il recupero dell'integrità epiteliale della portio mediante radiofrequenza: risultati preliminari.

PURPOSE: The aim of this study was to evaluate the efficacy of the radiosurgical procedure (high frequency, filtered wave-form energy) in the management of benign lesions of uterine cervix. MATERIALS AND METHODS: In a prospective study a radiothermal cautery treatment by micro-needle was performed to 168 women, attending a gynecology office, with an abnormal cervical cytology, istology and with a colposcopic diagnosis of benign cervical lesions with a total visibility of squamous columnar junction and no extended lesion of cervical canal. Cytology and colposcopy were used to follow up after treatment 3-4 months and 10-12 months after the procedure. RESULTS: 130 women (77.6%) obtained a complete recovery at the first follow-up. Partial treatment failure, defined as the persistence or recurrence of a small cervical lesion after three months, was observed in 19 women (18.2%) but after a second treatment in the 100% we obtained a complete recovery with a well visible squamous columnar junction. Radiothermal cautery procedure was advantageous with a shorter duration of surgery, lower cost, reduced operation bleeding, no need for pain-relieving medication and shorter duration of postoperative disability. CONCLUSIONS: This surgical procedure resulted an excellent technique to obtain a complete epithelial recovery of uterine cervix, easy and cheap to be executed in a outpatient office.

[Hyperemesis gravidarum--etiology and treatment]. / Eziologia e trattamento dell'iperemesi gravidica.

Hyperemesis gravidarum is a common pathology encountered by the obstetrician in 0.1-2% of all pregnancies. The purpose of our review, along with other literature, is to report general outline of the syndrome, with etiology, complications and some guidelines about conventional and newer therapy.