Diagnostic accuracy of hysteroscopy in endometrial hyperplasia.

Objectives: To determine the diagnostic accuracy of hysteroscopy in the diagnosis of endometrial hyperplasia in women with abnormal uterine bleeding.

Methods: From 1993 through 1995, 980 women referred to our institution for abnormal uterine bleeding underwent diagnostic hysteroscopy with eye direct biopsy of the endometrium in case of macroscopic abnormalities. Hysteroscopic features were compared with pathologic findings in order to detect the reliability of the endoscopic procedure.

Hysteroscopic Polypectomy in the Office without Anesthesia.

Hysteroscopy is a reliable procedure not only for diagnosis, but also for office treatment of uterine pathologies that, until recently, required general or at least topical anesthesia. The vaginoscopic approach without a speculum and tenaculum avoids discomfort to patients and ensures complete compliance. We treated 253 endometrial and cervical polyps with 5F instruments and an office hysteroscope with operative sheath.

Hyperplastic Human Endometrium.

Endometrial hyperplasia is considered to be a frequent cause of menorrhagia. Traditionally, this pathology was diagnosed from specimens obtained by uterine curettage or after hysterectomy for benign disease. With hysteroscopy one can visualize the uterine cavity directly and perform guided biopsies of the endometrial mucosa.

Anatomic Impediments to the Performance of Hysteroscopy.

Infertility and menorrhagia in menopausal women are the most frequent indications for hysteroscopy. Often, however, the procedure turns out to be difficult or impossible due to stenosis and reduction in the size of the cervical canal. With the availability of more and more atraumatic endoscopic instrumentations and improvements in the technique, hysteroscopy can be performed in all women, whatever the obstacle.

The role of contact hysteroscopy.

Contact hysteroscopy has been replaced by a new technique based on the use of a special hysteroscope. The instrument was designed to study the squamocolumnar junction and the lesions of the portio. A new technique, endometrial dating, uses the Hamou hysteroscope to study endometrial physiology.

Endometrial hyperplasia and endometrial carcinoma induce a vasoproliferative response in the chick embryo chorioallantoic membrane.

Ten specimens of endometrial adenocarcinoma, of endometrial hyperplasia and uterine prolapse (the latter used as controls), respectively, were grafted onto the chick embryo chorioallantoic membrane (CAM) to investigate their angiogenic activity. The vasoproliferative response was assessed four days after grafting on histologic sections by a planimetric point-count method. Microvessel counts in the CAM area under and around the implants were significantly higher in endometrial adenocarcinoma than in endometrial hyperplasia and in the latter over the controls.

Pathological significance of first-trimester fetal nuchal oedema.

The pathological mechanism that causes the transient phenomenon sonographically defined as "nuchal translucency' is still poorly understood. Seven pregnancies in which the fetuses clearly presented this ultrasonic sign at 10-14 weeks' gestation were terminated because of an abnormal fetal karyotype. The pathological specimens, compared by morphometric analysis with normal fetuses of the same gestational age, showed oedema and dilatation of lymphatic capillary vessels.

[Gonadal function after chemotherapy for acute lymphoblastic leukemia].

Object of this study was to verify long term effects on gonadal function in pre- and pubertal patients affected by acute lymphoblastic leukemia (ALL). The population examined was represented by 15 patients, 10 males and 5 females, who came to our Unit after a period of time ranging from 4.5 to 6.

Successful establishment of pregnancy by superovulation and intrauterine insemination with sperm recovered by a modified Hotchkiss procedure from a patient with retrograde ejaculation.

Objective: To improve the quality of the sperm recovered from the bladder in a patient with retrograde ejaculation who already had failed to conceive after several attempts at IUI with sperm recovered by conventional techniques.

Setting: University Hospital.

Patients: A couple with male infertility due to retrograde ejaculation caused by the Zielke operation, a spinal fixation procedure performed to correct severe kyphoscoliosis.

Effect of oestrogen replacement on bone metabolism and cytokines in surgical menopause.

The effect of oestrogen replacement on bone metabolism and serum cytokine levels (IL1,IL6) was investigated in surgical menopause. The study included 40 female subjects; 10 healthy premenopausal women underwent total hysterectomy without oophorectomy. Thirty healthy premenopausal women underwent total hysterectomy with bilateral oophorectomy.

Angiogenesis in pre-eclampsia.

Objective: To study the angiogenetic activity of decidua basalis from primigravid women with pre-eclampsia.

Study Design: Fresh fragments of decidua basalis from 10 primigravid women with pre-eclampsia and from 10 healthy, control primigravid women, were grafted onto the chick embryo chorioallantoic membrane (CAM) at the 6th incubation day. Four days later the CAMs were fixed and the angiogenic response of the CAMs was assessed on histologic sections by a planimetric point-count method.

Magnetic resonance imaging in pregnancy: study of fetal cerebral malformations.

This paper reports 15 examinations by magnetic resonance imaging (MRI) performed in pregnant women whose fetuses had cerebral malformations identified by sonography. In all the cases the fetuses were immobilized by ultrasound-guided intravenous or intramuscular curarization. The diagnoses by MRI and ultrasound differed only in one case where an occipital meningocele had first been suggested.

Lymphocyte subpopulations in patients with cervical cancer.

The evaluation of the immunological aspects in cervical cancer has been a point of major interest in the past few years. Data found in literature are, however, often confusing. In order to identify changes in cell mediated immunoresponse in these malignancies, we have studied the lymphocyte subpopulations from peripheral blood samples in women with FIGO intraepithelial + IB stages vs a control group.

[Role of interleukin-1-alpha and growth factors in postmenopausal osteoporosis].

This study aims to verify the changes occurring in factors such as interleukin alfa-1 (IL1-alpha) and growth factor (GF1) during surgical menopause, with or without hormone replacement therapy. Forty patients, who underwent hysterectomy, entered this perspective and longitudinal study: in ten out of these forty patients the ovaries were preserved. The remaining thirty patients, whose ovaries were removed, were randomly given either estrogen or estro-progestin therapy or no therapy at all.

Does gestational diabetes represent an obstetrical risk factor?

In order to assess the clinical consequences of gestational diabetes in the index pregnancy, a group of patients with positive oral glucose challenge test and their matched controls have been closely followed up. No differences in perinatal outcome have been pointed out, except for the higher rate (p < 0.01) among diabetic patients of preterm delivery and pregnancy-induced hypertension.

Diagnosis of endometrial hyperplasia in women with abnormal uterine bleeding.

Background: Reliability of hysteroscopy in diagnosing endometrial hyperplasia in women with abnormal uterine bleeding.

Methods: Out of 105 patients with abnormal uterine bleeding 47 showed structural abnormalities. Comparative analysis between hysteroscopic and histological results in 58 women without gross abnormalities has been performed in order to verify sensitivity and specificity of hysteroscopy in the diagnosis of endometrial hyperplasia.

Lipid peroxidation products and antioxidant enzymes in red blood cells during normal and diabetic pregnancy.

Oxygen free radicals produced during normal aerobic metabolism have been implicated in several pathophysiological mammalian processes. The importance of free radical-mediated fatty acid oxidation has received much attention. The generation of active oxygen species may lead to lipid peroxidation and formation of reactive products, which may be involved in severe damage of cell molecules and structures.

[The selective embolization of the hypogastric arteries in the treatment of hemorrhages due to cervical carcinoma. The report of 2 clinical cases].

Transcatheter arterial embolization (TAE) has been reported to effectively control bleeding in the gynecological and obstetric field. We report the use of selective hypogastric arteries embolization in the management of severe persistent cervical bleeding in two patients affected by advanced cervical cancer. Bleeding stopped in both cases; no serious side-effects were noticed.

The diagnostic potential of fetal renal biopsy.

The feasibility of fetal renal biopsy has been investigated in order to assess the diagnostic value of the histological specimen. Two fetuses with a severe bilateral renal abnormality (multicystic dysplastic kidney, Meckel-Gruber syndrome with polycystic kidney) and one fetus with Down syndrome (no detectable structural anomaly) were sampled. Histological findings in the biopsy specimens of cases 1 and 2 were diagnostic of an early obstructive renal disease.

Primary malignant melanoma arising in an ovarian dermoid cyst: proposed use of radioimmunoscintigraphy with 99mTc-F(ab')2 antimelanoma antibody for staging and follow-up. Case report.

A case of primary amelanotic ovarian malignant melanoma arising in a dermoid cyst is presented. Grossly, inside the cyst, pigmented solid lesions were not detected. Histologically, an area with undeniable malignant microscopic features was revealed and its melanomatous identity was confirmed by positive S-100 protein and melanoma antigen immunoreactivity.

Abnormal cervical PAP smear leading to the diagnosis of gastrointestinal cancer without cervico-vaginal metastases.

We report the case of an unsuspected G.I. cancer in a patient with no clinical signs other than ascites and positive PAP-smear on admission.

Polymyositis and vaginal carcinoma.

The strange association of Dermatomyositis-Polymyositis (DM-PM) and cancer has been known for many years. We present the case of a 57-year-old woman with polymyositis refractory to steroid therapy, in whom extensive investigation finally revealed a squamous cell carcinoma of the vagina. The clinical course of myositis paralleled the course of vaginal cancer, with complete resolution of symptoms after radiotherapy for the malignancy.