Laura Giambanco - Academia.edu (original) (raw)
Papers by Laura Giambanco
Ugeskrift for laeger, Jan 2, 1989
Copyright © 2014 Laura Giambanco et al. This is an open access article distributed under the Crea... more Copyright © 2014 Laura Giambanco et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Brugada syndrome is characterized by a disruption of heart’s normal rhythm. It is an autosomal dominant disease due to a mutation of SNC5A gene. Its prevalence is low all over the world, but it is a lethal disease. Sudden cardiac death is the result of phenotypic manifestation of Brugada syndrome. Among asymptomatic Brugada patients, arrhythmia could be provoked by physical activity, fever, or pregnancy. About obstetrical management, very few data or reports have been published since this syndrome has been diagnosed in late 1992. Case Presentation. A 20-year-old pregnant woman at 13 weeks of gestation was referred
International journal of hygiene and environmental health, Apr 24, 2016
Polychlorinated dibenzodioxins (PCDDs), polychlorodibenzofurans (PCDFs), and polychlorobiphenyls ... more Polychlorinated dibenzodioxins (PCDDs), polychlorodibenzofurans (PCDFs), and polychlorobiphenyls (PCBs) are persistent organic pollutants that represent a major concern for women of reproductive age because of the neurodevelopmental effects associated to perinatal exposure. This study was aimed at characterizing exposure of women of reproductive age to PCDDs, PCDFs, and PCBs as a function of residence in different Italian Regions, in areas at presumable different environmental contamination and human exposure to these pollutants. Study participants were enrolled in 2011-2012 in 6 Italian Regions representative of Northern, Central and Southern Italy; in each region, areas at presumed different exposure (rural, urban and industrial) were selected for enrolment. Each participant provided a serum sample for the analysis of PCDDs, PCDFs and PCBs. Median concentrations of PCDDs+PCDFs, DL-PCBs, NDL6-PCBs and NDL9-PCBs in serum samples were respectively 6.0 and 3.5 pgWHO-TE05/g fat, and 75...
Case Reports in Obstetrics and Gynecology, 2014
Introduction. Brugada syndrome is characterized by a disruption of heart’s normal rhythm. It is a... more Introduction. Brugada syndrome is characterized by a disruption of heart’s normal rhythm. It is an autosomal dominant disease due to a mutation of SNC5A gene. Its prevalence is low all over the world, but it is a lethal disease. Sudden cardiac death is the result of phenotypic manifestation of Brugada syndrome. Among asymptomatic Brugada patients, arrhythmia could be provoked by physical activity, fever, or pregnancy. About obstetrical management, very few data or reports have been published since this syndrome has been diagnosed in late 1992.Case Presentation. A 20-year-old pregnant woman at 13 weeks of gestation was referred to our department because of her familial history of sudden cardiac deaths. Brothers and sisters of her mother died of Brugada syndrome in childhood or older and live components of this family were carrier of mutation in Brugada gene. The pregnancy was uneventful. The patient gave birth vaginally without any arrhythmia. Strictly cardiological monitoring was pe...
Pan African Medical Journal, 2014
pregnancy, the implantation of a fertilized ovum outside the endometrial cavity, occurs in 1.5%-2... more pregnancy, the implantation of a fertilized ovum outside the endometrial cavity, occurs in 1.5%-2% of pregnancies. It is one of the major causes (about 6%) of maternal death during the first trimester of pregnancy. The remaining 5% implant in the ovary, peritoneal cavity, within the cervix, and the omental pregnancy is the least common form of abdominal pregnancies. A review of the literature on Medline for the period 1958-2012 reported only 16 cases of omental pregnancy. Here we report a case of primary omental pregnancy in a nulliparous woman. A 24 year-old woman gravid 1, para 0, with lower abdominal pain. Her last menstrual period occurred 8 weeks before the visit. The physical examination revealed abdominal tenderness in the lower quadrants, she was not bleeding. Transvaginal ultrasound showed: a free anechoic/hypoechoic area of 30 x 57 mm in the pouch of Douglas and the endometrium was homogeneus with a thickness of 12 mm and no evidence of gestational sac in the uterine cavity. Laboratory data revealed a normal cell blood count and beta hcg levels of 8047 IU / L. Because of continuing abdominal pain and a diagnosis of ectopic pregnancy a diagnostic laparoscopy was performed, which showed hemoperitoneum. Further inspection of abdominal cavity revealed a bloody lesion that was tenaciously adherent to the omentum, using non traumatic laparoscopic forceps and bipolar scissors we carefully removed a friable mass of about 30 mm from the omental attachments. Histological examination showed the presence of blood clot material mixed with trophoblastic tissue. Ultrasound evaluation and and hCG assessment are important to determine the extrauterine location of the ectopic pregnancy but the early diagnosis of abdominal pregnancy requires also a laparoscopic evaluation and , as our case has highlighted, thorough abdominal exploration especially in the absence of adnexal findings when ectopic pregnancy is highly suspected. Early diagnosis of omental pregnancy is difficult but essential to reduce the high mortality risk for the mother.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2014
To evaluate outcomes of women undergoing cesarean hysterectomy for abnormal invasive placenta (AI... more To evaluate outcomes of women undergoing cesarean hysterectomy for abnormal invasive placenta (AIP) with and without preoperative balloon catheter placement in internal iliac arteries. A prospective observational study of women with ultrasound diagnosis of AIP and a planned delivery at our institution. From January 2004 to June 2009, all AIP cases were treated with planned multidisciplinary cesarean hysterectomy alone (CHa group). From July 2009 to September 2013 a pre-operative balloon catheter protocol was introduced (BC group). Statistical analysis considered the entire sample (placenta accreta/increta and percreta) and the individual subgroups (accreta/increta vs percreta). Twenty-three cases of AIP (10 accreta/increta and 13 percreta) were treated with cesarean hysterectomy alone, and 30 cases of AIP (12 accreta/increta and 18 percreta) were treated with cesarean hysterectomy and pre-operative balloon catheters. For the entire sample, a significant difference in estimated blood loss and transfused blood products units was observed between CHa group and BC group. When women with placenta accreta/increta and women with placenta percreta were analysed separately, no difference in estimated blood loss and transfused blood products units was found between the BC and the CHa groups in women with placenta accreta/increta. However, in women with placenta percreta, mean estimated blood loss and transfused blood products units were higher in the CHa group compared with BC group (1507ml vs 933.33ml; 3.31 units vs 0.67 units). Postoperative recovery differed between the two groups, but no differences were observed in any other outcomes. Pre-operative placement of intravascular balloon catheters is a feasible treatment for AIP, and is particularly useful in cases of placenta percreta.
Journal of Endometriosis, 2011
Purpose Endometriosis remains a challenging condition for clinicians, research scientists, and pa... more Purpose Endometriosis remains a challenging condition for clinicians, research scientists, and patients alike. Routine clinical examination is insufficient to diagnose and evaluate the extent of pelvic endometriosis which can be assessed by means of imaging techniques, including transvaginal sonography (TVS), transrectal sonography (TRS), rectal endoscopic sonography (RES), and magnetic resonance imaging (MRI). Our purpose was to analyze the different imaging techniques and their efficacy for the ultrasound diagnosis of pelvic endometriosis. Materials and methods This review examined 85 studies on the ultrasound diagnosis of endometriosis published between 2005 and 2010. The structure of the review is based first on the anatomical location of the endometriosis lesion, and then on the study of the techniques used, including transvaginal sonography, transrectal sonography, rectal endoscopic sonography, and MRI. Results TVS is the first-line imaging technique for diagnosing pelvic endometriosis. Many studies have demonstrated that sensitivities and specificities of TVS for diagnosing endometriomas range from 75% to 91% and 88% to 99%, respectively, while for RES the percentages are 88% and 90%, respectively, for the diagnosis of intestinal endometriosis. TVS and RES can correctly diagnose posterior deep infiltrating endometriosis (DIE) with an accuracy of 86.4% and 74.1%, respectively. Conclusions The analysis of these results show that ultrasound is the first-line diagnostic technique for the diagnosis of pelvic endometriosis. RES can help to identify the presence and the degree of wall infiltration of bowel sites. However, in patients with a consistent clinical suspicion of deep endometriosis, MRI is a good “all in one” examination to diagnose and define the exact extent of DIE.
The Journal of the American Association of Gynecologic Laparoscopists, 1998
Journal of Minimally Invasive Gynecology
PAMJ Clinical Medicine
HPV infection is widespread. Approximately 40 HPV serotypes infect ano-genital area, but most inf... more HPV infection is widespread. Approximately 40 HPV serotypes infect ano-genital area, but most infections are asymptomatic and can get cleared spontaneously. HPV clearance is modified during pregnancy. Many information have been published about HPV infection and preterm birth, unfortunately the results are often not corresponding. The aim of this study was to understand whether there is an association between HPV infection and preterm birth. In our study we reported results about 20 pregnant women admitted for preterm birth. We assessed if and how papillomavirus cervical infection affects pregnancy outcome. HPV prevalence in pregnant women in this case series was 45% (9/20), while 55% pregnant women were found HPV-negative (11/20). There was no difference between HPV positive group and HPV negative group in terms of gestational age at delivery, neonatal weight, Apgar score. Our data, even though from a very small series, confirm the absence of different outcomes due to HPV infection. It has been reported that women with H-SIL have a higher baseline risk for PTB than general population and treatment for H-SIL probably increase this risk further. The research on HPV and PTB should go straight to this direction.
Open Journal of Obstetrics and Gynecology
Disclaimer of liability Statements and opinions expressed in the articles and communications are ... more Disclaimer of liability Statements and opinions expressed in the articles and communications are those of the individual contributors and not the statements and opinion of Scientific Research Publishing, Inc. We assume no responsibility or liability for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained herein. We expressly disclaim any implied warranties of merchantability or fitness for a particular purpose. If expert assistance is required, the services of a competent professional person should be sought.
Journal of Obstetrics and Gynaecology Research
Vulvar carcinoma represents 3–5% of all female genital cancers; the main surgical treatment is ra... more Vulvar carcinoma represents 3–5% of all female genital cancers; the main surgical treatment is radical vulvectomy and inguinal lymphadenectomy. The aim of this study is to analyze prognostic factors in the patients underwent to primary surgery for vulvar carcinoma.
Surgical Oncology
OBJECTIVE To demonstrate step-by-step minimally invasive surgical technique for dissection of iso... more OBJECTIVE To demonstrate step-by-step minimally invasive surgical technique for dissection of isolated inguinal node relapse of high grade serous ovarian cancer. METHODS A 54-year-old woman, BRCA1 +, underwent to open abdominal total hysterectomy, bilateral salpingo-oophorectomy, total omentectomy, pelvic and aortic lymphadenectomy with zero residual disease, for high grade serous ovarian carcinoma FIGO stage IIB. After surgery, patient underwent platinum-based chemotherapy for six cycles and follow-up examinations every 3 months for the first year and biannual for the second one. Abdominal TC-PET scan after 18 months revealed a right distal iliac external/inguinal nodal relapse (SUV max 18,4). Ca125 was 9,1 mUI/ml. Right pelvic peritoneum was opened (step 1) and right retroperitoneal spaces were developed. Ureter was medialized (step 2) and obturator fossa was developed (step 3). Access to the deep inguinal ring (step 4) allows to identify inguinal lymph node relapse caudally to deep iliac circumflex artery. Bulky node was isolated (step 5) and excised en-block with obturator nodes (step 6). The entire procedure was performed using only a bipolar combination instrument for laparoscopy. Operating time was about 120 minutes and estimated blood loss was <100 ml. RESULTS Pathology confirmed relapse of high grade serous ovarian cancer (CK7+; WT1+). Patient was discharged in post-operative day 3 without complications. CONCLUSION Minimally invasive surgery for excision of isolated inguinal node relapse of ovarian cancer is a feasible and effective technique.
Pan African Medical Journal
Massive and severe epistaxis is an uncommon event in pregnancy. It could be life threatening and ... more Massive and severe epistaxis is an uncommon event in pregnancy. It could be life threatening and could affect the normal preg nancy course. The best management is still on debate; it could be medical, conservative or surgical. Pregnancy termination often is problem solving. Hormonal changes during pregnancy affects nasal physiology. Vaginal delivery, labour induction or cesarean section are all suitable, after hemodynamic stabilization of pregnant woman. We report a case and review the available literature.
Journal of Endometriosis and Pelvic Pain Disorders
Endometriosis causes a decrease in fertility in affected patients. The different forms of the dis... more Endometriosis causes a decrease in fertility in affected patients. The different forms of the disease, peritoneal, ovarian, deep infiltrating and adenomyosis, are often present in varying degrees in the same patient, either together or individually, and cause infertility through a pathogenesis that is not yet clear. A significant number of women with endometriosis and endometriomas will eventually seek assisted reproductive technology (ART) for conception. The specific impact of endometriomas alone and the impact of surgical intervention for endometriomas on the reproductive outcome of women undergoing in vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI) are areas that need further clarification and, for this reason, the management of endometriomas before clinical IVF is a very complex topic. In order to provide useful information for the clinical management of patients with endometriomas having IVF, in this review we investigated: the impact of the presence of endome...
International Journal of Gynecology & Obstetrics, 2012
International Journal of Gynecology & Obstetrics, 2012
Objectives: Cervical pregnancy is a rare life-threatening ectopic pregnancy; its incidence has be... more Objectives: Cervical pregnancy is a rare life-threatening ectopic pregnancy; its incidence has been estimated 1/1000–1/18000 of all pregnancies. We report our experience on a single case of cervical pregnancy successfully treated conservatively. Materials: A 32 years-old nulliparous woman, 8 weeks pregnant, was referred to our department after an ultrasound examination with an identification of isthmic gestational sac and diagnostic doubt of spontaneous abortion vs cervical localization of pregnancy. Transvaginal ultrasound evaluation by an expert operator showed a cervical gestational sac within an embryo (CRL7mm) and presence of vascular activity. Endometrium appareance was as a decidual reaction. Methods: The woman was admitted to our department, blood exams, urine exam and ECG were performed. Beta hCG serum levels were evaluated every 48h after administration of systemic MTX. At admission therapeutical options were explained to woman, underlyning the high risk for hemorrhage: -sistemic MTX -intraamniotic MTX – uterine arteries embolization if both previous options failed. A single dose systemic MTX protocol was choosen (50mg × m), the Mosteller formula was used for calculating body surface (m) (weight 60 kg; height 164 cm, 1.65m body surface). After 24 hours 50mg MTX were injected into amniotic sac under continous ultrasound visualization, because fetal heart beat was still present. Results: Serum levels oh Beta hCG were monitored every 48 hours, showing a plateau for the first 3 days, followed by a continous decrease after fifth day post MTX. The woman was discharged on day 9 when transvaginal ultrasonography revelead absence of vital emmryo eventhough peritrophoblastic vascularization was still active. Post menstrual evaluation showed no peritrophoblastic vasculrization. Conclusions: Cervical ectopic pregnancy usually was misdiagnosed before performing a curettage with the obvious consequence of hysterectomy for massive hemorrhage. The development of transvaginal scans performed routinely during first trimester pregnancy allows an earl diagnosis with an accuracy of 80%. Sonographic diagnostic criteria have been identified: intracervical gestational sac with a normal shape, internal uterine orifice closed, trophoblastic invasion of uterine cervix through all the depth. An hyseterctomy for acute and massive hemorrhage is a surgical procedure with high morbidity and potential mortality. Earlier diagnosis means a conservative management with much lower morbidity and fertility preserved.
International Journal of Gynecology & Obstetrics, 2012
ABSTRACT S305 health for stabilizing patient before transfer to higher facility, they noted lack ... more ABSTRACT S305 health for stabilizing patient before transfer to higher facility, they noted lack of knowledge to give the intervention, fear attitude recognizing the side effects of MgSO4, and lack of effort by midwife and the stakeholders to improve their skill competency to use the medicine as mentioned in the institutional guidelines. Care had barriers of limited drugs and availability of equipment and the efforts from health department to review the feasibility of the midwife practice were not been completely considered. The influence of social factors also contributed to the delay of management to transfer patient and the difficulty of midwife to make a clinical decision making. Conclusions: The case study highlights the complexities of barriers to optimize the utilization of MgSO4 in referral case from midwife in private practice to higher facilities. A better understanding of midwife clinical competency and standard obstetrics practice to facilitate management of preeeclampsia should be the main focus intervention by stakeholders to improve the midwife capacity in translation the evidence of clinical practice. Objectives: Scar pregnancy is an ectopic pregnancy with a peculiar localization of placenta on/in previous hysterotomy site. Scar pregnancy could be cause of placenta accreta, uterine rupture, massive hemorrhage and so on. Early diagnosis of abnormal localization could preserve the woman from dangerous and life-threatening complications and her fertility as well. Transvaginal sonography performed in first trimester can identify scar pregnancies. Materials: Between 2009 and 2011 we diagnosed 16 scar pregnancies by transvaginal and transabdominal sonography, all of these patients had at least 1 previous caesarean section. Methods: Diagnostic criteria we look for are (fig. 1): an intrauterine gestational sac with localization on the anterior uterine wall, at internal orifice, thinnening of myometrial layer, defect of decidua basalis between placenta and myometrium and abnormal placental vascularization. Our purpose was to identify as soon as possible scar pregnancies in order to reduce maternal morbidity and mortality. Figure 1.
Ugeskrift for laeger, Jan 2, 1989
Copyright © 2014 Laura Giambanco et al. This is an open access article distributed under the Crea... more Copyright © 2014 Laura Giambanco et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Brugada syndrome is characterized by a disruption of heart’s normal rhythm. It is an autosomal dominant disease due to a mutation of SNC5A gene. Its prevalence is low all over the world, but it is a lethal disease. Sudden cardiac death is the result of phenotypic manifestation of Brugada syndrome. Among asymptomatic Brugada patients, arrhythmia could be provoked by physical activity, fever, or pregnancy. About obstetrical management, very few data or reports have been published since this syndrome has been diagnosed in late 1992. Case Presentation. A 20-year-old pregnant woman at 13 weeks of gestation was referred
International journal of hygiene and environmental health, Apr 24, 2016
Polychlorinated dibenzodioxins (PCDDs), polychlorodibenzofurans (PCDFs), and polychlorobiphenyls ... more Polychlorinated dibenzodioxins (PCDDs), polychlorodibenzofurans (PCDFs), and polychlorobiphenyls (PCBs) are persistent organic pollutants that represent a major concern for women of reproductive age because of the neurodevelopmental effects associated to perinatal exposure. This study was aimed at characterizing exposure of women of reproductive age to PCDDs, PCDFs, and PCBs as a function of residence in different Italian Regions, in areas at presumable different environmental contamination and human exposure to these pollutants. Study participants were enrolled in 2011-2012 in 6 Italian Regions representative of Northern, Central and Southern Italy; in each region, areas at presumed different exposure (rural, urban and industrial) were selected for enrolment. Each participant provided a serum sample for the analysis of PCDDs, PCDFs and PCBs. Median concentrations of PCDDs+PCDFs, DL-PCBs, NDL6-PCBs and NDL9-PCBs in serum samples were respectively 6.0 and 3.5 pgWHO-TE05/g fat, and 75...
Case Reports in Obstetrics and Gynecology, 2014
Introduction. Brugada syndrome is characterized by a disruption of heart’s normal rhythm. It is a... more Introduction. Brugada syndrome is characterized by a disruption of heart’s normal rhythm. It is an autosomal dominant disease due to a mutation of SNC5A gene. Its prevalence is low all over the world, but it is a lethal disease. Sudden cardiac death is the result of phenotypic manifestation of Brugada syndrome. Among asymptomatic Brugada patients, arrhythmia could be provoked by physical activity, fever, or pregnancy. About obstetrical management, very few data or reports have been published since this syndrome has been diagnosed in late 1992.Case Presentation. A 20-year-old pregnant woman at 13 weeks of gestation was referred to our department because of her familial history of sudden cardiac deaths. Brothers and sisters of her mother died of Brugada syndrome in childhood or older and live components of this family were carrier of mutation in Brugada gene. The pregnancy was uneventful. The patient gave birth vaginally without any arrhythmia. Strictly cardiological monitoring was pe...
Pan African Medical Journal, 2014
pregnancy, the implantation of a fertilized ovum outside the endometrial cavity, occurs in 1.5%-2... more pregnancy, the implantation of a fertilized ovum outside the endometrial cavity, occurs in 1.5%-2% of pregnancies. It is one of the major causes (about 6%) of maternal death during the first trimester of pregnancy. The remaining 5% implant in the ovary, peritoneal cavity, within the cervix, and the omental pregnancy is the least common form of abdominal pregnancies. A review of the literature on Medline for the period 1958-2012 reported only 16 cases of omental pregnancy. Here we report a case of primary omental pregnancy in a nulliparous woman. A 24 year-old woman gravid 1, para 0, with lower abdominal pain. Her last menstrual period occurred 8 weeks before the visit. The physical examination revealed abdominal tenderness in the lower quadrants, she was not bleeding. Transvaginal ultrasound showed: a free anechoic/hypoechoic area of 30 x 57 mm in the pouch of Douglas and the endometrium was homogeneus with a thickness of 12 mm and no evidence of gestational sac in the uterine cavity. Laboratory data revealed a normal cell blood count and beta hcg levels of 8047 IU / L. Because of continuing abdominal pain and a diagnosis of ectopic pregnancy a diagnostic laparoscopy was performed, which showed hemoperitoneum. Further inspection of abdominal cavity revealed a bloody lesion that was tenaciously adherent to the omentum, using non traumatic laparoscopic forceps and bipolar scissors we carefully removed a friable mass of about 30 mm from the omental attachments. Histological examination showed the presence of blood clot material mixed with trophoblastic tissue. Ultrasound evaluation and and hCG assessment are important to determine the extrauterine location of the ectopic pregnancy but the early diagnosis of abdominal pregnancy requires also a laparoscopic evaluation and , as our case has highlighted, thorough abdominal exploration especially in the absence of adnexal findings when ectopic pregnancy is highly suspected. Early diagnosis of omental pregnancy is difficult but essential to reduce the high mortality risk for the mother.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2014
To evaluate outcomes of women undergoing cesarean hysterectomy for abnormal invasive placenta (AI... more To evaluate outcomes of women undergoing cesarean hysterectomy for abnormal invasive placenta (AIP) with and without preoperative balloon catheter placement in internal iliac arteries. A prospective observational study of women with ultrasound diagnosis of AIP and a planned delivery at our institution. From January 2004 to June 2009, all AIP cases were treated with planned multidisciplinary cesarean hysterectomy alone (CHa group). From July 2009 to September 2013 a pre-operative balloon catheter protocol was introduced (BC group). Statistical analysis considered the entire sample (placenta accreta/increta and percreta) and the individual subgroups (accreta/increta vs percreta). Twenty-three cases of AIP (10 accreta/increta and 13 percreta) were treated with cesarean hysterectomy alone, and 30 cases of AIP (12 accreta/increta and 18 percreta) were treated with cesarean hysterectomy and pre-operative balloon catheters. For the entire sample, a significant difference in estimated blood loss and transfused blood products units was observed between CHa group and BC group. When women with placenta accreta/increta and women with placenta percreta were analysed separately, no difference in estimated blood loss and transfused blood products units was found between the BC and the CHa groups in women with placenta accreta/increta. However, in women with placenta percreta, mean estimated blood loss and transfused blood products units were higher in the CHa group compared with BC group (1507ml vs 933.33ml; 3.31 units vs 0.67 units). Postoperative recovery differed between the two groups, but no differences were observed in any other outcomes. Pre-operative placement of intravascular balloon catheters is a feasible treatment for AIP, and is particularly useful in cases of placenta percreta.
Journal of Endometriosis, 2011
Purpose Endometriosis remains a challenging condition for clinicians, research scientists, and pa... more Purpose Endometriosis remains a challenging condition for clinicians, research scientists, and patients alike. Routine clinical examination is insufficient to diagnose and evaluate the extent of pelvic endometriosis which can be assessed by means of imaging techniques, including transvaginal sonography (TVS), transrectal sonography (TRS), rectal endoscopic sonography (RES), and magnetic resonance imaging (MRI). Our purpose was to analyze the different imaging techniques and their efficacy for the ultrasound diagnosis of pelvic endometriosis. Materials and methods This review examined 85 studies on the ultrasound diagnosis of endometriosis published between 2005 and 2010. The structure of the review is based first on the anatomical location of the endometriosis lesion, and then on the study of the techniques used, including transvaginal sonography, transrectal sonography, rectal endoscopic sonography, and MRI. Results TVS is the first-line imaging technique for diagnosing pelvic endometriosis. Many studies have demonstrated that sensitivities and specificities of TVS for diagnosing endometriomas range from 75% to 91% and 88% to 99%, respectively, while for RES the percentages are 88% and 90%, respectively, for the diagnosis of intestinal endometriosis. TVS and RES can correctly diagnose posterior deep infiltrating endometriosis (DIE) with an accuracy of 86.4% and 74.1%, respectively. Conclusions The analysis of these results show that ultrasound is the first-line diagnostic technique for the diagnosis of pelvic endometriosis. RES can help to identify the presence and the degree of wall infiltration of bowel sites. However, in patients with a consistent clinical suspicion of deep endometriosis, MRI is a good “all in one” examination to diagnose and define the exact extent of DIE.
The Journal of the American Association of Gynecologic Laparoscopists, 1998
Journal of Minimally Invasive Gynecology
PAMJ Clinical Medicine
HPV infection is widespread. Approximately 40 HPV serotypes infect ano-genital area, but most inf... more HPV infection is widespread. Approximately 40 HPV serotypes infect ano-genital area, but most infections are asymptomatic and can get cleared spontaneously. HPV clearance is modified during pregnancy. Many information have been published about HPV infection and preterm birth, unfortunately the results are often not corresponding. The aim of this study was to understand whether there is an association between HPV infection and preterm birth. In our study we reported results about 20 pregnant women admitted for preterm birth. We assessed if and how papillomavirus cervical infection affects pregnancy outcome. HPV prevalence in pregnant women in this case series was 45% (9/20), while 55% pregnant women were found HPV-negative (11/20). There was no difference between HPV positive group and HPV negative group in terms of gestational age at delivery, neonatal weight, Apgar score. Our data, even though from a very small series, confirm the absence of different outcomes due to HPV infection. It has been reported that women with H-SIL have a higher baseline risk for PTB than general population and treatment for H-SIL probably increase this risk further. The research on HPV and PTB should go straight to this direction.
Open Journal of Obstetrics and Gynecology
Disclaimer of liability Statements and opinions expressed in the articles and communications are ... more Disclaimer of liability Statements and opinions expressed in the articles and communications are those of the individual contributors and not the statements and opinion of Scientific Research Publishing, Inc. We assume no responsibility or liability for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained herein. We expressly disclaim any implied warranties of merchantability or fitness for a particular purpose. If expert assistance is required, the services of a competent professional person should be sought.
Journal of Obstetrics and Gynaecology Research
Vulvar carcinoma represents 3–5% of all female genital cancers; the main surgical treatment is ra... more Vulvar carcinoma represents 3–5% of all female genital cancers; the main surgical treatment is radical vulvectomy and inguinal lymphadenectomy. The aim of this study is to analyze prognostic factors in the patients underwent to primary surgery for vulvar carcinoma.
Surgical Oncology
OBJECTIVE To demonstrate step-by-step minimally invasive surgical technique for dissection of iso... more OBJECTIVE To demonstrate step-by-step minimally invasive surgical technique for dissection of isolated inguinal node relapse of high grade serous ovarian cancer. METHODS A 54-year-old woman, BRCA1 +, underwent to open abdominal total hysterectomy, bilateral salpingo-oophorectomy, total omentectomy, pelvic and aortic lymphadenectomy with zero residual disease, for high grade serous ovarian carcinoma FIGO stage IIB. After surgery, patient underwent platinum-based chemotherapy for six cycles and follow-up examinations every 3 months for the first year and biannual for the second one. Abdominal TC-PET scan after 18 months revealed a right distal iliac external/inguinal nodal relapse (SUV max 18,4). Ca125 was 9,1 mUI/ml. Right pelvic peritoneum was opened (step 1) and right retroperitoneal spaces were developed. Ureter was medialized (step 2) and obturator fossa was developed (step 3). Access to the deep inguinal ring (step 4) allows to identify inguinal lymph node relapse caudally to deep iliac circumflex artery. Bulky node was isolated (step 5) and excised en-block with obturator nodes (step 6). The entire procedure was performed using only a bipolar combination instrument for laparoscopy. Operating time was about 120 minutes and estimated blood loss was <100 ml. RESULTS Pathology confirmed relapse of high grade serous ovarian cancer (CK7+; WT1+). Patient was discharged in post-operative day 3 without complications. CONCLUSION Minimally invasive surgery for excision of isolated inguinal node relapse of ovarian cancer is a feasible and effective technique.
Pan African Medical Journal
Massive and severe epistaxis is an uncommon event in pregnancy. It could be life threatening and ... more Massive and severe epistaxis is an uncommon event in pregnancy. It could be life threatening and could affect the normal preg nancy course. The best management is still on debate; it could be medical, conservative or surgical. Pregnancy termination often is problem solving. Hormonal changes during pregnancy affects nasal physiology. Vaginal delivery, labour induction or cesarean section are all suitable, after hemodynamic stabilization of pregnant woman. We report a case and review the available literature.
Journal of Endometriosis and Pelvic Pain Disorders
Endometriosis causes a decrease in fertility in affected patients. The different forms of the dis... more Endometriosis causes a decrease in fertility in affected patients. The different forms of the disease, peritoneal, ovarian, deep infiltrating and adenomyosis, are often present in varying degrees in the same patient, either together or individually, and cause infertility through a pathogenesis that is not yet clear. A significant number of women with endometriosis and endometriomas will eventually seek assisted reproductive technology (ART) for conception. The specific impact of endometriomas alone and the impact of surgical intervention for endometriomas on the reproductive outcome of women undergoing in vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI) are areas that need further clarification and, for this reason, the management of endometriomas before clinical IVF is a very complex topic. In order to provide useful information for the clinical management of patients with endometriomas having IVF, in this review we investigated: the impact of the presence of endome...
International Journal of Gynecology & Obstetrics, 2012
International Journal of Gynecology & Obstetrics, 2012
Objectives: Cervical pregnancy is a rare life-threatening ectopic pregnancy; its incidence has be... more Objectives: Cervical pregnancy is a rare life-threatening ectopic pregnancy; its incidence has been estimated 1/1000–1/18000 of all pregnancies. We report our experience on a single case of cervical pregnancy successfully treated conservatively. Materials: A 32 years-old nulliparous woman, 8 weeks pregnant, was referred to our department after an ultrasound examination with an identification of isthmic gestational sac and diagnostic doubt of spontaneous abortion vs cervical localization of pregnancy. Transvaginal ultrasound evaluation by an expert operator showed a cervical gestational sac within an embryo (CRL7mm) and presence of vascular activity. Endometrium appareance was as a decidual reaction. Methods: The woman was admitted to our department, blood exams, urine exam and ECG were performed. Beta hCG serum levels were evaluated every 48h after administration of systemic MTX. At admission therapeutical options were explained to woman, underlyning the high risk for hemorrhage: -sistemic MTX -intraamniotic MTX – uterine arteries embolization if both previous options failed. A single dose systemic MTX protocol was choosen (50mg × m), the Mosteller formula was used for calculating body surface (m) (weight 60 kg; height 164 cm, 1.65m body surface). After 24 hours 50mg MTX were injected into amniotic sac under continous ultrasound visualization, because fetal heart beat was still present. Results: Serum levels oh Beta hCG were monitored every 48 hours, showing a plateau for the first 3 days, followed by a continous decrease after fifth day post MTX. The woman was discharged on day 9 when transvaginal ultrasonography revelead absence of vital emmryo eventhough peritrophoblastic vascularization was still active. Post menstrual evaluation showed no peritrophoblastic vasculrization. Conclusions: Cervical ectopic pregnancy usually was misdiagnosed before performing a curettage with the obvious consequence of hysterectomy for massive hemorrhage. The development of transvaginal scans performed routinely during first trimester pregnancy allows an earl diagnosis with an accuracy of 80%. Sonographic diagnostic criteria have been identified: intracervical gestational sac with a normal shape, internal uterine orifice closed, trophoblastic invasion of uterine cervix through all the depth. An hyseterctomy for acute and massive hemorrhage is a surgical procedure with high morbidity and potential mortality. Earlier diagnosis means a conservative management with much lower morbidity and fertility preserved.
International Journal of Gynecology & Obstetrics, 2012
ABSTRACT S305 health for stabilizing patient before transfer to higher facility, they noted lack ... more ABSTRACT S305 health for stabilizing patient before transfer to higher facility, they noted lack of knowledge to give the intervention, fear attitude recognizing the side effects of MgSO4, and lack of effort by midwife and the stakeholders to improve their skill competency to use the medicine as mentioned in the institutional guidelines. Care had barriers of limited drugs and availability of equipment and the efforts from health department to review the feasibility of the midwife practice were not been completely considered. The influence of social factors also contributed to the delay of management to transfer patient and the difficulty of midwife to make a clinical decision making. Conclusions: The case study highlights the complexities of barriers to optimize the utilization of MgSO4 in referral case from midwife in private practice to higher facilities. A better understanding of midwife clinical competency and standard obstetrics practice to facilitate management of preeeclampsia should be the main focus intervention by stakeholders to improve the midwife capacity in translation the evidence of clinical practice. Objectives: Scar pregnancy is an ectopic pregnancy with a peculiar localization of placenta on/in previous hysterotomy site. Scar pregnancy could be cause of placenta accreta, uterine rupture, massive hemorrhage and so on. Early diagnosis of abnormal localization could preserve the woman from dangerous and life-threatening complications and her fertility as well. Transvaginal sonography performed in first trimester can identify scar pregnancies. Materials: Between 2009 and 2011 we diagnosed 16 scar pregnancies by transvaginal and transabdominal sonography, all of these patients had at least 1 previous caesarean section. Methods: Diagnostic criteria we look for are (fig. 1): an intrauterine gestational sac with localization on the anterior uterine wall, at internal orifice, thinnening of myometrial layer, defect of decidua basalis between placenta and myometrium and abnormal placental vascularization. Our purpose was to identify as soon as possible scar pregnancies in order to reduce maternal morbidity and mortality. Figure 1.