Benito Chiofalo | University of Messina (original) (raw)

Papers by Benito Chiofalo

Endometriosis is one of the most common gynecological diseases and affects ~10% of women in repro... more Endometriosis is one of the most common gynecological diseases and affects ~10% of women in reproductive age. The most common clinical signs of endometriosis are menstrual irregularities, chronic pelvic pain (CPP), dysmenorrhea, dyspareunia and infertility. Symptoms of endometriosis often affect psychological and social functioning of patients. For this reason,
endometriosis is considered as a disabling condition that may significantly compromise social relationships, sexuality and mental health. Considering this point, the aim of this narrative review is to elucidate the impact of anxiety and depression in the management of women with endometriosis. Psychological factors have an important role in determining the severity of symptoms, and women who suffer from endometriosis report high levels of anxiety, depression and other psychiatric disorders. In addition, endometriosis is one of the most important causes of CPP; women with endometriosis suffer from a wide range of pelvic pain such as dysmenorrhea, dyspareunia, nonmenstrual (chronic) pelvic pain, pain at ovulation, dyschezia and dysuria. Several studies have underlined the influence of CPP on quality of life and psychological well-being
of women with endometriosis. Data suggest that the experience of pelvic pain is an important component of endometriosis and may significantly affect emotive functioning of affected women. It has been demonstrated that high levels of anxiety and depression can amplify the severity of pain. Further studies are needed to better understand the relationship between psychological factors and perception of pain. Treatment of endometriosis may be hormonal or surgical. Surgery is the primary treatment for more severe forms of endometriosis. There are few data in the literature about the influence of psychological factors and psychiatric comorbidities on the effectiveness of treatments. It is important to evaluate the presence of previous psychiatric
diseases in order to select the most appropriate treatment for the patient.

AIM: This technical note aims to suggest a safe introduction of ancillary trocars in gynaecologic... more AIM:
This technical note aims to suggest a safe introduction of ancillary trocars in gynaecological surgery, in order to prevent inferior epigastric artery damage.
MATERIAL OF STUDY:
We performed a narrative overview, synthesizing the findings of literature retrieved from searches of computerized databases.
RESULTS:
Among the different techniques, the identification of the "yellow island" as anatomical landmark seems to be a useful aid to avoid complication. This particular landmark is identified taking the lateral third of a line between the anterior superior iliac spine and the umbilicus as reference points, by a subperitoneal accumulation of adipose tissue located in that area.
DISCUSSION:
"Yellow island" could be considered a safe place for trocars introduction because epigastric artery never runs there, even in patients with particular anatomical variants. This technique is particularly useful in obese patients, in which "yellow island" appears to be more evident respect to lean ones. Furthermore, the use of "open" trocars insertion may reduce the possibility of epigastric artery lesions respect to "Verres needle technique".
CONCLUSION:
The identification of the "yellow island" anatomical landmark could be considered an useful aid for the safe introduction of ancillary trocars in gynaecological surgery.
KEY WORDS:
Gynaecology, Laparoscopic surgery, Trocars placement.

International Journal of Endocrinology and Metabolism, 2017

Annali italiani di chirurgia, Jan 18, 2016

This technical note aims to suggest a safe introduction of ancillary trocars in gynaecological su... more This technical note aims to suggest a safe introduction of ancillary trocars in gynaecological surgery, in order to prevent inferior epigastric artery damage. We performed a narrative overview, synthesizing the findings of literature retrieved from searches of computerized databases. Among the different techniques, the identification of the "yellow island" as anatomical landmark seems to be a useful aid to avoid complication. This particular landmark is identified taking the lateral third of a line between the anterior superior iliac spine and the umbilicus as reference points, by a subperitoneal accumulation of adipose tissue located in that area. "Yellow island" could be considered a safe place for trocars introduction because epigastric artery never runs there, even in patients with particular anatomical variants. This technique is particularly useful in obese patients, in which "yellow island" appears to be more evident respect to lean ones. Further...

Placenta is the crucial organ for embryo and fetus development and plays a critical role in the d... more Placenta is the crucial organ for embryo and fetus development and plays a critical role in the development of fetal growth restriction (FGR). There are increasing evidences on the role of microRNAs (miRNAs) in a variety of pregnancy-related complications such as preeclampsia and FGR. More than 1880 miRNAs have been reported in humans and most of them are expressed in placenta. In this paper, we aimed to review the current evidence about the topic. According to retrieved data, controversial results about placental expression of miRNAs could be due (at least in part) to the different experimental methods used by different groups. Despite the fact that several authors have demonstrated a relatively easy and feasible detection of some miRNAs in maternal whole peripheral blood, costs of these tests should be reduced in order to increase cohorts and have stronger evidence. In this regard, we take the opportunity to solicit future studies on large cohort and adequate statistical power, in order to identify a panel of biomarkers on maternal peripheral blood for early diagnosis of FGR.

This case report of a 36-year-old woman with a diagnosis of cervical pregnancy describes a novel ... more This case report of a 36-year-old woman with a diagnosis of cervical pregnancy describes a novel approach to this rare form of ectopic pregnancy, which was successfully treated with systemic and local methotrexate (MTX) therapy combined with hysteroscopic resection. After local and systemic administration of MTX, the patient underwent hysteroscopic resection of the cervical pregnancy using a 27 bipolar resectoscope with a 4-mm loop. The cervical pregnancy was completely treated, and satisfactory hemostasis was achieved with electrocoagulation. The reported case and literature review demonstrate that the combination of systemic and local (hysteroscopic) administration of MTX with hysteroscopic resection could offer the possibility of a safe, successful, minimally invasive, and fertility-sparing surgical treatment for cervical pregnancy. ÖZ Servikal gebelik tanısı almış 36 yaşında bir kadın hasta hakkındaki bu vaka sunumunda ektopik gebeliğin, his-teroskopik rezeksiyon ile kombine sistemik ve lokal metotreksat (MTX) ile başarılı bir şekilde tedavi edilmiş olan bu nadir şekline karşı yeni bir yaklaşım tanımlanmaktadır. Lokal ve sistemik MTX uygulaması sonrasında hastaya servikal gebelik için, 4-mm loop ile 27 bipolar rezektoskop kullanılarak histeroskopik rezeksiyon ya-pıldı. Servikal gebelik tamamen tedavi edildi ve elektrokoagülasyon ile yeterli bir hemostaz sağlandı. Yapılan bu literatür taraması ve indeks olgu, sistemik ve lokal (histeroskopik) MTX uygulaması ile histeroskopik re-zeksiyon kombinasyonunun, servikal gebeliğin güvenli, başarılı, minimal düzeyde invaziv ve fertilite-koruyucu cerrahi tedavisinin mümkün olabileceğini göstermektedir. Anahtar Kelimeler: Histeroskopi, metotreksat, servikal gebelik Eurasian J Med 2017; 49: 66-8

Archives of gynecology and obstetrics, 2014

Purpose To assess the concordance between the presumed diagnosis obtained with the 3D sonohystero... more Purpose To assess the concordance between the presumed diagnosis obtained with the 3D sonohysterography (SHG) and with the diagnostic hysteroscopy (HYS); to determine whether the 3D SHG has the accuracy needed to be considered as a diagnostic screening standard in cases of suspected endouterine pathology. Methods We selected 224 patients who voluntarily decided to undergo 3D SHG from a population with suspected presence of endouterine disease at TVS. The patients underwent first 3D SHG and then diagnostic HYS. We recorded each patient’s discomfort/pain during the two techniques. We used the “Bayes Theorem” to calculate the sensitivity and specificity of the 3D SHG as compared to HYS. Results Overall the 3D SHG diagnosis was confirmed in 156/224 cases (69.64 %). Concordance for endometrial thickening was 0 %; for Asherman’s syndrome was 50.00 %; for polyp was 77.78 %; and for myoma, mucus accumulation and Müllerian anomalies (arcuate uterus, septate and subseptate uterus) was 100.00 %. Furthermore, 3D SHG was better tolerated than HYS. Conclusion Despite the diagnostic accuracy and mini-invasiveness of 3D SHG, we suggest that it cannot be a substitute of HYS in endouterine disease diagnosis, but it could be considered as a good method of screening to address patients to hysteroscopic confirmation.

Thrombotic thrombocytopenic purpura (TTP) is a rare and potentially lethal syndrome characterized... more Thrombotic thrombocytopenic purpura (TTP) is a rare and potentially lethal syndrome characterized by severe thrombocytopenia, microangiopathic haemolytic anaemia, and aspecific neurologic symptoms. This syndrome is the result of an abnormal intravascular platelet aggregation which induces transient ischemia in various organs, especially in the central nervous system. Platelet aggregation causes also fragmentation of erythrocytes, thus leading to the characteristic anaemia. The exact cause of TTP is unknown, but a large body of evidence suggest that this syndrome might be due to acquired (immunological) or congenital ADAMTS13 deficiency. The dysregulation of ADAMTS 13 activity could promote massive release of high molecular weight multimers of von Willebrand factor (VWF) from endothelium and, as a consequence, could cause intravascular platelet aggregation. Pregnancy is commonly associated with numerous metabolic, immunological, and haemostatic changes which could increase thrombotic risk: during pregnancy, in fact, it is generally observed an increase of procoagulant activity and a decrease of fibrinolytic activity; moreover, at the end of pregnancy, it is not rare to find thrombocytopenia. All these reasons lead us to consider pregnancy itself as a triggering event for the onset of TTP. The authors describe a case of TTP occurred during puerperium, in a patient who underwent caesarean section.

BACKGROUND: Man, since ancient times, has been convinced of, and has researched scientific eviden... more BACKGROUND:
Man, since ancient times, has been convinced of, and has researched scientific evidence that the barometric and gravitational forces play an important role in structural and biological variation of the planets, influencing the various forms of life. In particular, the synergistic relationships between variations in atmospheric pressure and gravitational forces on human gestation period have been the subject of rigorous observations and statistical calculations, which have not led to a universal conclusion in literature.
OBJECTIVES:
The aim of our work was to check whether there is a higher incidence of spontaneous deliveries, during the periods of full Moon than during the other phases of the Moon.
METHODS:
We performed a retrospective analysis of 327 non-induced vaginal deliveries in a year, divided by month. We subsequently analyzed the incidence of these deliveries during periods of full Moon Vs other lunar phases.
RESULTS:
We evidenced a statistically significant difference between the annual total spontaneous deliveries happened in full Moon periods Vs all other Moon phases (T= 2,3948; p=0,0256). However, we reported a discordant trend of deliveries in full Moon period, depending on each considered month.
CONCLUSION:
Since these differences were found both in increase and decrease, it is unacceptable the assumption of a linear correlation between periods of full Moon and increased frequency of spontaneous deliveries. For this reason, our data allow us to conclude that there is no need to increase the number of doctors and midwives in obstetric units during these periods.

Ovarian cancer is one of the most frequent solid tumor that shows clearly biphasic behaviour in r... more Ovarian cancer is one of the most frequent solid tumor that shows clearly biphasic behaviour in response to chemotherapy, with the majority of patients who achieved complete remission after the first cycle of chemotherapy, and subsequently present a relapse which, in most cases, leads to death. Epithelial ovarian cancer (EOC) arises as a consequence of genetic alterations that affect the cells of the ovarian surface, which leads to changes that occur through the activation of oncogenes and inactivation of tumor suppressor genes. The progression of EOC is characterized by a series of combined epigenetic aberrations, including the most important of those determined by the loss of methylation of certain regions of DNA encoding genes such as Ras-association domain-containing family 1 [(RASSF1A) tumor suppressor], death-associated protein kinase [(DAPK) protein kinase associated with the regulation of apoptosis], human sulfa- tase-I [(hSulf-1) sulfatase, which plays a key role in the regulation of apoptosis], breast cancer 1 gene [(BRCA1) tumor suppressor gene, involved in the processes of DNA repair], and HOXAI0 (gene required to promote many transcription factors). To date, accumulating evidence suggests that the initial clinical response is due primarily to the therapeutic efficacy of chemotherapy against differentiated can- cer cells that constitute the bulk of the tumor, whereas the high rate of recurrence is thought to be due to remaining drug-resistant cells, biologically distinct, identified as cancer stem cells (CSC). Current efforts are focusing on genetic and cytological definition of CSC, to guide the development of new diagnostic, and therapeutic perspectives.

Secondary headache is one of the most common side effect during oral contraceptive (OC) treatment... more Secondary headache is one of the most common side effect during oral contraceptive (OC) treatment and it leads many patients to stop the therapy. Patent foramen ovale (PFO) is an interatrial communication that spontaneously closes at birth in about 75% of the population. However, in the rest of adults PFO maintains a direct communication between the right and left side of circulation. In these patients PFO is a tunnel-like structure that could allow a blood clot to pass from the right to the left side of circulation, thus can cause paradoxical embolization. Although an increased frequency of PFO in patients with migraine was already reported, the relationship between PFO and migraine remains uncertain. In patients with migraine, the prevalence of moderate or large PFO is 35% and seems not associated with the presence of aura or the frequency of headache. Basing on these assumptions, we hypothesize that asymptomatic PFO could play a role in secondary headache due to OC. The procoagulant effect of OC improves the production of microemboli that through the POF could pass from the right to the left atrium and than to the brain, where they could be responsible of secondary headache. If our hypothesis would be confirmed in future studies, it would be possible to identify high-risk patients for developing OC-induced headache and other cerebrovascular major diseases through transcranial Doppler and transesophageal echocardiography. This scenario may radically change the management of reproductive-age woman who have to undergo OC therapy for contraception or other medical conditions.

Archives of gynecology and obstetrics, 2014

Purpose To evaluate maternal–fetal outcomes in women of advanced maternal age (AMA; >35 years old... more Purpose To evaluate maternal–fetal outcomes in women of advanced maternal age (AMA; >35 years old) and women of physiological maternal age as controls (C; <35 years old). Methods Single-center, retrospective case–control analysis, from January 1 to December 31, 2013. For each group, we evaluated obstetric history, number of twin pregnancies, delivery mode, incidence of obstetric diseases and neonatal outcomes (5-min Apgar score, neonatal weight, meconium stained fluid rate, admission to the neonatal intensive care unit rate, and incidence of congenital malformations). Data are presented as n (%) and analyzed with χ 2 test and Fisher exact test (when required). A p value < 0.05 was considered statistically significant. Moreover, we calculated the odds ratio (OR), with confidence interval (CI) at 95 %. Results We enrolled 1,347 pregnant women, 210 (15.6 %) in AMA and 1,137 (84.4 %) C. AMA patients showed a higher rate of previous (anamnestic) spontaneous abortion (SA; p = 0.001; OR = 2.10) and previous (anamnestic) voluntary pregnancy termination (p = 0.022; OR = 1.59), iterative cesarean section (p = 0.026; OR = 2.33), SA (p = 0.001; OR = 12.82), preterm delivery (p = 0.001; OR = 69.84), congenital malformations (p = 0.036; OR = 3.94). In C there was a greater number of nulliparous (p = 0.009; OR = 0.52) and vaginal deliveries (p = 0.025; OR = 0.41). There were not any statistically significant differences between the two groups for twin pregnancies (p = 0.862; OR = 0.97), first cesarean section (p = 0.145; OR = 0.95), other obstetric diseases and neonatal outcomes. Conclusion AMA could be considered an important risk factor only for SA and PTD and does not influence neonatal outcomes except for congenital malformations.

Archives of Gynecology and Obstetrics, 2014

To evaluate maternal-fetal outcomes in women of advanced maternal age (AMA; &amp;amp;amp;... more To evaluate maternal-fetal outcomes in women of advanced maternal age (AMA; &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;35 years old) and women of physiological maternal age as controls (C; &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;35 years old). Single-center, retrospective case-control analysis, from January 1 to December 31, 2013. For each group, we evaluated obstetric history, number of twin pregnancies, delivery mode, incidence of obstetric diseases and neonatal outcomes (5-min Apgar score, neonatal weight, meconium stained fluid rate, admission to the neonatal intensive care unit rate, and incidence of congenital malformations). Data are presented as n (%) and analyzed with χ (2) test and Fisher exact test (when required). A p value &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05 was considered statistically significant. Moreover, we calculated the odds ratio (OR), with confidence interval (CI) at 95 %. We enrolled 1,347 pregnant women, 210 (15.6 %) in AMA and 1,137 (84.4 %) C. AMA patients showed a higher rate of previous (anamnestic) spontaneous abortion (SA; p = 0.001; OR = 2.10) and previous (anamnestic) voluntary pregnancy termination (p = 0.022; OR = 1.59), iterative cesarean section (p = 0.026; OR = 2.33), SA (p = 0.001; OR = 12.82), preterm delivery (p = 0.001; OR = 69.84), congenital malformations (p = 0.036; OR = 3.94). In C there was a greater number of nulliparous (p = 0.009; OR = 0.52) and vaginal deliveries (p = 0.025; OR = 0.41). There were not any statistically significant differences between the two groups for twin pregnancies (p = 0.862; OR = 0.97), first cesarean section (p = 0.145; OR = 0.95), other obstetric diseases and neonatal outcomes. AMA could be considered an important risk factor only for SA and PTD and does not influence neonatal outcomes except for congenital malformations.

Introduzione e obiettivi. Le evidenze in letteratura supportano l’importanza di una diagnosi accu... more Introduzione e obiettivi. Le evidenze in letteratura supportano l’importanza di una diagnosi accurate e tempestiva delle patologie endouterine, che possono essere alla base di sintomatologia sfumata o manifesta e che spesso sottendono altre patologie funzionali del tratto riproduttivo femminile [1]. Generalmente, l’iter diagnostico prevede l’esecuzione di una ecografia transvaginale 2D (TVS) e, in caso di sospetta patologia, l’uso dell’isteroscopia diagnostica (HYS) con eventuale biopsia mirata come esame di conferma [2]. L’avvento della sonoisterografia 3D (SHG) sembra poter essere di ausilio diagnostico nello screening accurato delle patologie endouterine [3]. Per tale motivo, lo scopo del nostro lavoro è stato di valutare il grado di concordanza tra la diagnosi presunta ottenuta con la SHG rispetto all’HYS, e di determinare se la SHG possa avere l’accuratezza necessaria per essere considerata “gold standard” nello screening delle patologie endouterine.
Materiali e metodi. Da una popolazione con sospetta patologia endocavitaria alla TVS, abbiamo selezionato 224 pazienti che volontariamente hanno deciso di sottoporsi a SHG (Tab. 1). Le pazienti sono state sottoposte prima a SHG e successivamente a HYS. Per ogni paziente abbiamo registrato il grado di dolore/fastidio durante le due metodiche. Inoltre, abbiamo valutato la sensibilità e specificità della SHG rispetto all’HYS mediante il teorema di Bayes.
Risultati. Complessivamente, la diagnosi ottenuta mediante SHG è stata confermata in 156/224 casi (69,64%). Il grado di concordanza (Tab. 2) per l’ispessimento della rima endometriale è stato 0%; per sindrome di Asherman 50%; per polipo 77,78%; per mioma, mucocele e anomalie Mülleriane (utero arcuato, setto e subsetto) 100%. Inoltre, la SHG è stata meglio tollerata rispetto all’HYS (Tab. 3).
Conclusione. Nonostante l’accuratezza diagnostica e la scarsa invasività della SHG, suggeriamo che essa non possa sostituire l’HYS nell’iter diagnostico delle patologie endouterine, ma debba essere considerata come metodo di screening per selezionare le pazienti da sottoporre a successiva conferma diagnostica isteroscopica.

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016

Medical Hypotheses, 2016

ABSTRACT Introduzione e obiettivi. Le evidenze in letteratura supportano l’importanza di una diag... more ABSTRACT Introduzione e obiettivi. Le evidenze in letteratura supportano l’importanza di una diagnosi accurate e tempestiva delle patologie endouterine, che possono essere alla base di sintomatologia sfumata o manifesta e che spesso sottendono altre patologie funzionali del tratto riproduttivo femminile [1]. Generalmente, l’iter diagnostico prevede l’esecuzione di una ecografia transvaginale 2D (TVS) e, in caso di sospetta patologia, l’uso dell’isteroscopia diagnostica (HYS) con eventuale biopsia mirata come esame di conferma [2]. L’avvento della sonoisterografia 3D (SHG) sembra poter essere di ausilio diagnostico nello screening accurato delle patologie endouterine [3]. Per tale motivo, lo scopo del nostro lavoro è stato di valutare il grado di concordanza tra la diagnosi presunta ottenuta con la SHG rispetto all’HYS, e di determinare se la SHG possa avere l’accuratezza necessaria per essere considerata “gold standard” nello screening delle patologie endouterine. Materiali e metodi. Da una popolazione con sospetta patologia endocavitaria alla TVS, abbiamo selezionato 224 pazienti che volontariamente hanno deciso di sottoporsi a SHG (Tab. 1). Le pazienti sono state sottoposte prima a SHG e successivamente a HYS. Per ogni paziente abbiamo registrato il grado di dolore/fastidio durante le due metodiche. Inoltre, abbiamo valutato la sensibilità e specificità della SHG rispetto all’HYS mediante il teorema di Bayes. Risultati. Complessivamente, la diagnosi ottenuta mediante SHG è stata confermata in 156/224 casi (69,64%). Il grado di concordanza (Tab. 2) per l’ispessimento della rima endometriale è stato 0%; per sindrome di Asherman 50%; per polipo 77,78%; per mioma, mucocele e anomalie Mülleriane (utero arcuato, setto e subsetto) 100%. Inoltre, la SHG è stata meglio tollerata rispetto all’HYS (Tab. 3). Conclusione. Nonostante l’accuratezza diagnostica e la scarsa invasività della SHG, suggeriamo che essa non possa sostituire l’HYS nell’iter diagnostico delle patologie endouterine, ma debba essere considerata come metodo di screening per selezionare le pazienti da sottoporre a successiva conferma diagnostica isteroscopica.

The aim of this single-center, prospective, randomized, parallel-group study was to compare desog... more The aim of this single-center, prospective, randomized, parallel-group study was to compare desogestrel and danazol as preoperative endometrial preparation for hysteroscopic surgery. We enrolled 200 consecutive eligible patients, in reproductive age, with endouterine diseases. Pre- and post-treatment characterization of endometrium was performed by hysteroscopic visual observation and histologic confirmation. The enrolled patients were randomly assigned to two groups: 100 were treated with 75 μg of desogestrel/die, 100 with 100 mg of danazol/die, both orally for 5 weeks, starting on Day 1 of menstruation. We recorded intraoperative data (cervical dilatation time, operative time, infusion volume and severity of bleeding) and drugs&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; side effects. Post-treatment comparison of endometrial patterns showed a significant more marked effect of desogestrel, respect to danazol, in atrophying endometrium (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;normotrophic non-responders&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; versus &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;hypotrophic&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;-&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;atrophic&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;, p = 0.031). Intraoperative data showed no significant differences between the two groups for cervical dilatation time (p = 0.160), while in the desogestrel group we found a significant reduction of operative time (p = 0.020), infusion volume (p = 0.012), and severity of bleeding (p = 0.004). Moreover, desogestrel caused less side effects (p = 0.031). According to our data analysis, desogestrel showed most marked effect in inducing endometrial atrophy, allowed a better intraoperative management and caused less side effects during treatment.

International Journal of Endocrinology and Metabolism, 2017

Annali italiani di chirurgia, Jan 18, 2016

Archives of gynecology and obstetrics, 2014

Archives of Gynecology and Obstetrics, 2014

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016

Medical Hypotheses, 2016