Tito Silvio Patrelli | Università degli Studi di Parma (Italy) (original) (raw)

Papers by Tito Silvio Patrelli

PLOS ONE, Sep 11, 2012

Background: A variety of indicators of potentially successful ovarian stimulation cycles are avai... more Background: A variety of indicators of potentially successful ovarian stimulation cycles are available, including biomarkers such as anti-Mullerian hormone. The aim of our study was to confirm the usefulness of serum anti-Mullerian hormone assay in predicting ovarian response and reproductive outcome in women eligible for ART cycles. Materials: Forty-six women undergoing ART cycles at the Centre for Reproductive Medicine in Parma were recruited from March-to-June 2010. Inclusion criteria: age,42 years; body-mass-index = 20-25; regular menstrual cycles; basal serum FSH concentration ,12 IU/L and basal serum estradiol concentration ,70 pg/mL. The couples included in our study reported a variety of primary infertility causes. All women underwent FSH stimulation and pituitary suppression (GnRH-agonist/GnRHantagonist protocols). Women were considered poor-responders if thay had #3 oocytes; normal-responders 4-9 oocytes and high-responders $10 oocytes. Serum samples for the AMH assays were obtained on the first and last days of stimulation. A P value #0.05 was considered statistically significant. Result: FSH levels increased significantly when AMH levels decreased. The total dose of r-FSH administered to induce ovulation was not correlated to AMH. The number of follicles on the hCG, serum estradiol levels on the hCG-day, and the number of retrieved oocytes were significantly correlated to AMH. The number of fertilized oocytes was significantly correlated to the AMH levels. No significant correlation was found between obtained embryos or transferred embryos and AMH. Basal serum AMH levels were significantly higher than those measured on the hCG-day, which appeared significantly reduced. There was a significant correlation between AMH in normal responders and AMH in both high and poor responders. Conclusions: Our data confirm the clinical usefulness of AMH in ART-cycles to customize treatment protocols and suggest the necessity of verifying an eventual permanent decrease in AMH levels after IVF.

Journal of Maternal-fetal & Neonatal Medicine, Aug 24, 2012

Since the early 1980s, epidemiological evidence has suggested a connection between low calcium in... more Since the early 1980s, epidemiological evidence has suggested a connection between low calcium intake and preeclampsia The purpose of this meta-analysis is to summarize current evidence regarding calcium supplementation during pregnancy in predicting preeclampsia and associated maternal-fetal complications. Literature revision of all RCT (random allocation of calcium versus placebo) available in MEDLINE/PUBMED up to 2/29/2012 regarding calcium supplementation during pregnancy for preventing preeclampsia. We used the Mantel-Haenszel's Method for four subgroup of patients: Adequate calcium intake; Low calcium intake; Low risk of preeclampsia; High risk of preeclampsia. We considered p < 0.05 as significant. There is no consensus in Literature about: (1) the efficacy of calcium supplementation in the prevention of preeclampsia, (2) other/adverse/long-term effects of calcium supplementation in pregnancy. Preeclampsia is likely to be a multifactorial disease. However, inadequate calcium intake represents a factor associated with an increased incidence of hypertensive disease. The results of our meta-analysis demonstrate that the additional intake of calcium during pregnancy is an effective measure to reduce the incidence of preeclampsia, especially in populations at high risk of preeclampsia due to ethnicity, gender, age, high BMI and in those with low baseline calcium intake.

Reproductive Sciences, Dec 13, 2013

We performed an observational cohort study in order to assess the correlation between precancerou... more We performed an observational cohort study in order to assess the correlation between precancerous cervical lesions (cervical intraepithelial neoplasia [CIN]) and immunological state in human immunodeficiency virus (HIV)-positive women treated by highly active antiretroviral therapy (HAART). We analyzed 194 HIV-infected women referred to the Parma-Universitary Hospital for early detection of human papilloma virus-induced CINs. We analyzed cytology, colposcopy, and CIN degree according to HAART: group A untreated and group B treated. We compared the CD4+ count and viral load at the time of CIN onset and the time interval between diagnosis of HIV and the onset of CIN. Group A and group B showed homogeneous results for general features, CD4+ count, viral load, and Papanicolaou test features. Differences were not found in terms of histology and CD4+ value, viral load count, pharmacological treatment, years since the diagnosis of HIV, age, smoking, sexual promiscuity, previous intravenous narcotics abuse, prostitution, sexually transmitted diseases, ethnicity, and age at diagnosis. Histology and the clinical stage of HIV showed significant concordances between the high degree of cervical dysplasia and advanced stage of HIV disease.

Ultrasound in Obstetrics & Gynecology, Sep 1, 2015

, pregnancies referred for suspected or confirmed fetal abnormalities were scanned using a transa... more , pregnancies referred for suspected or confirmed fetal abnormalities were scanned using a transabdominal CCT (4-8 MHz) first and then HFLT (9 MHz) with colour flow whenever necessary by a single experienced operator to determine if additional abnormal ultrasound findings could be found using the HFLT. All pregnancies outcomes were traced after birth or abortion. Results: A total of 87 pregnancies were studied at a median gestation of 21 (range, 12-36) weeks. The median maternal age was 32 (range, 22 to 42). There were 88 abnormalities found at birth or abortion including heart (27), kidneys (13), extremities (11), brain (10), bowel (7), hydrops (6), face (5), chest (2), abdominal wall (2), lung (2), umbilical vessels (2) and bladder (1). The additional use of a HFLT allowed acquisition of subjectively better imaging in 15 abnormalities (17.1%), but gave only four (4.6%) additional abnormal findings. The latter included two cases of suspected atrial septal defect at 21 week and 23 week, one case of abnormal three vessel view at 13 week and one case of bilateral echogenic kidneys with dilated renal pelvis at 14 week. The corresponding final diagnosis was patent foramen ovale, atrial septal defect, transposition of great vessels and dysplastic kidneys. There were no changes in clinical management of these cases. The likelihood of getting additional finding was higher for cardiac than non-cardiac anomalies (11.1% vs. 1.6%, p = 0.049). For the remaining 73 abnormalities (82.9%), there were no additional findings or image quality was suboptimal due long transducer-object distance, advanced gestation, shadowing, maternal obesity or oligohydramnios. Conclusions: Under favourable conditions, it may be feasible to use a HFLT to assess atrial septal defect in mid-trimester or abnormal three-vessel view in early second trimester. Further evaluations are ongoing.

Ultrasound in Obstetrics & Gynecology, Sep 1, 2015

Ultrasound in Obstetrics & Gynecology, Sep 1, 2015

Copyright © 2014 Salvatore Gizzo et al.This is an open access article distributed under the Creat... more Copyright © 2014 Salvatore Gizzo 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. The aim of our study was to assess the value of a preoperative He4-serum-assay and ROMA-score assessment in improving the accuracy of frozen section histology in the diagnosis of borderline ovarian tumors (BOT). 113 women presenting with a unilateral ovarian mass diagnosed as serous/mucinous BOT at frozen-section-histology (FS) and/or confirmed on final pathology were recruited. Pathologists were informed of the results of preoperative clinical/instrumental assessment of all patients. For Group A patients, additional information regarding He4, CA125, and ROMA score was available (in Group B only CA125 was known). The comparison betweenGroupA andGroup B in terms of FS accuracy, demonstrated a consensual diagnosis in 62.8 % versus 58.6...

Ultrasound in Obstetrics & Gynecology, 2015

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2014

To the Editor: My colleagues and I appreciate the letter by Ülker about our article concerning ad... more To the Editor: My colleagues and I appreciate the letter by Ülker about our article concerning adequate conservative treatment of third-trimester isolated oligohydramnios.1 Certainly, the data of Ülker and Ciçek2 strongly demonstrated that the maternal left lateral decubitus position positively affected the sonographically measured AFI despite the finding that “the AFI increased more rapidly with hydration.”2 In light of the evidence that amniotic fluid measurement is a fundamental means for assessing maternal and fetal well-being and determining the timing and type of delivery, in an era with an emphasis on peripartum ultrasound use, standardization of the amniotic fluid evaluation is mandatory.3 The importance of a correct amniotic fluid measurement is related both to the possibility of improving it by conservative management of idiopathic conditions and to using it as an early predictor of nonreassuring fetal well-being.1 Adjunctively, more recent evidence has indicated that alterations in the amniotic fluid volume could negatively affect delivery outcomes, increasing the rates of surgical and elective/urgent cesarean deliveries and the risk of postpartum hemorrhage.3–6

Clinical and experimental obstetrics & gynecology, 2012

The aim of this study was to measure plasmatic concentrations of vascular endothelial growth fact... more The aim of this study was to measure plasmatic concentrations of vascular endothelial growth factor-A (VEGF-A) and placental growth factor (PIGF) in pregnant women, and to evaluate their relationship with age, hormonal status, gestational age, and different diseases of pregnancy. We selected a control group of 163 patients (96 fertile and 67 in menopause) and a group of 214 pregnant patients during the whole gestational period. VEGF-A and PlGF were assayed by ELISA and EIA methods, respectively. Statistical analysis was performed using the Mann-Whitney test. The control group showed mean VEGF-A and PlGF values of 89.87 pg/ml and 10.22 pg/ml, respectively; PlGF showed the highest values in menopausal patients. The group of pregnant patients showed VEGF-A values of 27.05 pg/ml and PlGF values of 231.36 pg/ml respectively, with lower (for the VEGF-A) and higher (for the PlGF) statistical significance. These values were not influenced by biological age, but were related to gestational a...

PLoS ONE, 2012

Background: A variety of indicators of potentially successful ovarian stimulation cycles are avai... more Background: A variety of indicators of potentially successful ovarian stimulation cycles are available, including biomarkers such as anti-Mullerian hormone. The aim of our study was to confirm the usefulness of serum anti-Mullerian hormone assay in predicting ovarian response and reproductive outcome in women eligible for ART cycles. Materials: Forty-six women undergoing ART cycles at the Centre for Reproductive Medicine in Parma were recruited from March-to-June 2010. Inclusion criteria: age,42 years; body-mass-index = 20-25; regular menstrual cycles; basal serum FSH concentration ,12 IU/L and basal serum estradiol concentration ,70 pg/mL. The couples included in our study reported a variety of primary infertility causes. All women underwent FSH stimulation and pituitary suppression (GnRH-agonist/GnRHantagonist protocols). Women were considered poor-responders if thay had #3 oocytes; normal-responders 4-9 oocytes and high-responders $10 oocytes. Serum samples for the AMH assays were obtained on the first and last days of stimulation. A P value #0.05 was considered statistically significant. Result: FSH levels increased significantly when AMH levels decreased. The total dose of r-FSH administered to induce ovulation was not correlated to AMH. The number of follicles on the hCG, serum estradiol levels on the hCG-day, and the number of retrieved oocytes were significantly correlated to AMH. The number of fertilized oocytes was significantly correlated to the AMH levels. No significant correlation was found between obtained embryos or transferred embryos and AMH. Basal serum AMH levels were significantly higher than those measured on the hCG-day, which appeared significantly reduced. There was a significant correlation between AMH in normal responders and AMH in both high and poor responders. Conclusions: Our data confirm the clinical usefulness of AMH in ART-cycles to customize treatment protocols and suggest the necessity of verifying an eventual permanent decrease in AMH levels after IVF.

Endocrine-Related Cancer, 2013

To determine the role, timing and indications for endometrial hysteroscopic investigation in rela... more To determine the role, timing and indications for endometrial hysteroscopic investigation in relation to the clinical, ultrasound and histological features of the endometrium during tamoxifen (TAM) use. We performed an observational longitudinal cohort study (years 2007–2012) that investigated the endometria of 151 TAM users with hysteroscopy and histology. For all patients, gynaecological history, years of adjuvant treatment, ultrasound endometrial thickness measurement and indications for hysteroscopy were recorded. Hysteroscopic findings showed that 100% of patients referred for simple follow-up had no evidence of endometrial disease. We found a strong correlation between previous history of abnormal uterine bleeding (with or without endometrial thickening) and hysteroscopic suspicion of endometrial atypia that was confirmed by histology. Hysteroscopy had 83.3% sensitivity, 99% specificity, 83.3% positive predictive value (PPV) and 99% negative predictive value (NPV) in detecting...

Reproductive Sciences, Jul 1, 2014

Obstetrical and Gynecological Survey, Jun 1, 2013

Raloxifene is the only selective estrogen receptor modulator approved for long-term treatment in ... more Raloxifene is the only selective estrogen receptor modulator approved for long-term treatment in the prevention of osteoporotic fractures and for the reduction of invasive breast cancer risk in post-menopausal women. The demonstrated beneficial effects on bone and mammalian tissue led clinical and molecular research to focus mainly on these organs, giving less attention to all other systemic effects. The aim of this review was to evaluate all described systemic effects of raloxifene, investigating its molecular and tissutal mechanism of action. A literature research was carried out in electronic databases MEDLINE, EMBASE, ScienceDirect, and the Cochrane Library in interval time between 2000 and 2012. Outcomes were considered in relation to positive/adverse effects concerning bone metabolism, lipid metabolism, coagulation pattern, menopausal symptoms, breast cancer onset, and endometrial cancer onset. Raloxifene acts as an estrogen agonist or antagonist depending on the tissue. This feature is related to specific actions on at least 2 distinct estrogen receptors, whose proportions vary according to tissue type. Raloxifene is a drug for the treatment of osteoporosis and for the prevention of estrogen receptor-positive breast cancer because it guarantees a safety profile on the endometrium. Raloxifene is furthermore an effective therapy in women with increased levels of plasma cholesterol. Raloxifene treatment shifts the coagulation pattern toward prothrombosis, and the patients should be exhaustively informed about the risks associated with therapy. Raloxifene does not show to affect memory and cognition. Finally, it is noteworthy that quality-of-life studies demonstrated some favorable effects of raloxifene.

PLOS ONE, Sep 11, 2012

Background: A variety of indicators of potentially successful ovarian stimulation cycles are avai... more Background: A variety of indicators of potentially successful ovarian stimulation cycles are available, including biomarkers such as anti-Mullerian hormone. The aim of our study was to confirm the usefulness of serum anti-Mullerian hormone assay in predicting ovarian response and reproductive outcome in women eligible for ART cycles. Materials: Forty-six women undergoing ART cycles at the Centre for Reproductive Medicine in Parma were recruited from March-to-June 2010. Inclusion criteria: age,42 years; body-mass-index = 20-25; regular menstrual cycles; basal serum FSH concentration ,12 IU/L and basal serum estradiol concentration ,70 pg/mL. The couples included in our study reported a variety of primary infertility causes. All women underwent FSH stimulation and pituitary suppression (GnRH-agonist/GnRHantagonist protocols). Women were considered poor-responders if thay had #3 oocytes; normal-responders 4-9 oocytes and high-responders $10 oocytes. Serum samples for the AMH assays were obtained on the first and last days of stimulation. A P value #0.05 was considered statistically significant. Result: FSH levels increased significantly when AMH levels decreased. The total dose of r-FSH administered to induce ovulation was not correlated to AMH. The number of follicles on the hCG, serum estradiol levels on the hCG-day, and the number of retrieved oocytes were significantly correlated to AMH. The number of fertilized oocytes was significantly correlated to the AMH levels. No significant correlation was found between obtained embryos or transferred embryos and AMH. Basal serum AMH levels were significantly higher than those measured on the hCG-day, which appeared significantly reduced. There was a significant correlation between AMH in normal responders and AMH in both high and poor responders. Conclusions: Our data confirm the clinical usefulness of AMH in ART-cycles to customize treatment protocols and suggest the necessity of verifying an eventual permanent decrease in AMH levels after IVF.

Journal of Maternal-fetal & Neonatal Medicine, Aug 24, 2012

Since the early 1980s, epidemiological evidence has suggested a connection between low calcium in... more Since the early 1980s, epidemiological evidence has suggested a connection between low calcium intake and preeclampsia The purpose of this meta-analysis is to summarize current evidence regarding calcium supplementation during pregnancy in predicting preeclampsia and associated maternal-fetal complications. Literature revision of all RCT (random allocation of calcium versus placebo) available in MEDLINE/PUBMED up to 2/29/2012 regarding calcium supplementation during pregnancy for preventing preeclampsia. We used the Mantel-Haenszel's Method for four subgroup of patients: Adequate calcium intake; Low calcium intake; Low risk of preeclampsia; High risk of preeclampsia. We considered p < 0.05 as significant. There is no consensus in Literature about: (1) the efficacy of calcium supplementation in the prevention of preeclampsia, (2) other/adverse/long-term effects of calcium supplementation in pregnancy. Preeclampsia is likely to be a multifactorial disease. However, inadequate calcium intake represents a factor associated with an increased incidence of hypertensive disease. The results of our meta-analysis demonstrate that the additional intake of calcium during pregnancy is an effective measure to reduce the incidence of preeclampsia, especially in populations at high risk of preeclampsia due to ethnicity, gender, age, high BMI and in those with low baseline calcium intake.

Reproductive Sciences, Dec 13, 2013

We performed an observational cohort study in order to assess the correlation between precancerou... more We performed an observational cohort study in order to assess the correlation between precancerous cervical lesions (cervical intraepithelial neoplasia [CIN]) and immunological state in human immunodeficiency virus (HIV)-positive women treated by highly active antiretroviral therapy (HAART). We analyzed 194 HIV-infected women referred to the Parma-Universitary Hospital for early detection of human papilloma virus-induced CINs. We analyzed cytology, colposcopy, and CIN degree according to HAART: group A untreated and group B treated. We compared the CD4+ count and viral load at the time of CIN onset and the time interval between diagnosis of HIV and the onset of CIN. Group A and group B showed homogeneous results for general features, CD4+ count, viral load, and Papanicolaou test features. Differences were not found in terms of histology and CD4+ value, viral load count, pharmacological treatment, years since the diagnosis of HIV, age, smoking, sexual promiscuity, previous intravenous narcotics abuse, prostitution, sexually transmitted diseases, ethnicity, and age at diagnosis. Histology and the clinical stage of HIV showed significant concordances between the high degree of cervical dysplasia and advanced stage of HIV disease.

Ultrasound in Obstetrics & Gynecology, Sep 1, 2015

, pregnancies referred for suspected or confirmed fetal abnormalities were scanned using a transa... more , pregnancies referred for suspected or confirmed fetal abnormalities were scanned using a transabdominal CCT (4-8 MHz) first and then HFLT (9 MHz) with colour flow whenever necessary by a single experienced operator to determine if additional abnormal ultrasound findings could be found using the HFLT. All pregnancies outcomes were traced after birth or abortion. Results: A total of 87 pregnancies were studied at a median gestation of 21 (range, 12-36) weeks. The median maternal age was 32 (range, 22 to 42). There were 88 abnormalities found at birth or abortion including heart (27), kidneys (13), extremities (11), brain (10), bowel (7), hydrops (6), face (5), chest (2), abdominal wall (2), lung (2), umbilical vessels (2) and bladder (1). The additional use of a HFLT allowed acquisition of subjectively better imaging in 15 abnormalities (17.1%), but gave only four (4.6%) additional abnormal findings. The latter included two cases of suspected atrial septal defect at 21 week and 23 week, one case of abnormal three vessel view at 13 week and one case of bilateral echogenic kidneys with dilated renal pelvis at 14 week. The corresponding final diagnosis was patent foramen ovale, atrial septal defect, transposition of great vessels and dysplastic kidneys. There were no changes in clinical management of these cases. The likelihood of getting additional finding was higher for cardiac than non-cardiac anomalies (11.1% vs. 1.6%, p = 0.049). For the remaining 73 abnormalities (82.9%), there were no additional findings or image quality was suboptimal due long transducer-object distance, advanced gestation, shadowing, maternal obesity or oligohydramnios. Conclusions: Under favourable conditions, it may be feasible to use a HFLT to assess atrial septal defect in mid-trimester or abnormal three-vessel view in early second trimester. Further evaluations are ongoing.

Ultrasound in Obstetrics & Gynecology, Sep 1, 2015

Ultrasound in Obstetrics & Gynecology, Sep 1, 2015

Copyright © 2014 Salvatore Gizzo et al.This is an open access article distributed under the Creat... more Copyright © 2014 Salvatore Gizzo 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. The aim of our study was to assess the value of a preoperative He4-serum-assay and ROMA-score assessment in improving the accuracy of frozen section histology in the diagnosis of borderline ovarian tumors (BOT). 113 women presenting with a unilateral ovarian mass diagnosed as serous/mucinous BOT at frozen-section-histology (FS) and/or confirmed on final pathology were recruited. Pathologists were informed of the results of preoperative clinical/instrumental assessment of all patients. For Group A patients, additional information regarding He4, CA125, and ROMA score was available (in Group B only CA125 was known). The comparison betweenGroupA andGroup B in terms of FS accuracy, demonstrated a consensual diagnosis in 62.8 % versus 58.6...

Ultrasound in Obstetrics & Gynecology, 2015

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2014

To the Editor: My colleagues and I appreciate the letter by Ülker about our article concerning ad... more To the Editor: My colleagues and I appreciate the letter by Ülker about our article concerning adequate conservative treatment of third-trimester isolated oligohydramnios.1 Certainly, the data of Ülker and Ciçek2 strongly demonstrated that the maternal left lateral decubitus position positively affected the sonographically measured AFI despite the finding that “the AFI increased more rapidly with hydration.”2 In light of the evidence that amniotic fluid measurement is a fundamental means for assessing maternal and fetal well-being and determining the timing and type of delivery, in an era with an emphasis on peripartum ultrasound use, standardization of the amniotic fluid evaluation is mandatory.3 The importance of a correct amniotic fluid measurement is related both to the possibility of improving it by conservative management of idiopathic conditions and to using it as an early predictor of nonreassuring fetal well-being.1 Adjunctively, more recent evidence has indicated that alterations in the amniotic fluid volume could negatively affect delivery outcomes, increasing the rates of surgical and elective/urgent cesarean deliveries and the risk of postpartum hemorrhage.3–6

Clinical and experimental obstetrics & gynecology, 2012

The aim of this study was to measure plasmatic concentrations of vascular endothelial growth fact... more The aim of this study was to measure plasmatic concentrations of vascular endothelial growth factor-A (VEGF-A) and placental growth factor (PIGF) in pregnant women, and to evaluate their relationship with age, hormonal status, gestational age, and different diseases of pregnancy. We selected a control group of 163 patients (96 fertile and 67 in menopause) and a group of 214 pregnant patients during the whole gestational period. VEGF-A and PlGF were assayed by ELISA and EIA methods, respectively. Statistical analysis was performed using the Mann-Whitney test. The control group showed mean VEGF-A and PlGF values of 89.87 pg/ml and 10.22 pg/ml, respectively; PlGF showed the highest values in menopausal patients. The group of pregnant patients showed VEGF-A values of 27.05 pg/ml and PlGF values of 231.36 pg/ml respectively, with lower (for the VEGF-A) and higher (for the PlGF) statistical significance. These values were not influenced by biological age, but were related to gestational a...

PLoS ONE, 2012

Background: A variety of indicators of potentially successful ovarian stimulation cycles are avai... more Background: A variety of indicators of potentially successful ovarian stimulation cycles are available, including biomarkers such as anti-Mullerian hormone. The aim of our study was to confirm the usefulness of serum anti-Mullerian hormone assay in predicting ovarian response and reproductive outcome in women eligible for ART cycles. Materials: Forty-six women undergoing ART cycles at the Centre for Reproductive Medicine in Parma were recruited from March-to-June 2010. Inclusion criteria: age,42 years; body-mass-index = 20-25; regular menstrual cycles; basal serum FSH concentration ,12 IU/L and basal serum estradiol concentration ,70 pg/mL. The couples included in our study reported a variety of primary infertility causes. All women underwent FSH stimulation and pituitary suppression (GnRH-agonist/GnRHantagonist protocols). Women were considered poor-responders if thay had #3 oocytes; normal-responders 4-9 oocytes and high-responders $10 oocytes. Serum samples for the AMH assays were obtained on the first and last days of stimulation. A P value #0.05 was considered statistically significant. Result: FSH levels increased significantly when AMH levels decreased. The total dose of r-FSH administered to induce ovulation was not correlated to AMH. The number of follicles on the hCG, serum estradiol levels on the hCG-day, and the number of retrieved oocytes were significantly correlated to AMH. The number of fertilized oocytes was significantly correlated to the AMH levels. No significant correlation was found between obtained embryos or transferred embryos and AMH. Basal serum AMH levels were significantly higher than those measured on the hCG-day, which appeared significantly reduced. There was a significant correlation between AMH in normal responders and AMH in both high and poor responders. Conclusions: Our data confirm the clinical usefulness of AMH in ART-cycles to customize treatment protocols and suggest the necessity of verifying an eventual permanent decrease in AMH levels after IVF.

Endocrine-Related Cancer, 2013

To determine the role, timing and indications for endometrial hysteroscopic investigation in rela... more To determine the role, timing and indications for endometrial hysteroscopic investigation in relation to the clinical, ultrasound and histological features of the endometrium during tamoxifen (TAM) use. We performed an observational longitudinal cohort study (years 2007–2012) that investigated the endometria of 151 TAM users with hysteroscopy and histology. For all patients, gynaecological history, years of adjuvant treatment, ultrasound endometrial thickness measurement and indications for hysteroscopy were recorded. Hysteroscopic findings showed that 100% of patients referred for simple follow-up had no evidence of endometrial disease. We found a strong correlation between previous history of abnormal uterine bleeding (with or without endometrial thickening) and hysteroscopic suspicion of endometrial atypia that was confirmed by histology. Hysteroscopy had 83.3% sensitivity, 99% specificity, 83.3% positive predictive value (PPV) and 99% negative predictive value (NPV) in detecting...

Reproductive Sciences, Jul 1, 2014

Obstetrical and Gynecological Survey, Jun 1, 2013

Raloxifene is the only selective estrogen receptor modulator approved for long-term treatment in ... more Raloxifene is the only selective estrogen receptor modulator approved for long-term treatment in the prevention of osteoporotic fractures and for the reduction of invasive breast cancer risk in post-menopausal women. The demonstrated beneficial effects on bone and mammalian tissue led clinical and molecular research to focus mainly on these organs, giving less attention to all other systemic effects. The aim of this review was to evaluate all described systemic effects of raloxifene, investigating its molecular and tissutal mechanism of action. A literature research was carried out in electronic databases MEDLINE, EMBASE, ScienceDirect, and the Cochrane Library in interval time between 2000 and 2012. Outcomes were considered in relation to positive/adverse effects concerning bone metabolism, lipid metabolism, coagulation pattern, menopausal symptoms, breast cancer onset, and endometrial cancer onset. Raloxifene acts as an estrogen agonist or antagonist depending on the tissue. This feature is related to specific actions on at least 2 distinct estrogen receptors, whose proportions vary according to tissue type. Raloxifene is a drug for the treatment of osteoporosis and for the prevention of estrogen receptor-positive breast cancer because it guarantees a safety profile on the endometrium. Raloxifene is furthermore an effective therapy in women with increased levels of plasma cholesterol. Raloxifene treatment shifts the coagulation pattern toward prothrombosis, and the patients should be exhaustively informed about the risks associated with therapy. Raloxifene does not show to affect memory and cognition. Finally, it is noteworthy that quality-of-life studies demonstrated some favorable effects of raloxifene.