Alessio Perandini | Università di Verona (original) (raw)
Papers by Alessio Perandini
The impact of cancer therapy on the reproductive potential of patients is increasingly recognized... more The impact of cancer therapy on the reproductive potential of patients is increasingly recognized because survival rates of patients have clearly improved in recent years. Different fertility preservation methods, either generally accepted or still experimental, are currently available, and counseling of patients requires a delicate balance between the efficacy and side effects of the proposed method and the characteristics of both the tumor and the therapy. Deeper knowledge of the effects of cancer therapy on the reproductive potential of patients over time is required to identify the most appropriate fertility preservation method. In this paper, we report a case-control study in which female patients who were diagnosed with hematological malignancies and treated with chemotherapy and/or radiotherapy were compared with age-matched controls in terms of ovarian reserve, as measured by ultrasound examination and hormonal status. By stratifying patients for gonadotoxicity of the therapy receivedandtimeelapsedfromtheendofthetherapy,wereport that patients treated with low gonadotoxic therapies, while being similar to age-matched controls in their ovarian reserve when evaluated within a few years from the end of the therapy, show a clear impairment over longer times. We also report that anti-Müllerian hormone is the most sensitive hormonal parameter in detecting changes in ovarian reserve when compared with follicle-stimulating hormone or inhibin-B. This study stresses the importanceofaccuratecounselingatthetimeofdiagnosisofcancer and emphasizes the risks of infertility with low gonadotoxic therapies that may reduce the reproductive window of survivors. The Oncologist 2013;18:1307-1314 Implications for Practice: The need for accurate and personalized counseling of women diagnosed with hematological malignancies and exposed to anticancer therapy in their reproductive age is the major clinical implication of our study. More specifically, our study implies that adequate fertility preservation methods should be discussed when therapies with a low toxicity to the reproductive system are used. Indeed, patients may experience impairment of their reproductive potential, even several years post-therapy, hampering their fertility wishes. Patients should undergo frequent evaluation of their fertility potential to detect eventual impairments in a timely manner.
Oncologist, Oct 22, 2013
The impact of cancer therapy on the reproductive potential of patients is increasingly recognized... more The impact of cancer therapy on the reproductive potential of patients is increasingly recognized because survival rates of patients have clearly improved in recent years. Different fertility preservation methods, either generally accepted or still experimental, are currently available, and counseling of patients requires a delicate balance between the efficacy and side effects of the proposed method and the characteristics of both the tumor and the therapy. Deeper knowledge of the effects of cancer therapy on the reproductive potential of patients over time is required to identify the most appropriate fertility preservation method. In this paper, we report a case-control study in which female patients who were diagnosed with hematological malignancies and treated with chemotherapy and/or radiotherapy were compared with age-matched controls in terms of ovarian reserve, as measured by ultrasound examination and hormonal status. By stratifying patients for gonadotoxicity of the therapy receivedandtimeelapsedfromtheendofthetherapy,wereport that patients treated with low gonadotoxic therapies, while being similar to age-matched controls in their ovarian reserve when evaluated within a few years from the end of the therapy, show a clear impairment over longer times. We also report that anti-Müllerian hormone is the most sensitive hormonal parameter in detecting changes in ovarian reserve when compared with follicle-stimulating hormone or inhibin-B. This study stresses the importanceofaccuratecounselingatthetimeofdiagnosisofcancer and emphasizes the risks of infertility with low gonadotoxic therapies that may reduce the reproductive window of survivors. The Oncologist 2013;18:1307-1314 Implications for Practice: The need for accurate and personalized counseling of women diagnosed with hematological malignancies and exposed to anticancer therapy in their reproductive age is the major clinical implication of our study. More specifically, our study implies that adequate fertility preservation methods should be discussed when therapies with a low toxicity to the reproductive system are used. Indeed, patients may experience impairment of their reproductive potential, even several years post-therapy, hampering their fertility wishes. Patients should undergo frequent evaluation of their fertility potential to detect eventual impairments in a timely manner.
Journal of Obstetrics and Gynaecology Research, Nov 2, 2017
Aim: Deep endometriosis of the rectum is a highly challenging disease, and a surgical approach is... more Aim: Deep endometriosis of the rectum is a highly challenging disease, and a surgical approach is often needed to restore anatomy and function. Two kinds of surgeries may be performed: radical with segmental bowel resection or conservative without resection. Most patients undergo magnetic resonance imaging (MRI) before surgery, but there is currently no method to predict if conservative surgery is feasible or whether bowel resection is required. The aim of this study was to create an algorithm that could predict bowel resection using MRI images, that was easy to apply and could be useful in a clinical setting, in order to adequately discuss informed consent with the patient and plan the an appropriate and efficient surgical session. Methods: We collected medical records from 2010 to 2016 and reviewed the MRI results of 52 patients to detect any parameters that could predict bowel resection. Parameters that were reproducible and with a significant correlation to radical surgery were investigated by statistical regression and combined in an algorithm to give the best prediction of resection. Results: The calculation of two parameters in MRI, impact angle and lesion size, and their use in a mathematical algorithm permit us to predict bowel resection with a positive predictive value of 87% and a negative predictive value of 83%. Conclusions: MRI could be of value in predicting the need for bowel resection in deep endometriosis of the rectum. Further research is required to assess the possibility of a wider application of this algorithm outside our single-center study.
Polish Journal of Radiology, 2018
The purpose of the present study is to systematically assess the prevalence and characteristics o... more The purpose of the present study is to systematically assess the prevalence and characteristics of the corona mortis (CM) variant of the obturator artery by means of computerised tomography angiography (CTA). Material and methods: A total of 150 consecutive patients (112 males, average age 73 years) referred to CTA for lower limb arterial evaluation were included in this retrospective study. Patient demographics, anastomosis incidence, artery diameter, distance from the symphysis pubis, Kellgren-Lawrence score, and pelvic size were evaluated. Results: In this study 40.6% of patients presented at least one competent CM arterial anastomosis. In the 300 evaluated arteries, 90 arterial anastomoses were found (30%), 40 on the right side (average diameter 1.63 mm) and 50 on the left side (1.78 mm). In 32 cases there was only one anastomosis, while in 29 cases the CM was bilateral. No anastomoses were detected in 89 patients. Mean distance from the symphysis was 50 mm. No relevant association with hip osteoarthrosis was found for CM. Mean pelvic size was 213 mm. Conclusions: The evidence from this study suggests that CM is a common variant that needs to be acknowledged before pelvic intervention.
Journal of Minimally Invasive Gynecology
The new advances in the treatment have greatly increased the life expectancy of premenopausal wom... more The new advances in the treatment have greatly increased the life expectancy of premenopausal women with hematological malignancies. The susceptibility of their ovarian reserve to chemotherapy is however highly variable. The anti-mullerian hormone (AMH) is one of the most sensitive markers of ovarian reserve and fertility preservation. In this study, antral follicle counts (AFC), serum AMH, follicle stimulating hormone (FSH) and inhibin B were assayed in female patients treated for lymphoma and hematological disease to characterize the evolution of fertility preservation. 63 consecutive women (48 with Hodgkin's lymphoma, 9 non-Hodgkin's lymphoma, 6 acute myeloid leukemia) were eligible for enrolment. All patients [median age, 31 years (range: 17-40)] were in complete remission with a median follow-up time of 9.0 years after therapy. 64 healthy controls were also evaluated [median age, 31 years (range: 20-42)]. Participants had a baseline blood drawing during the early follicular phase of the menstrual cycle. A significant difference in AFC (9.8 vs. 16.0, P=0.0001), AMH (2.02 \u3bcg/L vs. 2.97 \u3bcg/L, P=0.02), FSH (16.9 U/L vs. 8.1 U/L, P=0.03) and inhibin B (33.7 ng/L vs. 69.4 ng/L, P <0.005) was observed between patients and controls. The ROC curve analysis comparing AMH and FSH concentrations of patients (at the same AFC cut-off point of 8) revealed that AMH had a better area under the curve (0.904) than FSH (0.678) (P=0.0013). The ovarian reserve is reduced in female patients affected by hematological malignancies after chemotheraphy. AMH is the most reliable serum marker of fertility preservation in these subjects. \ua9 2014 biochimica clinica
The new advances in the treatment have greatly increased the life expectancy of premenopausal wom... more The new advances in the treatment have greatly increased the life expectancy of premenopausal women with hematological malignancies. The susceptibility of their ovarian reserve to chemotherapy is however highly variable. The anti-mullerian hormone (AMH) is one of the most sensitive markers of ovarian reserve and fertility preservation. In this study, antral follicle counts (AFC), serum AMH, follicle stimulating hormone (FSH) and inhibin B were assayed in female patients treated for lymphoma and hematological disease to characterize the evolution of fertility preservation. 63 consecutive women (48 with Hodgkin's lymphoma, 9 non-Hodgkin's lymphoma, 6 acute myeloid leukemia) were eligible for enrolment. All patients [median age, 31 years (range: 17-40)] were in complete remission with a median follow-up time of 9.0 years after therapy. 64 healthy controls were also evaluated [median age, 31 years (range: 20-42)]. Participants had a baseline blood drawing during the early follicular phase of the menstrual cycle. A significant difference in AFC (9.8 vs. 16.0, P=0.0001), AMH (2.02 \u3bcg/L vs. 2.97 \u3bcg/L, P=0.02), FSH (16.9 U/L vs. 8.1 U/L, P=0.03) and inhibin B (33.7 ng/L vs. 69.4 ng/L, P <0.005) was observed between patients and controls. The ROC curve analysis comparing AMH and FSH concentrations of patients (at the same AFC cut-off point of 8) revealed that AMH had a better area under the curve (0.904) than FSH (0.678) (P=0.0013). The ovarian reserve is reduced in female patients affected by hematological malignancies after chemotheraphy. AMH is the most reliable serum marker of fertility preservation in these subjects. \ua9 2014 biochimica clinica
Climacteric, 2019
The incidence of endometriosis in middle-aged women is not minimal compared to that in the reprod... more The incidence of endometriosis in middle-aged women is not minimal compared to that in the reproductive age group. The treatment of affected women after childbearing age to the natural transition toward menopause has received considerably poor attention. Disease management is problematic for these women due to increased contraindications regarding hormonal treatment and the possibility for malignant transformation, considering the increased cancer risk in patients with a long-standing history of the disease. This state-of-the-art review aims for the first time to assess the benefits of the available therapies to help guide treatment decisions for the care of endometriosis in women approaching menopause. Progestins are proven effective in reducing pain and should be preferred in these women. According to the international guidelines that lack precise recommendations, hysterectomy with bilateral salpingo-oophorectomy should be the definitive therapy in women who have completed their reproductive arc, if medical therapy has failed. Strict surveillance or surgery with removal of affected gonads should be considered in cases of long-standing or recurrent endometriomas, especially in the presence of modifications of ultrasonographic cyst patterns. Although rare, malignant transformation of various tissues in endometriosis patients has been described, and management is herein discussed.
The journal of obstetrics and gynaecology research, Jan 2, 2017
Deep endometriosis of the rectum is a highly challenging disease, and a surgical approach is ofte... more Deep endometriosis of the rectum is a highly challenging disease, and a surgical approach is often needed to restore anatomy and function. Two kinds of surgeries may be performed: radical with segmental bowel resection or conservative without resection. Most patients undergo magnetic resonance imaging (MRI) before surgery, but there is currently no method to predict if conservative surgery is feasible or whether bowel resection is required. The aim of this study was to create an algorithm that could predict bowel resection using MRI images, that was easy to apply and could be useful in a clinical setting, in order to adequately discuss informed consent with the patient and plan the an appropriate and efficient surgical session. We collected medical records from 2010 to 2016 and reviewed the MRI results of 52 patients to detect any parameters that could predict bowel resection. Parameters that were reproducible and with a significant correlation to radical surgery were investigated b...
Journal of Minimally Invasive Gynecology, 2015
A panel of experts in the field of endometriosis expressed their opinions on management options i... more A panel of experts in the field of endometriosis expressed their opinions on management options in a 35-year-old patient, desiring pregnancy, with a previous surgery for endometrioma and with bowel obstructive symptoms. Many questions that this paradigmatic patient may pose to the clinician are addressed, and all clinical scenarios are discussed. A decision algorithm derived from this discussion is also proposed.
Archives of Gynecology and Obstetrics, 2021
Purpose To evaluate obstetric outcome in women with endometriosis who conceive naturally and rece... more Purpose To evaluate obstetric outcome in women with endometriosis who conceive naturally and receive standard obstetric care in Italy. Methods Cases were consecutive women with endometriosis managed in eleven Italian referral centers. Controls were women in whom endometriosis was excluded. All women filled in a questionnaire addressing previous natural pregnancies. Marginal logistic regression models were fitted to evaluate the impact of endometriosis on obstetric outcome. A post hoc analysis was performed within the endometriosis group comparing women with severe adenomyosis versus women with absent or mild adenomyosis. Results Three hundred and fifty-five pregnancies in endometriosis group and 741 pregnancies in control group were included. Women with endometriosis had a higher risk of preterm delivery < 34 weeks (6.4% vs 2.8%, OR 2.42, 95% CI 1.22–4.82), preterm delivery < 37 weeks (17.8% vs 9.7%, OR 1.98, 95% CI 1.23–3.19), and neonatal admission to Intensive Care Unit (14...
reproductive physicians in predicting the outcome of ART as it involves huge costs and burden to ... more reproductive physicians in predicting the outcome of ART as it involves huge costs and burden to the couples who seek treatment. Over the past two decades, a number of tests of ovarian reserve have been designed. Recent studies indicate that anti-mullerian hormone (AMH) and antral follicle count (AFC) are the two tests of ovarian reserve that are very useful in predicting ovarian response to controlled ovarian stimulation. [5,6] AMH is a glycoprotein and member of the transforming growth factor β family. It causes regression of the mullerian ducts during male fetal development. AMH is also produced by the growing ovarian follicles of women during their reproductive
Human Reproduction Open
A network of endometriosis experts from 16 Italian academic departments and teaching hospitals di... more A network of endometriosis experts from 16 Italian academic departments and teaching hospitals distributed all over the country made a critical appraisal of the available evidence and definition of 10 suggestions regarding measures to be de-implemented. Strong suggestions were made only when high-quality evidence was available. The aim was to select 10 low-value medical interventions, characterized by an unfavorable balance between potential benefits, potential harms, and costs, which should be discouraged in women with endometriosis. The following suggestions were agreed by all experts: do not suggest laparoscopy to detect and treat superficial peritoneal endometriosis in infertile women without pelvic pain symptoms; do not recommend controlled ovarian stimulation and IUI in infertile women with endometriosis at any stage; do not remove small ovarian endometriomas (diameter <4 cm) with the sole objective of improving the likelihood of conception in infertile patients scheduled f...
Polish Journal of Radiology
The purpose of the present study is to systematically assess the prevalence and characteristics o... more The purpose of the present study is to systematically assess the prevalence and characteristics of the corona mortis (CM) variant of the obturator artery by means of computerised tomography angiography (CTA). Material and methods: A total of 150 consecutive patients (112 males, average age 73 years) referred to CTA for lower limb arterial evaluation were included in this retrospective study. Patient demographics, anastomosis incidence, artery diameter, distance from the symphysis pubis, Kellgren-Lawrence score, and pelvic size were evaluated. Results: In this study 40.6% of patients presented at least one competent CM arterial anastomosis. In the 300 evaluated arteries, 90 arterial anastomoses were found (30%), 40 on the right side (average diameter 1.63 mm) and 50 on the left side (1.78 mm). In 32 cases there was only one anastomosis, while in 29 cases the CM was bilateral. No anastomoses were detected in 89 patients. Mean distance from the symphysis was 50 mm. No relevant association with hip osteoarthrosis was found for CM. Mean pelvic size was 213 mm. Conclusions: The evidence from this study suggests that CM is a common variant that needs to be acknowledged before pelvic intervention.
Journal of Minimally Invasive Gynecology, 2016
A panel of experts in the field of endometriosis expressed their opinions on management options i... more A panel of experts in the field of endometriosis expressed their opinions on management options in a 28-year-old patient, attempting pregnancy for 1 year, with severe cyclic pelvic pain and with clinical examination and imaging techniques suggestive of adenomyosis. Many questions this paradigmatic patient may pose to the clinician are addressed, and all clinical scenarios are discussed. A decision algorithm derived from this discussion is also proposed.
Human reproduction (Oxford, England), Jan 18, 2015
Is the combined excisional/ablative technique for the treatment of ovarian endometriomas better t... more Is the combined excisional/ablative technique for the treatment of ovarian endometriomas better than the traditional stripping technique in terms of recurrence rate? There is no evidence that the combined excisional/ablative technique is better than the traditional stripping technique, as similar recurrence rates were observed for the two techniques. The stripping technique is associated with better results compared with ablative, non-excisional techniques for the treatment of ovarian endometriomas. Excisional techniques, such as stripping, have, however, been associated with reduced ovarian reserve as evaluated with anti-Mullerian hormone, and surgical techniques that better preserve the ovarian reserve are needed. A prospective, multicentre, randomized blinded clinical trial was carried out on 51 patients with bilateral endometriomas larger than 3 cm. For each patient, serving as her own control, one ovary was randomized to the stripping technique and the contralateral to the comb...
The Oncologist, 2013
The impact of cancer therapy on the reproductive potential of patients is increasingly recognized... more The impact of cancer therapy on the reproductive potential of patients is increasingly recognized because survival rates of patients have clearly improved in recent years. Different fertility preservation methods, either generally accepted or still experimental, are currently available, and counseling of patients requires a delicate balance between the efficacy and side effects of the proposed method and the characteristics of both the tumor and the therapy. Deeper knowledge of the effects of cancer therapy on the reproductive potential of patients over time is required to identify the most appropriate fertility preservation method. In this paper, we report a case-control study in which female patients who were diagnosed with hematological malignancies and treated with chemotherapy and/or radiotherapy were compared with age-matched controls in terms of ovarian reserve, as measured by ultrasound examination and hormonal status. By stratifying patients for gonadotoxicity of the therapy receivedandtimeelapsedfromtheendofthetherapy,wereport that patients treated with low gonadotoxic therapies, while being similar to age-matched controls in their ovarian reserve when evaluated within a few years from the end of the therapy, show a clear impairment over longer times. We also report that anti-Müllerian hormone is the most sensitive hormonal parameter in detecting changes in ovarian reserve when compared with follicle-stimulating hormone or inhibin-B. This study stresses the importanceofaccuratecounselingatthetimeofdiagnosisofcancer and emphasizes the risks of infertility with low gonadotoxic therapies that may reduce the reproductive window of survivors. The Oncologist 2013;18:1307-1314 Implications for Practice: The need for accurate and personalized counseling of women diagnosed with hematological malignancies and exposed to anticancer therapy in their reproductive age is the major clinical implication of our study. More specifically, our study implies that adequate fertility preservation methods should be discussed when therapies with a low toxicity to the reproductive system are used. Indeed, patients may experience impairment of their reproductive potential, even several years post-therapy, hampering their fertility wishes. Patients should undergo frequent evaluation of their fertility potential to detect eventual impairments in a timely manner.
Journal of Minimally Invasive Gynecology, 2015
The impact of cancer therapy on the reproductive potential of patients is increasingly recognized... more The impact of cancer therapy on the reproductive potential of patients is increasingly recognized because survival rates of patients have clearly improved in recent years. Different fertility preservation methods, either generally accepted or still experimental, are currently available, and counseling of patients requires a delicate balance between the efficacy and side effects of the proposed method and the characteristics of both the tumor and the therapy. Deeper knowledge of the effects of cancer therapy on the reproductive potential of patients over time is required to identify the most appropriate fertility preservation method. In this paper, we report a case-control study in which female patients who were diagnosed with hematological malignancies and treated with chemotherapy and/or radiotherapy were compared with age-matched controls in terms of ovarian reserve, as measured by ultrasound examination and hormonal status. By stratifying patients for gonadotoxicity of the therapy receivedandtimeelapsedfromtheendofthetherapy,wereport that patients treated with low gonadotoxic therapies, while being similar to age-matched controls in their ovarian reserve when evaluated within a few years from the end of the therapy, show a clear impairment over longer times. We also report that anti-Müllerian hormone is the most sensitive hormonal parameter in detecting changes in ovarian reserve when compared with follicle-stimulating hormone or inhibin-B. This study stresses the importanceofaccuratecounselingatthetimeofdiagnosisofcancer and emphasizes the risks of infertility with low gonadotoxic therapies that may reduce the reproductive window of survivors. The Oncologist 2013;18:1307-1314 Implications for Practice: The need for accurate and personalized counseling of women diagnosed with hematological malignancies and exposed to anticancer therapy in their reproductive age is the major clinical implication of our study. More specifically, our study implies that adequate fertility preservation methods should be discussed when therapies with a low toxicity to the reproductive system are used. Indeed, patients may experience impairment of their reproductive potential, even several years post-therapy, hampering their fertility wishes. Patients should undergo frequent evaluation of their fertility potential to detect eventual impairments in a timely manner.
Oncologist, Oct 22, 2013
The impact of cancer therapy on the reproductive potential of patients is increasingly recognized... more The impact of cancer therapy on the reproductive potential of patients is increasingly recognized because survival rates of patients have clearly improved in recent years. Different fertility preservation methods, either generally accepted or still experimental, are currently available, and counseling of patients requires a delicate balance between the efficacy and side effects of the proposed method and the characteristics of both the tumor and the therapy. Deeper knowledge of the effects of cancer therapy on the reproductive potential of patients over time is required to identify the most appropriate fertility preservation method. In this paper, we report a case-control study in which female patients who were diagnosed with hematological malignancies and treated with chemotherapy and/or radiotherapy were compared with age-matched controls in terms of ovarian reserve, as measured by ultrasound examination and hormonal status. By stratifying patients for gonadotoxicity of the therapy receivedandtimeelapsedfromtheendofthetherapy,wereport that patients treated with low gonadotoxic therapies, while being similar to age-matched controls in their ovarian reserve when evaluated within a few years from the end of the therapy, show a clear impairment over longer times. We also report that anti-Müllerian hormone is the most sensitive hormonal parameter in detecting changes in ovarian reserve when compared with follicle-stimulating hormone or inhibin-B. This study stresses the importanceofaccuratecounselingatthetimeofdiagnosisofcancer and emphasizes the risks of infertility with low gonadotoxic therapies that may reduce the reproductive window of survivors. The Oncologist 2013;18:1307-1314 Implications for Practice: The need for accurate and personalized counseling of women diagnosed with hematological malignancies and exposed to anticancer therapy in their reproductive age is the major clinical implication of our study. More specifically, our study implies that adequate fertility preservation methods should be discussed when therapies with a low toxicity to the reproductive system are used. Indeed, patients may experience impairment of their reproductive potential, even several years post-therapy, hampering their fertility wishes. Patients should undergo frequent evaluation of their fertility potential to detect eventual impairments in a timely manner.
Journal of Obstetrics and Gynaecology Research, Nov 2, 2017
Aim: Deep endometriosis of the rectum is a highly challenging disease, and a surgical approach is... more Aim: Deep endometriosis of the rectum is a highly challenging disease, and a surgical approach is often needed to restore anatomy and function. Two kinds of surgeries may be performed: radical with segmental bowel resection or conservative without resection. Most patients undergo magnetic resonance imaging (MRI) before surgery, but there is currently no method to predict if conservative surgery is feasible or whether bowel resection is required. The aim of this study was to create an algorithm that could predict bowel resection using MRI images, that was easy to apply and could be useful in a clinical setting, in order to adequately discuss informed consent with the patient and plan the an appropriate and efficient surgical session. Methods: We collected medical records from 2010 to 2016 and reviewed the MRI results of 52 patients to detect any parameters that could predict bowel resection. Parameters that were reproducible and with a significant correlation to radical surgery were investigated by statistical regression and combined in an algorithm to give the best prediction of resection. Results: The calculation of two parameters in MRI, impact angle and lesion size, and their use in a mathematical algorithm permit us to predict bowel resection with a positive predictive value of 87% and a negative predictive value of 83%. Conclusions: MRI could be of value in predicting the need for bowel resection in deep endometriosis of the rectum. Further research is required to assess the possibility of a wider application of this algorithm outside our single-center study.
Polish Journal of Radiology, 2018
The purpose of the present study is to systematically assess the prevalence and characteristics o... more The purpose of the present study is to systematically assess the prevalence and characteristics of the corona mortis (CM) variant of the obturator artery by means of computerised tomography angiography (CTA). Material and methods: A total of 150 consecutive patients (112 males, average age 73 years) referred to CTA for lower limb arterial evaluation were included in this retrospective study. Patient demographics, anastomosis incidence, artery diameter, distance from the symphysis pubis, Kellgren-Lawrence score, and pelvic size were evaluated. Results: In this study 40.6% of patients presented at least one competent CM arterial anastomosis. In the 300 evaluated arteries, 90 arterial anastomoses were found (30%), 40 on the right side (average diameter 1.63 mm) and 50 on the left side (1.78 mm). In 32 cases there was only one anastomosis, while in 29 cases the CM was bilateral. No anastomoses were detected in 89 patients. Mean distance from the symphysis was 50 mm. No relevant association with hip osteoarthrosis was found for CM. Mean pelvic size was 213 mm. Conclusions: The evidence from this study suggests that CM is a common variant that needs to be acknowledged before pelvic intervention.
Journal of Minimally Invasive Gynecology
The new advances in the treatment have greatly increased the life expectancy of premenopausal wom... more The new advances in the treatment have greatly increased the life expectancy of premenopausal women with hematological malignancies. The susceptibility of their ovarian reserve to chemotherapy is however highly variable. The anti-mullerian hormone (AMH) is one of the most sensitive markers of ovarian reserve and fertility preservation. In this study, antral follicle counts (AFC), serum AMH, follicle stimulating hormone (FSH) and inhibin B were assayed in female patients treated for lymphoma and hematological disease to characterize the evolution of fertility preservation. 63 consecutive women (48 with Hodgkin's lymphoma, 9 non-Hodgkin's lymphoma, 6 acute myeloid leukemia) were eligible for enrolment. All patients [median age, 31 years (range: 17-40)] were in complete remission with a median follow-up time of 9.0 years after therapy. 64 healthy controls were also evaluated [median age, 31 years (range: 20-42)]. Participants had a baseline blood drawing during the early follicular phase of the menstrual cycle. A significant difference in AFC (9.8 vs. 16.0, P=0.0001), AMH (2.02 \u3bcg/L vs. 2.97 \u3bcg/L, P=0.02), FSH (16.9 U/L vs. 8.1 U/L, P=0.03) and inhibin B (33.7 ng/L vs. 69.4 ng/L, P <0.005) was observed between patients and controls. The ROC curve analysis comparing AMH and FSH concentrations of patients (at the same AFC cut-off point of 8) revealed that AMH had a better area under the curve (0.904) than FSH (0.678) (P=0.0013). The ovarian reserve is reduced in female patients affected by hematological malignancies after chemotheraphy. AMH is the most reliable serum marker of fertility preservation in these subjects. \ua9 2014 biochimica clinica
The new advances in the treatment have greatly increased the life expectancy of premenopausal wom... more The new advances in the treatment have greatly increased the life expectancy of premenopausal women with hematological malignancies. The susceptibility of their ovarian reserve to chemotherapy is however highly variable. The anti-mullerian hormone (AMH) is one of the most sensitive markers of ovarian reserve and fertility preservation. In this study, antral follicle counts (AFC), serum AMH, follicle stimulating hormone (FSH) and inhibin B were assayed in female patients treated for lymphoma and hematological disease to characterize the evolution of fertility preservation. 63 consecutive women (48 with Hodgkin's lymphoma, 9 non-Hodgkin's lymphoma, 6 acute myeloid leukemia) were eligible for enrolment. All patients [median age, 31 years (range: 17-40)] were in complete remission with a median follow-up time of 9.0 years after therapy. 64 healthy controls were also evaluated [median age, 31 years (range: 20-42)]. Participants had a baseline blood drawing during the early follicular phase of the menstrual cycle. A significant difference in AFC (9.8 vs. 16.0, P=0.0001), AMH (2.02 \u3bcg/L vs. 2.97 \u3bcg/L, P=0.02), FSH (16.9 U/L vs. 8.1 U/L, P=0.03) and inhibin B (33.7 ng/L vs. 69.4 ng/L, P <0.005) was observed between patients and controls. The ROC curve analysis comparing AMH and FSH concentrations of patients (at the same AFC cut-off point of 8) revealed that AMH had a better area under the curve (0.904) than FSH (0.678) (P=0.0013). The ovarian reserve is reduced in female patients affected by hematological malignancies after chemotheraphy. AMH is the most reliable serum marker of fertility preservation in these subjects. \ua9 2014 biochimica clinica
Climacteric, 2019
The incidence of endometriosis in middle-aged women is not minimal compared to that in the reprod... more The incidence of endometriosis in middle-aged women is not minimal compared to that in the reproductive age group. The treatment of affected women after childbearing age to the natural transition toward menopause has received considerably poor attention. Disease management is problematic for these women due to increased contraindications regarding hormonal treatment and the possibility for malignant transformation, considering the increased cancer risk in patients with a long-standing history of the disease. This state-of-the-art review aims for the first time to assess the benefits of the available therapies to help guide treatment decisions for the care of endometriosis in women approaching menopause. Progestins are proven effective in reducing pain and should be preferred in these women. According to the international guidelines that lack precise recommendations, hysterectomy with bilateral salpingo-oophorectomy should be the definitive therapy in women who have completed their reproductive arc, if medical therapy has failed. Strict surveillance or surgery with removal of affected gonads should be considered in cases of long-standing or recurrent endometriomas, especially in the presence of modifications of ultrasonographic cyst patterns. Although rare, malignant transformation of various tissues in endometriosis patients has been described, and management is herein discussed.
The journal of obstetrics and gynaecology research, Jan 2, 2017
Deep endometriosis of the rectum is a highly challenging disease, and a surgical approach is ofte... more Deep endometriosis of the rectum is a highly challenging disease, and a surgical approach is often needed to restore anatomy and function. Two kinds of surgeries may be performed: radical with segmental bowel resection or conservative without resection. Most patients undergo magnetic resonance imaging (MRI) before surgery, but there is currently no method to predict if conservative surgery is feasible or whether bowel resection is required. The aim of this study was to create an algorithm that could predict bowel resection using MRI images, that was easy to apply and could be useful in a clinical setting, in order to adequately discuss informed consent with the patient and plan the an appropriate and efficient surgical session. We collected medical records from 2010 to 2016 and reviewed the MRI results of 52 patients to detect any parameters that could predict bowel resection. Parameters that were reproducible and with a significant correlation to radical surgery were investigated b...
Journal of Minimally Invasive Gynecology, 2015
A panel of experts in the field of endometriosis expressed their opinions on management options i... more A panel of experts in the field of endometriosis expressed their opinions on management options in a 35-year-old patient, desiring pregnancy, with a previous surgery for endometrioma and with bowel obstructive symptoms. Many questions that this paradigmatic patient may pose to the clinician are addressed, and all clinical scenarios are discussed. A decision algorithm derived from this discussion is also proposed.
Archives of Gynecology and Obstetrics, 2021
Purpose To evaluate obstetric outcome in women with endometriosis who conceive naturally and rece... more Purpose To evaluate obstetric outcome in women with endometriosis who conceive naturally and receive standard obstetric care in Italy. Methods Cases were consecutive women with endometriosis managed in eleven Italian referral centers. Controls were women in whom endometriosis was excluded. All women filled in a questionnaire addressing previous natural pregnancies. Marginal logistic regression models were fitted to evaluate the impact of endometriosis on obstetric outcome. A post hoc analysis was performed within the endometriosis group comparing women with severe adenomyosis versus women with absent or mild adenomyosis. Results Three hundred and fifty-five pregnancies in endometriosis group and 741 pregnancies in control group were included. Women with endometriosis had a higher risk of preterm delivery < 34 weeks (6.4% vs 2.8%, OR 2.42, 95% CI 1.22–4.82), preterm delivery < 37 weeks (17.8% vs 9.7%, OR 1.98, 95% CI 1.23–3.19), and neonatal admission to Intensive Care Unit (14...
reproductive physicians in predicting the outcome of ART as it involves huge costs and burden to ... more reproductive physicians in predicting the outcome of ART as it involves huge costs and burden to the couples who seek treatment. Over the past two decades, a number of tests of ovarian reserve have been designed. Recent studies indicate that anti-mullerian hormone (AMH) and antral follicle count (AFC) are the two tests of ovarian reserve that are very useful in predicting ovarian response to controlled ovarian stimulation. [5,6] AMH is a glycoprotein and member of the transforming growth factor β family. It causes regression of the mullerian ducts during male fetal development. AMH is also produced by the growing ovarian follicles of women during their reproductive
Human Reproduction Open
A network of endometriosis experts from 16 Italian academic departments and teaching hospitals di... more A network of endometriosis experts from 16 Italian academic departments and teaching hospitals distributed all over the country made a critical appraisal of the available evidence and definition of 10 suggestions regarding measures to be de-implemented. Strong suggestions were made only when high-quality evidence was available. The aim was to select 10 low-value medical interventions, characterized by an unfavorable balance between potential benefits, potential harms, and costs, which should be discouraged in women with endometriosis. The following suggestions were agreed by all experts: do not suggest laparoscopy to detect and treat superficial peritoneal endometriosis in infertile women without pelvic pain symptoms; do not recommend controlled ovarian stimulation and IUI in infertile women with endometriosis at any stage; do not remove small ovarian endometriomas (diameter <4 cm) with the sole objective of improving the likelihood of conception in infertile patients scheduled f...
Polish Journal of Radiology
The purpose of the present study is to systematically assess the prevalence and characteristics o... more The purpose of the present study is to systematically assess the prevalence and characteristics of the corona mortis (CM) variant of the obturator artery by means of computerised tomography angiography (CTA). Material and methods: A total of 150 consecutive patients (112 males, average age 73 years) referred to CTA for lower limb arterial evaluation were included in this retrospective study. Patient demographics, anastomosis incidence, artery diameter, distance from the symphysis pubis, Kellgren-Lawrence score, and pelvic size were evaluated. Results: In this study 40.6% of patients presented at least one competent CM arterial anastomosis. In the 300 evaluated arteries, 90 arterial anastomoses were found (30%), 40 on the right side (average diameter 1.63 mm) and 50 on the left side (1.78 mm). In 32 cases there was only one anastomosis, while in 29 cases the CM was bilateral. No anastomoses were detected in 89 patients. Mean distance from the symphysis was 50 mm. No relevant association with hip osteoarthrosis was found for CM. Mean pelvic size was 213 mm. Conclusions: The evidence from this study suggests that CM is a common variant that needs to be acknowledged before pelvic intervention.
Journal of Minimally Invasive Gynecology, 2016
A panel of experts in the field of endometriosis expressed their opinions on management options i... more A panel of experts in the field of endometriosis expressed their opinions on management options in a 28-year-old patient, attempting pregnancy for 1 year, with severe cyclic pelvic pain and with clinical examination and imaging techniques suggestive of adenomyosis. Many questions this paradigmatic patient may pose to the clinician are addressed, and all clinical scenarios are discussed. A decision algorithm derived from this discussion is also proposed.
Human reproduction (Oxford, England), Jan 18, 2015
Is the combined excisional/ablative technique for the treatment of ovarian endometriomas better t... more Is the combined excisional/ablative technique for the treatment of ovarian endometriomas better than the traditional stripping technique in terms of recurrence rate? There is no evidence that the combined excisional/ablative technique is better than the traditional stripping technique, as similar recurrence rates were observed for the two techniques. The stripping technique is associated with better results compared with ablative, non-excisional techniques for the treatment of ovarian endometriomas. Excisional techniques, such as stripping, have, however, been associated with reduced ovarian reserve as evaluated with anti-Mullerian hormone, and surgical techniques that better preserve the ovarian reserve are needed. A prospective, multicentre, randomized blinded clinical trial was carried out on 51 patients with bilateral endometriomas larger than 3 cm. For each patient, serving as her own control, one ovary was randomized to the stripping technique and the contralateral to the comb...
The Oncologist, 2013
The impact of cancer therapy on the reproductive potential of patients is increasingly recognized... more The impact of cancer therapy on the reproductive potential of patients is increasingly recognized because survival rates of patients have clearly improved in recent years. Different fertility preservation methods, either generally accepted or still experimental, are currently available, and counseling of patients requires a delicate balance between the efficacy and side effects of the proposed method and the characteristics of both the tumor and the therapy. Deeper knowledge of the effects of cancer therapy on the reproductive potential of patients over time is required to identify the most appropriate fertility preservation method. In this paper, we report a case-control study in which female patients who were diagnosed with hematological malignancies and treated with chemotherapy and/or radiotherapy were compared with age-matched controls in terms of ovarian reserve, as measured by ultrasound examination and hormonal status. By stratifying patients for gonadotoxicity of the therapy receivedandtimeelapsedfromtheendofthetherapy,wereport that patients treated with low gonadotoxic therapies, while being similar to age-matched controls in their ovarian reserve when evaluated within a few years from the end of the therapy, show a clear impairment over longer times. We also report that anti-Müllerian hormone is the most sensitive hormonal parameter in detecting changes in ovarian reserve when compared with follicle-stimulating hormone or inhibin-B. This study stresses the importanceofaccuratecounselingatthetimeofdiagnosisofcancer and emphasizes the risks of infertility with low gonadotoxic therapies that may reduce the reproductive window of survivors. The Oncologist 2013;18:1307-1314 Implications for Practice: The need for accurate and personalized counseling of women diagnosed with hematological malignancies and exposed to anticancer therapy in their reproductive age is the major clinical implication of our study. More specifically, our study implies that adequate fertility preservation methods should be discussed when therapies with a low toxicity to the reproductive system are used. Indeed, patients may experience impairment of their reproductive potential, even several years post-therapy, hampering their fertility wishes. Patients should undergo frequent evaluation of their fertility potential to detect eventual impairments in a timely manner.
Journal of Minimally Invasive Gynecology, 2015