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Comelli A, Genovese C, Gobbi F, Brindicci G, Capone S, Corpolongo A, Crosato V, Mangano VD, Marrone R, Merelli M, Prato M, Santoro CR, Scarso S, Vanino E, Marchese V, Antinori S, Mastroianni C, Raglio A, Bruschi F, Minervini A, Donà D, Garazzino S, Galli L, Lo Vecchio A, Galli A, Dragoni G, Cricelli C, Colacurci N, Ferrazzi E, Pieralli A, Montresor A, Richter J, Calleri G, Bartoloni A, Zammarchi L. Schistosomiasis in non-endemic areas: Italian consensus recommendations for screening, diagnosis and management by the Italian Society of Tropical Medicine and Global Health (SIMET), endorsed by the Committee for the Study of Parasitology of the Italian Association of Clinical Microbiologists (CoSP-AMCLI), the Italian Society of Parasitology (SoIPa), the Italian Society of Gastroenterology and Digestive Endoscopy (SIGE), the Italian Society of Gynaecology and Obstetrics (SIGO), the Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV), the Italian Society of General Medicine and Primary Care (SIMG), the Italian Society of Infectious and Tropical Diseases (SIMIT), the Italian Society of Pediatrics (SIP), the Italian Society of Paediatric Infectious Diseases (SITIP), the Italian Society of Urology (SIU). Infection 2023; 51:1249-1271. [PMID: 37420083 PMCID: PMC10545632 DOI: 10.1007/s15010-023-02050-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/08/2023] [Indexed: 07/09/2023]
Affiliation(s)
- Agnese Comelli
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Camilla Genovese
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- II Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Federico Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
- University of Brescia, Brescia, Italy
| | - Gaetano Brindicci
- AOU Consorziale Policlinico di Bari, Infectious Diseases Unit, Bari, Italy
| | - Susanna Capone
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Angela Corpolongo
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Verena Crosato
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Valentina Dianora Mangano
- Department of Translational Research, N.T.M.S, Università di Pisa, Pisa, Italy
- Programma Di Monitoraggio Delle Parassitosi e f.a.d, AOU Pisana, Pisa, Italy
| | - Rosalia Marrone
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Maria Merelli
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Marco Prato
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | | | - Salvatore Scarso
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Elisa Vanino
- Unit of Infectious Diseases, Ospedale "Santa Maria delle Croci", AUSL Romagna, Ravenna, Italy
| | - Valentina Marchese
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Claudio Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Annibale Raglio
- Committee for the Study of Parasitology of the Italian Association of Clinical Microbiologists (CoSP-AMCLI), Milan, Italy
| | - Fabrizio Bruschi
- Department of Translational Research, N.T.M.S, Università di Pisa, Pisa, Italy
- Programma Di Monitoraggio Delle Parassitosi e f.a.d, AOU Pisana, Pisa, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Urology, University of Florence, Florence, Italy
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Silvia Garazzino
- Paediatric Infectious Disease Unit, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's Hospital, IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Paediatric Infectious Disease Unit, University of Naples Federico II, Naples, Italy
| | - Andrea Galli
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Gabriele Dragoni
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Claudio Cricelli
- Health Search-Istituto di Ricerca della SIMG (Italian Society of General Medicine and Primary Care), Florence, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Enrico Ferrazzi
- Department of Woman, New-Born and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Annalisa Pieralli
- Ginecologia Chirurgica Oncologica, Careggi University and Hospital, Florence, Italy
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Joachim Richter
- Institute of International Health, Charité Universitätsmedizin, Corporate Member of Freie und Humboldt Universität Berlin and Berlin Institute of Health, Berlin, Germany
| | - Guido Calleri
- Amedeo Di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
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Luvero D, Angioli R, Baruch Y, Salvatore S, Filippini M, Pieralli A, Montera R. The efficacy and feasibility of fractional CO2 laser therapy for the treatment of urinary incontinence: a multicentric case-control study. Minerva Obstet Gynecol 2023:S2724-606X.23.05290-9. [PMID: 37140590 DOI: 10.23736/s2724-606x.23.05290-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Female urinary incontinence is a significant public health problem. Conservative treatments require high patient compliance, while surgery often leads to more complications and recovery time. Our aim is to evaluate the efficacy of microablative fractional CO<inf>2</inf> laser (CO<inf>2</inf>-laser) therapy in women with urinary incontinence (UI). METHODS This is a retrospective analysis of prospectively collected data on women with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) with predominant SUI subjected to four sessions of CO<inf>2</inf>-laser therapy performed once a month, between February 2017 and October 2017, with a 12-month follow-up. The subjective Visual Analogue Scale (VAS) 0-10 was used to score and variables were evaluated at baseline and at one, six and 12 months after initiation of therapy. Finally, results were compared to a control group. RESULTS The cohort consisted of 42 women. The proportion of patients with vaginal atrophy among those younger than 55 years was substantially lower (3/23; 13%) than among those older than 55 years (15/19; 78.9%). CO<inf>2</inf> laser treatment was associated with a significant improvement in VAS scores recorded one-month, six-months, and one-year, after conclusion of therapy (P<0.001). VAS scores improved significantly in patients with either SUI (26/42; 61.9%) or mixed UI (16/42; 38.1%). No major post treatment complications were registered. Women with vaginal atrophy demonstrated significantly better results (P<0.001). CONCLUSIONS Results confirm the efficacy and a good safety profile, for CO<inf>2</inf> laser treatment in SUI, mostly in women with postmenopausal vaginal atrophy and should be considered as a treatment option for female patients with concomitant SUI and vaginal atrophy.
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Affiliation(s)
- Daniela Luvero
- Department of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy -
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Yoav Baruch
- Unit of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Stefano Salvatore
- Unit of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Maurizio Filippini
- Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, San Marino, Republic of San Marino
| | - Annalisa Pieralli
- Section of Gynecology and Obstetrics, Department of Woman and Child Health, Careggi University Hospital, Florence, Italy
| | - Roberto Montera
- Department of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
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Delli Carpini G, Giorgi Rossi P, Giannella L, Di Giuseppe J, Clemente N, Sopracordevole F, Barbero M, Bogani G, De Vincenzo R, Origoni M, Cantatore F, Gardella B, Dominoni M, Monti E, Liverani CA, Viscardi A, Pagan A, Amadori A, Alessi C, Andolfatto M, Cattani P, Pieralli A, Stevenazzi G, Ciavattini A. Monitoring the activities of Italian colposcopy clinics before and during the COVID-19 pandemic. J Gynecol Oncol 2023; 34:e7. [PMID: 36245226 DOI: 10.3802/jgo.2023.34.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/18/2022] [Accepted: 08/29/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To evaluate the impact of healthcare reorganization during the severe acute respiratory syndrome coronavirus 2 pandemic on Italian colposcopy clinic activities, focusing on cervical excision procedures, follow-ups for conservative management of low-grade lesions, and follow-ups post cervical excision. METHODS Retrospective study conducted in 14 Italian colposcopy clinics. The number and clinical characteristics of cervical excisions, follow-ups for conservative management of low-grade lesions, and follow-ups after cervical excision were compared between the period March 1, 2019 to February 29, 2020 (pre-pandemic) and March 1, 2020 to February 28, 2021 (pandemic) with a Poisson regression analysis. RESULTS In the pandemic period, the number of cervical excisions was reduced by 8.8% (95% confidence interval [CI]=-15.6% to -2%; p=0.011). Excisions were less frequently performed in the operating room (-35.1%; 95% CI=-47.6% to -22.6%; p<0.001), the number of patients from spontaneous screening was reduced by -14.0% (95% CI=-23.4% to -4.6%; p=0.003), and the CO2-laser technique was used less frequently (-30%; 95% CI=-45.1% to -15.0%; p<0.001). As compared to the pre-pandemic period, the number of follow-ups for conservative management of low-grade lesions was reduced by -26.7% (95% CI=-39.0% to -14.4%; p<0.001), and the follow-up appointments after cervical excision were reduced by -51.0% (95% CI=-58.1% to -43.9%; p<0.001). CONCLUSION The most significant impact of the healthcare reorganization during the coronavirus disease 2019 pandemic was on follow-ups after cervical excision. The resumption of disrupted activities should follow a risk-based prioritization, starting from women in follow-up after cervical excision. It is advisable that the trend of performing cervical excision as an outpatient procedure is maintained in the post-pandemic period.
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Affiliation(s)
- Giovanni Delli Carpini
- Gynecology Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Giannella
- Gynecology Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Jacopo Di Giuseppe
- Gynecology Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Nicolò Clemente
- Gynecological Oncology Unit, Centro di Riferimento Oncologico-National Cancer Institute, Aviano, Italy
| | - Francesco Sopracordevole
- Gynecological Oncology Unit, Centro di Riferimento Oncologico-National Cancer Institute, Aviano, Italy
| | - Maggiorino Barbero
- Department of Obstetrics and Gynecology, Asti Community Hospital, Asti, Italy
| | - Giorgio Bogani
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Rosa De Vincenzo
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy.,Dipartimento di Scienze della vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimo Origoni
- Department of Gynecology & Obstetrics, Vita Salute San Raffaele University School of Medicine, Milan, Italy
| | - Francesco Cantatore
- Department of Gynecology & Obstetrics, Vita Salute San Raffaele University School of Medicine, Milan, Italy
| | | | | | - Ermelinda Monti
- Gynecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Antonio Liverani
- Gynecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Viscardi
- Gynecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Chiara Alessi
- UOC Ostetricia Ginecologia, Dipartimento per la Salute della Donna e del Bambino, Azienda Ospedaliera - Università di Padova, Padova, Italy
| | - Matteo Andolfatto
- UOC Ostetricia Ginecologia, Dipartimento per la Salute della Donna e del Bambino, Azienda Ospedaliera - Università di Padova, Padova, Italy
| | - Paolo Cattani
- Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV), Rome, Italy
| | - Annalisa Pieralli
- Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | - Guido Stevenazzi
- Department of Obstetrics and Gynaecology, ASST OVEST MI, Legnano (Milan) Hospital, Legnano, Italy
| | - Andrea Ciavattini
- Gynecology Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy.
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Agarossi A, Delli Carpini G, Sopracordevole F, Serri M, Giannella L, Gardella B, Maestri M, Del Fabro A, Sansone M, Fallani MG, Pieralli A, Fasolo MM, Mazzali C, Ciavattini A. High-risk HPV positivity is a long-term risk factor for recurrence after cervical excision procedure in women living with HIV. Int J Gynaecol Obstet 2021; 155:442-449. [PMID: 33721323 PMCID: PMC8596685 DOI: 10.1002/ijgo.13674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/05/2021] [Accepted: 03/12/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To evaluate the risk factors for recurrence of high-grade disease after cervical excision in women living with HIV (WLWH), with a specific interest in the role of high-risk (HR-) HPV positivity. METHODS Multicentric retrospective study conducted on WLWH who underwent cervical excision between January 1987 and June 2017 in six Italian institutions. The rate of high-grade recurrence was determined. Risk factors for recurrence and HR-HPV positivity were determined with the Log-rank test and Cox proportional hazards regression models. RESULTS A total of 271 WLWH were included in the final analysis. A high-grade recurrence was found in 58 (21.4%) patients. Age 41 years or more at inclusion and HR-HPV positivity during follow up were independently associated with a higher risk of disease recurrence with relative risks of 4.15 (95% confidence interval [CI] 2.01-8.58, P < 0.001) and 5.18 (95% CI 2.12-12.67, P < 0.01), respectively. Age 41 years or more (relative risk 1.75, 95% CI 1.01-3.04, P = 0.047) resulted as a risk factor for HR-HPV positivity during follow up. CONCLUSION HR-HPV positivity is a risk factor for recurrence after cervical excision in WLWH. Women older than 41 years may benefit from a long-term yearly follow up. Future studies regarding HPV vaccination after treatment in WLWH may be useful, considering the protective role of the higher probability of HPV negativity in vaccinated women.
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Affiliation(s)
- Alberto Agarossi
- Department of Obstetrics and GynecologyL. Sacco HospitalASST‐Fatebenefratelli‐SaccoUniversity of MilanMilanItaly
| | - Giovanni Delli Carpini
- Woman’s Health Sciences DepartmentGynecologic SectionUniversità Politecnica delle MarcheAnconaItaly
| | - Francesco Sopracordevole
- Gynecological Oncology UnitCentro di Riferimento Oncologico – National Cancer InstituteAvianoItaly
| | - Matteo Serri
- Woman’s Health Sciences DepartmentGynecologic SectionUniversità Politecnica delle MarcheAnconaItaly
| | - Luca Giannella
- Woman’s Health Sciences DepartmentGynecologic SectionUniversità Politecnica delle MarcheAnconaItaly
| | - Barbara Gardella
- Department of Obstetrics and GynecologyUniversity of PaviaFondazione IRCCS PoliclinicoPaviaItaly
| | - Marta Maestri
- Department of Obstetrics and GynecologyL. Sacco HospitalASST‐Fatebenefratelli‐SaccoUniversity of MilanMilanItaly
| | - Anna Del Fabro
- Gynecological Oncology UnitCentro di Riferimento Oncologico – National Cancer InstituteAvianoItaly
| | - Matilde Sansone
- Regional Reference Center for AIDS and Infectious Diseases in Obstetrics and GynecologyAOU Federico IINaplesItaly
| | | | | | - Maria Michela Fasolo
- DivisionDepartment of Infectious DiseasesASST Fatebenefratelli Sacco University HospitalMilanItaly
| | - Cristina Mazzali
- Presidio Regionale HTA dei Dispositivi MediciASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Andrea Ciavattini
- Woman’s Health Sciences DepartmentGynecologic SectionUniversità Politecnica delle MarcheAnconaItaly
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5
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Angioli R, Stefano S, Filippini M, Pieralli A, Montera R, Plotti F, Gatti A, Bartolone M, Luvero D. Effectiveness of CO 2 laser on urogenital syndrome in women with a previous gynecological neoplasia: a multicentric study. Int J Gynecol Cancer 2020; 30:590-595. [PMID: 32221022 DOI: 10.1136/ijgc-2019-001028] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Many women diagnosed with gynecological cancers undergo adjuvant therapy, which may lead to transient or permanent menopause that ultimately leads to urogenital syndrome and vulvovaginal atrophy. Studies advise against the use of estrogen in women with a history of hormone-dependent cancer. One alternative is vaginal microablative fractional CO2 laser, which promotes tissue regeneration through the production of collagen and elastic fibers. OBJECTIVE To evaluate the effectiveness of CO2 laser in the treatment of urogenital syndrome-in particular, symptomatic vulvovaginal atrophy in women who have survived gynecological cancers. METHODS A retrospective study was carried out, including all patients with a history of gynecological cancers and vulvovaginal atrophy who underwent CO2 laser treatment between November 2012 and February 2018 in four Italian centers. The study was approved by the local ethics committee of each participating institution. The inclusion criteria were women aged between 18 and 75; Eastern Cooperative Oncology Group performance status <2; and history of breast, ovarian, cervical, or uterus cancer. Patients had to have vulvovaginal atrophy and at least one of the following symptoms of urogenital syndrome: vaginal dryness, dyspareunia, vaginal introitus pain, burning, or itching. Three applications were administered at baseline, 30 days, and 60 days. All patients were evaluated before the first laser session, at each session, and 4 weeks after the last session. In particular, patients were asked to indicate the intensity of symptoms before the first session and 4 weeks after the last session, using Visual Analog Scale (VAS) scoring from 0 ('no discomfort') to 10 ('maximum discomfort'). RESULTS A total of 1213 patients underwent CO2 laser treatment and of these, 1048 were excluded because they did not meet the inclusion criteria in the analysis. Finally, a total of 165 patients were included in the study. The mean age at the time of treatment was 53 years (range 31-73). Dryness improved by 66%, dyspareunia improved by 59%, burning improved by 66%, pain at introitus improved by 54%, and itching improved by 54%. The side effects were evaluated as pain greater than VAS score 6 during and after the treatment period. No side effects were seen in any sessions. CONCLUSIONS Fractional microablative CO2 laser therapy offers an effective strategy in the management of the symptoms of genitourinary syndrome in post-menopausal women and in survivors of gynecological cancer.
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Affiliation(s)
- Roberto Angioli
- Department of Gynecology, University Campus Biomedico, Rome, Italy
| | - Salvatore Stefano
- Department of Obstetrics and Ginecology, IRCCS San Raffaele Hospital, Milan, Lombardia, Italy
| | - Maurizio Filippini
- Department of Ostetrics and Gynecology, Hospital State of Republic of San Marino, San Marino, Republic of San Marino
| | - Annalisa Pieralli
- Department of Women and Child Health, Careggi University Hospital, Florence, Toscana, Italy
| | - Roberto Montera
- Department of Gynecology, University Campus Biomedico, Rome, Italy
| | - Francesco Plotti
- Department of Gynecology, University Campus Biomedico, Rome, Italy
| | - Alessandra Gatti
- Department of Gynecology, University Campus Biomedico, Rome, Italy
| | | | - Daniela Luvero
- Department of Gynecology, University Campus Biomedico, Rome, Italy
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6
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Malentacchi F, Bussani C, Pavone D, Anderson KL, Fambrini M, Cocco C, Fantappiè G, Pieralli A, Dubini V, Petraglia F, Sorbi F. HPV genotype distribution and age correlation in a selected Italian population undergoing conization. ACTA ACUST UNITED AC 2020; 72:1-11. [DOI: 10.23736/s0026-4784.20.04506-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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7
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Ciavattini A, Serri M, Di Giuseppe J, Liverani CA, Fallani MG, Tsiroglou D, Papiccio M, Delli Carpini G, Pieralli A, Clemente N, Sopracordevole F. Reliability of colposcopy during pregnancy. Eur J Obstet Gynecol Reprod Biol 2018; 229:76-81. [DOI: 10.1016/j.ejogrb.2018.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/29/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
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Ghelardi A, Parazzini F, Martella F, Pieralli A, Bay P, Tonetti A, Svelato A, Bertacca G, Lombardi S, Joura EA. SPERANZA project: HPV vaccination after treatment for CIN2. Gynecol Oncol 2018; 151:229-234. [PMID: 30197061 DOI: 10.1016/j.ygyno.2018.08.033] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/21/2018] [Accepted: 08/25/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Alessandro Ghelardi
- Azienda Usl Toscana Nord-Ovest, UOC Ostetricia e Ginecologia, Ospedale Apuane, Massa, Italy.
| | - Fabio Parazzini
- Policlinico Mangiagalli, Dipartimento di Scienze Cliniche e di Comunità, IRCCS, Milano, Italy
| | | | - Annalisa Pieralli
- Azienda Ospedaliero Universitaria Careggi, Ginecologia Chirurgica Oncologica, Firenze, Italy
| | - Paola Bay
- Azienda Usl Toscana Nord-Ovest, UOC Ostetricia e Ginecologia, Ospedale Apuane, Massa, Italy
| | - Arianna Tonetti
- Azienda Usl Toscana Nord-Ovest, UOC Ostetricia e Ginecologia, Ospedale Apuane, Massa, Italy
| | - Alessandro Svelato
- Azienda Usl Toscana Nord-Ovest, UOC Ostetricia e Ginecologia, Ospedale Apuane, Massa, Italy
| | - Gloria Bertacca
- Azienda USL Toscana Nord Ovest, SSD Analisi ChimicoCliniche ed ImmunoAllergologia, Ospedale Apuane, Massa, Italy
| | - Stefania Lombardi
- Azienda USL Toscana Nord Ovest, SSD Analisi ChimicoCliniche ed ImmunoAllergologia, Ospedale Apuane, Massa, Italy
| | - Elmar A Joura
- Medical University of Vienna, AKH Department of Obstetrics and Gynecology, Comprehensive Cancer Center Vienna, Italy
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Becorpi A, Campisciano G, Zanotta N, Tredici Z, Guaschino S, Petraglia F, Pieralli A, Sisti G, De Seta F, Comar M. Fractional CO 2 laser for genitourinary syndrome of menopause in breast cancer survivors: clinical, immunological, and microbiological aspects. Lasers Med Sci 2018; 33:1047-1054. [PMID: 29492713 DOI: 10.1007/s10103-018-2471-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 02/20/2018] [Indexed: 02/06/2023]
Abstract
The composition of vaginal microbiome in menopause and cancer survivor women changes dramatically leading to genitourinary syndrome of menopause (GSM) in up to 70% of patients. Recent reports suggest that laser therapy may be valuable as a not hormonal therapeutic modality. The aim of the present study was to evaluate the effects of fractional CO2 laser treatment on the vaginal secretory pathway of a large panel of immune mediators, usually implicated in tissue remodeling and inflammation, and on microbiome composition in postmenopausal breast cancer survivors. The Ion Torrent PGM platform and the Luminex Bio-Plex platform were used for microbiome and immune factor analysis. The significant reduction of clinical symptoms and the non-significant changes in vaginal microbiome support the efficacy and safety of laser treatment. Moreover, the high remodeling status in vaginal epithelium is demonstrated by the significant changes in inflammatory and modulatory cytokine patterns. Laser therapy can be used for the treatment of GSM symptoms and does not show any adverse effects. However, further studies will be needed to clarify its long-term efficacy and other effects.
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Affiliation(s)
- Angelamaria Becorpi
- Section of Gynecology and Obstetrics, Department of Woman and Child Health, Careggi University Hospital, Largo Brambilla 3, 50144, Florence, Italy
| | - Giuseppina Campisciano
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", via dell'Istria 65/1, 34100, Trieste, Italy
| | - Nunzia Zanotta
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", via dell'Istria 65/1, 34100, Trieste, Italy
| | - Zelinda Tredici
- Section of Gynecology and Obstetrics, Department of Woman and Child Health, Careggi University Hospital, Largo Brambilla 3, 50144, Florence, Italy
| | - Secondo Guaschino
- Section of Gynecology and Obstetrics, Department of Woman and Child Health, Careggi University Hospital, Largo Brambilla 3, 50144, Florence, Italy
| | - Felice Petraglia
- Section of Gynecology and Obstetrics, Department of Woman and Child Health, Careggi University Hospital, Largo Brambilla 3, 50144, Florence, Italy
| | - Annalisa Pieralli
- Section of Gynecology and Obstetrics, Department of Woman and Child Health, Careggi University Hospital, Largo Brambilla 3, 50144, Florence, Italy
| | - Giovanni Sisti
- Section of Gynecology and Obstetrics, Department of Woman and Child Health, Careggi University Hospital, Largo Brambilla 3, 50144, Florence, Italy
| | - Francesco De Seta
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", via dell'Istria 65/1, 34100, Trieste, Italy.,Department of Medical Sciences, University of Trieste, Piazzale Europa 1, 34127, Trieste, Italy
| | - Manola Comar
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", via dell'Istria 65/1, 34100, Trieste, Italy. .,Department of Medical Sciences, University of Trieste, Piazzale Europa 1, 34127, Trieste, Italy.
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Pieralli A, Bianchi C, Longinotti M, Corioni S, Auzzi N, Becorpi A, Fallani MG, Cariti G, Petraglia F. Erratum to: Long-term reliability of fractioned CO 2 laser as a treatment for vulvovaginal atrophy (VVA) symptoms. Arch Gynecol Obstet 2017; 296:1237. [PMID: 28956066 DOI: 10.1007/s00404-017-4538-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In original publication, the Fig. 1 was incorrect. The correct figure has been given below.
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Affiliation(s)
- Annalisa Pieralli
- Section of Oncological Gynecology, Department of Woman and Child Health, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Claudia Bianchi
- Section of Oncological Gynecology, Department of Woman and Child Health, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Manuela Longinotti
- Section of Oncological Gynecology, Department of Woman and Child Health, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Serena Corioni
- Section of Oncological Gynecology, Department of Woman and Child Health, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Noemi Auzzi
- Section of Oncological Gynecology, Department of Woman and Child Health, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Angelamaria Becorpi
- Section of Oncological Gynecology, Department of Woman and Child Health, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Maria Grazia Fallani
- Section of Oncological Gynecology, Department of Woman and Child Health, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Giuseppe Cariti
- Section of Oncological Gynecology, Department of Woman and Child Health, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Felice Petraglia
- Section of Oncological Gynecology, Department of Woman and Child Health, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
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Sopracordevole F, Clemente N, Barbero M, Agarossi A, Cattani P, Garutti P, Fallani MG, Pieralli A, Boselli F, Frega A, De Piero G, Del Fabro A, Buttignol M, Ciavattini A. Colposcopic patterns of vaginal intraepithelial neoplasia: a focus on low-grade lesions. Eur Rev Med Pharmacol Sci 2017; 21:2823-2828. [PMID: 28682436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the colposcopic patterns observed in women with a histopathological diagnosis of vaginal intraepithelial neoplasia, with a particular interest in analyzing the colposcopic characteristics of low-grade squamous intraepithelial lesions (LSIL). PATIENTS AND METHODS Medical charts and colposcopy records of women diagnosed with vaginal intraepithelial neoplasia from January 1995 to December 2015, were analyzed in a multicenter retrospective case series. The abnormal colposcopic patterns observed in women with vaginal LSIL and vaginal high-grade SIL (HSIL) were compared. The vascular patterns and micropapillary pattern were considered separately. RESULTS Regardless the histopathological grading, in women with vaginal SIL, the grade I abnormal colposcopic findings were more frequent than grade II abnormalities. However, a grade I colposcopy was more commonly observed in women with a biopsy diagnosis of LSIL rather than HSIL (p<0.0001). Similarly, the micropapillary pattern was more frequently observed in women with LSIL (p=0.004), while vascular patterns were observed more frequently in women diagnosed with vaginal HSIL (p<0.0001). In women with grade I colposcopy, the menopausal status and a previous hysterectomy appeared to be associated with the diagnosis of vaginal HSIL. CONCLUSIONS Grade I abnormal colposcopic findings were more commonly observed in women with vaginal LSIL, as well as the micropapillary pattern. On the other hand, grade II abnormal colposcopy and the presence of vascular patterns were more frequently observed in women with vaginal HSIL.
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Affiliation(s)
- F Sopracordevole
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy.
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Pieralli A. Feasibility of Quadrivalent HPV Vaccination as Immunologic Booster to Prevent Relapses In an Italian Cohort of Women Treated for Cervical Intraepithelial Neoplasia (CIN). MOJWH 2016. [DOI: 10.15406/mojwh.2016.02.00040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Sopracordevole F, Barbero M, Clemente N, Fallani MG, Cattani P, Agarossi A, De Piero G, Parin A, Frega A, Boselli F, Mancioli F, Buttignol M, Currado F, Pieralli A, Ciavattini A. High-grade vaginal intraepithelial neoplasia and risk of progression to vaginal cancer: a multicentre study of the Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV). Eur Rev Med Pharmacol Sci 2016; 20:818-824. [PMID: 27010135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of this study was to analyse the women with high grade vaginal intraepithelial neoplasia (HG-VaIN), in order to identify a subset of women at higher risk of progression to invasive vaginal cancer. MATERIALS AND METHODS The medical records of all the women diagnosed with HG-VaIN, and subsequently treated, from January 1995 to December 2013 were analyzed in a multicentre retrospective case series. The rate of progression to invasive vaginal cancer and the potential risk factors were evaluated. RESULTS 205 women with biopsy diagnosis of HG-VaIN were considered, with a mean follow up of 57 months (range 4-254 months). 12 cases of progression to vaginal squamocellular cancer were observed (5.8%), with a mean time interval from treatment to progression of 54.6 months (range 4-146 months). The rate of progression was significantly higher in women diagnosed with VaIN3 compared with VaIN2 (15.4% vs. 1.4%, p < 0.0001). Women with HG-VaIN and with previous hysterectomy showed a significantly higher rate of progression to invasive vaginal cancer compared to non-hysterectomised women (16.7% vs. 1.4%, p < 0.0001). A higher risk of progression for women with VaIN3 and for women with previous hysterectomy for cervical HPV-related disease was confirmed by multivariable logistic regression analysis. CONCLUSIONS A higher rate of progression to vaginal cancer was reported in women diagnosed with VaIN3 on biopsy and in women with previous hysterectomy for HPV-related cervical disease. These patients should be considered at higher risk, thus a long lasting and accurate follow up is recommended.
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Affiliation(s)
- F Sopracordevole
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy.
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Fambrini M, Bussani C, Sorbi F, Pieralli A, Cioni R. Methylation of the HOXA10 homeobox gene promoter is associated with endometrial cancer: a pilot study. J OBSTET GYNAECOL 2014; 33:519-20. [PMID: 23815210 DOI: 10.3109/01443615.2013.776027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Methylation in the promoter region represents an epigenetic mechanism that silences expression of various homeobox genes in cancers. We compare the methylation profile of HOXA10 promoter gene in 19 histologically proven endometrioid cancers and 27 normal endometrial tissues. Endometrial cancer tissue displays significantly higher methylation status in HOXA10 gene promoter than normal tissue, suggesting a possible role of epigenetic changes in HOXA10 gene regulation in tumorigenesis. Further studies in human tissue and cell lines are necessary to validate these preliminary results and to investigate HOXA10 expression according to methylation status in endometrial cancer.
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Affiliation(s)
- M Fambrini
- Department of Science for Woman and Child Health, University of Florence, Florence, Italy.
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15
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Lozza V, Pieralli A, Corioni S, Longinotti M, Bianchi C, Moncini D, Fallani MG. HPV-related cervical disease and oropharyngeal cancer. Arch Gynecol Obstet 2014; 290:375-9. [PMID: 24584479 DOI: 10.1007/s00404-014-3187-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 02/12/2014] [Indexed: 11/27/2022]
Abstract
Human papillomavirus (HPV), especially HPV 16, is associated with the development of both cervical and oral cancer. We show the case of a woman affected by HPV-related cervical disease and oropharyngeal squamous cell carcinoma (OPSCC). A 41-year-old woman arrived at our Colposcopy Center following an abnormal Pap smear result (ASC-H) and a diagnosis of moderate cervical dysplasia obtained by a cervical biopsy. She underwent a colposcopy that showed a cervical abnormal transformation zone grade 2. A laser conization was performed in November 2010. Histology reported a moderate/severe dysplasia. The cone resection margins were free. Follow-up colposcopy and cytology were negative. The HPV testing showed an infection by HPV 16. In October 2012, the patient presented to the Head-Neck ER after episodes of hemoptysis; a lesion was found in the left tonsillar lodge. A biopsy was performed with a result of squamous cell carcinoma with low-grade differentiation. The HPV testing detected a high-risk HPV and the immunohistochemical analysis was positive for p16. She was treated by chemotherapy and brachytherapy. She was followed at the head-neck center with monthly visits with oral visual inspection that showed complete absence of mucosal abnormalities. HPV-related OPSCC and cervical precancerous/cancerous lesions have significant similarities in terms of pathogenesis. They are both caused largely by HPV 16, as in the present case. In conclusion, because of this association found in literature and in our case, we think that women with HPV cervical lesions should have regular surveillance for oropharyngeal cancer, whereas women with OPSCC should be encouraged to have diligent cervical screening.
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Affiliation(s)
- Virginia Lozza
- Maternal and Child Department, Careggi University Hospital Florence, Largo Brambilla 3, 50134, Florence, Italy,
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Sorbi F, Sisti G, Pieralli A, Di Tommaso M, Livi L, Buccoliero AM, Fambrini M. Cervicoisthmic choriocarcinoma mimicking cesarean section scar ectopic pregnancy. J Res Med Sci 2013; 18:914-7. [PMID: 24497867 PMCID: PMC3897080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 02/13/2013] [Accepted: 04/09/2013] [Indexed: 11/14/2022]
Abstract
Primary choriocarcinoma of the uterine cervix is an extremely rare disease. The clinical diagnosis of cervical choriocarcinoma is difficult, because of its rarity and being non-specific abnormal vaginal bleeding the most common symptom. In the present report, the authors present a case of cervical choriocarcinoma, which was initially misdiagnosed as a cesarean section scar ectopic pregnancy. Remission of cervical choriocarcinoma was accomplished with the combination of hysterectomy and chemotherapy.
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Affiliation(s)
- Flavia Sorbi
- Department of Science for Woman and Child Health, University of Florence, Florence, Italy
| | - Giovanni Sisti
- Department of Science for Woman and Child Health, University of Florence, Florence, Italy,Address for correspondence: Dr. Giovanni Sisti, Viale Morgagni, 85; 50134; Florence, Departments of Science for Woman and Child Health Obstetrics and Gynecology division, Azienda Ospedaliero-Universitaria Careggi, Florence University, Italy. E-mail:
| | - Annalisa Pieralli
- Department of Science for Woman and Child Health, University of Florence, Florence, Italy
| | | | - Lorenzo Livi
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | | | - Massimiliano Fambrini
- Department of Science for Woman and Child Health, University of Florence, Florence, Italy
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Sisti G, Buccoliero AM, Novelli L, Sansovini M, Severi S, Pieralli A, Livi L, Fambrini M. A case of metachronous double primary neuroendocrine cancer in pancreas/ileum and uterine cervix. Ups J Med Sci 2012; 117:453-6. [PMID: 23009225 PMCID: PMC3497223 DOI: 10.3109/03009734.2012.707254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We describe an unusual case of a 50-year-old female patient developing two primary cancers with neuroendocrine features. Initially the patient underwent surgery for an entero-pancreatic neuroendocrine carcinoma. During the subsequent follow-up she experienced some episodes of vaginal bleeding with negative PET scanning with the tracer fluorine-18 (F-18) fluorodeoxyglucose (FDG). A Papanicolaou (pap) smear and an endometrial biopsy revealed a primary neuroendocrine cancer of the uterine cervix. The present case underlines the importance of clinical follow-up after a diagnosis of intestinal neuroendocrine tumor, investigating any new symptom. Female patients, after the diagnosis of entero-pancreatic neuroendocrine carcinoma, must be recommended to continue screening pap test examinations for the likelihood of classical squamous and glandular cervical cancers and also for neuroendocrine cervical cancer.
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Affiliation(s)
- Giovanni Sisti
- Department of Science for Woman and Child Health, University of Florence, Florence, Italy.
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Fallani MG, Fambrini M, Lozza V, Bianchi C, Pieralli A. CO2 laser total superficial vulvectomy: an outpatient treatment for wide multifocal vulvar intraepithelial neoplasia grade 3. J Minim Invasive Gynecol 2012; 19:758-61. [PMID: 23084682 DOI: 10.1016/j.jmig.2012.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 07/27/2012] [Accepted: 08/02/2012] [Indexed: 11/29/2022]
Abstract
The ideal treatment of large multifocal vulvar intraepithelial neoplasia grade 3 (VIN 3) in young patients is still debated. The goal is to prevent development of invasive vulvar cancer while preserving normal vulvar anatomy and function. The authors describe the case of a 37-year-old woman affected by a biopsy-proven VIN 3 involving the entire external genitalia. A total superficial vulvectomy was carried out in 2 closer sessions by CO(2) laser used in an excisional way. Both procedures were performed in an outpatient setting with the patient under local anesthesia and without suturing stitches or skin flaps. Definitive pathologic analysis confirmed VIN 3 with free margins. No intraoperative and postoperative complications were documented. Functional and anatomic outcomes were optimal, and no relapse occurred after 12 months of follow-up. Use of CO(2) laser total superficial vulvectomy shows promise of a safe and adequate treatment in selected young patients with VIN 3 involving the entire external genitalia.
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Affiliation(s)
- Maria Grazia Fallani
- Department of Science for Woman and Child Health, University of Florence, Florence, Italy
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Fambrini M, Buccoliero AM, Pieralli A, Taddei G. A pilot study evaluating liquid-based endometrial cytology and transvaginal ultrasonography in women with postmenopausal bleeding. Cytopathology 2012; 24:402-3. [DOI: 10.1111/cyt.12027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Serena C, Marchetti G, Rambaldi MP, Ottanelli S, Di Tommaso M, Avagliano L, Pieralli A, Mello G, Mecacci F. Stillbirth and fetal growth restriction. J Matern Fetal Neonatal Med 2012; 26:16-20. [PMID: 22882114 DOI: 10.3109/14767058.2012.718389] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To confirm the role of fetal growth restriction (FGR) as a cause of stillbirth, and to compare diagnostic accuracy of customized fetal growth and population-based standards in identifying FGR within a pathological population of early and late stillbirths. METHODS Retrospective study on a cohort of 189 stillbirths occurred in single pregnancy between January 2006 and September 2011. Unexplained stillbirths, defined by Aberdeen-Wigglesworth and ReCoDe classifications, were evaluated on the basis of fetal birthweight with both Tuscany population and Gardosi customized standards. Unexplained stillbirths have been classified as early or late depending on the gestational age of occurrence. RESULTS Aberdeen-Wigglesworth classification, applied to the 189 cases of stillbirth, left 94 unexplained cases (49.7%), whereas the ReCoDe classification left only 40 (21%). By applying population standards to the 94 unexplained stillbirths we have identified 31 FGRs (33% of sample), while customized standards identified 54 FGRs (57%). Customised standards identified a larger number of FGRs with respect to population standards during the third trimester (i.e. 51% vs. 25% respectively) than in the second trimester (73% vs. 54% respectively) (p = 0.05). CONCLUSIONS Customized standards have a higher diagnostic accuracy in identifying FGRs especially during the third trimester.
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Affiliation(s)
- C Serena
- Department of Sciences for the Health of Women and Children, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
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Rambaldi MP, Pieralli A, Ottanelli S, Serena C, Simeone S, Mello G, Mecacci F. OS086. Methylation status of the HOXA13 promoter region in placental tissue of pregnancies complicated by early onset severe preeclampsia. Pregnancy Hypertens 2012; 2:224-5. [PMID: 26105300 DOI: 10.1016/j.preghy.2012.04.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Compromised placental function and morphology found in early onset preeclampsia as well as a modified phenotype of the fetus may derive from a deviation in the normal gene expression pattern. Previous studies demonstrated by experimental animal models, that the gene HOXA13 plays an essential role in the arrangement of the placental vascular net, identifying direct and indirect target functions this gene has on the endothelial component. Research in model systems and now expanding to human studies has suggested that the causes and consequences of a variety of pregnancy-related pathologies are connected to epigenetic regulation. OBJECTIVES To evaluate the methylation status of the promoter region of HOXA13 within placental tissue and its association with specific clinical signs of severe early onset preeclampsia. METHODS A prospective case - control study was performed to evaluate the methylation status of the promoter region of HOXA13 by pyrosequencing analysis within placental tissue and its association with specific clinical signs of severe early onset preeclampsia (EOSP). RESULTS The group of preeclamptic patients reached a mean methylation degree of 27.06% (±8.94) and 30.56% (±8.08) on two CpG islands of HOXA13 5' promoter respectively. Conversely in the group of physiologic controls the mean degree of methylation resulted 15.12%(±3.64) (p<0.0016) and 18.25% (±3.45) (p<0.0005). CONCLUSION This study firstly demonstrated that an hypermethylation of placental HOXA13 exists in preeclamptic placental tissues and concentrates only on the gene promoter. Additionally, the existence of a correspondence between themethylation process of the gene promoter HOXA 13 and the clinical manifestation of severe early onset preeclampsia supports the original hypothesis that this process may be at the base of the preeclamptic pathogenesis.
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Affiliation(s)
- M P Rambaldi
- Obstetric and gynecology - High risk pregnancy unit, AOU Careggi, Florence, Italy
| | - A Pieralli
- Obstetric and gynecology - High risk pregnancy unit, AOU Careggi, Florence, Italy
| | - S Ottanelli
- Obstetric and gynecology - High risk pregnancy unit, AOU Careggi, Florence, Italy
| | - C Serena
- Obstetric and gynecology - High risk pregnancy unit, AOU Careggi, Florence, Italy
| | - S Simeone
- Obstetric and gynecology - High risk pregnancy unit, AOU Careggi, Florence, Italy
| | - G Mello
- Obstetric and gynecology - High risk pregnancy unit, AOU Careggi, Florence, Italy
| | - F Mecacci
- Obstetric and gynecology - High risk pregnancy unit, AOU Careggi, Florence, Italy
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Fambrini M, Pieralli A, Bitossi U, Andersson KL, Scarselli G, Livi L, Taddei G, Marchionni M. Mini-laparotomy versus vaginal surgery for class II-III obese patients with early-stage endometrial cancer. Anticancer Res 2012; 32:707-712. [PMID: 22287767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM To compare minilaparotomic and vaginal surgery in selected obese patients with early-stage endometrial cancer at high surgical risk. PATIENTS AND METHODS Data of 37 consecutive class II-III obese patients submitted to minilaparotomic surgery were retrospectively reviewed. Thirty-seven women matched for demographic characteristics, BMI and stage of disease submitted to vaginal surgery in the same period comprised the control group. RESULTS No difference was observed concerning intra- and postoperative data among the two groups. The patients who were submitted to general anesthesia exhibited a larger use of supplemental drugs for pain control (p>0.01), a higher incidence of thromboembolic events (p>0.005) and a longer hospitalization (p>0.02). No statistical difference was observed in terms of pattern of recurrence, disease-free survival and overall survival between the two groups of patients. CONCLUSION Obese patients with endometrial cancer unfit for vaginal surgery can be safely managed through mini-laparotomy with the same surgical and oncological outcomes.
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Affiliation(s)
- Massimiliano Fambrini
- Dipartimento di Scienze per la Salute della Donna e del Bambino, Sezione di Ginecologia e Ostetricia, Policlinico di Careggi, Via Morgagni 85, 50134, Firenze, Italy.
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Fambrini M, Buccoliero AM, Pieralli A, Andersson KL, Mattei A, Scarselli G, Taddei G, Marchionni M. [Tamoxifen, endometrial cancer risk and liquid based cytology. A paradigmatic case]. Minerva Ginecol 2011; 63:465-470. [PMID: 21926955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Long-term users of tamoxifen (TMX) are at increased risk for developing endometrial cancer. Early diagnosis is mainly based on transvaginal scan (TVS) and hysteroscopy with endometrial biopsy. Nevertheless, TVS does not provide a definitive diagnosis in most cases, particularly due to its high false-positive rate. In addition TMX related changes, such as "pseudocistic" pattern, affect endoscopic evaluation of the endometrium and biopsy sampling (in particular blind procedures) frequently yields insufficient tissue for diagnosis. The cause of the high inadequacy rate of endometrial biopsies in women on TMX might be related to the increase in endometrial fibrous component. The present case emphasizes the main difficulties in surveillance and early diagnosis of endometrial pathologies in TMX users. Liquid-based endometrial cytology played a determinant role in the diagnostic pathway of this patient. We believe it could be used solely or in association with TVS leading to many advantages in the surveillance of women receiving TMX.
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Affiliation(s)
- M Fambrini
- Dipartimento di Scienze per la Salute della Donna e del Bambino, Sezione di Ginecologia ed Ostetricia, Università degli Studi di Firenze, Italia.
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Scarselli G, Bargelli G, Taddei GL, Marchionni M, Peruzzi E, Pieralli A, Mattei A, Buccoliero AM, Fambrini M. Levonorgestrel-releasing intrauterine system (LNG-IUS) as an effective treatment option for endometrial hyperplasia: a 15-year follow-up study. Fertil Steril 2011; 95:420-2. [DOI: 10.1016/j.fertnstert.2010.07.1044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 06/18/2010] [Accepted: 07/07/2010] [Indexed: 10/19/2022]
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Fambrini M, Andersson KL, Campanacci DA, Vanzi E, Bruni V, Buccoliero AM, Pieralli A, Livi L, Scarselli G. Large-muscle endometriosis involving the adductor tight compartment: case report. J Minim Invasive Gynecol 2010; 17:258-61. [PMID: 20226421 DOI: 10.1016/j.jmig.2009.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 09/15/2009] [Accepted: 12/04/2009] [Indexed: 11/26/2022]
Abstract
Extrapelvic endometriosis is an uncommon condition but can involve nearly every organ, resulting in a wide range of clinical manifestations. Herein, we describe the case of a 45-year-old woman not a candidate for hormonal therapy who had cyclic pain in the left thigh associated with progressive impairment of walking ability. Clinical, instrumental, and laboratory data supported the diagnosis of endometriosis involving the adductor muscles compartment associated with ovarian endometriomas. Laparoscopic bilateral salpingo-oophorectomy and local wide excision in collaboration with an experienced orthopedic oncologist were performed, and definitive histologic analysis confirmed the diagnosis of endometriosis. The patient was pain-free at 6-month follow-up and demonstrated substantial improvement in ambulation and quality of life. Large-muscle endometriosis is a rare entity that can compromise musculoskeletal integrity and decrease quality of life. In this case, surgical excision in collaboration with an orthopedic oncologist was the cornerstone of treatment.
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Affiliation(s)
- Massimiliano Fambrini
- Department of Gynecology, Perinatology, and Human Reproduction, University of Florence, Florence, Italy.
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Pieralli A, Bussani C, Andersson KL, Mattei A, Fambrini M. Appendix to: "PCR detection rates of high risk human papillomavirus DNA in paired self-collected urine and cervical scrapes after laser CO(2) conization for high-grade cervical intraepithelial neoplasia". Gynecol Oncol 2009; 116:586-7. [PMID: 19969337 DOI: 10.1016/j.ygyno.2009.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 11/06/2009] [Indexed: 11/26/2022]
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Fambrini M, Tondi F, Scarselli G, Penna C, Pieralli A, Andersson KL, Marchionni M. Comparison of the number of uterine myomas detected by in-office transvaginal ultrasonography removed by laparotomic myomectomy: preoperative work-up concerns. CLIN EXP OBSTET GYN 2009; 36:97-101. [PMID: 19688951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE OF INVESTIGATION To assess the ability of detecting the number of uterine myomas by transvaginal ultrasonography (TVS) performed supporting the clinical examination of general gynecologists' office practice. METHODS A retrospective comparison of the number of myomas revealed by preoperative in-office TVS and documented after laparotomic myomectomy was conducted in 110 consecutive premenopausal patients referred for surgery. RESULTS The sensitivity of TVS in revealing the exact number of myomas was 59.4% in the whole series. In the subgroup of 88 patients with a preoperative diagnosis of three or fewer myomas TVS missed at least one myoma in 31 (35.2%) cases, achieving a 64.8% sensitivity. Among the 72 women diagnosed with one myoma at preoperative TVS, 19 (26.4%) resulted to have two or more myomas at the end of surgery, reaching a 73.6% sensitivity of TVS in revealing the exact number of myomas. CONCLUSIONS In-office TVS reinforces the clinical diagnosis of uterine myomas but it often fails in the detection of their number, resulting in a poor preoperative characterization of patients. The fact that one myoma may be overlooked in one-third of patients theoretically eligible for laparoscopic conservative surgery may motivate the implementation of US diagnosis when laparoscopic myomectomy is considered.
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Affiliation(s)
- M Fambrini
- Department of Gynaecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy.
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Mecacci F, Bianchi B, Pieralli A, Mangani B, Moretti A, Cioni R, Giorgi L, Mello G, Matucci-Cerinic M. Pregnancy outcome in systemic lupus erythematosus complicated by anti-phospholipid antibodies. Rheumatology (Oxford) 2008; 48:246-9. [PMID: 19109318 DOI: 10.1093/rheumatology/ken458] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Pregnant women affected by SLE are at high risk of gestational hypertension and pre-eclampsia (32-50%). This risk is particularly elevated if aPLs are dosable. The present study was planned to evaluate maternal-fetal outcomes of different groups of SLE pregnant patients characterized by diverse risk factors: patients affected by APS treated with a combination of low-dose aspirin (LDA) and low-molecular weight heparin (LMWH), nulliparous patients with dosable aPL treated by LMWH and SLE patients with no aPL administered no treatment during pregnancy. METHODS A retrospective description of maternal and fetal outcomes was made in a total of 62 pregnancies presenting APS in 8 cases (12.9%), aPL in 20 (32.2%) and no aPL in 34 (54.8%). RESULTS No statistically significant difference was found comparing fetal and maternal outcomes of the three groups despite differences in SLE activity: SLE aPL-positive pregnancies were associated with a higher incidence of nephritis and chronic hypertension than pregnancies treated for APS or not presenting with the added risk factor. The incidence of pre-eclampsia is 15% in aPL positive, 12.5% in APS and 14.7% in no aPL pregnancies, respectively. CONCLUSIONS LMWH is rather a possible option of prophylaxis for SLE aPL-positive pregnancies with potential maternal-fetal outcomes similar to aPL-negative patients or to standard treated APS.
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Affiliation(s)
- F Mecacci
- Department of Gynaecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy
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Fambrini M, Penna C, Pieralli A, Fallani MG, Andersson KL, Lozza V, Scarselli G, Marchionni M. CO2 laser cylindrical excision or standard re-conization for persistent-recurrent high-grade cervical intraepithelial neoplasia (HG-CIN) in women of fertile age. Anticancer Res 2008; 28:3871-3875. [PMID: 19192643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM To investigate the therapeutic efficacy of cylindrical or cone-shaped excision performed by laser CO2 in the conservative management of persistent-recurrent high-grade cervical intraepithelial neoplasia (HG-CIN) in women of fertile age. PATIENTS AND METHODS Ninety-four premenopausal patients with persistent-recurrent HG-CIN had undergone re-conization or cylindrical excision according to the time of reappearance of the disease. The length of the procedures, intra- and postoperative complications, height of the excised specimens, final histological findings and follow-up data were retrospectively evaluated. RESULTS Fifty-five (58.5%) persistent and 39 (41.5%) recurrent cases had undergone cylindrical excision and standard re-conization respectively. All the treatments were successfully performed in an out-patient setting under local anesthesia with no differences in term of operative time, height of removed specimens, intra- and postoperative complications between the two groups. Definitive histology confirmed HG-CIN in 95.7% of the cases and FIGO Stage Ia1 cervical cancer (negative lymph vascular space involvement, LVSI) in 4.3% of the cases. The endocervical margins were involved in 3.6% of the cylindrical (persistent) and in 17.9% of the cone-shaped (recurrent) specimens (p = 0.03). The overall cure rate after a median follow-up time of 54 months (range 10-196) was 91.5%. A third excisional procedure was performed in 8 cases of persistent-recurrent HG-CIN with a disease-free subsequent follow-up of 38 months (range 6-108). CONCLUSION Cylindrical or conical re-excision performed by CO2 laser according to the time of reappearance of the disease seems to be a promising conservative approach for persistent-recurrent HG-CIN even though further randomised prospective studies are needed to confirm the long-term efficacy and reproductive outcomes.
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Affiliation(s)
- Massimiliano Fambrini
- Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy.
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Pieralli A, Andersson KL, Bussani C, Fambrini M. Muscle architecture in uterine leiomyomas and 5-hydroxytryptamine type 2A receptor. Int J Gynaecol Obstet 2008; 103:261-2. [PMID: 18775534 DOI: 10.1016/j.ijgo.2008.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 06/03/2008] [Accepted: 06/03/2008] [Indexed: 11/28/2022]
Affiliation(s)
- Annalisa Pieralli
- Department of Gynecology, Perinatology and Human Reproduction, University of Florence, School of Medicine, Florence, Italy
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Fambrini M, Andersson KL, Buccoliero AM, Pieralli A, Livi L, Marchionni M. Late solitary metastasis of cutaneous malignant melanoma presenting as abnormal uterine bleeding. J Obstet Gynaecol Res 2008; 34:731-4. [DOI: 10.1111/j.1447-0756.2008.00917.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fambrini M, Penna C, Pieralli A, Fallani MG, Andersson KL, Lozza V, Scarselli G, Marchionni M. Carbon-dioxide Laser Vaporization of the Bartholin Gland Cyst: A Retrospective Analysis on 200 Cases. J Minim Invasive Gynecol 2008; 15:327-31. [DOI: 10.1016/j.jmig.2008.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 02/12/2008] [Accepted: 02/16/2008] [Indexed: 11/25/2022]
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Fambrini M, Penna C, Pieralli A, Bussani C, Fallani MG, Andersson KL, Scarselli G, Marchionni M. PCR detection rates of high risk human papillomavirus DNA in paired self-collected urine and cervical scrapes after laser CO2 conization for high-grade cervical intraepithelial neoplasia. Gynecol Oncol 2008; 109:59-64. [PMID: 18255129 DOI: 10.1016/j.ygyno.2007.12.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 12/19/2007] [Accepted: 12/31/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the PCR detection rates of high risk human papillomavirus DNA in self-collected urine and cervical scrapes during follow-up of patients treated for HG-CIN by laser CO2 conization. PATIENTS AND METHODS 52 women who submitted to laser conization for HG-CIN were enrolled into this prospective follow-up study receiving liquid-based cytology and HR-HPV testing by PCR assay on self-collected urine and cervical scrapes before and at 3, 6 and 12 months after treatment. Diagnostic accuracy and predictive values for treatment failure were evaluated for both urinary and cervical HPV testing and follow-up cytology. RESULTS 3 cases (5.8%) of recurrent HG-CIN occurred during follow-up. Positive margins and HR-HPV persistence resulted to significant risk factors for recurrence (p=0.01). The overall concordance on HR-HPV detection between paired urine and cervical samples was 96.6% and discord trend between agreement rates during follow-up were excluded by overall fixed-effect index (OR 1.03; 95% CI 0.62-1.70). No difference was observed comparing the three- and six-month cumulative sensitivity and NPV for recurrent disease of urinary and cervical HPV detections, with an increase of 5.6% in specificity associated with urinary testing. CONCLUSIONS PCR detection of HR-HPV in paired urine and cervical samples during follow-up revealed an excellent concordance, suggesting a potential equivalent role of the two methods within post-treatment follow-up. In our experience HPV testing on self-collected urine was more sensitive than cytology and more specific than cervical HPV detection to predict treatment failure. Larger studies are needed to definitively establish the role of urine-based HPV testing during follow-up.
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Affiliation(s)
- Massimiliano Fambrini
- Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Policlinico di Careggi, Viale Morgagni 85, 50134 Florence, Italy.
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Fambrini M, Buccoliero AM, Bargelli G, Cioni R, Piciocchi L, Pieralli A, Andersson KL, Scarselli G, Taddei G, Marchionni M. Clinical utility of liquid-based cytology for the characterization and management of endometrial polyps in postmenopausal age. Int J Gynecol Cancer 2008; 18:306-11. [PMID: 17624992 DOI: 10.1111/j.1525-1438.2007.01019.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The proper management of endometrial polyps still represents a clinical ongoing challenge, especially when they are asymptomatic and occasionally discovered. The aim of this study was to evaluate liquid-based endometrial cytology to manage endometrial polyps in postmenopausal age by its ability to exclude hidden premalignant and malignant changes within polyps. Three hundred fifty-nine consecutive postmenopausal patients who underwent hysteroscopic diagnosis of endometrial polyp over a 3-year period and who were scheduled for surgical removal within the three subsequent months were retrospectively evaluated. Histologic results after resection during operative hysteroscopy or during hysterectomy were compared with liquid-based cytology and endometrial biopsy obtained at the time of diagnostic hysteroscopy. Eight of 359 patients (2.2%) had malignant or premalignant polyps interpreted as benign finding at hysteroscopy. Unsatisfactory samples were higher for endometrial biopsy compared to liquid-based cytology in the whole series and in the subgroup of low-risk asymptomatic patients (P< 0.001). Endometrial biopsy and liquid-based cytology revealed a sensitivity of 62% and 87.5%, respectively and a 100% specificity. Considering the subgroup of low-risk asymptomatic patients, liquid-based cytology disclosed all the five pathologic lesions with a 100% sensitivity and specificity. In conclusion, liquid-based cytology proved to be a useful tool to establish the nature of endometrial polyps in postmenopausal patients. Complete removal of the lesion should be offered to all symptomatic patients and those with established risk factors for endometrial cancer. Conversely, a wait and see attitude should be considered in case of asymptomatic low-risk polyps with typical appearance on hysteroscopy and negative liquid-based cytology.
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Affiliation(s)
- M Fambrini
- Department of Gynecology, Perinatology, and Human Reproduction, University of Florence, School of Medicine, Florence, Italy.
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Fallani MG, Penna C, Marchionni M, Bussani C, Pieralli A, Andersson KL, Fambrini M. Prognostic significance of high-risk HPV persistence after laser CO2 conization for high-grade CIN: a prospective clinical study. EUR J GYNAECOL ONCOL 2008; 29:378-382. [PMID: 18714574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE OF INVESTIGATION To estimate the persistence rate of high-risk HPV DNA (HR-HPV DNA) in a population treated totally by laser CO2 conization for high-grade cervical intraepithelial neoplasia (HG-CIN), and to examine if this persistence might be considered an independent risk factor for relapsing disease. METHODS All women with a histological diagnosis of HG-CIN and planned for laser CO2 conization from January 2003 to December 2004 were prospectively submitted to a HR-HPV test prior to surgery and at three and six months of follow-up. Women providing written informed consent with 24 months of follow-up were enrolled in the study group. A positive HPV test, involvement of resection margins, age at first intercourse, smoking habits, parity and age at conization > 50 years old were considered as risk factors for relapsing HG-CIN during follow-up, and were univariately and multivariately analyzed to discover any independent influencing factors. RESULTS Of HG-CIN 15.4% resulted not to be HPV related nor relapsing. The HPV clearance rate after treatment was 78.8%. Involvement of resection margins and HR-HPV DNA persistence post-treatment resulted as the only two statistically significant risk factors for HG-CIN recurrence (rate 3.8%). HR-HPV DNA persistence in follow-up resulted to be independent from other risk factors at multivariate analysis. CONCLUSIONS Although able to reach a low recurrence rate of HG-CIN, laser CO2 conization does not remove HPV infection completely from the cervix with a case of persistence in every five treated patients. In our experience this persistence in itself represents an independent risk factor for developing relapsing disease and constitutes the basis to introduce HPV testing even in the follow-up of patients treated for HG-CIN by laser CO2 conization.
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Affiliation(s)
- M G Fallani
- Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy
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Fambrini M, Pieralli A, Marchionni M. Surgery by minilaparotomy under spinal anesthesia for high-risk obese patients with early stage endometrial cancer. Int J Gynaecol Obstet 2007; 100:191-3. [PMID: 17888924 DOI: 10.1016/j.ijgo.2007.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 07/18/2007] [Accepted: 07/18/2007] [Indexed: 11/22/2022]
Affiliation(s)
- M Fambrini
- Department of Gynecology, Perinatology and Human Reproduction, University of Florence, School of Medicine, Florence, Italy.
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Abstract
Autoimmune diseases are a group of heterogeneous disorders equally characterized by the same pathogenetic mechanism: an immunological reaction against self antigens promoted by antibodies, immuno-complex formation, and self-reactive T lymphocytes. Autoimmune diseases may be separated into organ-restricted diseases and systemic ones. The damage of single organs produced by antibodies focused against specific cellular antigens characterizes the first group of diseases, whereas the latter are produced by a systemic inflammatory process initiated by inappropriate and excess immune activation that leads to immuno-complex formation and deposition onto sensitive tissues. Since connective and vascular tissue are principally damaged in these disorders, systemic autoimmune diseases are more commonly known as "connective tissue diseases" (CTD) and include: systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, Sjogren syndrome, and others. Although they are considered as different from a pathogenetic point of view, they overlap in many aspects, such as general symptoms as fever and fatigue, chronical ongoing, steroid therapy. As patients suffering from CTD are predominantly young women between the ages of 20 and 40 years, which is the period of the highest childbearing potential, particular interest must be regarded to the impact that these diseases and their therapies have on pregnancy and, conversely, the effect of pregnancy on these disorders, which may have long-lasting implications for mothers and neonates. Adverse fetal outcomes, maternal disease flares, and drug potential teratogenic risk are the main reasons why women suffering from CTD and who are pregnant or intend to become pregnant are considered a high-risk population. These patients require integrated, interdisciplinary care, addressing every aspect of rheumatology, obstetrics, and neonatology to reduce maternal, fetal, and neonatal complications.
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Affiliation(s)
- Federico Mecacci
- Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy.
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Fambrini M, Penna C, Fallani MG, Pieralli A, Mattei A, Scarselli G, Taddei GL, Marchionni M. Feasibility and outcome of laser CO2conization performed within the 18th week of gestation. Int J Gynecol Cancer 2007; 17:127-31. [PMID: 17291242 DOI: 10.1111/j.1525-1438.2007.00802.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The purpose of this study is to evaluate the feasibility, safety, and potential therapeutic benefit of laser CO2conization of the cervix forin situand minimally invasive carcinoma diagnosed during pregnancy. Twenty-six pregnant patients with biopsy-proven carcinomain situ/cervical intraepithelial neoplasia III but colposcopically suspicious for invasion underwent laser CO2conization during the 18th week of gestation in an outpatient setting under local anesthesia. No major intraoperative or postoperative complications occurred, and cervical cerclage was not required in any case. Two cases (7.7%) of occult FIGO stage IA1 minimally invasive cervical cancers with free surgical margins were diagnosed. Both patients delivered vaginally at term and were free of disease at postpartum follow-up. Median length of gestation was 39.1 weeks with a median birth weight of 3450 g. All 1-min Apgar scores were 8 or greater. Twenty patients (76.9%) delivered vaginally, while six patients underwent cesarean section for indications not related to the prior conization. After a mean postpartum follow-up of 18 months (range 3–42), 92.3% of patients continued to have both cytologic and colposcopic evaluations negative for persistent or recurrent disease. Two cases of persistent intraepithelial disease were successfully managed by reconization. In summary, our data suggest that laser CO2conization performed within the 18th week of gestation is safe for both the patient and the fetus, provides reliable histologic diagnosis, and can be curative. Further studies are required to confirm the favorable risk–benefit ratio of laser CO2conization in the management of non-reassuring cervical lesions observed in the first half of pregnancy.
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Affiliation(s)
- M Fambrini
- Department of Gynecology, Perinatology and Human Reproduction, School of Medicine, University of Florence, Via Morgagni 85, 50134 Florence, Italy.
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Fambrini M, Pieralli A, Taddei GL, Penna C. Laser cylindrical excision for cervical adenocarcinoma in situ. Int J Gynaecol Obstet 2006; 95:292-3. [PMID: 16999959 DOI: 10.1016/j.ijgo.2006.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2006] [Revised: 06/27/2006] [Accepted: 07/25/2006] [Indexed: 11/30/2022]
Affiliation(s)
- M Fambrini
- Department of Gynecology, Perinatology and Human Reproduction, University of Florence School of Medicine, Florence, Italy.
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Fambrini M, Penna C, Pieralli A, Andersson KL, Zambelli V, Scarselli G, Marchionni M. Feasibility of myomectomy performed by minilaparotomy. Acta Obstet Gynecol Scand 2006; 85:1109-13. [PMID: 16929417 DOI: 10.1080/00016340600722823] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND To evaluate feasibility and clinical outcomes of myomectomy performed through minilaparotomic access in a large series of consecutive patients. METHODS All patients submitted to laparotomic conservative surgery for uterine myomas through an initial minilaparotomic approach (4-8-cm transverse skin incision) were retrospectively evaluated. Preoperative findings, surgical technique, rate of laparotomic enlargement, operative time, surgical complications and length of recovery were the main analyzed outcomes. RESULTS One hundred and seventy out of 212 patients experienced minilaparotomic approach for uterine myomatosis. In 97 (57.1%) multiple myomas were present (maximum, 23). The size of the largest myoma ranged from 2 to 19 cm (median 5.6). In 161 (94.7%) patients myomectomy was ended through minilaparotomic access with a mean length of skin incision of 6.2 cm (4-7.8). The correlation between severe obesity and laparotomic enlargement was statistically significant (p<0.05). The mean operative time was 57 min (32-118). One bladder intraoperative injury was successfully managed through minilaparotomic incision. Bowel or vascular complications never occurred. Estimated blood loss was not significant except in three cases (1.9%) requiring transfusion. Febrile complications were observed in nine patients (5.6%). The median postoperative stay in uncomplicated patients was 2.5 days (2-4). CONCLUSIONS Our report supports the wide application of minilaparotomic myomectomy and suggests that more than 85% of women with fit uterine myomatosis could be successfully managed in this way with a failure rate of 5.3% in eligible patients. The main criteria of minimal invasive surgery seem to be by minilaparotomic myomectomy, which should be considered a valid option for uterine myohas conservative treatment.
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Affiliation(s)
- Massimiliano Fambrini
- Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy.
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Penna C, Fambrini M, Fallani MG, Pieralli A, Scarselli G, Marchionni M. Laser CO2 conization in postmenopausal age: risk of cervical stenosis and unsatisfactory follow-up. Gynecol Oncol 2005; 96:771-5. [PMID: 15721425 DOI: 10.1016/j.ygyno.2004.11.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2004] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To assess chances of adequate cyto-colposcopic follow-up after laser conization performed in postmenopausal screening population by the evaluation of postoperative cervical stenosis and unsatisfactory colposcopy rates. PATIENTS AND METHODS One thousand two hundred eighteen patients were submitted to laser CO2 conization for cervical intraepithelial neoplasia (CIN). Incidence and risk factors for cervical stenosis and unsatisfactory follow-up were retrospectively evaluated comparing fertile with postmenopausal patients. RESULTS Global incidences of postoperative unsatisfactory colposcopy and cervical stenosis were 46.2% and 7.1%. These rates were higher in postmenopausal patients compared with fertile ones, revealing a statistical correlation between unsatisfactory follow-up and postmenopausal status at the time of conization. Association between CIN relapse and cervical stenosis was significantly higher in postmenopausal group (66.7% vs. 8.6%; P <0.05), where two cases of recurrence were detected only after hysterectomy, because of an insurmountable cervical stenosis. Univariate and multivariate analysis revealed HRT use as the only significant factor in influencing postoperative cervical stenosis. CONCLUSION Conization is still considered as the standard treatment for CIN at any woman's age, when excisional management is indicated, but all postmenopausal patients should be counseled about the possibility of postoperative stenosis that could exclude an adequate follow-up, configuring a failure of the conservative treatment. HRT use is associated with a low risk of stenotic complications; therefore, if possible, users should be encouraged to continue therapy at least 1 year after laser conization.
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Affiliation(s)
- Carlo Penna
- Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy
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