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Valletta R, Corato V, Lombardo F, Avesani G, Negri G, Steinkasserer M, Tagliaferri T, Bonatti M. Leiomyoma or sarcoma? MRI performance in the differential diagnosis of sonographically suspicious uterine masses. Eur J Radiol 2024; 170:111217. [PMID: 38042020 DOI: 10.1016/j.ejrad.2023.111217] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/04/2023]
Abstract
PURPOSE To assess the diagnostic performance of MRI in distinguishing between leiomyomas and malignant/potentially malignant mesenchymal neoplasms in patients with rapidly enlarging/sonographically suspicious uterine masses. METHODS IRB-approved retrospective study including 88 patients (51 ± 11 years) who underwent MRI for rapidly enlarging/sonographically suspicious uterine mass at our Institution between January 2016 and December 2021, followed by surgery or >12 months follow-up. Qualitative image analysis was independently performed by 2 radiologists and included lesion's margins (sharp/irregular), architecture (homogeneous/inhomogeneous), presence of endometrial infiltration (yes/no), necrotic areas (yes/no), hemorrhagic areas (yes/no), predominant signal intensity on T1-WI, T2-WI, CE T1-WI, DWI, and ADC map. The same radiologists performed quantitative image analysis in consensus, which included lesion's maximum diameter, lesion/myometrium signal intensity ratio on T2-WI and CE T1-weighted images, lesion/endometrium signal intensity ratio on DWI and ADC map and necrosis percentage. Lesions were classified as benign or malignant. Imaging findings were compared with pathology and/or follow-up. RESULTS After surgery (52/88 patients) or follow-up (36/88 patients, 33 ± 20 months), 83/88 (94.3%) lesions were classified as benign and 5/88 (5.7%) as malignant/potentially malignant. Presence of necrotic areas, high necrosis percentage, hyperintensity on DWI and high lesion/endometrium DWI signal intensity ratio were significantly associated with malignant/potentially malignant lesions (p = 0.027, 0.002, 0.008 and 0.015, respectively). The two readers identified malignant/potentially malignant lesions with 95.5% accuracy, 80.0% sensitivity, 96.4% specificity, 57.1 % PPV, 93.3% NPV. CONCLUSION MRI has high accuracy in identifying malignant/potentially malignant myometrial masses. In everyday practice, however, MRI positive predictive value is relatively low given the low pre-test malignancy probability.
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Affiliation(s)
- Riccardo Valletta
- Department of Radiology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsius Medical University (PMU), Bolzano-Bozen, Italy.
| | - Valentina Corato
- Department of Radiology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsius Medical University (PMU), Bolzano-Bozen, Italy
| | - Fabio Lombardo
- Department of Radiology, IRCCS Ospedale Sacro Cuore - Don Calabria, via Don Sempreboni 5, 37024 Negrar, VR, Italy
| | - Giacomo Avesani
- Department of Radiology, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Roma, Italy
| | - Giovanni Negri
- Department of Pathology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsius Medical University (PMU), Bolzano-Bozen, Italy
| | - Martin Steinkasserer
- Department of Gynecology and Obstetrics, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsius Medical University (PMU), Bolzano-Bozen, Italy
| | - Tiziana Tagliaferri
- Department of Gynecology and Obstetrics, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsius Medical University (PMU), Bolzano-Bozen, Italy
| | - Matteo Bonatti
- Department of Radiology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsius Medical University (PMU), Bolzano-Bozen, Italy
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Taliento C, Pontrelli G, Rondoni A, Desgro M, Steinkasserer M, Scutiero G, Vizzielli G, Greco P. Major and minor complications in Veress needle (VN) and direct trocar insertion (DTI) for laparoscopic closed-entry techniques: an updated systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:152. [PMID: 37069276 DOI: 10.1007/s00423-023-02891-8] [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: 12/12/2022] [Accepted: 04/09/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE Direct insertion of the trocar is an alternative method to Veress needle insertion for the creation of pneumoperitoneum. We conducted a systematic review and meta-analysis to compare these two entry closed techniques. DATA SOURCE A systematic review of the literature was done on PubMed, MEDLINE, Embase, Scopus, and EBSCO. METHODS The literature search was constructed until May 01, 2022, around search terms for "Veress," "direct trocar," "needle," "insertion," and "laparoscopic ways of entry." This systematic review was reported according to the PRISMA Statement 2020. RESULTS Sixteen controlled trials (RCTs) and 5 observational studies were included in the systematic review. We found no significant differences in the risk of major complication during the access manoeuvres between DTI and VN: bowel injuries (OR = 0.76, 95% CI: 0.24-2.36, P = 0.63), major vascular injuries (OR = 1.74, 95% CI 0.56-5.38, P = 0.34), port site hernia (OR = 2.41, 95% CI: 0.28-20.71, P = 0.42). DTI has a lower risk of minor complications such as subcutaneous emphysema (OR = 5.19 95% CI: 2.27-11.87, P < 0.0001), extraperitoneal insufflation (OR = 5.93 95% CI: 1.69-20.87, P = 0.006), omental emphysema (OR = 18.41, 95% CI: 7. 01-48.34, P < 0.00001), omental bleeding (OR = 2.32, 95% CI: 1.18-4.55, P = 0.01), and lower number of unsuccessful entry or insufflation attempts (OR = 2.25, 95% CI: 1.05-4.81, P = 0.04). No significant differences were found between the two groups in terms of time required to achieve complete insufflation (MD = - 15.53, 95% CI: - 91.32 to 60.27, P = 0.69), trocar site bleeding (OR = 0.66, 95% CI, 0.25-1.79, P = 0.42), and trocar site infection (OR = 1.19, 95% CI, 0.34-4.20, P = 0.78). CONCLUSION There were no statistically significant differences in the risk of major complications during the access manoeuvres between DTI and VN. A lower number of minor complications were observed in DTI compared with those in Veress access.
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Affiliation(s)
- C Taliento
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Ferrara, Italy.
| | - G Pontrelli
- Policlinico Abano Terme, Abano Terme, Padua, Italy
| | - A Rondoni
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Ferrara, Italy
| | - M Desgro
- Policlinico Abano Terme, Abano Terme, Padua, Italy
| | - M Steinkasserer
- Department of Obstetrics and Gynecology, Bolzano Hospital, Bolzano, Italy
| | - G Scutiero
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Ferrara, Italy
| | - G Vizzielli
- Department of Medical Area (DAME), Clinic of Obstetrics and Gynecology, University of Udine, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - P Greco
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Ferrara, Italy
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Ruiu A, Stuppner S, Bertelli G, Armatura G, Luethy M, Damiani D, Cagini A, Steinkasserer M, Lusso MR, Ferro F. [Rare mass in the breast]. Radiologe 2021; 61:1020-1023. [PMID: 34287666 DOI: 10.1007/s00117-021-00888-2] [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] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Affiliation(s)
- A Ruiu
- Abteilung für Diagnostische und Interventionelle Radiologie, Regionalkrankenhaus Bozen, 39100, Bozen, Provinz Bozen - Südtirol, Italien.
| | - S Stuppner
- Abteilung für Diagnostische und Interventionelle Radiologie, Regionalkrankenhaus Bozen, 39100, Bozen, Provinz Bozen - Südtirol, Italien
| | - G Bertelli
- Abteilung für Allgemeinchirurgie, Regionalkrankenhaus Bozen, 39100, Bozen, Provinz Bozen - Südtirol, Italien
| | - G Armatura
- Abteilung für Allgemeinchirurgie, Regionalkrankenhaus Bozen, 39100, Bozen, Provinz Bozen - Südtirol, Italien
| | - M Luethy
- Abteilung für pathologische Anatomie, Regionalkrankenhaus Bozen, 39100, Bozen, Provinz Bozen - Südtirol, Italien
| | - D Damiani
- Abteilung für pathologische Anatomie, Regionalkrankenhaus Bozen, 39100, Bozen, Provinz Bozen - Südtirol, Italien
| | - A Cagini
- Abteilung für pathologische Anatomie, Regionalkrankenhaus Bozen, 39100, Bozen, Provinz Bozen - Südtirol, Italien
| | - M Steinkasserer
- Abteilung für Gynäkologie und Geburtshilfe, Regionalkrankenhaus Bozen, 39100, Bozen, Provinz Bozen - Südtirol, Italien
| | - M R Lusso
- Abteilung für Onkologie, Regionalkrankenhaus Bozen, 39100, Bozen, Provinz Bozen - Südtirol, Italien
| | - F Ferro
- Abteilung für Diagnostische und Interventionelle Radiologie, Regionalkrankenhaus Bozen, 39100, Bozen, Provinz Bozen - Südtirol, Italien
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Donati S, Corsi E, Salvatore MA, Maraschini A, Bonassisa S, Casucci P, Cataneo I, Cetin I, D’Aloja P, Dardanoni G, De Ambrosi E, Ferrazzi E, Fieni S, Franchi MP, Gargantini G, Iurlaro E, Leo L, Liberati M, Livio S, Locci M, Marozio L, Martini C, Maso G, Mecacci F, Meloni A, Mignuoli AD, Patanè L, Pellegrini E, Perotti F, Perrone E, Prefumo F, Ramenghi L, Rusciani R, Savasi V, Schettini SCA, Simeone D, Simeone S, Spinillo A, Steinkasserer M, Tateo S, Ternelli G, Tironi R, Trojano V, Vergani P, Zullino S. Childbirth Care among SARS-CoV-2 Positive Women in Italy. Int J Environ Res Public Health 2021; 18:ijerph18084244. [PMID: 33923642 PMCID: PMC8074190 DOI: 10.3390/ijerph18084244] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022]
Abstract
The new coronavirus emergency spread to Italy when little was known about the infection’s impact on mothers and newborns. This study aims to describe the extent to which clinical practice has protected childbirth physiology and preserved the mother–child bond during the first wave of the pandemic in Italy. A national population-based prospective cohort study was performed enrolling women with confirmed SARS-CoV-2 infection admitted for childbirth to any Italian hospital from 25 February to 31 July 2020. All cases were prospectively notified, and information on peripartum care (mother–newborn separation, skin-to-skin contact, breastfeeding, and rooming-in) and maternal and perinatal outcomes were collected in a structured form and entered in a web-based secure system. The paper describes a cohort of 525 SARS-CoV-2 positive women who gave birth. At hospital admission, 44.8% of the cohort was asymptomatic. At delivery, 51.9% of the mothers had a birth support person in the delivery room; the average caesarean section rate of 33.7% remained stable compared to the national figure. On average, 39.0% of mothers were separated from their newborns at birth, 26.6% practised skin-to-skin, 72.1% roomed in with their babies, and 79.6% of the infants received their mother’s milk. The infants separated and not separated from their SARS-CoV-2 positive mothers both had good outcomes. At the beginning of the pandemic, childbirth raised awareness and concern due to limited available evidence and led to “better safe than sorry” care choices. An improvement of the peripartum care indicators was observed over time.
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Affiliation(s)
- Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Viale Regina Elena 299, 00161 Rome, Italy; (M.A.S.); (A.M.); (P.D.)
- Correspondence: ; Tel.: +39-0649904318
| | - Edoardo Corsi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Montpellier 1, 00133 Rome, Italy;
| | - Michele Antonio Salvatore
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Viale Regina Elena 299, 00161 Rome, Italy; (M.A.S.); (A.M.); (P.D.)
| | - Alice Maraschini
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Viale Regina Elena 299, 00161 Rome, Italy; (M.A.S.); (A.M.); (P.D.)
| | - Silvia Bonassisa
- Department of Obstetrics and Gynecology, University Hospital Maggiore della Carità, 28100 Novara, Italy;
| | - Paola Casucci
- Sistema Informativo e Mobilità Sanitaria, Umbria Region, 06121 Perugia, Italy;
| | - Ilaria Cataneo
- Department of Obstetrics and Gynecology, Ospedale Maggiore, 40133 Bologna, Italy;
| | - Irene Cetin
- Unit of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20154 Milan, Italy; (I.C.); (S.L.)
| | - Paola D’Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Viale Regina Elena 299, 00161 Rome, Italy; (M.A.S.); (A.M.); (P.D.)
| | - Gabriella Dardanoni
- Osservatorio Epidemiologico Assessorato Salute Regione Siciliana, Sicily Region, 90145 Palermo, Italy;
| | | | - Enrico Ferrazzi
- Unit of Obstetrics, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 55031 Milan, Italy; (E.F.); (E.I.)
| | - Stefania Fieni
- Department of Obstetrics and Gynecology, University Hospital of Parma, 43126 Parma, Italy;
| | | | - Gianluigi Gargantini
- Maternal and Child Committee—Lombardy Region, 20124 Milan, Italy; (G.G.); (E.P.)
| | - Enrico Iurlaro
- Unit of Obstetrics, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 55031 Milan, Italy; (E.F.); (E.I.)
| | - Livio Leo
- Hospital “Beauregard” Valle D’Aosta, 11100 Aosta, Italy;
| | - Marco Liberati
- D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Stefania Livio
- Unit of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20154 Milan, Italy; (I.C.); (S.L.)
| | | | - Luca Marozio
- Department of Obstetrics and Gynecology, University of Turin, 10124 Turin, Italy;
| | - Claudio Martini
- Territorio e Integrazione Ospedale Territorio, Marche Region, 60122 Ancona, Italy;
| | - Gianpaolo Maso
- Obstetrics and Gynecology, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy;
| | - Federico Mecacci
- Department of Biomedical, Division of Obstetrics and Gynecology, Experimental and Clinical Sciences, University of Florence, 50134 Florence, Italy;
| | - Alessandra Meloni
- Maternal and Neonatal Department, Azienda Ospedaliero Universitaria, 09042 Cagliari, Italy;
| | - Anna Domenica Mignuoli
- Dipartimento Regionale Tutela della Salute, Calabria Region, 88100 Reggio Calabria, Italy;
| | - Luisa Patanè
- Department of Obstetrics and Gynecology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy;
| | - Edda Pellegrini
- Maternal and Child Committee—Lombardy Region, 20124 Milan, Italy; (G.G.); (E.P.)
| | - Francesca Perotti
- Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo Foundation, University of Pavia, 27100 Pavia, Italy; (F.P.); (A.S.)
| | - Enrica Perrone
- Servizio Assistenza Territoriale, Direzione Generale Cura Della Persona, Salute e Welfare, Emilia-Romagna Region, 40127 Bologna, Italy;
| | - Federico Prefumo
- Department of Clinical and Experimental Sciences, Division of Obstetrics and Gynecology, ASST Spedali Civili, University of Brescia, 25123 Brescia, Italy;
| | - Luca Ramenghi
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Raffaella Rusciani
- Department of Epidemiology, ASL TO3 Piedmont Region, 10095 Turin, Italy;
| | - Valeria Savasi
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, University of Milan, 20157 Milan, Italy;
| | | | - Daniela Simeone
- Ospedale Civile Antonio Cardarelli, 86100 Campobasso, Italy;
| | - Serena Simeone
- Department of Woman and Child’s Health, Careggi University Hospital, 50141 Florence, Italy;
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo Foundation, University of Pavia, 27100 Pavia, Italy; (F.P.); (A.S.)
| | - Martin Steinkasserer
- Central Teaching Hospital of Bozen, Division of Gynecology and Obstetrics, 39100 Bozen, Italy;
| | | | - Giliana Ternelli
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | | | | | - Patrizia Vergani
- Department of Obstetrics and Gynecology, MBBM Foundation/San Gerardo Hospital, University of Milan–Bicocca, 20900 Monza, Italy;
| | - Sara Zullino
- Department of Experimental and Clinical Medicine, Division of Obstetrics and Gynecology, University of Pisa, 56126 Pisa, Italy;
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Negri G, Macciocu E, Cepurnaite R, Kasal A, Troncone G, Steinkasserer M, Vittadello F. Non-human papilloma virus associated adenocarcinomas of the cervix uteri. Cytologic features and diagnostic agreement using whole slide digital cytology imaging. Diagn Cytopathol 2020; 49:316-321. [PMID: 33118707 DOI: 10.1002/dc.24652] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/11/2020] [Accepted: 10/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Non-Human Papilloma Virus associated adenocarcinomas (NHPVAs) are uncommon tumors of the cervix uteri which often show a deceptive morphology. Therefore, their diagnostic assessment may be challenging. Slide digital cytology imaging may be an useful tool to improve cytological diagnostic accuracy. However, this novel technology has not been applied to NHPVAs associated cytologies yet. METHODS The study included 31 whole slide digital cytology cases from 10 women with a proven histological diagnosis of NHPVA. As a control group, three further digital slides, from two women with a histological diagnosis of squamous intraepithelial lesion (SIL), were included. The digitally scanned cytological slides were revised to assess the concordance rate among three observers and to find out the most relevant NHPVA cytological criteria. RESULTS Overall diagnostic agreement between observers was 67.60% (K = 0.50; P < 0.0001). At the consensus diagnosis 34 cases were re-classified as at least suspicious for glandular lesion (n = 24), SIL (n = 2) and negative (n = 8). The most relevant cytologic features for atypical glandular cells or adenocarcinoma at consensus were evident nucleoli, nuclear overlapping and atypical enlarged nuclei. CONCLUSIONS The diagnosis of NHPVA in digital cytology is feasible using criteria which are also used in conventional microscopy. Our study shows a moderate agreement for the cytological diagnosis of NHPVAs using whole slide digital cytology approach. These results are discussed taking into account the most relevant differential diagnostic issues.
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Affiliation(s)
- Giovanni Negri
- Pathology Unit, Central Hospital Bolzano, Bolzano, Italy
| | - Elena Macciocu
- Pathology Unit, Central Hospital Bolzano, Bolzano, Italy
| | - Rima Cepurnaite
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Armin Kasal
- Pathology Unit, Central Hospital Bolzano, Bolzano, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy
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Scarperi S, Pontrelli G, Campana C, Steinkasserer M, Ercoli A, Minelli L, Bergamini V, Ceccaroni M. Laparoscopic Radiofrequency Thermal Ablation for Uterine Adenomyosis. JSLS 2016; 19:JSLS.2015.00071. [PMID: 26648676 PMCID: PMC4653579 DOI: 10.4293/jsls.2015.00071] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Symptomatic uterine adenomyosis, unresponsive to medical therapy, is a challenging condition for patients who desire to preserve their uterus. This study was an evaluation of the feasibility and efficacy of laparoscopic radiofrequency thermal ablation of symptomatic nodular uterine adenomyosis. METHODS Fifteen women with symptomatic nodular adenomyosis, who had no plans for pregnancy but declined hysterectomy, underwent radiofrequency thermal ablation. Ultrasonography was performed at baseline and at postoperative follow-ups at 3, 6, 9, and 12 months. The impact of uterine adenomyosis-related symptoms was assessed according to the visual analog scale. RESULTS The median number of nodular lesions treated per patient was 1 (range, 1-2). The median baseline volume of the adenomyosis area was 60 cm(3) (range, 18-128). The median reduction in volume was 32, 49.4, 59.6, and 65.4% at 3, 6, 9, and 12 months, respectively. A significant progressive improvement in the symptoms score was observed at the 4 follow-ups. CONCLUSION In this study, laparoscopic radiofrequency thermal ablation reduced uterine adenomyosis-related symptoms and volume, with significant relief of symptoms.
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Affiliation(s)
- Stefano Scarperi
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, Sacred Heart Hospital, Negrar Verona, Italy
| | - Giovanni Pontrelli
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, Sacred Heart Hospital, Negrar Verona, Italy
| | - Colette Campana
- Department of Gynecology, Policlinico Abano Terme, Padua, Italy
| | | | - Alfredo Ercoli
- Department of Gynecology, Policlinico Abano Terme, Padua, Italy
| | - Luca Minelli
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, Sacred Heart Hospital, Negrar Verona, Italy
| | - Valentino Bergamini
- Department of Obstetrics and Gynecology, University of Verona, Verona, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, Sacred Heart Hospital, Negrar Verona, Italy
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Scioscia M, Bruni F, Ceccaroni M, Steinkasserer M, Stepniewska A, Minelli L. Distribution of endometriotic lesions in endometriosis stage IV supports the menstrual reflux theory and requires specific preoperative assessment and therapy. Acta Obstet Gynecol Scand 2010; 90:136-9. [PMID: 21241258 DOI: 10.1111/j.1600-0412.2010.01008.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A detailed picture of the prevalence and distribution of abdomino-pelvic endometriosis in more that 1,500 cases of endometriosis stage IV is presented. A great prevalence of endometriotic localizations in the posterior pelvic compartment compared to the other quadrants with more frequently observed lesions on the left part of the pelvis supports the menstrual reflux theory. The extent of anatomical sites suggests the opportunity to plan a proper preoperative instrumental study for patients with clinical suspect of severe endometriosis possibly to set a multidisciplinary clinical or surgical management.
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Affiliation(s)
- Marco Scioscia
- Department of Obstetrics and Gynecology, Sacro Cuore Don Calabria General Hospital, Negrar, Verona, Italy.
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Pezzuto A, Steinkasserer M, Tricolore C, Ferrari B, Nardelli GB, Minelli L. Successful laparoscopic management of adnexal torsion during week 15 of a single pregnancy. J Minim Invasive Gynecol 2010; 17:686. [PMID: 20955980 DOI: 10.1016/j.jmig.2009.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2009] [Revised: 09/18/2009] [Accepted: 09/25/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Antonio Pezzuto
- Department of Obstetrics, Gynaecology and Neonatology, Centre for Reproductive Medicine, University of Parma, Parma, Italy.
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Ruffo G, Stepniewska A, Crippa S, Serboli G, Zardini C, Steinkasserer M, Ceccaroni M, Minelli L, Falconi M. Laparoscopic ileocecal resection for bowel endometriosis. Surg Endosc 2010; 25:1257-62. [PMID: 20848137 DOI: 10.1007/s00464-010-1354-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 08/26/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Ileocecal endometriosis is a very rare entity, and its diagnosis is usually made during surgery for other endometriosis sites or, rarely, because of direct complications of ileal involvement. This study was designed to analyze perioperative and long-term outcomes after bowel resection for ileocecal endometriosis. METHODS All patients who underwent surgery for ileocecal endometriosis between October 2004 and January 2008 were prospectively collected and analyzed. RESULTS Thirty-one women (median age, 34 (range, 25-40) years) were identified. Ileocecal endometriosis was diagnosed during surgery in all patients, and it was associated with colorectal endometriosis in 29 patients (94%). All patients underwent laparoscopic ileocecal resection with no laparotomic conversion. Rectosigmoid or rectal resections was associated in 28 patients (90%) and nodulectomy for sigmoid endometriosis in 1 patient. Median duration of surgery was 301 (range, 90-480) min. Other associated surgical procedures included total hysterectomy (n = 3, 14%), ureterolysis (n = 7, 23%), excision of vesical (n = 4, 13%), vaginal (n = 8, 26%), and parametrial (n = 3, 14%) nodules. There was no mortality. Four patients (13%) required blood transfusions and one a reoperation for bleeding. In a patient who performed ureterolysis, a ureteral fistula occurred. The median hospital stay was 7 (range, 5-18) days. Long-term (>12 months) follow-up data were available for 18 patients. After a median follow-up of 27 months, in 12 of 18 patients (67%) defecation after surgery was normal. Only one patient developed recurrence, which is under medical treatment. CONCLUSIONS Laparoscopic ileocecal resection is safe and feasible and should be considered as part of surgery for endometriosis with radical intent.
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Affiliation(s)
- Giacomo Ruffo
- Department of Surgery, Ospedale Sacro Cuore, Via Sempreboni, 5, 37024 Negrar, VR, Italy.
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Pezzuto A, Pomini P, Steinkasserer M, Nardelli GB, Minelli L. Successful Laparoscopic Management of Spontaneous Hemoperitoneum at 15 Weeks of Pregnancy: Case Report and Review of Literature. J Minim Invasive Gynecol 2009; 16:792-4. [DOI: 10.1016/j.jmig.2009.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 08/05/2009] [Accepted: 08/20/2009] [Indexed: 11/29/2022]
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Steinkasserer M, Engl B. Endometriosis in the north Italian province of South Tyrol. Gynecol Endocrinol 2009; 25:748-50. [PMID: 19903053 DOI: 10.3109/09513590903230408] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Here, we report regarding the health status and medical support for patients suffering from endometrioisis in South Tyrol, which is a politically autonomous province in the north of Italy containing three different ethnic groups. The health service is administered largely by the autonomous regional government. Because of the establishment of a centre for reproductive medicine and the introduction of laparoscopy as a prime surgery method, the gynaecological department of the hospital in Bruneck developed into a reference centre for diagnosis and surgical treatment for endometriosis. The planned future social, health care and insurance developments on local and national level regarding this illness will be discussed.
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Affiliation(s)
- Martin Steinkasserer
- Department of Obstetrics and Gynaecology, Center for Human Reproductive Medicine, Hospital Bruneck, Spitalstrasse 11, 39031 Italy
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