Outpatient hysteroscopy

Modern hysteroscopy represents a copernical revolution for the diagnosis and treatment of uterine pathology. Traditionally hysteroscopy was performed in a conventional operation room under general anaesthesia (in-patient hysteroscopy). Recent advances in technology and techniques made hysteroscopy less painful and invasive allowing it to be performed in an ambulatory setting (outpatient hysteroscopy). The so called "see & treat hysteroscopy", has reduced the distinction between diagnostic and operative procedure, thus, introducing the concept of a single procedure in which the operative part is perfectly integrated within the diagnostic work-up. The "digital hysteroscopic clinic" (DHC) on the other hand combines ultrasound with hysteroscopy, ideal for a one stop diagnostic procedure and surgical approach, outlasting laparoscopy with ultrasound, for increased surgical performance in outpatient settings. The aim of this paper is to describe the "state of the art" in an outpatient hysteroscopy setting.

Obesity in pregnancy as a model to identify women at risk for later metabolic syndrome

The aim of our study is to identify - in a cohort of obese women - cardiovascular and clinical risk factors in women with previous complicated pregnancies and protective factors in women with previous physiological pregnancies. A total of 135 nonpregnant obese women referring to Policlinico Gemelli in Rome were prospectively collected in 2009-2010. Thirty-two women matched inclusion criteria: 16 reported a previous physiological pregnancy and 16 reported previous obstetric complications. A clinical, instrumental and laboratory evaluation has been performed for each patient. Statistical analysis was performed using StatView Software. Values are expressed as mean ± standard error (SEM). All tests were two-tailed with a confidence level of 95% (p < .05). Statistically significant reduced flow-mediated dilatation (p = .0338), increased serum values of vascular cell adhesion molecule (p = .0154) and higher systolic blood pressure values (p = .0427) have been detected in obese women with previous complicated pregnancies due to gestational diabetes and/or hypertension. In conclusion, obese patients with previous complicated pregnancies develop signs of endothelial dysfunction in the postpartum period. Future research should focus on the early identification of possible molecular mechanisms implicated in the development of glyco-metabolic and cardiovascular diseases in obese patients, since they are at higher risk of metabolic syndrome.

Effect of pravastatin on endothelial function and endothelial progenitor cells in healthy postmenopausal women

PURPOSE

Coronary heart disease is the leading cause of morbidity and mortality in postmenopausal women. Among statins, pravastatin has been shown to significantly reduce fatal and non-fatal cardiovascular events in primary and secondary prevention trials. The aim of the present research was to investigate whether treatment with pravastatin can modify some indices of cardiovascular risk in healthy postmenopausal women such as significant reductions in total and LDL cholesterol and triglyceride levels.

METHODS

20 patients were randomized in double-blind fashion to treatment for eight weeks with either pravastatin 40 mg/day or placebo, and subsequently, after one-week wash-out, crossed-over to the alternative treatment (placebo or pravastatin) for the following eight weeks. We performed clinical and laboratory investigations, before and at the end of each treatment period, to evaluate patient response to the treatment with pravastatin.

RESULTS

After eight weeks pravastatin therapy reduced the median low density lipoprotein (LDL) and total cholesterol (p < 0.01 in both cases). In contrast, insulin level and insulin sensitivity did not show any difference with regard to values observed after placebo treatment. The absolute number of endothelial progenitor cells-colony forming unit (EPC-CFU) was significantly increased by pravastatin treatment (30.6% increase, p < 0.05) and the number of senescent cells was significantly decreased. However pravastatin did not increase tube-like formation by EPC and did not improve endothelial function.

CONCLUSIONS

Despite beneficial effect on lipids and EPC, short term pravastatin does not seem to improve other cardiovascular risk factors, at least in healthy postmenopausal women.

Palpable uterine artery pulsation as a clinical indicator of early pregnancy

The objective of this study was to determine if palpable uterine artery pulsation is a reliable clinical indicator of pregnancy at less than six weeks' gestation. A preliminary, nonblind study involved 299 women. Of 31 women who were at less than six weeks' gestation, 24 had definite uterine artery pulsations, and 7 did not. Of 268 nonpregnant women, 256 did not have pulsation, while 12 did (P < .001). Because other clinical parameters could bias the interpretation of uterine artery pulsation, a second, blind study was undertaken. During it, 155 patients underwent bimanual examination only, and no other clinical information was available to the examiner. Of 25 women at less than six weeks' gestation, 19 had definite uterine artery pulsation, while 6 did not. Of 130 nonpregnant patients, 121 did not have uterine artery pulsation, while 9 did (P < .001). Palpable uterine artery pulsation seems to be associated with early pregnancy, and physicians should add evaluation of pulsation to their clinical armamentarium.

Evaluation of endometrial biopsy using an aspiration curet without cervical tenaculum

In a study of 132 women having endometrial biopsy with either a Novak or Randall aspiration curet before hysterectomy, a tenaculum was not used initially if the curet could be passed easily through the cervix. One biopsy specimen was taken from the anterior endometrium and one from the posterior endometrium. Biopsy was successful in 80 women (61%) and unsuccessful in 52 (39%). Women who are premenopausal, who do not have cervical stenosis, and who have a uterus that sounds to 3.5 inches or less are significantly more likely to have a successful biopsy. Excluding six women in whom the curet could not be passed through the cervix, adequate tissue for histologic evaluation was obtained in 101 of 126 women (80%). Furthermore, endometrial biopsy accurately reflected histopathologic features of the surgical specimen in 98% (98/101) of the women who had sufficient tissue obtained for evaluation. Endometrial biopsy done with an aspiration curet but without placing a tenaculum on the cervix should be attempted in women who require evaluation. Endometrial biopsy would appear to rival dilation and curettage for obtaining endometrial tissue that accurately reflects endometrial histopathology.