Follow-Up and Relook Hysteroscopy

Intra-uterine adhesions (IUAs) after initial treatment in patients with Asherman’s Syndrome are one of the main challenging issues in the gynecological practice, since its incidence has been increasing over the last few decades, with a reported recurrence rate up to 30%. Asherman syndrome is characterized by variable scarring inside the uterine cavity that can lead to partial or complete dysfunction of the endometrium with impairment of fertility and menstrual pattern (amenorrhea and hypomenorrhea). The advent of hysteroscopy has revolutionized the diagnosis and the management of IUAs and is therefore considered the most valuable tool in diagnosis and management. Nowadays, there is no clear consensus about management and treatment of Asherman Syndrome (AS). The aim of the therapeutic approach is to re-establish a pear-like shaped uterine cavity and therefore its physiological function. Good surgical practice and technique, together with the choice of the type of energy used during the procedure, are considered the “key points” for avoiding the formation of intrauterine scarring. It is also recommended to perform an “early second look” hysteroscopy a few days after surgery to evaluate the normalization of the uterine cavity and to avoid re-occurrence of adhesions thanks to the immediate lysis of any small persistent synechiae. The use of intrauterine anti-adhesive gels is an effective strategy to reduce re-occurrence of adhesions after surgical treatment of AS. Despite advances in hysteroscopic surgery and various methods for prevention of recurrent adhesive disease, AS recurrence rates remain high and new follow up strategies are required

The effect of lipoic acid on wound healing in a full thickness uterine injury model in rats

Aim of this study was to investigate the effects of lipoic acid on uterine wound healing by immunohistochemical and biochemical assay in a rat uterine horn model with full thickness injury. Thirty-two female Wistar albino rats were randomised into five groups: Control group, with no intervention; uterine scar group 15days (US15d), uterine scar group 15 days + alpha lipoic acid (ALA) (US15d + ALA), uterine scar group 30 days (US30d) and uterine scar group 30 days + ALA (US30 days + ALA). After uterine incision 100 mg/kg of ALA was administered by oral gavage for either 15 or 30 days. Vascular endothelial growth factor (VEGF) and alpha smooth muscle actin (alpha-SMA) distribution were evaluated by immunohistochemical methods in tissue and ELISA methods in tissue homogenate. The percentage of alpha-SMA positive area in US15d + ALA and US30d + ALA groups was significantly higher than US15 and US30d groups. The percentage of VEGF positive area in US15d + ALA group was significantly higher than US15d group and US30d + ALA group was significantly higher than US30d group. Biochemically, alpha-SMA was significantly higher in the US15d + ALA group when compared to US15d group and higher in US30d + ALA group when compared to US30d group. VEGF was significantly higher in US15d + ALA and US30d + ALA groups when compared to US15 and US30d groups. In conclusion, ALA was found to be effective in enhancing wound healing in uterine full thickness injury