La patologia endometriale e la sorveglianza della paziente in postmenopausa

La patologia endometriale assume un ruolo molto importante in postme- nopausa. Allo scopo di chiarire I'importanza della sorveglianza endometria Ie, nel presente capitola si trattera dell'endometrio normale e delle sue caratteristi- che in menopausa e verr-a data rilevanza alia patologia preneoplastica e neo- plastica, ed ai fattori di rischio. Si discuteranno, inoltre, i mezzi diagnostici disponibili allo scopo di fomire un orientamento allo specialista chiamato oggi a fare diagnosi corrette e precoci

Mammella: è possibile la chemioprevenzione?

La prevenzione delle malattie oncologiche riveste un grande interesse e rappresenta uno dei principali obiettivi di politica sanitaria. La prevenzione primaria, ovvero I' abolizione delle cause cancerogene, rimane I'obiettivo principale. Questo obiettivo e oggi pili vicino gra- =ie alla maggiore consapevolezza della popola- none dei rischi causati dai diversi cancerogeni :!IDbientali, dalle errate abitudini alimentari e :oluttuarie. :..a farmaco-prevenzione e una disciplina relati- ente nuova che si propone di agire sulle ::!ppe intermedie che portano alla manifestazio- ;;,~c1inica della neoplasia. ::"'erecenti conoscenze dei meccanisrni della can- _"fogenesi e l' acquisizione di nuove sostanze _~n attivita preventive ne hanno ampliato Ie -=-,plicazioni. - termini di prevenzione oncologic a e utile pun- ::!3lizzare la differenza tra "prevenzione prima- ~"e "prevenzione secondaria". Infatti, se si :sdude il tentativo di ridurre l' esposizione della -<Jpolazione a fattori di rischio noti, l'approc- pili frequente in oncologia e quello della Copyright 2002, ere Edizioni lnternazionali, Roma prevenzione secondaria, cioe una diagnosi pm precoce possibile per condizionare favorevol- mente la prognosi dei soggetti affetti. La farmaco-prevenzione si prop one di interve- nire a livello della sequenza di eventi che costi- tuiscono il processo di cancerogenesi al fine di prevenire la progressione neoplastica prima del- l'evento clinico terminale, cioe la formazione del tumore. Negli ultirni anni l'interesse per la farmaco-pre- venzione e progressivamente aumentato, poiche la prospettiva di una riduzione del rischio di tumore trarnite l'uso di farmaci e diventata plau- sibile grazie ai risultati di numerosi studi pre- clinici, epidemiologici e clinici

Risk identification of osteoporosis in postmenopausal women by a simple algorithm based on ultrasound densitometry and body mass index

Dual-energy X-ray absorptiometry (DXA) method is the main device for diagnosing osteoporosis; this method, however, involves the use of expensive equipment. Ultrasound method, being portable, noninvasive, and cost-effective, seems to be an appropriate screening device to identify subjects at risk of osteoporosis. Two hundred and twenty-four postmenopausal women (mean age: 57.9+/-6.2yr) were recruited at 2 Menopause Centers. All subjects were assessed by phalangeal Quantitative Ultrasound (QUS) and by DXA at femur and rachis. Applying the first-level screening strategy, the following risk factors were considered: (1) Amplitude Dependent Speed-of-Sound T-score<-1.8 standard deviation (SD) or Ultrasound Bone Profile Index T-score<-1.8SD; (2) body mass index (BMI)<20kg/m(2). BMI identified 25 subjects (11%) of the total population as at risk, the QUS parameters 100 subjects (45%), and the combination of the 2 showed 118 subjects (53%). The percentage of osteoporotics identified by BMI was 17%, by QUS 78%, and by the combination of the two 90%. The sensitivity of this algorithm was 90%; 53% of the subjects would undergo a further densitometric evaluation, the remaining 47% were correctly identified as not at risk. The diagnostic work up proposed appears effective to be indicated for extensive clinical employment, thanks also to its simplicity

Endometrial evaluation with transvaginal ultrasound during hormone therapy : a prospective multicenter study

Objective To assess the value of endometrial thickness as a marker of endometrial abnormality risk during hormone therapy (HT) and to study the correlation between abnormal bleeding and abnormal endometrial histology in patients with thick endometrium. Design Prospective multicenter study. Setting University and general hospitals outpatient centers. Patient(s) Postmenopausal women (702) on HT. Intervention(s) Biendometrial thickness was measured by transvaginal sonography (TVS) between day 5 and day 10 after the last P intake and, when present, after the end of the menstrual-like bleeding. Main outcome measure(s) Hysteroscopy and biopsy were performed within 5 days from TVS on all patients with an endometrial thickness >4.5 mm (precision scale 0.5 mm). Result(s) Endometrial thickness >4.5 mm was observed in 20.5% of patients. One hundred sixteen hysteroscopies and biopsies were performed. Hyperplasia, polyps, and endocavitary fibroids were detected in 15%, 24%, and 8% of cases, respectively. The positive predictive value of TVS examination was 47%. Endometrial thickness was the only variable significantly and independently associated with histologic abnormalities and endocavitary fibroids. Abnormal bleeding occurred in 17.1% of patients. Among 17 patients detected with thick endometrium and hyperplasia, 8 cases showed abnormal bleeding. Conclusion(s): Sonographic endometrial thickness of 4.5 mm provides a sensitive tool to select HT patients who might benefit from hysteroscopy and biopsy. Abnormal bleeding is not a sensitive sign of hyperplasia in patients with thick endometrium

Endometrial evaluation with transvaginal ultrasound during hormone therapy: a prospective multicenter study.

Objective: To assess the value of endometrial thickness as a marker of endometrial abnormality risk during hormone therapy (HT) and to study the correlation between abnormal bleeding and abnormal endometrial histology in patients with thick endometrium. Design: Prospective multicenter study. Setting: University and general hospitals outpatient centers. Patient(s): Postmenopausal women (702) on HT. Intervention(s): Biendometrial thickness was measured by transvaginal sonography (TVS) between day 5 and day 10 after the last P intake and, when present, after the end of the menstrual-like bleeding. Main Outcome Measure(s): Hysteroscopy and biopsy were performed within 5 days from TVS on all patients with an endometrial thickness 4.5 mm (precision scale 0.5 mm). Result(s): Endometrial thickness 4.5 mm was observed in 20.5% of patients. One hundred sixteen hysteroscopies and biopsies were performed. Hyperplasia, polyps, and endocavitary fibroids were detected in 15%, 24%, and 8% of cases, respectively. The positive predictive value of TVS examination was 47%. Endometrial thickness was the only variable significantly and independently associated with histologic abnormalities and endocavitary fibroids. Abnormal bleeding occurred in 17.1% of patients. Among 17 patients detected with thick endometrium and hyperplasia, 8 cases showed abnormal bleeding. Conclusion(s): Sonographic endometrial thickness of 4.5 mm provides a sensitive tool to select HT patients who might benefit from hysteroscopy and biopsy. Abnormal bleeding is not a sensitive sign of hyperplasia in patients with thick endometrium

Reproductive Issues and Pregnancy Implications in Systemic Sclerosis.

Systemic sclerosis (SSc) is a rare systemic autoimmune disease that can influence reproductive health. SSc has a strong female predominance, and the disease onset can occur during fertility age in almost 50% of patients. Preconception counseling, adjustment of treatment, and close surveillance during pregnancy by a multidisciplinary team, are key points to minimize fetal and maternal risks and favor successful pregnancy outcomes. The rates of spontaneous pregnancy losses are comparable to those of the general obstetric population, except for patients with diffuse cutaneous SSc and severe internal organ involvement who may carry a higher risk of abortion. Preterm birth can frequently occur in women with SSc, as it happens in other rheumatic diseases. Overall disease activity generally remains stable during pregnancy, but particular attention should be paid to women with major organ disease, such as renal and cardiopulmonary involvement. Women with such severe involvement should be thoroughly informed about the risks during pregnancy and possibly discouraged from getting pregnant. A high frequency of sexual dysfunction has been described among SSc patients, both in females and in males, and pathogenic mechanisms of SSc may play a fundamental role in determining this impairment. Fertility is overall normal in SSc women, while no studies in the literature have investigated fertility in SSc male patients. Nevertheless, some considerations regarding the impact of some immunosuppressive drugs should be done with male patients, referring to the knowledge gained in other rheumatic diseases

Disease course and obstetric outcomes of pregnancies in juvenile idiopathic arthritis: are there any differences among disease subtypes? A single-centre retrospective study of prospectively followed pregnancies in a dedicated pregnancy clinic

16siTo study disease activity during pregnancy and obstetric outcomes in patients with juvenile idiopathic arthritis (JIA) upon different subsets and with focus on medication use. Retrospective observational study of 22 pregnancies in 16 JIA patients (95.5% Caucasian) who were followed between 2010 and 2018. Disease activity, flares and medications were recorded before conception, during each trimester and postpartum period. Pregnancies occurred in 10 (45.5%) oligoarticular extended (OLA-E), 6 (27.3%) in polyarticular (PLA), 4 in (18.2%) systemic (SYS), 1 (4.5%) in oligoarticular persistent (OLA-P) and 1 (4.5%) in enthesitis-related arthritis (ERA) JIA patients. The median age at disease diagnosis and at conception was 5.5 and 28 years (respectively). The median disease duration was 20 years. Nineteen (95%) pregnancies started in a period of stable disease remission. Among the 22 pregnancies, 20 ended with a live birth (90.9%). No spontaneous miscarriages occurred; two voluntary interruption of pregnancy were performed. There were 7 flares in 6/20 pregnancies (35%) and 8 flares (8/22, 36.4%) occurred in postpartum period, all of them in OLA-E and PLA patients. Seven patients (35%) were taking biological disease-modifying anti-rheumatic drugs (bDMARDs) at conception, and 6 of them stopped this treatment at positive pregnancy test. Five patients resumed bDMARDs either during pregnancy (3 exposed during the third trimester) or puerperium due to a flare. Four preterm deliveries (20%) were recorded, all in patients who had a flare during pregnancy. The preconception counselling should include the evaluation of disease subset, as OLA-E and PLA may flare more than other subsets, especially if bDMARDs are discontinued at positive pregnancy test. Continuation of bDMARDs during pregnancy should be considered to minimize the risk of adverse pregnancy outcomes, particularly preterm delivery.• In our cohort, all the flares during pregnancy and 75% of postpartum flares were observed in patients who withdrew bDMARDs and cDMARDs at the beginning of pregnancy.• Flares were observed only in PLA and OLA-E patients.• Preterm delivery occurred in 20% of the pregnancies; all of these patients had a disease flare during pregnancy.nonenoneGarcia-Fernandez A.; Gerardi M.C.; Crisafulli F.; Filippini M.; Fredi M.; Gorla R.; Lazzaroni M.G.; Lojacono A.; Nalli C.; Ramazzotto F.; Taglietti M.; Zanardini C.; Zatti S.; Franceschini F.; Tincani A.; Andreoli L.Garcia-Fernandez, A.; Gerardi, M. C.; Crisafulli, F.; Filippini, M.; Fredi, M.; Gorla, R.; Lazzaroni, M. G.; Lojacono, A.; Nalli, C.; Ramazzotto, F.; Taglietti, M.; Zanardini, C.; Zatti, S.; Franceschini, F.; Tincani, A.; Andreoli, L

Wound complications after midline laparotomy in endometrial cancer patients. A multicentric trial.

Objective: To evaluate the role of constitutional, clinical and surgical factors in the development of wound complications following midline laparotomy for endometrial cancer.Methods: A database created for a multicentric randomized clinicaltrial comparing two different methods of fascial closure was used to identify patients undergoing total or radical hysterectomy through a midline laparotomy for endometrial cancer. A total of 617 patients were followed to detect the occurrence of early (infection, dehiscence) and late (incisional hernia) postoperative wound complications.Patients who presented an early and/or late woundcomplication (Group 1, n¼513), were compared to those who didnot (Group 2, n¼104).Results: The median patients age was significantly higher in Group1 than in Group 2 (67 [45—81] vs 63 [30—94] years, p<.05). Theproportion of women with diabetes was 21% in Group 1 comparedto 10% in Group 2 (p<.01). The median (range) BMI was higher inpatients who developed a wound complication than in those whodid not (29 [20—48] vs 26 [10—51] kg/m2, p<.05). The closure of thefascia was more frequently performed by experienced surgeons inGroup 1 compared to Group 2 (68.4% vs 49.5%, p<.001). Multiplelogistic regression analysis showed that the presence of diabeteswas the only independent risk factor for wound complications(OR 2.24 [CI 1.28—3.91], p<.005).Conclusions: Wound complications following gynecologic surgeryfor endometrial cancer seem to be related to metabolic disorderssuch as diabetes more than to surgical technique or other coexisting medical conditions