La miomectomia laparoscopica: nostra esperienza

I miomi uterini rappresentano la più comune neoplasia benigna della sfera genitale femminile, con una incidenza del 20-25% ed incremento nel periodo premenopausale fino al 50%. Il trattamento può essere medico e/o chirurgico, conservativo o demolitore. La miomectomia laparoscopica consente un approccio il meno traumatico possibile, con ottimi risultati in termini di efficacia della risoluzione della sintomatologia; di ottimizzazione della fertilità; di riduzione dei costi di degenza, in quanto non comporta l’attesa della canalizzazione nel postoperatorio, riduce significativamente la perdita di sangue e consente un rapido ritorno all’attività lavorativa

Changes in androgens and insulin sensitivity indexes throughout pregnancy in women with polycystic ovary syndrome (PCOS): relationships with adverse outcomes

<p>Abstract</p> <p>Background</p> <p>Given the high rate of pregnancy and perinatal complications recently observed in patients with polycystic ovary syndrome (PCOS) and the lack of data on the serum variations in androgens and insulin sensitivity indexes in pregnant women with PCOS, the current study was aimed to assess these changes and their potential effect on pregnancy outcomes in a population of women with PCOS.</p> <p>Methods</p> <p>Forty-five pregnant patients with ovulatory PCOS (PCOS group) and other 42 healthy pregnant women (control group) were studied assaying serum androgen levels and insulin sensitivity indexes throughout pregnancy serially, and recording obstetrical outcomes.</p> <p>Results</p> <p>Serum androgen levels and insulin resistance indexes were significantly (<it>p </it>< 0.05) higher in PCOS than in control group at study entry, these differences were sustained throughout pregnancy, and their changes resulted significantly (<it>p </it>< 0.05) different between PCOS and control group. In PCOS patients, women who had a complicated pregnancy showed serum androgen levels and insulin sensitivity indexes significantly (<it>p </it>< 0.05) worse in comparison to subjects without any pregnancy and/or neonatal complications.</p> <p>Conclusions</p> <p>PCOS patients have impaired changes in serum androgen levels and insulin sensitivity indexes during pregnancy. These alterations could be implicated in the pregnancy and neonatal complications frequently observed in women affected by PCOS.</p

Serum and follicular anti-Mullerian hormone levels in women with polycystic ovary syndrome (PCOS) under metformin

<p>Abstract</p> <p>Background</p> <p>No data regarding metformin effects on follicular fluid anti-Müllerian hormone (AMH) levels were to date available in literature. The aim of the present study was to evaluate in patients with polycystic ovary syndrome (PCOS) whether metformin administration affects serum and follicular AMH levels, and whether this is related to ovarian response to the treatment.</p> <p>Methods</p> <p>Twenty young patients with PCOS who had received metformin were enrolled. Ten patients were anovulatory (Met-anov group), whereas the other 10 were ovulatory (Met-ov group) but had failed to conceive. Further untreated PCOS (PCOS controls, n. 10) and healthy controls (non-PCOS controls, n. 10) who were scheduled for laparoscopic surgery were enrolled. In each subjects, clinical and biochemical evaluations were performed. AMH concentrations in blood and antral follicular fluid were assayed.</p> <p>Results</p> <p>In both Met-anov and Met-ov groups, and without difference between them, serum androgens and AMH, and indices of insulin resistance were significantly (<it>p </it>< 0.05) improved after treatment. On the other hand, significant differences (<it>p </it>< 0.05) between the two groups were detected with respect to the same biochemical parameters in antral follicular fluid. In the Met-anov group, no significant correlation was observed between AMH concentrations in the follicular fluid and variation in serum androgens, AMH and insulin resistance indexes; whereas in Met-ov group significant correlations were detected between AMH levels in the follicular fluid and variation in serum androgens, AMH and insulin resistance indexes.</p> <p>Conclusions</p> <p>Metformin administration in patients with PCOS exerts a differential action on the ovarian AMH levels on the basis of ovulatory response. Changes in AMH levels in antral follicular fluid during metformin treatment could be involved in the local mechanisms mediating the ovulatory restoration.</p

Does metformin affect ovarian morphology in patients with polycystic ovary syndrome? A retrospective cross-sectional preliminary analysis

Abstract Background The significance of polycystic ovarian morphology and its relation to polycystic ovary syndrome (PCOS) is unclear, but probably it is associated with higher androgen and insulin levels and lower sex hormone binding globulin (SHBG) in absence of identifiable differences in gonadotropin dynamics. The aim of this study was to evaluate ovarian morphology in patients affected by PCOS with different ovulatory responses to metformin. Methods In this cross-sectional analysis, we studied 20 young normal-weight PCOS patients who had received a six-month course of metformin treatment. Ten of these patients remained anovulatory (anovulatory group), whereas other ten became ovulatory, but failed to conceive (ovulatory group). Other ten age- and body mass index (BMI)-matched PCOS subjects were also enrolled as controls and observed without any treatment (control group). Results After six months of metformin, in both PCOS treated groups, a similar improvement in testosterone (T) and insulin resistance indexes was observed. Moreover, in one (10.0%) and nine (90.0%) subjects from anovulatory and ovulatory PCOS groups, respectively, ovarian morphology changed, whereas a significant reduction in ovarian dimension was observed in the PCOS ovulatory group only. Conclusion PCOS patients under metformin administration demonstrate a change in ovarian morphology closely related to ovulatory response.</p

Trattamento delle patologie infiammatorie e distrofiche vaginali con un nuovo preparato a base di 10 mg di acido jaluronico, acido 18β-glicirretico e sostanze naturali (Vaginol®)

Le vulvovaginiti sono il motivo più frequente di visita ginecologica e il 75% delle donne manifesta almeno una volta nella vita un episodio infiammatorio-distrofico vaginale. La causa più frequente è di natura infettiva, per lo più batterica, mentre nel 20-30% dei casi è dovuta alla Candida Albicans e non. Le vulvovaginiti da Candida non Albicans danno gli stessi sintomi di un’infezione urinaria, con conseguente impiego incongruo di antibiotici, responsabili di aggravamento del quadro clinico, elevata incidenza di forme ricorrenti e spesso croniche. In questo studio abbiamo valutato l’efficacia e la sicurezza di un nuovo preparato con un quantitativo di acido jaluronico di 10 mg, doppio rispetto ai preparati attualmente in commercio, in associazione con acido 18ß-glicirretico e sostanze naturali ad azione antimicrobica, antinfiammatoria, lenitiva, cicatrizzante, trofica, riepitelizzante. Lo studio si basa sulla valutazione di 35 pazienti affette da vulvovaginite di varia natura e 15 pazienti che avevano effettuato un trattamento per neoplasia intraepiteliale di vario grado. Alla visita di controllo effettuata dopo 30 giorni la quasi totalità delle pazienti con vulvovaginite presentava una netta riduzione della sintomatologia e negativizzazione dell’esame obiettivo, mentre delle 15 pazienti conizzate solo 1 presentava una piccola area di tessuto di granulazione e 2 riportavano un quadro di modesta congestione cervicale. Inoltre, nelle pazienti in epoca menopausale tale preparato ha svolto un’azione idratante ed elasticizzante, riducendo in maniera significativa secchezza vaginale e dispareunia