Chinese IUD removal techniques in a Chinese population in central Italy.

OBJECTIVE: To describe routine techniques and a newly developed approach to the removal of Chinese intrauterine devices (IUs). METHODS: Office records regarding women of Chinese nationality who presented to a tertiary care hospital for IUD removal between January 2007 and March 2012 were retrieved. Their demographic data were reviewed and menstrual/obstetric history, IUD type, and reasons given for removal were recorded. All underwent pelvic transvaginal ultrasound scanning. RESULTS: Of 134 Chinese IUDs, 18 (13.4%) were removed successfully in an office setting using a hook or uterine curette without general anesthesia or cervical dilation. Extraction under brief general anesthesia was performed in 55 (41.0%) cases. A further 61 (45.5%) Chinese IUDs were successfully removed in an office setting using a miniature resectoscope. Four types of Chinese IUDs were removed, the most common being the stainless steel ring (55.7%). CONCLUSIONS: All removal procedures were effective and safe. The mini-resectoscope appears to be a safe and effective tool enabling minimally invasive surgery.

The correspondence between abnormal transformation zone grade 1 and grade 2 colposcopic parameters and histology. Clinical implications.

OBJECTIVE: To analyse the correlation between the colposcopic parameters of Grade 1 and Grade 2 abnormal transformation zone (ANTZ G1-ANTZ G2) and histological examination of the cone. MATERIALS AND METHODS: A retrospective analysis of medical records of 600 women who underwent colposcopy and conisation (large loop excision of the transformation zone - LLETZ) between January 1, 2009 and July 31, 2012. The correlation between colposcopic and histological parameters was analysed using the Spearman nonparametric test. RESULTS: In ANTZG1 there was no correlation (r = - 0.03; p = 0.55); in ANTZG2 however, a low degree of correlation (r = 0.21; p = 0.03) was found. Sensitivity, specificity, and positive and negative predictive values of an ANTZ G2 colposcopic picture were 33.45% (confidence interval [CI] 95% 28.0% to 39.2%), 95.48% (CI 95% 92.5% to 97.5%), 87.4% (CI 95% 79.7% to 92.9%), and 60.5% (CI 95% 56% to 64.9%), respectively. CONCLUSIONS: The decisive factor in the diagnosis of the cervical oncologic pathologies is the histological examination of the cone, and not the colposcopy which should be seen as a "guiding" investigation in predicting conisation and application of the most appropriate treatment.

Placental site trophoblastic tumor on endometrial polyp: a case report.

Placental site trophoblastic tumor (PSTT) is the least common form of gestational trophoblastic disease (GTD), and is biologically different from other forms of GTD. There is a wide clinical spectrum of presentation and behavior ranging from a benign condition to an aggressive disease with a fatal outcome. The authors document a case of PSTT on an endometrial polyp. A 51-year-old woman had abnormal vaginal bleeding for the duration of two months. Her past history included a vaginal delivery in 1998. Her physical examination was normal. Tumor markers were at normal levels. Serum beta- human chorionic gonadotropin (hCG) level was 19 mIU/ml and human placental lactogen (hPL) level was in the normal range. The patient underwent an operative hysteroscopy. On examination the uterine cavity appeared to be occupied by a pedunculated polypoid neoformation measuring about 2.5 cm in diameter which was removed and later determined to be a PSTT. There were occasional mitotic figures (0-1/10 high power field). The patient underwent hysterectomy and bilateral salpingo-oophorectomy. The patient has no evidence of disease six months after surgery. The authors conclude that a high mitotic count and atypical undifferentiated pathological features are significant poor prognostic factors for survival in PSTT. Hysterectomy represents the gold standard of treatment in all cases of disease confined to the uterus.

New horizons in the non-invasive diagnosis of endometriosis.

Endometriosis is a chronic disorder, clinically associated with chronic pelvic pain, dyspareunia, dysmenorrhea, and infertility. Its socio-economic impact is extensive, given the large number of affected women in reproductive age, its symptomatology (that interferes with normal social life and the patient's ability to work), and its frequent association with infertility. Nonetheless, the diagnosis of endometriosis is still difficult and late in the evolution of the disorder. The authors have used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria to make a systematic review of the literature of the last 28 years, seeking to identify potential biomarkers useful for a non-invasive diagnosis of endometriosis. The authors have highlighted more than 50 biomarkers in the studies included in the present report, but they have not succeeded in identifying a clinically useful non-invasive diagnostic biomarker or panel of biomarkers. More studies are needed before biomarkers can be introduced in clinical practice.

Reversible posterior leukoencephalopathy syndrome in pregnancy: a case report.

Posterior reversible encephalopathy syndrome (PRES), is an acute, neurotoxic state. It is a very rare clinico-neuroradiological entity, and it is a complication of multiple clinical conditions. The association of PRES with toxemia in pregnancy is established. In this article, the authors discuss the case of a 22-year-old woman, gravida 1, 36-week pregnant, with extensive, bilateral white matter hypodensity, predominantly involving the parieto-occipital lobes region. These changes were highly suggestive of posterior reversible encephalopathy. This case report demonstrates that early treatment with control of blood pressure seizures can reverse this condition and also prevent progression to an irreversible damage, thus emphasizing the need for early diagnosis and treatment.

Intrauterine balloon tamponade as management of postpartum haemorrhage and prevention of haemorrhage related to low-lying placenta.

The aim of the present study was to evaluate the effectiveness of Bakri balloon in preventing and treating postpartum haemorrhage (PPH). Intrauterine Bakri balloon was used in a total of 16 patients with two different purposes: prophylactic placement of the balloon after cesarean section (CS) in six patients with low-lying placenta and therapeutic placement in ten patients with persistent bleeding from uterine atony, after spontaneous delivery, and administration of uterotonics. Intrauterine Bakri balloon was a successful approach in controlling and preventing PPH in all 16 patients. The median nadir hematocrit was 26.6% in six patients who underwent CS and 25.6% in ten patients with persistent bleeding after spontaneous delivery. The intrauterine balloon was in place for a duration of 24 hours. The median balloon infusion volume was 345 ml (range 250-455). No complications were reported. Bakri balloon tamponade was a useful measure in treating PPH unresponsive to pharmacological therapy in patients who delivered vaginally. Moreover, it was able to prevent persistent bleeding in patients who underwent CS for central placenta previa.