Prevalence and incidence of external genital warts in a sample of Italian general female population.

BACKGROUND: The Human papillomavirus is the most common sexually transmitted virus worldwide. The objective of this study was to estimate: 1) the prevalence and the incidence of external genital warts (eGW) in a sample of women attending community outpatient clinics and 2) the total number of eGW cases in the Italian female population aged 15-64 years. METHODS: A prospective study was performed for a 12-month period between 2009 and 2010, among a sample of women attending community gynecological outpatient clinics located throughout Italy. Demographic data, for every woman aged 15-64 years, were collected. For women diagnosed with eGW, behavioral and clinical data were recorded. Prevalence of eGW was calculated as the proportion between the number of women with eGW and that of women visiting any of the participating gynecologists; incidence of eGW was calculated as the proportion between the number of women with a new diagnosis of eGW and that of women visiting any of the participating gynecologists. Standardized prevalence by age was used to estimate the number of eGW cases occurring in the Italian female population aged 15-64 years. RESULTS: In 2009-2010, 44 community gynecologists were included in the network. In one-year period, 16,410 women visited any of the participating gynecologists; 63 women were diagnosed with eGW, corresponding to a prevalence of 3.8 cases per 1,000 women per year (95%CI: 2.9-4.9). The incidence of eGW was 3.0 cases per 1,000 women per year (95%CI: 2.2-3.9). Women aged 15-24 years showed both the highest prevalence and incidence. Prevalence and incidence significantly decreased by increasing age group (p <0.001), and were higher in Southern Italy compared to Central-Northern Italy. The estimated number of women with eGW among women aged 15-64 years in Italy, in 2010, was approximately 69,000. CONCLUSIONS: These data show a high prevalence and incidence of eGW among young women in Italy, stress the effectiveness of community clinical networks in investigating STI epidemiology among women from the general population, confirm the relevance of HPV vaccination programs among adolescents, and underscore the need of promoting safe sex, implementing early diagnosis, treatment and prevention of genital warts.

Beyond laparoscopy: 3-T magnetic resonance imaging in the evaluation of posterior cul-de-sac obliteration.

OBJECTIVES: Endometriosis is the ectopic localization of endometrial glands. Symptoms include a wide variety of chronic pelvic pain. Ovarian endometriosis represents the most frequent site of implantation followed by the Douglas pouch which is undepicted unless peritoneal fluid is present. Pelvic exams may be reported as normal in 40% of evaluations, although multiple nodularities are located in this region. Nowadays, laparoscopy represents the standard technique for endometriosis evaluation. However, magnetic resonance imaging (MRI) remains the best noninvasive technique for the evaluation of pelvic lesions. According to the importance of a precise preoperative diagnosis of deep infiltrative endometriosis involving the Douglas pouch, we evaluated feasibility of a 3-T system in the evaluation of this particular region. METHODS: We enrolled 19 women coming with either ultrasound or anamnestic suspicion of endometriosis. Pelvic MRI examination was performed on the 3-T system. We applied a standard exam protocol including pulse sequences [single-shot fast spin echo (FSE)] and high-resolution T2W and T1W FSE sequences with and without FS. RESULTS: MRI diagnosed posterior cul-de-sac obliteration in 15/19 patients. MRI findings were compared with laparoscopy, thus obtaining the following statistical values: mean sensitivity, specificity, positive predictive value and negative predictive value, respectively, of 93%, 75%, 93% and 75%. Moreover, we calculated an interobserver agreement k value of 0.72 with a substantial degree of agreement between two radiologists of a sensitivity value of 93% and specificity value of 75%. CONCLUSIONS: Precise preoperative mapping of posterior cul-de-sac region is essential for a preoperative planning. In our work, the 3-T MRI was shown to be excellent in the evaluation of posterior cul-de-sac obliteration associated to an optimal evaluation of the uterosacral ligaments due to the higher contrast spatial resolution.

Laparoscopic treatment of post-cesarean section bladder flap hematoma: A feasible and safe approach.

Bladder-flap haematoma (BFH) is a puerperal complication after caesarean section; it consists of a blood collection between the bladder and the lower uterine segment, in the vesico-uterine space, and it results from bleeding at the uterine suture. Ten symptomatic women were hospitalized and underwent a laparoscopy performed by tumescence incision, bladder wall detachment from the vesico-uterine space, drainage of the fluid material inside the collection, washing of the haematoma site and peritoneal suturing. After seven days, the time it takes to develop a BFH after caesarean section, laparoscopically collected dates were, on average: Total laparoscopy time 31 min, intrasurgical blood loss 36.5 ml, two patients with a draining catheter in the pelvis, two women who developed post-operative urinary symptoms; the duration of hospital stay was 1.3 days. None of the women had complications during the post-dismissal follow-up, and no further therapeutic intervention was required. No clear, defined and standardized protocols exist for the clinical and surgical management of post-caesarean section BFH; the conservative laparoscopic approach proposed would offer women a potentially safe and feasible minimally invasive treatment, reserving hysterectomy for severe uterine necrosis, myometritis or abscess formations. These findings should be confirmed by large extensive trials.

Myoma pseudocapsule: a distinct endocrino-anatomical entity in gynecological surgery.

BACKGROUND: The myoma pseudocapsule is a structure formed surrounding the uterine fibroid, that in the uterus separates the myoma from normal tissue; because literature is lack of detailed information concerning myoma pseudocapsule, the author reviewed this important topic. METHODS: An extensive literature review from 1980 to 2008 was performed on the myoma pseudocapsule, using: fibroid, myoma, myomectomy and reproductive outcome, as keywords. RESULTS: The fibroid removal should always be performed inside its pseudocapsule and with a careful stretching, to extract fibroid from the surrounding fibromuscular skeleton, breaking up the fibrous bridges; because the vascular network generally surrounds the myoma, detachment of the myoma occurring inside the pseudocapsule should cause less bleeding. The maintenance of myometrial integrity during myomectomy allows the facilitation of uterine healing and is of benefit for future reproductive outcome. CONCLUSION: The benefits of intracapsular myomectomy are evident, because it preserves myometrial integrity and allows for restoration of the uterine musculature. This correct myomectomy, if done by laparoscopy, confers significant advantages in less intraoperative blood loss, short duration of hospital stay, few therapeutic antibiotic administration and better future fertility.

Possible involvement of hMLH1, p16(INK4a) and PTEN in the malignant transformation of endometriosis.

Endometriosis is a common gynecologic disease, which generally follows a benign course. Notwithstanding, several clinical and histologic studies as well as molecular data show that endometriosis could be a precursor of sporadic endometrioid and clear cell carcinomas at extrauterine loci. Several reports have implicated alterations of the hMLH1 and p16(ink4a) (p16) genes, in particular hypermethylation of the promoter region, and of the PTEN gene, principally genetic mutations, in endometrial and ovarian cancers and have indicated that these alterations are already present in precancer conditions. In this report, we analyzed the methylation status of hMLH1 and p16 and the protein expression of PTEN and hMLH1 in 46 cases of endometriosis stages III and IV to better define the possible involvement of these genes in the malignant transformation of endometriosis. We found abnormal methylation of hMLH1 in 4 of the 46 cases (8.6%). In addition, these cases had no detectable hMLH1 protein expression. Regarding patients with hMLH1 alterations, 2 were classified as stage IV and 2 showed coexistent endometriosis and carcinoma. Only 1 case of endometriosis (2.17%), classified as atypical, showed abnormal methylation of p16. Reduced PTEN protein expression was detected in 7 of 46 cases (15.21%): 5 were clinically classified as stage IV, and the other 2 presented both cancer and hypermethylated hMLH1. Our preliminary study suggests that reduced expression of both hMLH1 and PTEN may be involved in the malignant evolution of endometriosis and should be used as markers of neoplastic transformation in aggressive endometriosis with elevated tumor markers.