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1.
J Sex Med ; 2024 Aug 21.
Artículo en Inglés | MEDLINE | ID: mdl-39165032

RESUMEN

BACKGROUND: To date, there is a lack of a structured national plan of sexual education in Italy, with large interregional differences and poor uniformity in the promotion and learning of sexual health. AIM: The aim of this study was to evaluate the level of knowledge on sexuality and reproductive function among adolescents before and after a sexual education program, considering gender differences in the results. METHODS: A longitudinal and interventional study was conducted on high school students. Six sessions for each class were carried out by a multidisciplinary team. Anonymous questionnaires were administered to investigate basic knowledge of human sexuality and reproduction before and after intervention. OUTCOMES: Participants were high school students who completed the questionnaires. Outcomes included pre and posttest answers on the knowledge questionnaire in study population. RESULTS: We obtained data from 842 high school students (mean ± SD age, 16.11 ± 1.74 years). The main informative sources on sexuality were social media in 37.9% of participants; family, school, and scientific material were the main source in 15.1%, 5.2%, and 4.4%, respectively. A total score of 12.6 ± 3.4 (range, 1-20) was obtained on the knowledge questionnaire; specifically, the score was higher in females than males (12.8 ± 3.4 vs 11.9 ± 3.4, P = .0001). In males and females, a statistically significant increase in level of knowledge was found after the multidisciplinary intervention (14.5 ± 3.6, P = .0001). CLINICAL IMPLICATIONS: The lack of sexual education programs in schools in Italy compels adolescents to refer to frequently unreliable sources, such as social media and peers, contributing to misinformation and adoption of risky sexual behaviors. STRENGTHS AND LIMITATIONS: This study is based on a large sample size and highlights the importance of sexual education programs. The main limitations are a greater representation of the female population and the inclusive nature of the school (ie, an artistic school), attracting students who identify with sexual minorities. CONCLUSIONS: Adolescents have limited knowledge about sexuality and reproduction, with a notable gender disparity; sexual education programs in schools, providing information from sexuality experts, led to a substantial increase in knowledge and a reduction in the gender gap.

2.
BMC Womens Health ; 24(1): 130, 2024 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-38373995

RESUMEN

BACKGROUND: The sars-Cov-2 pandemic has determined psychological stress, particularly in the young population of medical students. We studied the impact of the pandemic on menstrual cycle alteration in relation to psychological stress, presence of depression, sleep disturbances and post-traumatic stress, on a population of medical students. METHODS: 293 female students at the Faculty of Medicine and Psychology of the Sapienza University of Rome (23.08 years old ± 3.8) were enrolled. In March 2021, one year after quarantine, a personal data sheet on menstrual cycle, examining the quality of the menstrual cycle during the pandemic, compared to the previous period. Concomitantly, the Beck Depression Inventory and the Impact of Event Scale have been administered. A Pearson chi-square test was assessed to evaluate the difference between the characteristics of the menstrual cycle and the scores obtained with the questionnaires. RESULTS: A statistically significant association between menstrual alterations and stress during pandemic had been found. The onset of depressive symptoms and sleep disturbances was observed in 57.1% and in 58.1% of young women with cycle's alterations, respectively. Amenorrhea was three times more common in female students with depressive symptoms, premenstrual syndrome had a significant correlation with both depression and sleep disturbances. The pandemic has been related to menstrual alterations, with depressive symptoms and sleep disorders. Amenorrhea is connected to depression, as observed on the functional hypothalamic amenorrhea. CONCLUSIONS: The pandemic affected the menstrual cycle as well as the depressive symptoms and sleep. Practical implications of the study lead to the development of strategies for psychological intervention during the pandemic experience, in order to help medical trainees, with specific attention to women's needs. Future studies should analyze the impact of other types of social stress events, on sleep, depression and the menstrual cycle beside the pandemic.


Asunto(s)
COVID-19 , Trastornos del Sueño-Vigilia , Estudiantes de Medicina , Femenino , Humanos , Adulto Joven , Adulto , COVID-19/epidemiología , Amenorrea , Depresión/epidemiología , SARS-CoV-2 , Menstruación , Trastornos del Sueño-Vigilia/epidemiología , Sueño
3.
Arch Gynecol Obstet ; 309(3): 789-799, 2024 03.
Artículo en Inglés | MEDLINE | ID: mdl-37454351

RESUMEN

INTRODUCTION: Molecular and genomic profiling in endometrial cancer is increasing popularity. L1 cell adhesion molecule (L1CAM) is frequently mutated in endometrial cancer. In this paper, we aim to evaluate the prognostic role of L1CAM in patients with stage I endometrial cancer. METHODS: We performed a systematic review and meta-analysis searching in PubMed (MEDLINE), EMBASE, and Web of Science database to identify studies reporting the expression of L1CAM in endometrial cancer. The primary endpoint measure was to assess and evaluate the impact of L1CAM on survival outcomes. This study was performed according to the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) statement. RESULTS: Five studies were included. The pooled results suggested that L1CAM expression influences survival outcomes in stage I endometrial cancer. High L1CAM expression correlated with worse disease-free survival (HR 4.11, 95% CI 1.02-16.59, p = 0.047) and overall survival (HR 3.62, 95% CI 1.32-9.31, p = 0.012). High L1CAM level was also associated with a more aggressive FIGO grade and with older age. CONCLUSION: This systematic review supported that L1CAM have a prognostic role in stage I endometrial cancer, thus providing a potential useful tool for tailoring the need of adjuvant therapy.


Asunto(s)
Neoplasias Endometriales , Molécula L1 de Adhesión de Célula Nerviosa , Femenino , Humanos , Molécula L1 de Adhesión de Célula Nerviosa/genética , Molécula L1 de Adhesión de Célula Nerviosa/metabolismo , Estadificación de Neoplasias , Biomarcadores de Tumor/genética , Revisiones Sistemáticas como Asunto , Metaanálisis como Asunto , Neoplasias Endometriales/patología , Pronóstico
4.
Reprod Biol Endocrinol ; 21(1): 67, 2023 Jul 21.
Artículo en Inglés | MEDLINE | ID: mdl-37480081

RESUMEN

Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threating iatrogenic complication of the early luteal phase and/or early pregnancy after in vitro fertilization (IVF) treatment. The aim of the current study was to identify the most effective methods for preventing of and reducing the incidence and severity of OHSS in IVF patients. A systematic review of systematic reviews of randomized controlled trials (RCTs) with meta-analysis was used to assess each potential intervention (PROSPERO website, CRD 268626) and only studies with the highest quality were included in the qualitative analysis. Primary outcomes included prevention and reduction of OHSS incidence and severity. Secondary outcomes were maternal death, incidence of hospital admission, days of hospitalization, and reproductive outcomes, such as incidence of live-births, clinical pregnancies, pregnancy rate, ongoing pregnancy, miscarriages, and oocytes retrieved. A total of specific interventions related to OHSS were analyzed in 28 systematic reviews of RCTs with meta-analyses. The quality assessment of the included studies was high, moderate, and low for 23, 2, and 3 studies, respectively. The certainty of evidence (CoE) for interventions was reported for 37 specific situations/populations and resulted high, moderate, and low-to-very low for one, 5, and 26 cases, respectively, while it was not reported in 5 cases. Considering the effective interventions without deleterious reproductive effects, GnRH-ant co-treatment (36 RCTs; OR 0.61, 95% C 0.51 to 0.72, n = 7,944; I2 = 31%) and GnRH agonist triggering (8 RCTs; OR 0.15, 95% CI 0.05 to 0.47, n = 989; I2 = 42%) emerged as the most effective interventions for preventing OHSS with a moderate CoE, even though elective embryo cryopreservation exhibited a low CoE. Furthermore, the use of mild ovarian stimulation (9 RCTs; RR 0.26, CI 0.14 to 0.49, n = 1,925; I2 = 0%), and dopaminergic agonists (10 RCTs; OR 0.32, 95% CI 0.23 to 0.44, n = 1,202; I2 = 13%) coadministration proved effective and safe with a moderate CoE. In conclusion, the current study demonstrates that only a few interventions currently can be considered effective to reduce the incidence of OHSS and its severity with high/moderate CoE despite the numerous published studies on the topic. Further well-designed RCTs are needed, particularly for GnRH-a down-regulated IVF cycles.


Asunto(s)
Síndrome de Hiperestimulación Ovárica , Femenino , Humanos , Embarazo , Fertilización In Vitro , Hormona Liberadora de Gonadotropina , Incidencia , Síndrome de Hiperestimulación Ovárica/epidemiología , Síndrome de Hiperestimulación Ovárica/prevención & control , Revisiones Sistemáticas como Asunto
5.
BMC Womens Health ; 23(1): 397, 2023 07 29.
Artículo en Inglés | MEDLINE | ID: mdl-37516869

RESUMEN

BACKGROUND: Endometrial scratching (ES) or injury is intentional damage to the endometrium performed to improve reproductive outcomes for infertile women desiring pregnancy. Moreover, recent systematic reviews with meta-analyses and randomized controlled trials demonstrated that ES is not effective, data on the safety are limited, and it should not be recommended in clinical practice. The aim of the current study was to assess the view and behavior towards ES among fertility specialists throughout infertility centers in Italy, and the relationship between these views and the attitudes towards the use of ES as an add-on in their commercial setting. METHODS: Online survey among infertility centers, affiliated to Italian Society of Human Reproduction (SIRU), was performed using a detailed questionnaire including 45 questions with the possibility to give "closed" multi-choice answers for 41 items and "open" answers for 4 items. Online data from the websites of the infertility centers resulting in affiliation with the specialists were also recorded and analyzed. The quality of information about ES given on infertility centers websites was assessed using a scoring matrix including 10 specific questions (scored from 0 to 2 points), and the possible scores ranged from 0 to 13 points ('excellent' if the score was 9 points or more, 'moderate' if the score was between 5 and 8, and 'poor' if it was 4 points or less). RESULTS: The response rate was of 60.6% (43 questionnaires / 71 infertility SIRU-affiliated centers). All included questionnaires were completed in their entirety. Most physicians (~ 70%) reported to offer ES to less than 10% of their patients. The procedure is mainly performed in the secretory phase (69.2%) using pipelle (61.5%), and usually in medical ambulatory (56.4%) before IVF cycles to improve implantation (71.8%) without drugs administration (e.g., pain drugs, antibiotics, anti-hemorrhagics, or others) before (76.8%) or after (64.1%) the procedure. Only a little proportion of infertility centers included in the analysis proposes formally the ES as an add-on procedure (9.3%), even if, when proposed, the full description of the indications, efficacy, safety, and costs is never addressed. However, the overall information quality of the websites was generally "poor" ranging from 3 to 8 and having a low total score (4.7 ± 1.6; mean ± standard deviation). CONCLUSIONS: In Italy, ES is a procedure still performed among fertility specialists for improving the implantation rate in IVF patients. Moreover, they have a poor attitude in proposing ES as an add-on in the commercial setting.


Asunto(s)
Infertilidad Femenina , Femenino , Embarazo , Humanos , Infertilidad Femenina/terapia , Fertilidad , Italia , Endometrio , Actitud
6.
Int J Mol Sci ; 24(18)2023 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-37762488

RESUMEN

Ovarian hyperstimulation syndrome (OHSS) is the main severe complication of ovarian stimulation for in vitro fertilization (IVF) cycles. The aim of the current study was to identify the interventions for the prevention of and reduction in the incidence and severity of OHSS in patients who undergo IVF not included in systematic reviews with meta-analyses of randomized controlled trials (RCTs) and assess and grade their efficacy and evidence base. The best available evidence for each specific intervention was identified, analyzed in terms of safety/efficacy ratio and risk of bias, and graded using the Oxford Centre for Evidence-Based Medicine (CEBM) hierarchy of evidence. A total of 15 interventions to prevent OHSS were included in the final analysis. In the IVF population not at a high risk for OHSS, follitropin delta for ovarian stimulation may reduce the incidence of early OHSS and/or preventive interventions for early OHSS. In high-risk patients, inositol pretreatment, ovulation triggering with low doses of urinary hCG, and the luteal phase administration of a GnRH antagonist may reduce OHSS risk. In conclusion, even if not supported by systematic reviews with homogeneity of the RCTs, several treatments/strategies to reduce the incidence and severity of OHSS have been shown to be promising.


Asunto(s)
Síndrome de Hiperestimulación Ovárica , Femenino , Humanos , Síndrome de Hiperestimulación Ovárica/epidemiología , Síndrome de Hiperestimulación Ovárica/prevención & control , Incidencia , Hormona Liberadora de Gonadotropina/uso terapéutico , Revisiones Sistemáticas como Asunto , Fertilización In Vitro/efectos adversos
7.
Int J Mol Sci ; 23(6)2022 Mar 09.
Artículo en Inglés | MEDLINE | ID: mdl-35328379

RESUMEN

It has been widely demonstrated that endocrine disruptors play a central role in various physiopathological processes of human health. In the literature, various carcinogenic processes have been associated with endocrine disruptors. A review of the molecular mechanisms underlying the interaction between endocrine disruptors and the endometrial cancer has been poorly developed. A systematic review was performed using PubMed®/MEDLINE. A total of 25 in vivo and in vitro works were selected. Numerous endocrine disruptors were analyzed. The most relevant results showed how Bisphenol A (BPA) interacts with the carcinogenesis process on several levels. It has been demonstrated how BPA can interact with hormonal receptors and with different transcription proliferative and antiproliferative factors. Furthermore, the effect of Polycyclic aromatic hydrocarbons on Aryl hydrocarbon receptors was investigated, and the role of flame retardants in promoting proliferation and metastasis was confirmed. The results obtained demonstrate how the mechanisms of action of endocrine disruptors are manifold in the pathophysiology of endometrial cancer, acting on different levels of the cancerogenesis process.


Asunto(s)
Disruptores Endocrinos , Neoplasias Endometriales , Hidrocarburos Policíclicos Aromáticos , Compuestos de Bencidrilo/toxicidad , Carcinogénesis , Disruptores Endocrinos/toxicidad , Neoplasias Endometriales/inducido químicamente , Femenino , Humanos , Receptores de Hidrocarburo de Aril
8.
Gynecol Endocrinol ; 35(8): 727-731, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30806528

RESUMEN

Inadequate uterine receptivity is responsible for two-third of implanting failures. Aim of the study was to investigate the role of epithelial adherence and tight-junction molecules expressed by human endometrium in predicting womens' fertility outcome. A total of 76 consecutive women, including 24 fertile (G1), 40 primary infertile (G2), and 12 recurrent pregnancy loss (RPL, G3) women, who underwent diagnostic hysteroscopy plus endometrial biopsy between 2005 and 2016 at the Gynecology Division of Sant'Andrea Hospital, Sapienza University of Rome, in Italy, were retrospectively identified and included into the study. Endometrial biopsies were assessed for the immunohistochemical expression of beta-catenin (ß-catenin), E-cadherin and K-cadherin biomarkers. Expression profiles were compared between the three groups of patients and were correlated with patients' fertility outcome. In infertile patients there was a significant lower endometrial expression of ß-catenin (p = .001), E-cadherin (p = .001) and K-cadherin (p = .002), compared to the fertile ones. Furthermore, ß-catenin and E-cadherin intensity gradients of expression at glandular level were found totally reversed in infertile patients. Significant lower expression levels of K-catenin (p = .016) and E-cadherin (p < .0001) at glandular level were found in RPL patients. Results showed that the low endometrial expression of ß-catenin, E-cadherin and K-cadherin were associated to fertility-related problems, such as primary intertility and RPL.


Asunto(s)
Aborto Habitual/diagnóstico , Antígenos CD/genética , Cadherinas/genética , Endometrio/metabolismo , Infertilidad Femenina/diagnóstico , beta Catenina/genética , Aborto Habitual/genética , Aborto Habitual/metabolismo , Adolescente , Adulto , Antígenos CD/metabolismo , Biomarcadores/metabolismo , Cadherinas/metabolismo , Endometrio/patología , Femenino , Humanos , Infertilidad Femenina/genética , Infertilidad Femenina/metabolismo , Persona de Mediana Edad , Embarazo , Pronóstico , Estudios Retrospectivos , Transcriptoma , Adulto Joven , beta Catenina/metabolismo
9.
Arch Gynecol Obstet ; 299(3): 609-623, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30649605

RESUMEN

PURPOSE: During the second and the third trimesters of pregnancy and in the first 3 months following childbirth, about one-third of women experience urinary incontinence (UI). During pregnancy and after delivery, the strength of the pelvic floor muscles may decrease following hormonal and anatomical changes, facilitating musculoskeletal alterations that could lead to UI. Pelvic floor muscle training (PFMT) consists in the repetition of one or more sets of voluntary contractions of the pelvic muscles. By building muscles volume, PFMT elevates the pelvic floor and the pelvic organs, closes the levator hiatus, reduces pubovisceral length and elevates the resting position of the bladder. Objective of this review is to evaluate the efficacy of PFMT for prevention and treatment of UI during pregnancy and after childbirth and its effect on urinary system and supportive structures assessed by objective measurement techniques. METHODS: The largest medical information databases (Medline-Pubmed, EMBASE, Lilacs, Cochrane Library and Physiotherapy Evidence Database) were searched using the medical subject heading terms "pelvic floor muscle training", "prevention", "urinary incontinence", "urinary stress incontinence", "objective measurement techniques", "pregnancy, "exercise", "postpartum" and "childbirth" in different combinations. RESULTS AND CONCLUSIONS: Overall, the quality of the studies was low. At the present time, there is insufficient evidence to state that PFMT is effective in preventing and treating UI during pregnancy and in the postpartum. However, based on the evidence provided by studies with large sample size, well-defined training protocols, high adherence rates and close follow-up, a PFMT program following general strength-training principles can be recommended both during pregnancy and in the postnatal period.


Asunto(s)
Terapia por Ejercicio/métodos , Diafragma Pélvico/fisiología , Atención Posnatal/métodos , Incontinencia Urinaria/prevención & control , Incontinencia Urinaria/terapia , Femenino , Humanos , Embarazo , Incontinencia Urinaria/patología
10.
Reprod Biol Endocrinol ; 16(1): 112, 2018 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-30553277

RESUMEN

Hundreds of thousands of young women are diagnosed with cancer each year, and due to recent advances in screening programs, diagnostic methods and treatment options, survival rates have significantly improved. Radiation therapy plays an important role in cancer treatment and in some cases it constitutes the first therapy proposed to the patient. However, ionizing radiations have a gonadotoxic action with long-term effects that include ovarian insufficiency, pubertal arrest and subsequent infertility. Cranial irradiation may lead to disruption of the hypothalamic-pituitary-gonadal axis, with consequent dysregulation of the normal hormonal secretion. The uterus might be damaged by radiotherapy, as well. In fact, exposure to radiation during childhood leads to altered uterine vascularization, decreased uterine volume and elasticity, myometrial fibrosis and necrosis, endometrial atrophy and insufficiency. As radiations have a relevant impact on reproductive potential, fertility preservation procedures should be carried out before and/or during anticancer treatments. Fertility preservation strategies have been employed for some years now and have recently been diversified thanks to advances in reproductive biology. Aim of this paper is to give an overview of the various effects of radiotherapy on female reproductive function and to describe the current fertility preservation options.


Asunto(s)
Infertilidad Femenina/etiología , Radioterapia/efectos adversos , Supervivientes de Cáncer , Criopreservación , Femenino , Preservación de la Fertilidad , Humanos , Neoplasias/diagnóstico , Neoplasias/radioterapia
11.
Gynecol Oncol ; 150(1): 151-157, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29753392

RESUMEN

OBJECTIVE: To investigate the association of cancer stem cell biomarker aldehyde dehydrogenase-1 (ALDH1) with ovarian cancer patients' prognosis and clinico-pathological characteristics. METHODS: The electronic searches were performed in January 2018 through the databases PubMed, MEDLINE and Scopus by searching the terms: "ovarian cancer" AND "immunohistochemistry" AND ["aldehyde dehydrogenase-1" OR "ALDH1" OR "cancer stem cell"]. Studies evaluating the impact of ALDH1 expression on ovarian cancer survival and clinico-pathological variables were selected. RESULTS: 233 studies were retrieved. Thirteen studies including 1885 patients met all selection criteria. ALDH1-high expression was found to be significantly associated with poor 5-year OS (OR = 3.46; 95% CI: 1.61-7.42; P = 0.001, random effects model) and 5-year PFS (OR = 2.14; 95% CI: 1.11-4.13; P = 0.02, random effects model) in ovarian cancer patients. No correlation between ALDH1 expression and tumor histology (OR = 0.60; 95% CI: 0.36-1.02; P = 0.06, random effects model), FIGO Stage (OR = 0.65; 95% CI: 0.33-1.30; P = 0.22, random effects model), tumor grading (OR = 0.76; 95% CI: 0.40-1.45; P = 0.41, random effects model) lymph nodal status (OR = 2.05; 95% CI: 0.81-5.18; P = 0.13, random effects model) or patients' age at diagnosis (OR = 0.83; 95% CI: 0.54-1.29; P = 0.41, fixed effects model) was identified. CONCLUSIONS: Basing on the available evidence, this meta-analysis showed that high levels of ALDH1 expression correlate with worse OS and PFS in ovarian cancer patients.


Asunto(s)
Isoenzimas/biosíntesis , Neoplasias Ováricas/enzimología , Retinal-Deshidrogenasa/biosíntesis , Familia de Aldehído Deshidrogenasa 1 , Femenino , Humanos , Isoenzimas/metabolismo , Neoplasias Ováricas/sangre , Neoplasias Ováricas/mortalidad , Neoplasias Ováricas/patología , Pronóstico , Retinal-Deshidrogenasa/metabolismo , Análisis de Supervivencia
12.
Gynecol Endocrinol ; 34(10): 837-839, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-29676597

RESUMEN

The most recent evidences suggest the use of progesterone mimicking drugs for the treatment of endometriosis. Particularly, dienogest has been largely tested. However, the standard treatment of extra-pelvic endometriosis is debated. Particularly, cerebral localization of endometriosis is a very rare clinical condition. The surgical approach for such a particular disorder would consist in difficult procedures, thus leading to prefer the medical treatment. We hereby report the clinical case of a cerebral localization of endometriosis treated with dienogest who experienced a complete remission of the disease.


Asunto(s)
Encefalopatías/tratamiento farmacológico , Encéfalo/diagnóstico por imagen , Endometriosis/tratamiento farmacológico , Antagonistas de Hormonas/uso terapéutico , Nandrolona/análogos & derivados , Adulto , Encefalopatías/diagnóstico por imagen , Endometriosis/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética , Nandrolona/uso terapéutico , Resultado del Tratamiento
13.
Gynecol Endocrinol ; 34(11): 1001-1004, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-29842821

RESUMEN

Endocrine disruptors (EDs) are known to affect maternal and child health. The objective of our study was to identify the association between some of the most important endocrine-disruptive substances (perfluorooctane sulfonate [PFOS], perfluorooctanoic acid [PFOA], di2-ethylhexyl-phthalate [DEHP] and mono2-ethylhexyl-phthalate [MEHP]) and both pregnancy variability and birth outcomes. We measured the concentration of the EDs in maternal and cord blood samples of 29 mother-newborn pairs from the Pertini Hospital in Rome between March and June 2016. Each mother reported demographic, life style and diet information. We compared concentrations of the endocrine disruptors between mother and newborn, and among different molecules. We analyzed differences and trends of each ED substance according to the demography and diet information. PFOA levels in maternal blood showed a negative association with newborn weight. Concentration levels of PFOA in both maternal and cord blood of those with physiological progression of pregnancy were higher in than in those with pathological pregnancies. MEHP trend showed a positive association with maternal age. These results confirm the maternal-to-fetus transfer of EDs through the placenta and the impact that endocrine disruptors have on pregnancy and birth outcomes.


Asunto(s)
Peso al Nacer/efectos de los fármacos , Disruptores Endocrinos/toxicidad , Exposición Materna/efectos adversos , Intercambio Materno-Fetal , Embarazo/efectos de los fármacos , Adulto , Disruptores Endocrinos/sangre , Femenino , Sangre Fetal/química , Humanos , Recién Nacido , Proyectos Piloto
14.
Gynecol Endocrinol ; 33(3): 185-187, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28102088

RESUMEN

Most frequent causes of androgenic manifestation are Cushing's syndrome, PCO, benign and malignant androgen-secreting non adrenal tumors and iatrogenic hirsutism. Hyperplasia or neoplasms of ectopic adrenocortical gland are rare. We report a case of a 63-year old female with hirsutism and alopecia. Laboratory data highlighted increased levels of androgens. Diagnostic imaging revealed normal morphology of adrenocortical gland and ovaries. In view of the clinical picture and suspected diagnosis of extra-adrenal cause, she underwent bilateral salpingo-oophorectomy. Histologic examination showed an ectopic adrenal gland with adenoma in the ovarian and peri-ovarian tissue. At six months of follow up, the patients has no sign of hyperandrogenism. In case of hyperandrogenism in postmenopausal women and in the absence of the adrenocortical gland abnormality, ovarian origin should be considered in the differential diagnosis.


Asunto(s)
Adenoma/diagnóstico , Hiperandrogenismo/etiología , Neoplasias Ováricas/diagnóstico , Adenoma/patología , Adenoma/fisiopatología , Adenoma/cirugía , Alopecia/etiología , Alopecia/prevención & control , Diagnóstico Diferencial , Femenino , Hirsutismo/etiología , Hirsutismo/prevención & control , Humanos , Hiperandrogenismo/fisiopatología , Hiperandrogenismo/prevención & control , Persona de Mediana Edad , Neoplasias Ováricas/patología , Neoplasias Ováricas/fisiopatología , Neoplasias Ováricas/cirugía , Ovariectomía , Ciudad de Roma , Salpingectomía , Resultado del Tratamiento
15.
J Obstet Gynaecol Res ; 43(12): 1789-1804, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28892210

RESUMEN

AIM: Summarize the results of the many, but often underpowered, studies on pregnancy complicated by myoma or myomectomy. METHODS: Survey of the electronic PubMed database for the last two decades was conducted. We selected reviews, meta-analyses, case series, case reports, clinical studies only with statistical analysis, and guidelines from scientific societies. RESULTS: Delaying childbearing leads to an increased incidence of pregnancy complicated by fibroids or previous myomectomy. Approximately 10-30% of pregnant women with myomas develop complications during gestation, at delivery and in puerperium. Submucosal, retroplacental, large and multiple myomas have a greater risk of complications. Cervical myomas, although rare, need careful management. The location and size of the fibroids should be assessed from the first trimester. Despite the increased risk of cesarean section, fibroids are not a contraindication to labor, unless they obstruct the birth canal or other obstetric conditions coexist. Myomectomy during pregnancy, in selected cases, is feasible and safe. Myomectomy cannot be considered a prophylactic measure prior to conception, but has to be individualized. Uterine rupture after myomectomy generally occurs in the third trimester or during labor and some associated risk factors have been identified. There is no consensus on the optimal interval between myomectomy and conception. CONCLUSIONS: Pregnancy in patients with fibroids or previous myomectomy should be considered as high risk, requiring a maternal-fetal medicine specialist. To date available literature is inconsistent on evidence-based management. Further research is needed for definitive recommendations.


Asunto(s)
Leiomioma/complicaciones , Complicaciones Neoplásicas del Embarazo/cirugía , Miomectomía Uterina/efectos adversos , Neoplasias Uterinas/complicaciones , Cesárea , Parto Obstétrico , Femenino , Humanos , Leiomioma/cirugía , Embarazo , Resultado del Embarazo , Trastornos Puerperales , Factores de Riesgo , Neoplasias Uterinas/cirugía , Rotura Uterina/etiología
16.
Environ Monit Assess ; 189(9): 456, 2017 Aug 18.
Artículo en Inglés | MEDLINE | ID: mdl-28822013

RESUMEN

The PREVIENI project (funded by the Ministry of Environment) investigated the exposure to endocrine disrupters in samples of human population and environmental biota in Italy. The environmental biomonitoring considered two Italian WWF Oasis, with the aim to compare the presence and effects of endocrine disruptors in organisms from two protected natural areas, respectively, upstream and downstream a chemical emission site. Chemical analysis of pollutants' tissue levels was made on tissues from earthworm, barbell, trout, and coot, selected as bioindicator organisms. The contaminants considered were as follows: the perfluorinated compounds perfuoroctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA), polychlorinated biphenyls (PCBs 58 congeners), polybrominated diphenyl ethers (PBDEs, 13 congeners), polycyclic aromatic hydrocarbons (PAHs, 16 compounds), toxic trace elements, the phthalate di-2-ethylexyl phthalate (DEHP) and its primary metabolite, bisphenol A, synthetic musk compounds (musk xylene, musk ketone, tonalide, and galaxolide), and p-nonylphenol. The analyses showed low concentrations of most pollutants in all species from both areas, compared to available literature; noticeable exceptions were the increases of DEHP's primary metabolite, PBDE, PAHs, Hg, and Pb in barbells, and of PCB and Cd in earthworms from the downstream area. The results showed the presence of endocrine disruptors, including those considered as "non-persistent," in bioindicators from protected areas, albeit at low levels. The results provide a contribution to the evaluation of reference values in biota from Mediterranean Europe and support the relevance of monitoring exposure to pollutants, in particular for freshwater environment, also in protected areas.


Asunto(s)
Monitoreo del Ambiente , Contaminantes Químicos del Agua/análisis , Humedales , Compuestos de Bencidrilo/análisis , Biota , Caprilatos/análisis , Disruptores Endocrinos/análisis , Europa (Continente) , Fluorocarburos/análisis , Éteres Difenilos Halogenados/análisis , Humanos , Italia , Fenoles/análisis , Ácidos Ftálicos/análisis , Bifenilos Policlorados/análisis , Hidrocarburos Policíclicos Aromáticos/análisis
17.
Birth Defects Res C Embryo Today ; 108(3): 224-242, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27653964

RESUMEN

There is a widespread exposure of general population, including pregnant women and developing fetuses, to the endocrine disrupting chemicals (EDCs). These chemicals have been reported to be present in urine, blood serum, breast milk, and amniotic fluid. Endocrine disruptions induced by environmental toxicants have placed a heavy burden on society, since environmental exposures during critical periods of development can permanently reprogram normal physiological responses, thereby increasing susceptibility to disease later in life-a process known as developmental reprogramming. During development, organogenesis and tissue differentiation occur through a continuous series of tightly-regulated and precisely-timed molecular, biochemical, and cellular events. Humans may encounter EDCs daily and during all stages of life, from conception and fetal development through adulthood and senescence. Nevertheless, prenatal and early postnatal windows are the most critical for proper development, due to rapid changes in system growth. Although there are still gaps in our knowledge, currently available data support the urgent need for health and environmental policies aimed at protecting the public and, in particular, the developing fetus and women of reproductive age. Birth Defects Research (Part C) 108:224-242, 2016. © 2016 Wiley Periodicals, Inc.


Asunto(s)
Desarrollo Fetal/efectos de los fármacos , Exposición Materna/efectos adversos , Disruptores Endocrinos/efectos adversos , Sistema Endocrino , Exposición a Riesgos Ambientales/efectos adversos , Contaminantes Ambientales/efectos adversos , Femenino , Feto/efectos de los fármacos , Humanos , Salud del Lactante , Embarazo , Reproducción/efectos de los fármacos
18.
Arch Gynecol Obstet ; 294(2): 303-9, 2016 08.
Artículo en Inglés | MEDLINE | ID: mdl-26922440

RESUMEN

PURPOSE: The treatment of Bartholin's gland cysts by traditional surgery is characterized by some disadvantages and complications such as hemorrhage, postoperative dyspareunia, infections, necessity for a general anesthesia. Contrarily, CO2 laser surgery might be less invasive and more effective as it solves many problems of traditional surgery. The aim of our study is to describe CO2 laser technique evaluating its feasibility, complication rate and results vs traditional surgery. METHODS: Among patients treated for Bartholin's gland cyst, we enrolled 62 patients comparing traditional surgical excision vs CO2 laser surgery of whom 27 patients underwent traditional surgery, whereas 35 patients underwent CO2 laser surgery. Mean operative time, complication rate, recurrence rate and short- and long-term outcomes were assessed. RESULTS: The procedures required a mean operative time of 9 ± 5.3 min for CO2 laser surgery and 42.2 ± 13.8 for traditional surgery. Two patients (5.7 %) needed an hemostatic suture for intraoperative bleeding in the laser CO2 laser technique against 14.8 % for traditional surgery. Carbon dioxide allows a complete healing in a mean time of 22 days without scarring, hematomas or wound infections and a return to daily living in a mean time of 2 days. Instead, patients undergone traditional surgery required a mean time of 14 days to return to daily life with a healing mean time completed in 28 days. CONCLUSIONS: The minimum rate of intra- and post-operative complications, the ability to perform it under local anesthesia in an outpatient setting make CO2 laser surgery more cost-effective than traditional surgery.


Asunto(s)
Glándulas Vestibulares Mayores/cirugía , Quistes/cirugía , Terapia por Láser/métodos , Láseres de Gas/uso terapéutico , Complicaciones Posoperatorias , Glándulas Vestibulares Mayores/patología , Dióxido de Carbono , Cicatriz/patología , Quistes/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Tempo Operativo , Recurrencia , Estudios Retrospectivos , Resultado del Tratamiento
19.
Gynecol Endocrinol ; 31(10): 824-7, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26287363

RESUMEN

Our aim is to assess the impact of the ultrasonographic detection of follicular rupture on the intrauterine insemination success. A total of 313 women undergoing ovarian stimulation for intrauterine insemination were enrolled. Transvaginal ultrasonography was performed to check whether the dominant follicle had ruptured and according to that the patients were divided into two groups. The ultrasound detection of follicular rupture was observed in 156 patients (54%). The independent variables favoring follicular rupture were: Age (t: 7.646, p < 0.0005), FSH value (t: -5.637, p < 0.0005), duration of infertility (t: -4.265, p < 0.0005), menstrual cycle length (t: -4.927, p < 0.0005). Moreover, the logistic regression analysis demonstrated that the predictive variables for follicular rupture were: FSH value (OR 1.7, CI 95% 1.3-2.3, p < 0.0005), duration of infertility (OR 2.6, CI 95% 1.6-4.2, p < 0.0005) and menstrual cycle length (OR 2.4, CI 95% 1.7-3.4, p < 0.0005). Pregnancy occurred in 23 patients of the group A (14.7%) and in 22 patients of the group B (16.5%) without a significant difference (p = 0.6). The logistic regression analysis confirmed that neither the evidence of follicular rupture nor any other variables influenced the pregnancy rate.


Asunto(s)
Inseminación Artificial , Folículo Ovárico/diagnóstico por imagen , Inducción de la Ovulación , Adulto , Femenino , Humanos , Embarazo , Índice de Embarazo , Estudios Prospectivos , Resultado del Tratamiento , Ultrasonografía
20.
Arch Gynecol Obstet ; 291(1): 19-30, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25234517

RESUMEN

INTRODUCTION: The accurate evaluation of tubal patency as well of the morphologic characteristics of the uterine cavity is a fundamental step in the diagnostic work-up for infertility. Hysteroscopy and laparoscopy and dye have long been regarded as the reference methods to assess uterine morphology and tubal patency, respectively. However, their technical and clinical limitations have supported the introduction of an emerging technique: hysterosalpingo contrast sonography (HyCoSy), which has recently been improved with the use of modern contrast agents and three-dimensional resolution. METHODS: A systematic literature search was performed in electronic databases (PubMed and Scopus). Key search terms included Hysterosalpingo contrast sonography (HyCoSy), Tubal patency, Infertility, Uterine cavity, Ultrasounds. RESULTS: HyCoSy has proved to be as reliable as laparoscopic techniques in the assessment of tubal patency and uterine morphology, and also it overcomes such major drawbacks as hospitalization, radiation exposure, anesthesia and use of iodinated contrast media. All in all, HyCoSy is considered as a safe and well tolerated outpatient procedure, which apparently favors the onset of spontaneous pregnancies. CONCLUSION: This paper provides a comprehensive overview of the literature dealing with HyCoSy to support its use as a first-line technique in standard infertility work-up.


Asunto(s)
Pruebas de Obstrucción de las Trompas Uterinas/métodos , Histerosalpingografía/métodos , Infertilidad Femenina/diagnóstico , Medios de Contraste/administración & dosificación , Femenino , Humanos , Histeroscopía/métodos , Laparoscopía/métodos , Embarazo , Ultrasonografía , Útero/diagnóstico por imagen
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