[Day-surgery operative hysteroscopy with loco-regional anesthesia]. / L'isteroscopie operativa in regime di day-surgery con l'utilizzo dell'anestesia loco-regionale.

BACKGROUND: Nowadays hysteroscopic surgery offers the opportunity of treating in Day Hospital even patients who cannot undergo a traditional surgery because of high anesthesiological risk. The aim of this study is to prove that minimal invasive hysteroscopic procedures in loco-regional anesthesia can replace laparotomic gynecological surgery in many intrauterine lesions with the same effectiveness on pain and outcome. METHODS: From September 1999 to December 2000 at the Obstetric and Gynecological Department in Asti 200 hysteroscopic procedures have been performed. The patients (all i.v. line inserted, ECG and pulsometer monitored, and sublingual BDZ sedated) were divided into two groups: a group of 50 patients who underwent operation on paracervical block alone, and the other one of 150 women on paracervical block plus periorificial infiltration of local anesthetic. RESULTS: Only one woman in the first group paracervical block was totally insufficient and she needed a general anesthesia. In the same group, 44% of paracervical blocks required an additional conscious sedation with Propofol and Fentanyl. In the second group only 16 % of cases required an additional sedation. In all cases outcome was very good with complete recovery of the patients dismissed the same afternoon. CONCLUSIONS: In our experience operative hysteroscopies under loco-regional anesthesia with paracervical block and periorificial infiltration is a very satisfactory alternative to general anesthesia. Moreover the type of intrauterine lesion did not influence the tolerability of the operation.

[Comparative study of diagnostic hysteroscopy and transvaginal ultrasonography in patients with abnormal uterine hemorrhage during the peri- and post-menopausal period]. / Studio comparativo tra isteroscopia diagnostica ed ecografia transvaginale in pazienti con sanguinamento uterino anomalo in epoca peri- e postmenopausale.

BACKGROUND: The aim of this study was to determine the diagnostic value of hysteroscopy and transvaginal ultrasonography in patients with abnormal uterine bleeding (AUB) in the peri and postmenopausal period. METHODS: 302 patients with AUB, underwent hysteroscopy and in 86 cases, also a transvaginal ultrasonography before hysteroscopy was performed. Results were compared with the histological diagnosis. RESULTS: The diagnostic accuracy of hysteroscopy was very high in the cases of endometrial carcinoma (sensibility 100%, specificity 99%), and lower in the cases of endometrial hyperplasia (sensibility 69%, specificity 72%) and endometrial atrophy (sensibility 29% and specificity 97%). Sonography proved to be less reliable in the diagnosis of endometrial pathology (carcinoma: sensibility 57%, specificity 100%, hyperplasia: sensibility 62.5% specificity 63%). The results of this study show that sonography may be used as a first choice diagnostic test in the investigation of women with AUB. CONCLUSIONS: Hysteroscopy represent a second diagnostic step for achieving a proper histologic diagnosis.