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Biomedical subjects

L Mencaglia

Publications and source records attributed to L Mencaglia.

At least 19 recordsLinked to original sources
PubMed1998

Hysteroscopic metroplasty.

STUDY OBJECTIVE: To evaluate 10 years' experience with hysteroscopic treatment of septate uterus in Italy. DESIGN: Multicenter retrospective study conducted from January 1988 to March 1997 (Canadian Task Force classification II-2). SETTING: Twelve Italian centers for minimally invasive therapy. PATIENTS: Women (total 973) with hysteroscopically diagnosed septate uterus. INTERVENTIONS: Hysteroscopic metroplasty performed with scissors, resectoscope, or neodymium:yttrium-aluminum-garnet laser. MEASUREMENTS AND MAIN RESULTS: Data on indications for hysteroscopic metroplasty, details of patient management from pretreatment to follow-up, and pregnancy course and delivery were collected by questionnaire. Main indications were two or more abortions and primary infertility. Most procedures were performed with the resectoscope, followed by scissors and laser. Few minor complications occurred. Pregnancy rates were good. CONCLUSION: Hysteroscopy is safe and effective treatment of septate uterus in terms of both pregnancy rate and outcome.

Adult↗
PubMed1996

Missed hysteroscopic detection of uterine carcinoma before endometrial resection: report of three cases.

Endometrial ablation or resection using hysteroscopy appears to be an effective treatment for menorrhagia resistant to medical therapy. Three patients with endometrial adenocarcinoma missed in the preoperative hysteroscopic and histological assessment and subjected to endometrial resection were collected in a multicenter study. One case was an early adenocarcinoma in the background of late proliferative endometrium in a 39-year-old woman. In the other two patients, ages 51 and 68, the adenocarcinoma developed in a polyp in a background of simple hyperplasia. Since hysteroscopy with endometrial biopsy might not be able to exclude the presence of an early intrauterine cancer, appropriate selection and accurate evaluation of patients are imperative before ablative surgery. Endometrial resection is preferred over endometrial laser ablation since it provides additional tissue for histologic examination.

Adenocarcinoma↗
PubMed1996

Intramural Myomectomy Using a Combination of Hysteroscopy and Laparoscopy

Thanks to advances in hysteroscopic surgery and improvements in instrumentation, hysteroscopy can now be performed for intramural myomas. Twelve women with submucous or intramural myomas with a diameter ranging from 3.5 to 5.8 cm received preoperative preparation with 5 months of gonadotropin-releasing hormone analogs. The uterine cavity was distended with sorbitol-mannitol solution infused by an electronic pump. Hysteroscopic resection was performed with a 26F resectoscope and electrosurgical monopolar unit under laparoscopic control in all patients. Four women required a second procedure to complete the resection of myoma. No major complications occurred.

Journal Article↗
PubMed1996

Risks of Virus Transmission During Diagnostic Hysteroscopy

The high frequency of asymptomatic carriers of viral infections represents a major risk for transmission. Viral agents can be transmitted through blood or biologic fluids during diagnostic hysteroscopy. Routine disinfection methods to clean hysteroscopes cannot be considered adequate to prevent transmission. Hepatitis C and B viruses require 1-hour sterilization in glutaric aldehyde or gas sterilization (ethylene oxide) to be decontaminated. Human immunodeficiency virus decontamination of instruments is easier and safer. Blood test screening of patients positive for hepatitis B and C should be performed in all candidates for endoscopic gynecologic procedures to avoid the possibility of virus transmission.

Journal Article↗
PubMed1995

Hysteroscopy and adenocarcinoma.

Although the diagnostic accuracy of hysteroscopy is high, it should be considered a diagnostic technique and used together with endometrial biopsy. Hysteroscopy is useful for excluding those patients with abnormal uterine bleeding who show no signs of intrauterine pathology. The number of cases in which hysteroscopy is sufficient for reaching a diagnosis without the help of a subsequent biopsy will depend directly on the experience of the endoscopist. After a fair amount of practice, it is possible to use hysteroscopy for the identification of patients with either benign or malignant endometrial lesions with about 20% false positives and no false negatives. The combined use of hysteroscopy and biopsy leads to near 100% accuracy in the diagnosis of endometrial neoplasia and its precursors. The combination of hysteroscopy and endometrial biopsy is ideal for use in symptomatic patients for the early detection of endometrial neoplasia, its precursors, and benign lesions that cause abnormal bleeding. With benign and malignant endometrial lesions, the first symptom is generally bleeding. Zampi and coworkers analyzed the hysteroscopic finding and menometrorrhagia in 1295 women. While cystic hyperplasia and endometrial neoplasia gave rise to bleeding in many patients, many other lesions also caused the same symptom. Hysteroscopy represents the ideal technique for the examination of women over the age of 45 who complain of abnormal uterine bleeding. In association with endometrial biopsy, it can detect endometrial adenocarcinoma in its early stages and select those patients who have precursor lesions.

Adenocarcinoma↗
PubMed1993

GnRH agonist analogs and hysteroscopic resection of myomas.

OBJECTIVES: The purpose of this study was to evaluate the effects of pretreatment with GnRH analogs and hysteroscopic resection of submucous myomas previously deemed to be contraindicated for this approach. METHODS: Twenty-five patients were included in this study. Patients were assessed by ultrasonography and diagnostic hysteroscopy. They were treated with depot GnRH analogs for 3 months and then scheduled for hysteroscopic surgery. RESULTS: After GnRH therapy the diameter was 61 +/- 10% of the initial diameter. In one patient, therapy was almost ineffective. Hysteroscopic surgery was possible in all 25 patients. Seven patients presented an intramural myoma that was not possible to remove entirely during the first attempt. After dessication and 2 supplementary months of GnRH analog therapy, a second surgical attempt was successful in complete removal of the tumor in all except one case. In one patient hysterectomy 15 days after hysteroscopic surgery was necessary for incoercible bleeding due to a deep adenomiosis. CONCLUSIONS: A combined medical and surgical approach seems to reduce the limit of hysteroscopic surgery and avoid open myomectomy or hysterectomy in a well selected group of patients.

Chemotherapy, Adjuvant↗
PubMed1991

Early detection of endometrial cancer and hyperplasia: a reappraisal.

It is widely recognized that endometrial carcinoma represents one of the most frequent types of pelvic malignancy in women. Recent improved knowledge about population at risk, the criteria of classification of endometrial hyperplasia, different potential for neoplastic transformation for each type of neoplasia, and asymptomatic latency of the pathology allow some considerations. Endometrial cytology is of basic importance in a mass screening programme due to its low cost, accuracy and feasibility. The combination of hysteroscopy and endometrial biopsy is the diagnostic method of choice for symptomatic patients. It permits the elimination of curettage in the diagnostic management in over 95% of cases, with obvious advantages, better diagnostic accuracy and greater convenience for patients and doctors.

Biopsy↗
PubMed1990

Endometrial carcinoma and its precursors: early detection and treatment.

Endometrial carcinoma is the most frequent genital neoplasia in women. Precursors of this condition include endometrial hyperplasia, particularly when cytologic atypia occurs. Among the frequent early clinical manifestations of endometrial carcinoma is abnormal uterine bleeding that must be differentiated from bleeding associated with benign conditions. Early detection of endometrial carcinoma and its precursors in women at risk is the best prophylactic measure in the final therapeutic outcome. In this review, the accuracy of methods of early diagnosis of endometrial carcinoma and its precursors is assessed, in order to provide early therapy and optimum prognosis. The epidemiology of endometrial carcinoma, as well as the risk factors for the development of this neoplasia, are also reviewed. A histologic classification of endometrial hyperplasia and carcinoma of the endometrium, based on current theories of histopathogenesis, is included.

Biopsy↗
PubMed1988

Hysteroscopic detection of heterotopic intrauterine bone formation.

The diagnosis and management of heterotopic intrauterine bone formation was performed hysteroscopically in nine patients. The presenting symptom was secondary infertility in seven, pelvic pain in one and passage of bone fragments in one. All nine patients had a history of spontaneous and therapeutic abortion. Hysteroscopy was more accurate than hysterosalpingography in detecting the condition. Four pregnancies occurred in the seven infertile patients following removal of the bone. In four of nine cases there was clear evidence of remaining bone fragments after the initial removal.

Adult↗
PubMed1987

Endometrial cytology: six years of experience.

This article deals with a 6-yr mass screening program for the early detection of endometrial cancer, which took place 1978-1983. The diagnostic accuracy of endometrial cytology and the possibility of integrating this technique with the hysteroscopy and endometrial biopsy were studied. The authors analyzed 2,504 outpatients, all over the age of 45. The results of endometrial cytology were compared with those found using hysteroscopy and endometrial biopsy. Endometrial cytology showed high sensitivity in diagnosing endometrial cancer (97.7%) and high specificity in diagnosing true negatives. However, this technique was not adequate in identifying benign endometrial pathology, e.g., endometrial hyperplasia, polyps, or submucous fibromas. Epidemiological and clinical data in our series were fundamental in establishing mass screening for the early detection of endometrial cancer using integrated techniques. These data should be taken into consideration for creating new projects. The significantly high prevalence of endometrial neoplasia even in asymptomatic women over 45 years of age (4 per 1000) and the possibility of improving the accuracy of endometrial diagnosis using hysteroscopy and endometrial biopsy were the cornerstones of this project.

Cytodiagnosis↗
PubMed1987

Hysteroscopy in perimenopausal and postmenopausal women with abnormal uterine bleeding.

From February 1983 to January 1985, we performed outpatient microhysteroscopic examinations on 618 women 45 years of age or older with abnormal uterine bleeding (AUB). Three hundred thirty-four (54%) had normal and functional or hypoatrophic endometrium, 78 (12.6%) had low-risk hyperplasia, 8 (1.3%) had high-risk hyperplasia, and 66 (10.6%) had adenocarcinoma. Correlation with histologic findings revealed the considerable diagnostic accuracy of the technique: its reliability approaches 100% when one deals with endometrial neoplasia, 87.5% with high-risk hyperplasia and 65.2% with low-risk hyperplasia. The diagnosis cannot rely on hysteroscopic examination only. A biopsy can be performed during the examination or immediately thereafter. In 54.1% of AUB patients, no endometrial changes could be detected on hysteroscopy and biopsy. Curettage, therefore, would have resulted in overtreatment of these patients. Moreover, the usefulness of dilatation and curettage in about half of AUB patients over 45 should be questioned seriously.

Adenocarcinoma↗
PubMed1983

The microcolposcopy in the management of the cervical intraepithelial neoplasia.

The authors report their experience with the microcolpohysteroscope of Hamou. This instrument allows a magnification from 0 to 150 times. Its fine caliber (4 mm) allows to work easily also in the interior of the cervical canal, without preventive dilatation. The instrument allows the in vivo vision of the cellular arrangement at the superficial level, after vital staining. The purpose of this research is the discussion of the potentiality of the microcolpohysteroscopy as complementary mean to colposcopy, citology and histology in the management of the Cervical Intraepithelial Neoplasia (CIN). The authors conclude showing the advantages of this technique underlining as this method does not interfere with the natural evolution of the pathologic process, allowing at the contrary to determine the nature and the extension of the lesion. Then, without opposing or to citology or to colposcopy or to histology, it is not only a valid complementary diagnostic mean, but in particularly it contributes to a more rational therapeutic decision.

Carcinoma in Situ↗
PubMed1982

Usefulness of hysteroscopy in endometrial adenocarcinoma staging.

Endometrial carcinoma has an absolutely unfavourable prognosis when it involves the cervix. Clinical staging, which is essential to a correct therapeutical approach, has proven quite wrong when relying on endocervical curettage. This work deals with the use of Hamou's microhysteroscope to assess the endocervical diffusion of endometrial cancer. Thanks to its very high sensitivity (100%), high specificity (89%) and diagnostic accuracy (92%), this method has proven extremely reliable in the clinical staging of endometrial carcinoma.

Endoscopes↗