Minerva ginecologica
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Surgery is still the gold standard in breast cancer. Also if the elective treatment, thanks to the adjuvant therapy, ha became more conservative than once was, breast surgery remains, in the mind of the woman affected by breast cancer, a demolitive surgery. ⋯ Oncoplastic surgery is the answer to these human and medical necessities, giving the correct approaches about breast volume, tumor volume, radicality of the treatment and esthetic outcome. This review will focus on different oncoplastic approaches, to help improving both the esthetic outcome of breast cancer resection and the likelihood of surgeons obtaining wide surgical margins in preparation for breast-conserving radiotherapy.
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Minerva ginecologica · Aug 2009
Review Comparative StudyRobotic radical hysterectomy. A literature review.
Advanced laparoscopic procedures are increasingly being used as an alternative to laparotomy in gynecologic surgery. Several reviews have been completed that examine the advantages and drawbacks of this technique. Robotic technology offers the promise of overcoming many of the shortcomings of laparoscopy, while preserving classic operative techniques. This review article summarizes some of the most recent literature provided in the arena of robotic assisted radical hysterectomy for the treatment of cervical or endometrial cancer.
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Endometriosis is a common gynecological condition, responsible for significant morbidity and social-economic impact. Although the condition has been recognized for many years, the underlying pathophysiology is poorly understood. In turn, this results in inadequate treatment and high recurrence rates. ⋯ Recent work has focused on identifying the role of vascularization in the pathogenesis of endometriosis, by allowing lesions to establish and grow. In this review the authors outline the basic mechanisms of angiogenesis and vasculogenesis in the human eutopic endometrium, and consider how this data can be applied to endometriotic implants. Furthermore, the authors discuss molecular mechanisms of angiogenesis and vasculogenesis, and how this may be used to therapeutic advantage in the treatment of endometriosis.
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Minerva ginecologica · Feb 2008
Review Comparative StudyEvidence-based approach for the use of ultrasound in the management of polycystic ovary syndrome.
Polycystic ovary syndrome (PCOS) is a complex endocrinopathy, affecting 5-10% of women in the reproductive age group, with a wide spectrum of phenotypes. The cardinal features are hyperandrogenism, ovulatory dysfunction and/or polycystic ovary (PCO) appearance. Three major diagnostic criteria for PCOS have been proposed by the National Institute of Health (NIH 1990), the Rotterdam European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine sponsored PCOS Consensus Workshop Group (ESHRE/ASRM 2003) and the recent task force of the Androgen Excess Society (AES 2006). ⋯ In particular, ovarian stromal area/total area (S/A) ratio seems to have the most efficient diagnostic performance for hyperandrogenism. Three-dimensional (3D) ultrasound is a relatively new imaging modality that has the potential to improve the sensitivity and specificity of ultrasound without adding much to the practical management of the syndrome. In addition to its role in the definition of PCO, ultrasound is helpful to predict fertility outcome in patients undergoing treatment.
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Minerva ginecologica · Aug 2007
Review[Individualization of low-dose oral contraceptives. Pharmacological principles and practical indications for oral contraceptives].
The contraceptive pill has been a revolution of the last 40 years. In Italy, however, it is much less widely used than in other countries. Explanations for this phenomenon range from religious implications and customs to misinformation and word-of-mouth communication of negative experiences. ⋯ Since high plasma concentrations of androgens have been recorded in these women, a progesterone with antiandrogen and antiedema activity can be beneficial. Finally, it is worth recalling that monophasic pills with low estrogen doses, such as the formulations mentioned above, ensure good mood control, reducing the depressive symptoms often associated with oral contraceptive use. In conclusion, formulations containing drospirenone are a valid alternative to conventional oral contraceptives for the personalisation of these drugs.