Morbidity after pelvic exenteration for gynecological malignancies: a retrospective multicentric study of 230 patients.
ObjectiveOur study purpose was to evaluate morbidity and postoperative mortality in patients who underwent pelvic exenteration (PE) for primary or recurrent gynecological malignancies.MethodsWe identified 230 patients who underwent PE, referred to the gynecological oncology units of 4 institutions: Charitè University in Berlin, Friedrich-Schiller University in Jena, S. Orsola-Malpighi University in Bologna, and Catholic University in Rome and in Campobasso.ResultsThe median age was 55 years. The tumor site was the cervix in 177 patients, the endometrium in 28 patients, the vulva in 16 patients, and the vagina in 9 patients. Sixty-eight anterior, 31 posterior, and 131 total PEs were performe…
Temporal trends and determinants of peripartum hysterectomy in Lombardy, Northern Italy, 1996-2010.
Purpose: To analyze the temporal trends of peripartum hysterectomy (PH) in the period 1996-2010 in Lombardy, Italy. Methods: Using data from the Regional Database, PH ratios/1,000 deliveries were calculated from 1996 to 2010, in strata of age and mode of delivery among women resident in Lombardy, Italy. PH cases were identified searching the database for the ICD-9 and ICD-10 codes for subtotal and total hysterectomy. PH ratios/1,000 deliveries in strata of age, mode of delivery and calendar year were computed. Poisson's regression analysis was used to test trend over time. Results: A total of 905 PH and 1,289,163 deliveries were recorded between 1996 and 2010. The overall PH ratio was 0.70/…
Population attributable risk for ovarian cancer
Parity, oral contraceptive (OC) use, age at menopause, a family history of the disease and selected aspects of diet have been related to the risk of ovarian cancer. The quantification of their impact on a population level may help focus and rank the importance of potential prevention strategies. Using data from a case-control study conducted in Italy between 1983 and 1991 on 971 ovarian cancer cases and 2758 control women we computed the multivariate relative risk estimates, and population attributable risks (PARs), i.e. the proportion of ovarian cancers that would have been avoided if a given exposure had not been present in the population. Overall, the PARs were 5% for nulliparity, 12% fo…
Uterine fibroids risk and history of selected medical conditions linked with female hormones
To understand the role of several medical conditions on the risk of uterine fibroids, we analysed the findings of a large case-control study. Cases were 843 women aged 54 or less (median age 43 years, range 21-54) with histologically confirmed uterine fibroids, whose clinical diagnosis dated back no more than 2 years. Indications for surgery were recurrent menorrhagia or ultrasound evidence of fibroids larger than 10 cm in diameter. Controls were 1557 women aged 54 years or less of comparable quinquennia of age (median age 43 years, range 21-54) who had not undergone hysterectomy and were admitted for acute, non-gynecologic, non-hormonal, non-neoplastic conditions to a network of hospitals …
Observational prospective study on Lactobacillus plantarum P 17630 in the prevention of vaginal infections, during and after systemic antibiotic therapy or in women with recurrent vaginal or genitourinary infections
We performed a prospective cohort parallel observational study on the use of Lactobacillus plantarum P 17630 in the prevention of vaginal infections. Eligible were women with a diagnosis of bacterial vaginosis (15 days) and documented history of recurrent vaginal infections; and/or cystitis (15 days); and/or treatment with antibiotics for bacterial respiratory tract infections during the week before the study entry. Study subjects were prescribed Lactobacillus plantarum P 17630 100.000.000 UFC one vaginal capsule per day for 6 days, then a capsule per week for 16 weeks. Eligible subjects were enrolled in two parallel cohorts: 85 women using (group A) and 39 not using (group B) Lactobacillu…
Regular use of aspirin for cardiovascular disease prevention in Italy
Abstract Objective Only a few European studies focused on aspirin use in the general population. We provide updated information on the prevalence and determinants of regular aspirin use for the prevention of cardiovascular disease (CVD) in the Italian adult population. Method We used data from a survey conducted in Italy in 2013, on a sample of 3000 individuals, representative of the general Italian population aged ≥ 15 years. Results Overall, 10.9% of Italians reported a regular use of aspirin, 11.2% of men and 10.5% of women. Aspirin use significantly increased with age. The highest prevalence of aspirin use was observed among the elderly (30.3%), ex-smokers (22.6%), and in individuals wi…
Temporal Trend in the Frequency of Ectopic Pregnancies in Lombardy, Italy
<b><i>Background:</i></b> In recent years, epidemiological data showed that the incidence of ectopic pregnancies (EP) is decreasing, but few data are available on the time trend in Southern European populations. <b><i>Methods:</i></b> Using data from the Lombardy Region Database, we calculated and standardized the EP rates/10,000 resident women and the ratios/1,000 pregnancies. <b><i>Results:</i></b> Data regarding 1,777,011 pregnancies and 17,028 cases of EP were recorded among women resident in Lombardy between 1996 and 2010, aged 15-50 years old. The age-adjusted EP rates increased from 4.4 in 1996 to 5.8 in 2010. Th…
Does Preoperative Treatment with a Gonadotropin-Releasing Hormone Agonist Improve the Outcome of Endometrial Resection?
Abstract Study Objective. To verify if more favorable long-term results of endometrial resection can be obtained with preoperative gonadotropin-releasing hormone (GnRH) agonist treatment. Design. Multicenter, randomized, controlled trial (Canadian Task Force classification I). Setting. Tertiary care academic department. Patients. Sixty-three premenopausal women with established menorrhagia. Intervention. Eight weeks of goserelin depot treatment before endometrial resection or immediate surgery in the early proliferative phase of the cycle. Measurements and Main Results. Variations in menstrual patterns and bleeding scores as well as overall degree of satisfaction with treatment were determi…
Alcohol consumption and risk of uterine myoma: A systematic review and meta analysis
Background The published data about alcohol consumption and uterine myoma are scanty and controversial: some studies found positive association whereas other studies showed no association. Objectives To conduct a systematic review and meta-analysis to determine whether alcohol is a risk factor for myoma. Search strategy A MEDLINE/EMBASE search was carried out, supplemented by manual searches of bibliographies of the selected studies. Selection criteria Articles published as full-length papers in English. In the review we included all identified studies. Otherwise, the inclusion criteria for studies included in the meta-analysis were: a) case-control or cohort studies, reporting original dat…
Correlates of hormone replacement therapy use in Italian women, 1992-1996
we analyzed the determinants of hormonal replacement therapy (HRT) use in Italy for the period 1992-1996, using data from a framework of case-control studies of colon and rectal neoplasm.a total of 1574 women aged 45-74 years were considered. This group comprised women with acute, non neoplastic, non-hormone-related diseases admitted to a network of hospitals in six areas of Italy.a total of 146 women (8.5%) reported ever HRT use. The multivariate odds ratio (OR) of ever use was 1.6 (95% CI 1.0-2.6) for women with 12 years of education or more, compared with those with7 years. The frequency of use of HRT tended to decrease with increasing parity: the OR was 0.6 for women with four or more c…
Goserelin acetate to avoid hysterectomy in pre-menopausal women with fibroids requiring surgery
Objective: To obtain information on the efficacy of repeated short cycles of GNRH agonist treatment in order to avoid hysterectomy in near-menopausal women with symptomatic fibroids. Study design: 72 pre-menopausal women (mean age 50 years) with one or more uterine fibroids >10 cm in diameter, symptomatic menorrhagia lasting three months or more and haemoglobin=9 g/dl entered the study. The patients were randomized with ratio of approximately 1:4 to: (a) immediate surgery; or (b) treatment with goserelin acetate. Patients randomized to goserelin acetate received a first cycle of 3.6 mg depot once every 28 days for four months. They were followed-up for three years. If menorrhagia was observ…
Diet and risk of seromucinous benign ovarian cysts
Abstract Objective : To analyze the relation between selected dietary indicators and the risk of seromucinous benign ovarian cysts. Study design : We used data from a case–control study on risk factors for benign ovarian cysts conducted in Italy between 1984 and 1994. Cases included 225 women with a histologically confirmed diagnosis of benign seromucinous ovarian neoplasm dating back no more than 2 years. Controls were 450 women below the age of 65 years admitted for acute non-gynecological, non-hormonal, non-neoplastic conditions. Results : Women with seromucinous cysts reported more frequent consumption of beef and other red meat and cheese and less frequent consumption of green vegetabl…
Selected food intake and risk of endometriosis.
Background: To offer data on the relationship between diet and risk of pelvic endometriosis, we analysed data collected in the framework of two case-control studies. Methods: Data from two case-control studies conducted in Northern Italy between 1984 and 1999 were combined. Cases were 504 women aged < 65 years (median age 33 years, range 20-65) with a laparoscopically confirmed diagnosis of endometriosis, admitted to a network of obstetrics and gynaecology departments in Milan, Brescia and Pavia. Controls were 504 women (median age 34 years, range 20-61) admitted for acute non-gynaecological, non-hormonal, non-neoplastic conditions. Results: Compared to women in the lowest tertile of intake…
Diagnosis and treatment of vulvovaginal candidiasis: a practical approach
Coffee drinking and risk of preterm birth
Objectives: We analysed the association between coffee drinking before and during the three trimesters of pregnancy and the risk of preterm birth of babies normal for gestational age (NGA) or small for gestational age (SGA). Methods: Case-control study conducted in University clinics of North Italy. Cases were 502 women who delivered at < weeks of gestation. The controls included 1966 women who gave birth at term (≥37 weeks of gestation) to healthy infants on randomly selected days at the hospitals where cases had been identified. Results: There was inverse association for coffee consumption in the third trimester of pregnancy in SGA cases compared to NGA (heterogeneity test between OR: χ12…
Survival after curative pelvic exenteration for primary or recurrent cervical cancer a retrospective multicentric study of 167 patients
ObjectiveEvaluate the survival of patients who underwent pelvic exenteration (PE) with curative intent for primary persistent or recurrent cervical cancer.MethodsWe retrospectively investigated 167 consecutive patients, referred to the gynecological oncology units of 4 centers in Germany or Italy, who underwent PE. Data regarding surgery, histology, and oncologic outcomes were collected and statistically evaluated. Survival was determined from the day of exenteration until last follow-up or death.ResultsThe median age was 51 years. Twenty-seven patients (16.2%) underwent PE owing to advanced primary tumors (group A), 34 patients (20.4%) underwent PE owing to persistent cancer after chemothe…
Tobacco smoking and risk of endometriosis: a systematic review and meta-analysis
Objective Since conflicting results have been published on the role of tobacco smoking on the risk of endometriosis, we provide an up-to-date summary quantification of this potential association. Design We performed a PubMed/MEDLINE search of the relevant publications up to September 2014, considering studies on humans published in English. We searched the reference list of the identified papers to find other relevant publications. Case–control as well as cohort studies have been included reporting risk estimates on the association between tobacco smoking and endometriosis. 38 of the 1758 screened papers met the inclusion criteria. The selected studies included a total of 13 129 women diagn…
Cigarette smoking and risk of uterine myoma: Systematic review and meta-analysis
Abstract Objective To review the literature on the relationship between smoking and the risk of uterine myoma, we conducted a systematic review and a meta-analysis of published studies. In this meta-analysis, we included all identified studies of association between smoking and uterine myoma where these were case–control or cohort studies, reporting original data, ultrasound or histological confirmed diagnosis of myomas and information on the association between tobacco smoking and myomas. Study design We carried out a literature search on MEDLINE/EMBASE of all studies published as original articles in English up to October 2015, using the Medical Subject Heading terms and free search terms…
Induced abortion and risk of small-for-gestational-age birth.
Objective: To investigate the possibility of an association between previous induced abortion and subsequent birth of a small-for-gestational-age (SGA) infant. Design: Case-control study. Setting: General and university hospitals. Methods: Cases were 555 women who delivered SGA babies. Controls were 1966 women who gave birth at term (>37 weeks of gestation) to healthy infants of normal weight on randomly selected days at the hospital where cases had been identified. All women in the case and control categories were interviewed on the obstetric wards by one of a team of six interviewers. During the interviews, information was obtained regarding general socio-demographic factors, personal cha…
Maternal coffee drinking in pregnancy and risk of small for gestational age birth
Objective: We have analysed the association between coffee drinking before and during the three trimesters of pregnancy and risk of small for gestational age (SGA) birth. Methods: Cases were 555 women who delivered SGA births (ie <10th percentile according Italian standard). The controls included 1966 women who gave birth at term (≥37 weeks of gestation) to healthy infants of normal weight. Results: In comparison with nondrinkers, the ORs for SGA birth were 1.3 (95% confidence interval, CI, 0.9–1.9) for consumption of four or more cups of coffee/day before pregnancy, and 1.2 (95% CI 0.8–1.8), 1.2 (95% CI 0.8–1.8) and 0.9 (95% CI 0.6–1.4) for consumption of three or more cups of coffee/day d…
Pelvic exenteration for recurrent endometrial adenocarcinoma: a retrospective multi-institutional study about 21 patients.
ObjectiveThe aim of our study was to evaluate morbidity, mortality, and long-term survival of patients who underwent pelvic exenteration (PE) with curative intent for recurrence of endometrial adenocarcinoma during a single decade.MethodsWe defined a cohort of 21 patients who met our inclusion criteria, referred to 4 cooperating gynecologic oncology settings in Germany and Italy between 2000 and 2011. Data regarding surgery, histology, and oncologic outcomes were collected and statistically evaluated. Survival was determined from the day of exenteration until the last follow-up or death.ResultsThe median age was 66 years. A total of 42.9% of the patients had major complications, and a compl…