Objective: The aim of this study was to evaluate, in a multicenter study, whether the narrow-band imaging (NBI) technology may improve the diagnostic reliability of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia. Methods: A total of 801 outpatient women undergoing diagnostic hysteroscopy were enrolled. All women underwent fluid minihysteroscopy with white light (WL) and NBI exploration with endometrial eye-directed biopsy. Results: NBI hysteroscopy significantly improved the sensitivity for diagnosing endometrial cancer compared with WL (93% and 81%, P < 0.05). In detecting low-risk hyperplasia, the use of NBI significantly improved the sensitivity (82% vs 56%, P < 0.005) and positive predictive value (79% and 71%, P < 0.05) compared with WL hysteroscopy. In the diagnosis of high-risk hyperplasia, NBI significantly improved the sensitivity (60% vs 20%, P < 0.005) and positive predictive value (67% and 25%, P < 0.0001), whereas no difference was seen for specificity (99% and 99%, P > 0.005), negative predictive value (99% and 99%, P > 0.05), and accuracy (99% and 98%, P > 0.05). Conclusions: NBI showed significantly higher values in sensitivity for the detection of low-risk and high-risk hyperplasia, and this could be useful for reducing the risk of missing severe pathologies at hysteroscopy, and improving the diagnosis of preneoplastic and neoplastic pathologies. NBI hysteroscopy showed a very high diagnostic accuracy for the exploration of the uterine cavity, reducing the number of biopsies performed in wrong areas, although multicenter randomized trials are required to establish the true value of this interesting technological advancement. © 2011 by The North American Menopause Society.

In this randomized controlled study, effectiveness, operative time, and acceptability of endometrial polypectomy were compared using an AlphaScope vs an office operative lens-based hysteroscope (LBH). One hundred fifty women with a diagnosis of endometrial polyp were operated on using an AlphaScope or LBH in the office setting. In 73 procedures using the AlphaScope (97.3%) and 68 using the LBH (90.7%), the polyp was successfully removed completely. In the AlphaScope group, 2 procedures were incomplete because of excessive endometrial mucosa thickness. In the LBH group, 3 procedures were incomplete because of difficulty in management of a large polyp, and 4 procedures were stopped because of patient pain and low compliance. Time to completion of the procedure and complete removal of the polyp was significantly shorter in the AlphaScope group than in the LBH group (p < .05). Similarly, the pain score at the end of the procedure was significantly lower in the AlphaScope group than in the LBH group (p < .05). The AlphaScope is an effective operative hysteroscope that increases the possibility of performing endometrial polypectomy in the office setting without anesthesia and improves the indications for and acceptability of office hysteroscopy.

Recurrent miscarriage (RM) is defined as 3 or more miscarriages before 20 weeks' pregnancy. In recent years, interest has been focused on chronic endometritis (CE), a subtle inflammation thought to be associated with RM. We aimed to evaluate the relationships between CE and RM. The records of 360 women with unexplained RM were retrospectively analyzed. Data from hysteroscopy, endometrial histology, endometrial culture, and polymerase chain reaction for chlamydia, performed before and after antibiotic treatment for CE, were analyzed. The occurrence of successful pregnancies within 1 year after treatment was also evaluated. Results showed that 208 (57.8%) women with RM showed CE at hysteroscopy; 190 (91.3%), positive at hysteroscopy, were also positive at histology, and 142 (68.3%) had positive cultures. Common bacteria were found in 110 (77.5%) patients. Mycoplasma and Ureaplasma were found in 36 (25.3%) patients and Chlamydia in 18 patients (12.7%). In 102 (71%) women, antibiogram-based antibiotic treatment normalized hysteroscopy, histology, and cultures (group 1); while in 40 (28.2%) patients, CE was still present at hysteroscopy (group 2). In 16 of the 66 patients positive at hysteroscopy, but not at cultures, the hysteroscopy becomes normal (group 3) after a Centers for Disease Control and Prevention-based therapy; while in 50 women, CE was still present (group 4). One year after treatment, group 1 showed a significantly higher number of pregnancies (78.4%) compared to group 2 (17.5%; P < .001) and group 4 (15.3%; P = .005). The CE is frequent in women with RM. Antibiotic treatment seems to be associated with an improved reproductive outcome.

OBJECTIVE: To estimate if findings in women with chronic endometritis (CE) at fluid hysteroscopy correlate with the severity of inflammation at histology and to assess the possibility to score the severity of inflammation by fluid hysteroscopy. DESIGN: Controlled clinical study. SETTING: University hospital. POPULATION: A total of 211 outpatient women with a hysteroscopic diagnosis of CE and 30 control women without any such signs. METHODS: All patients underwent endometrial biopsy by means of a 3-mm Novak's curette connected to a 20-ml syringe without any anesthesia. MAIN OUTCOME MEASURES: Hysteroscopic records were reviewed and compared with histologic findings by using an arbitrary inflammation score (Grades 0-2, no inflammation to severe infiltration, nodules and glands disruption, respectively). RESULTS: A significant correlation between focal hyperemia and isolated micropolyps with Grade 1 inflammation and between generalized hyperemia, presence of diffuse micropolyps and polypoid endometrium with Grade 2 inflammation was found. Hysteroscopic and histologic grading showed good agreement (kappa index = 0.62). CONCLUSIONS: In women affected by CE the severity of histological alterations may be reliably evaluated by fluid hysteroscopy. This information may be clinically useful not only for giving a prognosis and as a basis for interpretation of patients' complaints, but also for monitoring treatment.????

Sex hormonal variations have been shown to affect functional cerebral asymmetries in cognitive domains, contributing to sex-related differences in functional cerebral organization. The aim of this study was to investigate spatial attention by means of a bisection line test and computer-supported attention task during the menstrual cycle in healthy women compared to men, in basal condition and under Transcranial Direct Current Stimulation (TDCS) of the left parietal cortex. Women were studied during the menses, follicular and luteal phases, ascertained by transvaginal ultrasounds. In basal conditions, women showed a clear deviation toward the right in the bisection line test during the menstrual phase, similarly to men. The midpoint recognition in the computer-supported attention task was not influenced by the menstrual cycle for women, while men showed a significant increase in errors toward the left side. The anodal activation of the left parietal cortex did not affect the line bisection task, while in men it reduced the total amount of errors in midpoint recognition observed in the computer supported attention task. The hand-use effect demonstrated by the bisection-line test could be influenced by estrogen fluctuations, while the right hemisphere prevalence in spatial attention appears to be gender-related and scarcely influenced by the menstrual cycle. The left parietal cortex seems to exert a scarce effect on hand-use effect, while its activation is able to revert sex related right hemisphere supremacy.

Study Objective: To estimate the effectiveness of Qlaira for endometrial preparation in women undergoing hysteroscopic polypectomy in the office setting. Design: Randomized clinical pilot study (Canadian Task Force classification II-2). Setting: Academic research environment. Patients: Seventy-four cycling women undergoing hysteroscopic polypectomy (polyp size <1.5 cm). Interventions: Women were randomized to be operated on during the proliferative phase (cycle day 5-7) of a spontaneous cycle (group A) or after 9 to 11 days of Qlaira intake (group B). Polypectomy was performed by using forceps and bipolar electrodes when required. Measurements and Main Results: The quality of visualization of the uterine cavity during the procedure (visual analog score [VAS] 0-5, bad to optimal), total surgeon satisfaction (VAS 0-5, very difficult to easy to perform), and total patient satisfaction (VAS 0-5, severe pain to no pain) were compared. Endometrial thickness before and at the end of the procedure was significantly less in women in group B. Mean duration of interventions was shorter in group B than in group A. In addition, vision quality, and surgeon and patient satisfaction rates were significantly higher in women in group B. Conclusions: At 10 days before surgery, administration of Qlaira is effective for preparation of the endometrium for hysteroscopic polypectomy in the office setting. With preoperative administration of Qlaira, the surgical procedure can be performed more easily and faster, and both surgeon and patient satisfaction rates are improved

INTRODUCTION: In the Puglia region (South Italy) about 200 new hospitalizations for cervical cancer are registered every year. The study investigated the frequency of Human Papillomavirus (HPV) infection and the genotype distribution of HPV in a sample of women with known cytology attending the outpatient clinics of four Gynecological Departments of the University of Bari over a four-year period (2005-2008). METHODS: Cervical samples from 1,168 women were analyzed for the presence of HPV-DNA through Polymerase Chain Reaction (PCR) in L1 region and reverse hybridization. The cytological results were associated with HPV positivity and type-specific prevalence. RESULTS: Overall, HPV infection was found in 355 (30.4%) women. HPV-DNA was found in 34.4% of women with a cytological diagnosis of ASCUS, in 46.8% of women with Low-grade Squamous Intraepithelial Lesion (LSIL) and in 87.0% of women with High-grade Squamous Intraepithelial Lesion (HSIL)/carcinoma. Also 16.0% of women with normal Pap smear were found to be HPV-DNA positive. The most common HPVgenotype was type 16 found in 27.3% of positives, followed by type 53 (11.5%), type 66 (9.2%) and type 31 (9.0%). HPV genotype 18 was found in 6.4% of positives. Types 16 or 18 were detected in about 34% (120/355) of all infected women, in about 33% of LSIL and in 60% of HSIL/ carcinoma HPV-positive women. Among low risk (LR) genotypes, type 61 was found in 10.7% of HPV positive women, type 62 in 8.4%, type 42 in 8.1% and type CP6108 in 7.8%. DISCUSSION AND CONCLUSIONS: The findings of the study give evidence that HPV infection is frequent in the studied cohort of women. The most widespread genotypes found were 16 and 53. These data may represent a benchmark for future evaluation after the recent introduction of vaccination against HPV in 12-year-old girls.

OBJECTIVE: To assess the relationship between chronic endometritis (CE) and proinflammatory cytokine levels in menstrual effluents and to develop a simple noninvasive test for screening CE. DESIGN: Case-control study. SETTING: Academic center. PATIENT(S): Sixty-four women referred to our center for infertility. INTERVENTION(S): Office hysteroscopy; endometrial biopsy; collection of menstrual blood at subsequent cycle. MAIN OUTCOME MEASURE(S): Interleukin (IL) 6, IL-1β, and tumor necrosis factor (TNF) α concentrations in menstrual effluents. RESULT(S): Thirty-six out of 64 infertile women had histologically proven CE. The remaining 28 women were included as controls. IL-6, IL-1β, and TNF-α levels were markedly higher in menstrual effluents of women with CE compared with control subjects. Receiver operating characteristic curve analysis revealed a good CE screening capacity for all of the cytokines. The combined evaluation of either IL-6/TNF-α or IL-6/IL-1β increased the diagnostic capacity of the test, which reached a 100% sensitivity and a negative predictive value of 100 when at least one cytokine was found to exceed its cutoff value; it also reached a 100% specificity and a positive predictive value of 100 in cases of positivity of both cytokines. Logistic regression analysis confirmed the IL-6/TNF-α-based model as a significant predictor of CE. CONCLUSION(S): Proinflammatory cytokine levels are increased in menstrual effluents of women with CE. A test dosing IL-6 and TNF-α seems to have a high screening capacity for CE.

We report a case of benign multicystic mesothelioma in a 20-year-old woman referred because of amenorrhea. She underwent pelvic transabdominal ultrasound, which disclosed a micropolycystic appearance of the ovaries and a fluid collection in the pouch of Douglas. Tumor serum markers revealed an increase in CA19.9. Abdominal and pelvic computed tomography scans confirmed the presence of ascites. Laparoscopy disclosed small, thin-walled, translucent cysts in the Douglas cavity. The cysts were free-floating in a yellowish, sticky, gelatinous material. Microscopically, cystic lesions showed mesothelium-lined cystic spaces surrounded by a delicate thin fibrovascular wall. With immunohistochemistry, the tumor cells were strongly positive for cytokeratin and calretinin. These aspects were suggestive of benign multicystic mesothelioma. Electron microscopy confirmed the mesothelial nature of this tumor. Serial evaluation of the CA19.9 concentration showed a progressive decrease in the serum marker in the normal range. The patient is now well and symptom-free with no recurrence 24 months after surgery. The association between benign multicystic mesothelioma and increased CA19.9 serum concentration has been described only once, in a man. To our knowledge, this is the second case of benign multicystic mesothelioma associated with increased CA19.9 serum concentration and the first diagnosed in a woman. In the present case, a minimally invasive laparoscopic approach enabled not only histologic diagnosis of benign multicystic mesothelioma but also its surgical treatment. Although benign multicystic mesothelioma is a rare pathologic entity, it is important that sonologists include it in the differential diagnosis of diseases that manifest with ascites. Furthermore, all surgeons should be aware of the macroscopic and laparoscopic appearance of the lesion, and its generally benign course.

Purpose: According to the literature, estradiol has a direct vasodilator action by means of endothelium-derived relaxing factor synthesis. The present study aims to evaluate the acute hemodynamic effects of intranasal 17-β-estradiol on cerebral and lower limb arterial circulation in postmenopausal women. METHODS: Sixteen healthy women in natural menopause (mean age: 54 ± 3 years) were investigated for at least 6 months, each receiving 300 µg of intranasal 17-β-estradiol. We evaluated the heart rate, systolic/diastolic blood pressure, peak systolic velocity, end-diastolic velocity, and velocity-time integral (VTI) at the level of internal carotid and posterior tibial arteries, before and after 30, 60, and 180 minutes of drug administration. RESULTS: After intranasal 17-β-estradiol administration, the internal carotid artery VTI showed statistically significant (P < .05) variations at all the time intervals after administration of the drug (30, 60, and 180 minutes) when compared with "time zero" (T0, ie, the speed recorded at baseline before drug administration). No significant variation was found at the posterior tibial artery. The systolic/diastolic blood pressure and heart rate did not significantly differ before and after drug administration. CONCLUSIONS: The administration of a single intranasal dose of 17-β-estradiol in healthy postmenopausal women increased cerebral perfusions, whereas the effect on peripheral circulation was much more limited.