Emanuela Mela Tafi

OBJECTIVE To assess the impact of endometriosis of the posterior cul-de-sac on quality of sleep, average daytime sleepiness and insomnia. STUDY DESIGN This age-matched case-control study was conducted in a tertiary referral centre for the diagnosis and treatment of endometriosis between May 2012 and December 2013. It included 145 women with endometriosis of the posterior cul-de-sac (cases; group E) and 145 patients referred to our Institution because of routine gynaecologic consultations (controls; group C). This study investigated whether sleep is impaired in patients with endometriosis of the posterior cul-de-sac. Sleep quality, daytime sleepiness and insomnia were assessed using the following self-administered questionnaires: the Pittsburgh Sleep Quality Index, the Epworth sleepiness scale and the Insomnia Severity Index, respectively. The primary objective of the study was to evaluate sleep quality in the two study groups. Secondary outcomes of the study were to assess average d...

The potential impact of antimuscarinics (AMs) on cardiac function is a major concern in the treatment of overactive bladder (OAB) patients, especially in older ones who are likely to present cardiovascular (CV) comorbidities and other risk factors that may predispose them to the adverse cardiac effects of this therapy. This article aims to review the literature on the impact on the CV system of AMs used in the treatment of OAB, giving a comprehensive explanation of the pathogenetic mechanisms of AMs' effects on CV system and the impact of each AM drug on cardiac function. Although the CV safety of AM drugs seems to be good, evidence provided in this manuscript does not allow to exclude an increase in HR, QT prolongation or an increase in the CV risk due to drug-drug interactions in OAB patients who are usually elderly and have comorbidities. Clinical and electrocardiographic monitoring may be necessary throughout the administration period in selected populations such as patients...

To investigate spontaneous pregnancy rate (SPRs) of women with rectovaginal endometriosis (RV) with/without ovarian endometrioma (OMA) and treated with the use of expectant or surgical management. Retrospective study. University hospital. The study included patients with RV with or without OMA who tried to conceive spontaneously for 1 year either without undergoing surgery (group E; n = 284) or after surgery (group S; n = 221). The study population was further divided into four subgroups: women with RV without OMA who directly tried to conceive (group eRV; n = 121) or tried to conceive after surgery (group sRV; n = 96), and women with RV with OMA who directly tried to conceive (group eOMA; n = 163) or tried to conceive after surgery (group sOMA; n = 125). Expectant or surgical management. Crude and cumulative SPRs. At 1 year, crude and cumulative SPRs were lower in group E (17.3% and 23.8%, respectively) than in group S (35.7% and 39.5%). Similarly, crude and cumulative SPRs were lower in group eRV (24.8% and 30.6%) than in group sRV (42.7% and 45.7%, respectively) and in group eOMA (11.7% and 18.0%) than group sOMA (30.4% and 34.5%). At 1 year, crude and cumulative SPRs were higher in group eRV (24.8% and 30.6%) than in group eOMA (11.7% and 18.0%), and in group sRV (42.7% and 45.7%) than in group sOMA (30.4% and 34.5%). Crude and cumulative SPRs are lower in women treated with the use of expectant rather than surgical management. The presence of OMAs decreases SPRs independently from the treatment modality adopted.

Ulipristal acetate (UPA) is a selective progesterone-receptor modulator (SPRM). SPRMs are a new class of progesterone-receptor ligands that exert tissue selective agonist, antagonist or mixed agonist-antagonist activity in target cells. UPA inhibits the proliferation, induces apoptosis of leiomyoma cells in vitro and demonstrates potent progesterone antagonist activity in vitro and in vivo. Areas covered: This manuscript aims to review the available data on safety of UPA in the treatment of uterine fibroids. Data and articles included in this manuscript were obtained via PubMed, Medline and Embase up to November 2014. Expert opinion: UPA is efficacious in the treatment of uterine fibroids before surgery; it decreases leiomyoma volume and uterine bleeding; furthermore, it improves quality of life. Short-term administration of UPA has been shown to be safe at short follow-up (months) and it is associated with minimal adverse side effects; further studies with longer follow-up are requ...

To compare the efficacy of two hormonal therapies in treating symptoms caused by bowel endometriosis. Patient preference study. University hospital. A total of 143 women with rectovaginal endometriosis infiltrating the rectum. This study was performed between January 2008 and June 2011. Patients were treated with a desogestrel-only contraceptive pill or with the sequential combined contraceptive vaginal ring for 12 months. The primary endpoint of the study was the rate of satisfied patients at 12-month follow up. The changes in symptoms and in the volume of the nodules were secondary endpoints. At 12-month follow up, the rate of satisfied patients was higher in the group treated with the desogestrel-only contraceptive pill than in the group treated with the sequential combined contraceptive vaginal ring (p = 0.004). When only changes in gastrointestinal symptoms were considered, 50% of patients treated with the desogestrel-only contraceptive pill and 31.3% of those treated with the ...

To evaluate the efficacy of preoperative treatment with ulipristal acetate (UPA) in patients undergoing high complexity hysteroscopic myomectomy. Retrospective analysis of a prospectively collected database. classification: Level: II-2. University Teaching Hospital. Patients of reproductive age requiring hysteroscopic myomectomy with STEPW score = 5 or 6. Patients included in the study either underwent direct surgery (group S) or received a 3-month preoperative treatment with UPA (group UPA). Based on a power calculation, 25 patients were required in each study group. ments & Main Results: The characteristics of myomas were similar in the two study groups. The 3-month UPA treatment caused a 21.9% (± 10.3%) mean (± SD) percentage decrease in myoma volume. The number of complete resections (primary outcome of the study) was higher in group UPA (92.0%) than in group S (68.0%; p = 0.034). The operative time was lower in group UPA than in group S (p = 0.048), while there was no significant difference in fluid balance between the two study groups (p = 0.256). The incidence of complications was similar in the two groups (p = 0.609). Patient satisfaction at 3 months from surgery was higher in group UPA than in group S (p = 0.041). A 3-month preoperative treatment with UPA increases the possibility of complete resection in high complexity hysteroscopic myomectomy; it decreases the operative time and improves patient satisfaction at three months from surgery.