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Advances in Gynecological Diseases

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: 10 July 2024 | Viewed by 16605

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Guest Editor
Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy
Interests: women's Health; mini-invasive surgery; new therapy; urogynecology; female healthcare
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Special Issue Information

Dear Colleagues, 

This Special Issue, entitled “Advances in Gynecological Diseases”, will focus on the latest diagnostic and therapeutic techniques that enable adequate treatment of gynecological pathologies. Technological innovations and new diagnostic techniques allow increasingly precise and faster diagnoses to be performed. Technological and pharmacological innovations, combined with the use of minimally invasive surgery (hysteroscopy, laparoscopy and robotic surgery), have also enabled increasingly precise and tailored therapy to be introduced.

Please note that clinical studies not sufficiently addressing the aim of the journal will not be considered.

You may choose our Joint Special Issue in JCM.

Dr. Guglielmo Stabile
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • gynecology
  • women's health
  • mini-invasive surgery
  • laparoscopy
  • hysteroscopy
  • diagnostic imaging
  • gynecological oncology
  • endometriosis
  • new therapy
  • urogynecology
  • female healthcare

Related Special Issue

Published Papers (7 papers)

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13 pages, 1334 KiB  
Article
Pap Smear Cancer Coverage in Brazilian Capitals including the Pandemic Period Caused by the SARS-CoV-2 Virus: Ecological Study
by Annielson de Souza Costa, Edmund Chada Baracat, José Maria Soares Júnior and Isabel Cristina Esposito Sorpreso
Int. J. Environ. Res. Public Health 2024, 21(3), 303; https://doi.org/10.3390/ijerph21030303 - 5 Mar 2024
Viewed by 1325
Abstract
Introduction: Cervical cancer develops slowly and may not manifest signs and symptoms at an early stage. It is worth mentioning the factors that can influence the onset of cervical cancer: smoking, early sexual life, multiple sexual partners, use of oral contraceptives, multiparity, low [...] Read more.
Introduction: Cervical cancer develops slowly and may not manifest signs and symptoms at an early stage. It is worth mentioning the factors that can influence the onset of cervical cancer: smoking, early sexual life, multiple sexual partners, use of oral contraceptives, multiparity, low socioeconomic status, among others. An important risk factor for the onset of this disease is HPV infection, a virus associated with most cases of precursor lesions of this type of cancer. It is essential to understand the comprehensiveness of the scope and adherence to the recommended guidelines throughout the national territory. Therefore, health indicators are important management tools that make it possible to evaluate the services offered, measuring the reach of the target population, the supply and access to preventive exams. Objective: To analyze the trend of progress in cervical cancer coverage actions in Brazilian capitals from 2016 to 2021. Method: This is an ecological study with temporal analysis that used secondary data referring to process indicators for cervical cancer control actions in women aged between 25 and 64 years living in Brazilian capitals between 2016 and 2021. Aspects related to the quality of care in the cervical cancer prevention program were evaluated using databases of the Cancer Information System (SISCAN), available in DATASUS. The indicators used to monitor and evaluate cervical cancer control actions were (i) cervical coverage, (ii) reason for cervical surgery, and (iii) proportion of cervical cancer every 3 years. Results: In 2016, 410,000 tests were performed and notified in the SISCAN system in all Brazilian capitals, with emphasis on Curitiba, with 65,715 tests performed, and Porto Velho, with 174. In 2020, there was a reduction in exams compared to the previous year in all capitals, with the exception of Palmas, which went from 7655 exams to 9604. It was observed that all the capitals studied showed an increase in the annual percentage variation of Pap smear coverage, with the exception of Brasília, Manaus, Porto Alegre and Porto Velho, which did not show a statistically significant increase (APC = 3.01, 2.746, 3.987, 3.69, respectively). When analyzing the performance of oncotic cytology exams in the capitals according to the years 2019 and 2020, it was observed that only Manaus registered an increase in the number of procedures performed, reaching a difference of 56.5% from one year to the next. Conclusion: The ecological analysis revealed a worrying drop in the number of tests performed in 2020, reflecting a sharp drop in coverage actions in Brazilian capitals during the pandemic caused by the SARS-CoV-2 virus. The pandemic has exacerbated existing inequalities and highlighted the need for adaptive strategies to maintain essential screening services in times of crisis. Full article
(This article belongs to the Special Issue Advances in Gynecological Diseases)
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12 pages, 1417 KiB  
Article
Could Vaspin Be a Potential Diagnostic Marker in Endometrial Cancer?
by Dominika Pietrzyk, Piotr Tkacz, Mateusz Kozłowski, Sebastian Kwiatkowski, Małgorzata Rychlicka, Ewa Pius-Sadowska, Bogusław Machaliński and Aneta Cymbaluk-Płoska
Int. J. Environ. Res. Public Health 2023, 20(6), 4999; https://doi.org/10.3390/ijerph20064999 - 12 Mar 2023
Viewed by 1333
Abstract
Obesity and being overweight are risk factors for many types of cancer, including endometrial cancer. Adipose tissue is thought to be an endocrine organ that produces various hormones, including one known as vaspin. Insulin resistance, metabolic syndrome and type 2 diabetes are all [...] Read more.
Obesity and being overweight are risk factors for many types of cancer, including endometrial cancer. Adipose tissue is thought to be an endocrine organ that produces various hormones, including one known as vaspin. Insulin resistance, metabolic syndrome and type 2 diabetes are all associated with higher vaspin levels. A total of 127 patients divided into study (endometrial cancer) and control groups (non-cancerous) participated in this research. Serum vaspin levels were measured for all patients. The analysis was performed while taking into account grading and staging. In order to assess the usefulness of the tested protein as a new diagnostic marker, we used the plotting of a curve (ROC) and the calculation of the AUC curve to characterize the sensitivity and specificity of the parameters tested. We concluded that there were significantly lower vaspin levels in patients with endometrial cancer compared to patients with benign endometrial lesions. Vaspin may be a useful diagnostic marker in separating benign lesions from endometrial cancer. Full article
(This article belongs to the Special Issue Advances in Gynecological Diseases)
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11 pages, 651 KiB  
Article
Beyond Sentinel Lymph Node: Outcomes of Indocyanine Green-Guided Pelvic Lymphadenectomy in Endometrial and Cervical Cancer
by Benito Chiofalo, Antonio Simone Laganà, Fabio Ghezzi, Camilla Certelli, Jvan Casarin, Valentina Bruno, Isabella Sperduti, Vito Chiantera, Panagiotis Peitsidis and Enrico Vizza
Int. J. Environ. Res. Public Health 2023, 20(4), 3476; https://doi.org/10.3390/ijerph20043476 - 16 Feb 2023
Cited by 2 | Viewed by 1878
Abstract
Background: The aim of our study was to compare the number of lymph nodes removed during indocyanine green (ICG)-guided laparoscopic/robotic pelvic lymphadenectomy with standard systematic lymphadenectomy in endometrial cancer (EC) and cervical cancer (CC). Methods: This is a multicenter retrospective comparative study (Clinical [...] Read more.
Background: The aim of our study was to compare the number of lymph nodes removed during indocyanine green (ICG)-guided laparoscopic/robotic pelvic lymphadenectomy with standard systematic lymphadenectomy in endometrial cancer (EC) and cervical cancer (CC). Methods: This is a multicenter retrospective comparative study (Clinical Trial ID: NCT04246580; updated on 31 January 2023). Women affected by EC and CC who underwent laparoscopic/robotic systematic pelvic lymphadenectomy, with (cases) or without (controls) the use of ICG tracer injection within the uterine cervix, were included in the study. Results: The two groups were homogeneous for age (p = 0.08), Body Mass Index, International Federation of Gynaecology and Obstetrics (FIGO) stages (p = 0.41 for EC; p = 0.17 for CC), median estimated blood loss (p = 0.76), median operative time (p = 0.59), and perioperative complications (p = 0.66). Nevertheless, the number of lymph nodes retrieved during surgery was significantly higher (p = 0.005) in the ICG group (n = 18) compared with controls (n = 16). Conclusions: The accurate and precise dissection achieved with the use of the ICG-guided procedure was associated with a higher number of lymph nodes removed in the case of systematic pelvic lymphadenectomy for EC and CC. Full article
(This article belongs to the Special Issue Advances in Gynecological Diseases)
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12 pages, 355 KiB  
Article
Risk Assessment Model for Complications in Minimally Invasive Hysterectomy: A Pilot Study
by Matteo Bruno, Francesco Legge, Cosimo Gentile, Vito Carone, Guglielmo Stabile, Federico Di Leo, Manuela Ludovisi, Christian Di Florio and Maurizio Guido
Int. J. Environ. Res. Public Health 2023, 20(1), 234; https://doi.org/10.3390/ijerph20010234 - 23 Dec 2022
Cited by 2 | Viewed by 1238
Abstract
Objective: To estimate the rate of intra-operative and postoperative complications, and to define the risk of 30-day major postoperative complications (Clavien-Dindo > 2) according to the presence of one of 10 different variables of minimally invasive (MI) hysterectomy; and then to create a [...] Read more.
Objective: To estimate the rate of intra-operative and postoperative complications, and to define the risk of 30-day major postoperative complications (Clavien-Dindo > 2) according to the presence of one of 10 different variables of minimally invasive (MI) hysterectomy; and then to create a risk assessment model easily applicable in clinical practice. Methods: A single center single arm retrolective study. Data of consecutive patients who have undergone MI hysterectomy for gynaecologic disorders between May 2018 and April 2021 were analyzed. Perioperative surgical outcomes, occurrence of intra- and postoperative complications, and readmissions within 30 days from surgery were registered. Univariate and multivariable analyses were performed to determine the factors associated with major postoperative complications. Results: Over the study period, 445 patients were included in the study. The majority of patients developed a minor event, while major complications (grade III) were required in 14 patients. None of the patients showed a grade IV or V complication. Univariate analysis was performed on patients who had developed intra- or postoperative complications from those who did not experience complications. Body mass index (BMI) (p-value 0.045) and surgeon’s experience (p-value 0.015) were found to be associated with a different surgery time. Regarding major postoperative complications, a statistically significant association was found for the variables: BMI (p-value 0.006), previous abdominal surgery (p-value 0.015), and surgeon’s experience (p-value 0.035) in the univariate analysis. Also in the multivariate analysis, the risk of major postoperative complications was higher in these three different variables. BMI, previous surgery, and surgeon’s experience were inserted in a reproducible risk assessment model in order to stratify the risk of major postoperative complications. Conclusions: We proposed a risk assessment model including factors not previously considered in the literature: the standardization of the surgical technique, the surgeon’s experience, the best MI approach (laparoscopy or robot-assisted), and previous abdominal surgery are crucial tools to consider. Further prospective studies with a larger population sample are needed to validate these preliminary evaluations for patients undergoing MI hysterectomy. Full article
(This article belongs to the Special Issue Advances in Gynecological Diseases)
11 pages, 6902 KiB  
Article
Clinical Features and Management of Umbilical Endometriosis: A 30 Years’ Monocentric Retrospective Study
by Dhouha Dridi, Laura Buggio, Agnese Donati, Francesca Giola, Caterina Lazzari, Massimiliano Brambilla, Francesca Chiaffarino and Giussy Barbara
Int. J. Environ. Res. Public Health 2022, 19(24), 16754; https://doi.org/10.3390/ijerph192416754 - 14 Dec 2022
Cited by 4 | Viewed by 6750
Abstract
Introduction: Umbilical endometriosis (UE) is defined as the presence of endometrial-like tissue within the umbilicus and represents around 0.5–1% of all cases of endometriosis. UE is classified into primary or secondary UE. In this retrospective study, we aimed to assess symptoms, signs, recurrence [...] Read more.
Introduction: Umbilical endometriosis (UE) is defined as the presence of endometrial-like tissue within the umbilicus and represents around 0.5–1% of all cases of endometriosis. UE is classified into primary or secondary UE. In this retrospective study, we aimed to assess symptoms, signs, recurrence rate of treated lesions, psychological wellbeing and health-related quality of life in women with UE. Material and methods: We retrospectively reviewed all cases of women diagnosed with UE in the period 1990–2021 in our center. Post-operative recurrence of UE was considered as the reappearance of the umbilical endometriotic lesion, or as the recurrence of local symptoms in the absence of a well-defined anatomical recurrence of the umbilical lesion. Moreover, participants were invited to fill in standardized questionnaires on their health conditions. Results: A total of 55 women with histologically proven UE were assessed in our center during the study period. At time of diagnosis, local catamenial pain and swelling were reported by 51% and 53.2% of women, respectively. A total of 46.8% of women reported catamenial umbilical bleeding. Concomitant non-umbilical endometriosis was identified in 66% of cases. As regards the treatment of UE, 83.6% of women underwent an en-bloc excision with histological confirmation of UE. During the follow-up period, 37 women (67.3%) agreed to undergo a re-evaluation. Recurrence of either umbilical symptoms, or umbilical nodule, was observed in 27% of patients, 11% of which did not receive post-operative hormonal therapy. Specifically, a recurrence of the umbilical endometriotic lesion was observed only in two women. Among the 37 women which we were able to contact for follow-up, 83.8% were satisfied with the treatment they had received. Conclusions: The high rate of patient satisfaction confirmed that surgical excision should be considered the gold standard treatment for umbilical endometriosis. Future studies should investigate the role of post-operative hormonal therapy, particularly in reducing the risk of symptom recurrence. Full article
(This article belongs to the Special Issue Advances in Gynecological Diseases)
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7 pages, 1873 KiB  
Case Report
Hysteroscopic Resection Followed by Adjuvant Radiotherapy: Report of a New Therapeutic Approach to Primary Cervical Diffuse Large B-Cell Lymphoma
by Guglielmo Stabile, Lara Sancin, Pierino Boschian Bailo, Chiara Ripepi, Andrea Romano, Stefania Carlucci and Giuseppe Ricci
Int. J. Environ. Res. Public Health 2022, 19(18), 11779; https://doi.org/10.3390/ijerph191811779 - 18 Sep 2022
Cited by 3 | Viewed by 1455
Abstract
The female genital tract can be involved as a secondary manifestation of disseminated lymphomas or leukemia but can rarely be the primary site of so-called extranodal lymphomas. Primary lymphomas of the female genital tract can affect the uterine corpus, uterine cervix, vulva, vagina [...] Read more.
The female genital tract can be involved as a secondary manifestation of disseminated lymphomas or leukemia but can rarely be the primary site of so-called extranodal lymphomas. Primary lymphomas of the female genital tract can affect the uterine corpus, uterine cervix, vulva, vagina or adnexa. Only about 0.008% of all cervical tumors are primary malignant lymphomas. The presenting symptoms are unspecific and also refer to much more common diseases of the female genital tract. Cervical cytology is usually negative. Preoperative diagnosis requires deep cervical biopsy. To date there is no consensus regarding optimal treatment. Radiotherapy, chemotherapy and surgery are used in different association. We report the first case reported in literature managed with an urgent hysteroscopic resection of a primary cervical diffuse large B-cell lymphoma, followed by adjuvant radiotherapy. Relevant literature was reviewed. Our conservative approach needs to be validated in the future, especially for women with pregnancy desire and for those with low performance status. To date, after 24 months from diagnosis, our patient is still disease-free. Full article
(This article belongs to the Special Issue Advances in Gynecological Diseases)
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9 pages, 2964 KiB  
Case Report
Interstitial Pregnancy Treated with Mifepristone and Methotrexate with High Serum β-hCG Level in a Patient Wishing to Preserve Fertility: Time to Define Standardized Criteria for Medical/Surgical Therapy?
by Felice Sorrentino, Lorenzo Vasciaveo, Vincenzo De Feo, Erika Zanzarelli, Elvira Grandone, Guglielmo Stabile and Luigi Nappi
Int. J. Environ. Res. Public Health 2022, 19(18), 11464; https://doi.org/10.3390/ijerph191811464 - 12 Sep 2022
Cited by 5 | Viewed by 1821
Abstract
Interstitial pregnancy (IP) accounts for 2% of all ectopic pregnancies and has a mortality rate of 2–2.5%. The diagnosis is made by a transvaginal ultrasound and the treatment can be medical or surgical. We report the case of a 36-year-old primigravida who was [...] Read more.
Interstitial pregnancy (IP) accounts for 2% of all ectopic pregnancies and has a mortality rate of 2–2.5%. The diagnosis is made by a transvaginal ultrasound and the treatment can be medical or surgical. We report the case of a 36-year-old primigravida who was 6 + 5 weeks pregnant, diagnosed with interstitial pregnancy by ultrasound, who had a very high serum β-hCG level (31,298 mIU/mL) and wanted to preserve her fertility. The patient was treated with one dose of mifepristone and a double dose of methotrexate since the decrease in the β-hCG serum level was less than 15% after the first dose. At the beginning, medical therapy was effective, as no embryonal cardiac activity was detected and serum β-hCG levels decreased early, but on the 20th day of hospitalization, the patient underwent surgery for her clinical symptoms and the evidence of free fluid in the Douglas pouch at a transvaginal ultrasound exam. Our experience showed that medical treatment should be considered, especially in women wishing to preserve their fertility. Further studies are needed to establish a standardized protocol and maybe a clinical score that can be useful in predicting the patients in which medical therapy could be most successful. Full article
(This article belongs to the Special Issue Advances in Gynecological Diseases)
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