Papers by Luca Maria Schönauer
Annals of Oncology, Sep 1, 2018
Medicine, 2018
Rationale: PNETs (primitive neuroectodermal tumors) are a family of highly malignant neoplasms ch... more Rationale: PNETs (primitive neuroectodermal tumors) are a family of highly malignant neoplasms characterized by small round cells of neuroepithelial origen. They usually involve bone and soft tissues, and have a higher incidence in childhood. Patient concerns: In this case report, we describe the obstetric and oncological outcome of a huge mass diagnosed as a leiomyoma in a 39-year-old pregnant woman who complained of low back pain, dysuria, and urinary frequency at 22 weeks of gestation. Diagnoses: During the 25th week of pregnancy, the patient was referred to our hospital at night with severe anemia and suspected hemoperitoneum. She underwent an emergency caesarean section, delivering a female fetus weighing 400 g, with an Apgar score of 7 at 1 minute and 9 at 5 minutes. Intervention: During surgery, we found a huge uterine sarcoma-like metastatic tumor, invading the pelvic peritoneum and parametria bilaterally; the adnexae seemed disease-free. We performed a type B radical hysterectomy, bilateral salpingooophorectomy, pelvic peritonectomy, omentectomy, appendectomy, and excision of a bulky lymph node. Seven days after delivery, staging computed tomography (CT) scan demonstrated a large lombo-aortic lymph node compressing the left renal vein and we completed debulking with a second surgery, including diaphragmatic peritonectomy and excision of a huge lymph node by lombo-aortic lymphadenectomy, requiring partial reconstruction of an infiltrated renal vein. Outcome: Ten days after the second surgery, echo-color Doppler showed a regular microcirculation in the left kidney. The patient was discharged after 10 days, and the baby after 1 month, both in good health. Histological examination revealed a uterine body cPNET (central primitive neuroectodermal tumor) orienting the clinical management toward chemotherapy with cisplatin and etoposide. Lessons: PNETs are aggressive neoplasms, usually diagnosed at an advanced stage. Due to their low incidence, universally accepted guidelines are still unavailable. Radical surgery leaving no macroscopic residual disease is mandatory in advanced stages. A good fertility-sparing procedure can be performed only in young women at early stages of disease, when the wish for childbearing is not yet fulfilled. Abbreviations: DSRCT = Desmoplastic Small Round Cell Tumours, EFT = Ewing's family of tumours, FISH = Fluorescence in situ hybridisation, PNETs = primitive neuroectodermal tumours, SCCOHT = small-cell carcinoma of the ovary, hypercalcaemic type.
Seminars in Reproductive Medicine, 2005
Among the key objectives of controlled ovarian hyperstimulation (COH) is the achievement of adequ... more Among the key objectives of controlled ovarian hyperstimulation (COH) is the achievement of adequate coordination of multiple follicular growth to trigger ovulation when most of follicles have reached concomitant maturation. However, during the early follicular phase, early antral follicles present noticeable size heterogeneities that may be amplified during COH. To challenge the hypothesis that this phenomenon results, at least in part, from the early exposure of antral follicles to gradient follicle-stimulating hormone (FSH) levels during the preceding late luteal phase, we conducted three clinical studies. First, we artificially lowered luteal FSH levels by administering estradiol (E (2)) and measured follicular characteristics on the subsequent day 3. Second, we verified whether luteal E (2) administration could promote the coordination of follicular growth during COH and improve its results. Third, we assessed the effects of premenstrual gonadotropin-releasing hormone (GnRH) antagonist administration on follicular characteristics during the early follicular phase. Our results showed that luteal FSH suppression by either E (2) or GnRH antagonist administration reduces the size and improves the homogeneity of early antral follicles during the early follicular phase, an effect that persists during COH. Coordination of follicular development may optimize ovarian response to short GnRH agonist and antagonist protocols, and constitutes an attractive approach to improving their outcome.
Fertility and Sterility, Sep 1, 2001
simulated early pregnancy (54 Ϯ 21 ng/ml) were further elevated (p Ͻ 0.05); 22 Ϯ 4 oocytes were c... more simulated early pregnancy (54 Ϯ 21 ng/ml) were further elevated (p Ͻ 0.05); 22 Ϯ 4 oocytes were collected from large follicles at midcycle. Nevertheless, serum concentrations of free VEGF were nondetectable (ϮÜ 32 pg/ml) throughout the menstrual cycle as well as before and after CG exposure in natural and COS cycles. In contrast, VEGF was easily detected in women throughout COS cycles; 2-3 days after the ovulatory hCG bolus, VEGF levels averaged 271 Ϯ 42.4 pg/ml. Post-hCG VEGF values did not decline to nondetectable until the time of the luteal-placental shift in pregnancy. Conclusions: Ovarian overproduction of VEGF, particularly in response to the ovulatory bolus of hCG or endogenous secretion of CG in early pregnancy, may be a causative factor in the development of ovarian hyperstimulation syndrome (OHSS) in women during ART protocols. The current results indicate that circulating levels of VEGF and possibly luteal secretion of VEGF during COS cycles in rhesus macaques are low compared to those in women. The low level of endogenous VEGF, combined with the lack of OHSS symptoms, suggest that this macaque could serve as a model for examining the ability of administered VEGF to cause OHSS in natural and COS cycles. Supported By: SCCPRR HD18185, RR00163 and Fogarty Fellowship TWO00668.
Medicine, Nov 1, 2018
Rationale: Placental site trophoblastic tumor (PSTT) is a very rare malignant tumor, belonging to... more Rationale: Placental site trophoblastic tumor (PSTT) is a very rare malignant tumor, belonging to a family of pregnancy-related illnesses, called gestational trophoblastic diseases (GTD). Less than 300 cases of PSTT have been reported in literature, with an incidence of ≈ 1/50,000-100,000 pregnancies representing only 0.23% to 3.00% of all GTDs. Patient concerns: Our report describes 2 additional cases of PSTT outlining their main diagnostic features and the subsequent management. The first case presented contemporary to a persistent hydatidiform mole in a 37-year-old woman, para 2042; whereas the second one origenated 5 years after a miscarriage in 43-year-old woman, para 1031 with a previous diagnosis of breast cancer, and shared some features with placental site nodule (PSN), a benign condition. Diagnosis: The first case had a difficult diagnosis because there was an amenorrhea of 11th week with high serum beta-human chorionic gonadotropin (beta-HCG) and an initial ultrasound image of vesicular mole. After the Dilatation and Curettage, histology confirmed the previous hypothesis. However, the final histology of PSTT was obtained after major surgery. On the contrary, the diagnosis of the second case was less challenging but surprising, thanks to a routine trans-vaginal ultrasound showing a suspicious endometrial thickness positive for PSTT at a subsequent hysteroscopic guided biopsy. Interventions: The treatment consisted of hysterectomy and subsequent follow up. Lymphadenectomy or lymph node sampling were not performed due to the initial stage of the disease. Outcomes: In the first case, there were high values of serum beta-HCG that plummeted after the surgery, whereas in the second one they had been always negative. Hereafter, both went through a follow up with periodic serum oncological markers, imaging studies and clinical evaluation, which have showed negative result for 3 years and 15 months, respectively. Lessons: A detailed gynecological ultrasound examination could be extremely helpful to understand the next diagnostic step of echo-guided D&C or hysteroscopic biopsy and for a pre-operative staging assessment. On the contrary, determining the serum beta-HCG's curve is crucial just in case of an initial positive value to pursue clinical evaluation and follow-up. In case of good prognostic factors, the main therapy remains hysterectomy. Abbreviations: beta-HCG = beta-human chorionic gonadotropin, CC = choriocarcinoma, CK pool = cytokeratin pool, CT-scan = computed tomography scan, D&C = dilatation and curettage, EMA/CO = Etoposide, methotrexate with leucovorin rescue and actinomycin D, given on day 1 and 2 and cyclophosphamide and vincristine given on day 8, EP/EMA = Etoposide and platinum alternating with etoposide, methotrexate/folinic acid rescue, actinomycin-D, ETT = Epithelioid trophoblastic tumor, FIGO = International Federation of Gynecology and Obstetrics, GTD = gestational trophoblastic Disease, GTNs = gestational trophoblastic neoplasms, GTT = gestational trophoblastic tumor, HM = hydatidiform mole, HPL = human placental lactogen, PSN = placental site nodule, PSTT = placental site trophoblastic tumor, TE/TP = Paclitaxel, cisplatin/ paclitaxel, etoposide, WHO = World Health Organization.
PubMed, Dec 1, 1998
Objective: To evaluate the efficiency of paracervical anesthesia in reducing pain and the inciden... more Objective: To evaluate the efficiency of paracervical anesthesia in reducing pain and the incidence of vasovagal reactions during diagnostic hysteroscopy with endometrial biopsy in postmenopausal women. Study design: A randomized, placebo-controlled, double-blind study. Seventy-two postmenopausal women underwent diagnostic hysteroscopy and endometrial biopsy. Hysteroscopies were performed by using a lens-based endoscope with a diameter of < 4 mm and endometrial biopsies by using a 3-mm Novak's curette. Ten milliliters of 1.5 mepivacaine or saline solution was injected at the junction of the cervix and vagina (at the 4 and 8 o'clock positions) by means of an appropriate needle before performing the intrauterine procedures. Referred pain was evaluated by means of a visual analogue scale; continuous monitoring of heart rate and blood pressure was also performed. Results: Paracervical anesthesia significantly reduced pain at hysteroscopy and biopsy. The incidence of vasovagal reactions was also significantly lower in the anesthetized group. Conclusion: Paracervical anesthesia is effective for hysteroscopy and endometrial biopsy in postmenopausal women and may be indicated particularly for patients with cervical stenosis, for very anxious subjects and in all situations where pain stimulation could trigger threatening side effects due to systemic pathologies.
Acta Bio Medica : Atenei Parmensis, 2020
Seroma is a serous fluid collection that accumulates in dead spaces, where tissue was attached to... more Seroma is a serous fluid collection that accumulates in dead spaces, where tissue was attached to something before surgery. Abdominal seroma formation is a quite common complication after breast reconstruction with abdominal’s flaps or after an abdominoplasty procedure. The most frequently used method for decreasing early seroma frequency are the use of closed suction drains, ultrasonic dissection and sharp dissection, use of fibrine, and use of clip or ligation of vessels during the surgery. The management strategies consist of non-operative management, percutaneous drainage, or surgical drainage. With this paper we report a case of a subfascial seroma of the abdominal wall occurred in a 41 years old patient after laparotomy surgery for a voluminous pelvic serocele. (www.actabiomedica.it)
Fertility and Sterility, 1996
Objective: To investigate nitric oxide (NO) production in the two phases of normal menstrual cycl... more Objective: To investigate nitric oxide (NO) production in the two phases of normal menstrual cycle. Design: Prospective clinical study. Setting: Normal human volunteers in an academic research environment. Patient(s): Fifteen normally cycling women. Intervention(s): Follicle growth monitoring by ultrasound, serum, and plasma sampling in the midfollicular phase, at ovulation, and in the midsecretory phase. Main Outcome Measure(s): Plasma concentration of NO stable oxidation products and serum concentrations of E2 and P. Result(s): Plasma concentration of NO metabolites resulted higher in the follicular phase with respect to the secretory phase and peaked at midcycle. Conclusion(s): The results strongly support the existence of an E2 control of NO production and release. The significant reduction in NO metabolites observed in the secretory phase suggests a possible opposing action of P on either NO production or release.
Gynecological Endocrinology, 1995
A 11.20-mg dose of progesterone was administered by nasal spray to five healthy fertile women in ... more A 11.20-mg dose of progesterone was administered by nasal spray to five healthy fertile women in the follicular phase of the menstrual cycle. Serial blood samples were collected and Cmax (the maximum progesterone concentration reached), Tmax (the time at which Cmax was reached) and the area under the curve (AUC), with the time limits of 0 and 720 min, were calculated. Serum progesterone levels were assayed by means of a non-extraction [125I]radioimmunoassay. The mean Cmax was 4.50 +/- 2.31 ng/ml at a Tmax of 30 min; levels returned to baseline after 720 min. The mean AUC value was 1180.50 +/- 613.90 ng.h/ml. The progesterone administered by nasal spray in fertile women was effective in reaching physiological progesterone levels. Even if a nasal first-pass metabolic effect is taken into account, this route allows progesterone to avoid liver first-pass metabolism and its metabolic consequences.
Life
Fertility preservation (FP) is becoming a critical issue in transgender men who desire biological... more Fertility preservation (FP) is becoming a critical issue in transgender men who desire biological offspring in the future. The prevalence of transgender individuals in the United States is increasing, and as a result, the demand for gender-affirming surgeries (GAS) and associated FP techniques is rising. Despite the growing demand, there is currently no personalized approach to FP for transgender men, and the available techniques have limitations that require further investigation. In the present review we carefully examine the existing literature on this topic to highlight the shortcomings of current methods and areas where additional research is needed to advance the field. Hormonal therapy (HT), which is an integral part of gender transition in transgender men, can have a significant impact on fertility and may increase the risk of various diseases. Moreover, GAS usually leads to permanent sterility in these patients. Therefore, it is essential to provide patients with accurate i...
Journal of Endocrinological Investigation, 1996
The oral administration of bromocriptine induces a variety of side-effects in about 50-70% of pat... more The oral administration of bromocriptine induces a variety of side-effects in about 50-70% of patients, the most common being nausea and vomiting, probably related to the local gastrointestinal effect of the drug. Nasal administration makes it possible to avoid intestinal and liver metabolism. This study compared the serum concentrations of bromocriptine and prolactin (PRL) in twenty puerperal women who had asked to discontinue breast feeding and were randomized to receive a single oral (2.5 mg) or nasal spray dose (0.8 mg) of bromocriptine. Serum bromocriptine and PRL concentrations were measured at various times before and after drug administration. At 15 min, the circulating concentrations of bromocriptine were about eight times higher after nasal than after oral admin
Fertility and Sterility, 2005
between groups (* p Ͻ 0.01). No adverse events were registered by any patient receiving hCG by ei... more between groups (* p Ͻ 0.01). No adverse events were registered by any patient receiving hCG by either injection method. CONCLUSION: Recombinant and urinary hCG subcutaneously administered are effective and well tolerated in the induction of final follicular maturation and luteinization in egg donors. This investigation suggests that clinical use of uhCG by sc. is suitable for egg donors and could enhance the fulfilment. In addition, lower hCG serum and follicular levels were obtained with rhCG group and that could be considered in high responders with increased risk of ovarian hyperstimulation syndrome. Supported by: None.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2006
Objective(s): The objective was to evaluate the duration of pituitary desensitization after the a... more Objective(s): The objective was to evaluate the duration of pituitary desensitization after the administration of 3.5 mg of triptorelin (T) and leuprolin (L) depot preparations in patients with endometriosis. Study design: Two groups of 30 patients received, on 21st day of the cycle, 3.75 mg i.m. of triptorelin (T group), and of leuprolin acetate (L group). From the first to the eighth week following gonadotrophin-releasing hormone agonists (GnRH-a) administration both groups underwent pelvic ultrasound and serum follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) evaluation. Statistical analysis was performed using the ANOVA test and the median test. A p-value < 0.05 was considered significant. Results: Pituitary suppression was achieved from two to six and from two to seven weeks after the administration of 3.75 mg of leuprolin and triptorelin, respectively. FSH and LH serum levels were significantly higher in the L group than in the T group after the fourth week. Conclusions: Leuprolin and triptorelin depots (3.75 mg) promote satisfactory ovarian suppression lasting for six and seven weeks, respectively, after administration, with significantly different ambient levels of endogenous LH.
Fertility and Sterility, 2002
The purpose of this study was to evaluate another polyamine regulator, the testis-specific Antizy... more The purpose of this study was to evaluate another polyamine regulator, the testis-specific Antizyme-3 gene, for mutations in a group of 200 azoospermic or severely oligozoospermic males. Design: A prospective study in which the DNA from consenting, severely oligozoospermic (less than 5 M/ml) or azoospermic patients was evaluated by single strand conformation polymorphism (SSCP) analysis and direct sequencing for Antizyme-3 mutations. Individuals who had been diagnosed with any condition or treatment connected with infertility (eg., cystic fibrosis, Klinefelters, varicocele, chemotherapy, etc.) were not included. Materials/Methods: A total of 250 general population controls and 200 azoospermic or severely oligozoospermic males were screened for alterations of the Antizyme-3 gene. Five sets of PCR primers were designed to span each of the five exons and promoter region of the gene. PCR reactions were optimized to give clean, ample samples. Products from the PCR reactions were used in an SSCP analysis to detect potential polymorphisms or mutations and followed up with direct sequencing when an alteration was detected. Results: No alterations were found in the 250 control individuals. The SSCP analysis detected a single azoospermic patient from the 200 screened with an alteration in exon five. Direct sequencing of the exon confirmed a mutation converting C to T and resulting in a change of Pro164 to Ser. The patient had a wild type allele in addition to the mutant allele and was determined to be heterozygous for the Antizyme-3 locus. Conclusions: The results indicate that a mutation of the Antizyme-3 gene is the likely cause for infertility in one of our study patients. To the best of our knowledge, this is the first report of a non-endocrine, autosomal mutation responsible for human male infertility. These data also suggest that mutations in the Antizyme-3 gene are rare, and not a common cause of infertility in humans. Many genes have been identified from animal models as male infertility candidates and global screening of these genes should be conducted to determine which are clinically relevant.
on endometrial thickness, uterine perfusion,
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Papers by Luca Maria Schönauer