2002 - A BENEFIT-RISK ASSESSMENT OF MEDICAL TREATMENT FOR UTERINE LEIOMYOMAS - Prof. Antonio La Marca
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Prof. La Marca receives by appointment at the Policlinico di Modena.

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Prof. Antonio La Marca

2002 - A BENEFIT-RISK ASSESSMENT OF MEDICAL TREATMENT FOR UTERINE LEIOMYOMAS

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De Leo V1, Morgante G, La Marca A, Musacchio MC, Sorace M, Cavicchioli C, Petraglia F. Abstract The growth of uterine leiomyoma growth stops and regresses after the menopause suggesting that leiomyoma growth is dependent on ovarian steroids. Therefore, estrogen has received much attention as the major factor responsible for the development of uterine leiomyomas, but progesterone also plays an important role in development of this disease. Cytogenetic analyses of resected samples has revealed that about 40 to 50% of leiomyomas show karyotypically detectable chromosomal abnormalities. Gonadotrophin releasing hormone (GnRH) agonists exert their action through the suppression of endogenous gonadotrophins and gonadal steroid secretion. Significant reductions of uterine/leiomyoma volume under GnRH agonist therapy has been reported in several studies. However, the leiomyoma generally returns to its pretreatment volume within a few months after discontinuation of the GnRH agonist. To minimise the adverse effects of hypoestrogenism during GnRH agonist treatment, add back therapy can be used (estrogen-progestin, progestin alone and recently tibolone). Antiprogestins have a potential clinical utility in uterine leiomyomas. Mifepristone is a synthetic steroid with both antiprogesterone and antiglucocorticoid activities, that may have an inhibitory effect on growth of leiomyoma. Danazol is an isoxazole of 17beta-ethinyl testosterone, a synthetic steroid, which has a suppressive effect on sex hormone binding globulin concentrations, resulting in efficacy in the short-term treatment of uterine leiomyomas. Gestrinone is a tri-enic steroid with antiestrogen and antiprogesterone properties and has been shown to reduce uterine volume and stop bleeding. Growth factors play a relevant role on the pathophysiology of uterine leiomyoma and probably the inhibition of the action of growth factors on the myometrium will be the basis for future therapy. A number of agents are under investigation for treating uterine leiomyoma. Agents developed from increasing genetic knowledge of this condition could represent, in the next few years, new trends in the medical treatment of uterine leiomyomas.

Performances

Myolysis or thermoablation of uterine fibroids

Myolysis or Thermoablation is a technique currently only performed in a few centres. Prof La Marca personally handles the method and receives patients from all over the country to perform this innovative therapy.

Radiofrequency and microwaves for gynaecological pathology

Radiofrequency and microwaves have been introduced into our clinical practice with excellent results. Prof La Marca is considered among the pioneers for the use of this procedure in gynaecology and receives patients from all over the country for the ultra minimally invasive treatment of uterine fibroids and adenomyosis.

In vitro fertilisation

In vitro fertilisation is a therapeutic strategy that is far from standardised. Like all medical and surgical practices, it is greatly affected by the technical skills and cultural updating of the practitioners involved. The results are therefore by far operator-dependent. This aspect is very little known, both by clinicians and patients.

Gynaecological endocrinology

The ovarian and menstrual function of women is extremely delicate and responds to a complex interaction between the centres (hypothalamus-pituitary) and the periphery (ovary-uterus).

Transfer to the blastocyst stage

In in vitro fertilisation, fertilised oocytes (zygotes) are kept in the laboratory, in incubators, under controlled temperature conditions (37°C) and an atmosphere with 5% oxygen and 6% carbon dioxide.

Infertility

It is well known that a considerable percentage of couples experience difficulties in conceiving. It is estimated that 10-15% of the population can be classified as infertile.

Recurrent abortion

Miscarriage is defined as a termination of pregnancy that occurs spontaneously within 24 weeks of gestation.

Diagnostic and operative hysteroscopy

Diagnostic Hysteroscopy is an endoscopic technique that can be performed in an outpatient setting using a hysteroscope.

Heterologous fertilisation

For certain clinical conditions, couples desiring offspring must resort to gametes (oocytes and/or spermatozoa) from voluntary and disinterested donors in order to fulfil their reproductive desire.

Fertility preservation

Over the past three decades, a phenomenon has taken hold in the Western world that is likely to have major implications for birth rates: the scheduling of births at a significantly older age than in the past.

Gynaecology and obstetrics

Gynaecology and Obstetrics is the medical discipline par excellence in the care of women. The aim of this clinical speciality has always been to care for the patient in all phases of her life.

Diagnosis and treatment of adenomyosis

At our clinic, the diagnosis and therapy of adenomyosis is performed to the most up-to-date standards. Prof La Marca is among the clinicians with the most experience in treating adenomyosis with thermoablation, an innovative therapeutic strategy for this disease.

Diagnostic examinations

Diagnostic examinations in gynaecology and obstetrics are nowadays very accurate and their correct execution and interpretation are the basis for the right clinical picture of the patient and the most appropriate therapeutic strategy.

Fibroids therapy

Uterine leiomyomas, more commonly called fibroids, are benign solid neoformations and represent the most frequent gynaecological neoplasm in women of childbearing age.

Uterine anomalies

An arrest of the organogenic stages can cause uterine and vaginal abnormalities of varying degrees.

Endometriosis

Endometriosis is a chronic, oestrogen-dependent inflammatory disease characterised by the presence of functional endometrial tissue (glands and stroma) in extrauterine sites.

Menstrual cycle disorders

It represents the most obvious and measurable clinical sign of pubertal maturation and in most women it occurs about two to three years after the onset of telarche with an average age of around 12½ years.

Intrauterine insemination

A Level I medically assisted procreation procedure based on the deposition of spermatozoa directly inside the uterine cavity. This procedure is carried out after ovulation induction.

Outpatient ultrasound aspiration of ovarian cysts

At our clinic, Prof La Marca personally handles the method. Ultrasound-guided aspiration of ovarian cysts is an ultra-mini-invasive method that is only available in very few centres nationwide. If there are the right indications, the method allows a rapid and non-invasive solution for the pathology in question

Tubal recanalisation

At our clinic, Prof La Marca personally handles the method. Endoscopic tubal recanalisation, where indicated, is today performed in only a few centres throughout Europe. The expertise is therefore concentrated in a limited number of experts capable of performing it correctly.

Assisted laser hatching

Laser-assisted hatching (LAH) is a laboratory technique that consists of cutting a small section of the zona pellucida (ZP).

IMSI, intracytoplasmic sperm injection

This is a level II technique used in the field of in vitro fertilisation. It takes the form of a variant of traditional ICSI, both of which consist of the direct injection of a spermatozoon into the cytoplasm of the oocyte.