Botox® for idiopathic overactive bladder: efficacy, duration and safety. Effectiveness of subsequent injection

Purpose To test the efficacy, duration and safety of 100 U of botulinum toxin type A (BoNT/A) in women affected by idiopathic detrusor overactivity (IDO) and the effectiveness of subsequent injections. Methods In this double centre, prospective study con- ducted from March 2008 to March 2010, we selected women affected by IDO who failed to respond to various antimuscarinic agents, reported intolerable anticholinergic side-effects or contraindication to their use, also without any response to tibial stimulation. Medical history, physi- cal examination, standard urodynamic examination, uri- nalysis, urine culture, a 4-day voiding diary and a quality of life questionnaire were requested for al…

Parasitic myomas after laparoscopic surgery: an emerging complication in the use of morcellator? Description of four cases

Objective To report the development of parasitic myomas after the use of a morcellator. Design Retrospective study. Setting Tertiary care referral center for the treatment of benign gynecologic pathologies. Patient(s) Women undergoing surgery for uterine fibroids. Intervention(s) Chart review. Main Outcome Measure(s) Presence of parasitic leiomyomas. Result(s) We identified four cases of parasitic myomas over the 3-year study period. Two out of the four were symptomatic. The prevalence of this complication, considering all women with whom the electric morcellator was used (n = 423) was 0.9% (95% CI, 0.3–2.2%). Considering exclusively the women who underwent myomectomy (n = 321), it was 1.2%…

Role of oxidative stress in neonatal respiratory distress syndrome

Respiratory distress syndrome is the commonest respiratory disorder in preterm infants. Although it is well known that preterm birth has a key role, the mechanisms of lung injury have not been fully elucidated. The pathogenesis of this neonatal condition is based on the rapid formation of the oxygen reactive species, which surpasses the detoxification capacity of anti-oxidative defense system. The high reactivity of free radical leads to damage to a variety of molecules and may induce respiratory cell death. There is evidence that the oxidative stress involved in the physiopathology of this disease, is particularly related to oxygen supplementation, mechanical ventilation, inflammation/infe…

Is intravesical instillation of hyaluronic acid and chondroitin sulfate useful in preventing recurrent bacterial cystitis? A multicenter case control analysis.

Abstract Objective Urinary tract infections (UTIs) are common in the female population and, over a lifetime, about half of women have at least one episode of UTI requiring antibiotic therapy. The aim of the current study was to compare two different strategies for preventing recurrent bacterial cystitis: intravesical instillation of hyaluronic acid (HA) plus chondroitin sulfate (CS), and antibiotic prophylaxis with sulfamethoxazole plus trimethoprim. Materials and methods This was a retrospective review of two different cohorts of women affected by recurrent bacterial cystitis. Cases (experimental group) were women who received intravesical instillations of a sterile solution of high concen…

Preterm birth: seven-year retrospective study in a single centre population

Preterm birth is a health and social problem, considered the leading cause of neonatal mortality worldwide. It is associated with higher rates of neurodevelopmental morbidity, sensorineural impairments and other complications. The aim of the study was to describe the incidence and the major risk factors associated with preterm birth. METHODS: We performed a single center, observational and retrospective Cohort study in the Division of Obstetrics and Gynaecology, University Hospital "G. Martino", Messina. Clinical records of all pregnant women who delivered from 1st January 2010 to 31 of December 2016 were collected. RESULTS: In the 7 years considered, a total of 7954 pregnant women were inc…

High mobility group box 1 and markers of oxidative stress in human cord blood.

Background Parturition induces considerable oxidative stress and many inflammatory mediators, such as high mobility group box 1 (HMGB1), are involved from the beginning of the pregnancy to birth. The aim of the present study was to evaluate serum cord blood concentration of diacron-reactive oxygen metabolites (d-ROM), biological antioxidant potential (BAP), and HMGB1 to investigate the perinatal oxidative status of neonates and correlation with mode of delivery, as well as the influence of labor. Methods The subjects consisted of 214 neonates delivered at University Hospital "G. Martino", Messina, in a 6 months period. Venous blood samples were collected from the umbilical cord after cord s…

Oral contraceptives in the prevention of endometrioma recurrence: does the different progestins used make a difference?

""The primary aim of the study was to analyze the endometrioma recurrence rate in patients who underwent laparoscopic excision followed by postoperative long-term regimen of oral contraceptives (OCs).. . MATERIALS AND METHODS: 168 patients who underwent a conservative laparoscopic surgery for endometrioma, during the period between September 2009 and August 2010 in three university hospitals were studied. A long-term OCs therapy was offered to all women following surgery. Patients were randomly divided into three groups according to different progestins used (desogestrel, gestodene, dienogest). Women who refused a postoperative hormonal therapy served as control. Follow-up visits and transv…

Genistein supplementation and cardiac function in postmenopausal women with metabolic syndrome: Results from a pilot strain-echo study

Genistein, a soy-derived isoflavone, may improve cardiovascular risk profile in postmenopausal women with metabolic syndrome (MetS), but few literature data on its cardiac effects in humans are available. The aim of this sub-study of a randomized double-blind case-control study was to analyze the effect on cardiac function of one-year genistein dietary supplementation in 22 post-menopausal patients with MetS. Participants received 54 mg/day of genistein (n = 11) or placebo (n = 11) in combination with a Mediterranean-style diet and regular exercise. Left ventricular (LV) systolic function was assessed as the primary endpoint, according to conventional and strain-echocardiography measurement…

Isolated Endometriosis on the Rectus Abdominis Muscle in Women without a History of Abdominal Surgery: a Rare and Intriguing Finding

We report 2 rare cases of endometriosis on the rectus abdominal muscle diagnosed incidentally during an operation for inguinal hernia repair in women with no surgical history. Two women sought medical attention for a mass found in the pubic abdominal wall. Only 1 woman reported occasional pain. At physical examination in both women, an ovoid swelling in the right pubic area was felt. One woman experienced pain on palpation, and one reported slight discomfort. Ultrasonography demonstrated a heterogeneous hypoechogenic formation with indistinct edges; diagnosis was difficult. Routine clinical and instrumental (pelvic ultrasonography) gynecologic examination in both patients performed shortly …

Cystic adenomyosis spreading into subserosal-peduncolated myoma: How to explain it?

Abstract Introduction Cystic adenomyosis is a rare variant of adenomyosis characterized by well- circumscribed cavitated endometrial gland and stroma located within the myometrium. The cysts usually measure ≥ 1 cm in diameter, contain a “chocolate-colored” fluid and do not open into the overlaying endometrium. Case presentation We present a case of a peduncolated-subserosal cystic adenomyoma, namely cystic adenomyosis, correlated with pelvic MR imaging, laparoscopic surgery technique and histopathology findings. Conclusions In this case, the peculiar growth pattern of cystic adenomyosis in a myoma represents a singular condition rarely reported in the medical literature. We therefore suppor…

Surgical management of cystic adenomyosis. Why the laparoscopic approach is preferable?

New treatment for stress urinary incontinence

Objective: The aim of this study is to evaluate the safety and efficacy of the Zuidex implacement for the treatment of type III incontinence. Methods: We evaluated 36 women (median age 51) with type III ( MUCP<20 cm H2O and VLPP<60 cm H2O), with fixed urethra demonstrated (Delta Value<30 at Q-tip test). 21 (58.3%) had undergone previous continence surgery .They were recluted by a complete urogynaecological work-up( Vaginal profile, Q- tip test, Endoscopy and Urodynamic study, one hour Pad test, Ultrasonography). We defined as cured patients that were dry after the implant was performed, and as improved those who decreased in number of pads and symptoms.We underwent all patients an intrauret…

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

Abstract Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pre…

Vulvar involvement in pediatric Crohn’s disease: a systematic review

Purpose: The aim of the study is to report a systematic review (from 2000 to 2017) of all pediatric cases of vulvar Crohn’s disease (VCD) and to highlight the key-points for a correct diagnosis and management of this rare condition. Methods: An electronic search using the Pubmed/Medline, Scopus, EMBASE, Cochrane database and Google Scholar database was performed according to PRISMA guidelines. Results: Twenty pediatric studies and 22 cases of VCD were included for analysis. All the articles reported a single case, except two articles where two cases, respectively, are described. Clinical vulvar examination showed the following main manifestations: vulvar erythema (9/22 cases, 40.9%), vulv…

Laparoscopic treatment of diaphragmatic endometriosis causing chronic shoulder and arm pain

Interstitial Pregnancy: A 'Road Map' of Surgical Treatment Based on a Systematic Review of the Literature.

An electronic search concerning the surgical approach in cases of interstitial pregnancy from January 2000 to May 2013 has been carried out. Fifty three studies have been retrieved and included for statistical analysis. Conservative and radical surgical treatments in 354 cases of interstitial pregnancy are extensively described. Hemostatic techniques have been reported as well as clinical criteria for the medical approach. Surgical outcome in conservative versus radical treatment were similar. When hemostatic techniques were used, lower blood losses and lower operative times were recorded. Conversion to laparotomy involved difficulties in hemostasis and the presence of persistent or multipl…

Bladder endometriosis: laparoscopic treatment and follow-up

Objectives: This study aims to show the treatment outcome in women affected by isolated bladder endometriosis who underwent laparoscopic surgery in our units. Only women with deep nodules located in the bladder were selected, thus excluding women with deep lesions located in other sites. Study design: Between March 2005 and 2007, women with deep vesical endometriosis, referring to the Departments of Obstetrics and Gynaecology of University Hospitals "G. Martino" of Messina, "Paolo Giaccone" of Palermo and "San Paolo" of Milano, were respectively recruited. A preoperative assessment of the pathology was performed. Women who were concomitantly diagnosed deep nodules of the rectovaginal septum…

Laparoscopic sacrocolpopexy in the treatment of vaginal vault prolapse: 8 years experience

Abstract Objective The aim of this study was to evaluate the long-term results of a laparoscopic sacrocolpopexy for the treatment of vaginal vault prolapse. Study design Between January 1999 and January 2007, 165 laparoscopic sacrocolpopexy procedures, using a polypropylene mesh, were performed on women affected by vaginal vault prolapse. Intraoperative complications included: 5 bladder injuries and 3 sigmoid perforations. Postoperative complications included: 10 cases of fever, 5 cases of lumbosciatica, 15 cases of detrusor overactivity, 2 cases of vaginal haematoma, and 5 cases of minimal dispareunia. At 1, 6 and 12 months after surgery, a clinical evaluation was carried out for all patie…

Hysteroscopic Evaluation of Endometrial Changes in Breast Cancer Women with or without Hormone Therapies: Results from a Large Multicenter Cohort Study

ABSTRACT Study Objective The primary aim of our study was to investigate the incidence of endometrial pathologies, especially endometrial cancer, in women with breast cancer treated with tamoxifen (TAM), aromatase inhibitors (AIs), or receiving no treatment (NT). The secondary aim was to identify, in this cohort, ultrasonographic findings that represent robust indications for hysteroscopy and endometrial biopsy, to avoid unnecessary second-level diagnostic procedures. Design Multicenter retrospective cohort study (Clinical Trial ID: NCT03898947). Setting Data were collected from different Italian centers: Regina Elena National Cancer Institute of Rome, Arbor Vitae Centre of Rome, Gaetano Ma…

Data comparison between pharmacological induction of labour and spontaneous delivery. A single centre experience.

Objectives: To assess the differences in the maternal and fetal outcomes between pharmacological induced and sponta­neous labour in nulliparous women. Material and methods: Observational cohort study carried out over a period of 2 years. Inclusion criteria: nulliparous sin­gleton pregnancies, with cephalic fetal presentation, elective labour induction with intra-vaginal prostaglandin E2 (PGE2) gel (Prepidil® 2 mg) at a gestational age of 41 weeks. Control group: patients who entered labour spontaneously at a gestational age of ≥ 40 weeks. The main demographic maternal characteristics and intra- and postpartum data were extracted from computer records and obstetrics diaries and were used for…

Gonadotrophin-releasing hormone analogue or dienogest plus estradiol valerate to prevent pain recurrence after laparoscopic surgery for endometriosis: A multi-center randomized trial

Objectives To evaluate the efficacy of dienogest + estradiol valerate (E2V) and gonadotrophin-releasing hormone analogue (GnRH-a) in reducing recurrence of pain in patients with chronic pelvic pain due to laparoscopically diagnosed and treated endometriosis. Design Multi-center, prospective, randomized study. Setting Three university departments of obstetrics and gynecology in Italy. Population Seventy-eight women who underwent laparoscopic surgery for endometriosis combined with chronic pelvic pain. Methods Post-operative administration of dienogest + E2V for 9 months (group 1) or GnRH-a monthly for 6 months (group 2). Main outcome measures A visual analogue scale was used to test intensit…

Spontaneous rupture of splenic artery aneurysm in pregnancy: is splenectomy always necessary?

Letter to Editor