IL vaccino quadrivalente anti-HPV: efficacia e sicurezza.

La prevalenza globale del Papillomavirus (HPV) nelle neoplasie cervicali è maggiore del 90%. Il 70% delle donne si espone all'infezione da HPV almeno una volta nella vita: una su cinque può sviluppare il cancro. Il vaccino quadrivalente anti HPV 16, 18, 6 e 11 Sanofi Pasteur MSD (GARDASIL) ad azione profilattica ha come target il 70% dei casi di CIN 2/3 e di cancro cervicale, il 90% dei casi di condilomi genitali, il 30-35% dei casi di CIN. L'efficacia del vaccino è stata valutata in 4 studi clinici di fase II e III, randomizzati, in doppio cieco, verso placebo, che hanno coinvolto un totale di 20.583 donne dai 16 ai 26 anni d'età. I risultati di questo studio a 3 anni dalla sommministrazio…

Fractional CO2 Laser: the new frontier for the treatment of vulvo-vaginal atrophy symptoms

The vulvo-vaginal atrophy (VVA) is a chronic condition characterized by gradual involution of the mucous membranes and vulvo-vaginal tissues, which is manifested in the climacteric phase. Numerous therapeutic options, hormonal and non-hormonal, have been proposed to alleviate the symptoms related to VVA, but to date none of them is able to guarantee long-term effects. The use of Fractional CO2 Laser technology applied to the vulvo-vaginal area represents an innovative procedure to make a real "regeneration treatment" of the vaginal tissues. In fact, it is possible to spread the laser energy in the various layers of the vaginal wall, reactivating the synthesis of extracellular matrix and col…

Educational Interventions on Pregnancy Vaccinations during Childbirth Classes Improves Vaccine Coverages among Pregnant Women in Palermo’s Province

Maternal immunization is considered the best intervention in order to prevent influenza infection of pregnant women and influenza and pertussis infection of newborns. Despite the existing recommendations, vaccination coverage rates in Italy remain very low. Starting from August 2018, maternal immunization against influenza and diphtheria-tetanus-pertussis were strongly recommended by the Italian Ministry of Health. We conducted a cross sectional study to estimate the effectiveness of an educational intervention, conducted during childbirth classes in three general hospitals in the Palermo metropolitan area, Italy, on vaccination adherence during pregnancy. To this end, a questionnaire on kn…

La maturazione ovocitaria in vitro nella paziente neoplastica: vantaggi e applicazioni

Patogenesi dell’endometriosi: aspetti cellulari e molecolari

L'endometriosi è una malattia ginecologica benigna che interessa il 10-15% delle donne in età fertile. Nonostante l'elevata prevalenza e l'importanza sociale della malattia, l'eziopatogenesi dell'endometriosi non è ad oggi completamente nota. L'ipotesi della mestruazione retrograda proposta da Sampson è quella maggiormente accettata, tuttavia la discrepanza tra il frequente reperimento di cellule endometriali refluite in cavità peritoneale e l'effettiva prevalenza di endometriosi sintomatica, suggerisce il coinvolgimento di uno o più fattori predisponenti nella patogenesi nella patogenesi della malattia.

Early onset Mirror Syndrome associated with foetal sacrococcigeal teratoma: a rare entity

In the mirror syndrome, maternal symptoms mime foetal and placental oedema. The pathogenesis is unknown. The most common etiologic associations are rhesus isoimmunization, twin-twin transfusion syndrome and viral infections. Few reports are associated to foetal tumors and particularly to sacroccoccigeal teratoma (SCT). Based on several published series, foetal SCT with placentomegaly and hydrops is almost universally fatal; foetal surgery is not typically offered for hydropic foetuses beyond 26 weeks of gestational age. Delivery of the foetus is the choise treatment when mirror syndrome is present with supporting the pregnancy until delivery is necessary for maternal indications or the foet…

Fitz-hugh-curtis syndrome secondary to postpartum endometritis: Case Report and literature review

We report a case of Fitz‑Hugh‑Curtis syndrome (FHCS) 1 week after an urgent cesarean section. Although its onset in the postpartum period is poorly reported in the literature, we suggest that FHCS can complicate puerperal endometritis; therefore, it should be consider in differential diagnosis in puerpera with right upper quadrant pain. Again, it can be useful to perform a contrast computed tomography that allows early diagnosis and conservative treatment

The methylenetetrahydrofolate reductase C677T polymorphism and the risk of congenital heart diseases: a literature review

Congenital Heart Diseases (CHDs) are the most commonand serious developmental anomaly and the leading non-infectious cause of mortality in the first year of life. Despite the advances in diagnosis and treatment, understanding of the developmental causes and aetiologies of CHDs has been limited. The hyperhomocysteinemia is one of the proved risk factors related to the occurrence of CHDs. The connection between cardiac defects, folate and hyperhomocysteinemia could be explained by a mutation in the methylenetetrahydrofolate reductase (MTHFR) gene. Indeed, the C677T MTHFR mutation produces a thermolabile variant of MTHFR with reduced enzymatic action resulting in higher plasma levels of homocy…

Unexpected finding of urachal remnant cyst. Tips for laparoscopic approach

Highlights • Urachal cyst is a common anomaly related to the incomplete obliteration of the urachal lumen. • This condition, per se asymptomatic, is not without risk. • In symptomatic cases, the main approach is the laparoscopic excision.

Metroplastica isteroscopica: trattamento resettoscopico monopolare versus isteroscopia operativa bipolare

The presence of genital HPV does not affect the in vitro fertilization outcome: preliminary data of a prospective study

Reply of the Authors: Hysteroscopic resection of the uterine septum: is it always a necessity?

[No abstract available]

PARASITIC DERMOID CYST COEXISTING WITH ABSENCE OF AN ADNEXA

Chronic renal failure and endometrial osseous metaplasia: a hypothetical pathway.

LA PREVENZIONE ED IL TRATTAMENTO DELLE PATOLOGIE HPV-CORRELATE: FOLLOW-UP E PERFORMANCE RIPRODUTTIVA

Relationship between HPV-infection and reproductive performance includes patients who during trial become pregnant. Main chapter indeed represents genital lesions treatments sequelae. Clinical phase 3 studies showed that spontaneous abortion rate in both groups (Gardasil and placebo respectively) was comparable (33% vs 31.6%). Moreover, there were 25 cases of congenital abnormalities among newborns and live foetuses, and congenital abnormalities global rate was similar than normal population. Therefore, there is no evidence that Gardasil adversely influences fertility, pregnancy and neonatal outcome. Cold-cut conization, laser-conization, laser-ablation, LEEP or LLETZ are conservative techn…

valutazione isteroscopica della cicatrice isterotomica post-cesareo:classificazione,patologie ad essa correlate e trattamento

Hysteroscopic resection of the septum improves the pregnancy rate of women with unexplained infertility: a prospectine controlled trial

Objective: To assess fecundity of infertile women after surgical correction of uterine septum. Design: Prospective controlled trial. Setting: Three academic infertility clinics. Patient(s): Forty-four women affected by septate uterus and otherwise unexplained infertility represented the study group (group A), and 132 women with unexplained infertility were enrolled as control subjects (group B). Intervention(s): Hysteroscopic metroplasty was performed in group A, and group B was managed expectantly. All women were followed-up for 1 year without any other intervention. Main Outcome Measure(s): Fecundity rate was calculated as the number of pregnancies per 100 person-months Result(s): Pregnan…

la papulosi bowenoide: descrizione di uin caso clinico

A randomized comparison of endometrial laser intrauterine thermotherapy and hysteroscopic endometrial resection.

Objective To investigate the difference of long-term amenorrhea rate in patients with menorrhagia treated by endometrial laser intrauterine thermal therapy (ELITT), a new nonhysteroscopic endometrial ablation procedure, versus transcervical hysteroscopic endometrial resection (TCRE). Design Randomized clinical study. Healthy volunteers in an academic research environment. Setting Academic teaching hospital. Patient(s) Premenopausal women with abnormal uterine bleeding. Intervention(s) Fifty-eight patients were treated with the ELITT procedure and 58 patients with TCRE; both groups were treated with GnRH agonists before the procedure. Main outcome measure(s) Bleeding status and patient satis…

Predictive factors of polycystic ovary syndrome in girls with precocious pubarche

Objective: The aim of this study is to clarify, in girls with premature pubarche (PP), the influence of premature androgenization on the prevalence of polycystic ovary syndrome (PCOS). Design and patients: Ninety-nine PP girls, 63 who developed PCOS and 36 who did not develop PCOS, were retrospectively included. Clinical, anthropometric, and metabolic parameters were evaluated at the time of diagnosis of PP and after 10 years from menarche to find predictive factors of PCOS. Results: Young females with PP showed a PCOS prevalence of 64% and showed a higher prevalence of familial history of diabetes (P = 0.004) and a lower prevalence of underweight (P = 0.025) than PP-NO-PCOS. In addition, g…

Struma ovarii. Case report and revision of the literature

Struma ovarii is a rare form of ovarian neoplasm, entirely or predominantly composed of thyroid tissue. This tumour generally has a benign biological behavior, although some cases of malignant transformation have been reported (5-10%). The tumour usually presents as an asymptomatic mature mass that may measure as much as 10 cm in diameter. The presence of ascites is possible (15-20%), and in a few cases the association of ascites and hydrothorax has been recorded (Pseudo-Meigs Syndrome); a close relationship between ascites and high levels of Ca-125, that may wrongly induce to a diagnosis of ovarian carcinoma is present. Other possible clinical consequences are compressive symptoms on adjac…

Total laparoscopic hysterectomy versus total abdominal hysterectomy: an assessment of the learning curve in a prospective randomized study.

The present randomized study was undertaken in order to compare the short-term results between total laparoscopic hysterectomy and abdominal hysterectomy in a centre with experience in laparoscopic surgery. From January 1997 to September 1998 inclusive, 102 women aged 44-71 years were randomly assigned to either total laparoscopic hysterectomy (n = 51 patients) or abdominal hysterectomy (n = 51 patients). The patients' demographic characteristics were similar in both groups. Average intra-operative blood loss was lower in laparoscopic hysterectomy than in abdominal hysterectomy (P </= 0. 001). The average time employed for laparoscopic hysterectomy was 104.1 +/- 26.98 min; according to the …

Initial experience of a new linear everting falloposcopy system in comparison with hysterosalpingography

Objective To assess the endolumenal portion of the fallopian tube from ostium to fimbria using a specially designed linear everting catheter and microendoscope. The study compared falloposcopy results with those obtained with hysterosalpingography (HSG) in the same patients and explored the system's ability to classify internal tubal conditions. Design A prospective study of a new diagnostic technique, falloposcopy, versus conventional means of evaluating tubal status. Setting A tertiary university infertility center. Patients Eighteen infertile patients with a previous history of infertility of at least 2 years duration. Intervention Diagnostic falloposcopy was performed on a total of 31 t…

What is the impact of a novel MED12 variant on syndromic conotruncal heart defects? Analysis of case report on two male sibs

Abstract Background Syndromic congenital heart disease accounts for 30% of cases and can be determined by genetic, environmental or multifactorial causes. In many cases the etiology remains uncertain. Many known genes are responsible for specific morphopathogenetic mechanisms during the development of the heart whose alteration can determine specific phenotypes of cardiac malformations. Case presentation We report on two cases of association of conotruncal heart defect with facial dysmorphisms in sibs. In both cases the malformations’ identification occurred by ultrasound in the prenatal period. It was followed by prenatal invasive diagnosis. The genetic analysis revealed no rearrangements …

Preliminary reference intervals of Glycated Albumin in healthy Caucasian pregnant women

Abstract Background and aims Glycated albumin (GA) could represent a useful biomarker in pregnant women for diagnosing and monitoring gestational diabetes mellitus (GDM). The establishment of reference intervals (RI) is mandatory before assessing its clinical usefulness. The RIs of GA in healthy pregnant women are not well defined. The aim of the current study was to establish the RI in a cohort consisting of Caucasian pregnant women without overt diabetes mellitus or gestational diabetes mellitus. Methods The study included 183 healthy pregnant women. GA was measured on plasma by an enzymatic method (quantILab Glycated Albumin, IL Werfen, Germany). The RI was calculated by the non-parametr…

Conservative treatment of ectopic pregnancies using a single echo-guided injection of methotrexate into the gestational sac

The authors describe the possibility of the conservative treatment of five early ectopic pregnancies. A single injection of methotrexate into the tubal gestational sac was performed under vaginal ultrasound guidance. In all five cases, a clear ectopic gestational sac could be visualized. The pregnancies dated from the 5th to the 7th week of amenorrhea. Strict ultrasound follow-up following injection showed a gradual reduction in the size of the tubal gestational sac. At the same time, plasma beta-hCG gradually decreased to zero after a maximum time period of 25 days. Subsequent hysterosalpingography performed on all of the women demonstrated bilateral normal patent tubes. It is concluded th…

DIAGNOSI PRECOCE DELLA VENTRICOLOMEGALIA NEL I° TRIMESTRE:CASO CLINICO

THE HYDROCEPHALUS IS ONE OF THE MOST FREQUENT CONGENITAL ANOMALIES

Detection of oncogenic human papillomavirus genotypes on spermatozoa from male partners of infertile couples

Objective To evaluate the prevalence of human papillomavirus (HPV) sperm infection and its correlation with sperm parameters in patients who attended a fertility clinic. Design Cross-sectional clinical study. Setting University-affiliated reproductive medicine clinic. Patient(s) A total of 308 male partners of couples undergoing in vitro fertilization techniques. Intervention(s) Specimens of semen were collected from all patients. Main Outcome Measure(s) Sperm parameters were evaluated according to the World Health Organization manual. The presence of HPV DNA was researched by the combined use of two HPV assays and a highly sensitive nested polymerase chain reaction assay followed by HPV ge…

Ablazione endometriale: le tecniche di seconda generazione

Laparoscopic-ultrasonographic combined technique for the creation of a neovagina in Mayer-Rokitansky-Kuster-Hauser syndrome

Objective To create a neovagina using a combined laparoscopic and ultrasonographic technique in Mayer-Rokitansky-Kuster-Hauser syndrome by modification of Vecchietti's operation. Design Case report. Setting Division of Physiopathology of Reproduction, University of Palermo, Palermo, Italy. Main Outcome Measure(s) The advancement of the needle from the pseudohymen, through the vesicorectal space using a triple contrast ultrasonographic technique. Result(s) The ultrasonographic scanning guides the accurate transit from external genitalia to the peritoneal cavity. Conclusion(s) This original approach allowed a safe and rapid creation of a neovagina in a case of Mayer-Rokitansky-Kuster-Hauser s…

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…

Nostra esperienza con l'istillazione intratubarica di un gel di idrossietilcellulosa contenente glicerolo, lidocaina e clorexidina (Instillagel) per la diagnosi di infertilità tubarica

Diagnosi precoce del carcinoma endometriale