Non-immune hydrops fetalis: Two case reports

BACKGROUND Fetal hydrops is a serious condition difficult to manage, often with a poor prognosis, and it is characterized by the collection of fluid in the extravascular compartments. Before 1968, the most frequent cause was the maternal-fetal Rh incompatibility. Today, 90% of the cases are non-immune hydrops fetalis. Multiple fetal anatomic and functional disorders can cause non-immune hydrops fetalis and the pathogenesis is incompletely understood. Etiology varies from viral infections to heart disease, chromosomal abnormalities, hematological and autoimmune causes. CASE SUMMARY A 38-year-old pregnant woman has neck lymphoadenomegaly, fever, cough, tonsillar plaques at 14 wk of amenorrhea…

Closed vs. Open Oocyte Vitrification Methods Are Equally Effective for Blastocyst Embryo Transfers: Prospective Study from a Sibling Oocyte Donation Program.

<b><i>Purpose:</i></b> To assess whether open and closed vitrification protocols are equally effective for sibling-oocyte cycles when performing blastocyst embryo transfers. <b><i>Materials and Methods:</i></b> A prospective study was set up comparing the open and the closed vitrification techniques in oocyte recipients sharing sibling oocytes between 2014 and 2016. Sibling oocytes were randomly and equally assigned into the closed group (oocytes vitrified in a closed system) or the open group (oocytes vitrified in an open system). Intracytoplasmic sperm injection was performed on all cases. Embryo transfers were performed on day 5. Power anal…

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…

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…

Interstitial pregnancy in a patient with ipsilateral adnexal absence: Case report and literature review

Unilateral ovarian absence (UOA) with fallopian tube absence is a rare condition. The true incidence is unknown. Here, we report a case of a woman with left tubal and ovarian absence, undergoing laparoscopy for an ipsilateral interstitial pregnancy (IP). The gestational mass was excided using the purse string technique to achieve better haemostasis. Probable etiologies are discussed and literature reviewed. According to our analysis the reproductive outcome of women affected by this rare anomaly is not compromised. Its impairment should be related to comorbidities or other unexplained causes. © Copyright 2014, CIC Edizioni Internazionali, Roma.

Cellular schwannoma of the retroperitoneum with cystic degeneration, mimicking an ovarian cyst, with CKAE1/AE3 and desmin expression.

Schwannoma is an encapsulated benign tumour usually presenting as a solitary mass on the flexor surfaces of the extremities, neck, mediastinum, posterior spinal roots and cerebellopontine angle, an...

Spontaneous bilateral tubal pregnancy in a nulliparous woman. Laparoscopic diagnosis and treatment

A 34 year-old nulliparous woman was referred to our Department, complaining of vaginal bleeding and intermittent lower abdominal cramping. serum level of β-hCG was 4954 IU/L. Transvaginal ultrasound examination revealed no gestational sac in the uterine cavity and a right adnexal mass, suggestive of ectopic pregnancy; left adnexal area appeared regular. At laparoscopy, the presence of an ectopic pregnancy was confirmed in the right tube; on the left side, surprisingly, there was an intact infundibular ectopic pregnancy. Right tuba was removed; considering the condition of nulliparous of the patient, we decided to perform a linear salpingostomy. Histologic exam confirmed the diagnosis of spo…

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%…

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…

Transplacental permeability of heavy metals in relation to newborn sex - evidence from the neurodevelopment project

Introduction: Gender medicine is an innovative medical approach that studies how some biological variables are influenced by the male or female sex and gender. This issue is under debate because it characterizes the impact of tailored or individual medicine. In this scenario, the aim of this study is to study the correlation between heavy metal exposure and pathologies of neurodevelopment, according to the sex of newborns. In particular, this is an observational study under the name of the Neurosviluppo Project, involving 217 mother-child couples. Material and methods: The correlation with phenotype small for gestational age and congenital malformations were studied, but above all we focuse…

Biomesh (Pelvicol®) for vaginal anterior wall prolapse. A three-year follow-up

Assisted Reproductive Techniques and Risk of Congenital Heart Diseases in Children: a Systematic Review and Meta-analysis

AbstractInfertility is a growing phenomenon and leads to an increased use of assisted reproductive techniques (ARTs). In recent years, concerns about the safety of these procedures emerged and ARTs were hypothesized to be a risk factor for developing congenital heart diseases (CHDs) in offspring. Our aim is to investigate the association between ART and CHD, specifying results according to various subtypes of defects. We performed a systematic review and random-effects meta-analysis following the PRISMA guidelines. MEDLINE and Google Scholar were searched from January 2011 to May 2022. Data about incidence of CHD in ART were tabulated and extracted from all the studies included. Twenty-four…

Histologic analysis of specimens from laparoscopic endometrioma excision performed by different surgeons: does the surgeon matter?

Objective To evaluate whether the amount of ovarian tissue inadvertently removed along with the endometrioma cyst wall at laparoscopy differs in relation to the operating surgeon's level of expertise. Design Multicenter, prospective trial. Setting Four tertiary care university hospitals. Patient(s) Fifty patients, aged 25 to 40 years, with monolateral ovarian endometriomas who underwent laparoscopic excision. Intervention(s) Operation with the stripping technique by surgeons with specific expertise in endometriosis surgery in four centers (groups A, B, C, and D) and by residents with average training in laparoscopic surgery (group E). Main Outcome Measure(s) Histologic examination for the e…

Agroalimentare, il lato buono dell’economia siciliana

3D laparoscopic surgery: a prospective clinical trial

Since it's introduction, laparoscopic surgery represented a real revolution in clinical practice. The use of a new generation three-dimensional (3D) HD laparoscopic system can be considered a favorable "hybrid" made by combining two different elements: feasibility and diffusion of laparoscopy and improved quality of vision. In this study we report our clinical experience with use of three-dimensional (3D) HD vision system for laparoscopic surgery. Between 2013 and 2017 a prospective cohort study was conducted at the University Hospital of Palermo. We considered 163 patients underwent to laparoscopic three-dimensional (3D) HD surgery for various indications. This 3D-group was compared to a r…

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.

Fertility-sparing approach in women affected by stage i and low-grade endometrial carcinoma: An updated overview

Endometrial cancer (EC) is a deleterious condition which strongly affects a woman’s quality of life. Although aggressive interventions should be considered to treat high-grade EC, a conservative approach should be taken into consideration for women wishing to conceive. In this scenario, we present an overview about the EC fertility-sparing approach state of art. Type I EC at low stage is the only histological type which can be addressed with a fertility-sparing approach. Moreover, no myometrium and/or adnexal invasion should be seen, and lymph-vascular space should not be involved. Regarding the pharmaceutical target, progestins, in particular medroxyprogesterone acetate (MPA) or megestrol …

Prospective sonographic detection of spina bifida at 11–14 weeks and systematic literature review

Objective: To conduct a literature review to assess the effectiveness of first trimester ultrasonographic markers of spina bifida (SB) integrating data with our prospective experience. Methods: The analysis of the SB cases that we prospectively detected in the first trimester, between January 2012 and February 2014, and a systematic review of all the papers evaluating the effectiveness of SB ultrasonographic markers at 11–14 weeks, namely brain stem diameter (BS), fourth ventricle/intracranial translucency (IT), cisterna magna (CM), brain stem/occipital bone distance (BSOB), the ratio between BS and BSOB. Some studies assess only the effectiveness of IT, others include more parameters, and …

Metroplastica isteroscopica: trattamento resettoscopico monopolare versus isteroscopia operativa bipolare

Laparoscopic Retropubic Colposuspension for the Treatment of S.U.I.

Vulvo-vaginal atrophy: A new treatment modality using thermo-ablative fractional CO2 laser.

a b s t r a c t Objective: To evaluate the efficacy and feasibility of thermo-ablative fractional CO2 laser for the treatment of symptoms related to vulvo-vaginal atrophy (VVA) in post-menopausal women. Methods: From April 2013 to December 2013, post-menopausal patients who complained of one or more VVA-related symptoms and who underwent vaginal treatment with fractional CO2 laser were enrolled in the study. At baseline (T0) and 30 days post-treatment (T1), vaginal status of the women was evaluated using the Vaginal Health Index (VHI), and subjective intensity of VVA symptoms was evaluated using a visual analog scale (VAS). At T1, treatment satisfaction was evaluated using a 5-point Likert …

Incidental Detection of a Chromosomal Aberration by Array-CGH in an Early Prenatal Diagnosis for Monogenic Disease on Coelomic Fluid

Background: Turner syndrome is a rare genetic condition in which a female is partly or completely missing an X chromosome. Signs and symptoms vary among those affected. In fetuses that survive at birth and without congenital malformations, the prognosis is usually positive, but it has high lethality in utero, especially in the first trimester of pregnancy. Methods: We report a case of monosomy X detected during a prenatal diagnosis for beta thalassemia on coelomic fluid (CF) at the VIII week of gestation. Beta globin gene analysis, whole genome amplification (WGA), quantitative fluorescent PCR and array comparative genomic hybridization (array-CGH) were performed on DNA extracted from CF. R…

PARASITIC DERMOID CYST COEXISTING WITH ABSENCE OF AN ADNEXA

The gender gap in the diagnostic-therapeutic journey of the infertile couple

Medical procreation impairs both the biological and psychological lives of couples. However, male and female attitudes to infertility are different and require a different approach during the IVF journey. Thus, the gender impact assessment (GIA) method was used to analyse original studies present in the literature. We found some gender-related differences and, subsequently, possible outcomes of intervention to improve healthy reproduction management and prevent infertility. In particular, it became apparent that there was the need for an in-depth male infertility assessment and a gender-specific follow-up.

Hysteroscopic and ultrasonographic evaluation of ulipristal acetate treatment for symptomatic myomas in premenopausal women: a prospective study

Objective: This study aimed to analyze the effects of a six-month therapy with ulipristal acetate (UPA) on myoma size and endometrial thickness in premenopausal women. Material and methods: Seventy-four women undergoing conservative therapy with UPA were enrolled for this study. All women underwent transvaginal ultrasound evaluation to assess the endometrial thickness, and the number and size of myomas at the beginning and after six months. Hysteroscopy and biopsy were performed after six months, if necessary. Results: After six months of treatment, sonographic examination showed a statistically significant (p <.05) reduction of the size of the largest myoma (56.3 ± 5.1 vs. 31.7 ± 10.1 m…

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…

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…

TENSION FREE CYSTOCELE REPAIR. FOUR YEARS FOLLOW-UP

Aims of study: Anterior vaginal wall descensus is one of the most frequent alteration in patients with pelvic defects. At least 50% of women that had delivered two or more times presented a certain degree of this pathologic alteration of the anatomy, even thought only 10-20% of the patients complained of associated pains. The use of synthetic biocompatible materials has become more common in gynecology surgery(1)-(3). Polypropylene mesh to be proposed as a mean of surgical correction of moderate severe cystocele (Cervigni 1998)(2) Methods: 97 patients aged 42-75, parity 1-5, body weight 45-90, menopause 41 pts. (61%).Irritative sintoms( nocturia, frequency, urgency, dysuria and urge inconti…

Laparoscopic, three-port and SILS cholecystectomy: a retrospective study.

Introduction. The aim of this study was to compare the results of classic laparoscopic, three-port and SILS cholecystectomy. Materials and methods. We conducted a retrospective study of da- ta collected between January 2010 and December 2012 pertaining to 159 selected patients with symptomatic gallstones. 57 underwent lapa- roscopic cholecystectomy, 51 three-port cholecystectomy and 48 SILS cholecystectomy. We then compared the groups with respect to mean ope- rating time, intraoperative complications, postoperative pain, duration of hospitalization and final aesthetic result. Introduction The first laparoscopic cholecystectomy was carried out in 1987 in France by Philippe Mouret (1). The p…

Neonatal Outcomes and Long-Term Follow-Up of Children Born from Frozen Embryo, a Narrative Review of Latest Research Findings

In recent years, the growing use of ART (assisted reproductive techniques) has led to a progressive improvement of protocols; embryo freezing is certainly one of the most important innovations. This technique is selectively offered as a tailored approach to reduce the incidence of multiple pregnancies and, most importantly, to lower the risk of developing ovarian hyperstimulation syndrome when used in conjunction with an ovulation-triggering GnRH antagonist. The increase in transfer cycles with frozen embryos made it possible to study the effects of the technique in children thus conceived. Particularly noteworthy is the increase in macrosomal and LGA (large for gestational age) newborns, i…

DISTRIBUTION OF GENITAL HUMAN PAPILLOMAVIRUS IN SICILIAN MEN WITH AND WITHOUT CLINICAL MANIFESTATIONS

Introduction: Infection Human Papillomavirus (HPV) is the cause of several disease in men and in women: genital warts, penile and cervical intraepithelial neoplasia, invasive penile carcinoma and cervical cancer. However, less is known about HPV infection and prevalence of HPV types in men. Materials and Methods: 820 genital samples of men (age 19-77; mean age: 36.7 ys) who had come to the Virology laboratory of the Department of Sciences for Health Promotion and Mother and Child Care (Policlinico, University of Palermo, Italy) were examined for HPV infection. The study included men with genital warts, men with atypical genital lesion, partners of HPV-positive women and asymptomatic men for…

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 …

Transobturator Safyre sling is as effective as the transvaginal procedure

Very early prenatal diagnosis of Cockayne’s syndrome by coelocentesis

Cockayne’s syndrome (CS) is a rare autosomal recessive multisystem disease characterised by early severe progression of symptoms. This study reports the feasibility of earlier prenatal diagnosis of CS by coelocentesis at 8 weeks of gestation respect to amniocentesis or villocentesis. Three couples at risk for CS asked to perform prenatal diagnosis by coelocentesis. Coelomic fluid was aspired from coelomic cavity in four singleton pregnancy at 8 weeks of gestation and 40 foetal cells were recovered by micromanipulator. Maternal DNA contamination was evaluated by quantitative fluorescent PCR (QF-PCR) and target regions of foetal DNA containing parental mutations of ERCC6 gene were amplified a…

Luteinised unruptured follicle syndrome: pathophysiological background and new target therapy in assisted reproductive treatments

Luteinised unruptured follicle syndrome (LUFS) is a cause of infertility consisting in the unruptured of the dominant follicle after the LH-surge. In fact, during assisted reproductive treatments (ART) clomiphene citrate and letrozole are frequently administered in order to achieve ovulation. However, considering the pathophysiology of LUFS, new possible therapy can be proposed. On this scenario, we performed a review of the literature searching for LUFS recurrency and its impact in infertility and ART. An inflammation theory has been proposed that can be fuel for further therapeutic possibilities. In particular, considering the increase in granulocytes accumulation, the granulocyte colony-…

Uterine Involvement in Klippel–Trenaunay Syndrome: A Rare But Relevant Event. Review of the Literature

IntroductionKlippel–Trenaunay syndrome (KTS) is a rare vascular congenital disorder characterized by the classical triad of port-wine stains, abnormal growth of soft tissues and bones, and vascular malformations. The involvement of the genitourinary tract and of the uterus in particular is extremely infrequent but relevant for possible consequences.MethodsWe performed an extensive review of the literature using the Pubmed, Scopus and ISI web of knowledge database to identify all cases of KTS with uterine involvement. The search was done using the MeSH term “Klippel–Trenaunay syndrome” AND “uterine” OR “uterus.” We considered publications only in the English language with no limits of time. …

Innovation in endocrine surgery: robotic versus laparoscopic adrenalectomy. Meta-analysis and systematic literature review.

Several studies in the last years demonstrated the better surgical outcome of laparoscopic approach to adrenal gland. Laparoscopic surgery is more difficult to learn and requires different psychomotor skills than open surgery, especially with regard to complex maneuvers requiring precision and dexterity. The development of robotic platform with three-dimensional vision and increased degrees of freedom of the surgical instruments has the aim to overcome these problems. We performed a systematic literature review with meta-analysis to evaluate preoperative data and surgical outcomes of robotic adrenalectomy compared with laparoscopic technique. In September 2016 we performed a systematic lite…

Endometrial cancer: Robotic versus Laparoscopic treatment. Preliminary report

Laparoscopic approach is today the standard treatment for benign and malignant gynecological pathologies. To traditional laparoscopic surgery in the last 10 years we can add the possibility to use a robotic platform. The adoption of this system allows undoubted advantages as the three-dimensional vision, the absence of the physiological tremor with enhanced ergonomics and possibility of using articulable tools. In this study we analyzed the results of 18 patients with endometrial cancer (Stage I) treated with robotic approach. The results were compared with a selected sample of 26 patients, with the same characteristics, treated with traditional laparoscopic approach in the same period by t…

Robotic versus laparoscopic sacrocolpopexy for apical prolapse: a case-control study

The apical prolapse has always been considered the most complex of the defects of the pelvic floor, for both the difficulty of the surgical corrective technique and for the high post-surgical recurrence rate. Today, the laparoscopic sacrocolpopexy can be considered the standard treatment for apical prolapse. In the last years, several author performed robotic sacrocolpopexy, obtaining positive results. So, we developed a case-control study in order to compare the surgical outcome of robotic group with a control group of laparoscopic approach in patients with symptomatic apical pro-lapsed between January 2015 and December 2015 at University Hospital Policlinico “P. Giaccone” and Ospedali Riu…

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?

Psychological variables in medically assisted reproduction: a systematic review

Introduction: The paths of medically assisted reproduction represent the most important scientific progress to cope with the inability to achieve spontaneous conception (SC) and to reach desired parenthood. Couples undergoing assisted reproductive technology (ART) and couples not facing ovulation induction and artificial fertilization show sufficient levels of well-being and psychological adjustment. However, in some cases couples undergoing ART show lower perceived quality of life than couples with SC. Our aim is to investigate the main psychological variables involved in the special risk condition of medically assisted reproduction and how they could direct specific guidelines to enhance …

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…

A prospective randomized study comparing laparoscopic burch versus tvt. Short and long term follow-up.

Objective: To report short and long-terms results of a prospective randomized laparoscopic Burch vs TVT for the treatment of stress incontinence (GSI). Methods: Since January 1999 to January 2003 we performed 66 LB and 67 TVT. In the LB group the mean age was 51years ( range 38–65), mean body weight 73 Kg.(range 48–88), mean parity 2,5 (range 1–5), menopause 38 (57,5%), while in the TVT group the mean age was 53years (range 37–72), mean body weight 70Kg. (range 46–84), mean parity 2,3 (range 1–4), menopause 19 (28,3%). All pts. preoperativelly underwent a complete urogynaecological work-up . All the pts. showed S.U.I. mean grade II (according to Ingelman Sundeberg) and urethra hypermobile. …

Preface

Laparoscopic treatment of diaphragmatic endometriosis causing chronic shoulder and arm pain

Acute appendicitis and endometriosis: Retrospective analysis in emergency setting

Introduction. The aim of this study is to evaluate the incidence of appendiceal and pelvic endometriosis in a population with diagnosis of acute appendicitis in an emergency setting. Materials and methods. We carried out a retrospective study in the period between January 2010 and October 2013. We performed 429 appendectomy including 233 in female subjects (54.3%). In all patients of childbearing age, we did β-hCG urine test to rule out the presence of an extra-uterine pregnancy. Results. 127 of 233 patients received a laparoscopic approach (54.5%). The median age was 29 years-old (range 17-68). The diagnosis of appendiceal and/or pelvic endometriosis was performed in 10 patients (4.3%): 9 …

Outcomes of monopolar versus bipolar endometrial ablation on uterine bleeding and psychophysical wellbeing.

Background To compare outcomes of endometrial ablation with monopolar versus bipolar resection on uterine bleeding and psychophysical wellbeing. Methods In a prospective randomized study, 100 perimenopausal patients, without desire of pregnancy and with no response to pharmacological treatment, underwent endometrial ablation from 2012 to 2014. They were randomly divided in two groups: 50 patients treated with monopolar electrode resection loop (group A) and 50 patients treated with bipolar electrode resection loop (group B). Operative parameters were immediately assessed. Menstrual outcome parameters and psycho-physical well-being parameters were evaluated after 12 months. Results No signif…

'Secondary prevention' against female HPV infection: literature review of the role of carrageenan.

Introduction: Human papillomaviruses (HPVs) are common sexually transmitted pathogens, causally associated with cervical cancer and other anogenital cancers, as well as approximately 20% of head and neck cancers. The HPV vaccine is an exceptional primary prevention tool, but the question of adequate secondary-prevention strategies remains open. The aim of this review is to better clarify the role of carrageenan in HPV prevention-strategies. Areas covered: A comprehensive literature search was performed (PubMed/MEDLINE, Embase, Google Scholar, Cochrane Databases) to identify articles on the use of carrageenan against HPV infection. The studies were identified using combinations of the search…

Primary umbilical endometrioma: Analyzing the pathogenesis of endometriosis from an unusual localization

Abstract Objective This report presents a rare case of symptomatic primary umbilical endometriosis and reviews the literature on the topic with the aim to clarify some questions on the origin of endometriosis. Case report A 33-year-old woman with cyclic umbilical bleeding was found to have umbilical endometriosis. She had no history of pelvic or abdominal surgery. There was no past history of endometriosis or endometriosis-associated symptoms. An omphalectomy was performed after explorative laparoscopy to carefully inspect the abdominopelvic cavity and assess any coexisting pelvic endometriotic lesions. Histological examination confirmed the diagnosis of umbilical endometriosis. Conclusion …

Minilaparoscopic hysterectomy.

Minilaparoscopic surgery was performed in a 38-year-old woman scheduled for hysterectomy and ovarian cystectomy. Image resolution was similar to that of conventional laparoscopy. There were no intraoperative or postoperative complications. Since it has many advantages and few complications, minilaparoscopy appears to be an attractive way to decrease morbidity associated with conventional laparoscopy. (J Am Assoc Gynecol Laparosc 5(4):97-100, 1998)

Fertility-Sparing Strategies for Early-Stage Endometrial Cancer: Stepping towards Precision Medicine Based on the Molecular Fingerprint

Endometrial cancer represents the fifth most common cancer in women, and the most common gynecological malignancy in developed countries [...]

Cell-Free Fetal DNA and Non-Invasive Prenatal Diagnosis of Chromosomopathies and Pediatric Monogenic Diseases: A Critical Appraisal and Medicolegal Remarks

Cell-free fetal DNA (cffDNA) analysis is a non-invasive prenatal diagnostic test with a fundamental role for the screening of chromosomic or monogenic pathologies of the fetus. Its administration is performed by fetal DNA detection in the mother’s blood from the fourth week of gestation. Given the great interest regarding its validation as a diagnostic tool, the authors have set out to undertake a critical appraisal based on a wide-ranging narrative review of 45 total studies centered around such techniques. Both chromosomopathies and monogenic diseases were taken into account and systematically discussed and elucidated. Not surprisingly, cell-free fetal DNA analysis for screening purposes …

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…

Laparoscopic retropubic colposuspension for the treatment of genuine stress incontinence. long term follow up

Objectives: The minimal surgical treatment of stress urinary incontinence with endoscopic operation has four basic advantages compared with traditional open procedures: decreased blood loss due to better visualization of the space of Retzius, decreased postoperative pain, shorter hospitalization and faster recovery. Comparative studies have shown a higher subjective and objective cure rate for the retropubic urethropexy(Burch procedure) than for the anterior colporraphy or endoscopic needle urethropexy(1). The aim of this study is to evaluate the safety, the efficacy and morbility of laparoscopic Burch procedure for the surgical treatment of genuine stress incontinence. Methods: We reviewed…

Gene expression profiling of peripheral blood mononuclear cells in endometriosis identifies genes altered in non-gynaecologic chronic inflammatory diseases

background: Pelvic inflammatory phenomena have been suggested as critical players in the natural history of endometriosis. However, to what extent these events could affect the systemic immunologic status remains to be clarified. Here, we compared the gene expression profile in peripheral blood mononuclear cells from endometriosis patients in the severe diseased stage with the profile after a conventional surgical treatment for removal of endometriotic lesions and adhesions.   methods: Microarray analysis included four patients suffering from severe endometriosis in which blood samples were obtained few days before the surgical intervention and again 6 months later. Real-time quantitative…

Diagnostic tools for female urethral diverticulum: Current perspectives

Although once considered quite a rare condition in the past, female urethral diverticulum (UD) would now appear to have a higher frequency, perhaps due to greater attention from physicians. To date, there is no agreement on which is the best method for diagnosis of female UD. Traditionally, the approach was based on quite invasive techniques, such as voiding cystourethrography, and double-balloon urethrography, with satisfactory results but relevant limitations. More recent high-resolution imaging techniques, such as 2D-3D ultrasonography (US) and magnetic resonance imaging (MRI) have also been applied in the study of the abnormalities of the female urethra. US had the advantage of the outp…

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 …

Impact of monopolar and bipolar endometrial resection on abnormal uterine bleeding

Study Objective. To compare two procedures for endometrial resection: resectoscopy with monopolar knife versus resectoscopy with bipolar knife. Patients and methods. 76 perimenopausal patients affected by DUB (Dysfunctional Uterine Bleeding), no longer wishing to remain pregnant and having failed to respond to pharmacological treatment, underwent endometrial ablation with monopolar loop (group A: 38 women) or bipolar loop (group B: 38 women). Operative parameters, complication rate, menstrual outcome were considered. Results. Operative time was no different between groups. The amount of distention fluid adsorbed was significantly higher in group A than in group B, and late cumulative compli…

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…

Adenomyotic Cyst in a 25-Year-Old Woman: Case Report

Adenomyotic cysts are uncommon findings, usually in the context of diffuse adenomyosis and <5 mm in diameter. Herein we report a 4.5-cm adenomyotic cyst in a 25-year-old nulliparous woman with severe dysmenorrhea and pelvic pain. Transvaginal ultrasonography and magnetic resonance imaging revealed a well-circumscribed hypoechogenic mass in the posterior uterine wall, well separated from the uterine cavity. Pathologic analysis demonstrated that the cyst was lined with endometrial epithelium and stroma and was surrounded by smooth muscle hyperplasia. In the literature, we found 30 reports of cysts with similar characteristics. Because this cyst has not been clearly defined, it has been called…

Laparoscopic Sacrocolpopexy in the treatment of Vaginal Vault Prolapse and Rectocele. Retrospective Study of 85 cases

Testo Atlante di Chirurgia Laparoscopica in Ginecologia

Progesterone: the key to success?

DIAGNOSI PRECOCE DELLA VENTRICOLOMEGALIA NEL I° TRIMESTRE:CASO CLINICO

THE HYDROCEPHALUS IS ONE OF THE MOST FREQUENT CONGENITAL ANOMALIES

Factors Associated with Anti-SARS-CoV-2 Vaccine Acceptance among Pregnant Women: Data from Outpatient Women Experiencing High-Risk Pregnancy

Pregnant women are at higher risk of severe Coronavirus disease 2019 (COVID-19) complications than non-pregnant women. The initial exclusion of pregnant women from anti-SARS-CoV-2 vaccines clinical trials has caused a lack of conclusive data about safety and efficacy for this vulnerable population. This cross-sectional study aims to define the factors related to vaccination adherence in a sample of women experiencing high-risk pregnancies. The recruited women completed a questionnaire based on the Health Belief Model. Data were analyzed to evaluate the associations between socio-demographic variables and vaccination acceptance through descriptive, univariate and multivariate logistic analys…

Sacrocolpopessia laparoscopica nel trattamento del prolasso della cupola vaginale: follow-up dopo 8 anni su 165 casi

Chirurgia Pre-Sling

Diagnosi e trattamento endoscopico dell'endometriosi vescicale

L’endometriosi coinvolge l’apparato urinario in circa 1-2% dei casi e la sede più frequentemente colpita e la vescica. Obiettivo del nostro studio e la valutazione dell’efficacia e della sicurezza del trattamento laparoscopico in corso di endometriosi vescicole, attraverso l’analisi degli aspetti clinici prima e dopo l’intervento. Dal Giugno 2005 al Gennaio 2007, abbiamo trattato mediante chirurgia laparoscopica otto donne affette da endometriosi vescicale. In tre pazienti la lesione interessava ilde-trusore a tutto spessore ed è stata necessaria una cistectomla parziale; negli altri cinque casi il nodulo endometriosico era più superficiale ed e stata sufficiente una resezione extramucoca …

Daphne II - Ve.R.S.O project: a new protocol for the management of sexual assault victims

Daphne II - Ve.R.S.O project: a new protocol for the management of sexual assault victims. Sexual assault is a worldwide problem that has not yet been sufficiently acknowledged, as confirmed by analyses and studies carried out at different levels and in different contexts. Internationally, different approaches are taken to the collection of forensic evi- dence and to the clinical and psychological treatment of alleged victims. Italian law n.96, 1996, foreseeing norms regarding rape and abuse, finally gave signifi- cant relevance to sex crimes. In 2004, the European Commission for Justice Internal Affairs and Social Politics promoted the Daphne II pro- gram to support victims of rape and abu…

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…

Placenta Accreta Spectrum Disorder in a Patient with Six Previous Caesarean Deliveries: Step by Step Management

The definition placenta accreta spectrum disorders (PAS) introduced by FIGO (International Federation of Gynaecology and Obstetrics) indicates an abnormal, pathological adherence or invasion of the placenta. The growing worldwide incidence of this pathological entity, and the possible serious correlated surgical risks, has caused a significant increase in attention among the scientific community. Previous caesarean delivery and presence of placenta previa are the main risk factors for the onset of PAS. Here, we present the intriguing case of a 39-year-old woman, at the 33rd week of gestation, with six previous caesarean sections and with a diagnosis of placenta previa accreta. At our referr…

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…

Septate uterus: nosographic overview and endoscopic treatment

To comment on the prevalence, diagnosis, and treatment of the septate uterus, with special reference to hysteroscopic metroplasty and its effect on reproductive outcome, we searched publications in PubMed and Embase. Original articles, meta-analysis, reviews, and opinion articles were selected. The studies suggest that the prevalence of the septate uterus is increased in women with repeated pregnancy loss and infertility. Reliable diagnosis depends on accurate assessment of the uterine fundal contour and uterine cavity by means of magnetic resonance and three-dimensional ultrasound. Pertinent published data comparing pregnancy outcome before and after hysteroscopic metroplasty indicated a m…

What are the Cancer Risks in BRCA Carriers Apart from Those Regarding the Breast and the Ovary?

Germline mutations in the tumor suppressor genes BRCA1 and BRCA2 predispose to familial breast and/or ovarian cancer. The lifetime risk of members of families with genetic predisposition depends on the mutations of susceptibility genes. BRCA1 mutations seem to confer the highest risk of developing neoplastic diseases. Apart from breast and ovarian cancer mutations in BRCA, related pathways are supposed to confer a smaller risk for additional cancers (colon, melanoma, pancreas, lymphoma, prostate, liver). All these tumors have an inherited component not necessarily associated with genetic susceptibility to BRCA genes. To date he main focus of this review has been argued still with difficulty…

Laparoscopic-assisted Retropubic Midurethral Sling Placement: A Technique to Avoid Major Complications

Abstract Study Objective To describe a technique for the safe placement of retropubic midurethral slings in patients undergoing concomitant laparoscopic surgery in order to avoid major complications associated with this procedure such as bladder perforation and retropubic hematomas. Design Step-by-step video demonstration of the technique. Setting A university tertiary care hospital. Patients Patients with an indication for retropubic midurethral sling placement because of recurrent stress urinary incontinence, intrinsic sphincter deficiency, or severe pelvic organ prolapse in whom a concomitant laparoscopic surgery has to be performed for other medical conditions. Intervention Laparoscopic…

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…

Burkitt’s lymphoma in pregnant woman: Difficult management of a rare case

Highlights • Burkitt’s lymphoma, an aggressive non-Hodgkin lymphoma, is extremely rare during pregnancy. • Lymphoma of the small intestine is often overlooked in the early stages of the disease. • We described a multidisciplinary approach, cesarean section with surgical intestinal exploration.

Early diagnosis and surgical management of heterotopic pregnancy allows us to save the intrauterine pregnancy

Heterotopic pregnancy is a rare but intriguing disease, which poses a high risk for pregnant women and for intrauterine pregnancy. Clinically, it is mainly characterized by pain and vaginal bleeding. b-hCG serum dosage is used to detect the pregnancy, but transvaginal ultrasound is needed to diagnose heterotopic pregnancy. From all the risk factors, the assisted reproductive treatments represent the most important, especially when multiple embryos are transferred. Patients with a heterotopic pregnancy are at risk of having a spontaneous or medically induced abortion, and for this reason appropriate and tailored treatment should be considered, pursuing the optimal risk/benefit ratio. Althoug…

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

Letter to Editor

Efficacy of Low-Dose Paroxetine for the Treatment of Hot Flushes in Surgical and Physiological Postmenopausal Women: Systematic Review and Meta-Analysis of Randomized Trials

Background and Objectives: Hot flushes and sleep disturbances are the most common vasomotor symptoms (VMS) reported by postmenopausal women. Hormonal treatment is to date referred to as the gold standard approach but not suitable for all the patients. Alternative treatments are needed in case of a contraindication to menopausal hormone therapy (MHT), adverse side effects, and poor compliance. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS. Nonetheless, few trials with low consensus are available about this topic. In this review, we aimed to evaluate the efficacy of low-dose paroxetine therapy in the treatment of v…

How Much of Familial Breast Cancer Risk is Currently Explained by the Known Genes?

The need to answer the question “how much of the familial risk is currently explained by the known genes?” has increased ,and although BRCA1 and BRCA2 are considered the two major breast cancer (BC) susceptibility genes, they do not justify the entire percentage of all hereditary BC cases. The current consensus is that other BC predisposing genes could explain at least a portion of the remaining non-mutated familial cases, including not only other high- penetrance BC genes, but also moderate and low-penetrance genes. Considering these three different categories of genes, a gap of risk estimation in breast cancer can be observed. Moreover, different researchers tried to give significance to …

Uterine preservation in pelvic organ prolapse and urinary stress incontinence using robot-assisted laparoscopic surgery. Case report

Highlights • Pelvic organ prolapse (POP) represents a common and bothersome condition in parous women. • The demand to “save” the uterus has fuelled a renewal of the surgical technique. • Robotic surgery was conceived with the intent to overcome the limitations of laparoscopic surgery. • The characteristics of the robotic system help surgeons to perform conservative management of POP.

Laparoscopic management of diaphragmatic endometriosis: what can we learn