HPV infection in male partners of infertile couples seems to not affect seminal parameters

[P-057] HPV infection in male partners of infertile couples seems to not affect seminal parameters A.M. Brucculeri1, G. Ruvolo1, L. Giovannelli2, R. Schillaci3, E. Cittadini1, G. Scaravelli4, A. Perino3. 1Centro di Biologia della Riproduzione, Centro di Biologia della Riproduzione, Palermo, Italy; 2University of Palermo, Dipartimento di Scienze per la Promozione della Salute, Palermo, Italy; 3University of Palermo, Dipartimento Materno Infantile, Palermo, Italy; 4Istituto Superiore di Sanità, Istituto Superiore di Sanità, Roma, Italy Introduction: Human papilloma viruses (HPV) are agents of the most common sexually transmitted disease. This small DNA viruses induce epithelial cell prolifera…

Simplified first-trimester fetal cardiac screening (four chamber view and ventricular outflow tracts) in a low-risk population

Objectives Our aim was to assess the accuracy of a simplified fetal cardiac study, inclusive of four-chamber view (4CV) and ventricular outflow tracts, performed during the 11–14 week screening by well-trained obstetricians to detect congenital heart diseases (CHDs). Methods A transabdominal ultrasound was performed on 4820 singleton pregnant women at 11–14 weeks to visualize the visceral site, the 4CV, and the outflow tracts. Neonatal outcomes were recorded 6 and 12 months after birth. Results Among the 4820 patients reviewed, 790 were excluded because of loss at prenatal or postnatal follow-up (649 cases), or inability to obtain adequate first-trimester sonographic cardiac evaluation (141…

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…

Prevalence of human papilloma virus infection in patients with male accessory gland infection

The frequency of human papillomavirus (HPV) infection in the semen of patients with male accessory gland infection (MAGI) was evaluated. One hundred infertile patients with MAGI were classified into group A: patients with an inflammatory MAGI (n = 48) and group B: patients with a microbial form (n = 52). Healthy age-matched fertile men (34.0 ± 4.0 years) made up the control group (n = 20). Amplification of HPV DNA was carried out by HPV-HS Bio nested polymerase chain reaction for the detection of HPV DNA sequences within the L1 ORF. Ten patients in group A (20.8%) and 15 patients in group B (28.8%) had a HPV infection; two controls (10.0%) had HPV infection. Patients with MAGI had a signifi…

HPV in semen: evaluation of the link among infection, sperm parameters and viral genome integration

Human papillomaviruses (HPVs) are agents of the most common sexually transmitted diseases. Both in men and in women, HPVs cause a variety of clinical symptoms ranging from warts to cancer. It has been shown that infection with oncogenic HPV is the major cause of development of cervical cancer in women and less frequently of penile cancers in men. HPV infects epithelial cells and can bind other cell types. Its presence in semen is widely known, but the effects on fertility and reproductive function are still controversial. Partners of women with high-grade squamous intraepithelial lesions were enrolled. From each subject seminal parameters were evaluated. HPV was detected and genotyped both …

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...

Persistence of human papillomavirus infection in men evaluated by analysing multiple genital sites

HPV Infection in partners of women with HPV positive cervical cytology: diagnosis by sampling different genital sites.

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…

Excision of ectopic adrenocortical tissue during laparoscopy for isolated tubal torsion

Ectopic adrenal tissue is an occasional finding during surgery procedures. These remnants are usually found near the primary gland or along the course of gonadal vessels consistently with embryologic development. The appearance is of a small but distinct, soft, round, yellow nodule and only cortical adrenal tissue is normally observed. We report a case of an emergency laparoscopic salpingostomy for isolated tubal torsion with excision of EAT, incidentally found in left ovarian pedicle, followed by postoperative resumption of regular menses and regression of hirsutism. Although intraoperative research of ectopic adrenal tissue is not necessary its removal is indicated in case of incidental f…

Is x-ray compulsory in pubic symphysis diastasis diagnosis?

SirWe read with great interest your case of postpartum symphy-sis pubis separation (1). We would like to present a case ofpubic symphysis diastasis that we diagnosed with a differentapproach.A 36-year-old gravida 1 para 0 at 39.6 weeks’ gestation wasadmitted with the onset of spontaneous contraction. After threehours and 18 min she delivered a 3170 g baby without compli-cations.Three hours after delivery, she complained of severe pain inthe symphysis pubic region. On examination, there was localtenderness in that region. We performed an ultrasound exami-nation, which revealed a 15.2-mm gap in the region of the sym-physis pubis (Figure 1), diagnosed as pubic symphysis diastasis.She was given…

Molecular analyses on HPV infections in semen

Introduction: Human Papillomaviruses (HPVs) are non-enveloped double stranded DNA viruses classified in different genera and several different genotypes. Depending on the genotypes, HPV infections can be asymptomatic or can cause from warts to malignant tumours. Some genotypes, such as HPV18 and HPV16, are considered high risk (HR) HPVs and they are the major cause of cervical cancer. HPV is highly tissue-tropic and infects epithelial cells, but it can also binds other cell types. It is known that HPV can be found in semen but its effects on spermatozoa and male reproductive system are not completely clarified. Materials and Methods: In order to study the HPV infection in semen, we develope…

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.

Timing of embryo transfer: correlation between embryonic stage and IVF outcome

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…

Selection of the best three oocytes for intracytoplasmic sperm injection (ICSI) using apoptotic analysis of cumulus cells

Introduction: We studied the apoptosis rate of the cumulus cells of individual cumulus-oocyte complex (COC), to verify a relationship with clinical outcomes, in terms of pregnancy and implantation rates. Usually oocytes are selected using morphological criteria. We tried to verify if cumulus cell apoptotic rate could be used as a molecular criteria in selecting oocytes with higher implantation potentiality. Material and Methods: The study design consisted in two different trials: in the first we investigated apoptosis rate in cumulus cells of the three selected oocytes, according to Italian law, to be fertilized by intracytoplasmic sperm injection (ICSI). In a second trial, average apoptosi…

Determinants of short term recurrence rate of endometriosis

Objective: To analyse the frequency and the determinants of recurrence rate of clinically detectable endometriosis. Study design: Prospective cohort multicenter study. Eligible for the study were all women observed for the first time during the period January–June 1998 at the participating centres with a laparoscopically confirmed first diagnosis of endometriosis. After diagnosis, patients were treated according to standard care of each centre and desire for pregnancy. The protocol required all women to be followed up at the centre each year for 2 years with a clinical examination, an ultrasound pelvic examination and a CA125 assay, unless pregnancy occurred. Second look laparoscopy was per…

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…

Human Papilloma virus association with outcome of in vitro fertilization : a prospective study.

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 …

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…

Laparoscopic management of quadruplet heterotopic pregnancy after ovarian stimulation cycle

Introduction. We report a rare case of a heterotopic abdominal pregnancy with three intrauterine pregnancy, one with a viable fetus, treated successfully by laparoscopy. Methods. A 40-year-old patient with primary sterility, who un- derwent pharmacological ovulation induction, presented abdominal pain in the right iliac region. A trans-vaginal ultrasound showed an image suggestive of ectopic gestation near the right ovary, associated with three intrauterine gestational sacs with only one viable fetus. Basing on this observation, we performed an operative laparoscopy that confirmed the presence of a right ectopic abdominal pregnancy. Since the right ampullar tubal was ruptured and bleeding, …

Reproductive outcomes in couples affected by human papillomavirus infection undergoing in vitro fertilization procedures

Reproductive outcomes in couples affected by human papillomavirus infection undergoing in vitro fertilization procedures G. Ruvolo1, L. Giovannelli2, R. Schillaci3, P. Alimondi3, A. Pane1, A. Perino3, E. Cittadini1 1Centro di Biologia della Riproduzione, Centro di Biologia della Riproduzione, Palermo, Italy 2Dipartimento di Scienze per la Promozione della Salute, Dipartimento di Scienze per la Promozione della Salute, Palermo, Italy 3Dipartimento Materno Infantile University of Palermo, Dipartimento Materno Infantile University of Palermo, Palermo, Italy Introduction: Genital human papillomavirus (HPV) infection is the most common sexually transmitted viral infection worldwide, and has been…

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

Follow up endometriale in pazienti trattate con tamoxifene dopo intervento per carcinoma mammario

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 …

Carcinoma della cervice uterina: Monitoraggio delle strategie di prevenzione primaria e secondaria nella provincia di Palermo.

CONCORDANCE AND DISTRIBUTION OF HPV GENOTYPES IN HPV INFECTED SEXUAL COUPLES

Introductions: The characteristics of HPV infection in women have been extensively investigates, however, only a few studies have analyzed the characteristics of HPV infection in men and in sexual couples. Materials and methods: 195 sexual couples positive for HPV-DNA were examined, at the Virology laboratory of the Department of Sciences for Health Promotion and Mother and Child Care (Policlinico, University of Palermo, Italy). HPV-DNA detection was performed by the INNOLiPA HPV Genotyping Extra II Test (Fujirebio) and nested PCR/sequencing method. All women (range: 20-60, mean age: 31.5 ys) had performed a pap smear and knew the cytological diagnosis: 73 (37.4%) negative at Pap smear, 21 …

Riscontro di HPV DNA in brushing penieno, tampone uretrale e liquido seminale di partners di donne HPV positive: analisi della prevalenza e della concordanza tipo-specifica nella coppia.

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

[No abstract available]

Effetti dell'infezione da HPV sugli esiti della fecondazione in vitro in pazienti sterili: dati preliminari di uno studio prospettico

PARASITIC DERMOID CYST COEXISTING WITH ABSENCE OF AN ADNEXA

L’impianto nei cicli FIV: il valore predittivo dell’ultrasonografia in uno studio controllato

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…

Recombinant human LH supplementation versus recombinant human FSH (rFSH) step-up protocol during controlled ovarian stimulation in normogonadotrophic women with initial inadequate ovarian response to rFSH. A multicentre, prospective, randomized controlled trial

Background: In ∼ 12-14% of young normogonadotrophic women treated with a depot GnRH agonist long protocol, the initial ovarian response to recombinant human FSH (rFSH) can be suboptimal. We have tested the hypothesis that these women may benefit from recombinant human LH (rLH) supplementation in a multicentre, prospective, randomized trial compared with patients treated with an rFSH step-up protocol. Methods: A total of 260 young normogonadotrophic women undergoing controlled ovarian stimulation with a GnRH agonist long protocol for IVF/ICSI were enrolled. The starting dose of rFSH was 225 IU. One hundred and thirty patients with serum estradiol levels 5 mm but none >10 mm on both day 5 and…

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…

Use of trans-labial ultrasound in the diagnosis of female urethral diverticula: A diagnostic option to be strongly considered.

AIM: To demonstrate effectiveness of trans-labial ultrasound (TL-US) in the evaluation of female urethral diverticula (UD). METHODS: In the study period, 20 UD were diagnosed and treated. All data on demographic characteristics, presenting symptoms, physical examination findings, diagnostic and operative procedures, were considered. Patients were referred to TL-US for diverticular evaluation, using a 2D 7.5-MHz endfire probe. For each UD, size, complexity, echogenicity content, and presence of diverticular neck were considered. Follow-up controls were carried out at 1, 6 and 12 months after surgery, to evaluate outcome and need for further intervention. RESULTS: Mean patient age was 46 year…

Role of HPV Infection in the outcome of in-vitro fertilization

Resectoscope versus small diameter hysteroscopy for endometrial polypectomy in patients with "unfavorable" cervix

BACKGROUND: The aim of this study was to compare resectoscopic and small-diameter hysteroscopic techniques for endometrial polypectomy in patients with "unfavorable" cervix.METHODS: Eighty women with a single 2-4 cm sized endometrial polyp, with unfavorable cervical anatomical conditions were enrolled in the study. Forty patients were treated with a 26F resectoscope requiring cervical dilatation (group A), forty patients were treated with a 5-mm hysteroscope requiring vaginoscopic approach (group B). Operative time, fluid absorption, complications, instrument failure, postoperative pain, overnight stay were analyzed. Operative visualization, operative difficulty and overall surgeon's satisf…

Follow-up endometriale in pazienti trattate con tamoxifene per carcinoma mammario

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…

Potential impact of a nonavalent anti HPV vaccine in Italian men with and without clinical manifestations

AbstractHuman papilloma virus infection (HPV) is the most common sexually transmitted disease. Little is known about male infection. Nonavalent vaccine against types 6/11/16/18/31/33/45/52/58 was approved and neutral gender immunization programs have been proposed. This study evaluates the potential impact of nonavalent vaccine compared to quadrivalent in male living in Sicily (Italy). 58.7% of samples were HPV positive and forty-four types of HPV were identified. A significant higher estimated coverage of nonavalent vaccine than quadrivalent was observed (64.3% vs. 45.8%), with absolute and relative additional impact of 20.1% and 47.2%, respectively. Low impact of the vaccine were calculat…

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…

la papulosi bowenoide: descrizione di uin caso clinico

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…

Efficacy and acceptance of the sacral neuromodulation in the treatment of female lower urinary tract dysfunctions.

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 …

The Role of Hysteroscopy in the Diagnosis and Treatment of Adenomyosis

Uterine adenomyosis is a common gynecologic disorder in women of reproductive age, characterized by the presence of ectopic endometrial glands and stroma within the myometrium. Dysmenorrhea, abnormal uterine bleeding, chronic pelvic pain, and deep dyspareunia are common symptoms of this pathological condition. However, adenomyosis is often an incidental finding in specimens obtained from hysterectomy or uterine biopsies. The recent evolution of diagnostic imaging techniques, such as transvaginal sonography, hysterosalpingography, and magnetic resonance imaging, has contributed to improving accuracy in the identification of this pathology. Hysteroscopy offers the advantage of direct visualiz…

Laparoscopic treatment of diaphragmatic endometriosis causing chronic shoulder and arm pain

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 …

Immunogenicity and safety of a nine-valent human papillomavirus vaccine in women 27–45 years of age compared to women 16–26 years of age: An open-label phase 3 study

Abstract: Background: Efficacy of the nine-valent human papillomavirus (9vHPV; HPV types 6/11/16/18/31/33/45/52/58) vaccine was demonstrated in a phase 3 study in women 16 & ndash;26 years of age. We present a phase 3 immunogenicity and safety study of the 9vHPV vaccine in women 27 & ndash;45 versus 16 & ndash;26 years of age. Methods: This international, open-label study (NCT03158220) was conducted in women 16 & ndash;45 years of age. Participants (16 & ndash;26 years, n = 570 and 27 & ndash;45 years, n = 642) received a three-dose 9vHPV vaccination regimen (day 1, month 2, month 6). Month 7 geometric mean titers (GMTs) and seroconversion percentages to anti-HPV 6/11/16/18/31/33/45/52/58 w…

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…

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 …

Imaging ecografico del cordone ombelicale umano.

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…

Imaging ecografico del cordone ombelicale umano Ecographic imaging of the human umbilical cord

Endometriosis and strategies of fertility preservation: a systematic review of the literature.

Endometriosis is a common chronic inflammatory disorder, often causing both pain and infertility. It is estimated that 25-50 % of patients undergoing fertility treatments have had endometriosis as it involves an impairment of the ovarian reserve. For these reasons, endometriosis has been highlighted as a condition that may require a fertility preservation procedure, while being benign in nature. The aim of this review is to summarize the current evidence on fertility preservation techniques for patients affected by endometriosis, focusing on the main characteristics of the different approaches. A systematic review of literature was performed by searching in the main electronic databases (ME…

Prevenzione del carcinoma della cervice uterina: monitoraggio delle strategie di prevenzione primaria e secondaria nella provincia di palermo

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…

Human papillomavirus infection in couples undergoing in vitro fertilization procedures: impact on reproductive outcome

Fattori influenzantin l'esordio del diabete mellito tipo 1 in bambini immigrati

EPIDEMIOLOGIA DELLE LESIONI PRE-NEOPLASTICHE E NEOPLASTICHE DELLA CERVICE UTERINA

Randomized study of subcutaneous low molecular weight heparin plus aspirin versus intravenous immunoglobulin in the treatment of recurrent fetal loss associated with antiphospholipid antibodies.

Objective To compare the 2 most efficacious therapeutic regimens, intravenous immunoglobulin (IVIG) and anticoagulation with low molecular weight (LMW) heparin plus low-dose aspirin, in women with recurrent pregnancy loss associated with antiphospholipid antibodies (aPL). Methods We examined 40 women with recurrent abortion (at least 3 occurrences) and repeatedly positive test results for anticardiolipin or lupus anticoagulant. The subjects were randomly assigned to treatment with IVIG or LMW heparin plus low-dose aspirin. Both therapies were started when the women were pregnant as documented by a positive urine test. IVIG was stopped at the thirty-first week of gestation, aspirin at the th…

IVIG in APS pregnancy

For more than two decades, the intravenous administration of high doses of IgG pooled from the plasma of healthy donors (immune globulin therapy, also known as ‘IVIG’) has benefited patients with a variety of autoimmune disorders. A potential therapeutic role of IVIG in the prevention of thrombosis and of miscarriages in antiphospholipid syndrome (APS) has been postulated. Multicenter randomized controlled trials attempted to define the role of IVIG in preventing pregnancy complications in APS indicate that simple anticoagulation could not be completely satisfactory, and certain patient subgroups might take advantage of IVIG therapy alone or in combination with heparin.

HPV infection in semen: results from a new molecular approach

AbstractHuman papillomavirus (HPV) is the agent of the most common sexually transmitted diseases causing a variety of clinical manifestations ranging from warts to cancer. Oncogenic HPV infection is the major cause of cervical cancer and less frequently of penile cancers. Its presence in semen is widely known, but the effects on fertility are still controversial. We developed a new approach to evaluate virus localisation in the different semen components. We analysed also the specific genotype localisation and viral DNA quantity by qPCR. Results show that HPV DNA can be identified in every fraction of semen: spermatozoa, somatic cells and seminal plasma. Different samples can contain the HP…

Ablazione endometriale: le tecniche di seconda generazione

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

Chirurgia Pre-Sling

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…

Role of hysteroscopy in endometrial osseus metaplasia diagnosis: case report and literature review

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…

Effetti del Papillomavirus genitale sulla riproduzione umana

Human papillomaviruses (HPVs) are agents of the most common sexually transmitted disease that can infect both females and males. More than 100 HPV-genotypes are known, of these, 40 genotypes infect the low genital tract. Based on their association with cervical cancer and precursor lesions, genital HPVs can also be grouped to high-risk and low-risk HPV-types. Diagnosis of HPV infection is sometime difficult because the infection is often transient and asymptomatic. High-risk HPV types are more likely to persist than are low-risk HPV types. It’s the inability of the immune system to spontaneously clear HPV that leads to development of precancerous cervical lesions. It is generally assumed th…

Infezione cervicale da HPV e genotipi prevalenti nella popolazione giovanile siciliana

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

PREVALENCE OF HPV INFECTION AND TYPES AMONG WOMEN AGED 18 TO >25 IN SICILY, SOUTH ITALY

“Outcome” della FIV dopo coltura e transfer di blastocisti ottenute con e senza l’ausilio della cocoltura

La coltura "in vitro" di blastocisti fu messa a punto agli inizi degli anni '80 in alcune specie di animali d'allevamento (Camous, 1984) e solo successivamente applicata agli embrioni umani. Scopo della tecnica era quello di incrementare le percentuali di impianto nei cicli FIV riducendo il numero di embrioni trasferiti. La coltura di blastocisti consentiva, infatti, di effettuare il trasferimento di embrioni con elevate potenzialità evolutive e in perfetto sincronismo con l'endometrio uterino. Attraverso il sistema della cocoltura fu possibile supportare lo sviluppo embrionario "in vitro" dallo stadio di singola cellula a quello di blastocisti con l'ausilio di monostrati cellulari costitui…

Peritoneal tuberculosis in the differential diagnosis with peritoneal carcinomatosis: Case report and literature review

Tuberculosis is a severe public health problem in developing countries, but it is taking on the characteristics of a global epidemic. By virtue of migration flows, in fact, we are observing a resurgence of this disease in western countries, in all its forms including the genital one. The problem became more serious with the emergence of multidrug-resistant mutant (MDR) strains of Mycobacterium Tuberculosis. In this paper we describe a case of peritoneal tuberculosis, whose diagnosis was histologically made after laparoscopic examination. Laparoscopy proved crucial for the differential diagnosis with peritoneal carcinomatosis, particularly following the discrepancy in the results provided by…

Laparoscopic management of diaphragmatic endometriosis: what can we learn

VACCINO QUADRIVALENTE ANTI-HPV NELLA PREVENZIONE DELLA PATOLOGIA VAGINALE, VULVARE E DEI CONDILOMI ANOGENITALI

Valutazione della infezione cervicale da HPV e dei genotipi prevalenti nella popolazione siciliana femminile di età compresa tra 18 e 25 anni. Dati preliminari

Diagnosi precoce del carcinoma endometriale

Riscontro di HPV DNA in brushing penino, tampone uretrale e liquido seminale di partners di donne HPV positive; analisi della prevalenza e della concordanza tipo-specifica nella coppia