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Due to the high number of cesarean sections over the last two decades, there has been a growing awareness of the post-surgical obstetric long-term sequelae (i.e., uterine scar defects and abnormal placentation) following this surgical procedure. Knotless barbed suture is an absorbable bidirectional and unidirectional monofilament, characterized by the presence of "barbs" along its length. After being introduced in gynecology, the favorable features of the knotless barbed suture, such as the uniform distribution of tensile force, provide the rationale for studying its benefits in obstetric surgery. Recently, our research group has investigated a double-layer barbed suture ("fishbone" suture) for closing the uterine wall during cesarean section by a case–control study, reporting a low incidence of uterine scar defects and a reduced size of defects in women who had developed them (NCT04825821). In the near future, large prospective studies are strongly awaited to investigate reproductive outcomes and long-term sequelae after cesarean section performed with knotless barbed suture. [ABSTRACT FROM AUTHOR]

Correspondence to the original research entitled "Effects of ranibizumab and zoledronic acid on endometriosis in a rat model" published by Ozdemir et al. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effectiveness and safety of periurethral injections (PIs) of polyacrylamide hydrogel (PAHG, Bulkamid) for the treatment of female stress urinary incontinence (SUI). Methods: This double-centre prospective study included 82 female patients with SUI who were treated with PIs of PAHG between January 2008 and December 2010 in outpatient setting. The International Consultation on Incontinence Questionnaire short form (ICIQ-SF) and the Patient Global Improvement Impression (PGI-I) were used to assess incontinence and patient satisfaction after treatment. The impact of incontinence on quality of life (QoL) was investigated using the Incontinence Impact Questionnaire (IIQ-7). Results: All patients were discharged on the same day of treatment and there was no intraoperative complication. At 1-year follow-up, the efficacy of PIs of PAHG (subjective success rate) was 74.4 %. The subjective responder rate was 86.6 %, 8.5 % of patients had no change and no patient reported worsening of symptoms. The mean number of episodes of urine leakage/24 h and the mean leakage/24 h significantly decreased after treatment. At 1-year follow-up, the IIQ-7 results were significantly improved compared with baseline. 25.6 % of patients had adverse events (mainly urinary tract infections and injection site pain). Conclusion: This study demonstrates that PIs of PAHG are effective and safe and cause significant improvement of the QoL at 1-year follow-up. PIs of PAHG can be safely performed in an ambulatory setting and patients may be discharged on the day of the procedure. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the changes in the volume of rectovaginal endometriotic nodules infiltrating the rectum during 12-month treatment with hormonal therapies. Materials and methods: This prospective, non-randomized, self-controlled clinical trial included patients with rectovaginal endometriotic nodules infiltrating at least the muscularis propria of the rectum, who received one of the following therapies: norethisterone acetate, triptorelin and tibolone, norethisterone acetate and letrozole, desogestrel, sequential oral contraceptive pill. The volume of the nodules was determined by virtual organ computer-aided analysis (VOCAL, GE Healthcare, USA) at baseline and after 6 and 12 months of treatment. Results: Eighty-three women (90.2 %) completed the 12-month treatment. When compared with baseline values, the volume of the nodules decreased at 6-month ( p < 0.001) and 12-month treatment ( p < 0.001). After 12-month treatment, the volume of the nodules decreased in all study groups. The volume of the nodules decreased during therapy in 68 women (73.9 %) and increased in 11 women (12.0 %). Conclusion: 12-month administration of hormonal therapies reduces the volume of rectovaginal endometriotic nodules infiltrating the rectum in the majority of cases. [ABSTRACT FROM AUTHOR]

Purpose: This study compares the feasibility and outcome of sacrospinous colpopexy for treating vaginal vault prolapse (VVP) performed by either the traditional technique or a simplified procedure using the Capio™ suture-capturing device. Materials and methods: Eighty-six patients with VVP were included in the study. Forty-two patients were treated by traditional sacrospinous colpopexy (TSC group) and 44 patients were treated by the modified technique using the Capio device (CSC group). Additional procedures were performed to restore concomitant pelvic floor defects. Results: The mean (±SD) total operative time was significantly lower in the CSC group (71.7 ± 24.5 min) than in the TSC group (105.5 ± 31.5 min; p < 0.001); the intraoperative blood loss was higher in the TSC group than in the CSC group. In the CSC group, the mean operative time required to perform sacrospinous colpopexy was 21.4 ± 3.2 min. In patients who underwent only sacrospinous colpopexy, the time required to perform surgery was significantly lower in the CSC group (20.9 ± 3.3 min) than in the TSC group (39.1 ± 5.2 min; p < 0.001). There was no significant difference in the incidence of surgical complications between the two study groups. The objective and subjective success rates at 3-year follow-up were 88.1 and 92.9 % in the TSC group while in the CSC group they were 86.4 and 92.9 %. Conclusion: The modified technique of sacrospinous ligament fixation using the Capio device reduces the operative time and blood loss when compared to the traditional technique. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to present the clinical characteristics of a series of postmenopausal women with endometriosis and to evaluate the preferential location, extension and histopathological features of the lesions. Methods: We retrospectively examined the clinical records of 72 postmenopausal women with endometriosis who underwent surgery between January 1998 and December 2010. Results: The median age of patients at the time of surgery was 58.5 years. Eleven patients (15.3 %) had previous history of endometriosis and five patients had previously undergone surgery for this reason. Only two patients included in the study were using hormone replacement therapy at the time of surgery. The most frequent location of endometriotic lesions was the ovary and among patients with endometriomas, 35 % (20/57) had different grades of metaplasia, hyperplasia, atypia and endometrioid carcinoma arising in endometriosis. The proportions of epithelium, stroma and hemorrhage in endometriotic lesions were higher in patients with concomitant endometrial or ovarian cancer. Conclusions: Endometriosis should be considered in the differential diagnosis of postmenopausal cystic lesions of the ovary. The administration of exogenous estrogen is not a prerequisite for the presence of endometriosis in postmenopausal women, and histological signs of functionally active lesions were also observed in the absence of exogenous hormone intake. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the available information on the preoperative diagnosis of borderline ovarian tumors (BOTs). Methods: Articles were identified through electronic databases (Medline and EMBASE, MEDLINE, PubMed), no date or language restrictions were placed; relevant citations were hand searched. Results: Women with BOTs are more likely to have no symptom than women with invasive ovarian cancers; however, the type of symptoms is similar in patients with BOTs and invasive ovarian cancers. Up to 61% of women with BOTs have elevated CA-125; CA 19.9 and endoglin are not useful for diagnosing BOTs. Further studies are required to determine whether the measurements of calprotectin, oviductal glycoprotein 1 and growth differentiation factor-15 are useful for diagnosing BOTs. Ultrasonography and magnetic resonance imaging (MRI) are the mainstay for the diagnosis of BOTs. Combining MRI and positron emission tomography may facilitate the identification of BOTs. Conclusion: After completion of this article, the reader should be aware of the symptoms of BOTs, the potential role and pitfalls of tumor marker measurement. In addition, the reader will understand the appearance of BOTs at imaging techniques; the reader will be able to compare and combine ultrasonography, MRI and positron emission tomography in diagnosing BOTs. In clinical practice, the reader should be better able to assess whether an ovarian mass is a benign tumor, a BOT or an invasive cancer. [ABSTRACT FROM AUTHOR]

According to current definition, peripartum cardiomyopathy (PPCM) is a rare disorder in which left ventricular dysfunction and symptoms of heart failure occur in the last month of pregnancy. It has been reported that the incidence of PPCM is 1 in 3,000–4,000 live births. The pathogenesis is poorly understood, however, infectious, immunologic, and nutritional causes have been hypothesized. Clinical presentation includes usual signs and symptoms of heart failure, and unusual presentations such as thromboembolism. Diagnosis is based upon the clinical presentation of congestive heart failure and the objective evidence of left ventricular systolic dysfunction. Early diagnosis and initiation of treatment are essential to optimize pregnancy outcome. Patients with systolic dysfunction during pregnancy are treated similar to patients who are not pregnant. The mainstays of medical therapy are digoxin, loop diuretics, sodium restriction and afterload reducing agents (hydralazine and nitrates). Due to a high risk for venous and arterial thrombosis, anticoagulation with subcutaneous heparin should be instituted. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers should be avoided during pregnancy because of severe adverse neonatal effects. Effective treatment reduces mortality rates and increases the number of women who fully recover left ventricular systolic function. The prognosis is poor in patients with persistent cardiomyopathy. Subsequent pregnancies are often associated with recurrence of left ventricular systolic dysfunction. [ABSTRACT FROM AUTHOR]

The aim of this randomized, surgeon-blind, controlled study was to evaluate the role of a 7 days minimal-residue (low fibre intake) pre-operative diet compared with a mechanical bowel preparation in laparoscopic benign gynaecological surgery. This was a randomized, surgeon-blind, controlled study. The study included 83 women scheduled to undergo diagnostic or operative laparoscopy for various gynaecological benign conditions. Exclusion criteria were suspicion of malignancy, associated non-gynaecological surgical pathologies, severe endometriosis, and history of previous abdominal surgery. Study group had a total daily fibre intake inferior to 10 g for a week before the operation ( n = 42). Control group had a mechanical bowel preparation the day before the operation ( n = 41). The principal measures of outcome were the quality of bowel preparation, the acceptability of the preoperative diet and of the mechanical bowel preparation. Secondary outcomes included postoperative pain, time of ambulation, length of postoperative ileus, and length of postoperative hospital stay. The two treatment groups were comparable with respect to demographic characteristics and indications for surgery. Preoperatively, abdominal distension and overall discomfort were significantly more frequent in the control group ( P = 0.061 and 0.034 respectively). There was no significant difference in the small and large bowel preparation between the two groups. Postoperatively, no significant difference was observed between the two groups in pain, nausea, abdominal swelling, length of ileus, and of postoperative stay. This study shows that preoperative low fibre diet and mechanical bowel preparation provide similar quality of surgical field exposure. However, when compared with mechanical bowel preparation, preoperative low fibre diet may be better tolerated by the patients, thus increasing compliance. Moreover, a 7 days preoperative low fibre diet allow the patient to continue working and social activities until the day of surgery without requiring admission to the hospital or home bowel preparation on the day before surgery. [ABSTRACT FROM AUTHOR]

To compare the peritoneal fluid (PF) proteome of women with and without uterine leiomyomas. PF samples were collected at laparoscopy from 14 women with uterine leiomyomas and 14 patients without leiomyomas who underwent tubal sterilization. PF samples were subjected to two-dimensional gel electrophoresis, silver stained, digitally captured, and compared by computerised analysis. Protein spots with aberrant expression in PF of women with leiomyomas were identified by liquid chromatography tandem mass spectrometry. One isoform of leucine-rich alpha-2-glycoprotein (LRGm), one immunoglobulin light chain, and one unidentified protein (pI: 5.62; M r: 51.1 kDa) had significantly higher expression in PF of women with leiomyomas. Two isoforms of fibrinogen gamma chain had decreased expression in PF of women with uterine leiomyomas. Following Bonferroni correction for multiple comparisons, the aberrant expressions of LRGm and of one isoform of fibrinogen gamma chain was confirmed. The expression of these molecules was not affected by the phase of the menstrual cycle. Uterine leiomyomas are associated with changes in proteins present within the peritoneal fluid. The physiopathological relevance of the increased expression of LRGm in PF of women with uterine leiomyomas remains unclear. [ABSTRACT FROM AUTHOR]

The aim of the current study is to evaluate the differences in the rate of perinatal group B streptococcal vertical transmission between women who correctly underwent the CDC 2002 guidelines and women who did not. Two study groups: women who correctly underwent the CDC 2002 guidelines (study group 1) and women who did not (study group 2). Intrapartum chemoprophylaxis (IC) was administered to all pregnant women identified as GBS carrier. All newborns received, in the first hour of life, a culture based screening for GBS colonization. One thousand six hundred and sixty nine women were enrolled in the study. The 2002 CDC guidelines were correctly applied in 1273 (76.3%) subjects. There was no early-onset GBS disease. No statistically significant difference in the total number of colonized newborns between study group 1 (4.1%) and study group 2 (3.3%) was found. When the analysis was limited to women with positive GBS screening, a significant difference ( P < 0.001) was observed in the number of colonized newborns between mothers who received IC during at least 4 h (group 1; 3.7%) and those who received an IC during less than 4 h (group 1; 12.3%). The accurate application of the 2002 CDC guidelines is strongly supported but, to furthermore reduce the risk for GBS colonization and sepsis in the newborns, it appears desirable to identify additional and new prevention strategies. [ABSTRACT FROM AUTHOR]

This cross-sectional survey investigates patients’ attitudes towards the use of photos of children born following infertility treatment. Each partner of 270 infertile couples independently completed a standardized questionnaire investigating patients’ attitudes towards the presence of photos of children born following infertility treatment in fertility clinics, Internet websites, brochure, and videos. Subjects (77.4%) were pleased to provide a photo of their child to hang on the walls of the fertility centre, a lower percentage of subjects desired to exhibit the photo in the fertility centre website, brochure, and video. Among subjects wishing to hang the photo of their child in the infertility centre, 60.3% wanted the name of the child on the photo and 15.3% wanted both the name and surname of the child on the photo. If a photo is explicitly requested by a member of the fertility team, 30.9% of the subjects feel to have the duty to give it. No significant difference was observed in the desire to provide a photo of the child to hang on the walls of the fertility centre according to sex of the patient. The majority of infertile patients are pleased to exhibit a photo of their babies in the fertility centre. Members of the fertility team should avoid asking explicitly the photo because parents may feel to have the duty to give it. [ABSTRACT FROM AUTHOR]

Introduction.. An increased incidence of maternal cardiac arrhythmias is observed during pregnancy and they can range from clinically irrelevant isolated premature beats to debilitating supraventricular and ventricular tachycardias. Discussion.. Management of arrhythmias during pregnancy is similar to that in non-pregnant patients. However, the presence of the foetus and the risk of teratogenicity, the haemodynamic changes, the effect of therapy on labour, delivery and lactation must be evaluated. Antiarrhythmic drug selection depends on the specific arrhythmia being treated and the cardiac condition of the mother. Although no drug is completely safe, most are well tolerated and can be given with relatively low risk. Some antiarrhythmic agents, such as propranolol, metoprolol, digoxin and quinidine, have been extensively tested during pregnancy and have proved to be safe; they should therefore, whenever possible, be used as a first-line. For supraventricular tachycardia, intravenous adenosine may be used to terminate the arrhythmia if vagal manoeuvres fail. If possible, drug therapy should be avoided during the first trimester of pregnancy. When drug treatment fails or is not indicated because of the haemodynamic instability of the patient, direct current cardioversion can be used. Conclusion.. Most patients with arrhythmias during pregnancy can be treated with an excellent result. [ABSTRACT FROM AUTHOR]

This retrospective study evaluated complications associated with caesarean section in HIV-infected women. For each HIV-positive patient (n=45) a control group of ten seronegative women (n=450) was matched for age, number of foetuses, gestational age, indication for caesarean section, status of the membranes and kind of anaesthesia. All women delivered in the same hospital using a uniform protocol. We evaluated the duration of stay in hospital after operation, the need for antibiotics after caesarean section, the incidence of minor postoperative complications (mild anaemia, mild temperature or fever 24 h after surgery, wound haematoma or infection, urinary tract infection, endometritis) and major postoperative complications (severe anaemia, pneumonia, pleural effusion, peritonitis, sepsis, disseminated intravascular coagulation, thromboembolism). Most HIV-positive women (64.5%) had a complicated recovery after surgery. A higher incidence of major and minor postoperative complications were observed in the HIV-positive group than in the control group. There was a statistically significant greater incidence of mild anaemia, mild temperature or fever, urinary tract infection and pneumonia in the HIV-positive group. HIV-positive women with less than 500×106 CD4+ lymphocytest/l had higher post-caesarean section morbidity than HIV-positive women with more than 500×106 CD4+ lymphocytest/l. The median duration of hospital stay was significantly higher in the HIV-positive group (median 7 days) than in the HIV-negative group (median 4 days). The rate of HIV vertical transmission was 8.8%. Higher post-caesarean section morbidity was found in HIV-positive women than in controls. Unfortunately, the HIV-positive women (with low CD4 lymphocytes counts), whose infants theoretically will benefit most from caesarean delivery, are also the women who are most likely to experience post-operative complications. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Minimally Invasive Sacrospinous Ligament Suspension: Perioperative Morbidity and Review of the Literature" by O. Aksakal and M. Doğanay.

Few case reports describing endometriosis in patients with gonadal dysgenesis have been published, but none has reported the presence of adenomyosis in a patient with Turner's syndrome. Case: A 31-year-old woman with mosaic Turner's Syndrome (45,X/46,XX/47,XXX) was referred to us because of severe iron deficiency anaemia due to hypermenorrhea and persistent lower abdominal pain for more than six months. She presented normal secondary sex development, normal breast, normal pubic and axillary hair. The external genitalia were also normal. Laboratory examination showed normal gonadotropin, 17betaestradiol, plasma androgens and cortisol levels. At transabdominal ultrasound a myoma (15.8.5.8 cm) arising from the posterior uterine wall was suspected. The mass was removed during laparotomy. Histologic examination confirmed the presence of the myoma and revealed the presence of focal adenomyosis. Conclusion: Adenomyosis and leiomyomata are separate entities but they share a common pathology in that they develop primarily in women of reproductive age and their growth is oestrogen dependent. To our knowledge, this is the first case report in the literature of adenomyosis in a woman who had the Turner's syndrome. [ABSTRACT FROM AUTHOR]