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Aim: The purpose of this retrospective study is to underline the indications for the use of systemic methotrexate (MTX) in tubal pregnancies., Methods: One hundred and four (n=104) consecutive women were treated in our Department for tubal pregnancy. The database analysis showed that after careful respect for inclusion criteria, the treatment chosen was the intravenous administration of MTX in 68 patients, whereas laparoscopy constituted the primary treatment in 36 patients. A single dose of MTX was intravenously administered, diluted in saline solution, with a dosage of 50 mg/m2 of body surface. Close serum beta-hCG monitoring was performed, and in the case of a short fall, a 2nd dose of methotrexate was submitted., Results: The overall success rate of MTX treatment was 91%; the 2nd dose of MTX was used in 12% of patients, whereas in only 6 out of 68 patients included in the medical treatment group a surgical approach for suspected tubal rupture was necessary., Conclusion: Treatment with methotrexate is effective and safe in the presence of these criteria: patient hemodynamically stable, absence of tubal rupture sign and hemoperitoneum, an adnexal mass with a diameter < or = 5 cm, an amenorrhea < or = 6 weeks and HCG levels < or = 10,000 mIU/ml. Laparoscopy is indicated in diagnostic uncertainty, when MTX is not suggested, when adnexal mass is > 5 cm, or in patients in which beta-hCG levels was > 10,000 mIU/ml.

Aim: We investigate the possibility to use ultrasound-guided aspiration and alcohol sclerosis in patients with endometrioma., Methods: Ten patients with endometriotic ovarian cysts, mean diameter <70 mm, CA125 <35 UI, persistence of cyst after medical therapy and refusal of surgical therapy have been studied. The patients were submitted to ultrasound-guided aspiration of endometriomas. Fifty per cent of aspirated fluid was replaced with pure ethanol, which was left in situ for 10 to 20 minutes. No medical therapy was employed after aspiration and ethanol treatment., Results: In 9 patients no recurrence was observed at ultrasound after 21.2+/-6.62 months of follow-up. In 1 case only, after 6 months, a recurrence of the endometrioma in the same site was observed., Conclusion: Ultrasound-guided alcoholic sclerotherapy of the endometriotic ovarian cysts is effective and safe. We speculate that this procedure could be indicated in patients refusing standard surgical therapy.

Background: The purpose of this study is the comparison between the scar of myomectomy performed during cesarean section and out of the pregnancy., Methods: Eighteen pregnant patients were submitted to cesarean section between 37 and 39 weeks of gestation for previous myomectomy. The previous myomectomy has been performed in 8 patients during a cesarean section, in 10 patients out of pregnancy; in all patients only one subserous-intramural myoma of uterine fundus or body with a maximum diameter of 4-5 cm has been excised., Results: In myomectomies performed during cesarean section the scar appeared more linear, with good well defined limits, less wide and with modest introflection in comparison to surrounding myometrium. The myometrial thickness did not present variations and was well contracted., Conclusions: Our results show substantial differences: in fact, according to personal opinion, the different evolution of the healing process is due to variations occurring in pregnancy and particularly for local immunology system which in pregnancy is hyperactive. The presence and increased synthesis of immunological substances support a better healing with an optimal functional recovery.

Background: The aim of this study is to check whether there exists a difference in restitutio ad integrum of the uterus after myomectomy performed during Caesarean section and out of pregnancy., Methods: Two different groups are considered: Group A (n=8) that underwent myomectomy during Caesarean section; Group B (n=10) in which myomectomy was performed out of pregnancy. All patients were followed with serial scan evaluations., Results: The results showed a much more complete and faster absorption of hyperplasia and hypertrophy surrounding fibroid nodules when myomectomy was performed during Caesarean section., Conclusions: A later pregnancy in patients who underwent myomectomy during Caesarean section might have a favourable outcome, possibly reaching a term gestation and vaginal delivery.

The aim of the study is to report on the result achieved on uterus bicornate unicollis that after hysterosalpingography proved atypical in the isthmic section of the left horn because it was filiform and had irregular walls. The metroplasty technique was performed, applying the Jones technique, on a patient affected by infertility for six years, with uterine malformation. Hysterosalpingography evidenced an atypical malformation: a unicollis-bicornis uterus that was atypical in the isthmic section of the left horn, treated with the technique of Jones because it was filiform. Diagnostic laparoscopy visualized two symmetrical and separated horns. Metroplasty was performed applying Jones technique, by removing the isthmic miometrium of the left horn in order to widen the communication with the upper part. The result of postoperative hysterosalpingography, performed 10 months after intervention, showed a single uterine cavity with irregular walls that allowed the evolution of a pregnancy that was prematurely concluded after thirty-two weeks on the birth of a live, vital fetus. Infertility is probably associated with the complexity of uterine malformation. We can, therefore, underline that laparotomic metroplasty is an effective technique that can be performed in particular cases.