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Purpose to assess the quality of guidelines on clinical indications for the use of 18F-FDG PET/CT in oncology using the AGREE II tool. Method from March to May 2019, the current literature was searched to identify guidelines focused on clinical indications for the use of18F-FDG PET/CT in oncology. The quality of the selected guidelines was then assessed by four independent appraisers using the AGREE II tool, which is organized in six quality domains accounting for a total of 23 items. The agreement among appraisers was measured using the intraclass correlation coefficient (ICC) analysis. Results four guidelines were selected. Of these, one resulted of high quality (mean score 86.5 %), another showed an average quality (mean score 61.8 %), and the remaining two proved to be of low quality (mean scores of 53.3 and 45.7, respectively). With the exception of the high-quality guideline, critical domains were Domain 2 “Stakeholder involvement” (total mean score 56.28 + 15.9), Domain 3 “Rigor of development” (total mean score 43.48 + 27.6), Domain 5 “Applicability” (total mean score 46.90 + 19.4) and Domain 6 “Editorial independence” (total mean score 50.55 + 35.7). ICC values ranged from 0.939 to 0.995, indicating very good agreement among the four appraisers. Conclusions a heterogeneous quality of guidelines dealing with clinical indications for the use of 18F-FDG PET/CT in oncology emerged from our analysis. Further efforts should be made to improve the reporting of the applied methodology as well as to promote the applicability of guidelines into clinical practice.

To evaluate the efficacy of intraperitoneal subdiaphragmatic instillation of 0.5% lidocaine and 0.5% bupivacaine infiltration of cannula sites to control pain after diagnostic microlaparoscopy.Prospective, randomized study. (Canadian Task Force classification I).Day surgery unit of Endogyn Service, Private Endoscopic Associates, Naples, and Department of Gynecologic and Pediatric Sciences, Reggio Calabria University, Catanzaro, Italy.Forty women treated for infertility.The treated group received 0.5% intraperitoneal subdiaphragmatic lidocaine 40 ml and 0.5% bupivacaine 5 ml infiltration of cannula insertion sites. The control group received no treatment. In all patients the procedure was performed with atropine 0.5 mg, fentanyl 0.1 mg, droperidol 5 mg, and local anesthesia. Postoperatively, depending on the need, ketoprofene 100 mg or ketorolac 30 mg was administered intramuscularly.Postoperative pain score was evaluated by visual analog scale immediately postoperatively and 1, 3, 6, 12, 24, 36, and 48 hours afterward. The treated group had significantly lower pain scores at the end of surgery and at 1-, 3-, (p0.01), and 6-hour intervals (p0.05). No significant differences in scores between groups were observed starting from 6 hours postoperatively.Postoperative intraperitoneal lidocaine and bupivacaine infiltration of cannula sites offered a detectable benefit to women undergoing diagnostic microlaparoscopy. The effect was temporary, but induced a significant decrease in the postoperative pain for approximately 6 hours.

Heterotopic pregnancy (HT) in the absence of a previous ovarian hyperstimulation is a very rare condition. Transvaginal ultrasonography (TV) in the case of first trimester pelvic pain allows a high diagnostic reliability in the identification of HT and a successful conservative treatment by means of TV potassium chloride injection.

To demonstrate the safety and feasibility of laparoscopic surgery in complete resection of bowel endometriosis. METHOD: This is a 39 year old G2P0 who presented with dysmenorrhea associated with rectal pain. Upon entry with the laparoscope we observed a large mass measuring 45 cm extending from the rectovaginal septum to the rectal wall which we resected meticulously using both the PlasmaJet and the CO2 laser. RESULTS: We were able to perform complete excision of bowel endometriosis without the need for bowel resection and without compromising the integrity of the bowel. There were no complication. Six weeks follow up visit, the patient was improving clinically and had no complaints. CONCLUSIONS: Complete resection of bowel endometriosis without need for disk excision or segmental resection can be accomplished laparoscopicaly in experienced hands using PlasmaJet and the CO2 laser. We avoid using electrocautery in cases of bowel endometriosis as there is a higher incidence of bowel perforation and delayed necrosis.

Background: The use of methotrexate (MTX) by systemic administration in the treatment of unruptured ectopic pregnancy has been reported as a safe and effective method. Cases: We report three cases (one hematosalpinx and two pelvic hematocoeles) of complications after the use of MTX in the treatment of unruptured ectopic pregnancies. All three cases came to our observation for pelvic pain, abnormal bleeding and a pelvic mass after an interval of 3–5 months, subsequent to the disappearance of symptoms and normalization of serum human chorionic gonadotropin β-subunit (β-hCG) levels. Conclusions: These findings suggest that: (a) such complications should be considered before selecting the mode of treatment for ectopic pregnancy; and (b) that an early ultrasonographic control should be performed after MTX treatment even when the decline in β-hCG levels suggests a successful resolution. This would permit an early diagnosis of these late complications.

Several reports have shown elevated circulating beta-endorphin (beta-EP) levels in patients with polycystic ovarian disease (PCOD). However, it is not yet clear whether these high beta-EP levels are linked to the etiopathogenesis of PCOD or are secondary to the obesity. In the present study we measured beta-EP plasma concentrations in 19 PCOD patients, 10 with normal weight (Group A) and 9 with excessive weight (Group B), and in 18 normally ovulating women, 10 with normal weight (Group C) and 9 with excessive weight (Group D). beta-EP values were similar in the two groups of non-obese patients and controls. beta-EP concentrations were also similar in the two groups of obese patients and controls, and they were significantly higher (p less than 0.05) than in non-obese patients. Our data indicate that in PCOD, elevated beta-EP values are related to obesity, suggesting that they are not linked to the pathogenesis of PCOD.