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We investigate the possibility to use ultrasound-guided aspiration and alcohol sclerosis in patients with endometrioma.Ten patients with endometriotic ovarian cysts, mean diameter70 mm, CA12535 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.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.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.

Objective: To examine the association between the use of intra uterine device (IUD) and the risk of actinomycosis in postmenopausal women. Methods: We report a case of pelvic actinomycosis in a postmenopausal woman who was wearing an IUD for 14 years until 20 months after the beginning of menopause. In the last 5 years the patient had been suffering occasionally from pain, abdominal tension and rectal tenesmus. The disease was revealed clearly 18 months after removing the intrauterine device. Results: The diagnosis of pelvic actinomycosis was only possible after hysterectomy, bilateral oophorectomy and multiple biopsies. At histological features a focus with actynomycetes colonies was evident. Conclusions: This study supports the previously reported association between the pelvic location of actinomycosis and the use of the IUD. The removal of IUD should be mandatory in postmenopausal women.

The purpose of this retrospective study is to underline the indications for the use of systemic methotrexate (MTX) in tubal pregnancies.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.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.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 diameteror = 5 cm, an amenorrheaor = 6 weeks and HCG levelsor = 10,000 mIU/ml. Laparoscopy is indicated in diagnostic uncertainty, when MTX is not suggested, when adnexal mass is5 cm, or in patients in which beta-hCG levels was10,000 mIU/ml.

The aim of the present study was to determine a possible relationship between ovarian functionality and regression of ovarian enlargement according to the different categories and degree of severity of ovarian hyperstimulation syndrome (OHSS). Among a group of sterile woman (n = 111), two subgroups were studied: group A (n = 15), patients affected by severe syndrome; and group B (n = 96), patients with massive ovarian enlargement only. The protocol of ovarian stimulation was conducted in various in vitro fertilization (IVF) centers; ultrasonographic examination and hematological checks were carried out daily; patients with severe OHSS were hospitalized. In women of group A, severe symptoms disappeared in 7-11 days; in nine patients with regular cycles ovary size returned to normal in about 30-40 days, whereas in six subjects with anovulatory cycles, the resolution was recorded in about 50-60 days; serum estradiol returned to physiological levels within 20-30 days. Women of group B showed a spontaneous regression at different times: in 43 subjects that presented regular ovulatory cycles, the resolution was recorded in about 30-40 days, whereas in 36 women with anovulatory cycles before pharmacological induction, resolution occurred in 50-60 days, and in 17 cases with polycystic ovary syndrome before pharmacological ovulation, an incomplete resolution was obtained; serum estradiol levels returned to a physiological range within 20-30 days. Our results show that in patients with regular ovulatory cycles, resolution of symptoms is obtained in a shorter time than in patients with anovulatory cycles before pharmacological induction.

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.

The aim of this paper is to compare cesarean section according to Stark to cesarean section according to conventional technique in order to evaluate advantages and limits.Second University of Study of Naples, Department of Obstetrics and Gynaecology, during the period from March 1996 to March 1999.One hundred and two cesarean sections according to Stark were performed. These interventions have been compared with others performed, during the same period, according to the conventional technique.Comparison between cesarean section according to Stark and cesarean section according to conventional technique.For each case, several parameters have been compared: extraction time, total time, number of suture threads, canalization time, blood loss and fetal Apgar.Cesarean section according to Stark is an evolution of the conventional surgical technique, which can be applied for particular indications such as maternal, fetal and anesthesiologic conditions.

The diagnostic accuracy of dilatation and curettage (DC) was studied comparing retrospectively the results of histologic findings of DC with the correspondent specimen from hysterectomy.During five years, at the Institute of Gynecology and Obstetrics, II University of Studies in Naples, 260 women underwent hysterectomy, 160 of which underwent DC prior to hysterectomy. The histologic findings were classified in: a) physiological endometrium; b) hyperplasia; c) polyps; d) atrophia; e) adenomatous hyperplasia; f) adenocarcinoma. During the period January 1989-October 1993, 260 patients underwent hysterectomy. The age was between 32 and 65 years. The indications to the intervention were: menometrorrhagia, hypogastric pains, dysmenorrhea, metrorrhagia, genital prolapse, urinary incontinence, anemia. Two hundred-sixty patients underwent hysterectomy, 160 of which underwent DC prior to hysterectomy. Curettage was performed using a right size curette after dilatation of the uterine cervix using Hegar's metallic dilatator. Patients were submitted to general anesthesia. Histologic tissues were fixed with formalin and were sent to the Institute of Anatomopathology for examinations.The histologic results obtained by cavitary exploration have been compared with those reached by the analysis of the surgical samples. The results obtained confirm the reliability of DC for the identification of endometrial lesions.Therefore, the diagnostic utility of cavitary exploration before hysterectomy is confirmed, particularly in selected cases.