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CENNI DI ANATOMIA FUNZIONALE DEL PAVIMENTO PELVICO Lil pavimento pelvico è costituito da un insieme di strutture muscolari e fasciali che chiudono inferiormente lo scavo pelvico femminile, sostengono gli organi pelvici (vescica, vagina, utero, retto) e intervengono nei meccanismi della continenza urinaria e fecale, nell'attività sessuale e nel parto. La statica e la dinamica degli organi pelvici sono condizionate da due sistemi. - un sistema di sospensione costituito davanti dai legamenti pubo-vesci-co-uterini e dai legamenti rotondi, posteriormente dai legamenti ute-ro-sacrali, lateralmente dal legamento cardinale di Mackenrodt. Tale sistema collega i visceri pelvici alla parete della pelvi stessa e alla fascia endopelvica. - un sistema di sostegno, formato da un complesso di muscolatura striata e da tessuto connettivale (fascia endopelvica). Procedendo dall'interno verso l'esterno tale sistema è rappresentato: 1) dal diaframma pelvico, costituito dal muscolo elevatore dell'ano (con le sue componenti pubo-rettale, ileococcigea, pubococcigea e ischiococcigea) e dalla fascia endo-pelvica che lo riveste superiormente ed inferiormente; 2) dal diaframma urogenitale, situato inferiormente al diaframma pelvico, rappresentato da una lamina muscoloaponeurotica comprendente i legamenti pubo-uretra-li, uteropelvico e il muscolo traverso profondo del perineo; 3) dal piano dei muscoli superficiali del perineo (piano degli sfinteri) costituito dal muscolo bulbo-cavernoso, dall'ischio-cavernoso e dal trasverso superficiale dell'ano.

L'incontinenza urinaria femminile rappresenta un problema socio assistenziale sottostimato e, per molti aspetti, irrisolto. Numerosi studi hanno messo in evidenza il notevole impatto negativo che essa ha su molti aspetti della vita della donna, tanto da condizionarne le attività quotidiane, le relazioni sociali e la vita privata, fino ad un intenso disagio psicologico ed a una profonda ripercussione sulla qualità di vita

Introduction: The prognosis of glioma is dismal, and almost all patients relapsed. At recurrence time, several treatment options are considered, but to date there is no a standard of care. The Neurooncology Study Group of the Italian Association of Radiation Oncology (AIRO) collected clinical data regarding a large series of recurrent glioma patients who underwent re-irradiation (re-RT) in Italy. Methods: Data regarding 300 recurrent glioma patients treated from May 2002 to November 2017, were analyzed. All patients underwent re-RT. Surgical resection, followed by re-RT with concomitant and adjuvant chemotherapy was performed. Clinical outcome was evaluated by neurological examination and brain MRI performed, 1 month after radiation therapy and then every 3 months. Results: Re-irradiation was performed at a median interval time (IT) of 16 months from the first RT. Surgical resection before re-RT was performed in 19% of patients, concomitant temozolomide (TMZ) in 16.3%, and maintenance chemotherapy in 29%. Total doses ranged from 9 Gy to 52.5 Gy, with a median biological effective dose of 43 Gy. The median, 1, 2 year OS were 9.7 months, 41% and 17.7%. Low grade glioma histology (p ≪ 0.01), IT > 12 months (p = 0.001), KPS > 70 (p = 0.004), younger age (p = 0.001), high total doses delivered (p = 0.04), and combined treatment performed (p = 0.0008) were recorded as conditioning survival. Conclusion: our data underline re-RT as a safe and feasible treatment with limited rate of toxicity, and a combined ones as a better option for selected patients. The identification of a BED threshold able to obtain a greater benefit on OS, can help in designing future prospective studies.

Most vaccinations are recommended within the 15th month of life, in order to reduce risks and to protect children from the initial stages of their lives. A vaccination training session was carried out during the birthing preparation course, aimed at increasing the attitude toward vaccination in maternal-child age. A questionnaire on vaccination awareness was administered before and after the training session and on-site flu vaccination was offered to women and their companions. The percentage of participants who consider the preparatory course a useful tool to obtain information about vaccines increases significantly from 30.34% at pre-intervention to 64.56% at post-interven-tion (p < 0.001). There is a significant increase in the mean number of vaccinations that the participants want their children to get. The number of participants believing that there is no relationship between vaccination and autism rose from 41.05 to 72.97% (p < 0.001). In total, 48 out of 119 (40.34%) pregnant women participating in the course and 39 companions were vaccinated for influenza. Vaccination knowledge and attitude significantly increased after a training session dedicated to vaccination as a part of the pregnant pre-birth course, whose aim can be therefore extended to the management of the health of the child, well beyond the period of pregnancy, according to the life-course approach to health.

Naproxen is one of the less frequently used nonsteroidal anti-inflammatory drugs (NSAIDs) in Germany. Data on pregnancy outcomes in women exposed to naproxen are inconsistent. The objective of this study was to assess the risk of exposure to naproxen in the first trimester of pregnancy.

Objectives: To report on the prenatal ultrasonographic diagnosis of spina bifida (SB) and its natural history, treatment and long-term outcome in a large tertiary referral center. Methods: All cases of SB diagnosed between February 1980 and December 2015 in the Obstetric Prenatal Diagnosis Day Unit of the Obstetrics and Gynecology Department at the Catholic University of the Sacred Heart, Rome, were reviewed. All infants with an open defect were delivered by elective Cesarean section and underwent early repair of the spinal defect. A ventriculoperitoneal (VP) shunt and/or third ventriculostomy was performed when needed. Complete postnatal follow-up was carried out by our multidisciplinary team in the majority of cases. The cohort was analyzed in two groups: Group 1 included patients referred between February 1980 and December 1999; Group 2 included patients referred between January 2000 and December 2015. Results: There was a total of 222 cases of SB with a prenatal diagnosis rate of 94.6% (n = 210), with the majority of defects being meningomyeloceles (n = 142 (64.0%)), affecting the lumbosacral level (n = 110 (49.5%)) and being ≥ 2 cm in size (n = 163/195 (83.6%)). There were 174 (78.4%) live births, with more terminations in Group 2 (26.1%) than in Group 1 (10.8%; P = 0.003). Postnatal surgical repair was conducted in 157 cases (99.4% of eligible cases), with death of an infant who was operated on occurring more often in Group 1 (14.1%) than in Group 2 (4.2%; P = 0.03). VP shunt placement was required in 60.3% of infants operated on after January 2000. Long-term follow-up was available for 136 children (111 with open defects and 25 with closed defects). Infants born since 2000 with an open defect had normal ambulation or a mild defect in 50% of cases and normal or mild deficit of sphincter function in 37.8% of cases. An intelligence quotient of ≥ 70 was observed in the majority of children (81.4%; 35/43 cases). Worse motor function was associated with progressive