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Objective The aim of the presented study is to improve the office hysteroscopy success rate identifying some of the factors associated to an unsuccessful procedure. Moreover it would highlight the importance of an adequate patients follow up after office hysteroscopy failure enlightening the uterine pathologies missed at the first attempt. Studydesign This is a retrospective observational study. The Authors reviewed the medical records related to 516 office hysteroscopies performed from January 2016 to November 2018, extrapolating the data from the failed hysteroscopies occurred during this period. After the procedure failure all patients were offered to repeat the hysteroscopy under regional anesthesia in order to identify and treat uterine pathologies. Those patients, who declined to repeat the procedure, received an appropriate follow up. Each failure case is correlated with patient clinical characteristics, indications to hysteroscopy, risk factors presence, hysteroscopy patient compliance, pathology result and patient follow up. Results The presented study shows an office hysteroscopy failure rate of about 12 %. Severe pain due to cervical stenosis, previous uterine surgery, postmenopausal status and marked uterine ventrifixation/retroflexion, represent the main reason why the procedure was not completed in an office setting. The uterine cavity was subsequently examined in only 26 (42 %) out of 62 patients who reported hysteroscopy failure, mostly repeating the procedure under regional anesthesia (24 cases) or performing vaginal hysterectomy for associated benign gynaecological pathology (2 cases). Endometrial malign pathology (endometrioid carcinoma) was diagnosed in 2 cases of them (7.7 %). Moreover the endometrial cavity remained so far unexplored in 36 (58 %) out of 62 patients, due to the patient refuse to repeat the hysteroscopy under anesthesia. Discussion and conclusion Results of the present study suggest that office hysteroscopy should be sussessful at the first attempt due to the patients’ refuse, in majority of cases, to repeat the procedure after a failure. To not repeat the hysteroscopy may lead to lose or delay important diagnosis, such as that of endometrial cancer. In this context, to counsel all patients prior the procedure may singnificanly help to identify those who may benefit of pharmacological cervical softening, local anesthetic injection or small caliber hysteroscopes usage, increasing the procedure success rate.

Cervical incompetence is the inability of the cervix to retain fetus, in the absence of clinical symptoms or signs of labor, owing to a functional or structural defect and it is a known cause of abortion and preterm delivery. A widely used therapeutic option is cervical cerclage, which is performed electively at the beginning of the second trimester in high-risk pregnant human. Moreover, cervical cerclage is also performed as an emergency procedure. We reported a case of a pregnant women, who was hospitalized with incompetent cervix and bulging of both membranes and fetal lower limbs at 22 weeks of amenorrhea. She refused emergency cervical cerclage and chose conservative managing, tackling the risk of preterm labor. Although the medical team did not recommend the choice of the patient, bed rest with medical therapy allowed the delivery at term (39 weeks) through cesarean section. A female newborn weighing 3.590 gr was extracted in good health.

Introduction and importance The most common complication of pelvic organ prolapse is stress urinary incontinence, whereas hydronephrosis or stasis ulcers are quite rare and typical of severe stages. The best treatment for this unusual presentation is still controversial. Here we present our approach. Case presentation Here we present the case of a 70-year-old White/Caucasian woman who presented to our hospital with genital procidentia lasting for 10 years that was associated with both hydronephrosis and stasis ulcers. Clinical findings and investigations The Pelvic Organ Prolapse Quantitation system was used to assess the severity of the prolapse, being evaluated as stage IV with the apical compartment leading. A thorough search of the literature was conducted to find any similar cases and evaluate the best evidence treatment. Interventions and outcomes A no-mesh procedure comprising vaginal hysterectomy, axial apex suspension, and anterior and posterior repair with ulcerated skin removal resulted in complete resolution of both mechanical and functional symptoms. At 3- and 6-month follow-up visits, a satisfying vaginal profile without hydronephrosis was seen. The Pelvic Organ Prolapse Quantitation at 6 months follow-up was as follows: Aa -3, Ba -3, C -7; gh 2, pb 3, tvt 9; Ap -3, Bp -3. Relevance and impact Pelvic organ prolapse involves many organs and causes further complications, leading seldom to renal insufficiency and stasis ulcers. A temporary solution to the obstruction can be achieved by utilizing a pessary, but this device cannot be applied when a stasis ulcer has been previously established. The use of mesh for pelvic floor repair is controversial, but a previous vaginal ulcer may represent a contraindication. A complete evaluation and a challenging surgery may allow the recovery of complicated and severe pelvic organ prolapse. Native tissue pelvic repair gives no erosion postsurgical risk, which is the typical complication of the prosthesis.

Toxoplasmosis does not usually give any symptoms to a pregnant woman and in most cases she does not realize to be infected. On the contrary, in the newborn, congenital toxoplasmosis can be responsible of hydrocephalus, microcephaly, intracranial calcifications, strabismus, blindness, epilepsy, mental retardation, thrombocytopenia, anemia and chorioretinitis. All these pathologies have been reported in the primary infection, while they are unusual in either reinfections or recurrences. We report two rare cases of reinfection of the mother during pregnancy where the neonates showed chorioretinitis.

A 37 year old woman (G1P1 spontaneous delivery) was admitted to our university hospital for menometrorrhagia.

Myo-inositol (MI) is a precursor for the synthesis of phosphatidylinositol polyphosphates (PIPs). The aim of the study is to evaluate the effect of its administration on semen parameters of male patients undergoing an in vitro fertilization cycles.In vivo study. Samples were semen of 62 patients divided into three different groups: healthy fertile patients (Group A); patients with oligoasthenospermia (OA) (Group B); control group (CTR). The collected samples were analyzed by optic microscopy in order to evaluate semen's volume, spermatozoa's number and motility before and after density-gradient separation method. These parameters were evaluated before and after administration of 4000 mg/die of MI and 400 µg of folic acid for 2 months. The results were analyzed statistically with Student's t-test.After treatment there was a significant increase of basal and after density-gradient separation method spermatozoa concentration in Group B, and a significant increase of spermatozoa count after density-gradient separation method in Group A. The motility values were higher in healthy men than patients with OA before treatment, but there was no improvement in both groups after treatment.Exogenous administration of MI significantly improves semen's parameters both in patients with OA and in normal fertile men.

Small bowel perforation is a unique, serious complication during endometrial biopsy. The authors report a case of a double uterine-ileal perforation totally managed by primary laparoscopic repair. A 63-year-old female was admitted with acute abdomen 2 days after an endometrial curettage. Abdominal X-ray shows signs of pneumoperitoneum. Emergency diagnostic laparoscopy was performed and a uterine-ileal perforation was identified. Repair was accomplished by a totally laparoscopic intracorporeally suturing of the 2 breaches. Postoperative course showed only a delayed ileus and the patient was discharged after 5 days with no complications. When acute abdomen arises following uterine biopsy, a potential iatrogenic intestinal laceration always has to be ruled out. Laparoscopic approach is a quick and safe technique in these cases. Totally laparoscopic primary closure of the iatrogenic ileal laceration may be accomplished with low morbidity.

Neoplastic sigmoid-uterine fistula is an extremely rare condition because the uterus is a thick and muscular organ. A 74-year-old woman was admitted to the First Aid Station suffering from abdominal pain and foul smelling vaginal discharge. Gynaecological examination showed fecal drainage from the cervical orifice, while the uterus was regular in size but very firm and painful. Ovaries and fallopian tubes were not palpable owing to abdominal tenderness. Ultrasounds reveled inhomogeneous thickening of uterine cavity, without detecting fistula. Contrast Medium CT (CMCT) showed Douglas’ recto-uterine pouch occluded. The sigmoid wall was very thin exception a site where a fistula was suspected. At the surgery severe adhesions of the sigma-rectum with the posterior uterine wall were observed. After adhesiolysis, 18 cm colon-sigma-rectum was removed. Total hysterectomy with salpingooophorectomy was performed. Lymphadenectomy ended the procedure. Anatomical specimen confirmed sigmoid-uterine fistula. At histology a mildly differentiated adenocarcinoma of sigma-rectum was shown. Postoperative course was uneventful. Such a case of neoplastic sigmoid-uterine fistula has not been reported so far.

Objective. To evaluate both results and complications of Retro-pubic, Pre-pubic and Trans-obturator mini- invasive anti-incontinence surgical procedures. Material and methods. Search of PubMed, Cochrane library and relevant articles from 1996 to 2012. Results. Seventy-four works were found. Literature showed similar cure rates among retro-pubic (71,4-91%), trans- obturator (77,3-95%) and pre-pubic (81-87,2%) anti-incontinence procedures. Cystoscopy is considered as necessary in the retro-pubic, optional in the trans-obturator, unnecessary in the pre-pubic procedure. Intra-operative cough stress test is believed to be useful only when using the retro-pubic and the pre-pubic path. Obstruction symptoms prevail in the retro- pubic, are rare in the trans-obturator and not recorded in the pre-pubic procedure. The erosion rate is similar for the all the three techniques. Permanent catheterization is found in 3% of the retro-pubic technique group. The retro-pubic path may be mainly performed for the cure of recurrent stress incontinence (RSI) and intrinsic sphincter deficiency (ISD) in absence of obstructive symptoms. Due to the danger involved in the retro-pubic space, intra-operative vascular and perforating risks prevail in the retro-pubic procedure, whereas the onset of late infective complications in the trans-obturator tech- nique is due to the site of the mesh tip that may interfere with the movements of the thigh. No severe complications were reported in the pre-pubic procedure. Conclusion. In the severe cases of SUI, RSI and in ISD the retro-pubic tension-free route remains the favourite; when ob- structive symptoms prevail, the prepubic technique is the most appropriate; whereas for all other cases, the trans-obturator procedure is the most suitable.

Premature Ovarian Failure (POF) is a heterogeneous syndrome characterized by Hypergonadotropic Hypogonadism that affects about 1% of women younger than 40 years old, while an incidence of 1/1000 is reported in women younger than 30 years old. [1] This hormonal disorder is caused by the loss of the ovarian response towards the pituitary gonadrotropins synthesis (FSH and LH) that are secreted according to the inhibitory feedback between hypothalamus, pituitary gland and gonads.

Purpose: The iam of this study was retrospectively evaluate maternal platelet count fluctuation during pregnancy and puerperium and its correlation with the newborn’s platelet levels. Method: A group of 36 patients who have been referred to a haematology-clinic for gestational thrombocytopenia (GT) and who delivered at the same hospital during a period of 4 years, from January 2006 to December2009 were included in the study. Mothers and their related foetuses- newborns were evaluated retrospectively for symptoms and/or signs of external and internal haemorrhage throughout pregnancy and early puerperium, even in relationship with mode of delivery (caesarean section versus spontaneous vaginal delivery). Results: All observed cases of GT have an uncomplicated course with no related perinatal and maternal morbidity even in patients with initial platelet count < 75.000/ml independently from the route of delivery. Conclusion: In case of gestational thrombocytopenia a complete normalization of maternal platelet count should be expected during the postpartum period, even if a diagnosis of a concomitant incidental neonatal thrombocytopenia cannot be excluded.No intervention, such as a foetal platelet count or caesarean section, is necessary., Amaç: Bu çalışmanın amacı, hamilelik ve lohusalık döneminde ki trombosit sayısında meydana gelen değişimleri retrospektif olarak değerlendirmek ve yeni doğanın trombosit sayısı ile arasındaki ilişkiyi ortaya koymaktır. Materyal ve Metod: Bu çalışmada ki çalışma grubunu; Ocak 2006’ dan Aralık 2009’a kadar olan 4 yıllık bir süreçte, gestasyonel trombositopeniden (GT) dolayı hematoloji kliniğinde tedavi görmüş ve doğum yapmış 36 hasta oluşturmaktadır. Anneler ve onlara ait fetusler ile yeni doğanlar hamilelik ve lohusalığın erken dönemleri boyunca iç ve dış kanama (doğum şekli ile ilişkili durumlarda dahil-Normal doğumla sezeryan doğum karşılaştırılması) gibi belirtiler ve/veya semptomlar açısından geriye dönük olarak değerlendirilmiştir. Bulgular: Gestasyonel trombositopenili tüm vakalarda hastalık maternal ve perinatal morbidite ile ilgili olmaksızın, doğumun gidişatından bağımsız olarak başlangıçta ki trombosit sayısı< 75.000/ml. olduğu halde, komplike olmayan bir seyire sahiptir. Sonuç: Her ne kadar rastlantısal olarak eşlik eden neonatal trombositopeni gözardı edilemesede, gestasyonel trombositopeni durumunda maternal trombosit sayısının standardizasyonun postpartum dönemde gerçekleşmesi beklenmelidir. Bu gibi durumlarda fetal trombosit sayısının belirlenmesi veya sezeryan doğum gibi müdahaleler gerekmemektedir.

The case of a 45-year-old woman who was admitted to our university hospital for polymenorrhea, weight gain and pain in the left iliac region is reported. An abdominal ultrasound revealed a 9.5 × 5.2-cm, hypoechoic and inhomogeneous mass located on the left side of the pelvis and behind the ovary. The patient underwent surgery. The pelvic mass was firmly anchored to the small intestine, colon, sigma and uterine fundus. After removing the adhesions, double ureters, which had been incorporated in the mass, were observed on the left side. Resection of the unilateral double ureters was necessary in order to remove the entire mass, and thereafter, a left salpingoophorectomy was performed. A histological examination showed a malignant retroperitoneal mass. Termino-terminal ureteral anastomosis with two double-J stents was carried out. Total hysterectomy with preservation of the right adenexum and regional lymphadenectomy was performed. The purpose of this case report is to discuss the physical and psychological implications related to the combination of two rare entities: leiomyosarcoma and a double ureter located within the mass. A literature review on the clinical management and psychological aspects from a female cancer patient's perspective undergoing surgery with the aforementioned disorders will be discussed.

This study was undertaken to compare two surgical techniques for rectocele repair. Between January 2005 and December 2010, 180 patients with III grade symptomatic rectocele were enrolled in this alternative prospective randomized study. 90 patients (group A) were treated with perineal body anchorage of posterior septum, and 90 (group B) with the traditional Denonvilliers’ transversal suture. Pre- and post-operative data, including Ap and Bp values, recurrence rates and quality of life was assessed. The mean follow-up was 22 months (range 9-72 months). For statistical purpose, Student’s t test, chi-square test and logistic regression analysis were evaluated. Post-operatively, in group A Ap and Bp value were respectively –2.0±1.0 and –2.5±0.5 (P

A 37 year old woman was admitted to our university hospital for menometrorrhagia. The case history showed that the patient had menometrorrhagia for six months; moreover, during the abdominal examination we found a mass occupying the hipogastric and mesogastric area. The tumefaction was hard and it reached the level of the umbilicus. On combined vaginal-abdominal examination a mass on the anterior wall and multiple myomata were felt; the uterus was found to have been enlarged to the size equivalent to 18 weeks pregnancy; adnexa regular were felt. During the surgery multiple myomas were found. The largest, 10 cm diameter, was soft in consistence with a gelatinous structure. Total abdominal hysterectomy with preservation of adnexa was performed (Figure 1). Histopathological result gave evidence of myxoid leiomyosarcoma in the largest myoma, whereas the others fibroid nodes were without atypia.

We describe the relation between umbilical cord clamping time and two different enrichment system of CD34+ stem cells from umbilical cord blood with the proliferative ability and bone marrow reconstitution of the stem cells obtained. After an obstetrician performed the cord blood collection, the purification of stem cells was performed either with a combination of monoclonal antibodies (negative selections) using the Stem Sep method, or with a positive cells selection based on their surface CD34 antigens using the Mini Macs system. An excellent recovery of haematopoietic progenitors [Burst Forming Unit Erythroids (BFUE); Colony Forming Unit Granulocytes and Macrophages (CFU-GM); and Colony Forming Unit Granulocytes, Erythroids, Monocytes and Macrophages (CFU-GME)], inversely related to the increase in clamping time, was performed with the Mini Macs system (54% of colonies, with 90% purity). With Stem Sep method, haematopoietic progenitor’s recovery was 35% (with 80% purity). By applying early clamping of umbilical cord blood we obtained a greater number of CD34+ cells and their clonogenic activity was increased with enrichment. This is a useful technique considering that the number of CD34+ stem cells usually contained from a unit of placental blood is enough for the transplant to a child, but not for an adult. Thus, using these methods, we can get a larger number of CD34+ stem cells which reduces the risk of Graft versus Host Disease also in adult patients, producing survival rates similar to those obtained with transplantation of bone marrow from unrelated donors.

Introduction: Pelvic floor disorders compromise quality of life for a lot of women of all ages. The prevalence of urinary incontinence (UI) is thought to range from 17 to 45% among adult women. The etiology is thought to be multifactorial. Traumatic damage to fascial and muscular support structures during childbirth may be, an important contributor to the development of UI and prolapse of pelvic organ (POP). The aim of this study is to consider the association between delivery mode and pelvic floor disorders (POP and UI) Materials and methods: A review of the literature was undertaken using the Medline and Popline CD Rom considering articles published from 1996 to 2011; additional sources were identified from references cited in relevant research articles. We studied articles concerning stress urinary incontinence, pregnancy, childbirth, pelvic prolapse were considered. Conclusion: Literature research confirms that anatomic and functional damages are linked with obstetric factors. Pregnancy may cause urinary incontinence and prolapse. However vaginal delivery is associated with a significant higher risk of urinary incontinence and pelvic defects. Caesarean section may protect from perineal risk of delivery but not from the damage due to the pregnancy itself. During pregnancy UI ranges from 31 to 39%, in post-partum ranges from 24,5 to 29% and from 5 to 8% after vaginal and caesarean respectively. Pelvic floor disorders ranges from 21 to 36% after instrumental operative delivery and from 9 to 21% in vaginal spontaneous delivery. Forceps is found out the most dangerous instrument for pelvic floor, followed by vacuum and vaginal delivery with tears. The consequences of a traumatic delivery affect quality of life and increasing late damages have to be considered.

Giant ovarian cysts are very rare. Recently, laparoscopic treatment, with extirpation of the giant cyst and associated oophorectomy, has been reported. In this article, we describe the first case of complete laparoscopic enucleating of a giant serous cystoadenomyoma with preservation of residual ovarian parenchyma in an 18-year-old girl.

The purpose of this retrospective study is to evaluate the safety and the efficacy of a new surgical procedure for correcting both incontinence and cystocele. This method of Tension-free Incontinence Cystocele Treatment (T.I.C.T.) consists in using a polypropylene fly shaped mesh made up of a central body (positioned under both the urethra and the bladder) and two wings (which cross the Retzius and reach the suprapubic area after being pulled up with a modified Stamey needle, under digital control). Seventy patients with stress urinary incontinence and severe cystocele underwent the T.I.C.T. procedure. Their mean age was 56 years (range 40-78), the average follow up was 18 months (range 2-36 months). The objective cure rate was 90% for incontinence and 94.3% for cystocele. No intra-operative complications occurred. Postoperative complications included 2 cases (3%) of voiding difficulty, one case of de novo instability, and one case of erosion and granuloma. Neither bladder perforation nor vascular damage was found. These data show the low risks and the good results of this treatment.

Neural tube defects (NTDs) are congenital malformations of the brain and spinal cord caused by failure of the neural tube to close between 21 and 28 days following conception. Each year almost 400.000 infants are born with NTDs all over the world. Although many advances have been made in the spina bifida’s treatment and have led to an increased life expectancy and an improved life quality, no treatment exists that will completely eliminate the serious disability or premature mortality associated with it. For such a reason, reducing the risk of NTDs is an important goal. It is widely ac-cepted that adequate maternal consumption of folic acid before pregnancy and during the early weeks of gestation can reduce the danger of having a child with a neural tube defect (NTD). As a result, public health authorities worldwide have recommended consuming 400 μg folic acid per day during the periconceptional period in order to decrease the risk of first occurrence NTDs . This recommended dose is based mainly on the amount of folic acid associated with a reduction in NTDs in the majority of epidemiological studies. Literature data asserts that folic acid can prevent about 70% of NTD conceptions while folic acid-containing multivitamin can prevent about 90%; the diagnostic efficacy of ultrasound is nearly 100% in anencephalic fetuses and about 80% in fetuses with different manifestations of spina bifida. A bibliographical research regarding folate and NTD prevention, between 1988 and 2012, was done. The words used for Literature research were: Folic Acid, Spina bifida, Neural Tube Defects, Malformations. Search engines employed were: Medline, Pubmed, PopLine and the most relevant reports on the topic.

Objective: Benign breast disease includes a wide spectrum of lesions different for histology and natural history, whose association with oral contraceptives is of great interest because there are no univocal results in literature. Subjects and Methods: The purpose of our study is to assess the relationship between women who used long- term estro-progestin (for at least 12 consecutive months up to a maximum of 60 months) and the develop of benign breast disease comparing with a case- control group composed by patients with benign breast disease, non-users of oral contraceptives. The study included 263 women attending, from 2009 to 2012, the Gynecological Endocrinology and Ultrasounds outpatients of our Department, who used oestroprogestative pills for Contraception, treatment of acne, hirsutism and treatment of dysmenorrheal and a control group of 200 patients with benign breast disease, non-users of Oral Contraceptives.Results: According to recent trials we did not observe statistically significant morphological and anatomical alterations of the breast in the group treated with estrogen-progestin therapy in comparison with the control group. Conclusion: If the woman presents a nodular breast mass during estro-progestin therapy she should be evaluated ultrasonographically to assess if the formation grows. If there is an increase in volume of the mass the patient should suspend the therapy.