Fetal Growth Velocity according to the Mode of Assisted Conception.

INTRODUCTION: Pregnancies conceived through assisted reproductive techniques (ARTs) are on the rise worldwide and have been associated with a higher risk of placental-related disease in the third trimester. METHODS: A cohort was created of singleton pregnancies after assisted reproduction, admitted at our institution for delivery, between January 2020 and August 2022. Fetal growth velocity from the second trimester to delivery was compared against a gestational-age-matched group of pregnancies spontaneously conceived according to the origin of the selected oocyte (i.e., autologous vs. donated). RESULTS: 125 singleton pregnancies conceived through ART were compared to 315 singleton spontaneous conceptions. Overall, after adjusting for possible confounders, multivariate analysis demonstrated that ART pregnancies had a significantly lower estimated fetal weight (EFW) z-velocity from the second trimester to delivery (adjusted mean difference = -0.002; p = 0.035) and a higher frequency of EFW z-velocity in the lowest decile (adjusted OR = 2.32 [95% CI, 1.15-4.68]). Also, when ART pregnancies were compared according to the type of oocyte, those conceived with donated oocytes showed a significantly lower EFW z-velocity from the second trimester to delivery (adjusted mean difference = -0.008; p = 0.001) and a higher frequency of EFW z-velocity in the lowest decile (adjusted OR = 5.33 [95% CI, 1.34-21.5]). CONCLUSIONS: Pregnancies achieved through ART exhibit a pattern of lower growth velocity across the third trimester, especially those conceived with donated oocytes. The former represents a sub-group at the highest risk of placental dysfunction that may warrant closer follow-up.

Ecotoxicology and geostatistical techniques employed in subtropical reservoirs sediments after decades of copper sulfate application.

Spatial distribution linked to geostatistical techniques contributes to sum up information into an easier-to-comprehend knowledge. This study compares copper spatial distribution in surface sediments and subsequent categorization according to its toxicological potential in two reservoirs, Rio Grande (RG) and Itupararanga (ITU) (São Paulo-Brazil), where copper sulfate is applied and not applied, respectively. Sediments from 47 sites in RG and 52 sites in ITU were collected, and then, copper concentrations were interpolated using geostatistical techniques (kriging). The resulting sediment distributions were classified in categories based on sediment quality guides: threshold effect level and probable effect level; regional reference values (RRVs) and enrichment factor (EF). Copper presented a heterogenic distribution and higher concentrations in RG (2283.00 ± 1308.75 mg/kg) especially on the upstream downstream, associated with algicide application as well as the sediment grain size, contrary to ITU (21.81 ± 8.28 mg/kg) where a no-clear pattern of distribution was observed. Sediments in RG are predominantly categorized as "Very Bad", whereas sediments in ITU are mainly categorized as "Good", showing values higher than RRV. The classification is supported by the EF categorization, which in RG is primarily categorized as "Very High" contrasting to ITU classified as "Absent/Very Low". Copper total stock in superficial sediment estimated for RG is 4515.35 Ton of Cu and for ITU is 27.45 Ton of Cu.

Heat shock protein 60 and cardiovascular diseases: An intricate love-hate story.

Cardiovascular diseases (CVDs) are the result of complex pathophysiological processes in the tissues comprising the heart and blood vessels. Inflammation is the main culprit for the development of cardiovascular dysfunction, and it may be traced to cellular stress events including apoptosis, oxidative and shear stress, and cellular and humoral immune responses, all of which impair the system's structure and function. An intracellular chaperone, heat shock protein 60 (HSP60) is an intriguing example of a protein that may both be an ally and a foe for cardiovascular homeostasis; on one hand providing protection against cellular injury, and on the other triggering damaging responses through innate and adaptive immunity. In this review we will discuss the functions of HSP60 and its effects on cells and the immune system regulation, only to later address its implications in the development and progression of CVD. Lastly, we summarize the outcome of various studies targeting HSP60 as a potential therapeutic strategy for cardiovascular and other diseases.

Peptidic vaccines: The new cure for heart diseases?

Cardiovascular disease continues to be the most common cause of death worldwide. The global burden is so high that numerous organizations are providing counseling recommendations and annual revisions of current pharmacological and non-pharmacological treatments as well as risk prediction for disease prevention and further progression. Although primary preventive interventions targeting risk factors such as obesity, hypertension, smoking, and sedentarism have led to a global decline in hospitalization rates, the aging population has overwhelmed these efforts on a global scale. This review focuses on peptidic vaccines, with the known and not well-known autoantigens in atheroma formation or acquired cardiac diseases, as novel potential immunotherapy approaches to counteract harmful heart disease continuance. We summarize how cancer immunomodulatory strategies started novel approaches to modulate the innate and adaptive immune responses, and how they can be targeted for therapeutic purposes in the cardiovascular system. Brief descriptions focused on the processes that start as either immunologic or non-immunologic, and the ultimate loss of cardiac muscle cell contractility as the outcome, are discussed. We conclude debating how novel strategies with nanoparticles and nanovaccines open a promising therapeutic option to reduce or prevent cardiovascular diseases.

Cassava starch factory residues in the diet of slow-growing broilers.

The objective of this study was to evaluate the effect of inclusion of dehydrated cassava starch residue (DCSR) on the performance, gastrointestinal tract characteristics and carcass traits of ISA Label JA57 slow-growing broilers. A total of 510 broilers at 21 were distributed in a randomized experimental design with 5 treatments (2, 4, 6, 8, and 10 % DCSR inclusion) and a control group, 5 replicates, and 17 birds per experimental unit. The DCSR inclusion from 21 to 49 days of age negatively influenced (P < 0.05) weight gain and feed intake and did not affect (P > 0.05) feed conversion in the broilers with increasing of DCSR inclusion. From 21 to 79 days, DCSR inclusion impaired (P < 0.05) weight gain, feed conversion, and poultry litter quality with increasing of DCSR inclusion. The level of blood triglycerides showed a quadratic response (P < 0.05) at 79 days of age with the highest value predicted to occur at 5.45 % of DCSR inclusion. DCSR levels affected (P < 0.05) the gastrointestinal organ characteristics, cecal content pH, and pigmentation of the shank, breast, and thigh meat of the birds but did not alter (P > 0.05) the other parameters of carcass quality and yield, cuts, and percentage of abdominal fat. In conclusion, DCSR inclusion levels above 2 % compromised broiler performance.

Incidental Diagnosis of a Primary Pure "Mixed" Ovarian Carcinoid: Clinicopathological Report and Concise Review of the Recent Series.

Primary ovarian carcinoid tumors (POCT) are well-differentiated neuroendocrine neoplasms and account for <0.1% of ovarian tumors. POCT usually arise in the context of mature cystic teratoma; however, pure primary ovarian carcinoids without teratomatous or mucinous elements are very rare. We present a case of a 54-year-old woman that underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy because of endometrial hyperplasia without atypia. The ovaries were macroscopically normal. Pathology report revealed a primary ovarian carcinoid with mixed trabecular and insular growth patterns. Immunohistochemical was positive for chromogranine A, synaptophysin, and CDX2. The Ki-67 index was <1%. To exclude a metastatic carcinoid to the ovary, a Ga-68 PET/CT was performed. This case highlights the microscopic and immunohistochemical characteristics of pure POCT and potential pitfalls in their differentiation from metastatic carcinoids. In addition, differential characteristics of primary and metastatic ovarian carcinoids are discussed.

Endobronchial Obstruction: A Case of Well-Differentiated Liposarcoma.

Atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) is a rare subtype of endobronchial tumor that has been rarely reported in medical literature. Due to its low incidence, distinguishing it from endobronchial lipoma poses a significant diagnostic challenge, necessitating histopathologic and cytogenetic analysis. As of today, the treatment and surveillance protocols for these neoplasms remain poorly defined, often resulting in their misclassification and treatment as endobronchial lipomas. We present a case involving a 72-year-old male who presented with worsening dyspnea and cough. Diagnostic imaging revealed an endobronchial lesion obstructing the left main bronchus. The patient underwent a flexible bronchoscopy that identified a polypoid mass causing significant obstruction, which was subsequently resected via cryoablation. Histopathology confirmed ALT/WDL, supported by genetic analysis revealing chromosomal alterations. Following the intervention, symptoms resolved, with no recurrence on follow-up imaging. Differentiating ALT/WDL from endobronchial lipomas is necessary not only because it influences treatment decisions but also because it can significantly affect the prognosis of patients diagnosed with ALT/WDL. In this case, we emphasize the importance of considering ALT/WDL in the differential diagnosis of endobronchial tumors and highlight the use of flexible bronchoscopy as a viable substitute for rigid bronchoscopy, serving not only as a diagnostic tool but also as a therapeutic method.

In-hospital outcomes of septal myectomy vs. alcohol septal ablation for hypertrophic cardiomyopathy with outflow tract obstruction: An update and insights from the national inpatient sample from 2011 to 2019.

Septal Myectomy (SM) and Alcohol Septal Ablation (ASA) improve symptoms in patients with Hypertrophic Cardiomyopathy with outflow tract obstruction (oHCM). However, outcomes data in this population is predominantly from specialized centers. The National Inpatient Database was queried from 2011 to 2019 for relevant international classification of diseases (ICD)-9 and -10 diagnostic and procedural codes. We compared baseline characteristics and in-hospital outcomes of patients with oHCM who underwent SM vs ASA. A p-value < 0.001 was considered statistically significant. We identified 15,119 patients with oHCM who underwent septal reduction therapies, of whom 57.4% underwent SM, and 42.6% underwent ASA. Patients who underwent SM had higher all-cause mortality (OR: 1.8 (1.3-2.5)), post-procedure ischemic stroke (OR: 2.3 (1.7-3.2)), acute kidney injury (OR: 1.4 (1.2-1.7)), vascular complications (OR: 3.6 (2.3-5.3)), ventricular septal defect (OR: 4.4 (3.2-6.1)), cardiogenic shock (OR: 1.7 (1.3-2.3)), sepsis (OR: 3.2 (1.9-5.4)), and left bundle branch block (OR: 3.5 (3-4)), compared to ASA. Patients who underwent ASA had higher post-procedure complete heart block (OR: 1.3 (1.1-1.4)), right bundle branch block (OR: 6.3 (5-7.7)), ventricular tachycardia (OR: 2.2 (1.9-2.6)), supraventricular tachycardia (OR: 1.6 (1.4-2)), and more commonly required pacemaker insertion (OR: 1.4 (1.3-1.7)) (p < 0.001 for all) compared to SM. This nationwide analysis evidenced that patients undergoing SM had higher in-hospital mortality and periprocedural complications than ASA; however, those undergoing ASA had more post-procedure conduction abnormalities and pacemaker implantation. The implications of these findings warrant further investigation regarding patient selection strategies for these therapies.

[Allogenic hematopoietic stem cell transplantation with unrelated cord blood: report of three cases from the Chilean cord blood bank]. / Trasplante alogénico de precursores hematopoyéticos de sangre de cordón umbilical de donante no emparentado: primera experiencia, en tres casos, con donantes del banco público chileno de células de cordón.

Public cord blood banks are a source of hematopoietic stem cells for patients with hematological diseases who lack a family donor and need allogeneic transplantation. In June 2007 we started a cord blood bank with units donated in three maternity wards in Santiago, Chile. We report the first three transplants done with cord blood units form this bank. Cord blood units were obtained by intrauterine collection at delivery. They were depleted of plasma and red cells and frozen in liquid nitrogen. Tests for total nucleated cells, CD34 cell content, viral serology, bacterial cultures and HLA A, B and DRB1 were done. Six hundred cord blood units were stored by March 2012. Three patients received allogeneic transplant with cord blood from our bank, two with high risk lymphoblastic leukemia and one with severe congenital anemia. They received conditioning regimens according to their disease and usual supportive care for unrelated donor transplantation until full hematopoietic and immune reconstitution was achieved. The three patients had early engraftment of neutrophils and platelets. The child corrected his anemia and the leukemia patients remain in complete remission. The post-transplant course was complicated with Epstein Barr virus, cytomegalovirus and BK virus infection. Two patients are fully functional 24 and 33 months after transplant, the third is still receiving immunosuppression.

Use of vitamin d3 and its metabolites in broiler chicken feed on performance, bone parameters and meat quality.

The objective of this experiment was to assess the use of different vitamin D metabolites in the feed of broiler chickens and the effects of the metabolites on performance, bone parameters and meat quality. A total of 952 one-day-old male broiler chicks were distributed in a completely randomised design, with four treatments, seven replicates and 34 birds per experimental unit. The treatments consisted of four different sources of vitamin D included in the diet, D3, 25(OH)D3, 1,25(OH)2D3, and 1α(OH)D3, providing 2000 and 1600 IU of vitamin D in the starter (1 to 21 d) and growth phases (22 to 42 d), respectively. Mean weight, feed:gain and weight gain throughout the rearing period were less in animals fed 1α(OH)D3 when compared with the other treatments (p<0.05). No significant differences were noted among the treatments (p>0.05) for various bone parameters. Meat colour differed among the treatments (p>0.05). All of the metabolites used in the diets, with the exception of 1α(OH)D3, can be used for broiler chickens without problems for performance and bone quality, however, some aspects of meat quality were affected.

Engagement of the e-commerce industry in the US, according to Twitter in the period of the COVID-19 pandemic.

E-commerce and the use of social media, particularly Twitter, both grew rapidly during the COVID-19 period. Companies may significantly benefit from social media management, which highlights the significance of responsible consumerism highlighted in SDG 12. This study analyzed the relationship of the level of engagement of leading US e-commerce companies according to their position in the financial market through the use of Twitter. The methodology was a quantitative and longitudinal approach, analyzing statistically (through statistical analysis to descriptive statistics, multiple and simple regressions). The 22,400 tweets during 2020, to estimate their engagement. The results showed that the level of engagement on Twitter is not directly related to the financial ranking, neither to its sales nor to the share price. The main contribution lies in the contribution to the literature, to guide academics, managers and CEOs of companies in efficient decision-making in their business strategies in the areas of marketing with the use of Twitter, where companies can boost loyalty, engagement and sales of their users.

Spatial distribution of arsenic and metals suggest a high ecotoxicological potential in Puno Bay, Lake Titicaca, Peru.

Spatial distribution and interpolation methods provide a summarized overview about the pollution dispersion, concerning the environment's quality. A high-altitude lake was taken as a model to assess the metalloid As and metals Cr, Cu, Ni, Pb, Zn distribution in superficial sediment and classify them according to their ecotoxicological potential in the aquatic environment. Surface sediments were collected from 11 sites along Puno Bay located at the western area of Lake Titicaca, Peru, and analyzed for pseudo total-metals. Sediment concentration data and quality were plotted using the Inverse Distance Weighting (IDW) as an interpolation method. High concentrations of As were found especially in the outer bay (81.73 mg.kg-1). Spatial heterogeneity was evidenced for metal by the coefficient of variation, although no significative differences were observed between the two bays applying a Kruskall Wallis test (p < 0.05, df = 1). Sediment quality classification showed that most metal values were below TEL and toxicity was unlikely to occur, only As exceeded threefold PEL values, which categorized sediment as "Very Bad", indicating a rather high ecotoxicological potential to the aquatic environment. In conclusion, spatial analysis connected to interpolation methods demonstrated the superficial sediment heterogeneity in Puno Bay.

Aortic Dissection From an Intra-aortic Balloon Pump: A Dangerous Complication to Keep in Mind.

Despite the benefits of the intra-aortic balloon pump (IABP) being a subject of debate, it remains a widely available and easy-to-use mechanical circulatory support device. Nonetheless, its use is not exempt from complications. Aortic dissection from IABP is an infrequent but deathly complication. We describe a case in which early recognition of the condition led to control through an endovascular approach. A 57-year-old male was admitted for acute decompensated heart failure requiring intravenous inotropic agents. While undergoing assessment for a heart transplant, he developed cardiogenic shock requiring initiation of mechanical circulatory support with an IABP. A few hours after device implantation, the patient developed acute tearing chest pain and was found to have an acute dissection in the descending thoracic aorta. Prompt liaison with the endovascular team led to a thoracic endovascular aortic repair to control the extent of the lesion.

A Case of Subacute Stent Thrombosis.

A 67-year-old male presenting with an anterior ST-segment elevation myocardial infarction (STEMI) underwent stent placement in the left anterior descending coronary. The patient was discharged on an appropriate medical regimen containing dual antiplatelet therapy (DAPT). Four days later, the patient presented with repeat acute coronary syndrome symptomatology. Electrocardiogram demonstrated ongoing STEMI in the previously treated artery distribution. Emergency angiography revealed restenosis and total thrombotic occlusion. Post-intervention stenosis was 0% after aspiration thrombectomy and balloon angioplasty. Stent thrombosis is a high-mortality and therapeutically challenging condition requiring prepared clinicians who recognize predisposing risk factors and initiate early management.

Chronostratigraphy elucidates environmental changes in lacustrine sedimentation rates and metal accumulation.

All changes taking place in a watershed have repercussions on lacustrine environments, being these, the sink of all activities occurring in the basin. Lake Titicaca, the world's highest and navigable lake, is not unfamiliar with these phenomena that can alter the sedimentation dynamics and metal accumulation. This study aimed to identify temporal trends of sedimentation rates by employing a geochronological analysis (210Pb, 137Cs) and to propose metal background values in Puno Bay, as well as to identify metal concentrations (As, Ba, Ca, Cr, Cu, K, Mg, Mo, Ni, Pb, Zn) in the projected timeline to propose, for the first time, background values in Puno Bay. Two sediment cores were collected from the outer and inner bays. Sediment rate (SR) was calculated through the excess of 210Pb (210Pbxs) applying the Constant Flux Constant Sedimentation (CFCS) model. Results show that SR in the outer bay was 0.48 ± 0.08 cm a-1 and for the inner bay was 0.64 ± 0.07 cm a-1. Sediment quality guidelines (SQGs) did not indicate toxicity was likely to occur, except for As. However, enrichment factors (EFs) indicated that all metal accumulation is geogenic. Climatic factors had a marked influence on sedimentation rates for the outer bay, and in the case of the inner bay, it was a sum of climatic and human-based factors.

[Combined influence of preconception body mass index and gestational weight gain on fetal growth]. / Influencia combinada del índice de masa corporal pregestacional y de la ganancia de peso en el embarazo sobre el crecimiento fetal.

BACKGROUND: The Chilean Ministry of Health has been using standards for nutritional evaluation and weight gain recommendations during pregnancy in the last 25 years. In the meantime new standards have been developed. AIM: To study the combined influence of preconception maternal nutritional status and gestational weight gain, using new standards to classify those parameters, on perinatal outcomes. MATERIAL AND METHODS: A cohort of 11,465 healthy pregnant women was prospectively followed until term. Their pre-gestational nutritional status was classified using the body mass index cut-offs in use in the United States (USA). Their gestational weight gain was classified using categories proposed in a Danish study. Perinatal outcomes included were risky birth weight, i.e. < 3000 g and ≥ 4000 g, and cesarean delivery. Relative risks for those perinatal outcomes were calculated for all combined categories of pre-gestational nutritional status and gestational weight gain. RESULTS: Relative risks of almost all gestational weight gain results were statistically significant for women having a normal pre-gestational nutritional status meanwhile all of them were not significant for underweight women. Overweight and obese women had similar relative risks values as normal women. However, many of them were not significant, especially in obese women. CONCLUSIONS: There is an independent and combined influence of preconception nutritional status and gestational weight gain on perinatal outcomes, when using standards to classify those parameters developed in the USA and Denmark, respectively.

Effects of amino acid levels during rearing on Cobb 500 slow-feathering broiler breeders: 1. Growth and development.

Adequate pullet nutrition is essential to reach BW and suitable body composition for reproduction. An experiment was conducted to determine the effects of 4 dietary amino acid (AA) levels on BW, flock uniformity, body conformation, organ, leg, and feathering development of broiler breeder pullets during the rearing phase from 5 to 24 wk. A total of 1,360 Cobb-500 slow-feathering (SF) pullets were randomly placed in 16-floor pens with 85 females per pen. Diets with corn, soybean meal, and wheat-midds were formulated without protein restriction maintaining minimum ratios between essential AA and Lys on a digestible (dig) ideal basis. Treatments consisted of 4 dietary AA levels with 80% (low-AA), 90% (moderate-AA), 100% (standard-AA), and 110% (high-AA) of the Cobb-Vantress recommendations guided by dig Lys using balanced protein. Up to 4 wk, all pullets were fed a common starter crumble diet. Grower and developer mash diets were fed to pullets from 5 to 15 wk and from 16 to 24 wk, respectively. Pullets fed standard-AA and high-AA diets were heavier (P < 0.001) than those fed low-AA diets at 10, 15, and 20 wk of age. High-AA diets resulted in better (P = 0.040) flock uniformity at 10 wk. Pullets fed a high-AA diet had the highest (P = 0.041) relative breast weight at 20 wk of age and the lowest (P = 0.044) deposits of abdominal fat at 15 wk of age. Fleshing increased (P < 0.05) as AA content rise in the diet, while the relative shank length (P < 0.001) and the number of wing juvenile feathers (P = 0.004) decreased. Pullets fed the lowest dietary AA level had the longest (P = 0.007) small intestine relative to BW at 10 wk of age, but a smaller (P = 0.001) liver than those fed moderate and standard-AA diets at 20 wk of age. Dietary AA levels have important effects on pullet BW, fleshing, and organ development during rearing with potential reproductive performance impacts.

Multidisciplinary laparoscopic management of deep infiltrating endometriosis from 2010 to 2017: A retrospective cohort study. / Manejo laparoscópico multidisciplinario de la endometriosis profunda del 2010 al 2017: estudio de cohorte retrospectivo.

BACKGROUND: Laparoscopy has become the standard of care in the surgical management of deep infiltrating endometriosis (DIE). However, it is a challenging procedure with a high complication rate. Despite the benefits of the minimally invasive approach, DIE resection is often performed by surgeons without adequate training, especially in developing countries like Chile. OBJECTIVE: To asses our experience in the diagnosis and laparoscopic management of DIE during seven years. METHODS: A retrospective cohort study of data including 137 patients with pathology-proven DIE. Surgical and fertility outcomes were evaluated. RESULTS: All procedures were performed laparoscopically without conversion. Dysmenorrhea and dyspareunia were the most common symptoms in 85.4% and 56.9%, respectively. Uterosacral ligaments were the most common DIE location. Endometrioma was present in 48.9% of cases. Median operative time was 140 minutes; however, it was longer in cases requiring bowel surgery (p < 0.0001). The complication rate was 10.9%. Median follow-up was 24.5 months. The pregnancy rate was 58.1% and 90% of patients reported significant symptom relief after surgery. CONCLUSION: Laparoscopic surgical management of DIE is effective and safe but it must be performed in tertiary centers with the availability of multidisciplinary teams.

INTRODUCCIÓN: La laparoscopía es actualmente el estándar en el manejo de la endometriosis profunda. Sin embargo, requiere de un entrenamiento específico e involucra la realización de procedimientos complejos y asociados a una alta tasa de complicaciones. Por lo anterior en Chile y Latinoamérica, la endometriosis profunda es frecuentemente manejada de manera inadecuada. OBJETIVO: Describir nuestra experiencia en el enfrentamiento clínico y manejo quirúrgico laparoscópico de la endometriosis profunda, durante los últimos siete años. MÉTODOS: Estudio de cohorte retrospectivo de 137 pacientes consecutivas operadas y con confirmación histológica de endometriosis profunda. Se recolectaron los datos demográficos, datos quirúrgicos, complicaciones, resultados reproductivos y seguimiento. RESULTADOS: Todas las cirugías fueron completadas por laparoscopía, sin conversión. La dismenorrea y la dispareunia fueron los síntomas más frecuentes en 85,4 y 56,9%, respectivamente. La localización más frecuente de endometriosis profunda fueron los ligamentos úterosacros, coexistiendo un endometrioma en 48,9% de los casos. La mediana de tiempo operatorio fue de 140 minutos, siendo significativamente más prolongado en casos con compromiso intestinal (p < 0,0001). Quince pacientes (10,9%) presentaron complicaciones. El seguimiento medio fue de 24,5 meses. La tasa de embarazo fue de 58,1% y 90% de las pacientes reportó una mejoría significativa de su sintomatología. CONCLUSIONES: El manejo laparoscópico de la endometriosis profunda es efectivo y seguro, pero debe reservarse a centros especializados y con disponibilidad de equipo multidisciplinario.

Ovarian Torsion after Hysterectomy: Case Report and Concise Review of the Reported Cases.

Ovarian torsion after hysterectomy is a rare event. The diagnosis of ovarian torsion is challenging because symptoms are nonspecific. We present a case of ovarian torsion 2 years after laparoscopic hysterectomy (LH). Furthermore, we performed a literature review about ovarian torsion after hysterectomy. This case shows that, in cases of acute onset pelvic pain in patients with history of hysterectomy, the adnexal torsion must be kept in mind in the differential diagnosis, especially in those women who had undergone LH.

Thoracic and diaphragmatic endometriosis: Single-institution experience using novel, broadened diagnostic criteria

Objective: To describe our experience with the multidisciplinary management of both thoracic/diaphragmatic endometriosis (TED), applying a broadened definition of the "Thoracic endometriosis syndrome (TES)" to define cases. Material and Methods: We present a retrospective series of consecutive patients affected by pathology-proven TED, treated at our institution, during a period of 7 years. Results: Five women were included. Two patients were referred due to catamenial chest/shoulder pain, one due to recurrent catamenial pneumothorax, and one due to new-onset diaphragmatic hernia. One patient had no thoracic symptoms, but diaphragmatic endometriosis was found during gynecologic laparoscopy for pelvic endometriosis. Endometriosis was histologically confirmed in all cases. After follow-up, all patients remain asymptomatic. Conclusion: Broadened TES criteria could increase the incidence of TED and determine better knowledge of this condition. Multidisciplinary, minimally invasive surgery is effective and safe, but should be reserved for tertiary referral centers.