Effects of Oral Supplementation with Myo-Inositol and D-Chiro-Inositol on Ovarian Functions in Female Long-Term Survivors of Lymphoma: Results from a Prospective Case-Control Analysis.

The progressive improvement of lymphoma treatment has led to an important prolongation of patient survival and life expectancy. The principal international scientific societies of oncology now therefore recommend that long-term survivors of lymphoma join fertility programs. Specifically, fertile-age patients should be assisted by a multidisciplinary team, including specialists dedicated to fertility preservation in oncology, in order to support the completion of their reproductive project. In the general population, the use of Myo-Inositol and D-Chiro-Inositol (MI/DCI) has been demonstrated to be an effective choice to treat ovarian dysfunctions, with a consequent improvement in reproductive outcomes, so it may represent an adjuvant strategy for this purpose. We therefore conducted a pilot prospective case-control study to evaluate the potentialities of this nutritional supplement, with the aim of optimizing reproductive function in female long-term survivors of lymphoma. One group underwent oral supplementation with MI 1200 mg and DCI 135 mg per day for 12 months, compared with controls who underwent no treatment in the same period. After 12 months, FSH, LH, and progesterone levels, as well as oligomenorrhea and antral follicle count (AFC), were significantly improved in the MI/DCI group. In addition, a significantly higher mean value in FSH and LH and a significantly lower mean AFC value in the right ovary were observed in controls compared to the MI/DCI group. Despite the need for further investigation, MI/DCI could be considered a potential adjuvant strategy to restore ovarian function in female long-term survivors of lymphoma.

Robotics versus laparoscopic radical hysterectomy with lymphadenectomy in patients with early cervical cancer: a multicenter study.

BACKGROUND: The aim of this study was to retrospectively compare the safety, morbidity, and recurrence rate of total laparoscopic radical hysterectomy (TLRH) with lymphadenectomy and total robotic radical hysterectomy (RRH) with lymphadenectomy for early cervical carcinoma in a series of 99 consecutive women. MATERIALS AND METHODS: We studied 99 consecutive patients with FIGO stage Ia1 (LVSI), Ia2, Ib1, Ib2, and IIa cervical cancer, 76 of whom underwent TLRH and 23 underwent RRH with pelvic lymph node dissection. Para-aortic lymphadenectomy, with the superior border of the dissection being the inferior mesenteric artery, was performed in all cases with positive pelvic lymph nodes discovered at frozen section evaluation. RESULTS: The mean blood loss was 157 ml in the RRH group (95% confidence interval [95% CI] 50-400) and 95 ml in the TLRH group (95% CI 30-500) (not significant [NS]). The median length of hospital stay was 3 days in the RRH group (95% CI 2-7) and 4 days in the TLRH group (95% CI 3-7) (NS). The mean operating time was 255 min for the TLRH group (95% CI 182-415) compared with 323 min in the RRH group (95% CI 161-433) (P < 0.05). No significant difference was found between the 2 groups when comparing the recurrence rate. CONCLUSIONS: Robotic radical hysterectomy can be considered a safe and effective therapeutic procedure for managing early-stage cervical cancer without significant differences, if compared with laparoscopic radical hysterectomy, in terms of the recurrence rate and intraoperative and postoperative complications, although multicenter randomized clinical trials with longer follow-up are necessary to evaluate the overall oncologic outcomes of this procedure.

Total laparoscopic radical hysterectomy versus abdominal radical hysterectomy with lymphadenectomy in patients with early cervical cancer: our experience.

BACKGROUND: The aim of this study was to retrospectively compare, in a series of 127 consecutive women, the safety, morbidity, and recurrence rate of total laparoscopic radical hysterectomy (TLRH) with lymphadenectomy and abdominal radical hysterectomy with lymphadenectomy (ARH) for early cervical carcinoma. METHODS: A total of 127 consecutive patients with International Federation of Gynecology and Obstetrics stage Ia1 (lymphvascular space involvement), Ia2, and Ib1 early cervical cancer, 65 of whom underwent TLRH and 62 of whom underwent ARH with pelvic lymph node dissection, comprised the study population. The para-aortic lymphadenectomy with the superior border of the dissection being the inferior mesenteric artery was performed in all cases with positive pelvic lymph nodes discovered at frozen section evaluation. RESULTS: The median blood loss in the ARH group (145 ml; range, 60-225 ml) was significantly greater than TLRH group (55 ml; range, 30-80 ml) (P < .01). The median length of hospital stay was significantly greater in the ARH group (7 days; range, 5-9 days) than TLRH group (4 days; range, 3-7 days) (P < .01). The median operating time was 196 min in the TLRH group (range, 182-240 min) compared with 152 min in the ARH group (range, 161-240 min) (P < .01). No statistically significant difference was found between the two groups when the recurrence rate was compared. CONCLUSIONS: Total laparoscopic radical hysterectomy is a safe and effective therapeutic procedure for management of early-stage cervical cancer with a far lower morbidity than reported for the open approach and is characterized by far less blood loss and shorter postoperative hospitalization time, although multicenter randomized clinical trials with longer follow-up are necessary to evaluate the overall oncologic outcomes of this procedure.

The perception of healthcare quality of elderly in the city of Bari, South Italy.

BACKGROUND: In recent decades in Italy, as in all the industrialized nations, the proportion of elderly subjects in the total population is constantly on the increase. However the increased life expectancy is not always paralleled by a true improvement in the quality of life. In this context, it is essential to analyze elderly real health needs and the responses to these needs, especially in terms of healthcare, that the territorial services are perceived to offer. METHODS: In the period from June to September 2006 we selected randomly one General Practitioner (GP) for each district of the Bari Municipal Area and, form each GP, we randomly chose 25 patients over 65 years old (YO). We conducted phone interviews using a standard data collection questionnaire and, for each of the recruited subjects, the GP filled a data collection sheet. RESULTS: Although the mean age (73.6 years) of the population under study was quite high, the general state of health was judged good both by the G P- and by their elderly patients (>75%).Notably, the great majority of elderly patients considered the healthcare they receive to be satisfactory (>60%): in particular, the GP was the true point of reference for this slice of the population for strictly medical problems as well as for advice. On the contrary, the patients attributed little value to social services, which were poorly known and scarcely used (8.5%). Public hospital facilities played a central role in second level healthcare in more than 30% of cases; private facilities covered by public health insurance were also very important. As possible solutions to the problem of loneliness, 36.6% of the patients declared that they approved of nursing homes. CONCLUSION: Decision makers need to create services supporting the key role played by General Practitioners, who are well aware that their assistance is not sufficient to satisfy the health needs of the elderly.

[Risk factors for mortality during a heat-wave in Bari (Italy), summer 2005.]. / Fattori di rischio per la mortalità durante un'ondata di calore a Bari, estate 2005.

INTRODUCTION: The Italian Heat Health Watch Warning System (HHWWS) was set up following the over 3000 excess deaths which occurred in Italy during the heat wave of 2003, In June 2005 the warning system issued a heat warning in various Italian cities. METHODS: A case control study was performed in one of these cities (Bari) in order to identify individual and environmental risk factors as well as preventive strategies for reducing mortality during future heat waves. Cases were defined as subjects aged <65 years who had died during the heat wave and whose death certificate listed one of the following as the cause of death: heat, cardiovascular or cerebrovascular disorders, neurocognitive disorders, dehydration or fever/infection not otherwise specified. For each case, three age-matched controls were randomly selected among individuals followed by the same general practitioner as the case. All variables significantly associated with mortality (<0.1) in the univariate analysis were entered into a conditional logistic regression model and the population attributable fraction (PAF) was calculated for significant variables (at p<0.05). RESULTS: Twenty cases and sixty controls were included in the study. In 17 cases (89%) death had occurred at home and 11(55%) of these were cardiovascular- related deaths. At the multivariate analysis, the factors significantly associated with mortality risk during the heat wave were: having a functioning air conditioner at home [OR:0.09(95% CI 0.01-1.00)], having an Activities of Daily Living score <2 [OR:21.0(95%CI 1.81-242.47)] and having been hospitalized the year preceding death [OR:18.1(95%CI 2.04-160.51)]. CONCLUSIONS: Public health interventions during heat waves should include the provision of access to an air conditioned environment. Subjects with impaired health (especially if recently hospitalized) and with significant limitations in their activities of daily living are probably at higher risk during heat waves.

A multicenter study comparing surgical outcomes and ultrasonographic evaluation of scarring after laparoscopic myomectomy with conventional versus barbed sutures.

OBJECTIVE: To compare clinical outcomes after laparoscopic myomectomy using traditional interrupted sutures (TIS) versus continuous barbed suture (CBS) for treatment of symptomatic uterine myomas. METHODS: In a multicenter retrospective study, data were obtained for women with uterine myomas who underwent laparoscopic myomectomy at three centers between January 1, 2009 and January 31, 2015. Suturing of the uterine wall had been performed initially using TIS; CBS were used from January 31, 2012. RESULTS: Overall, laparoscopic myomectomy was performed using CBS for 360 women and using TIS for another 360. The mean operative time was 52±19min using CBS and 67±21min using TIS groups (P=0.001). The mean blood loss was 135±35mL in the CBS group and 215±55mL in the TIS group (P=0.006). The mean decrease in hemoglobin was 1.2±0.2g/L in the CBS group and 1.2±0.2g/L in the TIS group (P=0.072). CONCLUSION: Laparoscopic myomectomy using CBS is a suitable alternative to TIS in the treatment of uterine myomas for women with up to three tumors.

Advantages of laparoscopy versus laparotomy in extremely obese women (BMI>35) with early-stage endometrial cancer: a multicenter study.

BACKGROUND: The aim of the present study was to demonstrate the advantages of laparoscopy versus laparotomy for treatment of extremely obese women with early-stage endometrial cancer. MATERIALS AND METHODS: Seventy-five extremely obese patients with Body Mass Index >35 kg/m(2) and clinical stage I endometrial cancer underwent hysterectomy and bilateral salpingo-oophorectomy, and in all cases we performed systematic pelvic lymphadenectomy by laparoscopy (mean BMI of 38±7.3 kg/m(2)) or laparotomy (mean BMI of 39±8.1 kg/m(2)). RESULTS: In two (4.4%) patients of the laparoscopy group we observed a port site haematoma that was resolved without a second surgery. In three patients of the laparotomy-group, we observed dehiscence of the abdominal suture with surgical site infection that was re-sutured. CONCLUSION: Laparoscopy can be considered a safe and effective therapeutic procedure for managing early-stage endometrial cancer in extremely obese women with a lower complication rate, lower surgical site infection and postoperative hospitalization.

Accuracy and efficacy of narrow-band imaging versus white light hysteroscopy for the diagnosis of endometrial cancer and hyperplasia: a multicenter controlled study.

OBJECTIVE: The aim of this study was to evaluate, in a multicenter study, whether the narrow-band imaging (NBI) technology may improve the diagnostic reliability of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia. METHODS: A total of 801 outpatient women undergoing diagnostic hysteroscopy were enrolled. All women underwent fluid minihysteroscopy with white light (WL) and NBI exploration with endometrial eye-directed biopsy. RESULTS: NBI hysteroscopy significantly improved the sensitivity for diagnosing endometrial cancer compared with WL (93% and 81%, P < 0.05). In detecting low-risk hyperplasia, the use of NBI significantly improved the sensitivity (82% vs 56%, P < 0.005) and positive predictive value (79% and 71%, P < 0.05) compared with WL hysteroscopy. In the diagnosis of high-risk hyperplasia, NBI significantly improved the sensitivity (60% vs 20%, P < 0.005) and positive predictive value (67% and 25%, P < 0.0001), whereas no difference was seen for specificity (99% and 99%, P > 0.005), negative predictive value (99% and 99%, P > 0.05), and accuracy (99% and 98%, P > 0.05). CONCLUSIONS: NBI showed significantly higher values in sensitivity for the detection of low-risk and high-risk hyperplasia, and this could be useful for reducing the risk of missing severe pathologies at hysteroscopy, and improving the diagnosis of preneoplastic and neoplastic pathologies. NBI hysteroscopy showed a very high diagnostic accuracy for the exploration of the uterine cavity, reducing the number of biopsies performed in wrong areas, although multicenter randomized trials are required to establish the true value of this interesting technological advancement.

Risk of long-term pelvic recurrences after fluid minihysteroscopy in women with endometrial carcinoma: a controlled randomized study.

OBJECTIVE: Concerns exist about the risk of endometrial cancer cells spreading into the peritoneal cavity after fluid minihysteroscopy. The aim of our study was to evaluate the 5-year incidence of pelvic recurrences in women affected by early-stage endometrial carcinoma (stage IA or IB) who did or did not undergo preoperative hysteroscopy with low pressure (<70 mm Hg) saline uterine distention. METHODS: A total of 140 women were randomized into two groups of 70 women who underwent or did not undergo diagnostic fluid minihysteroscopy before surgical staging. Women were followed up every 6 months for at least 5 years. Diagnosis of pelvic recurrence was based on a positive result at clinical examination and/or at vaginal cytology and/or at magnetic resonance imaging/positron emission tomography scan. Univariate analysis of disease-free survival was performed with the Kaplan-Meier method and survival curves were compared using the long-rank test. RESULTS: No difference in peritoneal cytology was observed between the two groups (5.7% and 8.5% of cases in the hysteroscopy and control group, respectively). After a mean duration of follow-up of 62 months, 2 (2.85%) pelvic recurrences in the hysteroscopy group and 3 (4.28%) in the control group were found. No significant difference was found between the two groups when the recurrence rate was compared. Overall survival rates and disease-free survival projected by Kaplan-Meier curves were not significantly different for the two groups. CONCLUSIONS: Preoperative low-pressure fluid minihysteroscopy does not increase the risk of intraperitoneal transport of endometrial carcinoma cells during the examination or the risk of pelvic recurrence at the 5-year follow-up. It does not seem to modify the recurrence rate, disease-free survival, and overall survival, although multicenter randomized trials and long-term follow-up are required to evaluate the overall oncologic outcomes of this procedure.