Balloon tamponade for prevention and treatment of vaginal hemorrhages in gynecology.

The preliminary experience of balloon tamponade in planned vaginal surgery and in emergency vaginal bleeding using a new device (Vagistop) is reported. The results shows the advantages of the system in comparison with vaginal gauze packing.

Minimally invasive vaginal hysterectomy using bipolar vessel sealing: preliminary experience with 500 cases.

The objective of our study was to evaluate surgical outcome of minimally invasive vaginal hysterectomy (MIVH), using the bipolar vessel sealing system (BVSS; BiClamp®). The design was a retrospective analysis (Canadian Task-force Classification II-3). The setting was a secondary care hospital. Records of patients who underwent vaginal hysterectomy for benign indications in our centre between November 2005 and March 2011 were reviewed. The demographic patients' data, indications for surgery, patient history with regard to previous surgery, duration of surgery, blood loss (postoperative hemoglobin drop '∆Hb'), perioperative complications, and length of inpatient stay were collected from the medical records. The intervention was vaginal hysterectomy using BVSS (BiClamp®). Results showed that the mean duration of surgery was 48.9 ± 15.3 min (95% CI, 49.2-52.5). The mean duration of hospital stay was 3.2 ± 1.2 days (95% CI, 2.8-3.2). The mean ∆Hb was 1.4 ± 1.8 g/dl. Overall, conversion to laparotomy was required in three cases (0.6%). Only one haemoperitoneum occurred (0.2%) and this is the only case who required blood transfusion. The main indication for VH was uterine prolapse in 52.0% (n = 260) of cases; uterine fibroids in 37.4% (n = 187); adenomyosis uteri in 4.2% (n = 21); cervical dysplasia in 22 patients (4.4%) and in 2% (n = 10) of patients, endometrial hyperplasia and other pathologies were the indications for VH. It was concluded that electrosurgical bipolar vessel sealing by (BiClamp®) can provide a safe and feasible alternative to sutures in vaginal hysterectomy, resulting in reduced operative time and blood loss, with acceptable surgical outcomes.

D-dimer after delivery in uncomplicated pregnancies.

UNLABELLED: D-dimer is now widely used as a coagulation marker. During pregnancy the D-dimer level increases until term even in uncomplicated pregnancies. The aim of the study was to establish the D-dimer immediately after delivery in uncomplicated pregnancies. A rapid immunoturbidimetric assay for D-dimer determination was employed in 100 consecutive deliveries. D-dimer level increased significantly in all women after delivery (increase from 1 to more than 10 times over the normal range). CONCLUSION: An increase in fibrinolysis is associated with pregnancy and delivery, and D-dimer level must be interpreted only in association with other clinical, laboratory and instrumental methods when pathological conditions (e.g. pulmonary embolism, deep vein thrombosis or disseminated coagulation) are suspected.

Advantages of spinal anesthesia in abdominal gynecologic surgery.

The advantages obtained in vaginal surgery and caesarean section using spinal anesthesia led us to test this anesthesia to verify feasibility, problems and advantages in abdominal surgery. Spinal anesthesia was performed in 60 patients between 21 and 87 years of age. Thirty-seven total abdominal hysterectomies with or without adnexectomy, 5 laparotomic miomectomies, 3 adnexectomies, 5 colposacropexies, 2 hysterectomies with lymphadenectomy, 7 Burch colposuspension with or without hysterectomy and 1 laparoscopy for sterilization were performed. No significant problems during surgery and the postoperative period were observed. Resumption of the different physiologic functions were more rapid, hospital stay shorter and compliance greater than with general anesthesia.

Partial detachment of round ligament found at laparoscopy for chronic pelvic pain in a female adolescent.

A 13-year-old female adolescent presented with pelvic pain localized in the right lower abdominal quadrant with diffusion to the groin and internal thigh and worsened by marked leg abduction. No symptoms were detected on physical or sonography examination. The patient reported pain for a further 4 months with no moderation. A laparoscopy was performed, which showed normal adnexa and pelvic hollow. No adhesions were found. The uterus was normal in size and appearance, but the right round ligament presented with a partial detachment at cornual insertion. An inflammation was present. The decision was made to perform no surgical repair with the belief that pain would worsen. The pain gradually lessened, and in 1998 she remains pain free.

Severe coital injury after Frank's creation of a neovagina.

A neovagina was created by the Frank's dilatation method in a girl with vaginal agenesis. At the first coital attempt complete laceration of the cul de sac with copious bleeding occurred. Daily application of estrogen cream was the only therapy until complete healing after four weeks. Possible causes and therapeutic approaches are discussed.

Chickenpox complications among immunocompetent hospitalized children in Italy. Acyclovir-Chickenpox Italian Study Group.

OBJECTIVE: To evaluate the frequency and clinical spectrum of chickenpox complications among immunocompetent hospitalized children. PATIENTS AND METHODS: Multicentre retrospective study of clinical records of all patients consecutively hospitalized for varicella during the last decade, in ten tertiary care clinical centres of Pediatrics and Infectious Diseases, throughout Italy. RESULTS: Two hundred and nineteen out of 991 patients (22.1%) hospitalized for varicella suffered from a complicated disease (247 complicating events on the whole). Central nervous system (CNS) involvement was prevalent (104 episodes), followed by skin/soft tissue infections, lower respiratory tract involvement, and thrombocytopenia. A complicated disease was significantly associated with the male gender and an elevated incidence of varicella-zoster (VZ) virus infection acquired by household contacts. The involvement of lower respiratory airways and skin/soft tissues seemed to occur at an earlier age, compared with CNS and thrombocytopenia. Moreover, lower respiratory tract and skin/soft tissue infections occurred earlier during disease course than complications interesting the CNS and coagulation system. All subjects with complicated chickenpox showed a favourable outcome within 5-40 days, except two patients developing a lethal cardiomyopathy and Reye syndrome, respectively. Anyway, chickenpox complications led to a prolonged hospitalization, and needed further pharmacologic treatment in all evaluated cases. The administration of anti-VZ virus treatments (i.v. acyclovir or VZ immunoglobulins) did not modify significantly the course of disease in treated patients, when compared with untreated ones. CONCLUSIONS: Although chickenpox is considered a self-limiting, uncomplicated disease in immunocompetent children, when assessing hospitalized patients a considerable incidence and a broad spectrum of complications are observed, requiring prolonged admission and pharmacologic and supportive care. Even though a lethal outcome remains a rare occurrence, it may be of relevant concern when considering the overall incidence of chickenpox in the general population. The role of an early antiviral treatment in reducing the incidence and severity of varicella complications deserves further evaluation.

Non-invasive early prenatal molecular diagnosis using retrieved transcervical trophoblast cells.

Fetal DNA was recovered from 17 of 39 (44%) transcervical cell (TCC) samples obtained between 7 and 9 weeks of gestation by endocervical canal flushing. Trophoblast retrieval was adequate for polymerase chain reaction (PCR) amplification of Y chromosome-specific DNA sequences and detection of paternal-specific microsatellite alleles. The fetal sex predicted by PCR in TCCs was confirmed in all cases by karyotype analysis of chorionic villi at 10 weeks of gestation. The absence of the disease-associated paternal alleles in TCC samples from two pregnancies at risk for spinal muscular atrophy and myotonic dystrophy predicted unaffected fetuses in agreement with subsequent results on chorionic villi and newborns' leukocytes. A trisomy 21 fetus was diagnosed in TCCs using fluorescent in situ hybridization (FISH) and semi-quantitative PCR analysis of superoxide dismutase-1 (SOD 1). Present experience indicates that TCC sampling is a promising technique for early prenatal monitoring of Mendelian disorders and chromosome aneuploidy.

Varicella in immunocompetent children in the first two years of life: role of treatment with oral acyclovir. Italian Acyclovir-Chickenpox Study Group.

An open multicenter study has been carried out to evaluate efficacy and tolerability of oral acyclovir in the treatment of varicella in immunocompetent patients in the first two years of life. Fifty-three children aged 3-24 months received acyclovir at 80 mg/Kg/day in four divided doses for 4 to 6 days; 24 of them were treated in the first 24 hours following disease onset, while the remaining 29 patients were enrolled within 48 hours. The assessment of evolution of disease signs and symptoms showed a rapid resolution of fever, itching and other constitutional symptoms, with interruption of vesicle formation and acceleration of cutaneous healing processes. No statistically significant differences have been demonstrated as to disease progression between patients treated in the first 24 hours, when compared with subjects receiving acyclovir in the following 24 hours. Acyclovir confirmed its excellent clinical and laboratory safety profile. By acting favorably on both the duration and severity of disease signs and symptoms, acyclovir treatment should be recommended in young children and infants with varicella, since a higher incidence of severe and complicated disease has been observed in these patient groups.

Mayer-Rokitansky-Küster-Hauser syndrome and ovarian cancer. Report of a case.

A case of ovarian cancer associated with the Mayer-Rokitansky-Küster-Hauser syndrome is reported. As far as we know, this is the second report of ovarian neoplasm associated with this syndrome. The need for gynecological control of ovarian and other possible pathologies of the genital tract in these women is discussed.

The Mayer-von Rokitansky-Küster-Hauser syndrome (uterus bipartitus solidus rudimentarius cum vagina solida): the development of gynecology through the history of a name.

A summary of the original descriptions of the Authors who gave the name to the syndrome characterized by absence of uterus and vagina is presented. Through these original descriptions a complete view of the development in gynecology over the last 150 years is offered.

Creation of a neovagina by pelviscopy.

A pelviscopic method for the creation of a neovagina in a case of Mayer-von Rokitansky-Kuester-Hauser syndrome is described. Only one procedure for endoscopic diagnosis and minimal access operative therapy is required. The operative trauma of the Vecchietti procedure is greatly reduced by replacing the Pfannenstiel incision by pelviscopy.

Recurrent empty follicle syndrome.

We report a case of recurrent empty follicle syndrome over two stimulated cycles in a patient having immunological infertility. All follicles contained follicular fluid but aspirated granulosa cells were rarely observed. No oocytes were obtained from a total of 24 follicles.