Hybrid cooperative complexes to decrease VAS score and enhance sexual function in women with vulvar lichen sclerosus.

OBJECTIVE: Lichen sclerosus is a chronic, inflammatory, progressive skin disease predominantly affecting anogenital areas. Vulvar lichen sclerosus (VLS) is one of the most common conditions treated in vulvar clinics; most patients report distressing symptoms of itching, burning, stinging, and pain (particularly during or after sexual intercourse). A preliminary, prospective, single-center study was performed to investigate the efficacy of hyaluronan hybrid cooperative complex (HCC) comprising high and low molecular weight hyaluronic acid to treat menopausal women with VLS. PATIENTS AND METHODS: Patients (N = 30) received two HCC injections at 32 mg/ml (one month apart). At baseline and one and six months after treatment, patients completed validated psychometric questionnaires to assess their self-reported pain, itching, and dryness using the Visual Analogue Scale (VAS) and sexual function by the Female Sexual Function Index (FSFI). RESULTS: After treatment with HCC, no side effects or complications were reported. VAS scores showed a trend towards reduced pain and itching intensity, and there was a statistically significant reduction in median VAS score for dryness at follow-up vs. baseline (p=0.038). For sexual function, there was a statistically significant improvement in lubrication (p=0.001) and orgasm (p=0.001) FSFI domains. CONCLUSIONS: Overall, this preliminary study demonstrated the promising efficacy of HCC in menopausal women with VLS without side effects.

Platelet-rich plasma for genital lichen sclerosus: analysis and results of 94 patients. Are there gender-related differences in symptoms and therapeutic response to PRP?

BACKGROUND: Lichen sclerosus is a chronic relapsing inflammatory dermatosis with a predilection for anogenital skin in 85%-98% of cases and is more prevalent in women (3%) than in men (> 0.07%). OBJECTIVES: The purpose of this study was to investigate gender differences in clinical presentation and therapeutic response to treatment with platelet-rich plasma (PRP), an emerging innovative strategy for LS. METHODS: Forty-three male and 51 female patients affected by LS were evaluated. Each patient was subjected to PRP treatment (1 infiltration every 15 days, for 3 times). RESULTS: The PRP procedure was well tolerated by all patients and an overall significant decrease in symptoms was reported 6 months after PRP infiltration. Reduction in pain and burning sensation was significant in both gender but more accentuated in women than in men, whereas reduction of itching was similar. On the contrary, dyspareunia evidenced sex-related difference since a significant diminution was observed only in male. CONCLUSIONS: This study demonstrates that PRP based therapy may exert a relevant role in LS patient management due to its effect on Quality of Life (QoL) and sexual function in both gender. In addition, the study underlined gender-related differences in severity of symptoms and disease age onset.

Usefulness of video thermography in the evaluation of platelet-rich plasma effectiveness in vulvar lichen sclerosus: preliminary study.

BACKGROUND: Lichen sclerosus (LS) is a chronic-relapsing and potentially serious skin disease that has a preference for genital skin. Currently, there is no standardized method for assessing the effects of therapies. OBJECTIVE: The objective of this preliminary study is to use video thermography (VTG) in the evaluation of vulvar lichen sclerosus (VLS) before and after platelet-rich plasma (PRP) therapy. METHODS: A sample of six female patients was enrolled. Patients were subjected to PRP treatment. Patients selected for the study had been assessed at baseline (T0) and after 7 and 30 d from PRP treatment (T1 and T2, respectively). Clinical and VTG evaluation was executed in every visit. RESULTS: The VTG examination showed at least one hypothermic area (HA) in all our patients. The average temperature measured in the vulvar and perineal region taken as a reference for each patient was found to be between 33.7 °C and 36.3 °C, with a fair difference between the patients. HAs showed thermal differences which varied between 2.2 °C and 1.2 °C. CONCLUSIONS: It is demonstrated here that PRP offers satisfactory effectiveness in treating VLS and that video thermograpy could represent a useful paraclinic method in the identification and follow-up of LS.

Role of ion exchange membranes and capacitive electrodes in membrane capacitive deionization (MCDI) for CO2 capture.

Recently we showed that membrane capacitive deionization (MCDI) can be used to capture CO2, but we found that the performance decreases with decreasing current density. In the present study, we investigate the effect of electrodes and ion exchange membranes by performing experiments with two membranes (CO2-MCDI), with one membrane (cation or anion exchange membrane), and without membranes (CO2-CDI). We find that the anion exchange membrane is essential to keep high CO2 absorption efficiencies ( [Formula: see text] /ncharge), while the absorption efficiency of the CO2-CDI cell was lower than expected (Λa≈0.5 for CO2-MCDI against Λa≈0.18 for CO2-CDI). Moreover, we theoretically investigate ion adsorption mechanisms in the electrodes by comparing experimental data of a CO2-CDI cell with theoretical results of the classic amphoteric-Donnan model developed for conventional CDI. By comparing the experimental results with the amph-D model, we find that the model overestimates the absorption efficiency in CO2-CDI experiments. To understand this discrepancy, we investigate the effects of other phenomena, i.e., (i) low ion concentration, (ii) passive CO2 absorption, and (iii) the effect of acid-base reactions on the chemical surface charge.

An organic neurophysiological tool for neuronal metabolic activity monitoring.

Monitoring cell metabolism in vitro is considered a relevant methodology in several scientific fields ranging from fundamental biology research to neuro-toxicology. In the last 20 years, several in vitro neuro-pharmacological and neuro-toxicological approaches have been developed, with the intent of addressing the increasing demand for real-time, non-invasive in vitro systems capable of continuously and reliably monitoring cellular activity. In this paper, an Organic Charge Modulated Field Effect Transistor-based device is proposed as a promising tool for neuro-pharmacological applications, thanks to its ultra-high pH sensitivity and a simple fabrication technology. The preliminary characterization of this versatile organic device with primary neuronal cultures shows how these remarkable properties can be exploited for the realization of ultra-sensitive metabolic probes, which are both reference-less and low cost. These features, together with the already assessed capability of this sensor to also monitor the electrical activity of electrogenic cells, could provide important advances in the fabrication of multi-sensing lab-on-chip devices, thus opening up interesting perspectives in the neuro-pharmacological field.

Arctic cut-off high drives the poleward shift of a new Greenland melting record.

Large-scale atmospheric circulation controls the mass and energy balance of the Greenland ice sheet through its impact on radiative budget, runoff and accumulation. Here, using reanalysis data and the outputs of a regional climate model, we show that the persistence of an exceptional atmospheric ridge, centred over the Arctic Ocean, was responsible for a poleward shift of runoff, albedo and surface temperature records over the Greenland during the summer of 2015. New records of monthly mean zonal winds at 500 hPa and of the maximum latitude of ridge peaks of the 5,700±50 m isohypse over the Arctic were associated with the formation and persistency of a cutoff high. The unprecedented (1948-2015) and sustained atmospheric conditions promoted enhanced runoff, increased the surface temperatures and decreased the albedo in northern Greenland, while inhibiting melting in the south, where new melting records were set over the past decade.

Ação genotóxica e antiproliferativa de Polygonum punctatum Elliott (Polygonaceae) sobre o ciclo celular de Allium cepa L / Genotoxic and antiproliferative action of Polygonum punctatum Elliott (Polygonaceae) on the cell cycle of Allium cepa L

RESUMO: A espécie Polygonum punctatum Elliott (Polygonaceae) é amplamente utilizada pela população como planta medicinal. O objetivo deste trabalho é o de avaliar o potencial genotóxico e mutagênico de P. punctatum utilizando raízes de bulbos e radículas em sementes germinadas de Allium cepa através do teste in vivo, e realizar comparações da extração do material vegetal por calor (infusões) e extração a frio (extrato). Para isso, foram preparadas dois tipos de soluções, infusões e extratos foliares de P. punctatum, em duas concentrações 0,4 g mL-1 e 2,4 g mL-1. A infusão foi preparada pela adição das folhas secas em água destilada fervente (100ºC), permanecendo por 10 minutos enquanto o extrato foi preparado através da maceração das folhas secas em água destilada fria. Para o teste em A. cepa foram utilizados, para cada tratamento, seis grupos de quatro bulbos e seis caixas gerbox com 50 sementes em cada caixa. Duas lâminas para cada tratamento foram obtidas através da técnica de esmagamento das raízes e coradas com orceína acética 2%. Foram contadas 2000 células por grupo de bulbos e 3000 células por grupo de sementes, observando-se a ocorrência de interrupções em metáfases, alterações cromossômicas estruturais, bem como a inibição ou aumento da divisão celular. Os valores do índice mitótico foram calculados e analisados estatisticamente pelo Teste χ2 (p≤0,05). Os resultados demonstraram que as infusões e os extratos de folhas apresentaram redução nos valores de índices mitóticos nas concentrações utilizadas em relação ao controle em água destilada. Foram identificadas alterações cromossômicas na divisão celular, tais como pontes anafásicas, em todas as concentrações de infusões e extratos indicando assim que P. punctatum possui atividade antiproliferativa e genotóxica.

ABSTRACT: The species Polygonum punctatum Elliott (Polygonaceae) is widely used by the Brazilian population as a medicinal plant. The aims of this study are to evaluate the genotoxic and mutagenic potential of P. punctatum, using its root bulbs and rootlets in germinated seeds of Allium cepa by in vivo testing, and to compare the extraction of plant material by heat (infusions) and cold (extract). Thus, two types of solutions - infusions and leaf extracts - of P. punctatum were prepared at the two concentrations of 0.4 g ml -1 and 2.4 g mL- 1. The infusion was prepared by addition of dry leaves in boiling distilled water (100ºC), remaining for 10 minutes, while the extract was prepared by maceration of dried leaves in cold distilled water. For the A. cepa, we used for each treatment six groups of six bulbs and six seedling boxes with 50 seeds each. Two slides for each treatment were obtained by the technique of crushing the roots, and they were stained with 2 % acetic orcein. For the analysis, 2000 cells per group of bulbs and 3000 cells per group of seeds were counted, and we noted the occurrence of interruptions in the metaphase, chromosomal aberrations, as well as inhibited or increased cell division. The values of the mitotic index were calculated and statistically analyzed by the χ2 test (p ≤ 0.05). The results showed that the infusions and extracts of leaves showed reduced values of mitotic indices in the concentrations used compared to the control in distilled water. Chromosomal alterations were identified in the cell division, in all concentrations of infusions and extracts, thus indicating that P. punctatum has an antiproliferative and genotoxic activity.

An organic transistor-based system for reference-less electrophysiological monitoring of excitable cells.

In the last four decades, substantial advances have been done in the understanding of the electrical behavior of excitable cells. From the introduction in the early 70's of the Ion Sensitive Field Effect Transistor (ISFET), a lot of effort has been put in the development of more and more performing transistor-based devices to reliably interface electrogenic cells such as, for example, cardiac myocytes and neurons. However, depending on the type of application, the electronic devices used to this aim face several problems like the intrinsic rigidity of the materials (associated with foreign body rejection reactions), lack of transparency and the presence of a reference electrode. Here, an innovative system based on a novel kind of organic thin film transistor (OTFT), called organic charge modulated FET (OCMFET), is proposed as a flexible, transparent, reference-less transducer of the electrical activity of electrogenic cells. The exploitation of organic electronics in interfacing the living matters will open up new perspectives in the electrophysiological field allowing us to head toward a modern era of flexible, reference-less, and low cost probes with high-spatial and high-temporal resolution for a new generation of in-vitro and in-vivo monitoring platforms.

Development of micro-electrode array based tests for neurotoxicity: assessment of interlaboratory reproducibility with neuroactive chemicals.

Neuronal assemblies within the nervous system produce electrical activity that can be recorded in terms of action potential patterns. Such patterns provide a sensitive endpoint to detect effects of a variety of chemical and physical perturbations. They are a function of synaptic changes and do not necessarily involve structural alterations. In vitro neuronal networks (NNs) grown on micro-electrode arrays (MEAs) respond to neuroactive substances as well as the in vivo brain. As such, they constitute a valuable tool for investigating changes in the electrophysiological activity of the neurons in response to chemical exposures. However, the reproducibility of NN responses to chemical exposure has not been systematically documented. To this purpose six independent laboratories (in Europe and in USA) evaluated the response to the same pharmacological compounds (Fluoxetine, Muscimol, and Verapamil) in primary neuronal cultures. Common standardization principles and acceptance criteria for the quality of the cultures have been established to compare the obtained results. These studies involved more than 100 experiments before the final conclusions have been drawn that MEA technology has a potential for standard in vitro neurotoxicity/neuropharmacology evaluation. The obtained results show good intra- and inter-laboratory reproducibility of the responses. The consistent inhibitory effects of the compounds were observed in all the laboratories with the 50% Inhibiting Concentrations (IC(50)s) ranging from: (mean ± SEM, in µM) 1.53 ± 0.17 to 5.4 ± 0.7 (n = 35) for Fluoxetine, 0.16 ± 0.03 to 0.38 ± 0.16 µM (n = 35) for Muscimol, and 2.68 ± 0.32 to 5.23 ± 1.7 (n = 32) for Verapamil. The outcome of this study indicates that the MEA approach is a robust tool leading to reproducible results. The future direction will be to extend the set of testing compounds and to propose the MEA approach as a standard screen for identification and prioritization of chemicals with neurotoxicity potential.

Cardiovascular outcome in asymptomatic hemodialysis patients submitted to aggressive medical therapy: results of a four-year follow-up.

AIM: Cardiovascular disease is a leading cause of morbidity and mortality in end-stage renal disease (ESRD) patients on maintenance hemodialysis (HD). Neither traditional nor emerging risk factors for cardiovascular disease can explain completely this excess of morbidity and mortality and the role and timing of primary prevention strategies in this population has not been clarified. The aim of this study was to assess if an aggressive pharmacological preventive treatment may reduce the myocardial ischemic burden and then improve the cardiovascular outcome In ESRD patients. METHODS: Forty-three asymptomatic ESRD patients on maintenance HD were evaluated. Asymptomatic patients with neither history nor clinical evidence of cardiovascular disease were considered. A total of 31 ESRD patients were enrolled into the study and were submitted to Tc-99m SESTAMIBI myocardial gated- single-photon emission computed tomography (SPECT) stress test. All patients then received an aggressive medical regimen with statins, antiplatelet drugs, ACE inhibitors (ACE-I) and/or Angiotensin II Receptor Blockers (ARB) and other hypotensive, glucose-lowering medications, sevelamer, calcium carbonate and calcitriol if required. RESULTS: A significant reduction of coronary functional reserve was found in more than 50% of otherwise asymptomatic HD patients and may often be reverted by prolonged aggressive medical therapy. After a four-year follow-up under aggressive medical therapy no significant difference was observed neither in the incidence of conventional and emerging cardiovascular risk factors nor in cardiovascular outcome of patients with or without silent myocardial ischemia (SMI). CONCLUSION: As cardiovascular disease (CVD) is by far the first cause of death in ESRD, an aggressive medical management may be highly advisable for the primary prevention of major adverse cardiac events in all HD patients despite the stress test evidence of inducible myocardial ischemia .

Nickel modulates the electrical activity of cultured cortical neurons through a specific effect on N-methyl-D-aspartate receptor channels.

Nickel (Ni(2+)) is a toxic metal that affects the function of several ionic channels. In the N-methyl-d-aspartate (NMDA) subtype of glutamate receptor (NR), it causes activity enhancement of the channels containing the NR2B subunit and voltage-independent inhibition of those containing NR2A. Thus, it may represent a functional marker for the identification of NR native channel subunits. We investigated the effect of Ni(2+) on spontaneous NR currents in cortical neurons, dissociated from 18-day rat embryos and maintained in culture for up to ∼40 days. In whole-cell voltage-clamp at -60 mV, in a Mg(2+)-free bath containing the alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionate (AMPA) antagonist 2,3-dihydroxy-6-nitro-7-sulfamoyl-benzo[f]quinoxaline-2,3-dione (NBQX) (10 µM), spontaneous currents were blocked by 10 µM D(-)-2-Amino-5-phosphonopentanoic acid (APV) (10 µM), and by NR2B antagonists, ifenprodil (10 µM) or Ro25-6981 (Ro25, 1 µM), indicating that they are due to NRs containing predominantly the NR2B subunit. In the presence of Ni(2+) (30 µM) the amplitude and the frequency of spontaneous currents were increased and the decay time decreased. A higher dose (300 µM) blocked all electrical activity. In current-clamp, Ni(2+) (30 µM) caused a ∼5 mV reversible depolarization. The effect of Ni(2+), as well as that of NR2B antagonists, was almost independent of days in vitro (DIV) in the range from 18 to 33 DIV. The electrical activity of the neuronal networks measured by microelectrode arrays (MEAs) was also affected by Ni(2+), which caused a decrease in firing rate, but an increase in burst duration, while Ro25 (1-10 µM) caused a decrease in both firing rate and burst duration. Finally, reverse transcription polymerase chain reaction (RT-PCR) revealed a predominant expression of NR2B, with no modification during DIV. These results demonstrate that, in these cultured cells, the NR spontaneous current is almost entirely due by NR2B-containing receptors and that Ni(2+) affects the electrical activity through a specific effect on NR channels.

Tracking burst patterns in hippocampal cultures with high-density CMOS-MEAs.

In this work, we investigate the spontaneous bursting behaviour expressed by in vitro hippocampal networks by using a high-resolution CMOS-based microelectrode array (MEA), featuring 4096 electrodes, inter-electrode spacing of 21 µm and temporal resolution of 130 µs. In particular, we report an original development of an adapted analysis method enabling us to investigate spatial and temporal patterns of activity and the interplay between successive network bursts (NBs). We first defined and detected NBs, and then, we analysed the spatial and temporal behaviour of these events with an algorithm based on the centre of activity trajectory. We further refined the analysis by using a technique derived from statistical mechanics, capable of distinguishing the two main phases of NBs, i.e. (i) a propagating and (ii) a reverberating phase, and by classifying the trajectory patterns. Finally, this methodology was applied to signal representations based on spike detection, i.e. the instantaneous firing rate, and directly based on voltage-coded raw data, i.e. activity movies. Results highlight the potentialities of this approach to investigate fundamental issues on spontaneous neuronal dynamics and suggest the hypothesis that neurons operate in a sort of 'team' to the perpetuation of the transmission of the same information.

Low-frequency stimulation enhances burst activity in cortical cultures during development.

The intact brain is continuously targeted by a wealth of stimuli with distinct spatio-temporal patterns which modify, since the very beginning of development, the activity and the connectivity of neuronal networks. In this paper, we used dissociated neuronal cultures coupled to microelectrode arrays (MEAs) to study the response of cortical neuron assemblies to low-frequency stimuli constantly delivered over weeks in vitro. We monitored the spontaneous activity of the cultures before and after the stimulation sessions, as well as their evoked response to the stimulus. During in vitro development, the vast majority of the cultures responded to the stimulation by significantly increasing the bursting activity and a widespread stabilization of electrical activity was observed after the third week of age. A similar trend was present between the spontaneous activity of the networks observed over 30 min after the stimulus and the responses evoked by the stimulus itself, although no significant differences in spontaneous activity were detected between stimulated and non-stimulated cultures belonging to the same preparations. The data indicate that the stimulation had a delayed effect modulating responsiveness capability of the network without directly affecting its intrinsic in vitro development.

Impact of preemptive reduction of immunosuppression with serial monitoring for BK virus replication in renal transplant recipients undergoing short-term evaluation.

The aim of this preliminary, prospective, longitudinal study was to evaluate the effects on graft function and viral loads of modulation of immunosuppressive therapy based upon serial noninvasive monitoring of urine and serum viral loads with real-time polymerase chain reaction among unselected renal transplant recipients. Thirty-nine renal transplant recipients with follow-up times of 7.8 +/- 4.3 months were monitored monthly with urine and serum samples to measure BK viral load. Interventions such as gradual reductions of mycophenolate mofetil and/or tacrolimus were performed when repeated urine and serum viral loads were >10(5) and >10(3) copies/mL, respectively. Among 271 samples, the patients were divided into 6 groups: negative urine (group = 1; n = 10) and negative serum (group 2; n = 25) versus BK viral loads that were intermittent (urine: group 3; n = 24 and serum: group 4; n = 11) versus persistent (urine: group 5; n = 5 and serum: group 6; n = 3). In groups 3-4 we observed the higher viral loads in the urine than in the serum (10(3): 21; 10(4): 1; 10(5): 1; 10(6): 1 vs 10(2): 8; 10(3): 2; 10(4): 1). The timing of resolution of viremia was more rapid than viruria. In groups 5-6 we observed the greatest viral load and greater number in urine. The overall incidences of viruria and viremia were 74.3% and 35.9%, respectively. The overall rates of clearance of viruria were 26/29 recipients (89%) and viremia, 11/14 recipients (78%). Only 10 patients (25.6%) needed extensive reduction of immunosuppression. No modifications of serum creatinine levels and no rejection episodes were observed. In conclusion this preliminary analysis suggested that serial, noninvasive monitoring of viral load allows gradual premptive reduction of immunosuppression with consequent strong reduction in viral load.

[Cytomegalovirus and BK polyomavirus infection after renal transplantation]. / Infezione da citomegalovirus (CMV) e da polioma BK virus (BKV) dopo trapianto di rene.

Cytomegalovirus (CMV) and BK polyomavirus (BKV) infections have been described in a high percentage of renal transplant patients and are known to cause various complications in renal transplantation. They are closely related to immunosuppressive therapy and implicated in the progression of graft failure. This review focuses on the clinical aspects of CMV and BKV infection after renal transplantation, optimal monitoring, and recent preventive measures and interventions to improve graft function and recipient survival.

Treatment of hyperhomocysteinaemia in haemodialysis patients at high cardiovascular risk.

OBJECTIVES: Cardiovascular disease (CVD) is the main cause of death among haemodialysis (HD) patients. Emerging cardiovascular risk factors such as oxidative stress and chronic inflammation are involved in these patients together with traditional risk factors. Here we investigate the effects of a short-term folate treatment on some markers of chronic inflammation in two groups of HD patients with and without vascular occlusive disease (VOD). PATIENTS AND METHODS: Homocysteine (HCy), C-reactive protein (CRP), Folate, fibrinogen and alpha1 acid glycoprotein (alpha1AGP) were dosed before and after a 3-month course of high-dose folate (25 mg intravenous calcium laevofolinate pentahydride once weekly) and again after a one-month washout in 15 HD patients with established VOD (group A) and in 15 comparable HD patients with no diagnosis of VOD (group B). RESULTS: Baseline HCy and CRP were significantly elevated in patients of both groups A and B compared to normal values. Folate treatment significantly reduced HCy in patients of both groups A and B and alpha1AGP only in patients of group A, while the other markers were not modified. After the one-month washout a significant raise of CRP could be observed in patients of group A; again, the other markers were not modified. CONCLUSIONS: Our results suggest that significant reduction of serum HCy can be achieved in both patients with or without VOD after administration of high-dose folic acid. Hence, folic acid supply is useful in the treatment of hyperhomocysteinemia in HD patients, although it is not sufficient to modify their chronic inflammatory status.

Extracellular recordings from locally dense microelectrode arrays coupled to dissociated cortical cultures.

High-density microelectrode arrays (MEAs) enabled by recent developments of microelectronic circuits (CMOS-MEA) and providing spatial resolutions down to the cellular level open the perspective to access simultaneously local and overall neuronal network activities expressed by in vitro preparations. The short inter-electrode separation results in a gain of information on the micro-circuit neuronal dynamics and signal propagation, but requires the careful evaluation of the time resolution as well as the assessment of possible cross-talk artifacts. In this respect, we have realized and tested Pt high-density (HD)-MEAs featuring four local areas with 10microm inter-electrode spacing and providing a suitable noise level for the assessment of the high-density approach. First, simulated results show how possible artifacts (duplicated spikes) can be theoretically observed on nearby microelectrodes only for very high-shunt resistance values (e.g. R(sh)=50 kOmega generates up to 60% of false positives). This limiting condition is not compatible with typical experimental conditions (i.e. dense but not confluent cultures). Experiments performed on spontaneously active cortical neuronal networks show that spike synchronicity decreases by increasing the time resolution and analysis results show that the detected synchronous spikes on nearby electrodes are likely to be unresolved (in time) fast local propagations. Finally, functional connectivity analysis results show stronger local connections than long connections spread homogeneously over the whole network demonstrating the expected gain in detail provided by the spatial resolution.

[A case of vulvar melanoma: surgical strategy and five years follow-up]. / Un caso di melanoma vulvare: strategia chirurgica e follow-up a 5 anni.

We report a case of a woman with vulvar melanoma, arisen from a plane melanocytic lesion, extended from clitoris to the left minor labium. After diagnostic biopsy, a preoperative lymphoscintigraphy with 99m-Tc nanocolloid was performed. Surgery consisted in a radical vulvectomy, radio-controlled lymphadenectomy and vulvar reconstruction by two bilateral subgluteus soft-tissue flaps, anastomosing the urethral and vaginal stumps. Five years follow-up was negative for neoplastic recurrence.