Climate change and its effect on groundwater quality.

Knowing water quality at larger scales and related ground and surface water interactions impacted by land use and climate is essential to our future protection and restoration investments. Population growth has driven humankind into the Anthropocene where continuous water quality degradation is a global phenomenon as shown by extensive recalcitrant chemical contamination, increased eutrophication, hazardous algal blooms, and faecal contamination connected with microbial hazards antibiotic resistance. In this framework, climate change and related extreme events indeed exacerbate the negative trend in water quality. Notwithstanding the increasing concern in climate change and water security, research linking climate change and groundwater quality remain early. Additional research is required to improve our knowledge of climate and groundwater interactions and integrated groundwater management. Long-term monitoring of groundwater, surface water, vegetation, and land-use patterns must be supported and fortified to quantify baseline properties. Concerning the ways climate change affects water quality, limited literature data are available. This study investigates the link between climate change and groundwater quality aquifers by examining case studies of regional carbonate aquifers located in Central Italy. This study also highlights the need for strategic groundwater management policy and planning to decrease groundwater quality due to aquifer resource shortages and climate change factors. In this scenario, the role of the Society of Environmental Geochemistry is to work together within and across geochemical environments linked with the health of plants, animals, and humans to respond to multiple challenges and opportunities made by global warming.

In situ arsenic immobilisation for coastal aquifers using stimulated iron cycling: Lab-based viability assessment.

Arsenic (As) is one of the most harmful and widespread groundwater contaminants globally. Besides the occurrence of geogenic As pollution, there is also a large number of sites that have been polluted by anthropogenic activities, with many of those requiring active remediation to reduce their environmental impact. Cost-effective remedial strategies are however still sorely needed. At the laboratory-scale in situ formation of magnetite through the joint addition of nitrate and Fe(II) has shown to be a promising new technique. However, its applicability under a wider range of environmental conditions still needs to be assessed. Here we use sediment and groundwater from a severely polluted coastal aquifer and explore the efficiency of nitrate-Fe(II) treatments in mitigating dissolved As concentrations. In selected experiments >99% of dissolved As was removed, compared to unamended controls, and maintained upon addition of lactate, a labile organic carbon source. Pre- and post experimental characterisation of iron (Fe) mineral phases suggested a >90% loss of amorphous Fe oxides in favour of increased crystalline, recalcitrant oxide and sulfide phases. Magnetite formation did not occur via the nitrate-dependent oxidation of the amended Fe(II) as originally expected. Instead, magnetite is thought to have formed by the Fe(II)-catalysed transformation of pre-existing amorphous and crystalline Fe oxides. The extent of amorphous and crystalline Fe oxide transformation was then limited by the exhaustion of dissolved Fe(II). Elevated phosphate concentrations lowered the treatment efficacy indicating joint removal of phosphate is necessary for maximum impact. The remedial efficiency was not impacted by varying salinities, thus rendering the tested approach a viable remediation method for coastal aquifers.

Changes in groundwater trace element concentrations before seismic and volcanic activities in Iceland during 2010-2018.

We analysed temporal variations of trace element concentrations in groundwater from a 101 m-deep borehole (HA01) in northern Iceland during 2010-2018 and compared them with seismic and volcanic events that occurred in the same period to identify potential hydrogeochemical precursors. An increase of B, Al, V, Li and Mo concentrations started from eight months to one month before the 2014 Bárðarbunga eruption (~115 km from HA01), a major rifting event in central Iceland, while Ga and V concentrations began to increase one day and one month after the onset of the event, respectively. We also found that concentrations of some trace elements (Li, B, Ga, Mo, Sr, Rb and Fe) significantly increased before an Mw 5.0 earthquake that occurred ~80 km from the borehole in 2018. However, other notable hydrogeochemical changes were detected during the monitoring period without apparent correlation with the seismic and volcanic events in the region. This study shows that the systematic long-term hydrogeochemical monitoring in seismic and volcanic areas is critical to advance the science of seismic and eruptive precursors. Furthermore, the use of statistical tools, such as Principal Component Analysis (PCA) and Change Point (CP) detection can help identify the most useful chemical elements and validate the trend variability of those elements in the time series, reducing arbitrary choices of pre-seismic and pre-volcanic hydrogeochemical anomalies as potential precursors.

Trace element contamination in the mine-affected stream sediments of Oued Rarai in north-western Tunisia: a river basin scale assessment.

High-quality and accurate environmental investigations are essential for the evaluation of contamination and subsequent decision-making processes. A combination of environmental geochemical indices, multivariate analyses and geographic information system approach was successfully used to assess contamination status and source apportionment of trace elements (Ag, As, Cd, Cr, Cu, Hg, Ni, Pb, Sb, V and Zn) in surface stream sediments from the Oued Rarai basin in north-western Tunisia, containing various metal and metalloid ores. The contamination level reported in this study indicates a non-negligible potential ecological risk, mainly related to sediment transport along the river. Antimony (concentrations ranged from 0.02 to 297 mg kg-1 and Igeo > 5), arsenic (from 0.5 to 1490 mg kg-1 and Igeo > 5), lead (from 2.9 to 5150 mg kg-1 and Igeo > 5) mercury (from 0.05 to 54.4 mg kg-1 and Igeo > 5) and silver (from 0.05 to 9.4 mg kg-1 and Igeo > 5) showed the most crucial contamination. Besides, potential ecological risk index values were maximum for arsenic with a median of 302, indicating a very high to serious ecological risk (> 160). Results from correlation analysis and principal component analysis revealed three main geochemical associations related to lithologic, tectonic and anthropogenic sources. V, Cr and Cu mainly originated from natural bedrock and soil. Ag and Cd were more controlled by both natural and mining enrichments. Mercury and Pb were mostly influenced by the ancient ore-related activities at the Oued Rarai site and north-east-south-west trending faults. Finally, Sb, As, Ni and Zn were largely controlled by the siliciclastic continental Neogene sequences. Finally, the physical and chemical dynamics of the watershed system, lithological properties, mineralisation, tectonic settings and mobilisation of subsurface sediments largely controlled both concentrations and spatial patterns of trace elements in the study basin. These results need to be considered in the strategies of suitable environmental management at former and current mining sites in north-western Tunisia.

New observations in Central Italy of groundwater responses to the worldwide seismicity.

Chemical and physical responses of groundwater to seismicity have been documented for thousands of years. Among the waves produced by earthquakes, Rayleigh waves can spread to great distances and produce hydrogeological perturbations in response to their passage. In this work, the groundwater level, which was continuously recorded in a monitoring well in Central Italy between July 2014 and December 2019, exhibited evident responses to dynamic crustal stress. In detail, 18 sharp variations of the groundwater level due to worldwide Mw ≥ 6.5 earthquakes were observed. Apart from earthquakes that occurred in Papua New Guinea and those with a hypocentral depth > 150 km, all far away Mw ≥ 7.6 earthquakes produced impulsive oscillations of groundwater. As the earthquake magnitude decreased, only some earthquakes with 6.5 ≤ Mw < 7.6 caused groundwater level perturbations, depending on the data acquisition frequency and epicentral distance from the monitoring well. A clear correlation between earthquake distance and magnitude in hydrogeological responses was found. Our results shed light on the hydrosensitivity of the study site and on the characteristics of fractured aquifer systems. Detecting the water table variations induced by distant earthquakes is another step towards a correct identification of (preseismic) hydrogeological changes due to near-field seismicity.

Salivary Levels of Titanium, Nickel, Vanadium, and Arsenic in Patients Treated with Dental Implants: A Case-Control Study.

BACKGROUND: Recent articles have hypothesized a possible correlation between dental implants dissolution products and peri-implantitis. The null hypothesis tested in this case-control study was that there would be no differences in salivary concentrations of titanium (Ti), vanadium (V), nickel (Ni) and arsenic (As) ions among patients with dental implants, healthy (Group A) or affected by peri-implantitis (Group B), compared to subjects without implants and/or metallic prosthetic restorations (Group C). METHODS: Inductively coupled plasma mass spectrometry was used to analyze saliva samples. One-way repeated-measure analysis of variance (ANOVA) was used to identify statistically significant differences in the salivary level of Ti, V, Ni and As between the three groups. RESULTS: A total of 100 patients were enrolled in the study (42 males and 58 females), distributed in three groups: 50 patients in Group C, 26 patients in Group B and 24 patients Group B. In our study, concentrations of metallic ions were higher in Group A and B, compared to the control group, with the exception of vanadium. However, there were no statistically significant differences (p > 0.05) for metallic ions concentrations between Group A and Group B. CONCLUSIONS: Based on our results, there are no differences in titanium or other metals concentrations in saliva of patients with healthy or diseased implants.

Potential toxic elements in groundwater and their health risk assessment in drinking water of Limpopo National Park, Gaza Province, Southern Mozambique.

Concentrations of trace elements in drinking water affect its safety and acceptability for use. Potentially toxic element (PTE) contaminations are considered extremely hazardous because of toxicity, persistence, and bioaccumulative behaviour. Many areas in the Southern African Development Community are data poor and have poor accessibility. The results of our previous research identified the presence of fossil waters in southern Limpopo National Park. Groundwater and river water are the only sources of drinking water for the villages in the study area. The current study focuses on the understanding of trace element distribution and health perspectives of PTEs (Hg, U, Sr, B, and Mn) in the groundwater and surface water samples (rivers and lakes) collected within the buffer zone of the Limpopo National Park, Southern Mozambique. Two sampling campaigns (October 2016-March 2017) were carried out during the end of the wet season and the end of the dry season to analyse the differences. The results improved our knowledge of the occurrence of trace elements in drinking water in an area where water resources play a fundamental role-because of their scarcity-and where the climate is harsh. ICP-MS results provided information on concentration ranges, highlighting the exceedance of the permissible maximum limit of mercury imposed by the World Health Organization on several groundwater samples. In the buffer zone of Limpopo Park, the highest levels of risk seem to be associated with the presence of Hg and U in drinking water. The use of risk assessment markers such as non-cancer risk value (hazard quotient [HQ]) revealed the exceedance of HQ values for Hg and U. The HQ values are higher in the wet season than the dry season, and most of the exceedance has been found in groundwater. HQ values are higher in exposed children than exposed adults. The water of Lake Massingir seems to be safer than any other source, but people do not currently use it because of the distance between the lake and their villages. Proactive control and research on alternative solutions for the water needs of the population and on creation of water distribution are recommended. In the current study, drinking water was the only route of exposure that was evaluated. Therefore, it would be appropriate to investigate the concentrations of PTEs in crops, livestock, and any other potential pathways.

Assessment of groundwater quality in the buffer zone of Limpopo National Park, Gaza Province, Southern Mozambique.

Many areas in the Southern African Development Community are data-poor and poorly accessible. Water quality assessment in these areas therefore has to rely on the limited available data, coupled with restricted field sampling. This paper documents the first evaluation of the main geochemical processes and impact of anthropogenic and natural sources of contamination on the groundwater quality of the aquifer system used for domestic and agricultural purposes in Limpopo National Park, Gaza Province, Southern Mozambique. Twenty-five groundwater and surface water samples were collected during two field campaigns, one in October 2016 (the end of the arid period) and the other in March 2017 (the end of the wet period). In the field, the researchers analysed chemical-physical parameters such as temperature, pH and EC. In the laboratory, the major ions (boron, Na+, Ca2+, K+, Mg2+) and anions (Cl-, SO42-, NO3-, HCO3-, CO32-) were determined, and almost all groundwater samples fall into the brackish water category. The B/Cl ratio and δ11B concentrations were then measured to better understand the origin of these brackish waters. The direct relationship between boron and chlorine and δ11B concentrations above 40‰ suggests the presence of fossil water in the aquifer. The groundwater in this area was found to be above the limits stated as desirable by the Department of Water and Sanitation (DWS) and the World Health Organisation for domestic and irrigation purposes. The suitability of the groundwater for drinking purposes was also evaluated, with the results indicating that it is not suitable. The values of the sodium absorption ratio, sodium percentage and electrical conductivity show that most of the groundwater samples are also not suitable for agricultural purposes. However, the surface waters have higher quality for both domestic and irrigation purposes. The water of Massingir Lake turns out to be the most suitable resource for a possible rural development plan for the area.

Hydrogeochemical changes before and during the 2016 Amatrice-Norcia seismic sequence (central Italy).

Seismic precursors are an as yet unattained frontier in earthquake studies. With the aim of making a step towards this frontier, we present a hydrogeochemical dataset associated with the 2016 Amatrice-Norcia seismic sequence (central Apennines, Italy), developed from August 24th, with an Mw 6.0 event, and culminating on October 30th, with an Mw 6.5 mainshock. The seismic sequence occurred during a seasonal depletion of hydrostructures, and the four strongest earthquakes (Mw ≥ 5.5) generated an abrupt uplift of the water level, recorded up to 100 km away from the mainshock area. Monitoring a set of selected springs in the central Apennines, a few hydrogeochemical anomalies were observed months before the onset of the seismic swarm, including a variation of pH values and an increase of As, V, and Fe concentrations. Cr concentrations increased immediately after the onset of the seismic sequence. On November 2016, these elements recovered to their usual low concentrations. We interpret these geochemical anomalies as reliable seismic precursors for a dilational tectonic setting.

Overexpression of AtPCS1 in tobacco increases arsenic and arsenic plus cadmium accumulation and detoxification.

MAIN CONCLUSION: The heterologous expression of AtPCS1 in tobacco plants exposed to arsenic plus cadmium enhances phytochelatin levels, root As/Cd accumulation and pollutants detoxification, but does not prevent root cyto-histological damages. High phytochelatin (PC) levels may be involved in accumulation and detoxification of both cadmium (Cd) and arsenic (As) in numerous plants. Although polluted environments are frequently characterized by As and Cd coexistence, how increased PC levels affect the adaptation of the entire plant and the response of its cells/tissues to a combined contamination by As and Cd needs investigation. Consequently, we analyzed tobacco seedlings overexpressing Arabidopsis phytochelatin synthase1 gene (AtPCS1) exposed to As and/or Cd, to evaluate the levels of PCs and As/Cd, the cyto-histological modifications of the roots and the Cd/As leaf extrusion ability. When exposed to As and/or Cd the plants overexpressing AtPCS1 showed higher PC levels, As plus Cd root accumulation, and detoxification ability than the non-overexpressing plants, but a blocked Cd-extrusion from the leaf trichomes. In all genotypes, As, and Cd in particular, damaged lateral root apices, enhancing cell-vacuolization, causing thinning and stretching of endodermis initial cells. Alterations also occurred in the primary structure region of the lateral roots, i.e., cell wall lignification in the external cortex, cell hypertrophy in the inner cortex, crushing of endodermis and stele, and nuclear hypertrophy. Altogether, As and/or Cd caused damage to the lateral roots (and not to the primary one), with such damage not counteracted by AtPCS1 overexpression. The latter, however, positively affected accumulation and detoxification to both pollutants, highlighting that Cd/As accumulation and detoxification due to PCS1 activity do not reduce the cyto-histological damage.

Cadmium-inducible expression of the ABC-type transporter AtABCC3 increases phytochelatin-mediated cadmium tolerance in Arabidopsis.

The heavy metal cadmium (Cd) is a widespread environmental contaminant with harmful effects on living cells. In plants, phytochelatin (PC)-dependent Cd detoxification requires that PC-Cd complexes are transported into vacuoles. Here, it is shown that Arabidopsis thaliana seedlings defective in the ABCC transporter AtABCC3 (abcc3) have an increased sensitivity to different Cd concentrations, and that seedlings overexpressing AtABCC3 (AtABCC3ox) have an increased Cd tolerance. The cellular distribution of Cd was analysed in protoplasts from abcc3 mutants and AtABCC3 overexpressors grown in the presence of Cd, by means of the Cd-specific fluorochromes 5-nitrobenzothiazole coumarin (BTC-5N) and Leadmium™ Green AM dye. This analysis revealed that Cd is mostly localized in the cytosol of abcc3 mutant protoplasts whereas there is an increase in vacuolar Cd in protoplasts from AtABCC3ox plants. Overexpression of AtABCC3 in cad1-3 mutant seedlings defective in PC production and in plants treated with l-buthionine sulphoximine (BSO), an inhibitor of PC biosynthesis, had no effect on Cd tolerance, suggesting that AtABCC3 acts via PCs. In addition, overexpression of AtABCC3 in atabcc1 atabcc2 mutant seedlings defective in the Cd transporters AtABCC1 and AtABCC2 complements the Cd sensitivity of double mutants, but not in the presence of BSO. Accordingly, the level of AtABCC3 transcript in wild type seedlings was lower than that of AtABCC1 and AtABCC2 in the absence of Cd but higher after Cd exposure, and even higher in atabcc1 atabcc2 mutants. The results point to AtABCC3 as a transporter of PC-Cd complexes, and suggest that its activity is regulated by Cd and is co-ordinated with the activity of AtABCC1/AtABCC2.

Adnexal masses in pregnancy: fetomaternal blood flow indices during laparoscopic surgery.

STUDY OBJECTIVE: To assess changes in uterine and umbilical arteries during laparoscopy in human pregnancy. DESIGN: Case series (Canadian Task Force classification III). SETTING: University tertiary care referral center for high-risk pregnancy and minimally invasive surgery. PATIENTS: Nine pregnant women who underwent first- and second-trimester laparoscopic surgery because of an adnexal mass. INTERVENTION: Laparoscopic cyst enucleation or annessiectomy. MEASUREMENTS AND MAIN RESULTS: No maternal complications and no miscarriages or adverse pregnancy outcome occurred. Mean (SD) gestational age at delivery was 39.1 (0.7) weeks, birth weight was 3390 (298) g, and Apgar score at 5 minutes was 9.6 (0.5). Mean uterine resistance index, umbilical artery pulsatility index, and fetal heart rate were measured using transvaginal ultrasonography at various times during surgery. Mean uterine resistance index and umbilical artery pulsatility index values remained constant during laparoscopy. Fetal heart rate was maintained in the normal range (120-160 bpm) but progressively decreased during the surgical procedure. CONCLUSION: In human pregnancy, laparoscopic techniques do not seem to modify uteroplacental perfusion evaluated using noninvasive ultrasonography.

Metals detected by ICP/MS in wound tissue of war injuries without fragments in Gaza.

BACKGROUND: The amount and identity of metals incorporated into "weapons without fragments" remain undisclosed to health personnel. This poses a long-term risk of assumption and contributes to additional hazards for victims because of increased difficulties with clinical management. We assessed if there was evidence that metals are embedded in "wounds without fragments" of victims of the Israeli military operations in Gaza in 2006 and 2009. METHODS: Biopsies of "wounds without fragments" from clinically classified injuries, amputation (A), charred (C), burns (B), multiple piercing wounds by White Phosphorus (WP) (M), were analyzed by ICP/MS for content in 32 metals. RESULTS: Toxic and carcinogenic metals were detected in folds over control tissues in wound tissues from all injuries: in A and C wounds (Al, Ti, Cu, Sr, Ba, Co, Hg, V, Cs and Sn), in M wounds (Al, Ti, Cu, Sr, Ba, Co and Hg) and in B wounds (Co, Hg, Cs, and Sn); Pb and U in wounds of all classes; B, As, Mn, Rb, Cd, Cr, Zn in wounds of all classes, but M; Ni was in wounds of class A. Kind and amounts of metals correlate with clinical classification of injuries, exposing a specific metal signature, similar for 2006 and 2009 samples. CONCLUSIONS: The presence of toxic and carcinogenic metals in wound tissue is indicative of the presence in weapon inducing the injury. Metal contamination of wounds carries unknown long term risks for survivors, and can imply effects on populations from environmental contamination. We discuss remediation strategies, and believe that these data suggest the need for epidemiological and environmental surveys.

Decidualized ovarian endometriosis in pregnancy: a challenging diagnostic entity.

BACKGROUND: The hormonal milieu that characterizes pregnancy may determine profound modifications of ovarian endometriomas leading to lesions mimicking malignancy. In this study, we report on our experience and perform a review of the literature on this issue. METHODS: Data from women evaluated at our referral center for prenatal diagnosis were reviewed in order to identify those who were detected with an ovarian endometrioma in pregnancy mimicking malignancy. A review of the literature on this issue (1990-2008) was also performed, using the PubMed database. RESULTS: Three cases were identified at our center. The literature reports on a further 19 cases (11 studies). Sonographic and color Doppler examination consistently documented rapidly growing and abundantly vascularized intracystic excrescences. Conversely, the presence of septations or significant free fluid was never reported. The vast majority of cases underwent surgical removal. Interestingly, in our experience, in a woman who declined surgery and had spontaneous miscarriage at 10 weeks' gestation, the sonographic examination performed 6 weeks after dilatation and curettage revealed an unremarkable typical endometrioma, thus suggesting that it is a transitory transformation. CONCLUSIONS: Pregnancy-related modifications of an ovarian endometrioma leading to the rapid development of vascularized intracystic excrescences are an uncommon but possible event. An expectant management and serial monitoring should first be envisaged in these cases provided that other features of malignancy, such as septations or free fluid, are absent.

How often are endometrial polyps malignant in asymptomatic postmenopausal women? A multicenter study.

OBJECTIVE: The objective of the study was to evaluate the prevalence of cancer and premalignant lesions in polyps on atrophic endometrium in asymptomatic postmenopausal women to compare these findings with a similar cohort of patients with abnormal uterine bleeding. STUDY DESIGN: One thousand one hundred fifty-two asymptomatic and 770 consecutive postmenopausal women with abnormal uterine bleeding were included in a retrospective multicenter study. Recruited patients underwent hysteroscopic polypectomy based on a sonohysterographic or hysteroscopic diagnosis. The pathologic report was the main outcome measure. RESULTS: One single case of stage 1 grade 1 endometrial carcinoma on a polyp with a mean diameter of 40 mm (0.1%) was observed in asymptomatic women. This prevalence was 10 times lower than in symptomatic patients (P < .0001). The prevalence of atypical hyperplastic polyps was 1.2% in asymptomatic women (2.2% in symptomatic patients; P < .005). At multivariate analysis, polyps' diameter was the only variable significantly associated to an abnormal histology (cancer, polypoid cancer, and atypical hyperplasia) in asymptomatic women (odds ratio for polyps with mean diameter > 18 mm, 6.9; confidence interval, 2.2-21.4). CONCLUSION: Follow-up and/or treatment of endometrial polyps incidentally diagnosed in asymptomatic postmenopausal patients could be safely restricted to few selected cases based on polyp diameter.

Use of an endoscopic ultrasound probe for the evaluation of the Müllerian rudiments in patients with Rokitansky syndrome.

OBJECTIVE: To assess the use of an endoscopic ultrasound probe in the evaluation of the uterine horns in a series of patients who were undergoing laparoscopy for the creation of a neovagina. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynecology in a tertiary care and referral center for Rokitansky syndrome. PATIENT(S): Thirty patients with Rokitansky syndrome who were undergoing laparoscopically assisted creation of a neovagina. INTERVENTION(S): Preoperative assessment with a pelvic transabdominal ultrasound scan and pelvic magnetic resonance imaging (MRI). An endoscopic ultrasound probe was used to study the uterine horns during laparoscopy. MAIN OUTCOME MEASURE(S): Presence or absence of the uterine rudiments, presence or absence of the endometrial cavity, and Doppler ultrasound vascularization of the rudiments. RESULT(S): Of the 24 uterine horns sized >or=2 cm that were identified at endoscopic ultrasound, 22 and 19, respectively, had been recognized at MRI and transabdominal ultrasound scan. The endoscopic ultrasound probe diagnosed 12 cavitated horns, of which 9 and 7 were seen at MRI and transabdominal ultrasound scan, respectively. CONCLUSION(S): Our experience shows the feasibility and accuracy of the endoscopic ultrasound probe in evaluating the structure of the rudimentary uterine horns in Rokitansky syndrome.

Ovarian recovery after laparoscopic enucleation of ovarian cysts: insights from echographic short-term postsurgical follow-up.

STUDY OBJECTIVE: To evaluate damage to ovarian reserve following laparoscopic cystectomy of benign ovarian cysts. DESIGN: Prospective study (Canadian Task Force classification II-3). SETTING: Tertiary gynecologic endoscopic unit at a university-affiliated hospital. PATIENTS: Thirty-one patients who underwent excision of monolateral (n=25) or bilateral (n=6) benign ovarian cysts. INTERVENTIONS: Serial transvaginal ultrasound examinations during the first and third postsurgical menstrual cycles. The following ovarian echographic variables were evaluated: antral follicle count, ovarian volume, stromal blood flow, and side of ovulation. Two types of statistical analysis were performed: a paired analysis comparing operated and intact ovaries of the same patient and a prospective analysis comparing ecographic characteristics of the operated gonad at first and second evaluation. MEASUREMENTS AND MAIN RESULTS: Antral follicle count and stromal blood flow were not significantly affected by surgery. While ovarian volume was similar in the operated and in the contralateral intact gonad at the first ultrasound evaluation, the volume of the operated ovary was significantly reduced at the second assessment. The median (interquartile range) of the percentage of this reduction was 33% (18%-81%). This progressive reduction was confirmed by prospectively analyzing the operated ovaries. An increased probability of ovulation in the intact gonad was observed at both assessments. CONCLUSION: Laparoscopic excision of ovarian cysts is associated with damage to ovarian reserve, at least immediately after surgery. This effect does not appear to be consequent to an injury to ovarian vascularization.

Pre- and post-treatment patterns of human chorionic gonadotropin for early detection of persistence after a single dose of methotrexate for ectopic pregnancy.

OBJECTIVE: Given the great variability of human chorionic gonadotropin (HCG) levels after a single dose of methotrexate (MTX) for ectopic pregnancy, it remains complicated to identify cases undergoing persistence until a week from treatment. We evaluated whether pre-treatment patterns of HCG levels could be useful for an earlier detection of persistent trophoblast. STUDY DESIGN: A retrospective study on 62 patients treated by a systemic single dose of methotrexate (50 mg/m(2)) for an ectopic pregnancy. Samples for HCG detection were obtained on days -2 and 0 before the therapy, on days +3, +7 and then weekly until values were undetectable. Patients were divided into three groups: Group U (up, meaning "increasing") and Group D (down, meaning "decreasing") when HCG levels on day 0 were respectively higher or lower than day -2 level of more than 20% and Group P (plateau) when the difference between day -2 HCG level and the level on day 0 was less than 20%. RESULTS: All the patients of Group D underwent a complete resolution, with a percentage of 33.3% of cases who underwent an initial rise of HCG levels on day +3. The percentage of cases undergoing an initial rise of HCG levels in Group U patients was significantly higher than in Group P patients (60.0% versus 28.6%), but the resolution rate resulted similar in the two groups. For patients of Group P, an increase of HCG levels on day +3 was significantly correlated to the failure of the therapy. Indeed, comparing the cases with an immediate increase of HCG levels to the cases with immediate decrease of HCG levels on day +3, the persistence rate was 80% for the former and 12% for the latter (P < 0.0001). CONCLUSION: An initial rise of HCG levels after the therapy does not seem to have a clinical relevance in Group D and Group U patients, it well correlates to trophoblastic persistence in Group P patients.