Pelvic floor muscle assessment on three- and four-dimensional transperineal ultrasound in women with ovarian endometriosis with or without retroperitoneal infiltration: a step towards complete functional assessment.

OBJECTIVES: Previous studies comparing women with deep infiltrating endometriosis (DIE) and healthy controls have underlined an association between pelvic floor muscle (PFM) hypertonic dysfunction and deep lesions. The aim of this study was to compare the morphometry of PFM in women affected by ovarian endometriosis with DIE vs those without DIE in order to assess the impact of retroperitoneal infiltration by the disease on PFM function. METHODS: This was a prospective study conducted between March 2015 and December 2016 on symptomatic women with a clinical and sonographic diagnosis of ovarian endometriosis with or without DIE, scheduled for laparoscopic surgery. We excluded patients with current or previous pregnancy, previous surgery for deep endometriosis, other causes of chronic pelvic pain or congenital or acquired abnormalities of pelvic floor anatomy. Three- and four-dimensional transperineal ultrasound was performed to evaluate PFM morphometry and assess levator hiatal area (LHA) and diameters at rest, during PFM contraction and during Valsalva maneuver. All volumes were analyzed offline by an investigator blinded to the clinical data. RESULTS: One hundred and fourteen patients with ovarian endometriosis were enrolled in the study, 75 with DIE and 39 without DIE. The diagnosis of endometriosis was confirmed by histological examination in all patients. Compared with women without DIE, women with DIE showed a smaller LHA at rest, during contraction and during Valsalva maneuver (P = 0.03, P = 0.03 and P = 0.02, respectively) and a smaller reduction in LHA during PFM contraction (P = 0.04). CONCLUSIONS: Women with ovarian endometriosis who were affected by DIE showed smaller hiatal dimensions than did women without DIE. Considering that PFM dysfunction in patients with DIE could cause pain symptoms and pelvic organ dysfunction, transperineal ultrasound could allow a more complete functional assessment and tailored therapy. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Urodynamic evaluation and anorectal manometry pre- and post-operative bowel shaving surgical procedure for posterior deep infiltrating endometriosis: a pilot study.

STUDY OBJECTIVE: To analyze bowel and urinary function in patients with posterior deep infiltrating endometriosis (DIE) >30 mm in largest diameter at transvaginal ultrasound before and after surgical nerve-sparing excision. DESIGN: Prospective observational study (Canadian Task Force classification III). SETTING: Tertiary care university hospital in Bologna, Italy. PATIENTS: Twenty-five patients with posterior DIE were included in the study between June 2011 and December 2012. Patients did not receive hormone therapy for at least 3 months before and 6 months after surgery. INTERVENTIONS: Patients underwent urodynamic studies and anorectal manometry before and after nerve-sparing laparoscopic excision of the posterior DIE nodule. MEASUREMENTS AND MAIN RESULTS: Intestinal and urinary function was evaluated in patients with bulky posterior DIE using urodynamic and anorectal manometry. Results of urodynamic studies and anorectal manometry were similar before and after nerve-sparing surgical excision of the posterior DIE nodule. Urodynamic studies demonstrated a high prevalence of voiding dysfunction, whereas anorectal manometry showed no reduction in rectoanal inhibitory reflex and hypertone of the internal anal sphincter. CONCLUSIONS: Patients with posterior DIE >30 mm in greatest diameter demonstrate preoperative dysfunction at urodynamic study and anorectal manometry, probably due to DIE per se. The nerve-sparing surgical approach seems not to influence the motility or sensory capacity of the bladder and the rectosigmoid colon.

Laparoscopic management of early stage ovarian cancer: is it feasible, safe, and adequate? A retrospective study.

INTRODUCTION: Minimally invasive surgery to stage early ovarian cancer is still regarded as pioneering among gynecologic oncologists. Previous retrospective experiences demonstrated the safety and feasibility of laparoscopy in this field. AIMS: To review the laparoscopic staging procedure in a series of patients with early ovarian cancer and compare results with the literature. MATERIALS AND METHODS: From January 2004 to September 2011, 19 patients with apparent early stage ovarian/fallopian tube cancer Stage IA to IC underwent either primary treatment or completion staging by laparoscopy. Surgical, pathologic, and oncologic outcomes were analyzed. RESULTS: The mean operative time was 212 +/- 69 minutes. Three patients (16%) underwent fertility sparing surgery. The mean estimated blood loss was two +/- two g/dl. The mean number of pelvic and para-aortic lymph nodes collected was 17 (range 7-27) and 14 (range 8-21), respectively. The mean volume of ovarian/tubal tumor was 119 cm3 (range 1.5-500). The disease was reclassified to a higher stage in ten women (52%). One major intraoperative complication (five percent) occurred which required the conversion to laparotomy. The mean follow up period was 30 +/- 16 months (range 10-74). Overall survival and disease-free survival were 100% and 84%, respectively. CONCLUSIONS: Laparoscopic staging of early ovarian cancer appears to be feasible and comprehensive when performed by gynecologic oncologists experienced with advanced laparoscopy.

[Small guillotine to obtain reproducible coronal sections from rat brain]. / Apparecchio a ghigliottina per ricavare sezioni coronali riproducibili dal cervello di ratto.

In order to study the morphology and function of central catecholaminergic and peptidergic neurons, it is necessary to obtain reproducible brain sections from several animals. We describe here a cutting machine for sectioning unfixed brains in frontal planes. This versatile guillotine gives a high degree of repeatability in sectioning brains of different animals in defined frontal planes.

[Selective percutaneous thermorhizotomy in the surgical treatment of facial pain: personal considerations in light of 180 patients treated]. / La termorizotomia selettiva percutanea nella terapia chirurgica delle algie facciali: considerazioni personali alla luce di 180 pazienti trattati.

The purpose of this paper is to report the experience of the authors regarding the treatment of the primitive and secondary facial pains by Percutaneous Selective Thermorhizotomy (P.S.T.), 180 patients having been treated in the period of two years. The immediate postoperative control has obtained 156 good results (86,6%), 10 medium results (5,5%) and 14 (7,7%) unsuccessful. The failure of the P.S.T. in the treatment of the post-zosterian neuralgias, in the atypical and in the vascular pains is stated. The P.S.T. appears resolutive in the "tic doloreux" and secondary painful syndromes. A far follow up was performed (4 months-2 years) on 94 patients and a good result was kept at 64,2% among all of them. The shortage of the postoperative not expected collateral effect is also stated. The causes of unsuccessful and poor results (mistaking in the choice of the patient or tecnical mistaking) are discussed. It is finally suggested a careful personal value of the patient candidated to operation, in order to reduce the poor results and therefore improve the successful ones.

[Persistence of the median artery: possible cause of the carpal tunnel syndrome]. / La persistenza dell'arteria mediana: una possibile causa di sindrome del tunnel carpale.

A case of Carpal Tunnel Syndrome (S.T.S.) in a patient with Persistence of the Median Artery is reported. The Authors consider this rare-condition as a possible cause of C.T.S. The persisting vessel may cause a damage to the Median Nerve in two difeent ways: 1) Compression and 2) Ischemia. The latter pathogenesis is expecially advocated when anastomotic connection between the Median Artery and the Radial and Ulnar Arteries as well as the Superficial Palmar Arch are poor. Two different clinical pictures are possible: an acute onset, after a thrombosis, or a chronic impairment when the vessel is previous. As treatment, the Authors always recommend the decompression of the Carpal Tunnel and the dissection of the Persisting Artery; on the other side, they consider the excision of the vessel possible only when a sufficient anastomotic blood-supply is ensured.