Adenomyotic Cyst in a 25-Year-Old Woman: Case Report

Adenomyotic cysts are uncommon findings, usually in the context of diffuse adenomyosis and <5 mm in diameter. Herein we report a 4.5-cm adenomyotic cyst in a 25-year-old nulliparous woman with severe dysmenorrhea and pelvic pain. Transvaginal ultrasonography and magnetic resonance imaging revealed a well-circumscribed hypoechogenic mass in the posterior uterine wall, well separated from the uterine cavity. Pathologic analysis demonstrated that the cyst was lined with endometrial epithelium and stroma and was surrounded by smooth muscle hyperplasia. In the literature, we found 30 reports of cysts with similar characteristics. Because this cyst has not been clearly defined, it has been called by various names including adenomyotic cyst, cystic adenomyosis, and cystic adenomyoma. We believe this lesion should not be called an adenomyoma, but is more correctly called an adenomyotic cyst or, depending on age at onset, a juvenile adenomyotic cyst

Symptomatic COVID-19 in pregnancy: hospital cohort data between may 2020 and april 2021, risk factors and medicolegal implications

Pregnancy does not appear to increase susceptibility to SARS-CoV-2 infection, but some physiological changes, such as the reduction of residual functional volumes, elevation of the diaphragm, and impaired cellular immunity, may increase the risk of severe disease and result in a higher risk of complications. The article's primary objective is to evaluate the factors associated with symptomatic COVID-19 disease in pregnancy. The secondary objective is to describe maternal and neonatal outcomes and cases of vertical transmission of the infection. All pregnant women hospitalized with SARS-CoV2 infection were included in a prospective study in the UOC of Obstetrics and Gynecology, AOOR Villa Sofia-Cervello, Palermo, between May 2020 and April 2021. The patients who requested the termination of the pregnancy according to Law 194/78 were excluded. We included 165 pregnancies with a total number of 134 deliveries. Overall, 88.5% of the patients were asymptomatic at the time of admission and 11.5% were symptomatic. Of them, 1.8% of the patients required hospital admission in the intensive care unit. Symptoms occurrences were positively associated with the increase in maternal BMI (OR 1.17; p = 0.002), the prematurity (OR 4.71; p = 0.022), and at a lower birth weight (OR 0.99; p = 0.007). One infant tested positive for SARS-CoV2 nasopharyngeal swab; 11.4% of newborns had IgG anti SARS-CoV2 at birth; IgM was positive in 2.4% of newborns. There was no difference statistically significant difference in the vertical transmission of the infection among the group of symptomatic pregnant women and that of asymptomatic pregnant women

Endometrial cancer: Robotic versus Laparoscopic treatment. Preliminary report

Laparoscopic approach is today the standard treatment for benign and malignant gynecological pathologies. To traditional laparoscopic surgery in the last 10 years we can add the possibility to use a robotic platform. The adoption of this system allows undoubted advantages as the three-dimensional vision, the absence of the physiological tremor with enhanced ergonomics and possibility of using articulable tools. In this study we analyzed the results of 18 patients with endometrial cancer (Stage I) treated with robotic approach. The results were compared with a selected sample of 26 patients, with the same characteristics, treated with traditional laparoscopic approach in the same period by the same surgical team. The mean total operative time was significantly longer for robotic than laparoscopic group (125.6 min vs 102.3 min). However, if to this operative time we remove the time of preparation (docking time) we obtain the following results: 102.5 min for robotic group and 95.7 min for the laparoscopic control group. Intra-operative blood loss are significantly lower in the robotic group than in laparoscopic group. The robotic treatment of gynecological cancer is a safe and feasible technique. The oncological results are also equivalent to those of traditional laparoscopic surgery with advantages in terms of precision and reduction of intraoperative bleeding. Additional clinical studies on larger samples and heterogeneous patients are necessary in order to clarify the real advantages of robotic treatment

Re-treatment by intravesical therapy in recurring patients affected by intermediate risk non-muscle invasive bladder cancer (NMIBC)

Introduction & Objectives: Up to 70% of patients affected by intermediate risk NMI-BC recur after intravesical therapy (IT). The majority of them will be retreated by IT. The therapeutic strategy for these patients is not well defined. BCG is advocated when intravesical chemotherapy (ICH) fails. However, some patients are retreated by ICH and some others repeat BCG adopted as the first treatment. Not many studies have been published on second line IT. A retrospective analysis on 179 intermediate-risk patients undergoing re-treatment by IT is presented. Materials & Methods: The clinical files of patients affected by NMI-BC recurring after TUR and IT and retreated by IT were reviewed. The patients not receiving at least 6 instillations of BCG or ICH after the first diagnosis and again after the TUR of the first recurrence were excluded. Only mitomycin c and epirubicin were accepted as chemotherapy. Only intermediate-risk tumours with a recurrencerisk score between 5 and 9 according to the EORTC Risk Tables and in absence of Tis were selected. A multivariate analysis was performed for recurrence-free interval (RFI) and progression considering, first line IT (BCG versus ICH), previous recurrence free interval, tumour’s T-category, G-grade, multiplicity, second line IT (BCG versus ICH) and maintenance regimen. Results: The study included 179 patients. The first line IT was ICH in 131 (73.2%) and BCG in 48 (26.8%) patients. The median RFI was 16 months. At recurrence, BCG in 83 (46.4%) and ICH in 96 (53.6%) patients were administered, with maintenance of at least 12 months in 31% and 38% of patients respectively. Of the 48 patients previously treated by BCG, 40 (83.3%) received BCG again, while of the 131 previously treated by ICH, 88 (67.2%) received ICH again and 43 (32.8%) BCG. Thus, only 8 patients received ICH at recurrence after BCG. At a median follow-up of 29 months, 65 (36.3%) patients recurred with a median RFI of 15 months, 25 (30.1%) and 40 (41.7%) after BCG and ICH respectively. Thirteen patients showed progression at a median interval of 19 months. At multivariate analysis no statistically significant correlation was detected among the considered parameters. Surprisingly, no statistical difference emerged in terms of RFI between first and second line IT (16 versus 15 months), and between patients receiving BCG or ICH as second line therapy at recurrence after ICH (=0.28). Conclusions: No reduction in RFI emerged in patients with intermediate-risk NMIBC recurring after a first cycle of intravesical therapy and retreated by intravesical chemotherapy or BCG. In patients recurring after intravesical chemotherapy, intravesical chemotherapy and BCG, as a second line therapy, resulted equally effective in preventing recurrence

Stem Cells and Infertility: A Review of Clinical Applications and Legal Frameworks

Infertility is a condition defined by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or due to an impairment of a person’s capacity to reproduce either as an individual or with their partner. The authors have set out to succinctly investigate, explore, and assess infertility treatments, harnessing the potential of stem cells to effectively and safely treat infertility; in addition, this paper will present the legal and regulatory complexities at the heart of stem cell research, with an overview of the legislative state of affairs in six major European countries. For couples who cannot benefit from assisted reproductive technologies (ART) to treat their infertility, stem-cells-based approaches have been shown to be a highly promising approach. Nonetheless, lingering ethical and immunological uncertainties require more conclusive findings and data before such treatment avenues can become mainstream and be applied on a large scale. The isolation of human embryonic stem cells (ESCs) is ethically controversial, since their collection involves the destruction of human embryonic tissue. Overall, stem cell research has resulted in important new breakthroughs in the treatment of infertility. The effort to untangle the complex web of ethical and legal issues associated with such therapeutic approaches will have to rely on evidence-based, broadly shared standards, guidelines, and best practices to make sure that the procreative rights of patients can be effectively reconciled with the core values at the heart of medical ethics

Systematic review of quality of life measures in patients with endometriosis

International audienceObjectives Endometriosis and quality of life has been the subject of much research, however, there is little consensus on how best to evaluate quality of life in endometriosis, resulting in many and diverse scales being used. In our study, we aim to identify quality of life scales used in endometriosis, to review their strengths and weaknesses and to establish what would define an ideal scale in the evaluation of endometriosis-related quality of life.Materials and methods A search of the MEDLINE and EMBASE databases was carried out for publications in English and French for the period from 1980 to February 2017, using the words ‘endometriosis’ and ‘quality of life’. Publications were selected if they reported on quality of life in patients with endometriosis and specified use of a quality of life scale. A quantitative and a qualitative analysis of each scale was performed in order to establish the strengths and weaknesses for each scale (systematic registration number: PROSPERO 2014: CRD42014014210).Results A total of 1538 articles publications were initially identified. After exclusion of duplicates and application of inclusion criteria, 201 studies were selected for analysis. The SF-36, a generic HRQoL measure, was found to be the most frequently used scale, followed by the EHP-30, a measure specific to endometriosis. Both perform well, when compared with other scales, with scale weaknesses offset by strengths. EHP-5 and EQ-5D also showed to be of good quality. All four were the only scales to report on MCID studied in endometriosis patients.Conclusion For clinical practice, routine evaluation of HRQOL in women with endometriosis is essential both for health-care providers and patients. Both SF-36 and EHP-30 perform better overall with regard to their strengths and weaknesses when compared to other scales

Acute appendicitis and endometriosis: Retrospective analysis in emergency setting

Introduction. The aim of this study is to evaluate the incidence of appendiceal and pelvic endometriosis in a population with diagnosis of acute appendicitis in an emergency setting. Materials and methods. We carried out a retrospective study in the period between January 2010 and October 2013. We performed 429 appendectomy including 233 in female subjects (54.3%). In all patients of childbearing age, we did β-hCG urine test to rule out the presence of an extra-uterine pregnancy. Results. 127 of 233 patients received a laparoscopic approach (54.5%). The median age was 29 years-old (range 17-68). The diagnosis of appendiceal and/or pelvic endometriosis was performed in 10 patients (4.3%): 9 treated in laparoscopy and only 1 treated in open. In only one case was required conversion to open surgery. We diagnosed appendiceal endometriosis in 3 patients, pelvic endometriosis with consensual acute appendicitis in 5 cases, pelvic endometriosis in the absence of macroscopic changes of the appendix in one case, sigmoid endometriosis in one case. There were no intraoperative complications, wound's complications or intra-abdominal abscesses. Conclusions. In general female population with clinical, laboratoristic and instrumental diagnosis of acute appendicitis and without anamnestic suspicion of gynecological pathology, it is always good to consider the hypothesis of pelvic and/or appendiceal endometriosis. The laparoscopic approach should be considered the treatment of choice for these patients in an emergency setting

Obstetric and Gynecological Admissions and Hospitalizations in an Italian Tertiary-Care Hospital during COVID-19 Pandemic: A Retrospective Analysis According to Restrictive Measures

Background: The national lockdown and the different restrictions applied in 2020 during the COVID-19 pandemic brought several changes to hospitalization procedures. The aim of this study was to evaluate the patterns in access to emergency services and hospitalization in a tertiary-care obstetric and gynecological emergency department (OG-ED) throughout the restrictions applied during 2020. Methods: A single-center retrospective comparative study on data from January to December 2020 was carried out on the following timeframes: January to February 2020 (before COVID-19 pandemic), March to June 2020 (nationwide lockdown period), July to September 2020 (removal of restrictive measures), October to December 2020 (regional lockdown) and compared to the same periods of 2019. All obstetric and gynecological patients with complete medical data admitted to the OG-ED were included. Results: Overall, 4233 accesses for 2019 and 3652 for 2020 were reported, with a decreasing trend of −13.7%. Between March and June 2020 (nationwide lockdown) and 2019, the overall number of patients attending the OG-ED decreased compared to July–September and October–December differences (Δ −23.5% vs. −3.1% and −5.9%; p = 0.001 respectively) for 2020–2019, but this reduction was not statistically significant when compared to January–February (Δ −23.5% vs. −18.5%; p = 0.356). No significant differences for obstetric patients (Δ −1.8% vs. −1.0% vs. −2.3% and +1.9% respectively; p = 0.883) were noted. Hospitalizations showed a stable trend with an increase between October–December 2019 and 2020 (Δ +4.6%; p = 0.001 vs. January–February (+2.4%) and March–June (+2.6%) 2019–2020), mainly related to regional lockdowns. Conclusions: In contrast to available national studies, in our institution, the overall rate of OG-ED admissions was slightly reduced with a similar trend of decrease even before COVID-19, with an increase in admissions for serious issues, despite expectations that the suspension of elective admissions and outpatient services would have led to an increase in non-urgent hospitalizations during the COVID-19 lockdown period