D-mannose: a promising support for acute urinary tract infections in women. A pilot study

Urinary tract infections still represent a significant bother for women and result in high costs to the health system. D-mannose is a simple sugar; it seems able to hinder bacteria adhesion to the urothelium. The present study aimed to determine whether D-mannose alone is effective in treating acute urinary tract infections in women and its possible utility in the management of recurrences

Comparison of anogenital distance and correlation with vulvo-vaginal atrophy: a pilot study on premenopausal and postmenopausal women

OBJECTIVES: Anogenital distance (AGD) represents the space between labia posterior commissure and anus. This was pilot study to investigate how menopause and so lack of oestrogens affects AGD. METHODS: A total of 109 patients were enrolled. AGD was measured in lithotomy position using sterile paper ruler. Anogenital index (AGI) was used to control 2 variables of height and weight (body mass index, kg/m2). Vaginal health index (VHI) was used to evaluate vaginal wellness. Female sexual function index (FSFI) questionnaire was administered to all women to evaluate the impact of menopause on their sexual function. RESULTS: AGD (30.87 ± 2.98 vs. 17.57 ± 2.18; P = 0.0001) and AGI (1.40 ± 0.21 vs. 0.70 ± 0.15; P = 0.0001) were both significantly lower in the postmenopausal group. Postmenopausal women were affected by vulvovaginal atrophy (VVA) significantly. Thus, VHI scores were dramatically worse in postmenopausal group (23.95 ± 1.28 vs. 10.75 ± 3.41; P = 0.0001) as well as FSFI results (32.68 ± 2.25 vs. 19.78 ± 5.46; P = 0.0001). CONCLUSIONS: This study confirms that AGD in post-menopausal women was significantly shorter than AGD in premenopausal women, correlating with an increase of VVA and sexual impairment. Changes of AGD and AGI demonstrated to predict hormonal changes that may occur after menopause

OSSERVAZIONI CLINICHE SULL’USO DI UN NUOVO DETERGENTE INTIMO NELLA PROTEZIONE QUOTIDIANA

Nel campo dell’igiene intima femminile, è stato realizzato un nuovo detergente a base di estratti naturali con proprietà antimicrobiche,antinfiammatorie e rinfrescanti indicato per la donna in età fertile. Laformulazione a pH4,5 è costituita da Thymus vulgaris conattività antimicrobica, Calendula officinalis con attività lenitiva,un derivato del Mentolo(MenthylEthylamidoOxalate) con attività rinfrescante a lento rilascio e non aggressiva e Gomma xantana che,grazie alle sue proprietà chimico fisiche ed alla sua natura di colloide idrofilo,consente di prolungare l’adesione del prodotto in situ. Scopo del presente studio è stato quello di confrontare gli effetti dell’applicazione di questo nuovo detergente intimo(SF)nella protezione quotidiana con l’abituale detergente utilizzato dalla donna. Allo studio crossover hanno partecipato 79 donne in età fertile,di età compresatra 18 e 56 anni(media/DS34.4±8.1), che sono state trattate in tempi successivi con il loro detergente intimo abituale(C)e con SF, detergente a base di estratti vegetali Thymus vulgaris e Calendula officinalis e di MenthylEthylamidoOxalate(SaugellaFresh,Rottapharm|Madaus)entrambi utilizzati due volte al giorno per due settimane. Al basale e dopo 2 settimane sono stati valutati i sintomi vulvo-vaginali(0=assente;1=lieve;2=moderato;3=intenso;4=molto intenso)e il secreto(0=assente,1=scarso,2=Evidente3=abbondante). Il confronto statistico tratrattamenti è stato eseguito con il test di Wilcoxon non parametrico e il chi-quadro

The role of hysteroscopy in unexplained infertility

Purpose of investigation: To evaluate pregnancy rate after diagnostic and operative hysteroscopy in nulliparous patients with infertility of unknown cause. Materials and Methods: The authors conducted this study on 92 nulliparous patients with unexplained infertility that underwent diagnostic hysteroscopy which showed an uterine lesion (submucous fibroids, uterine septa, polyps, synechias) and underwent operative hysteroscopy to remove the lesion between 2007 and 2011. Patients' data were retrospectively extrapolated from patient's charts, then the patients were called to ask if they had pregnancies after hysteroscopic surgery. Results: The present study showed a significant increase in pregnancy rate after hysteroscopic surgery (85% during the two years after the surgery). The most common endocavitary lesions were endometrial polyps (21%), uterine septa (25%), and submucous myomas (18%). Conclusions: According to the present data, hysteroscopic evaluation of nulliparous women with unexplained infertility could be useful to detect lesions not diagnosed with other tests, and the treatment of these endocavitary lesions plays an important role in the diagnostic and therapeutic ITER. The results show a pregnancy rate of 85% in the patients treated for endocavitary lesions, but 15% of the patients, despite a nor-mal uterine cavity, continue to have unexplained infertility and are classified as idiopathic infertility

The role of sleeve gastrectomy in reducing cardiovascular risk

BACKGROUND: Obesity is an independent cardiovascular risk factor and a catalyst of other cardiovascular risk factors, such as hypertension, dyslipidemia, type 2 diabetes mellitus (DM2) and metabolic syndrome. METHODS: We analyzed cardiovascular risk in obese patients before and after sleeve gastrectomy (SG). To this end, we studied changes in body mass index (BMI), blood chemistry parameters that characterize the risk of atherosclerosis and instrumental parameters (objective markers of this risk), namely intima-media thickness (IMT) and flow-mediated dilation (FMD), the latter reflecting endothelial function. We also considered purely cardiac parameters-mitral annular plane systolic excursion (MAPSE) and tricuspid annular plane systolic excursion (TAPSE)-which describe cardiac risk more specifically than the ejection fraction. Alteration of one or more of these parameters determines an increase in cardiovascular morbidity and mortality. RESULTS: The results showed that weight loss, in patients undergoing SG, is accompanied by a reduced BMI and a marked improvement in blood chemistry, confirming what has already been shown in many other studies, but the most interesting finding was the effect of SG on the instrumental markers of atherosclerosis. In particular, carotid IMT was significantly reduced (p < 0.001) and FMD significantly improved. MAPSE and TAPSE also improved significantly at both follow-up assessments (p < 0.001). CONCLUSIONS: This study suggests that SG should be considered from a broader perspective, i.e. as a weight loss treatment that also improves obesity-related morbidity and mortality, benefitting both the patient and, in an economic sense, the society as a whole.BACKGROUND: Obesity is an independent cardiovascular risk factor and a catalyst of other cardiovascular risk factors, such as hypertension, dyslipidemia, type 2 diabetes mellitus (DM2) and metabolic syndrome. METHODS: We analyzed cardiovascular risk in obese patients before and after sleeve gastrectomy (SG). To this end, we studied changes in body mass index (BMI), blood chemistry parameters that characterize the risk of atherosclerosis and instrumental parameters (objective markers of this risk), namely intima-media thickness (IMT) and flow-mediated dilation (FMD), the latter reflecting endothelial function. We also considered purely cardiac parameters-mitral annular plane systolic excursion (MAPSE) and tricuspid annular plane systolic excursion (TAPSE)-which describe cardiac risk more specifically than the ejection fraction. Alteration of one or more of these parameters determines an increase in cardiovascular morbidity and mortality. RESULTS: The results showed that weight loss, in patients undergoing SG, is accompanied by a reduced BMI and a marked improvement in blood chemistry, confirming what has already been shown in many other studies, but the most interesting finding was the effect of SG on the instrumental markers of atherosclerosis. In particular, carotid IMT was significantly reduced (p < 0.001) and FMD significantly improved. MAPSE and TAPSE also improved significantly at both follow-up assessments (p < 0.001). CONCLUSIONS: This study suggests that SG should be considered from a broader perspective, i.e. as a weight loss treatment that also improves obesity-related morbidity and mortality, benefitting both the patient and, in an economic sense, the society as a whole

Sonohysterosalpingography: Comparison of foam and saline solution

Purpose. To compare sonohysterosalpingography (sono-HSG) with foam instillation (HyFoSy) versus saline solution (HyCoSy) in the evaluation of tubal patency. Methods. We prospectively enrolled 37 infertile women, scheduled for laparoscopy. The women were randomized into two groups: HyFoSy (group I) and HyCoSy (group II). The patients of both groups underwent laparoscopy with dye test. We assessed the diagnostic performance (sensitivity, specificity, and overall accuracy) of HyFoSy and HyCoSy, compared with laparoscopy and dye test, in the assessment of tubal patency. Results. Sono-HSG findings in tubal patency assessment obtained in the HyFoSy group were concordant with laparoscopic results in 94.4% of cases, with a sensitivity of 87.5% and a specificity of 100%, whereas in the HyCoSy group, concordance occurred in only 57.8% of examinations, with a sensitivity of 50% and a specificity of 66.6%. Conclusions. HyFoSy allows a more accurate diagnosis of tubal patency compared with HyCoSy

Brain metastases from malignant Brenner tumor of the ovary. A case report and a literature review.

Introduction. Brenner tumor of the ovary represents an uncommon neoplasm. It constitutes about 1.5% of all ovarian tumors with a peak of incidence in the fifth decade. The vast majority of Brenner tumors is benign, while only 1% are malignant and associated with a poor prognosis. Diagnosis could be made only with histological examination, and surgery is the mainstay of treatment. Materials and methods. Here we present the case of a patient affected by a Malignant Brenner tumor of the ovary, with metastases to brain, lung and liver and by a concomitant low grade endometroid adenocarcinoma of the uterus. A postoperative platinum based chemotherapy (CHT) was planned. The adjuvant treatment was discontinued for hematologic and liver toxicity and the patient died one month later due to a cardiorespiratory arrest. Results and discussion. For what concerns adjuvant therapy, it is supposed that chemotherapy is profitable in the survival of these patients, but what agents would really provide an objective response in the presence of metastatic disease is not standardized. Conclusion. Because of the rarity and the limited good quality research reports, multicentric prospective trials are needed to improve preoperative diagnosis of MBTs and investigate the best treatment

Effectiveness, quality of life and sexual functions in women with anterior compartment prolapse treated by native tissue repair: a mini-review

Anterior compartment defect is the most common pelvic organ prolapse. It is defined as the descent of the bladder into the anterior vaginal wall. The etiology is multifactorial and the main risk factors are vaginal delivery and conditions associated with increased abdominal strain. Aging is significantly associated with the prevalence and severity of pelvic organ prolapse. Treatment may be conservative or surgical according to symptoms, prolapse degree and not forgetting both patient and doctor preferences. The aim of this work is to identify the most efficient surgical treatment of cystocele and its recurrences. There are two different surgical approaches for the treatment of cystocele: traditional repair and mesh repair. Prosthetic treatment gives higher anatomical success rate but traditional anterior repair has less complication demonstrating a lower risk of reoperation. Surgical treatment in general improves both the quality of life and the sexual function. We carried out a research on the impact of the anterior defect before and after native tissue surgery on quality of life and sexual function. The efficacy and complications of the treatment were also assessed

Labia Majora Labioplasty In A Morbid Obese Patient Affected By Vulvar Cancer Involving Urethra: A Case Report.

Urethral stricture represents a disabling complication of radical vulvectomy. In obese patients this complication can be worse, due to the large size of the labia majora. In October 2013 we performed a labioplasty after radical vulvectomy with partial urethral resection in a 68-year-old morbid obese patient with very large labia majora. The labioplasty was conducted in order to prevent urethral strictures and consequently achieving a regular urinary flow. This is the first case of labioplasty surgery, described in literature, performed for a functional purpose. Up to now, the labioplasty procedure was described only for aesthetic purposes. After 8 months, she reported that her urinary flow was regular. This case suggests that labioplasty could represent a safe and feasible technique in order to improve the overall outcomes of radical vulvectomy in morbid obese patients

Relationship between cervical excisional treatment for cervical intraepithelial neoplasia and obstetrical outcome

INTRODUCTION: The aim of our systematic review was the assessment of effects of excisional treatments for the management of cervical intraepithelial neoplasia (CIN) on pretenn delivery (PD), lower birth weight (LBW), preterm premature rupture of membrane (PPROM) and obstetrical outcomes. EVIDENCE ACQUISITION: A structured search was carried out in PubMed-Medlin, Embase, and Cochrane Controlled Trials Register databases through November 30, 2019. The search included a combination of the following terms: "loop electrosuigical excision procedure (LEEP)," "large loop excision of transformation zone (LLETZ)," "cold-knife conization (CKC)," "laser cervical conization (CLC)," "preterm delivery" and "neonatal outcome." EVIDENCE SYNTHESIS: Thirty-two of 561 publications considered were included: 28 retrospective series, 2 prospective studies and 2 multicenter trials. Globally in several studies there was a significant increase in PD, measured by the relative risk, in the women underwent a surgical procedure for the CIN. In their majority, the studies were retrospective and therefore a high risk of bias. CONCLUSIONS: This systematic review shows that the surgical treatment of the CM was associated with an increased risk of PD, LBW and pPROM before 37 pregnancy weeks compared to untreated women, especially in a CKC and LLETZ procedure. Moreover, the increase of the of PD was associated with cone size, cervical length, repeated treatment and a short conization-to-pregnancy interval