Over-the-counter emergency contraception in Italy: ethical reflections and medico-legal issues

Although more than ten years have passed since the marketing of Ulipristal acetate in Europe, emergency contraception remains a complex issue with many scientific, legal, ethical and social implications. The topic is an example of the differences that can exist between scientific evidence, the certainties on which law is based, and social implications. This paper shows the incompleteness of the scientific reconstruction on the effects of emergency hormonal contraceptives and the dangerousness of the decision to alienate the supply of over-the-counter drugs from the general rules of health care. This report shows the incompleteness of the scientific reconstruction on the effects of emergency hormonal contraceptives and the dangerousness of the decision to alienate the supply of over-the-counter drugs from the general rules of health care. Various ethical and medico-legal issues will be addressed, also focusing attention on underage women whose sexual and reproductive health requires not abandoning them, but actually taking charge of them without medicalizing their choices

Um dilema ético no campo da ginecologia

The aim of this paper is to assess a case report in the field of gynecology, starting from an ethical paradigm that relates primarily to the so-called “sources of morality” (objective structure, circumstances, aim). In order to do so, we first will present four ethical paradigms for the evaluation of clinical cases (preference utilitarianism, principlism, ontologically-grounded personalism and Aristotelian/ Thomist objective ethics). After introducing the main aspects of these paradigms and pointing out that what matters in an ethical evaluation is not so much the final judgement, but rather the argument that leads to it, we will assess the case report in light of the chosen paradigm. Lastly, we will outline a possible solution to the problem, starting from the previous ethical evaluation.DOI: 10.5294/pebi.2016.20.1.6  El objetivo de este texto es evaluar el informe de un caso clínico en el campo de la ginecología, a partir de un paradigma ético que se refiere principalmente a las denominadas “fuentes de la moral” (la estructura objetiva, las circunstancias, el objetivo). Primero se presentan cuatro paradigmas éticos para la evaluación de casos clínicos (utilitarismo de preferencia, principialismo, personalismo fundado ontológicamente y ética objetiva aristotélica/tomista). Después de la introducción de los aspectos principales de estos paradigmas y al señalar que lo que importa en una evaluación ética no es tanto el juicio final, sino más bien el argumento que conduce a ella, se evalúa el informe del caso a la luz del paradigma elegido. Por último, se esboza una posible solución al problema, a partir de la evaluación ética anterior.DOI: 10.5294/pebi.2016.20.1.6 O objetivo deste trabalho é avaliar o relatório de um caso clínico no campo da ginecologia a partir de um paradigma ético que se refere principalmente às denominadas “fontes da moral” (a estrutura objetiva, as circunstâncias, o objetivo). Nesse sentido, primeiramente apresentamos quatro paradigmas éticos para a avaliação de casos clínicos (utilitarismo de preferência, principialismo, personalismo fundado ontologicamente e ética objetiva aristotélica/tomista). Após introduzir os aspectos principais desses paradigmas e indicar que o importante numa avaliação ética não é tanto o julgamento final, mas sim o argumento de que conduz a ela, avaliamos o relatório do caso à luz do paradigma escolhido. Por último, esboçamos uma possível solução ao problema a partir da avaliação ética anterior.DOI: 10.5294/pebi.2016.20.1.6

An Ethical Dilemma in the Field of Gynecology

The aim of this paper is to assess a case report in the field of gynecology, starting from an ethical paradigm that relates primarily to the so-called “sources of morality” (objective structure, circumstances, aim). In order to do so, we first will present four ethical paradigms for the evaluation of clinical cases (preference utilitarianism, principlism, ontologically-grounded personalism and Aristotelian/ Thomist objective ethics). After introducing the main aspects of these paradigms and pointing out that what matters in an ethical evaluation is not so much the final judgement, but rather the argument that leads to it, we will assess the case report in light of the chosen paradigm. Lastly, we will outline a possible solution to the problem, starting from the previous ethical evaluation.DOI: 10.5294/pebi.2016.20.1.6  O objetivo deste trabalho é avaliar o relatório de um caso clínico no campo da ginecologia a partir de um paradigma ético que se refere principalmente às denominadas “fontes da moral” (a estrutura objetiva, as circunstâncias, o objetivo). Nesse sentido, primeiramente apresentamos quatro paradigmas éticos para a avaliação de casos clínicos (utilitarismo de preferência, principialismo, personalismo fundado ontologicamente e ética objetiva aristotélica/tomista). Após introduzir os aspectos principais desses paradigmas e indicar que o importante numa avaliação ética não é tanto o julgamento final, mas sim o argumento de que conduz a ela, avaliamos o relatório do caso à luz do paradigma escolhido. Por último, esboçamos uma possível solução ao problema a partir da avaliação ética anterior.DOI: 10.5294/pebi.2016.20.1.6 El objetivo de este texto es evaluar el informe de un caso clínico en el campo de la ginecología, a partir de un paradigma ético que se refiere principalmente a las denominadas “fuentes de la moral” (la estructura objetiva, las circunstancias, el objetivo). Primero se presentan cuatro paradigmas éticos para la evaluación de casos clínicos (utilitarismo de preferencia, principialismo, personalismo fundado ontológicamente y ética objetiva aristotélica/tomista). Después de la introducción de los aspectos principales de estos paradigmas y al señalar que lo que importa en una evaluación ética no es tanto el juicio final, sino más bien el argumento que conduce a ella, se evalúa el informe del caso a la luz del paradigma elegido. Por último, se esboza una posible solución al problema, a partir de la evaluación ética anterior.DOI: 10.5294/pebi.2016.20.1.6

European Menopause and Andropause Society (EMAS) and International Gynecologic Cancer Society (IGCS) position statement on managing the menopause after gynecological cancer: focus on menopausal symptoms and osteoporosis

Introduction: Worldwide, it is estimated that about 1.3 million new gynecological cancer cases are diagnosed each year. For 2018, the predicted annual totals were cervix uteri 569,847, corpus uteri 382,069, ovary 295,414, vulva 44,235 and vagina 17,600. Treatments include hysterectomy with or without bilateral salpingo-oophorectomy, radiotherapy and chemotherapy. These can result in loss of ovarian function and, in women under the age of 45, early menopause. Aim: The aim of this position statement is to set out an individualized approach to the management, with or without menopausal hormone therapy, of menopausal symptoms and the prevention and treatment of osteoporosis in women with gynecological cancer. Materials and methods: Literature review and consensus of expert opinion. Summary recommendations: The limited data suggest that women with low-grade, early-stage endometrial cancer may consider systemic or topical estrogens. However, menopausal hormone therapy may stimulate tumor growth in patients with more advanced disease, and non-hormonal approaches are recommended. Uterine sarcomas may be hormone dependent, and therefore estrogen and progesterone receptor testing should be undertaken to guide decisions as to whether menopausal hormone therapy or non-hormonal strategies should be used. The limited evidence available suggests that menopausal hormone therapy, either systemic or topical, does not appear to be associated with harm and does not decrease overall or disease-free survival in women with nonserous epithelial ovarian cancer and germ cell tumors. Caution is required with both systemic and topical menopausal hormone therapy in women with serous and granulosa cell tumors because of their hormone dependence, and non-hormonal options are recommended as initial therapy. There is no evidence to contraindicate the use of systemic or topical menopausal hormone therapy by women with cervical, vaginal or vulvar cancer, as these tumors are not considered to be hormone dependent

Metodo per il controllo della risposta temporale di un sensore per sostanze chimiche

The present invention relates to a method for the control or the response time of a sensor (1) for chemical substances, said sensor (1) being comprised of a first (2) and a second (3) pins, at least a layer of active material deposited between said first (2) and said second (3) pins, said active material varying its own impedance following the contact with said chemical substances and as a function of their concentration, and a further control pin (4); said method being characterized in that it provides at least a phase of detection of said chemical substances corresponding to an absorption of said chemical substances by said material, and at least a phase of recovery of said sensor, corresponding to a desorption of said chemical substances by said material; and in that during said phases of detection and recovery a signal is applied to said control pin (4), suited to solicit the absorption or desorption of said material varying the duration of the respective phases of detection and recovery

Intraoperative contact ultrasonography during open myomectomy for uterine fibroids

To evaluate the benefit of intraoperative ultrasound applied directly to the uterine serosa during surgery for uterine fibroids. Prospective study. University hospital, tertiary care. Women admitted for open myomectomy due to uterine fibroids. Intraoperative ultrasound (IUS) and intraoperative palpation were performed to detect the number of residual fibroids at the end of surgery, then the number of fibroids was recorded at anatomopathology examination. Residual fibroids detected at IUS and intraoperative palpation at the end of open myomectomy. The comparison between the number of residual fibroids at IUS and at intraoperative palpation was statistically significant. Intraoperative ultrasound is more efficient than palpation in detecting residual leiomyomata at the end of open myomectomy. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved

Metodo per il controllo della risposta temporale di un sensore per sostanze chimiche

The present invention relates to a method for the control or the response time of a sensor (1) for chemical substances, said sensor (1) being comprised of a first (2) and a second (3) pins, at least a layer of active material deposited between said first (2) and said second (3) pins, said active material varying its own impedance following the contact with said chemical substances and as a function of their concentration, and a further control pin (4); said method being characterized in that it provides at least a phase of detection of said chemical substances corresponding to an absorption of said chemical substances by said material, and at least a phase of recovery of said sensor, corresponding to a desorption of said chemical substances by said material; and in that during said phases of detection and recovery a signal is applied to said control pin (4), suited to solicit the absorption or desorption of said material varying the duration of the respective phases of detection and recovery

Quality of life in patients with endometrial cancer treated with or without systematic lymphadenectomy

Objective: To compare the quality of life (QoL) of women affected by endometrial cancer treated with surgery with or without systematic lymphadenectomy. Study design: Consecutive patients affected by stages I and II endometrial cancer and treated with surgery between 2008 and 2011 were selected. Eligible subjects were divided into two groups: Group A consisted of 36 patients who had hysterectomy plus bilateral salpingo-oophorectomy without lymphadenectomy; Group B consisted of 40 patients who had hysterectomy plus salpingo-oophorectomy plus pelvic and aortic lymphadenectomy. The EORTC Quality of Life Questionnaire-Cancer Module (QLQ-C30) and Quality of Life Questionnaire-Endometrial Cancer Module (QLQ-EN24) were administered to selected patients. All data were recorded and then analyzed using the scoring manual of the EORTC Quality of Life Group. Results: Among symptom scales, only lymphedema gave a statistically significant difference among two groups, with a score of 10.64 ± 17.43 in Group A and 21.66 ± 24.51 in Group B (p = 0.0285). The p value obtained comparing the "Global Health Status" (items 29 and 30) in Group A and in Group B was not statistically significant. Conclusion: Lymphadenectomy did not influence negatively global health status, but lymphadenectomy maintained its importance in determining a patient's prognosis and in tailoring adjuvant therapies. We therefore support its practice as part of the surgical procedure in patients affected by high risk endometrial cancer. © 2013 Elsevier Ireland Ltd. All rights reserved