Effective nasotracheal intubation using a modified transillumination technique

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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

Metabolic and Clinical Effects of the Supplementation of a Functional Mixture of Amino Acids in Cerebral Hemorrhage

Oral supplementation of a specific mixture of essential and non-essential amino acids has been shown to modulate hypercatabolism in patients with chronic heart failure, leading to improved clinical outcome. The aim of this study was to test whether such effects could be replicated in an acute clinical model of hypercatabolism. After approval by the Ethics Committee, patients with acute brain hemorrhage admitted to the Neurosurgical ICU were randomly assigned to receive enterally for 14 days 20% of their estimated nitrogen requirements as a standard protein supplement (control group; n = 9) or as a functional amino acid mixture (Aminotrofic(A (R)), Errekappa Euroterapici; study group; n = 10). Metabolic and clinical outcome measures were monitored. In the study group, insulin sensitivity and total lymphocyte count appeared to improve when compared with control patients. Less positive blood cultures were found in the study group against control patients (4 vs. 7, respectively; P = 0.05). Also, mortality in the study group was reduced than in control patients (60 vs. 77%; P = n.s.). Supplementation with specific amino acids in critically ill patients may modulate metabolic response and improve clinical outcome

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

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

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% is 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

Skin metastases from endometrial cancer treated with electrochemotherapy: case report and review of literature

Background: Cutaneous relapse from endometrial cancer is a rare event, and often is part of a plurimetastatic disease with poor prognosis. Besides palliative chemotherapy, no consensus is present in literature about the specific treatment of skin metastases, in particular in order to improve symptoms. Objectives: In this paper the authors present a case of multi-metastatic endometrial cancer patient with also cutaneous metastasis, treated with palliative systemic therapy and electrochemotherapy. In particular the authors will describe the clinical, dermatoscopic, and pathological features of cutaneous metastases and their management. A literature review on cutaneous metastasis from endometrial cancer is also presented. Materials and Methods: A PubMed research was made using the terms "endometrial carcinoma", "skin", "cutaneous", "metastasis", and "spread". Discussion: The present case of unusual localization of skin metastases from endometrial cancer is the second described in the literature. The other known cases of cutaneous metastasis from endometrial cancer are summarized and reviewed. Electrochemotherapy can be proposed as an effective and safe loco-regional therapy for skin metastases, especially in case of multiple lesions. To the present authors' knowledge this is the first case of cutaneous metastases from endometrial cancer treated with electrochemotherapy

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

Uterine asymptomatic myomas: An overview from diagnosis to treatment

Objective. Uterine myomas represent the most common benign gynecological tumors and about 40-60% of patients with fibroids are asymptomatic. The diagnosis is often incidental and the treatment depends on patient's age, size of fibroids, estimated rate of growth, woman's fertility plans and risk of malignancy. Despite the prevalence, scientific research regarding asymptomatic fibroids is still underfunded compared with other nonmalignant diseases and actually, no guidelines are reported about management and treatment of themselves. Material and method We conducted a review of literature from February to May 2017. PubMed (MEDLINE), Web of Science databases, EMBASE, Cochrane Library and Scopus database were systematically searched for records reporting on asymptomatic fibroids. Results. Further large studies are needed to define the management of asymptomatic fibroids, real indications to treatment and risks and benefits of a waiting strategy when no treatment is needed can be drawn. Conclusion. No standard guidelines for the management of asymptomatic fibroids have been reported. Treatment is individualized and depends on patient s age, size of fibroids, woman s fertility plans and risk of malignancy

Impact of Hormone Receptor Status and Ki-67 Expression on Disease-Free Survival in Patients Affected by High-risk Endometrial Cancer

The aim of this study was to evaluate the immunohistochemical (IHC) expression of Ki-67, estrogen receptors α (ERsα), and progesterone receptors (PRs) in high-risk endometrial cancer patients and to assess their prognostic impact