The Case of Pregnancies After Manchester-Fothergill Operation

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Uncommon causes of postoperative chronic diarrhoea mimicking enterocolitis in Hirschsprung's disease: is there a role for digestive endoscopy?

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Laser ablation is superior to TACE in large-sized hepatocellular carcinoma: A pilot case-control study

Background:Limited therapies are available for large ( 6540 mm) unresectable hepatocellular carcinoma (HCC). Currently, the standard treatment with transarterial chemoembolisation (TACE) is unsatisfactory with high recurrence rate and limited effect on survival. Laser Ablation (LA) has emerged as a relatively new technique characterized by high efficacy and good safety. This study is aimed to evaluate the efficacy of LA in comparison to TACE in patients with large HCC. Methods: Eighty-two patients with a single HCC nodule 6540 mm (BCLC stage A or B) were enrolled in this case-control study. Forty-one patients were treated with LA and 41 patients were treated with TACE. Response to therapy was evaluated according to the mRECIST criteria. Survival was calculated with Kaplan-Meier from the time of cancer diagnosis to death with values censored at the date of the last follow-up. Results: Twenty-six (63.4%) and 8 (19.5%) patients had a complete response after LA and TACE, respectively (p < 0.001). Subsequently we stratified the HCCs in 3 categories according to the nodule size: 40-50 mm, 51-60 mm, and > 60 mm. LA resulted superior to TACE especially in nodules ranging between 51 and 60 mm in diameter, with a complete response rate post-LA and post-TACE of 75% and 14.3%, respectively (p = 0.0133). The 36 months cumulative survival rate in patients treated with LA and TACE was 55.4% and 48.8%, respectively. The disease recurrence rates after LA and TACE were 19.5% and 75.0%, respectively. Conclusions: LA is a more effective therapeutic option than TACE in patients with solitary large HCC

Utero-vaginal anastomosis in the treatment of cervical atresia

Cervical atresia is an extremely rare malformation. Its incidence is not well known and management is controversial. The surgical technique and results of utero-vaginal anastomosis in 3 women affected by cervical atresia are described. \uc2\ua9 2007 Taylor & Francis

Myo-inositol administration positively affects hyperinsulinemia and hormonal parameters in overweight patients with polycystic ovary syndrome.

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Effect of L-arginine on blood pressure in pregnancy-induced hypertension: A randomized placebo-controlled trial

Objective. To evaluate the antihypertensive efficacy of L-arginine (L-Arg) repeated infusions in women affected by gestational hypertension. Methods. The women were referred to obstetric units in order to assess their clinical conditions and to exclude the presence of severe fetal and/or maternal complications. Inclusion criteria were: maternal age range 16 - 45 years, diagnosis of gestational hypertension without proteinuria ( patients normotensive until the 20th week), and gestational age ranging between 24 and 36 weeks. Each woman was allocated to receive either L-arginine ( 20 g/500 mL) or placebo treatment through an i.v. line. The infusion was carried out in the morning from 8 a. m. to 10 a. m. and it was repeated for the next four consecutive days. Systolic and diastolic blood pressure values as well as heart rate were recorded with the patient in an upright, seated position at 08: 00, 12: 00, 16: 00 and 20: 00 h. Results. Maternal clinical features such as age, height, weight, and gestational age at inclusion were similar between groups. Both systolic and diastolic blood pressures were reduced by treatment, the effect of L-arginine being significantly higher than that of the placebo ( systolic values F = 8.59, p<0.005; diastolic values F = 3.36; p<0.001). Twenty women assigned to the L-Arg group (32.2%) and 23 to the placebo group (37.7%) were concomitantly treated with antihypertensives before starting the study. Analyzing the subgroup of patients not receiving antihypertensive drugs we found that L-arginine was superior to placebo in lowering systolic ( F = 5.42, p<0.005) and diastolic ( F = 2.20, p<0.005) blood pressure values. Conclusions. In conclusion, these data support the use of L-Arg as an antihypertensive agent for gestational hypertension especially in view of the other beneficial effects nitric oxide donors display in pregnancy. Further, L-Arg seems well tolerated since in this sample none of the patients reported adverse effects requiring study interruption

Diagnostic and therapeutic approach to hypothalamic amenorrhea.

Hypothalamic amenorrhea (HA) is a secondary amenorrheawith no evidence of endocrine/systemic causal factors, mainly related tovarious stressors affecting neuroendocrine control of the reproductiveaxis. In clinical practice, HA is mainly associated with metabolic, physical,or psychological stress. Stress is the adaptive response of our bodythrough all its homeostatic systems, to external and/or internal stimulithat activate specific and nonspecific physiological pathways. HA occursgenerally after severe stressant conditions/situations such as dieting,heavy training, or intense emotional events, all situations that caninduce amenorrhea with or without body weight loss and HA is a secondaryamenorrhea with a diagnosis of exclusion. In fact, the diagnosisis essentially based on a good anamnestic investigation. It has to be investigatedusing the clinical history of the patient: occurrence of menarche,menstrual cyclicity, time and modality of amenorrhea, and it has to beexclude any endocrine disease or any metabolic (i.e., diabetes) and systemicdisorders. It is necessary to identify any stressant situation inducedby loss, family or working problems, weight loss or eating disorders, orphysical training or agonist activity. Peculiar, though not specific, endocrineinvestigations might be proposed but no absolute parameter canbe proposed since HA is greatly dependent from individual response tostressors and/or the adaptive response to stress. This article tries to giveinsights into diagnosis and putative therapeutic strategies

Intravenous L-arginine is a new anti-hypertensive agent for pregnant women

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Pyrexia, leukocytosis and elevated circulating platelets associated to uterine stromal sarcoma with rhabdoid differentiation

Fever of unknown origin can be associated to soft tissues sarcoma and two cases are reported in the literature regarding sarcoma and pyrexia sustained by the tumor [1]. In the present report, we describe a case of uterine sarcoma associated to fever, leukocytosis and circulating elevated levels of platelets.A 46-year-old women with diagnosis of severe anemia (Hb 5.9 gr/dl) and uterine leiomyoma was admitted as an emergency to our hospital. The patient experienced normal cycles until 5 months before when cyclic menhorragia appeared.An office endometrial biopsy showed proliferative endometrium and the patient was submitted to progestins administration in order to reduce the cyclic bleeding. During the last 5 months, pyrexia of unknown origin appeared and the laboratory examination showed leukocytosis and increased platelets.On presentation, the physical exam was notable for an enlarged irregularly shaped uterus. There was no inguinal, axillary or supraclavicolar adenopathy

The management of vaginal agenesis: report of 104 cases

Objective: To present the results obtained in 104 cases of vaginal aplasia resolved with self-dilatation or with surgical procedures such as the McIndoe or Williams operations. Design: Retrospective study. Setting: Departments of obstetrics and gynecology of universities in Bologna, Modena, and Messina, Italy. Patient(s): One hundred four cases of vaginal aplasia. Intervention(s): Self-dilatation and surgical procedures such as the McIndoe or Williams operations. Main Outcome Measure(s): Outcome of the treatment. Result(s): From 1977 to 2002, 104 cases of vaginal agenesis were treated. The mean age of the treated patients was 16.5 years old (range, 13-18 years). After 6 months of self-dilatation, 41 subjects obtained a new cavity of about 10-12 cm in length. In 14 patients, a space ranging from 3 to 5 cm was obtained. The technique failed in 49 patients. Fourteen patients underwent the Williams surgical procedure, while the remaining 49 patients underwent to the McIndoe procedure. All patients were successfully treated, and the only complication, a rectovaginal fistula that was repaired, occurred in one case of the McIndoe operation. Conclusion(s): Self-dilatation should be the first approach because of its high success rate; the Williams surgical approach should be chosen when self-dilatation partially fails or when previous surgical attempts are unsuccessful. Finally, the McIndoe procedure and its variants should be used when self-dilatation completely fails. © 2007 American Society for Reproductive Medicine