Impatto dei geni e delle etnie sulla sindrome dell’ovaio policistico

La sindrome dell’ovaio policistico è una complessa e eterogenea condizione che colpisce circa il 5-10% delle donne in età riproduttiva. L’effetto dell’etnia sulla prevalenza e sulla severità dell’espressione dei sintomi, è stato preso in considerazione in diversi studi. Tra le donne indiane vi è una alta prevalenza della PCOS rispetto alle donne caucasiche e una maggiore frequenza di insulino-resistenza. Tra le donne Maori e quelle provenienti dalle Isole del Pacifico affette dalla sindrome dell’ovaio policistico vi è un alto rischio di malattia cardiovascolare dovuto all’obesità e alle alterazioni del metabolismo glucidico e lipidico rispetto alle europee. L’irsutismo, l’acantosi nigricans, l’infertilità si presentano con maggiore frequenza tra le donne della regione sud asiatica. La concentrazione plasmatica di omocisteina nelle donne con sindrome dell’ovaio policistico varia in base all’etnia e correla con l’aumento della concentrazione insulinica a digiuno. Inoltre, la varietà dei sintomi con i quali la PCOS si presenta, non solo contribuisce alla grande eterogeneità fenotipica della malattia, ma può influire anche sulla qualità della vita delle donne affette

L’endometrio dismorfico

La valutazione ultrasonografica transvaginale dell’endometrio in 52 donne infertili ha consentito il riscontro di un eco-pattern endometriale dismorfico: è stata studiata la correlazione tra tale aspetto della mucosa uterina e patologie pelviche eventualmente ad esso associate. È stato così possibile riscontrare in 45 casi la concomitante presenza di endometriosi, varicocele pelvico, patologia del follicolo cistico e miomi. Nonostante l’intervento chirurgico secondo Cova e la somministrazione di farmaci induttori dell’ovulazione, sono state ottenute solo tre gravidanze, a riprova del fatto che l’inadeguatezza endometriale e le contemporanee affezioni locali comportano una bassa percentuale di impianti

Extrapleural access with removal of the 11th rib in type IV thoracoabdominal aneurysms: Impact on postoperative management

Aim. Postoperative respiratory failure is one of the most frequent complications of thoracoabdominal aortic aneurysms (-TAAA): its occurrence is mainly linked to the extent of the surgical access (thoraco-phreno-laparotomy). The aim of this study was to evaluate the postoperative management of Type 4 TAAA, paying special attention to respiratory complications, with left extrapleural surgical access and removal of the 11th rib. Methods. Type IV TAAA treated using left extrapleural surgical access and removal of the 11th rib were examined in a retrospective study. The following parameters were analysed: preoperative respiratory (FEV1) and renal function, postoperative intubation time, length of intensive care unit stay, postoperative respiratory complications, postoperative renal insufficiency, perioperative morbidity and mortality (30 days). Results. The study was performed in 10 patients (9 males) with a mean age of 69 years (range 60-75), diagnosed with Type 4 TAAA whose upper proximal limit was the celiac tripod. None of the patients were obese; 90% of the patients were smokers. The preoperative chest X-ray showed a supraelevation of the left hemidiaphragm in 2 cases. In 10 cases, FEV1 ranged from 57% to 144%. Preoperative renal insufficiency was present in 2 cases (creatinine >2.0 mgdl). Surgery was performed electively in all cases. In total, there were 2 cases of postoperative respiratory failure (postoperative intubation time >12 hours). In the remaining cases mean postoperative intubation time was 5.3 hours (range: 4-8 hours). Both cases of respiratory failure were associated with transient renal insufficiency. The mean length of intensive care unit stay was 3.5 days (range: 0-15 days): a single day was sufficient in 50% of cases. Postoperative chest X-rays revealed only 1 new case of supraelevation of the left hemidiaphragm (2 were already present preoperatively), no case of pneumothorax and no case of infection. Two cases of transient postoperative renal insufficiency were observed: only 1 case required temporary hemodialysis. Redo surgery was necessary in 2 cases: in 1 case to empty the retroperitoneal hematoma and cross-over surgery in 1 case due to thrombosis of an iliac branch. There was no case of perioperative mortality. Conclusion. Based on these preliminary results, when practicable, this surgical access appears to promote a more rapid recovery of postoperative respiratory function

Ruptured pancreaticoduodenal artery aneurysm. A case report and review of the literature

none4noneP. Buresta; A. Freyrie; O. Paragona; M. D'AddatoP. Buresta; A. Freyrie; O. Paragona; M. D'Addat

Port-a-Cath-related complications in 252 patients with solid tissue tumours and the first report of heparin-induced delayed hypersensitivity after Port-a-Cath heparinisation.

The use of the subcutaneous Port-a-Catheters (Port-a-Caths) provides an important mean of venous access for oncological patients. The aim of our retrospective consecutive single-centre study was to investigate Port-a-Cath-related complications in 252 cancer patients. Overall period of Port-a-Caths maintenance was 25 months. The strategy of our centre is to keep Port-a-Caths in situ up to the end of follow-up in adjuvant cancer patients. A total of 22 complications were recorded (8.73%). Interventional complications occurred in four patients. The main complications during Port-a-Cath use included thrombosis (4 patients, 1.58%), infections (4 patients, 1.58%), persistent pain or discomfort (3 patients, 1.19%) and dislocations (2 patients, 0.79%). Median time to the occurrence of any type of complications was 4.5 months. Eleven Port-a-Caths were removed due to complications (4.36%). Similar rate of Port-a-Cath-related thrombosis/infection was seen in adjuvant and advanced cancer patients (no statistical significance). Continuous infusion of anticancer therapy via a Port-a-Cath system is a relatively safe procedure, although major complications might occur. We are first to describe heparin-induced delayed hypersensitivity after heparinisation of Port-a-Cath. This fact should influence the preference to keep the Port-a-Cath after completion of adjuvant anticancer treatment