Laparoscopic creation of a neovagina in a woman with kidney transplant

The successful use of Vecchietti's technique for creating a neovagina in a case of Rokitansky syndrome with an associated transplanted kidney is reported. The technique is performed by means of a laparoscopic approach, adapted to the special anatomical situation, in order to avoid renal injuries. The accomplishment of a normally functioning neovagina, with no intra-operative or post-operative complications, proves that this technique can also be applied satisfactorily to this type of patient

Semantic Framework for Complex Knowledge Domains

Large amounts of scientific digital contents, potentially available for public sharing and reuse, are nowadays held by scientific and cultural institutions which institutionally collect, produce and store information valuable for dissemination, work, study and research. Semantic technology offers to these stakeholders the possibility to integrate dispersed heterogeneous yet related resources and to build value-added sharing services (overcoming barriers such as e.g. knowledge domain complexity, different classification, language, data format, localization) by exploiting semantic annotation and building virtual content aggregation schemas on top of distributed collections. Applications in real cases are anyway often hampered by difficulties related to the proper formalization of complex scientific knowledge (ontology engineering) and the classification of contents (semantic annotation). This paper illustrates the lessons learnt in applying the Semantic Web specifications to support content management and sharing in complex knowledge domains and provides practical example of application in an EC-funded project.Peer reviewe

Comparison of transdermal estradiol and tibolone for the treatment of oophorectomized women with deep residual endometriosis

Tibolone may be a safe hormonal treatment for postmenopausal women with residual endometriosis. STUDY OBJECTIVE: To compare the effect of HRT with transdermal estradiol and that of treatment with tibolone in post-menopausal women with residual endometriosis. MATERIALS AND METHODS: 21 women with residual pelvic endometriosis after bilateral oophorectomy with or without hysterectomy were enrolled in the study and were randomized to HRT with transdermal estradiol 50 mg twice weekly (n = 10) associated with cyclic medroxyprogesterone acetate 10 mg daily in women who preserved uterus, and to treatment with tibolone 2.5 mg administered orally once a day (n = 11). The duration of both treatments was scheduled to last at least 12 months. Residual endometriosis was located in the bowel wall in four patients, in the rectovaginal septum in six and deeply in the retroperitoneal pelvic space in six. All women were symptomatic before oophorectomy. RESULTS: All the women were followed for 12 months. No patient suspended therapy because of side effects. Four patients of the estradiol group experienced moderate pelvic pain during treatment compared with only one patient in the tibolone group. One patient in the estradiol group reported severe dyspareunia. CONCLUSION: Although our series is very small, it seems that tibolone may be a safe hormonal treatment for post-menopausal women with residual endometriosis

Laparoscopic creation of neovagina in women with pelvic kidney

Laparoscopic modification of Vecchietti's technique for creating a neovagina was carried out in four women with Rokitansky syndrome and renal anomalies. All four patients had pelvic kidney, and in two it was associated with contralateral renal agenesis. The procedure was specifically modified to reduce the risks inherent in the most difficult step, passing the thread-bearing cutting needle from the abdominal wall to the retrohymenal fossa, through the vesicorectal space. In all patients this was done successfully on the side contralateral to the pelvic kidney or in the hemipelvis in which the ureter was absent. Our experience proves that Vecchietti's technique for creating a neovagina, performed by laparoscopy, is feasible in patients with pelvic kidney, and laparotomy is unnecessary. (J Am Assoc Gynecol Laparosc 6(3):327-329, 1999

A randomized study of the effects of tibolone and transdemal estrogen replacement therapy in postmenopausal women with uterine myomas

Tibolone seems a valid alternative in menopausal patients with uterine myomas as it provides adequate relief from menopausal symptoms and avoids volume increase of the uterus aand myoma

Transrectal ultrasonography in the assessment of congenital vaginal canalization defects

Our aim was to evaluate the reliability of transrectal ultrasonography in the preoperative assessment of congenital vaginal canalization defects. We studied nine patients, six with suspected Rokitansky syndrome and three with suspected complete transverse septum. Before corrective surgery all the patients underwent pelvic examination, transabdominal and transrectal ultrasonography. The ultrasonographic findings were compared with the surgical ones. Transrectal ultrasonography provided an accurate map of the pelvic organs showing the precise distances between the urethra and bladder anteriorly, rectum posteriorly, retrohymenal fovea caudally, and pelvic peritoneum cranially. Transrectal ultrasonography produced a picture that corresponded perfectly with the real anatomical situation. Conversely, abdominal ultrasonography provided inadequate images in six of our nine patients, and magnetic resonance imaging was responsible for a mistaken diagnosis in one patient with suspected transverse vaginal septum. In conclusion, if our results are confirmed in larger series, transrectal ultrasonography could be considered as a diagnostic procedure of choice in the assessment of vaginal canalization defects