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Objective: The etiology of preterm labor is multifactorial. An inflammatory response is always involved with the activation of NF-kB that determines synthesis and release of inflammatory molecules, implicated in fetal membrane activation, cervical modifications, abdominal pain and spontaneous uterine contractions. There is a close relationship between preterm birth and cervical shortening in the second quarter of pregnancy. We evaluated the benefits of alpha-lipoic acid administration on women considered at risk of preterm delivery due to the presence of symptoms (pelvic pain and uterine contractions) or reduced cervical length. Patients and Methods: This prospective observational study was carried out at the Gynecology and Obstetrics Unit of Palermo University Hospital (Palermo, Italy), from October 2015 to April 2016. The inclusion criteria were: women aged 18-35, with gestational age between 24 and 33 weeks of amenorrhea, pregnancy at risk of preterm delivery due to cervical length between 35-25 mm (in presence of symptoms) or < 30 and > 15 mm (if asymptomatic), intact membranes and negative for vaginosis. Patients were treated daily with alpha lipoic acid orally (300 mg, twice a day for 30 days) and vaginally (10 mg, once a day for 10 days), or untreated (controls). Patients were evaluated at the baseline (T 0), after 7 days, after 30 days, and at 34 weeks of gestation considering: maternal characteristics, symptomology and cervical length. Results: Among 60 analyzed women, 50 were treated orally and vaginally with alpha-lipoic acid, whereas 10 did not undergo any therapy. In the treated group, 10 patients were asymptomatic and 40 symptomatic. The symptoms disappeared in 37 patients. In the untreated group, 4 women were symptomatic and 6 asymptomatic. At the end all women were symptomatic. Mean cervical length showed a reduction in the untreated group compared to the treated group. Conclusions: The vaginal/oral-combined administration with alpha-lipoic acid showed effectiveness in reducing symptoms and preventing cervical shortening in our set of patients. No adverse effects were detected during the treatment.

The purpose of this statistical analysis is to demonstrate the real advantages in terms of cost-benefit of combination chemotherapy compared with single-agent chemotherapy. The trials, which are used in this meta-analysis, have been searched on PubMed database and they are phase II or randomized phase III studies with only chemotherapy regimens. In this meta-analysis were evaluated adverse effects with odds ratio (OR), which is expressed in 95% confidence intervals (95% CI). Only 4 studies contained all the set selection criteria and they were selected. The data, which were obtained, were analyzed using MedCalc Application. The combination therapy was more strongly linked to certain adverse events than to chemotherapy with a single agent: thrombocytopenia, anemia, neutropenia and nausea. The data obtained for leukopenia, for vomiting and for stomatitis are not statistically significant, as well as those of antitumor activity. Obtained data allow us to state that the overall combination therapy is more closely related to adverse effects such as thrombocytopenia, anemia, neutropenia and nausea compared tosingle-agent chemotherapy.

Los linfangiomas son lesiones benignas, de baja incidencia, más comunes en niños y adolescentes. Con muy baja frecuencia son intraabdominales y poseen presentación clínica variable, yendo desde el hallazgo clínico hasta pacientes con riesgo vital por abdomen agudo. Presentamos el caso de un paciente de 19 años, sin antecedentes mórbidos que acude a urgencias por dolor abdominal asociado a fiebre, vómitos y distensión abdominal; la radiografía simple es sugerente de obstrucción intestinal. En laparotomía exploradora se encuentra un vólvulo y dilatación del intestino delgado en relación a una malformación vascular y lesiones multilobuladas en mesenterio. Se resecan 40 cm de yeyuno y realiza anastomosis término-terminal. La histología reveló un Linfangioma Multiquístico Mesentérico. El paciente evoluciona en buenas condiciones generales y se mantiene control clínico e imagenológico seriado. Aunque infrecuente, es uno de los diagnósticos diferenciales de abdomen agudo. A pesar de su naturaleza benigna puede llegar a comprometer el pronóstico vital del paciente. Lymphangiomas are rare benign lesions, most commonly seen in children and adolescents. Their intra-abdominal presentation is uncommon. We report a 19 years old male, presenting to the emergency room with abdominal pain associated with fever, vomiting and abdominal distensión. There was a history of múltiple previous consultations for abdominal pain. A plain abdominal X-ray examination suggested a bowel obstruction. At surgery a volvulus and dilation of the small bowel in relation to a vascular malformation was found, excising 40 cm of jejunum with an end-to-end intestinal anastomosis. The pathology report showed a Mesenteric Multicystic Lymphangioma. Presently, the patient is in good conditions.

Los linfangiomas son lesiones benignas, de baja incidencia, más comunes en niños y adolescentes. Con muy baja frecuencia son intraabdominales y poseen presentación clínica variable, yendo desde el hallazgo clínico hasta pacientes con riesgo vital por abdomen agudo. Presentamos el caso de un paciente de 19 años, sin antecedentes mórbidos que acude a urgencias por dolor abdominal asociado a fiebre, vómitos y distensión abdominal; la radiografía simple es sugerente de obstrucción intestinal. En laparotomía exploradora se encuentra un vólvulo y dilatación del intestino delgado en relación a una malformación vascular y lesiones multilobuladas en mesenterio. Se resecan 40 cm de yeyuno y realiza anastomosis término-terminal. La histología reveló un Linfangioma Multiquístico Mesentérico. El paciente evoluciona en buenas condiciones generales y se mantiene control clínico e imagenológico seriado. Aunque infrecuente, es uno de los diagnósticos diferenciales de abdomen agudo. A pesar de su naturaleza benigna puede llegar a comprometer el pronóstico vital del paciente.

Tuberculosis is a severe public health problem in developing countries, but it is taking on the characteristics of a global epidemic. By virtue of migration flows, in fact, we are observing a resurgence of this disease in western countries, in all its forms including the genital one. The problem became more serious with the emergence of multidrug-resistant mutant (MDR) strains of Mycobacterium Tuberculosis. In this paper we describe a case of peritoneal tuberculosis, whose diagnosis was histologically made after laparoscopic examination. Laparoscopy proved crucial for the differential diagnosis with peritoneal carcinomatosis, particularly following the discrepancy in the results provided by ultrasound and Computerized Tomography (CT) examinations. These two diseases are, in fact, very different in their pathogenesis, but above all in their treatment options and prognostic outcomes. Genital tuberculosis is a major cause of severe tubal disease leading to infertility. Unlike pulmonary tuberculosis, its clinical diagnosis is difficult because in most of cases genital tuberculosis can be asymptomatic or have a large variety of clinical features. © Copyright 2012, CIC Edizioni Internazionali, Rome.

Objective: The aim of this study is to clarify, in girls with premature pubarche (PP), the influence of premature androgenization on the prevalence of polycystic ovary syndrome (PCOS). Design and patients: Ninety-nine PP girls, 63 who developed PCOS and 36 who did not develop PCOS, were retrospectively included. Clinical, anthropometric, and metabolic parameters were evaluated at the time of diagnosis of PP and after 10 years from menarche to find predictive factors of PCOS. Results: Young females with PP showed a PCOS prevalence of 64% and showed a higher prevalence of familial history of diabetes (P = 0.004) and a lower prevalence of underweight (P = 0.025) than PP-NO-PCOS. In addition, girls with PP-PCOS showed higher BMI (P < 0.001), waist circumference (P < 0.001), total testosterone (P = 0.026), visceral adiposity index (VAI) (P = 0.013), total cholesterol (P < 0.001), LDL-cholesterol (P < 0.001), non-HDL cholesterol (P < 0.001) and lower age of menarche (P = 0.015), ISI-Matsuda (P < 0.001), DIo (P = 0.002), HDL cholesterol (P = 0.026) than PP-NO-PCOS. Multivariate analysis showed that WC (P = 0.049), ISI-Matsuda (P < 0.001), oral disposition index (DIo) (P < 0.001), VAI (P < 0.001), total testosterone (P < 0.001) and LDL-cholesterol (P < 0.001) are independent predictive factors for PCOS in girls with PP. Conclusions: Our study established a strong association between multiple risk factors and development of PCOS in PP girls. These risk factors are predominantly related to the regulation of glucose, lipid, and androgen metabolism. Among these factors, WC, ISI-Matsuda, DIo, VAI, total testosterone, and LDL-cholesterol predict PCOS.

Maternal immunization is considered the best intervention in order to prevent influenza infection of pregnant women and influenza and pertussis infection of newborns. Despite the existing recommendations, vaccination coverage rates in Italy remain very low. Starting from August 2018, maternal immunization against influenza and diphtheria-tetanus-pertussis were strongly recommended by the Italian Ministry of Health. We conducted a cross sectional study to estimate the effectiveness of an educational intervention, conducted during childbirth classes in three general hospitals in the Palermo metropolitan area, Italy, on vaccination adherence during pregnancy. To this end, a questionnaire on knowledge, attitudes, and immunization practices was structured and self-administered to a sample of pregnant women attending childbirth classes. Then, an educational intervention on maternal immunization, followed by a counseling, was conducted by a Public Health medical doctor. After 30 days following the interventions, the adherence to the recommended vaccinations (influenza and pertussis) was evaluated. At the end of the study 326 women were enrolled and 201 responded to the follow-up survey. After the intervention, among the responding pregnant women 47.8% received influenza vaccination (+44.8%), 57.7% diphtheria-tetanus-pertussis vaccination (+50.7%) and 64.2% both the recommended vaccinations (+54.8%). A significant association was found between pregnant women that received at least one vaccination during pregnancy and higher educational level (graduation degree/master’s degree), employment status (employed part/full-time) and influenza vaccination adherence during past seasons (at least one during last five years). The implementation of vaccination educational interventions, including counseling by healthcare professionals (HCPs), on maternal immunization during childbirth courses improved considerably the vaccination adherence during pregnancy.

The vulvo-vaginal atrophy (VVA) is a chronic condition characterized by gradual involution of the mucous membranes and vulvo-vaginal tissues, which is manifested in the climacteric phase. Numerous therapeutic options, hormonal and non-hormonal, have been proposed to alleviate the symptoms related to VVA, but to date none of them is able to guarantee long-term effects. The use of Fractional CO2 Laser technology applied to the vulvo-vaginal area represents an innovative procedure to make a real "regeneration treatment" of the vaginal tissues. In fact, it is possible to spread the laser energy in the various layers of the vaginal wall, reactivating the synthesis of extracellular matrix and collagen, with the recovery of tissue tropism and improved VVA-related disorders

Objective To evaluate the prevalence of human papillomavirus (HPV) sperm infection and its correlation with sperm parameters in patients who attended a fertility clinic. Design Cross-sectional clinical study. Setting University-affiliated reproductive medicine clinic. Patient(s) A total of 308 male partners of couples undergoing in vitro fertilization techniques. Intervention(s) Specimens of semen were collected from all patients. Main Outcome Measure(s) Sperm parameters were evaluated according to the World Health Organization manual. The presence of HPV DNA was researched by the combined use of two HPV assays and a highly sensitive nested polymerase chain reaction assay followed by HPV genotyping. To examine whether HPV was associated with the sperm, in situ hybridization (ISH) analysis was performed. Result(s) Results of HPV investigation were compared with sperm parameters and ISH analysis. Twenty-four out of 308 semen samples (7.8%) were HPV DNA positive, but HPV infection did not seem to affect semen quality. Moreover, ISH revealed a clear HPV localization at the equatorial region of sperm head in infected samples. Conclusion(s) Oncogenic HPV genotypes were detected on spermatozoa from asymptomatic subjects, but a role of the infection in male infertility was not demonstrated.

Objectives: This study aims to show the treatment outcome in women affected by isolated bladder endometriosis who underwent laparoscopic surgery in our units. Only women with deep nodules located in the bladder were selected, thus excluding women with deep lesions located in other sites. Study design: Between March 2005 and 2007, women with deep vesical endometriosis, referring to the Departments of Obstetrics and Gynaecology of University Hospitals "G. Martino" of Messina, "Paolo Giaccone" of Palermo and "San Paolo" of Milano, were respectively recruited. A preoperative assessment of the pathology was performed. Women who were concomitantly diagnosed deep nodules of the rectovaginal septum and/or endometriotic ovarian cysts were excluded. A medical therapy with oral contraceptive and/or GnRH analogues was first proposed to the patients affected. If medical treatment failed, a laparoscopic treatment was suggested. We performed a segmental resection of the involved wall or an extramucosal dissection of the bladder according to the cases. A clinical and an instrumental evaluation by ultrasound was performed every 6 months after surgery for the first year and subsequently every 12 months. At the time of referral, patients were also questioned about any recurrence of symptoms. Results: Eight women, with a mean age of 33.8 (range 30-37 years; S.D. = 2.5) and a mean parity of 1 (range 0-2) were recruited. Medical therapy failed in all cases and the women underwent laparoscopic treatment. Surgery was complete in all cases without a need for ureteral cannulation. No intraoperative complications occurred. The mean estimated blood loss was 98 ml (range 40-200 ml). All patients underwent at least the first follow-up assessment. In none of the women, recurrence of bladder endometriotic nodules was documented. In contrast, urinary symptoms were reported in three cases. Nevertheless, all the patients reported improvement of symptoms and declared to be satisfied. Conclusions: We recommend surgical eradication of bladder lesions. Laparoscopic treatment, in the hands of an expert surgeon, is the management of choice. It offers the best approach to the diagnosis allowing good long-term results, with a less invasive approach. Large multicentric studies are however required prior to drawing definite conclusions. © 2008 Elsevier Ireland Ltd. All rights reserved.

Objective To investigate the difference of long-term amenorrhea rate in patients with menorrhagia treated by endometrial laser intrauterine thermal therapy (ELITT), a new nonhysteroscopic endometrial ablation procedure, versus transcervical hysteroscopic endometrial resection (TCRE). Design Randomized clinical study. Healthy volunteers in an academic research environment. Setting Academic teaching hospital. Patient(s) Premenopausal women with abnormal uterine bleeding. Intervention(s) Fifty-eight patients were treated with the ELITT procedure and 58 patients with TCRE; both groups were treated with GnRH agonists before the procedure. Main outcome measure(s) Bleeding status and patient satisfaction after treatment were evaluated as well as the intraoperative complication rate. Result(s) At 12 months, the amenorrhea rate was 56% in the ELITT group and 23% in the TCRE group. At 36 months, the figures were 61% for ELITT and 24% for TCRE. No significant complications were recorded for either procedure. Conclusion(s) Results of this randomized study demonstrate that both procedures are equally effective in the treatment of menorrhagia. However, the ELITT procedure has proven to be superior in inducing amenorrhea.

The present randomized study was undertaken in order to compare the short-term results between total laparoscopic hysterectomy and abdominal hysterectomy in a centre with experience in laparoscopic surgery. From January 1997 to September 1998 inclusive, 102 women aged 44-71 years were randomly assigned to either total laparoscopic hysterectomy (n = 51 patients) or abdominal hysterectomy (n = 51 patients). The patients' demographic characteristics were similar in both groups. Average intra-operative blood loss was lower in laparoscopic hysterectomy than in abdominal hysterectomy (P