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To evaluate postoperative pain after mini-invasive surgical treatment for dysfunctional uterine bleeding (DUB) with transcervical endometrial resection or thermal ablation balloon.A longitudinal observational study, analyzing 47 women affected by DUB who underwent endometrial ablation was conducted. The authors collected evaluation of pelvic pain at one and four hours after intervention and the individual necessity of analgesics. After 30 days, all patients underwent a gynecological visit to evaluate postoperative outcome.Pelvic pain was higher one and four hours after procedure in thermal balloon ablation group, and patients in the same group required more analgesic rescue dose. There were no complications such as uterine perforation, heavy blood loss or thermal injuries with both the procedures.Thermal balloon ablation appears a more painful procedure than endometrial resection, both in the immediate postsurgical time and 30 days after surgery. Ad hoc anaesthesiologic and analgesic protocol should be adopted to ensure quick recovery and good acceptance of the procedure.

Purpose of investigation The authors' aim is to compare surgical outcome of hysteroscopic G1 and G2 submucous myomectomy using bipolar resectoscope to those performed by monopolar device. Materials and methods a multicenter-observational-case-control study was conducted on premenopausal women affected by menorrhagia, pelvic pain or infertility because of submucous uterine myoma. The authors considered eligible: single G1 or G2 submucous uterine myoma, at least 0.5 cm ultrasound 'myometrial-free-margin' and two months GnRH pre-surgical treatment (myoma > three cm). Goup A patients were treated b y bipolar resectoscope and Group B by monopolar resectoscope. Primary endpoint was to compare the groups in term of complete or incomplete myomas resection ("second-step-procedure" rate). Secondary endpoint was to compare two treatments in term of surgical time and intraoperative complications rate. Results Group A (60 patients) and Group B (216 patients) were homogeneous for general features and myomas location but they differed for G2 type prevalence (73.3% vs 50.5%), mean myomas diameter (33.17 +/- 11.93 vs 29.45 +/- 9.63), and surgical time (29.43 +/- 12.6 vs 23.2 +/- 8.2 minutes). In Group A patients both G1 and G2 myomas were completely removed in single step without intraoperative/postoperative complications; in Group B surgical outcomes of G1 myomas were similar to those of Group A, while G2 myomas required procedure termination in 12% of cases because of light electrolyte disturbance (22 cases) and severe iponatremia in four cases. All intraoperative complications occurred when procedure time exceeded 30 minutes and when myomas diameter was greater than 37.5 millimeters. Conclusion in the era ofmini-invasive surgery, hysteroscopic approach by bipolar device should be considered as a useful, safe, and large scale feasible procedure for submucosal myoma treatment, particularly when G2.

The authors report their experience with vaginal vault suturing procedure in patients that underwent total laparoscopic hysterectomy (TLH) for benign diseases. Vaginal vault colpotomy and closure were only laparoscopically carried out.Longitudinal retrospective study was conducted in 550 patients, affected by gynaecological benign pathologies, that underwent TLH were enrolled. Information about age, body mass index, parity, corticosteroid therapy, previous pelvic surgery, smoking, diabetes, menopausal status, and procedure characteristics (operating time, blood loss, uterus weight, postoperative recovery time, and adverse outcomes) were collected. Postoperative complications and adverse outcomes were recorded.Only one case (0.2%,) of vaginal cuff dehiscence (VCD) occurred four weeks after surgery, which was quickly laparoscopically repaired with interrupted intracorporeal knots. The trigger event was sexual intercourse in a patient affected by systemic lupus erythematosus (SLE). No cases of VCD presented in patients with other considered comorbidities.A careful technique could further decrease the incidence of postoperative vaginal cuff dehiscence, regardless of laparoscopic or vaginal suture approach.

We prospectively evaluated the effects of pneumoperitoneum and reverse Trendelenburg position on cardiopulmonary function in 20 ASA physical status II-III morbidly obese patients (body mass index35 kg m(-2)) undergoing laparoscopic gastric banding. After general anaesthesia was induced, patients' lungs were ventilated using intermittent positive pressure ventilation (at measurement times, the following parameters were used: tidal volume 12 mL kg(-1) ideal body weight, respiratory rate of 12 bpm, an inspiratory to expiratory time ratio of 1:2). Haemodynamic variables, blood gas parameters, and lung/chest compliance were recorded: in the supine position, after induction of general anaesthesia (T0, baseline) and induction of pneumoperitoneum (T1); after placing the patient in a 25 degree reverse Trendelenburg position (T2); during the surgical time (T3); before deflating the abdomen (T4); after pneumoperitoneum resolution (T5), and before the end of anaesthesia, with the patient supine (T6). The PaO2, PaO2/FiO2 ratio, and lung/chest compliance decreased during the study. After the pneumoperitoneum had been resolved, lung/chest compliance but not oxygenation parameters returned to baseline values. The arterial to end-tidal CO2 tension difference progressively increased from 0.38+/-0.3 kPa (2.85+/-2.25 mmHg) (T0) to 0.63+/-0.3 kPa (4.73+/-2.25 mmHg) (T6). In morbidly obese patients, undergoing laparoscopic gastric banding, a CO2 pneumoperitoneum markedly affected gas exchange and lung/chest compliance, while positioning the patient in a 25 degree reverse Trendelenburg position had no beneficial effects.

Rapid turnover proteins are often used as metabolic indicators in patients receiving nutritional therapy. However, their plasmatic concentration can be influenced by activation of acute phase reaction due to stress. The aim of this prospective, observational study was to evaluate changes of positive and negative acute phase proteins in mechanically ventilated ICU patients with acute stress.Plasmatic concentrations of prealbumin (PRA), retinol-binding protein (RBP), c-reactive protein (CRP) as well as resting energy expenditure (REE) and nitrogen balance were measured in thirty ICU patients before starting nutritional support (Baseline) and then after 3 and 8 days of parenteral nutrition (TPN).Plasmatic concentrations of CRP were high at baseline and did not change (p = 0.47), while RBP and PRA were low and progressively increased during the study (p = 0.0001 and p = 0.004). Percentage changes from baseline of both PRA and RBP were significantly correlated with nitrogen balance (p = 0.01 and p = 0.009); while no significant correlation was observed between changes of rapid turnover proteins and CRP (p = 0.72 and p = 0.10).All the variables involved in the study are known to be influenced by both metabolic state and resolution of inflammation. However, the observed changes of rapid turnover proteins significantly correlate with nitrogen balance in the face of a persistent inflammation, as documented by CRP plasmatic concentrations. This suggests that RBP and PRA monitoring may be used as complement clinical evaluation of nutritional therapy also in ICU patients with ongoing inflammation.