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Primary ovarian melanoma arising on a mature ovarian cystic teratoma is extremely rare. As best of our knowledge, to date, 49 cases have been reported in literature. Few information was reported about best management and therapy. We present a case occurred in a 69-year-old woman, without symptoms, who come to our unit for stress incontinence. A pelvic mass was detected and, after imaging evaluation, surgery was performed. The diagnosis was ovarian melanoma arose on a mature teratoma. No other adjuvant treatment was proposed after surgery. She died 9 months after the first diagnosis. Primary ovarian melanoma is a definite entity associated with a variable natural history and poor prognosis. Differential diagnosis is a challenge for the pathologist, because it must be differentiated by metastatic melanoma. The corner stone treatment of this disease is surgery; however, chemotherapy, immunotherapy, and target therapy seem to have a role.

We reported a case of secondary abdominal pregnancy with placental implantation into the fallopian tube, diagnosed at 16 weeks, in a woman admitted to the emergency room complaining of syncopal attacks. The best approach would be termination of the pregnancy, taking into consideration the high risk to the mother and the low possibility of alive and healthy birth. We had to perform an urgent surgical intervention due to the fact that the patient was in a clinically unstable condition, which was related to hemoperitoneum. If placental implantation is on abdominal organs or vessel the best approach would be to ligate the cord and to leave placenta in situ. Taking into consideration the place of placental implant, the removal of the fallopian tube with the placenta was the safest approach in this case. The best and most acceptable form of treatment would be individualized in case of rare form of ectopic pregnancy.

Objective: To examine associations of parental socioeconomic position with early-life offspring body mass index (BMI) trajectories in a middle-income country., Subjects: Overall, 12,385 Belarusian children born 1996-97 and enrolled in a randomised breastfeeding promotion trial at birth, with 3-14 measurements of BMI from birth to 7 years., Methods: Cohort analysis in which exposures were parental education (common secondary or less; advanced secondary or partial university; completed university) and occupation (manual; non-manual) at birth, and the outcome was BMI z-score trajectories estimated using multilevel linear spline models, controlling for trial arm, location, parental BMI, maternal smoking status and number of older siblings., Results: Infants born to university-educated mothers were heavier at birth than those born to secondary school-educated mothers [by 0.13 BMI z-score units (95% confidence interval, CI: 0.07, 0.19) for girls and 0.11 (95% CI: 0.05, 0.17) for boys; equivalent for an infant of average birth length to 43 and 38 g, respectively]. Between the ages of 3-7 years children of the most educated mothers had larger BMI increases than children of the least educated mothers. At age 7 years, after controlling for trial arm and location,  children of university-educated mothers had higher BMIs than those born to secondary school-educated mothers by 0.11 z-score (95% CI: 0.03, 0.19) among girls and 0.18 (95% CI: 0.1, 0.27) among boys, equivalent to differences in BMI for a child of average height of 0.19 and 0.26 kg/m 2 , respectively. After further controlling for parental BMI, these differences attenuated to 0.08 z-score (95% CI: 0, 0.16) and 0.16 z-score (95% CI: 0.07, 0.24), respectively, but changed very little after additional adjustment for number of older siblings and mother's smoking status. Associations were similar when based on paternal educational attainment and highest household occupation., Conclusions: In Belarus, consistent with some middle-income countries, higher socioeconomic position was associated with greater BMI trajectories from age 3 onwards.

Introduction and Hypothesis: Uterosacral ligament suspension at the time of primary prolapse repair represents a well-established surgical option. Our aim was to compare the effectiveness, complications rate, and functional results of modified McCall culdoplasty and Shull suspension., Methods: Patients who underwent vaginal hysterectomy and cuff suspension for pelvic organ prolapse were retrospectively analyzed. McCall culdoplasty (group A) or Shull suspension (group B) were performed according to surgeon choice based on age and sexual activity. Perioperative data, objective, and subjective cure rate were noted., Results: A total of 339 patients (215 in group A and 124 in group B) completed follow-up. Operating time and blood loss were slightly higher in group B. The complications rate was similar in the two groups. Anatomical outcomes in terms of recurrence and reoperation rate did not show any statistically significant differences. POP-Q items analysis revealed only a different total vaginal length between groups (8 mm longer in group B). Functional outcomes were similar in the two groups as was patient satisfaction., Conclusion: Both uterosacral ligament suspension procedures were shown to be safe and effective. There were no clinically significant differences with regard to surgical data, complications, anatomical, functional, and subjective outcomes between modified McCall culdoplasty and Shull suspension.

Objective: Pelvic reconstructive surgery can be associated to correction, persistence, or onset of stress urinary incontinence. The aim of our study was to evaluate the incidence of stress incontinence (SI) after prolapse repair in 3 groups with different preoperative urodynamic findings and to find out the predictiveness of occult SI., Methods: Patients undergoing vaginal hysterectomy, uterus-sacral ligament colposuspension, and traditional anterior repair for pelvic prolapse were retrospectively analyzed. No patient underwent any additional anti-incontinence procedure. Preoperative evaluation included clinical history, physical examination, and urodynamic assessment with a pessary reduction test. According to urodynamic findings, women were divided into SI (A), occult SI (B), and continence (C) groups. Primary outcome was to compare the incidence of postoperative SI among groups. Secondary outcome was to assess postoperative quality of life with International Consultation on Incontinence questionnaire-short form questionnaire., Results: One hundred fifty patients were analyzed (A: n = 30; B: n = 43; C: n = 77). Mean follow-up was 18.4 ± 0.9 months without differences among groups. Patients in group B did not have higher postoperative SI rate compared to group C. There were no differences in International Consultation on Incontinence questionnaire-short form scores in symptomatic women among groups., Conclusions: In our series, occult stress urinary incontinence is a poor urodynamic marker to predict the development of postoperative SI.

Introduction and Hypothesis: Unsuccessful primary repair of fourth-degree obstetric trauma can lead to permanent communication between the rectum and the vagina, which, in association with full-thickness anal sphincter defects, is characterized by complete fecal incontinence and severe impairment of quality of life. The aim of this video is to serve as a tutorial for repair., Methods: A 27-year-old woman who developed a full-thickness recto-vaginal defect extended from the perineum to the upper third of the vagina has been managed through layered surgical repair without flaps., Results: Anatomy and fecal continence have been completely restored by a follow-up of 24 months., Conclusion: The procedure described in this video has been shown to be effective and safe.

Background: Socioeconomic disadvantage is associated with shorter adult stature. Few studies have examined socioeconomic differences in stature from birth to childhood and the mechanisms involved, particularly in middle-income former Soviet settings., Methods: The sample included 12,463 Belarusian children (73% of the original cohort) born in 1996-1997, with up to 14 stature measurements from birth to 7 years. Linear spline multi-level models with 3 knots at 3, 12 and 34 months were used to analyse birth length and growth velocity during four age-periods by parental educational achievement (up to secondary school, advanced secondary/partial university, completed university) and occupation (manual, non-manual)., Results: Girls born to the most (versus least) educated mothers were 0.43 cm (95% confidence interval (CI): 0.28, 0.58) longer at birth; for boys, the corresponding difference was 0.30 cm (95% CI: 0.15, 0.46). Similarly, children of the most educated mothers grew faster from birth-3 months and 12-34 months (p-values for trend ≤ 0.08), such that, by age 7 years, girls with the most (versus least) educated mothers were 1.92 cm (95% CI: 1.47, 2.36) taller; after controlling for urban/rural and East/West area of residence, this difference remained at 1.86 cm (95% CI: 1.42, 2.31), but after additionally controlling for mid-parental height, attenuated to 1.10 cm (95% CI: 0.69, 1.52). Among boys, these differences were 1.95 cm (95% CI: 1.53, 2.37), 1.89 cm (95% CI: 1.47, 2.31) and 1.16 cm (95% CI: 0.77, 1.55), respectively. Additionally controlling for breastfeeding, maternal smoking and older siblings did not substantively alter these findings. There was no evidence that the association of maternal educational attainment with growth differed in girls compared to boys (p for interaction = 0.45). Results were similar for those born to the most (versus least) educated fathers, or who had a parent with a non-manual (versus manual) occupation., Conclusions: In Belarus, a middle-income former Soviet country, socioeconomic differences in offspring growth commence in the pre-natal period and generate up to approximately 2 cm difference in height at age 7 years. These associations are partly explained by genetic or other factors influencing parental stature., Trial Registration: Current Controlled Trials: NCT01352247 assigned 9 Sept 2005; ClinicalTrials.gov. Identifier: NCT01561612 received 20 Mar 2012.

Background: Nasal bacterial colonization is often dubbed "asymptomatic." We hypothesized that rhinitis, common in preschool children, is associated with bacterial colonization and that respiratory viruses, which cause rhinitis, interact with bacteria in ways which promote transmission., Methods: Five hundred eighty-five children (4.2-73.6 months) attending daycare had clinical information, a rhinitis score and nasal swabs collected in February 2009. Swabs in soya tryptone glucose glycerine broth were cultured for Streptococcus pneumoniae (Sp), Haemophilus influenzae (Hi) and Staphylococcus aureus and analyzed by real-time polymerase chain reaction for respiratory viruses, both semiquantitatively., Results: Rhinitis symptoms, carriage of Sp and Hi and viral detection fell, whereas S. aureus carriage rates rose with age. Significant, age-independent associations between rhinitis symptoms and detection of Hi (P < 0.033) and Hi colonization density (P < 0.027) were observed. Of the 42% with detected viruses, most (78%) had picornavirus detection. There was a significant age-independent association between viral detection (and viral load, picornavirus detection and picorn aviral load) and detection of Sp (P = 0.020, 0.035, 0.005, 0.014) and between viral detection and viral load and Sp colonization density (P = 0.024, 0.028) [corrected]., Conclusions: Hi may promote its own transmission by inducing or ampli¬fying rhinitis in children. There isa close quantitative relationship between respiratory viral detection, including picornavirus detection and Spcoloni¬zation. These findings have implications for understanding disease patho¬genesis and formulating prevention strategies using vaccines [corrected].

Background: Weight and length at birth (which represent fetal growth) and weight and length or height gain during childhood (which potentially represent catch-up growth) may be related to later health outcomes. However, methods for the assessment of such relations are complex and underdeveloped., Objectives: We aimed to describe childhood weight and length or height trajectories and to relate these to later outcomes by using rash at age 6.5 y as an example., Design: The data came from a prospective cohort study in Belarus in 10,494 children born in 31 hospitals that participated in a cluster randomized trial of breastfeeding promotion. Weight and length or height were measured at birth, at scheduled clinic visits up to 1 y, and at 6.5 y; intermediate measures were obtained from routine child health records. Linear spline multilevel models for weight and length or height were used to estimate each child's deviance from average birth weight, birth length, weight, and length or height gain velocity in each time period. Logistic regression was used to relate the outcome (parental report of rash at 6.5 y) to these weight and length or height estimates., Results: The best-fitting splines for length or height and weight had knots at 3 and 12 mo, with another knot at 34 mo for height. The only relation between weight and length or height and reported rash was a positive association with weight gain velocity between 12 and 34 mo (odds ratio per SD increase in weight gain velocity: 1.11; 95% CI: 1.01, 1.22)., Conclusion: Advantages of multilevel models include no restriction to measures at arbitrary times or to individuals with complete data and allowance for measurement error. This trial was registered at isrctn.org as ISRCTN37687716.

The activity of the occupational physician is one of the key elements for the management of psychosocial risk factor in companies, specifically in the healthcare system. The introduction of laws and agreements between the social partners regarding work-related stress have recently brought the attention upon further issues for the physician to work on. The role of the occupational physician is particularly important in the process of risk assessment, in informing and training the personnel as well as managing the more clinical aspects of the problem. The tasks and responsibilities of the occupational physician are therefore analysed in their more practical aspects, with particular attention to the currently evolving normative context, and are thereafter inserted into the field of primary, secondary and tertiary prevention.

Fractures of the radial head associated with dislocation of the elbow constitute a pathology for which it is difficult to choose treatment, and that has a high failure rate. A retrospective study of the literature and of a series of cases was conducted: 31 patients came to our observation between 1990 amd 2001 and were analyzed by clinical (Broberg and Morrey Score and SECEC Score) and radiographic testing. Based on the Broberg and Morrey Score the results were excellent in 4 patients (13%), good in 8 (26%), fair in 12 (39%), and poor in 7 (22%) with a success rate of 39% and a failure rate of 61% principally due to secondary stiffness and instability. In an attempt to reduce the number of failures, a treatment protocol aimed at restoring a stable, mobile and painless elbow was devised.

The importance of non-malignant pleural fibrosis in asbestosis in relation to respiratory function is still open to debate because of the differing results obtained in studies of different population groups. In the present study we selected 50 subjects with occupational exposure to asbestos presenting mono- or bilateral pleural fibrosis at X-ray but without lung impairment. Each subject underwent bronchial lavage and ventilatory function tests. The subjects were divided into 4 groups on the basis of the degree of pleural alterations according to the ILO Classification of Pneumoconioses. The results revealed that the mean values of CV and FEV1 in each group were within physiological limits. Moreover, analysis of the type of lung function showed a normal situation in 64% and restricted function in 28% of the cases. The prevalence of the latter finding was not correlated to the severity of pleural fibrosis in the various groups. Also, comparison between severity of pleural fibrosis and number of asbestos bodies/ml of BAL liquid on the one hand and frequency of alveolitis on the other did not reveal any relationship. Therefore, the onset of pleural fibrosis appears to be independent of the quantity of inhaled asbestos fibres and due to different mechanisms from those leading to lung fibrosis. In practice, a correct interpretation of the presence of pleural fibrosis from a clinical and prognostic viewpoint also requires other investigations such as BAL and a complete respiratory function study.

The paper reports the results of a prevalence study on functional impairment and chronic bronchitis in 733 foundry workers and in a control group of 1041 workers not exposed to the specific risks of the iron and steel industry. This study is the first part of a longitudinal study lasting 5 years within the framework of the Fourth Research Programme of the European Coal and Steel Community. Data on microclimate and particulate pollution for the various departments showed uniformly cold and damp conditions. Concentrations of pollutants were generally below the current T.L.V.'s. The subjects were subdivided into groups according to age, smoking and length of exposure. All the subjects were administered the "E.C.S.C. Questionnaire for the study of chronic bronchitis and pulmonary emphysema" and underwent a chest X-ray and spirometry to measure FVC, FEV1 and Vmax 50. The prevalence of functional impairment and chronic bronchitis was higher in the foundry workers than in the group of non-exposed workers. A statistical standardization was made of the effect of age and smoking thus accentuating the effect of exposure. The results are compared with the data obtained by other epidemiologic studies on working populations exposed to a similar risk.