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Male fertility significantly decreased in the last 50 years, as showed in several studies reporting a reduction of sperm counts per ml in the seminal fluid. Several “acute” pharmacological treatments, as antibiotics, could cause subclinical and temporary reduction of male fertility; conversely, long-term medical treatment may severely affect male fertility, although this effect could be considered transient in most of the cases. Thus, nowadays, several long-term pharmacological treatments may represent a clinical challenge. The association between several kind of antihypertensive drugs and reduction of male fertility has been showed in the mouse model, although the modification(s) which may alter this fine-regulated machinery are still far to be elucidated. Furthermore, well-designed observational studies and randomized controlled trials are needed to accurately define this association in human model, meaning a narrative overview synthesizing the findings of literature retrieved from searches of computerized databases. We strongly solicit future human studies (both observational and randomized clinical trials) on large cohorts with adequate statistical power which may clarify this possible association and the effects (reversible or permanent) of each drug. Furthermore, we suggest a close collaboration between general practitioners, cardiologists, and andrologists in order to choose the most appropriate antihypertensive therapy considering also patient’s reproductive desire and possible risk for his fertility.

Prolonged pregnancy is defined as a pregnancy that extends beyond 42 weeks of gestation (294 days) from the first day of the last normal menstrual period. An accurate estimation of the 'natural' incidence of prolonged pregnancy would require meticulous early pregnancy dating. The use of ultrasound to establish gestational age reduces the number of pregnancies that are classified as prolonged. Prolonged pregnancy is associated with an increased perinatal mortality and morbidity in pregnancies which appear to be otherwise low risk. Postterm births are easily preventable by intervening to deliver with the use of induction of labor. Thus, this potentially problematic condition deserves further attention and careful consideration. The focus of this article is to review and challenge some current concepts surrounding the diagnosis and management of prolonged pregnancy. We outline how to identify those women with prolonged pregnancy and which is the appropriate moment to start monitoring the fetal wellbeing. Finally we address the question of benefits and hazards of induction of labor strategies.

Fibroleiomyoma is the most common benign tumour of the uterus and sometimes it may also be present during pregnancy. The purpose of this study was to report 11 pregnant pazients with fibroleiomyomas larger than 5 cm submitted to myomectomy during cesarean section. No complications were observed and blood transfusion was given to only two patients with thrombocytopenia. This retrospective investigation would indicate that myomectomy during cesarean section can be performed without significant morbidity by expert surgeon and adopting careful and rigorous technique. © Copyright 2012, CIC Edizioni Internazionali.

Uterine fibroid is the most common benign tumor in women, above all in childbearing age because of estrogen-dependency. In fact, in this age group, it has an incidence of 25-30% and requires different management and treatment depending on various factors such as location, volume, number and symptoms. Fibroids originate from the uterine smooth muscle component, they can be single or more often multiple and their size can range from a few millimeters to more than 20 cm in diameter. Depending on their location within the uterine wall, they are classified into: submucosal fibroids which develop below the endometrium protruding, in some cases, into the uterine cavity; intramural fibroids which grow in the thickness of the myometrium; subserosal fibroids which originate below the peritoneal serosa. Our review takes into account the literature data on the various practical techniques for the treatment of uterine fibroids, emphasizing in particular those concerning the usefulness and effectiveness of uterine artery embolization (UAE). In fact, the UAE is an interventional radiologic technique of more recent introduction that, in appropriately selected cases, may represent a minimally invasive alternative to hysterectomy and myomectomy procedures. © Copyright 2011, CIC Edizioni Internazionali.

The fibroma is the most common benign tumour of the uterus. It originates from the uterine muscle, it has a rather hard texture and it is separated from the myometrium by a thick layer of connective tissue, without the presence of a real capsule. It may be single, multiple and with different sizes. The fibroma are often asymptomatic, but they can cause menorrhagia, menometrorragia, important compression, pain (for growth, degeneration, hemorrhage, or torsion of a pedunculated fibroids), urinary or bowel symptoms (e.g., urinary frequency or tenesmus bladder, constipation), recurrent miscarriages or infertility; they are often accompanied by anemia resulting from recurrent blood loss. the present case report is about the history of a thirty year old patient with uterine myoma, pregnant, that in the 24 week was admitted to our department for pelvic pain. It was found a correlation between pregnancy' s continuation and pain. After practised medical treatment and monitoring ultrasound, the patient is discharged with the recommendation to carry out appropriate checks. During 37 week the patient returns in the same hospital with worsening symptoms, anemia, and evidence of colliquation' s area in myoma, highlighted with ultrasound. Performed the cesarean section and myomectomy, the histological examination of surgical piece deposes for red myoma with superimposed phenomena of widespread hemorrhagic necrosis.

Introduction. During routine vaginal ultrasound in postmenopausal women it is frequently to find fluid collections in uterine cavity. The aim of this study is to analyze the clinical significance of this find, using as diagnostic methods hysteroscopy and endometrial biopsy. Materials and methods. Twenty postmenopausal patients (mean age 60.6±8.9 years) with endometrial fluid collections diagnosed by intravaginal ultrasound have been studied. Endometrial thickness was less than 5 mm in 16 patients, greater than 5 mm in the other 4 patients. All patients underwent to hysteroscopy and endometrial biopsy. Results. Histological examination of patients with endometrial ultrasound 5 mm deposed for endometrial hyperplasia. At ultrasound follow-up performed after one month, three months and six months from hysteroscopy, patients that showed endometrial atrophy had no more fluid collections, respectively, in 37.5%, in 43.75% and in 56, 25% of cases; in patients with endometrial hyperplasia, however, the fluid collection remained. Conclusion. Ultrasonographic finding of endometrial fluid collections when endometrium had not preneoplastic characteristics can presumably be attributed to impaired motility of the uterus and / or cervical stenosis. © Copyright 2012, CIC Edizioni Internazionali.