1,721,012 research outputs found
[Update on postcoital hormonal contraception. Part 1].
No full textIn recent years new protocols of post-coital hormonal contraception have been devised that cause fewer side-effects. 0.2 mg ethinyl-estradiol with 2 mg norgestrel twice within 72 hours after intercourse were among the first combinations that would utilize low doses of hormones. Other authors use even smaller doses; preparations for intramuscular injection are available if the woman vomits the tablets. Progesterone has been used alone within 12 hours following intercourse with a success rate close to estrogen-progestin combinations. Quingestanol acetate is used for 5 days, 0.9-1.5 mg/day. With danazol fewer side-effects are seen; 400 mg are taken twice within 72 hours with a good rate of success
[Update on mechanical methods of postcoital contraception. Pt. 2].
No full textUse of postcoital contraception (PC) has been suggested for women when hormonal contraceptives are contraindicated. This is achieved by means of the postcoital insertion of an IUD provided no side effects appear, such as persistent pelvic pain, recurring uterine cramps, prolonged bleeding, metrorrhagia, or expulsion of the device. This type of PC does not inhibit ovulation, but rather produces cellular and biochemical changes in the endometrial mucous membrane and effects tubal hypercontractility and hypermotility, which are responsible for the transport of the ovum into the uterine cavity. Impeding these phenomena results in the destruction of the fertilized egg. Apparently, the strong concentration of copper ions in the uterus from the IUD inhibits fetal development. The contraceptive activity also potentiates the blastocidal effect of bacteria that are inevitably introduced by the IUD. PC also has a great advantage compared to hormonal contraceptives, since it can be used 7-10 days after coitus. Other advantages are the low rate of contraindications, few side effects, and no injury to the embryo. Studies on PC IUD use indicate complete success with this method if CU 7, T-Cu 200, or ML Cu 250 devices are used 1 week or up to 10 days after unprotected sex
Management of ureteral endometriosis: areas of controversy.
No full textIn this review we critically evaluate what we know and what we still do not know about pathogenesis, diagnosis and treatment of ureteral endometriosis, highlighting areas of controversy.Recent studies have produced new insights into diagnostic and management options for ureteral endometriosis.The diagnosis of ureteral endometriosis entails a high index of suspicion for the disorder. Imaging techniques are of limited value in providing an accurate depiction of extension of ureteral lesions. Preliminary results suggest that magnetic resonance urography is accurate in differentiating between intrinsic and extrinsic forms of ureteral involvement, but further studies are required to define its role in directing better treatment. Current controversies in the treatment of ureteral endometriosis are over whether segmental resection and anastomosis or ureterolysis are indicated, and whether minimal-access procedures are equally effective than their traditional open counterparts. Recent studies suggest that laparoscopic ureterolysis can be an effective treatment option in most patients with ureteral endometriosis but that recurrence rates are not negligible, as suggested in pioneering works. Successful application of laparoscopic surgery, even for procedures that have traditionally necessitated laparotomy, has been reported. Extensive experience with endourological techniques is prerequisite for success
Umbilical Richter's hernia after minimally invasive laparoscopy. A case report.
No full textA case of Richter's hernia in the umbilical trocar site following laparoscopic radiofrequency thermal ablation of uterine myomas is presented. A 10-mm trocar was inserted through the umbilical site and the radiofrequency needle was introduced percutaneously into the uterine fibroid. Trocar was extracted under direct visual control after carbonic gas deflation. The fascial layer of umbilical port was not sutured. The umbilical Richter's hernia presented 13 days later required bowel resection. This case stresses the importance of suturing the fascial defects of 5-mm larger ports also in diagnostic and in minimally invasive laparoscopic procedures
Trattamento del carcinoma dell’endometrio: ruolo della laparoscopia
No full textLa chirurgia laparoscopica si propone come alternativa all’approccio laparotomico per il trattamento del carcinoma endometriale. L’analisi attuale degli studi finora effettuati risente della limitatezza degli stessi e della loro eterogeneità. In generale dai dati emerge che l’approccio laparoscopico richiede un tempo medio superiore, è correlato ad un minore dolore post-operatorio, ha una più breve degenza ospedaliera, un costo economico complessivo superiore, un più alto livello di soddisfazione della paziente. Rispetto alla linfoadenectomia non sembrano esservi differenze significative rispetto al numero di linfonodi asportati. Il tasso di conversione laparotomica varia tra lo 0 e il 17%. Studi futuri saranno necessari per validare i risultati ottenuti confermando anche quali siano le tecniche capaci di ottenere i risultati migliori in termini di radicalità e sopravvivenza
Chemotherapy in Uterine Mesenchymal Tumors
No full textComparison between single-agent and combination chemiotherapy against uterine mesenchymal tumors. Doxorubicine for LMS and ifosfamide and cisplatin for MMT are the most effective antineoplastic drugs in single-agent chemiotherapy. Combination chemiotherapy increases response rate as well as toxicity, but the impact on survival is unclear
Successful Pregnancy Outcome after Laparoscopic Cerclage in a Patient with Cervicovaginal Fistula
Full text linkObstetric fistula usually originates from obstructed labor or, less often, from invasive maneuvers on the genital tract or the pregnant uterus. Overall, it is a rare finding in the obstetric practice of high income countries. In this report we describe the case of a successful term pregnancy in a patient with a history of recurrent late miscarriage due to a large cervical fistula of traumatic origin, connecting the uterine cavity and the posterior vaginal fornix. A combined approach of laparoscopic cerclage and transvaginal fistula repair effectively restored cervical competence and created the conditions for a viable birth in a subsequent pregnancy. This unusual cause of cervical incompetence may be included in the indications which benefit from an abdominal cerclage carried out as a minimally invasive procedure in the nonpregnant state
Pregnancy outcome of migrant women delivering in a public institution in Northern Italy
No full textThere are differences in perinatal outcome between immigrant and italian women; within the large migrant population ethnic groups show wide disparities and challenge the health provider differently
A critical review on the use of recombinant factor VIIa in life-threatening obstetric post-partum hemorrhage.
No full textThe objective of this review was to evaluate and summarize the current literature on the unlicensed use of the novel agent recombinant activated factor VII (rFVIIa) in the management of major postpartum hemorrhage. After a systematic electronic search without temporal limits on MEDLINE, EMBASE, OVID and SCOPUS, the bibliographic references of all retrieved studies and reviews were additionally assessed for further reports of clinical trials. Unpublished works were also identified by searching abstracts from the most eminent conferences on this topic. In total, there were 31 studies that fulfilled our inclusion criteria. These studies incorporated 118 cases of massive postpartum hemorrhage treated with rFVIIa. The median age of the patients was 31.4 years, and cesarean section appeared to increase the risk of postpartum hemorrhage. At a median dose of 71.6 mug/kg, rFVIIa was reported to be effective in stopping or reducing bleeding in nearly 90% of the reported cases. Based on the evidence from the literature, we give some recommendations on the use of rFVIIa in massive postpartum hemorrhage. Nevertheless, although these reports suggest the potential role of rFVIIa in treating massive postpartum hemorrhage refractory to standard therapy, we advise particular caution in interpreting these results, as they are derived from few and uncontrolled studies. Further evidence is needed using well-designed clinical trials to better assess the optimal dose, the effectiveness, and the safety of rFVIIa in such critical bleeding conditions
Surgicopathologic outcome of laparoscopic versus open radical hysterectomy.
No full textTo compare the surgicopathologic outcome of total laparoscopic radical hysterectomy (LRH) with that of abdominal radical hysterectomy (ARH) for the treatment of early-stage cervical cancer.Radical hysterectomy specimens of sequential patients undergoing LRH (N=50) were compared with those of historical controls selected from consecutive women who have had conventional ARH (N=48), and who met the same criteria for eligibility as the cases. To evaluate the extent of parametrial resection, parametrial tissues were systematically measured at their widest dimensions before tissue processing.No difference was found in demographics, histologic type, tumor stage and grade between the two groups. The parametrial width was similar between LRH and ARH in both type II (right parametrium: 2.4 cm (1-3) vs. 2.3 (1.8-4.0), p=0.28; left parametrium: 2.3 cm (1.8-4) vs. 2.2 (1.2-3.0), p=0.54) and type III radical hysterectomy (right parametrium: 3.8 cm (2.3-6.5) vs. 3.4 (1.7-7.0), p=0.59; left parametrium: 3.6 cm (2-6) vs. 3.5 (1.5-6.5), p=0.82). There were no significant differences between the two groups with regard to lymph nodes yield and likelihood of identifying positive margins or metastatic disease.Our results suggest that laparoscopically managed patients with cervical cancer undergo a similar extent of surgery as those treated with the traditional ARH, as judged by objective pathologic criteria
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