1,721,279 research outputs found
Trattato di chirurgia ostetrica e ginecologica
No full textL’endometriosi è una malattia benigna e cronica caratterizzata dalla presenza di tessuto endometriale funzionale
(ghiandole endometriali e stroma) al di fuori dell’utero (1). La presenza di malattia endometriosica è un problema sociale significativo, in quanto causa nelle donne affette deficit di fertilità, dolore pelvico cronico, dispareunia, disuria e dischezia (2).
Con il termine neuropelveologia si intende quel complesso di pratiche mediche che si occupano delle patologie che interessano l’innervazione pelvica nel suo complesso. La disciplina, nata da un’intuizione di Possover all’inizio degli anni 2000, ha preso prepotentemente piede negli ultimi anni come sub-specialità trasversale ai normali campi di interesse delle patologie della pelvi (ginecologia, urologia, colo-proctologia, ortopedia ecc.
The Role of Radiotherapy in the Management of Vaginal Melanoma: A Literature Review with a Focus on the Potential Synergistic Role of Immunotherapy
Full text linkAmong the mucosal melanomas, vaginal melanomas are very rare tumors, accounting for less than 20% of melanomas arising from the female genital tract. They occur most frequently in women in post-menopausal age, but younger patients may also experience this neoplasm, mainly located in the lower third of the vagina or the anterior wall. The optimal management of this tumor remains controversial, with surgery reported as the most frequently adopted approach. However, a clear benefit of surgical treatment in terms of survival has not yet been demonstrated. Conversely, radiotherapy may represent an attractive non-invasive alternative, and there are several favorable reports of the role of radiation therapy, either delivered with photons, brachytherapy, or hadrontherapy. A wide range of techniques and fractionation regimens are reported with substantially good tolerance to the treatment, and acute G3 or higher toxicities are reported only in the case of concurrent immunotherapy. Of note, due to the rarity of the disease, there is a lack of high-level evidence for the optimal therapeutic option. In this scenario, recent studies theorize the possibility of developing combinatorial approaches of radiotherapy with immunotherapy based on cutaneous melanomas reports. In this review, we aim to summarize the evidence available in the literature supporting the role of definitive radiotherapy for vaginal melanomas, with a focus on the combination of RT with immunotherapy, in terms of optimal timing and biological rationale
Molecular Biology of Human Fertility: Stepping towards a Tailored Approach
No full textClinical pregnancies and live births result from a complex interaction of molecular pathways at the level of the female and male gametes during their development and interaction for fecundation, and the subsequent development of the embryo before, during, and after implantation [...
Diagnosis and Treatment of Endometriosis and Endometriosis-Associated Infertility: Novel Approaches to an Old Problem
Full text linkEndometriosis, defined by the presence of endometrial-like tissue, glad and stroma outside the uterus [...
Retroperitoneal squamous cell carcinoma involving the pelvic side wall arising from endometriosis: a case report
No full textIntroduction: Squamous cell carcinoma (SCC) arising from endometriosis is very rare. Moreover, endometriosis located on the pelvic side wall is uncommon, while its cancerization is quite unusual. We herein report the first case of retroperitoneal SCC arising from endometriosis. Case presentation: A case of 52-year-old woman with retroperitoneal pararectal right mass is presented. The pelvic magnetic resonance imaging showed a retroperitoneal tumor extended to the right pelvic side wall. The neuropelveological examination completed the preoperative assessment, showing a right-sided sciatica and overactive bladder symptoms. Tumor removal was completely managed by minimally invasive technique through laparoscopic laterally extended endopelvic resection (L-LEER) procedure and pelvic neurolysis. Final histology revealed a SCC in a context of diffuse endometriosis with a histologic continuity between the SCC and the endometriosis. The patient underwent adjuvant chemotherapy with no recurrence after six months. Discussion/conclusion: To the best of our knowledge, the present case represents the first evidence of retroperitoneal SCC of the pelvic side wall arising from endometriosis completely resected by laparoscopic approach. Although its rare occurrence, the gynecologist oncologist should maintain a high index of suspicion for malignant endometriosis transformation in case of retroperitoneal pelvic mass and history of endometriosis
Oncovascular surgery in gynecologic oncology: en bloc metastatic lymph node and infiltrated inferior vena cava resection followed by patch reconstruction
No full textHashimoto’s thyroiditis negatively influences ICSI outcome in euthyroid women on T4 substitution therapy; a retrospective study
No full textObjective: To analyze the impact of thyroid autoimmunity (TAI) on reproductive outcome parameters of ICSI cycles as compared to TAI negative ICSI cycles. Design: In this single IVF center retrospective study 86 infertile women with elevated TPOAb or TGAb levels, but euthyroid after thyroxine replacement (study group), were compared to 69 female patients with no thyroid abnormalities (controls). Following ICSI treatment fertilization rate (FR), clinical pregnancy rate (CPR), miscarriage rate (MR) and live birth rate (LBR) were analyzed. Materials, setting, methods: All subjects with various infertility factors were treated with ICSI in university based IVF center. Patients in the study group received thryroxine replacement and were euthyreoid at IVF treatment. Before the IVF cycles endocrinological parameters were uniformly assessed: thyroid function and antibodies, reproductive hormones (AMH, FSH, LH, E2, PRL, testosterone, DHEAS, 17-OHP, AD) and OGTT (0-60-120 min glucose and insulin). Following descriptive comparison of laboratory parameters, age adjusted analyses of FR, CPR, MR and LBR were performed. Results: TAI positive women were older (mean age 35.31±4.95 vs. 32.15±4.87 years; p=0.002), had higher FSH (8.4±3.4 vs. 7.4±2.32 U/L; p=0.024), higher E2 (53.94±47.61 vs. 42.93±18.92 pg/ml; p=0.025) levels, while AMH (2.88±2.62 vs. 3.61±1.69 ng/ml; p=0.0002) was lower. There were no differences in TSH levels (1.64±0.96 vs. 1.66±0.65 uIU/ml; p=0.652) between the two groups. FT3 (2.63±0.58 vs. 2.98±0.55 pg/ml; p=0.002) was lower and FT4 (1.3±0.29 vs. 1.13±0.21 ng/dl; p=0.0002) was higher in the TAI positive group, reflecting clinically irrevelant differences. Egg cell counts (6±3.8 vs. 7.5±3.95; p=0.015) were lower in TAI and remained so following age adjustment. Although the overall ICSI FR did not differ (62.9 % vs. 69.1 %, p=0.12), it was lower for patients under 35 with TAI showing decreasing differences in line with age. The CPR (36.04 % vs. 69.56 %; p<0.001), LBR (23.25 % vs. 60.86 %; p<0.001) were lower, the MR (35.48 % vs. 12.5 %; p=0.024) was higher in the TAI group and these differences remained after age adjustment. Limitations: Since the higher age of the study group may interfere with the effect of TAI, age adjustment calculations were necessary to perform to eliminate this confounding factor. Conclusion: Despite optimal thyroid supplementation in clinical or subclinical hypothyreoidism, the presence of TAI negatively influences clinical pregnancy rate and is connected to a higher miscarriage rate, thus resulting in a lower live birth rate after ICSI. Decreased fertilization rate with ICSI in TAI patients may also contribute to poorer outcomes, especially in younger women
Reproductive outcomes after expectant and surgical management for tubal pregnancy: a retrospective study
No full textBackground: The management of ectopic pregnancy is widely debated. Salpingectomy, salpingostomy, and expectant management are widely performed, but the best approach in terms of keeping good future spontaneous fertility chances is yet to be determined. Material and methods: We performed a retrospective analysis (Clinical Trial ID: NCT05479786) of the medical records of patients with an ultrasonographic or surgical diagnosis of tubal ectopic pregnancy that were admitted to the University of Debrecen Clinical Centre between 2012 and 2020. Results: A total of 312 patients were included in the analysis. Patients managed expectantly and patients treated with salpingostomy had significantly higher rates of clinical pregnancy than patients treated with salpingectomy. Pregnancy outcomes and recurrence rates were comparable between the study groups. Salpingectomy was found to decrease the likelihood of conceiving spontaneously by 65%. A stratified analysis based on serum β-HCG levels demonstrated that all treatment modalities carry the same reproductive opportunities for patients presenting with β-HCG levels ≤ 1745 IU/L. Conclusion: Salpingectomy was found to decrease the patient's chance of achieving a natural conception. Conservative approaches should be considered with caution only when the patient's clinical condition permits, and the patient is appropriately counseled
Robotic isolated lymphnodal debulking of the pelvic side wall in a secondary ovarian recurrence
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