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[Osteotomy of the transverse processes for correction of costal deformity in the surgical treatment of scoliosis. (Preliminary note)]
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Hormonal treatments for adenomyosis
No full textLike endometriosis and uterine myomas, adenomyosis presents the typical characteristics of oestrogen-dependent diseases. The medical treatment of adenomyosis is based on the hormonal dependency of the disease and its strongly debated similarities with endometriosis. Infact, despite the evident differences between the two conditions, the therapies that treat endometriosis effectively have also been successful for the treatment of adenomyosis. Although the two diseases have distinct epidemiological features, they have the same 'target tissue' for hormonal therapy, namely ectopic endometrium. Recognized approaches are systemic hormonal treatments, which are generally used for endometriosis and are capable of suppressing the oestrogenic induction of the disease, and local hormonal treatment that targets the ectopic endometrium directly. Gonadotropin-releasing hormone agonists, danazol and intrauterine levonorgestrel- or danazol-releasing devices have been used in the treatment of adenomyosis. Despite the solid rational basis for its hormonal treatment, few studies have been performed on medical therapy for adenomyosis
Septums and synechiae: Approaches to surgical correction
No full textIf the Mullerian ducts fail to fuse, or, if the wall which is the result of fusion is not adequately resorbed, the result is a spectrum of uterine abnormalities called Mullerian fusion and absorption defects. The impact of these abnormalities on fertility is a subject for debate, but at least a subset seems to have a negative impact on reproductive performance manifesting in recurrent abortion and/or premature labor. Previous surgical interventions required laparotomy, but, with careful application of imaging techniques, a group of patients can be identified with a uterine septum amenable to removal under hysteroscopic direction with little morbidity. Intrauterine adhesions or synechiae are usually secondary to curettage in the context of missed abortion or pregnancy-related hemorrhage. These lesions cover a spectrum that ranges from minor and insignificant to severe cohesive adhesions that affect menstrual function and fertility. Surgical repair of the endometrial cavity affected with such adhesions presents a challenge to the hysteroscopic surgeon. Appropriate management is controversial but may include second loop hysteroscopy and the use of postoperative adjuvants such as systemic estrogens and intrauterine devices or systems designed to impede the development of adhesions
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