1,721,250 research outputs found
When more is not better: 10 'don'ts' in endometriosis management. An ETIC* position statement
Full text linkA network of endometriosis experts from 16 Italian academic departments and teaching hospitals distributed all over the country made a critical appraisal of the available evidence and definition of 10 suggestions regarding measures to be de-implemented. Strong suggestions were made only when high-quality evidence was available. The aim was to select 10 low-value medical interventions, characterized by an unfavorable balance between potential benefits, potential harms, and costs, which should be discouraged in women with endometriosis. The following suggestions were agreed by all experts: do not suggest laparoscopy to detect and treat superficial peritoneal endometriosis in infertile women without pelvic pain symptoms; do not recommend controlled ovarian stimulation and IUI in infertile women with endometriosis at any stage; do not remove small ovarian endometriomas (diameter <4 cm) with the sole objective of improving the likelihood of conception in infertile patients scheduled for IVF; do not remove uncomplicated deep endometriotic lesions in asymptomatic women, and also in symptomatic women not seeking conception when medical treatment is effective and well tolerated; do not systematically request second-level diagnostic investigations in women with known or suspected non-subocclusive colorectal endometriosis or with symptoms responding to medical treatment; do not recommend repeated follow-up serum CA-125 (or other currently available biomarkers) measurements in women successfully using medical treatments for uncomplicated endometriosis in the absence of suspicious ovarian cysts; do not leave women undergoing surgery for ovarian endometriomas and not seeking immediate conception without post-operative long-term treatment with estrogen-progestins or progestins; do not perform laparoscopy in adolescent women (<20 years) with moderate-severe dysmenorrhea and clinically suspected early endometriosis without prior attempting to relieve symptoms with estrogen-progestins or progestins; do not prescribe drugs that cannot be used for prolonged periods of time because of safety or cost issues as first-line medical treatment, unless estrogen-progestins or progestins have been proven ineffective, not tolerated, or contraindicated; do not use robotic-assisted laparoscopic surgery for endometriosis outside research settings. Our proposal is to better address medical and surgical approaches to endometriosis de-implementing low-value interventions, with the aim to prevent unnecessary morbidity, limit psychological distress, and reduce the burden of treatment avoiding medical overuse and allowing a more equitable distribution of healthcare resources
Therapy with Anti-androgens in Gender Dysphoric Natal Males
No full textIn adult gender dysphoric natal males, where full development of male secondary sexual characteristics has already taken place, the goal of cross-sex hormonal therapy is the suppression of testosterone secretion to achieve regression of male characteristics and the development of feminine secondary sexual characteristics. For this reason, in transwomen an almost complete suppression of endogenous androgen production and action with combined administration of estrogens is required. The aim of therapy is to maintain hormone levels within the normal physiological range for the individual’s desired gender. Practice guidelines describe eligibility for puberty suppression in adolescents that have met the criteria for gender dysphoria and that have experienced at least Tanner stage 2 puberty. In these subjects if dysphoria persists, cross-hormonal therapy is generally started after 16 years of age
Correction to: Malignant epithelioid neoplasm of the ileum with ACTB-GLI1 fusion mimicking an adnexal mass (BMC Women's Health, (2022), 22, 1, (104), 10.1186/s12905-022-01679-0)
No full textFollowing publication of the original article (1), The author names were incorrectly published as Ambrosio Marco, Virgilio Agnese, Raffone Antonio, Arena Alessandro, Raimondo Diego, Alletto Andrea, Seracchioli Renato and Casadio Paolo. But this should have been Marco Ambrosio, Agnese Virgilio, Antonio Raffone, Alessandro Arena, Diego Raimondo, Andrea Alletto, Renato Seracchioli, and Paolo Casadio. The original article has been updated
Urogenital and Reproductive Disorders
No full textBiological and social gender differences should always be acknowledged when considering the presentation, the severity, the treatment, and the consequences of 6 both reproductive and general health diseases. Gender has a significant impact on health, and it should be considered in the development of strategies for prevention and treatment of health conditions.
• Biological differences can make women more prone than men to certain medical conditions during reproductive years. Women are more susceptible to HIV and other sexually transmitted infections with potential long-term consequences.
• Even if a large number of men would welcome the opportunity to use male contraceptive methods and recognize that sharing family planning should be an individual right other than responsibility, family planning continues to be demanded to women because options available for male contraception are still obsolete and affected by high failure rates. Women are still often stigmatized and blamed in case of infertility even if infertility can have also a male factor.
• Also after menopause, biological differences make women more susceptible to certain medical conditions such as genital organ prolapse, urinary incontinence, and vaginal atrophy with related sexual dysfunction.
• In certain societies women continue to face discrimination or gender prejudice limiting their access to knowledge and health resources and making them more susceptible to diseases. In rural and poor communities, women’s healthcare needs are barely addressed, and also in countries with a higher progress, there is still a need for continuous investment in greater gender equality
Clinical use of endovenous indocyanine green during rectosigmoid segmental resection for endometriosis
No full textTo describe a new use of endovenous indocyanine green (ICG) to allow real-time visualization of bowel perfusion in women with recto-sigmoid endometriosis who may be candidates for segmental resection
Laparoscopic management of severe ureteral obstruction after vaginal hysterectomy and colposuspension
No full textAfter vaginal hysterectomy, uterosacral ligaments are commonly used to suspend the vaginal vault in order to prevent and to treat recurrence of central prolapse. Shull et al. proposed a technique to fix endopelvic fascia and vagina to the higher portion of the uterosacral ligaments using a vaginal approach [1]. This technique is associated with a risk of ureteral obstruction (0-11%) [2, 3]. Although intraoperative cystoscopy is recommended to check ureteral patency at the end of colposuspension, this secondary prevention technique could be false negative due to partial stenosis [4]
High cytokine expression and reduced ovarian reserve in patients with Hodgkin lymphoma or non-Hodgkin lymphoma
No full textOBJECTIVE:
To investigate the ovarian reserve in female lymphoma patients and the potential relationships with the cytokine network.
DESIGN:
Age-matched control study.
SETTING:
Women's university hospital.
PATIENT(S):
Seventy-three lymphoma patients (57 with classic Hodgkin lymphoma [HL] and 16 with non-Hodgkin lymphoma [NHL]), approaching our center for ovarian tissue cryopreservation (study group) were compared with 25 age-matched healthy volunteers (control group).
INTERVENTION(S):
Measurements of antimüllerian hormone (AMH), soluble interleukin-2 receptor (SIL-2R), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor α (TNF-α) levels.
MAIN OUTCOME MEASURE(S):
The AMH and cytokine levels of the lymphoma patients and the healthy volunteers were compared. Correlations between AMH with SIL-2R, IL-6, and IL-8 levels were performed.
RESULT(S):
The AMH showed significant lower concentrations in lymphoma patients than in the control group. Higher significant concentrations in lymphoma patients than in control group were found for SIL-2R and IL-6. No differences were observed comparing HL and NHL groups and within the stages of HL group for AMH and all the cytokines analyzed. Finally, significant inverse correlations were observed in lymphoma patients between AMH and SIL-2R, IL-6, and IL-8 levels, but not with TNF-α levels. Positive correlations between SIL-2R with IL-6, and IL-6 with IL-8 were also shown.
CONCLUSION(S):
In patients with HL or NHL at baseline the cytokine network is particularly active and the ovarian reserve is reduced. A strong negative correlation between AMH and SIL-2R, IL-6, and IL-8 has been also evidenced
Ovarian tissue biopsy for cryopreservation by vaginal natural orifice transluminal endoscopic surgery: a new approach for a minimal invasive ovarian biopsy
No full textObjective: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging surgical procedure that combines the advantages of the vaginal approach with laparoscopic vision and instrumentation. Shorter hospitalization and lesser postoperative pain associated with vNOTES may be explained by the advantages of this innovative surgical approach (e.g., absence of abdominal incisions, shorter operative time, and lower insufflation pressure). Ovarian tissue cryopreservation allows to preserve reproductive and endocrine functions in young women with oncological disease at risk of premature ovarian insufficiency (POI) caused by gonadotoxic treatments. Ovarian tissue biopsy for cryopreservation consists of a large biopsy of 1 or both ovaries that is usually performed by laparoscopy. Then, the removed ovarian tissue is cryopreserved for the future transplant after cancer remission. The volume of ovarian biopsy ranges from 50% of the ovary for women at moderate risk of POI to 70%–100% of it for those at high risk. The inclusion criteria for ovarian tissue cryopreservation are women aged <35 years who cannot delay start of oncological treatments for follicle cryopreservation, with a moderate or high risk of POI and good chance of 5-year survival. Ovarian tissue cryopreservation cannot be performed if tumor treatments include uterine irradiation or for tumors at risk of ovarian metastases (as in the case of ovarian cancer, leukemia, neuroblastoma, or Burkitt lymphoma). Despite widespread adoption of vNOTES in gynecology, ovarian biopsy for cryopreservation has never been performed using this route. Design: Step-by-step explanation of the procedure with descriptive text and narrated video footage. Setting: Tertiary-level referral academic center. Patient(s): A 27-year-old patient recently diagnosed with low-grade follicular non-Hodgkin lymphoma was referred to our center for ovarian tissue cryopreservation before chemotherapy. The patient included in this study gave informed consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (e.g., PubMed, ScienceDirect, and Scopus), and other applicable sites. Because of the nature of the study, institutional review board approval was not required. Intervention(s): Access to the peritoneal cavity was created by a 3-cm posterior colpotomy. The peritoneum was then opened using cold scissors and temporarily fixed to the posterior vaginal wall. The GelPOINT Mini Advanced Access Platform (Applied Medical, Rancho Santa Margarita, CA), with 1 10-mm and 2 5-mm trocars, was used as the vNOTES port. The inner Alexis ring of the GelPOINT was inserted through the colpotomy into the pouch of Douglas. A hysterometer was placed into the uterine cavity to keep the uterus anteverted during the surgery. A pneumoperitoneum was created to a pressure of 8 mm Hg, and the operating table was tilted to a 20° Trendelenburg position. A 10-mm rigid 30° camera was inserted in the inferior and larger trocar, and both ovaries were visualized. Seventy percent of the left ovary was removed with cold scissors to minimize trauma on the surgical specimen. After removal of the GelPOINT cap, ovarian biopsy was immediately picked up by the biologist of our fertility center. The ovary was coagulated with a bipolar instrument. The hysterometer was then replaced by a uterine manipulator to perform tubal patency test, and blue dye passage through both salpinges was observed. Finally, the Alexis retractor and stich on the posterior peritoneum were removed, and the vagina was sutured using interrupted stiches. The total operative time was 25 minutes. Main Outcomes Measure(s): Ovarian tissue biopsy for cryopreservation by vNOTES. Result(s): No intraoperative and postoperative complications were reported, and the patient was discharged after 24 hours from surgery. Conclusion(s): Vaginal natural orifice transluminal endoscopic surgery may be a feasible alternative approach to laparoscopy for ovarian tissue cryopreservation: it allows an easy access to the ovaries and removal of different tissue volumes. Patients undergoing ovarian cryopreservation may benefit from the vNOTES approach because a rapid postoperative recovery is crucial to start chemotherapy in a short time. As for other vNOTES procedures, accurate selection of patients seems to be crucial for a successful ovarian tissue cryopreservation. We believe that the inclusion and exclusion criteria reported for other gynecologic procedures performed through vNOTES may also be valid for ovarian tissue cryopreservation by vNOTES. Women at high risk of pelvic adhesions (e.g., coexistent endometriosis, previous pelvic surgery, or inflammatory pelvic disease), those with an increased body mass index or enlarged uterus, and those with cervical, vaginal, or uterine cancer cannot be considered for this approach because all these factors are associated with failure of vNOTES. On the other hand, women with no history of surgery, endometriosis, and large myomas may benefit from the vNOTES approach, and these women represent most of patients who undergo ovarian tissue cryopreservation. Further and larger studies are needed to assess the efficacy and safety of this new approach
Mental Health and Endocrine Telemedicine Consultations in Transgender Subjects During the COVID-19 Outbreak in Italy: A Cross-Sectional Web-Based Survey
No full textBackground: Transgender people are a vulnerable group with a higher incidence of mental health issues and,
during the COVID-19 outbreak, they may have faced psychological, physical and social obstacles.
Aim: To evaluate the impact of the pandemic and the access to health care services during the COVID-19
pandemic on the mental health of the transgender people living in Italy.
Methods: An anonymous web-based survey was conducted among transgender people living in Italy.
Outcomes: The survey consisted of 41 questions (to address socio-demographic and COVID-19 related variables,
general health problems and trans-related health issues) and three validated questionnaires (the Impact of
Event Scale [IES], the Beck Depression Inventory [BDI-II] and the SF-12.
Results: In total 108 respondents were included in the analysis, of these 73.1% were transmen and 26.9% transwomen.
The mean age was 34.3 § 11.7 years with 88.9% undergoing gender affirming hormonal treatment
(GAHT). Of these respondents 55.6% were not working during the COVID-19 pandemic, mainly because they
lost their jobs due to the lockdown (30.5%) or because they were otherwise unemployed (25.0%). Only four subjects
were quarantined at home because of a positive COVID-19 swab. The mean total IES score was 21.1 § 14.9
with 24.1% of subjects scoring over the cut-off score of 26 thereby suggesting a moderate-to-severe impact of the
pandemic event. Mean BDI score was 8.6 § 8.4. SF-12 total mean score was 96.1 § 11.9 with a Mental Component
Summary (MCS) score of 42.8 § 9.1. Access to endocrinological consultations for hormonal prescription via
telemedicine services was associated with better IES total scores (P = .01).
Clinical Implications: Our results highlight the impact of the pandemic on the mental health of this particular
population and how telemedicine services may serve to mitigate negative psychological effects.
Strengths & Limitations: Internet-based surveys may select a group of people not necessary representative of
the whole population. The self-reporting bias should also be considered. Those who responded to our survey
were mainly from northern Italy were COVID-19 has had a greater impact.
Conclusion: Vulnerable groups such as the transgender population should receive more consideration also during
pandemic events and their access to health services especially for endocrine and mental health care should be
improved. A nationwide plan for the extended use of telemedicine should be established with targeted intervention
to reduce psychological distress
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