Reproductive outcome before and after laparoscopic or abdominal myomectomy for subserous or intramural myomas

Objectives: To analyze the reproductive outcome before and after myomectomy in patients with subserous or intramural myomas, and to assess the factors influencing pregnancy rate after myomectomy. Study design: Out of 128 patients submitted to myomectomy, we considered eligible for this study only the 41 patients wishing to conceive after surgery and who did not present any plausible infertility factor, apart from the removed myomas. We have evaluated the pregnancy outcome prior to and following myomectomy, and analyzed the correlation between conception rate after surgery and patient’s age at the time of the surgery, type of surgery, number and size of the myomas, location of the largest fibroid and previous pregnancies. Results: Nineteen patients had been submitted to abdominal (group A) and 22 to laparoscopic myomectomy (group B). Prior to surgery, 28 pregnancies had occurred in 14 of the 41 patients, with a miscarriage rate of 57.1%. Following surgery 29 pregnancies occurred in 25 patients (60.9%), pregnancy rate being similar in both groups. The postoperative delivery rate was 86.2% whereas the miscarriage rate was reduced to 13.8% (P<0.001). Overall, 60% of deliveries were vaginal. No cases of ectopic pregnancy or uterine rupture occurred. Those patients who conceived after surgery were significantly younger (32.36±4.06 years versus 35.88±3.57 years; P=0.0073), and their removed myomas were significantly larger (5.80±2.69 cm versus 4.28±1.54 cm; P=0.0274). Furthermore, a multivariate analysis shows that, apart from age and diameter, the probability of conceiving after myomectomy is higher in case of intramural myomas (intramural versus subserosal: OR 12.382, 95% CI: 1.61–95.22) or laparoscopic surgery (laparoscopy versus laparotomy: OR 14.062, 95% CI: 1.40–141.15). Conclusions: Our results suggest that myomectomy significantly improves pregnancy outcome in patients with subserous or intramural fibroids, probably removing a plausible cause of altered uterine contractility or blood supply. The main determinants of pregnancy rate after surgery are patient age, diameter and intramural localization of the myomas and type of surgery.     

Clinical and endocrine effects of ovulation induction with FSH and hCG supplementation in low responders in the midfollicular phase. A pilot study

OBJECTIVE: To assess the endocrine and clinical effects of luteinizing hormone (LH) activity supplementation administered in the midfollicular phase during controlled ovarian hyperstimulation to poor responders who were candidates for in vitro fertilization (IVF)--embryo transfer. STUDY DESIGN: Prospective, controlled, nonrandomized trial with historical controls. Twenty-five IVF patients who had shown a poor response to standard, long-protocol GnRH-a and FSH only in a preceding cycle (cycle A), were stimulated in the next cycle after six months with hCG supplementation (50 I.U. subcutaneously daily) starting on day 7 during standard, long-protocol GnRH-a and FSH (cycle B). The comparative analysis of clinical effects (duration of stimulation, total highly purified (HP)-FSH dose, number of oocytes retrieved and pregnancy rate) and endocrine responses (serum E2, follicular E2 and androstenedione levels) were determined between cycles A and B. RESULTS: Maximum serum E2 levels and clinical pregnancy rate were higher in cycle B, with hCG supplementation. Also, the follicular E2 and androstenedione levels were higher in cycle B. No differences were noted between cycles as regards the duration of stimulation, total HP-FSH dose and number of oocytes retrieved. CONCLUSION: LH activity supplementation in the midfollicular phase yields favorable pregnancy results in low responders. This may be due to enhanced release of follicular precursors for greater synthesis of E2.     

Influence of maternal preeclampsia on recombinant human granulocyte colony-stimulating factor effect in neutropenic neonates with suspected sepsis

AIM: To evaluate the effect of recombinant human granulocyte colony-stimulating factor (rhG-CSF) in preterm neonates with suspected sepsis and severe neutropenia (<1500 mm(3)), and to define the influence of maternal preeclampsia on rhG-CSF activity. METHODS: Twenty neonates of normotensive mothers (NNMs) (GA 29.2+/-0.5 weeks and BW 1.024+/-81 g) and 20 born to preeclamptic mothers (NPMs) (GA 29+/-0.4 weeks and BW 946+/-55 g) were treated with rhG-CSF, 10 microg/kg per day for 3 days. Complete blood counts were obtained at day 0 (before rhG-CSF administration) and 1-4, 6, 9, 20 and 30 days later. RESULTS: Absolute neutrophil count (ANC) increased rapidly (three-fold within 24h), and significantly (maximum approximately 20-25 times starting values) and remained within normal range in both groups. However, in NNMs a two-phase increase occurred with an early peak on day 2 and a further peak on day 6 giving significantly higher ANC (P<0.001) than for NPMs at days 2-4 and 6. NPMs showed a gradual ANC increase with a single late peak occurring 3 days later than NNMs (day 9). The highest peak values for ANC were similar (15,900+/-1395 mm(-3) for NNMs and 13,880+/-1097 mm(-3) for NPMs). Neutropenia was completely resolved within 2 days in NNMs and within 4 days in NPMs. CONCLUSION: Preeclampsia seemed to influence the course of the ANC in spite of rhG-CSF administration, and a higher daily-dose for NPMs with neutropenic sepsis may more rapidly resolve neutropenia by overcoming the preeclampsia-associated inhibitor of rhG-CSF through a dose-dependent mechanism.     

Respiratory emergencies in adolescents

BACKGROUND: The aim of this paper was to examine the present situation of adolescents admission for respiratory emergency, management of these patients, identify strategies for the best therapeutic options and better collaboration. METHODS: We have gathered data of adolescent patients who were referred to the Emergency Unit of "G. Gaslini" Children's Hospital, and "San Martino" Hospital in Genoa and to the Intensive Care Unit of both Hospitals and to the Emergency Service 118 in Liguria district. Respiratory emergency in adolescence is a rare condition and it is usually due to a poor control of respiratory chronic diseases, i.e. respiratory distress in patients with asthma. RESULTS: We found that there is an increased number of respiratory emergencies because of psychological problems, drugs addiction, multiple trauma; in other words, we had an increased number of admissions due to behavioural problems. Temporary in-patients care has been showed to be the best therapeutic option after the admission in the Emergency Unit. CONCLUSIONS: In conclusion, adolescent patients need to be hospitalized, but appropriate spaces and structures need to be found either in pediatric or adult Hospitals and qualified personnel must be trained.     

Evaluation of Glyde File Prep in combination with sodium hypochlorite as a root canal irrigant

The purpose of this study using a scanning electron microscope was to investigate the efficacy of four different irrigation techniques after canal preparation with Profile Ni-Ti rotary instruments. A modified technique for the use of Glyde File Prep is proposed. Forty anterior teeth were divided into four groups, instrumented, and irrigated as follows: physiological solution (group A), 2.5% sodium hypochlorite (group B), 2.5% sodium hypochlorite and Glyde File Prep (group C), and 2.5% sodium hypochlorite and Glyde File Prep applied at the end of the preparation with sterile paper points (group D). After scanning electron microscopic evaluation at three different levels, debris, smear layer, and dentinal tubules were scored. Groups A and B had significantly more smear layer and less open tubules on the canal walls compared with the group C and group D samples. Differences in the mean amount of debris between group A samples and other irrigation regimes were statistically significant.