Evaluation of Symptoms and Prevention of Cancer in Menopause: The Value of Vulvar Exam.

Vulvar and vaginal atrophy (VVA), is a chronic medical condition experienced by postmenopausal women, with prevalence estimated ranging from 10% to 50% [1]. VVA is characterized by a constellation of symptoms, that may affect daily activities, sexuality, relationships, and quality of life [3]. Early recognition and effective treatment of VVA may enhance sexual health and the quality of life of women and their partners. Some vulvar conditions such as lichen sclerosus are more prevalent in the postmenopausal years. Lichen sclerosus has been suggested as a precursor of Vulvar squamous cell carcinoma. The vulvar exam in post-menopausal women plays an essential role in prevention of cancer because it allows to identify women who should undergo vulvar skin biopsy in order to early detect pre-neoplastic lesions for early diagnosis of cancer of the vulva.

Comparison between two laparoscopic retropubic urethropexy.

BACKGROUND: To compare two different transperitoneal laparoscopic urethropexy procedures. METHODS: In this prospective randomized open trial, 60 women affected by genuine stress incontinence were enrolled and randomized in two groups of surgical technique. Group A was treated with transperitoneal laparoscopic retropubic urethropexy using non absorbable sutures, and group B with prolene meshes fixed with tackers or staplers. The failure rate was defined subjectively and objectively. The subjective evaluation was performed asking the patients if they had urine loss and expressing the symptomatology using a visual analog scale before surgery and after each follow-up visit. The objective evaluation was performed with clinical evaluation and/or with the use of multichannel urodynamic studies. RESULTS: No significant differences in intra- operative and postoperative complications between the two groups were observed. The subjective failure rate was not significantly different between the two groups at 3, 6, and 12 months from surgery. At 3 and 6 months follow-up, the objective failure rate was not significantly different between the two groups. Moreover, at 12 months from surgical procedure the objective failure rate was significantly lower in group A than in group B. CONCLUSIONS: Transperitoneal laparoscopic retropubic urethropexy performed using sutures is more effective than the mesh technique.

Laparoscopic Burch colposuspension: a randomized controlled trial comparing two transperitoneal surgical techniques.

OBJECTIVE: To compare the effectiveness of two transperitoneal laparoscopic Burch procedures. METHODS: The sample size required was 30 subjects per group to detect a statistically significant estimated difference of 15% between two surgical procedures with an alpha = 0.05 and a power of 0.7. Sixty women affected by genuine stress incontinence (GSI) were enrolled and randomly assigned to two groups of 30 women each. All women were treated with the transperitoneal laparoscopic Burch procedure using nonabsorbable sutures (group A) or Prolene mesh (Ethicon, Somerville, NJ) fixed with tacks or staples (group B). The failure rate was defined subjectively and objectively. The subjective evaluation was performed by asking the women to rate their urine loss on a visual analog scale. The objective evaluation was a clinical evaluation using multichannel urodynamic studies. RESULTS: The subjective failure rate was not significantly different between the two groups at 3 months (0% for both groups), 6 months (3.7% versus 3.8% for groups A and B, respectively), and 12 months (7.4% versus 15.4% for groups A and B, respectively) after surgery. At 3 months (3.7% versus 3.8% for groups A and B, respectively) and 6 months (7.4% versus 15.4% for groups A and B, respectively) follow-up, the objective failure rate was not significantly different between the two groups. However, at 12 months after the surgical procedure, the objective failure rate was significantly lower in group A than in group B (11.1% versus 26.9%, respectively; P <.05). CONCLUSION: Transperitoneal laparoscopic Burch colposuspension performed using sutures was more effective than the mesh technique.

[Prenatal diagnosis of beta-thalassemia. A study based in Calabria]. / Diagnosi prenatale di beta-talassemia. Esperienza in Calabria.

BACKGROUND: The aim of this study was to underline, given the well-known incidence of beta thalassemia in Calabria, the possibility of establishing a prevention programme based on an increased awareness among the population using information and health education, genetic consultancy to identify high-risk subjects and prenatal diagnosis. METHODS: Between January 1992 and December 1999, we analysed 181 high-risk couples for beta thalassemia using chorionic villi sampling (CVS) performed with an echoguided transcervical or transabdominal route. A steady rise was observed over the years in the number of couples asking for prenatal diagnosis, thus demonstrating that patients and doctors are increasingly aware of the importance of a correct prenatal diagnosis. The variability of molecular defects found and the number of complications linked to the technique used are underlined. RESULTS: Prenatal diagnosis revealed 46 fetuses with the disease (24.8%), 97 heterozygotes (53.2%) and 41 healthy fetuses (22%). Only one malformation was observed in the 41 healthy fetuses. The authors also report the incidence of complications linked to CVS. In overall terms, 2.2% of pregnancies ended in spontaneous abortions (4 cases) and 2.75% with preterm births (5 cases). These complications could not be correlated with gestational age at the time of biopsy or the number of attempts made to obtain an appropriate sample.

[Pregnancy management in women with thalassemia]. / Gestione della gravidanza nelle pazienti talassemiche.

Thanks to the improvement of the techniques of assisted fecundation, of the obstetric management and of the fetal and neonatal monitoring now it's possible for a woman suffering from beta-thalassemia to have a child. Our purpose is to stress the importance to control the high maternal and fetal risk through the monitoring of several scales. The problems, connected with pregnancy of beta-thalassemic women are discussed, emphasizing the connection between pregnancy management and gestational and neonatal outcome. A variety of problems should be considered such as the informed consent about maternal and fetal risks, the problems caused by infectious agents or due to the use of some antiviral; the difficulties connected with heart and endocrine diseases are also discussed. Personal experience, from 1995 to 1999, on 4 beta-thalassemic pregnant women (three with the intermediate type and one with the major type) is reported.