Incorporating 3D reconstruction in preoperative surgical planning of Multiple Myomectomy.

Background: Medical 3D imaging is a promising emerging technology that allows recreating the details of human anatomy. The use of this innovative technology has resulted in improved surgical efficiency and better clinical outcomes. However, its incorporation in gynaecologic surgery has not been widely adopted. Objectives: To demonstrate the use of Hyper Accuracy 3D reconstruction in a patient with infertility who underwent multiple myomectomy. Materials and Methods: A stepwise approach describing the incorporation of Hyper Accuracy 3D imaging technology into the preoperative surgical planning and intraoperative guidance of a patient with multiple myomas undergoing multiple myomectomy. Main Outcome Measures: Preoperative evaluation of a patient with multiple myoma and infertility who presented to our department seeking surgical management. Hyper Accuracy 3D image was obtained, and a 3D digital image reconstruction of the uterus delineating the exact number, volume, and location of the fibroids was created. The 3D digital image was available during the surgical procedure which helped to plan the surgical steps allowing a systematic surgical approach resulting in an effective surgery with minimal blood loss. Results: The benefits of intraoperative guidance using Hyper Accuracy 3D in a patient with multiple myomas and infertility are demonstrated. Conclusions: The adoption of this promising imaging technology into gynaecologic surgery is feasible and should be further investigated. Additional studies evaluating the clinical impact of using Hyper Accuracy 3D imaging in the preoperative planning of patients with gynaecologic surgical pathology are needed.

[Tissue engineering of parathyroid gland]. / L'ingegnerizzazione tissutale delle cellule paratiroidee.

BACKGROUND: The postoperative hypoparathyroidism is a not rare complication after total thyroidectomy and/or total parathyroidectomy. Attempts to transplant parathyroid tissue began in 1975 with the work of Wells, but still today results are disappointing. However, with the development of tissue engineering techniques, some experimental approaches to build artificial parathyroid are been made. Bioengineered device, actively secreting PTH, for transplant in patients with iatrogenic hypoparathyroidism is unavailable. PATIENTS AND METHODS: Parathyroid cells were obtained from three chronic uremic patients in hemodialysis, operated for secondary hyperparathyroidism. Cell cultures in RPMI medium were subsequently seeded on collagen scaffold (three-dimensional matrix with slow biodegradation). Collagen is the major component of the extracellular matrix and thus is a good substrate for cell adhesion and growth. Culture media, with a low calcium concentration, were optimised to physiologically stimulate parathyroid hormone secretion. Cell cultures were morphologically observed in optical and electron (ESEM) microscopy and metabolically assayed by MTT method until the tenth week. Besides, concentration of parathyroid hormone in the culture medium has been measured for several weeks. RESULTS: After 24 hours of culture in RPMI, cells extracted from human parathyroid glands were nearly all adherent and organised in clusters to resemble the glandular organization. The cellular population consisted predominantly of parathyroid cells (90-95%). On collagen scaffolds, cells maintains an epithelial-like morphology also after 10 weeks, colonizing the scaffold surface and keeping a good proliferative rate with a discrete production of parathyroid hormone. CONCLUSION: The use of parathyroid cells extracted from patients with secondary hyperparathyroidism was certainly an appropriate choice that enabled us to achieve these results, that albeit partial bode well for the experimental in vivo animal model. The bioengineered scaffolds when implanted in the subcutaneous can avoid the dispersion of parathyroid cells, assuring also the possibility to easily remove the implant in case of complications. Our research was aimed primarily to the optimisation of PTH secreting human parathyroid cells cultures and then to the in vitro engineering of human parathyroid glands in three-dimensional collagen scaffolds.

Influence of 1991-1995 war on breast-feeding in Croatia: questionnaire study.

AIM: To investigate the influence of 1991-1995 war on the prevalence, duration, and practice of breast-feeding Croatian children up to 5 years of age. METHOD: In 1996, interviews were conducted in households with children up to 2 years of age (757 children) and 2-5 years of age (1,180 children). Data for war-free areas, war-affected areas, and areas liberated after several years of occupation were analyzed separately. RESULTS: In 1996, 94.6% of mothers started breast-feeding, which lasted for an average of 3.4+/-2.9 months. The proportion of mothers who started breast-feeding did not vary with respect to either war-related or geographic areas of the country. Breast-feeding was significantly longer in war-free than in war-affected areas (3.7+/-3.1 vs. 2.7+/-2.1 months, respectively; p=0.015). The duration of breast-feeding in Croatia's geographic regions, Istria, Hrvatsko Primorje, and Gorski Kotar, was significantly longer than in Slavonia (3.9+/-3.4 vs. 3.4+/-3.0, respectively; p=0.037). On the country level, 49.4% of babies were fed on demand and 43.3% according to a daily schedule. The percent of children who were not breast-fed was significantly higher (p=0. 002) in the older age group (2-5 years of age, 9.3%) than in the younger age group (up to 2 years of age, 5.4%). CONCLUSIONS: The war decreased the prevalence and duration of breast-feeding, which might be related to regular humanitarian donations of infant food and mother's milk substitutes, especially in the war-affected areas. UNICEF breast-feeding campaign, which started in 1993, appeared to be effective.