Evaluation of vaginal microbiota in women admitted to the hospital for premature labour.

BACKGROUND AND AIM OF THE WORK: The aim of this study was to evaluate the vaginal microbiota of women admitted to the hospital for premature labour and to compare the flora of those who responded to the tocolytic treatment with the flora of those who did not respond to the treatment and delivered prematurely Materials: the hospital records of 245 women admitted to the division of Obstetrics and Gynaecology of 'Guglielmo da Saliceto' Hospital in Piacenza for premature labour, between 24 completed weeks and 36 weeks plus 6 days of pregnancy, were reviewed and the results of vaginal swabs collected on admission were evaluated. RESULTS: a vaginal dysbiosis, with reduction or absence of lactobacilli and presence of pathogenic microbial species, was found in all women admitted to the hospital for premature labour. Among them, 200 women (81,63%) responded to the tocolytic treatment while 45 women (18,36%) did not respond  and delivered before 37 completed weeks. The four microbial species most prevalent  in the vaginal flora were :Ureaplasma urealyticum, Streptococcus agalactiae, Candida albicans and Gardnerella vaginalis. When the characteristics of the vaginal flora of the two groups were compared, a more severe dysbiosis, with absence of lactobacilli and evidence of more than one pathogenic  species, was found in 18% of women who responded to the tocolysis and in 71,4% of women who did not respond. The difference was statistically significant (p< 0,05, two-tailed test). CONCLUSIONS: vaginal dysbiosis was diagnosed in all women admitted to the hospital for premature labour . A more severe dysbiosis, with complete absence of lactobacilli and presence of two or more pathogenic microbial species, was  in the majority of women who showed no response to the tocolytic treatment compared to women with minor degrees of alteration of the vaginal flora.

Swyer-James-MacLeod syndrome presenting as spontaneous pneumothorax in an adult: Case report and review of literature.

Swyer-James-MacLeod Syndrome (SJMS) is an uncommon, emphysematous disease characterized by obliteration of the small bronchioles, hypoplasia/or absence of pulmonary artery and peripheral vascular bed. It is most commonly diagnosed in childhood. Patients are often asymptomatic or they could suffer from symptoms of recurrent pulmonary infections. Spontaneous pneumothorax is a rare presentation of this syndrome. We report a case of a 42-year old female patient presented at our Emergency Department with complaints of dyspnea and pleuritic chest pain with a diagnosis of spontaneous pneumothorax in emphysematous disease. The diagnosis of SJMS is usually based on imaging and clinical findings rather than on the results of pathologic examination; indeed, asymptomatic adult patients with SJMS are often diagnosed after a chest radiograph obtained for another reason. High-resolution computed tomography (HRCT) seems to be the most appropriate technique for the diagnosis. SJMS can be associated with spontaneous pneumothorax which represent an emergency condition due to the underlying pathological disease. The surgical treatment of the affected lung should be considered when conservative approach is ineffective.

Giant solitary fibrous tumor of the pelvis: A case report and review of literature.

INTRODUCTION: Solitary fibrous tumors (SFTs) are rare spindle cells neoplasms most likely arising from mesenchymal cells. Usually they involve the pleura. Even if extra-thoracic SFTs are rare, lately they are diagnosed with increased frequency. CASE PRESENTATION: We describe the case of giant pelvic and retroperitoneal neoplasm, a rare solitary fibrous tumor, in a 51-year-old man that was admitted for abdominal pain. DISCUSSION: On CT a SFT appears usually as a smooth, lobulated mass with occasional calcifications, but the imaging differential diagnosis with other mesenchymal tumors is very difficult, if not impossible. CONCLUSION: The histological and immune-histochemical features of SFTs are helpful for the differential diagnosis. The malignant potential of this cancer is low, but it is very important to perform an optimized surgery and a close follow up in the patient. We believe that this case is particularly interesting and complex because of the difficulty of predicting the future biological behavior.

Ladd's band in the adult, an unusual case of occlusion: Case report and review of the literature.

INTRODUCTION: Malrotation of gut is a congenital anomaly of foetal intestinal rotation and it is mostly discovered in early childhood as acute intestinal obstruction. This condition is very rare and often silent in adults. PRESENTATION OF CASE: We present a case of 44-year-old woman admitted with acute abdominal pain. The abdominal CT scan showed ileal conglomerate loops with thickened walls filled of liquid in the right iliac side. Laparotomic Ladd's procedure was performed successfully with division of Ladd's band, adhesiolysis, reconstruction of Treitz's ligament, small bowel resection and Merckel's diverticulum removal. The patient made an unremarkable recovery. DISCUSSION: We discuss the rarity of intestinal malrotation in adulthood and made a literature review comparison of the therapeutic options available. CONCLUSION: Intestinal malrotation is a rare entity and adult presentation is even rarer. Some cases are asymptomatic, but when symptomatic a volvulus should be promptly suspected to avoid complications such as bowel ischemia.

Asymptomatic pneumoperitoneum in pneumatosis coli: A misleading operative indication.

INTRODUCTION: Pneumatosis cystoides intestinalis (PCI) is a rare clinical pathology characterized by sub-mucosal and/or sub-serous cysts of free gas, forming cystic lesions usually ranging from 0.5 to 2.0 cm in size within the gastrointestinal tract. About 3% of patients with PCI develop complications such as pneumoperitoneum, intestinal volvulus, obstruction, or hemorrhage, these cases need immediate surgical intervention. Cyst rupture can produce peritoneal irritation and pneumoperitoneum. PRESENTATION OF CASE: A 65-years-old woman was admitted to the Emergency Department for epileptiform convulsions. Her medical hystory included epilepsy, diabetes, lichenoid dermatitis, hypothyroidism, severe cognitive impairment. Abdominal CT scan revealed a dilated large intestine with parietal pneumatosis from the appendix to the transverse colon associated to extensive pneumoperitoneum. The patient underwent emergency laparotomy which revealed the presence of gas within the wall of right and transverse colon and distension of great omentum. No resection was needed as normal blood supply to the bowel present. DISCUSSION: Pneumatosis coli can be both asymptomatic or life-threatening condition associated to bowel infarction; this situation can mimic a bowel perforation causing pneumoperitoneum - that sometimes is a non-surgical pneumoperitoneum - and it could be a misleading indication to surgical exploration especially in the case of uncertain origin of a septic shock. CONCLUSIONS: We report a case of pneuomoperitoneum due to PCI. Surgical intervention was required for patient's conditions and unclear origin of the sepsis.

A rare case of Asherman's syndrome after open myomectomy: sonographic investigations and possible underlying mechanisms.

AIMS: To present a study on severe Asherman's syndrome after open myomectomy and investigate the possible reasons for this outcome. METHODS: This study involves a rare case of a 38-year-old nulliparous woman who underwent a relatively minor and straightforward open myomectomy in a university hospital setting, during which the uterine cavity was not entered and there were no post-operative complications. Post-operatively the patient had oligomenorrhoea for over a year. The patient was investigated with three-dimensional power Doppler angiography of the uterus and underwent diagnostic/operative hysteroscopy. Main outcome measures were to sonographically assess the blood flow and vascularisation throughout the uterus and to hysteroscopically confirm diagnosis of Asherman's syndrome and treat the patient at the same time. RESULTS: Sonographically there was reduced perfusion in the outer part of the uterus and the scarred areas of the endometrium. Upon hysteroscopic confirmation of diagnosis, the division of adhesions led to a normal sized uterine cavity. CONCLUSIONS: Among the predisposing and causal factors that have been implicated in post-operative adhesion formation, endometrial trauma, infection and tissue hypoxia are considered the most important. This case supports a role for tissue hypoxia in the development of Asherman's syndrome after open myomectomy.

An audit of using the H Pipelle for endometrial sampling at outpatient hysteroscopy and literature review comparison with the Pipelle de Cornier.

OBJECTIVE: To analyse the efficiency of the H Pipelle endometrial sampler at "no touch" (vaginoscopic) diagnostic hysteroscopy in terms of biopsy adequacy for histological diagnosis. STUDY DESIGN: Retrospective descriptive study of 200 premenopausal women including comparison with previously published data on traditional biopsy instruments. RESULTS: Biopsy was adequate in 82% of cases overall, rising to 87% in those without submucous fibroids or polyps. Comparison with published data on other biopsy instruments shows that the H Pipelle is at least as efficient. CONCLUSION: The H Pipelle appears to be at least as effective as traditional endometrial samplers even after hysteroscopy but allows hysteroscopy and biopsy to be done using a purely "no touch" (vaginoscopic) technique.

Impact of intravesical hyaluronic acid and chondroitin sulfate on bladder pain syndrome/interstitial cystitis.

INTRODUCTION AND HYPOTHESIS: Intravesical instillations of hyaluronic acid (HA) and chondroitin sulfate (CS) may lead to regeneration of the damaged glycosaminoglycan layer in interstitial cystitis/bladder pain syndrome (IC/BPS). METHODS: Twenty-two patients with IC/BPS received intravesical instillations (40 ml) of sodium HA 1.6% and CS 2.0% in 0.9% saline solution (IALURIL, IBSA) once weekly for 8 weeks, then once every 2 weeks for the next 6 months. RESULTS: The score for urgency was reduced from 6.5 to 3.6 (p = 0.0001), with a reduction in pain scores from an average of 5.6 to 3.2 (p = 0.0001). The average urine volume increased from 129.7 to 162 ml (p < 0.0001), with a reduction in the number of voids in 24 h, from 14 to 11.6 (p < 0.0001). The IC Symptom and Problem Index decreased from 25.7 to 20.3 (p < 0.0001), and the Pain Urgency Frequency score, from 18.7 to 12.8 (p < 0.0001). CONCLUSION: The treatment appeared to be effective and well tolerated in IC/BPS in this initial experience.

Interstitial cystitis is associated with vulvodynia and sexual dysfunction--a case-control study.

INTRODUCTION: Dyspareunia and sexual dysfunction are common in women with urological disorders. The study of comorbidity between interstitial cystitis (IC) and vulvodynia seems to be relevant to understand the mechanism generating pain in these conditions. AIM: To conduct a case-control study for evaluating vulvodynia and sexual dysfunction in women with IC. METHODS: Forty-seven women with new diagnosis (National Institutes of Health [NIH]/National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK] Criteria) of IC were compared with 188 age-matched, negative controls. Each woman completed a semi-structured interview and the Female Sexual Function Index (FSFI). A gynecological examination to assess vulvodynia (cotton swab testing) and genital health (vulvoscopy, Pap smear, culture, and vaginal health index score [VHIS]) was performed. MAIN OUTCOME MEASURES: Prevalence of vulvodynia, sexual function, and sociodemographic/gynecological variables significantly associated with IC. RESULTS: Spontaneous or provoked vulvodynia was reported by 23.4% and 74.5% of IC cases, respectively. Sexual function was significantly impaired (median total FSFI score: IC cases 16.85 ± 8.73 vs. controls 27.34 ± 6.41; P<0.0001) in sexually active women, and 23.4% of IC cases as compared to 9% of controls reported no sexual activity in the year preceding the study (χ(2) for trend=38.2, P<0.0001). VHIS was highly impaired in women with IC in comparison with controls (P<0.0001). Variables significantly associated with IC were a diagnosis of menopause (odds ratio [OR]=31.2, 95% confidence interval [CI]=8.1-120.5), past (OR=4.6, 95% CI=1.74-12.1) or current (OR=6.9, 95% CI=2.1-22.1) oral contraceptive use, and a histologically confirmed diagnosis of endometriosis (OR=3.7, 95% CI=1.1-12.7). CONCLUSION: We found an increased prevalence of vulvodynia among women with recently diagnosed IC; both conditions seem to have profound consequences on women's sexual function. A potential role for sex hormone-dependent mechanisms into the comorbidity of vulvar and bladder pain is proposed, but further research is warranted.

Multiple human papillomavirus infection and high grade cervical intraepithelial neoplasia among women with cytological diagnosis of atypical squamous cells of undetermined significance or low grade squamous intraepithelial lesions.

OBJECTIVE: To evaluate the effect of multiple human papillomavirus (HPV) infection on the prevalence of cervical intraepithelial neoplasia (CIN) among women undergoing colposcopy following a cytological diagnosis of atypical squamous cells of undetermined significance (ASCUS) or low grade squamous intraepithelial lesions (LSIL). METHODS: HPV type-specific sequences of 15 high-risk and 10 low risk types were detected by the line probe, INNO-LiPA HPV genotyping assay before colposcopic examination and targeted biopsies. Multinomial logistic regression was used to evaluate the effect of multiple infection on pathologic outcome adjusting for confounders. RESULTS: The prevalence of HPV infection in the 1218 women enrolled was 69.9% (851/1218). HPV 16 (37.4%), 31 (26.1%), 51 (17.4%), 52 (15.7%) and 18 (14%) were the commonest viral types identified. Overall, the rates of multiple infection were 22.5% (153/680) among subjects with negative colposcopy/biopsy, 63.6% (218/343) and 79.5% (155/195) among those with CIN 1 and CIN>or=2, respectively (p for trend <.001). The corresponding rates among subjects uninfected by HPV 16 or 18 were 13.5% (77/572), 57.4% (112/195) and 62% (48/77), respectively (p for trend <.001). In multinomial logistic regression, the odds ratio of CIN>or=2 in multiple high risk as compared to single high risk HPV infection was 4.33 (95% confidence intervals=2.32-7.14) in the overall population and 2.76 (95% confidence intervals=1.36-5.59) among women uninfected by HPV 16 or 18. CONCLUSIONS: Multiple HPV infection is a significant risk factor for CIN>or=2 among women undergoing colposcopy because of ASCUS/LSIL.