[Use of transcutaneous electrical stimulation and biofeedback for the treatment of vulvodynia (vulvar vestibular syndrome): result of 3 years of experience]. / Utilizzo dell'elettro-analgesia transcutanea e del biofeedback nel trattamento della vulvodinia: risultati di 3 anni di esperienza.

AIM: The safety, tolerability and efficacy of physical therapy with biofeedback and trans electrical nerve stimulation (TENS) with intravaginal probe for the treatment of vulvar pain and vulvar discomfort in women with vulvodynia, is evalued in the present study. Vulvodinia is a cronic syndrome of unexplained vulvar pain. Patients typically present with a history of intermittent or continuous, localized, vulvar pain, frequently accompanied by sexual dysfunction like entry dispareunia, burning and hiching localized to the vulvar vestibule. METHODS: From January 2005 and June 2007, a total 145 women diagnosed with vulvodynia presented in the ambulatory for the Diagnosis and Treatment of Vulvar Pain and Pelvic Floor Dysfunction, Clinical ''Santa Famiglia'', Rome. Patients were treated with weekly biofeedback (BFB) and transcutaneous electroanalgesia (TENS), in association with functional electrical stimulation (FES) and home-therapy with stretching exercise of pelvic floor. RESULTS: Hundred forty-five women completed both the biofeedback and trans electric nerve stimulation treatment for a total of 10 application, with a improvement of vulvar pain in 75.8% of cases. CONCLUSION: The pelvic floor relaxation with biofeedback and ellectroanalgesia is safe and effective in improvement in vulvar pain and dyspareunia in women with vulvodynia.

Primary leiomyosarcoma of the fallopian tube: a case report.

A primary leiomyosarcoma (LMS) arising from the left fallopian tube in a perimenopausal 48-year-old woman is reported. Primary tubal LMS is an uncommon, exceedingly rare neoplasm, accounting for only a few reported cases so far. To our knowledge, the present case is the 17th tubal LMS reported in the English-language literature. The diagnosis is usually made at the time of laparotomy for a pelvic or adnexal mass or other gynaecological indications. As in ovarian neoplasms, the mainstay of treatment is represented by debulking surgery consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy, random biopsies, peritoneal washing and excision of all the abdominal tumour masses. Although the approach is radical, the clinical behaviour is very poor. The role of adjuvant radio- or chemotherapy still remains unsolved.

[Topical imiquimod cream in the treatment of external anogenital warts: personal experience]. / Utilizzo dell'Imiquimod nel trattamento della condilomatosi ano-genitale. Nostra esperienza.

AIM: The clinical effects of home-therapy with 5% imiquimod cream in the treatment of cutaneous anogenital warts are evaluated. METHODS: From March 2000 to January 2002, 57 women presenting clinical cutaneous external genital and perianal warts were selected in the base-population observed at our clinical of vulvar pathology and sexually transmitted diseases, AIED Rome. The patients were divided into 2 groups: Group A, with new cutaneous viral lesions and Group B with recurrent anogenital warts pre-treated with CO2-laser therapy. A total of 36% (20) of all patients presented contemporaneous HPV lesions of cervix and/or vaginal wall. The follow-up was carried out at 4 weeks, 3 months and 6 months, evaluating the safety, clinical efficacy and tolerance of women. The Pearson chi2 test was used to evaluate trends significance. All lesions were photo-documented. RESULTS: Sixty-four per cent (64%) of the patients had complete clearance of anogenital warts within 16 weeks, for 3 times per week self-application of imiquimod, with clinical remission at short term (6/8 weeks) (chi2=1.42; p<0.05); 12% had partial clearance (<50%) and 20% had a clearance of about 75%. The coexistent lesions of cervix and/or vaginal walls had a high remission (>50%) and required surgical additional therapy with CO2-laser; 28% of patients (16/57) experienced mild to moderate drug-related side effects. There was a significant increase in the severity of local skin reactions due to the increased time and number of applications. CONCLUSION: These data confirm that imiquimod cream at the dose regimen of 3 times per week, is effective and well tolerated in the treatment of cutaneous external warts and is associated to a reduction of coexistent mucous viral lesions due to enhancement of local immune response.

Sarcoma botryoides of the uterine cervix in a young woman: a case report.

Among the rhabdomyosarcomas, which represent an uncommon neoplasm of mesoderm origin comprising about 1% of all female genital malignancies, sarcoma botryoides (SB) is an embrional variant usually found in the vagina of infants and young children under 16 years of age. The onset of SB from the uterine cervix is very rare with a peak incidence in the second decade; only a few cases have been published in the international literature so far. The authors report a case of embryonal rhabdomyosarcoma of the uterine cervix which occurred in a young woman treated by radical surgery, followed by adjuvant chemotherapy and radiotherapy.

Pseudomixoma peritonei: a case report.

Pseudomixoma Peritonei (PMP) is an uncommon neoplasm characterised by mucinous ascites and multifocal amorphous mucous substances involving the peritoneal surface, omentum and bowel loops. Although the origin of the Pseudomixoma Peritonei is still unclear, it could be due to the perforation of an ovarian mucinous cystoadenoma or an appendiceal mucocele. The further pelvic dissemination of the endotumor material, which adhere itself into the peritoneal surface, may induce an intra-abdominal transformation of the peritoneal mesothelium into mucin-producing tissue. A case of Pseudomyxoma Peritonei (PMP) which occurred in a young woman is reported.

[Preterm premature rupture of membranes in the 19th week of pregnancy. A clinical case]. / Rottura pretermine prematura delle membrane (pPROM) alla 19a settimana di gravidanza. Caso clinico.

A case of premature rupture of membranes occurred at 19 weeks of pregnancy is reported. The patient underwent a genetic amniocentesis at 16 weeks of gestational age. During the hospitalization period, she presented amniotic fluid leakage responsible of olygohidramnios. She was treated with antibiotic, spasmolytic, tocolytic and cortisone therapy. All subsequent parameters were evaluated: blood cell count, heart rate frequency, body temperature. Ultrasound examinations were performed every two weeks. Cervical smears to detect infections were normal. Labour started at 28 weeks and the patient delivered spontaneously a 1010 g male baby, Apgar 4/8. The heaviest complication was a cerebral hemorrhage and the subsequent frontoparietal hematoma which progressively reduced. To date the neurological prognosis is good.

[Risk factors for ectopic pregnancy. Case-control study]. / Fattori di rischio per la gravidanza ectopica. Studio caso-controllo.

BACKGROUND: To analyze risk factors for ectopic pregnancy in an Italian population. METHODS: A retrospective case-control study has been carried out on 213 cases of ectopic pregnancy and 213 controls. The control subjects were women who delivered spontaneously at the same time and in the same hospital of the cases considered. RESULTS: Smoking more than 10 cigarettes/die doubles the risk of ectopic pregnancy. IUD causes an increased risk in women using this contraceptive method for less than two years. A history of abdominal surgery was associated with about a double risk of ectopic pregnancy. The risk was higher in cases of cesarean section and pelvic surgery. CONCLUSIONS: Abdominal surgery (particularly pelvic surgery and cesarean sections), use of IUD for less than two years and cigarette smoking are the risk factors found to be a cause for ectopic pregnancy in the population studied. It was not possible to evaluate the history of pelvic inflammatory disease because there were not enough data. For this reason it is suggested it will be possible in the future to compile a register data, collecting all the cases of ectopic pregnancy as a part of a prevention campaign.