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1.
Acta Otorhinolaryngol Ital ; 44(Suppl. 1): S42-S57, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38745516

RESUMO

The oral cavity is a primary site for malignant neoplasms of the head and neck region. Surgery, with or without adjuvant therapy, offers the highest probability of cure by focusing on radical tumour removal and organ function restoration. Reconstructive options are represented by local and free flaps, while small defects can be managed without reconstruction. For medium-sized defects without bone involvement, local flaps can be a good alternative to free flaps in selected patients. The purposes of this article are to analyse the main minimally-invasive reconstructive techniques in oral cancer surgery through a systematic review of the literature and develop a reconstructive algorithm based on the site and size of the defect. We defined minimally-invasive reconstruction as any reconstructive option not involving flap dissection from the neck or other distant areas from the oral cavity. Options considered include: local myo-mucosal or mucosal flaps (based on the facial or buccal arteries, and palatal flap), Bichat's fat pad flap, and nasolabial flap. Use of biological or synthetic materials is also described. In selected patients with small to moderate-sized defects, the possibility of reconstruction with local flaps can be a viable option.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos , Boca , Procedimentos de Cirurgia Plástica , Humanos , Procedimentos de Cirurgia Plástica/métodos , Boca/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Neoplasias Bucais/cirurgia
3.
Pathobiology ; 81(4): 176-82, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25138577

RESUMO

OBJECTIVE: Indolent extranodal T-cell lymphoproliferative disorders have recently been described as new entities in the gastrointestinal tract and acral sites displaying clonal T-cell receptor (TCR) rearrangement and nonactivated cytotoxic CD8+ T-cell phenotypes. METHODS/RESULTS: We report a unique case of an atypical myometrial T-cell lymphoproliferation in a 39-year-old multiparous woman, which shares many of the features mentioned above: CD8+/TIA1+/granzyme B- phenotype, clonal TCR rearrangement and indolent course. CONCLUSION(S): We hypothesize that it might derive from a subset of uterine nonrecirculating CD8+ resident memory T cells expanded after repeated exposure to allo-extravillous trophoblastic antigen.


Assuntos
Linfócitos T CD8-Positivos , Transtornos Linfoproliferativos/imunologia , Transtornos Linfoproliferativos/patologia , Miométrio/patologia , Doenças Uterinas/imunologia , Doenças Uterinas/patologia , Adulto , Linfócitos T CD8-Positivos/imunologia , Feminino , Rearranjo Gênico da Cadeia gama dos Receptores de Antígenos dos Linfócitos T , Humanos , Memória Imunológica , Transtornos Linfoproliferativos/genética , Miométrio/imunologia , Doenças Uterinas/genética
4.
Gynecol Endocrinol ; 29(3): 219-21, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23153053

RESUMO

BACKGROUND: A progressive delay in the age of first conception results in an increased frequency of endometrial cancer patients in reproductive age and desiring childbearing. CASE: A 38-year-old infertile woman with stage I endometrioid adenocarcinoma was treated with gonadotropin releasing hormone agonist (GnRHa) and levonorgestrel-releasing intrauterine device (LNG-IUD). After disease remission, she underwent a controlled ovarian stimulation for standard in vitro fertilization (IVF) program and had a pregnancy delivering a healthy male baby. Total laparoscopic hysterectomy with bilateral salpingo-oophorectomy was performed four months after delivery. The patient is free of disease after 3-year follow-up. CONCLUSION: GnRHa plus LNG-IUD followed by IVF program is a safe and effective fertility-sparing strategy to manage infertile patients with stage I endometrial cancer.


Assuntos
Neoplasias do Endométrio/tratamento farmacológico , Preservação da Fertilidade , Fertilização in vitro , Hormônio Liberador de Gonadotropina/agonistas , Infertilidade Feminina/terapia , Dispositivos Intrauterinos Medicados , Levanogestrel/administração & dosagem , Adulto , Antineoplásicos Hormonais/administração & dosagem , Antineoplásicos Hormonais/efeitos adversos , Antineoplásicos Hormonais/uso terapêutico , Carcinoma Endometrioide/tratamento farmacológico , Carcinoma Endometrioide/patologia , Carcinoma Endometrioide/fisiopatologia , Carcinoma Endometrioide/cirurgia , Anticoncepcionais Femininos/administração & dosagem , Preparações de Ação Retardada/administração & dosagem , Preparações de Ação Retardada/efeitos adversos , Preparações de Ação Retardada/uso terapêutico , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/fisiopatologia , Neoplasias do Endométrio/cirurgia , Endométrio/efeitos dos fármacos , Endométrio/patologia , Feminino , Hormônio Liberador de Gonadotropina/administração & dosagem , Hormônio Liberador de Gonadotropina/efeitos adversos , Hormônio Liberador de Gonadotropina/uso terapêutico , Humanos , Infertilidade Feminina/tratamento farmacológico , Infertilidade Feminina/etiologia , Leuprolida/efeitos adversos , Leuprolida/uso terapêutico , Estadiamento de Neoplasias , Gravidez , Indução de Remissão , Nascimento a Termo
5.
Reprod Biomed Online ; 13(1): 65-70, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16820111

RESUMO

The new Italian law on assisted reproduction technology rules that no more than three oocytes can be fertilized at one time, and that all embryos obtained must be transferred to the maternal uterus simultaneously. The aim of the present study was to investigate the influence of the new law on spontaneous embryonic/fetal losses through comparison of data collected over an identical period of time: the first year of application of the new law compared with the same time period 1 year before (March 10, 2004 to March 9, 2005 versus March 10, 2003 to March 9, 2004). A total of 271 clinical pregnancies were analysed. In the post-law period, a significantly lower percentage of total spontaneous embryonic losses compared with the pre-law period, and a higher percentage of surviving embryos in singletons and twins was observed. In conclusion, the impact of the limitations imposed by the new legislation regulating assisted reproduction in Italy seems to exert positive effects on spontaneous embryonic loss both in singletons and multiple pregnancies. These findings are in contrast to international predictions on this issue and, in general, are counter-intuitive. This suggests that further investigations on a larger cohort of women are required to confirm these preliminary results.


Assuntos
Aborto Espontâneo/epidemiologia , Técnicas de Reprodução Assistida/legislação & jurisprudência , Adulto , Transferência Embrionária , Feminino , Humanos , Itália/epidemiologia , Idade Materna , Gravidez , Resultado da Gravidez , Gravidez Múltipla , Injeções de Esperma Intracitoplásmicas
6.
Fertil Steril ; 86(1): 247-9, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16716323

RESUMO

Survivors of the "vanishing" twin syndrome, which occurred in dichorionic twins only, and singletons that began as singletons, had similar mean gestational duration and birth weights, as well as similar frequencies of maternal and neonatal complications. This similarity persisted when conventional IVF and IVF plus ICSI cases were separately evaluated.


Assuntos
Aborto Espontâneo/epidemiologia , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/terapia , Avaliação de Resultados em Cuidados de Saúde/métodos , Resultado da Gravidez/epidemiologia , Técnicas de Reprodução Assistida/estatística & dados numéricos , Gêmeos , Adulto , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Itália/epidemiologia , Gravidez , Resultado do Tratamento
7.
Fertil Steril ; 84(6): 1602-5, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16359952

RESUMO

OBJECTIVE: To determine whether embryo quality is associated with early spontaneous loss rates in twin and singleton pregnancies after IVF/intracytoplasmic sperm injection (ICSI). DESIGN: Retrospective, single center analysis. SETTING: The Center of Reproductive Medicine, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. PATIENT(S): Women undergoing IVF/ICSI and two- or three-embryo transfer of intermediate- and top-quality embryos. INTERVENTION(S): First-trimester sonography at 6 to 7 weeks to determine number of embryos with positive heartbeat. Number of embryos lost was calculated from a second-trimester sonogram. MAIN OUTCOME MEASURE(S): Rates of total pregnancy loss, as related to embryo quality, initial number of embryos, maternal age <35 or > or =35 years, and IVF procedure. RESULTS: A total of 94 losses (23.1% of 407 pregnancies) were counted, with similar proportions in pregnancies after transfer of intermediate- or top-quality embryos. Neither the mode of IVF procedure nor the number of transferred embryos affected the loss rate. In contrast, the loss rate was significantly higher in older mothers after transfer of intermediate-quality embryos (odds ratio [OR 2.4], 95% confidence interval [CI] 1.1-5.5). Losses among singletons were significantly higher compared with losses among twins (OR 2.5, 95% CI 1.1-6.0), but this was observed in top-quality embryos only. CONCLUSION(S): Top-quality but not intermediate-quality ETs are associated with lower early spontaneous loss rates among twin pregnancies after IVF/ICSI.


Assuntos
Aborto Espontâneo/epidemiologia , Blastocisto , Transferência Embrionária/normas , Resultado da Gravidez/epidemiologia , Injeções de Esperma Intracitoplásmicas/normas , Gêmeos , Adulto , Transferência Embrionária/estatística & dados numéricos , Feminino , Humanos , Idade Materna , Gravidez , Primeiro Trimestre da Gravidez , Gravidez Múltipla/estatística & dados numéricos , Estudos Retrospectivos , Injeções de Esperma Intracitoplásmicas/estatística & dados numéricos
8.
Fertil Steril ; 82(6): 1536-9, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15589856

RESUMO

OBJECTIVE: To determine whether pregnancies after IVF, with and without intracytoplasmic sperm injection (ICSI), have different early spontaneous loss rates. DESIGN: Retrospective analysis of IVF/ICSI dataset. SETTING: The Center of Reproductive Medicine, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. PATIENT(S): Women undergoing IVF with or without ICSI. INTERVENTION(S): First-trimester sonography at 6-7 weeks to count the number of embryos with positive heartbeat. The number of embryos lost was calculated from a second-trimester sonogram. MAIN OUTCOME MEASURE(S): Embryonic loss rates related to the initial number of embryos, maternal age <35 or > or =35 years, and IVF procedure. RESULT(S): In vitro fertilization and ICSI had similar embryonic loss rates (odds ratio [OR] 1.2, 95% confidence interval [CI] 0.9-1.7, and OR 1.3, 95% CI 0.9-1.8 for women aged <35 years and > or =35 years, respectively). Younger women had fewer losses after IVF (OR 0.7, 95% CI 0.5-0.9). Multiples had lower loss rates compared with singleton pregnancies. CONCLUSION(S): In vitro fertilization and ICSI have similar spontaneous embryonic loss rates. Factors other than the initial number of embryos, maternal age, and IVF technique, such as embryo quality or uterine environment, might be involved in the outcome of multiple pregnancies in assisted reproductive technology procedures.


Assuntos
Aborto Espontâneo/epidemiologia , Fertilização in vitro/estatística & dados numéricos , Injeções de Esperma Intracitoplásmicas/estatística & dados numéricos , Aborto Espontâneo/diagnóstico por imagem , Adulto , Intervalos de Confiança , Feminino , Humanos , Incidência , Idade Materna , Razão de Chances , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Gravidez Múltipla/estatística & dados numéricos , Estudos Retrospectivos , Ultrassonografia Pré-Natal
9.
Am J Obstet Gynecol ; 191(3): 741-6, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15467533

RESUMO

OBJECTIVES: The purpose of this study was to determine the early spontaneous loss rate in multiple pregnancies following assisted reproductive technology (ART). STUDY DESIGN: Analysis of pregnancies following ART as related to the initial number of embryos and maternal age was performed. RESULTS: At least one spontaneous loss was observed in 47.0% (95% CI 29.8-64.9) of quadruplets, 59.3% (95% CI 48.2-69.8) of triplets, and 35.2% (95% CI 29.6-41.2) of twins. The increased loss rates in mothers > or =35 years was related to early twin pregnancies, but not to early triplet and quadruplet gestations. We could not find an effect of the starting number of embryos on either gestational age or birth weight characteristics. CONCLUSION: Our observations did not identify a clear relation between early spontaneous loss of multiple gestations and either initial number of embryos or maternal age. Other factors might be involved in the outcome of ART multiple pregnancies.


Assuntos
Aborto Espontâneo/epidemiologia , Fertilização in vitro , Adulto , Peso ao Nascer , Transferência Embrionária , Feminino , Idade Gestacional , Humanos , Idade Materna , Gravidez , Gravidez de Alto Risco , Gravidez Múltipla , Quadrigêmeos/estatística & dados numéricos , Trigêmeos/estatística & dados numéricos , Gêmeos/estatística & dados numéricos
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