Vito Leanza

Effect of treatment with myo-inositol on semen parameters of patients undergoing an IVF cycle: in vivo study.

Abstract Introduction: Myo-inositol (MI) is a precursor for the synthesis of phosphatidylinositol polyphosphates (PIPs). The aim of the study is to evaluate the effect of its administration on semen parameters of male patients undergoing an in vitro fertilization cycles. Methods: In vivo study. Samples were semen of 62 patients divided into three different groups: healthy fertile patients (Group A); patients with oligoasthenospermia (OA) (Group B); control group (CTR). The collected samples were analyzed by optic microscopy in order to evaluate semen’s volume, spermatozoa’s number and motility before and after density-gradient separation method. These parameters were evaluated before and after administration of 4000 mg/die of MI and 400 µg of folic acid for 2 months. The results were analyzed statistically with Students t-test. Results: After treatment there was a significant increase of basal and after density-gradient separation method spermatozoa concentration in Group B, and a significant increase of spermatozoa count after density-gradient separation method in Group A. The motility values were higher in healthy men than patients with OA before treatment, but there was no improvement in both groups after treatment. Conclusions: Exogenous administration of MI significantly improves semen’s parameters both in patients with OA and in normal fertile men.

Conservative Laparoscopic Treatment of a Benign Giant Ovarian Cyst in a Young Woman

Giant ovarian cysts are very rare. Recently, laparoscopic treatment, with extirpation of the giant cyst and associated oophorectomy, has been reported. In this article, we describe the first case of complete laparoscopic enucleating of a giant serous cystoadenomyoma with preservation of residual ovarian parenchyma in an 18-year-old girl.

Totally Laparoscopic Repair of an Ileal and Uterine Iatrogenic Perforation Secondary to Endometrial Curettage

Small bowel perforation is a unique, serious complication during endometrial biopsy. The authors report a case of a double uterine-ileal perforation totally managed by primary laparoscopic repair. A 63-year-old female was admitted with acute abdomen 2 days after an endometrial curettage. Abdominal X-ray shows signs of pneumoperitoneum. Emergency diagnostic laparoscopy was performed and a uterine-ileal perforation was identified. Repair was accomplished by a totally laparoscopic intracorporeally suturing of the 2 breaches. Postoperative course showed only a delayed ileus and the patient was discharged after 5 days with no complications. When acute abdomen arises following uterine biopsy, a potential iatrogenic intestinal laceration always has to be ruled out. Laparoscopic approach is a quick and safe technique in these cases. Totally laparoscopic primary closure of the iatrogenic ileal laceration may be accomplished with low morbidity.

Uterine Myxoid Leiomyosarcoma Associated with Multiple Myomas in a Fertile Woman: A Case Report

A 37 year old woman was admitted to our university hospital for menometrorrhagia. The case history showed that the patient had menometrorrhagia for six months; moreover, during the abdominal examination we found a mass occupying the hipogastric and mesogastric area. The tumefaction was hard and it reached the level of the umbilicus. On combined vaginal-abdominal examination a mass on the anterior wall and multiple myomata were felt; the uterus was found to have been enlarged to the size equivalent to 18 weeks pregnancy; adnexa regular were felt. During the surgery multiple myomas were found. The largest, 10 cm diameter, was soft in consistence with a gelatinous structure. Total abdominal hysterectomy with preservation of adnexa was performed (Figure 1). Histopathological result gave evidence of myxoid leiomyosarcoma in the largest myoma, whereas the others fibroid nodes were without atypia.

Delivery Mode and Pelvic Floor Disfunction

Introduction: Pelvic floor disorders compromise quality of life for a lot of women of all ages. The prevalence of urinary incontinence (UI) is thought to range from 17 to 45% among adult women. The etiology is thought to be multifactorial. Traumatic damage to fascial and muscular support structures during childbirth may be, an important contributor to the development of UI and prolapse of pelvic organ (POP). The aim of this study is to consider the association between delivery mode and pelvic floor disorders (POP and UI) Materials and methods: A review of the literature was undertaken using the Medline and Popline CD Rom considering articles published from 1996 to 2011; additional sources were identified from references cited in relevant research articles. We studied articles concerning stress urinary incontinence, pregnancy, childbirth, pelvic prolapse were considered. Conclusion: Literature research confirms that anatomic and functional damages are linked with obstetric factors. Pregnancy may cause urinary incontinence and prolapse. However vaginal delivery is associated with a significant higher risk of urinary incontinence and pelvic defects. Caesarean section may protect from perineal risk of delivery but not from the damage due to the pregnancy itself. During pregnancy UI ranges from 31 to 39%, in post-partum ranges from 24,5 to 29% and from 5 to 8% after vaginal and caesarean respectively. Pelvic floor disorders ranges from 21 to 36% after instrumental operative delivery and from 9 to 21% in vaginal spontaneous delivery. Forceps is found out the most dangerous instrument for pelvic floor, followed by vacuum and vaginal delivery with tears. The consequences of a traumatic delivery affect quality of life and increasing late damages have to be considered.

Case Report: Spontaneous cholecystocutaneous fistula, a rare cholethiasis complication

One of the most unusual complications in cholethiasis is spontaneous cholecystocutaneous fistula, which has only been reported a few times in the literature. We report the case of a 76 year old man who presented with a right hypochondrium subcutaneous abscess, with pain evoked through palpation. No comorbidity in the patient’s medical history were noted. Confirmation of cholecystocutaneous fistula was made using the proper diagnostic process, which is computed tomography with contrast media, followed by hepatobiliary MRI. This confirmed the presence of a fistulous pathway between the gallbladder and the skin. The patient underwent cholecystectomy surgery and open laparotomy with en block aponeurotic muscle, skin and fistula orifice excision.

Case Report: Atypical Cornelia de Lange Syndrome

Cornelia de Lange Syndrome (CdLS) (also called Bushy Syndrome or Amsterdam dwarfism), is a genetic disorder that can lead to several alterations. This disease affects both physical and neuropsychiatric development. The various abnormalities include facial dysmorphia (arched eyebrows, synophrys, depressed nasal bridge, long philtrum, down-turned angles of the mouth), upper-extremity malformations, hirsutism, cardiac defects, and gastrointestinal alterations. The prevalence of this syndrome is approximately one per 15,000. Ultrasound is not the perfect means to diagnose CdLS, however, many abnormalities can be detected prenatally by scrupulous image observation. We report an atypical CdLS case characterized by increased nuchal translucency in the first trimester, normal karyotype, saddle nose, micrognathia with receding jaw, low set ears, facies senilis, arthrogryposis of the hands, absence of the Aranzio ductus venous, dilatation of gallbladder and bowel, a unique umbilical artery, increased volume of amniotic fluid, and intrauterine growth retardation ending with the interruption of pregnancy.

Retroperitoneal Sarcoma Involving Unilateral Double Ureter: Management, Treatment and Psychological Implications

The case of a 45-year-old woman who was admitted to our university hospital for polymenorrhea, weight gain and pain in the left iliac region is reported. An abdominal ultrasound revealed a 9.5 × 5.2-cm, hypoechoic and inhomogeneous mass located on the left side of the pelvis and behind the ovary. The patient underwent surgery. The pelvic mass was firmly anchored to the small intestine, colon, sigma and uterine fundus. After removing the adhesions, double ureters, which had been incorporated in the mass, were observed on the left side. Resection of the unilateral double ureters was necessary in order to remove the entire mass, and thereafter, a left salpingoophorectomy was performed. A histological examination showed a malignant retroperitoneal mass. Termino-terminal ureteral anastomosis with two double-J stents was carried out. Total hysterectomy with preservation of the right adenexum and regional lymphadenectomy was performed. The purpose of this case report is to discuss the physical and psychological implications related to the combination of two rare entities: leiomyosarcoma and a double ureter located within the mass. A literature review on the clinical management and psychological aspects from a female cancer patients perspective undergoing surgery with the aforementioned disorders will be discussed.

Small for Gestational Age

Lots of diagnostic procedures are assessed to evaluate intrauterine retardation (IUGR), among them ultrasounds are the most relevant ones. Foetal surveillance includes assessment of growth, detection of the Doppler blood flow and volume of amniotic fluid. There is an evidence of the association between IUGR and foetal blood perfusion. Pregnancies with early onset of IUGR remain a challenge not solved yet, even if the velocimetry of the foetal middle cerebral artery is considered mandatory for neurological risk when altered. In mid-late onset, IUGR cerebral and umbilical blood Doppler is useful to detect the potential damage of the foetus and avoid the hypoxic risk. Ductus venous flow is also an indicator of foetal jeopardy in case of abnormal umblical artery waves. Review of literature shows that middle cerebral, umbilical arteries, ductus venosus and uterine arteries are the most relevant vessels to be evaluated in order to establish the foetal well-being when IUGR arises. Obstetric management aims to lead what is the better choice: prematurity with associated Infant Respiratory Distress Syndrome (IRDS) or, on the contrary, waiting with correlated either stillbirth risks or catch-up growth advantage. Small for Gestational Age