Our results suggest that the auto-crosslinked hyaluronan gel may have a favourable safety profile and efficacious antiadhesive action following laparoscopic myomectomy.

In the past, most cases of osseous metaplasia of the endometrium were diagnosed following removal of bone from the endometrium by dilatation and curettage and frequently subsequently treated by hysterectomy. Nowadays, management involves a suggested diagnosis by transvaginal ultrasound examination, confirmation by hysteroscopy and hysteroscopic removal of ectopic intrauterine bone. This is usually carried out under laparoscopic guidance. However, the degree of visual control provided by combined transabdominal and transrectal ultrasonography may prove sufficiently accurate for hysteroscopic guidance. In this report we describe a case of endometrial osseous metaplasia successfully managed by ultrasound-guided hysteroscopy. The advantages of our approach include reduced invasiveness, reduced costs and simultaneous visualization of the abdominal and intrauterine cavities. One limitation, however, is represented by the greater operator dependence of ultrasound guidance as compared to laparoscopy, the former requiring extensive training and state-of-the-art equipment. We suggest that ultrasound guidance for hysteroscopic removal of extensive osseous metaplasia may represent a potentially safer and more effective alternative to laparoscopy and would therefore encourage further clinical evaluation of this technique.

Ovarian stimulation is an important step in the success rate of in vitro fertilization (IVF) allowing multiple follicular growth, several oocytes and consequently more embryos. The combination of GnRH-antagonists (GnRH-ant) and gonadotrophins is now available for clinical use and represent a valid alternative to classical protocol with GnRH agonist. GnRH-antagonists induce a direct block of GnRH receptor with a rapid decrease in LH and FSH, preventing LH surge. Two protocols has been designed for assisted reproduction technology (ART) treatment: multiple-dose protocol and a single-dose. Both protocols are simply, efficacious, started in the late follicular phase and do not have side effects. A review of GnRH-antagonist applications in ART cycles are presented. Smaller doses of gonadotrophins, shorter stimulation period and lower ovarian hyperstimulation syndrome (OHSS) incidence are reported in literature using GnRH-antagonist compared to agonist. Triggering of ovulation, the use in polycystic ovarian syndrome (PCOS) and poor reponders patients are other interesting indication. Regarding to pregnancy rate and potentially adverse effects of drugs on endometrium or implantation needed more data.

No abstract

The genitourinary syndrome of menopause (GSM) and stress urinary incontinence (SUI) are common clinical challenges for women's health and quality of life. The laser treatment and particularly the vaginal erbium laser (VEL) may provide a new non-invasive treatment for both GSM and SUI. However, the estimation of the ultimate results of different laser treatments may be altered by different issues, such as patient selection, concomitant treatments, and long-term effect of vaginal laser thermotherapy. In the present paper, we present the protocol for a large multicenter study on the evaluation of the efficacy and safety of VEL for the treatment of GSM and SUI, the Vaginal Erbium Laser Academy Study (VELAS). This study will evaluate the effects of three laser applications in 1500 postmenopausal women. Subjective and objective symptoms will be evaluated prior to the first laser treatment with follow-up visits after 4 weeks from the last laser application, and subsequently after every 3 months for 1 year. Findings from the VELAS have the potential to affect clinical care practice and health decisions for millions of women world-wide for a non-hormonal treatment for GSM and a non-invasive treatment of SUI.

Biopsies taken from vulvar lesions in 12 women affected by vulvar lichen sclerosus et atrophicus (LSA) have been processed for immunohistological study. Activated (HLA-Dr+) T cells, associated with CD1a+ accessory cells, were found in the dermis in all cases, with architectural patterns varying in relation to the histological phase (early, well developed, old) of the lesion. Interestingly, the number of epidermal CD1a+ Langerhans cells (LCs) was increased in all cases, without any correlation with the amount of the dermal infiltrate and with the histological phase of the lesions. In fact, also in old lesions the number of epidermal CD1a+ LCs was increased, and the sparse dermal lymphoid cells showed a persistent HLA-Dr antigen expression. These data, indicating the persistent activation of epidermal antigen-presenting cells and lymphoid cells in all the evolutive phases of vulvar LSA, suggest a possible involvement of the skin immune system in the pathogenesis of LSA.

No abstract

No abstract