In critically ill neonates, peripheral perfusion and oxygenation assessment may provide indirect information on the circulatory failure of vital organs during circulatory shock. The development of pulse oximetry has recently made it possible to calculate the perfusion index (PI), obtained from the ratio between the pulsatile and nonpulsatile signals of absorbed light. The main goals of this study were: (1) to study foot PI; and (2) to evaluate the relationship between foot PI, obtained continuously by pulse oximetry, and a number of variables, i.e. blood flow (BF), oxygen delivery (DO 2 ), oxygen consumption (VO 2 ), and fractional oxygen extraction (FOE), measured indirectly by near-infrared spectroscopy (NIRS) on the calf in 43 healthy term neonates (weight 3474.6±466.9 g; gestational age 39.1±1.4 weeks). STUDY DESIGN:Calf BF, DO 2 and VO 2 were assessed by NIRS on short-lived venous and arterial occlusion maneuvers. PI was measured on the contralateral foot. RESULTS:Foot PI was 1.26±0.39. There was a positive correlation between foot PI and both calf BF (r ¼ 0.32, p ¼ 0.03) and DO 2 (r ¼ 0.32, p ¼ 0.03), but no correlation was found between foot PI and calf FOE and between foot PI and VO 2 . CONCLUSIONS:In the neonatal intensive care unit, continuously measuring foot PI by pulse oximetry seems clinically more feasible for peripheral perfusion monitoring than spot measurements of the calf BF and/or VO 2 by indirect NIRS.

Operative laparoscopy is the gold standard in the treatment of endometriotic ovarian cysts. Excisional surgery is the best technique to prevent recurrences and improve symptoms but it may result in ovarian reserve damage due to the removal of healthy ovarian cortex. The aim of this study was to investigate the extent of the ovarian reserve damage after stripping technique of unilateral endometriomas, by dosing the Anti-Müllerian Hormone (AMH). This prospective study was conducted at the Center of Minimally Invasive Pelvic Surgery of the Department of Health of Woman and Child, University of Padua, from October 2010 to June 2012. Twenty-five women underwent excision of monolateral endometriosis ovarian cyst by stripping without accessing a bipolar coagulation and performing an intracortical suture. The AMH serum levels were estimated in the early proliferative phase of the cycle, before surgery (time 0), 24 h after surgery (time 1), the first menstrual cycle after surgery (time 2) and the third menstrual cycle after surgery (time 3). We found a nonstatistically significant decreases in serum AMH levels after surgical excision of the cysts. Our results suggest that an appropriate surgical technique, without the use of the bipolar coagulation of ovarian border, does not determine a significant reduction of ovarian reserve.

No abstract

The objective of this longitudinal retrospective study was to evaluate the influence of submucosal myomas on pregnancy outcome in infertile patients after resectoscopic myomectomy. One-hundred and four women with at least a 1-year-long history of infertility and the presence of submucosal myomas as the only cause of infertility were selected after surgical treatment. Pregnancy, delivery and abortion rates were investigated. Patients were divided into three groups according to the myoma classification (G0, G1 and G2). Gestational outcomes were analyzed in the three groups correlated by size, location and number of fibroids. The total pregnancy rate was 85.8% and no difference was shown regarding myoma classification (G0 82.05% versus G1 87.09% versus G2 88.2%; p = ns). Pregnancy and delivery rates were not significantly related to the number, localization or diameter of the fibroids. The abortion rate was not statistically influenced by myoma type, but it was significantly inter-related with myomas situated in the anterior uterine wall (p = 0.03). Pre-term delivery was significantly influenced by myomas localized in the fundic wall (p = 0.02). Caesarean section rates were not affected by the characteristics of the myomas. Our results support the idea that resectoscopic myomectomy should be offered to infertile women who wish to become pregnant independently of their localization and number.

To identify the appropriate management we review the current literature on the diagnostic and different surgical procedures to which the patients affected by Sertoli-Leyding cell tumors (SLCTs) were submitted. Through the description of a case report we also propose an interdisciplinary diagnostic approach and a laparoscopic surgical staging, with a long-term follow-up. The analysis shows that pelvic ultrasound is primary diagnostic procedure, and only 36% of publications clearly describe to have performed more specific investigation. The hormone assessment is performed in the presence of specific endocrine symptoms. Laparoscopic approach is chosen by a few surgeon. Laparotomic surgery is preferred based in not recent recommendations for ovarian cancer treatment, although it is demonstrated the efficacy and safety of laparoscopy in the treatment of ovarian epithelial tumors. Different steps that are usually used for oncological ovarian cancer staging are not always performed. Conservative and fertility sparing surgery is commonly accepted, and even preferred due to the young age of patients. In the surgical treatment of SLCTs is necessary to adopt common guidelines, and evenly define the steps that the patient should be submitted. If are observed epithelial cancer oncological principles, laparoscopic surgery should be the approach of choice for these patients.