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Objective: To evaluate the impact on glucose and insulin metabolism of transdermal estrogen patches before and after the addition of cyclic dydrogesterone in postmenopausal women. Design: We studied 21 postmenopausal women seeking treatment for symptomatic menopause. All patients received transdermal 50 mg/day estradiol for 24 weeks. After 12 weeks of treatment, 10 mg/day dydrogesterone were added. Methods: During both regimens, insulin and C-peptide plasma concentrations were evaluated after an oral glucose tolerance test (OGTT); insulin sensitivity was evaluated by a hyperinsulinemic euglycemic clamp technique. Insulin and C-peptide response to OGTT were expressed as area under the curve (AUC) and as incremental AUC; insulin sensitivity was expressed as mg/kg body weight. Fractional hepatic insulin extraction (FHIE) was estimated by the difference between the incremental AUC of the C-peptide and insulin divided by the incremental AUC of the C-peptide. Plasma hormone and lipid concentrations were assessed at baseline and at 12 and 24 weeks of treatment. Results: Nine patients proved to be hyperinsulinemic and 12 were normoinsulinemic. Transdermal estrogen treatment significantly decreased the insulin AUC (P < 0.05) and the insulin incremental AUC in hyperinsulinemic patients; addition of dydrogesterone further decreased both the AUC and incremental AUC of insulin. Estrogen alone and combined with dydrogesterone evoked a significant increase in C-peptide AUC in hyperinsulinemic (79.2%) and normoinsulinemic (113%) patients. The treatment increased the values for FHIE and insulin sensitivity in all patients (P < 0.04) and in the hyperinsulinemic group (P < 0.01), whereas it did not affect such parameters in normoinsulinemic patients. Conclusions: Transdermal estrogen substitution alone and combined with cyclical dydrogesterone may ameliorate hyperinsulinemia in a selected population of postmenopausal women.

Vaginal hysterectomy appears to be feasible in about 97% of cases in which this approach would have been judged unsuitable. This figure decreases to 94.2% when oophorectomy is indicated.

The movement and the distribution of water, sodium, potassium, chloride, magnesium and calcium have been studied in slices prepared from rabbit placentae at different periods of gestation, incubated in condition of depressed metabolism (0-1 degree C). In these conditions the tissue takes up water from the external medium up to a maximum of about 2.0 kg/kg d. wt., which represents 30 per cent of the initial H2O content of the fresh tissue. The extracellular compartment swells progressively and proportionally to the age of the placenta. The sodium and chloride content of the tissue increases while that of potassium decreases and their intracellular concentration reaches, after 120 min, that of the external medium. Magnesium does not show appreciable changes and calcium, too, despite its extreme variability, does not seem to undergo significant variations during the cold incubation. The results obtained show that placenta, like most of other mammalian cell systems, possesses specific metabolism-dependent mechanisms responsible for the maintenance of water distribution and ion gradients among the different tissue compartments. The characteristics and the regulation of these mechanisms are discussed in detail.

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UretexTO and PelviLaceTO are two similarly safe and efficient slings in the management of SUI, with a good patient satisfaction and without any complications.

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INTRODUCTIONThe current management of vulvar cancer depends on the extension of disease, and includes primary tumor resection with safety margin as well as inguinofemoral lymph node staging. We report the case of the first leg videoendoscopic inguinal lymphadenectomy performed in a woman with a squamous cell vulvar carcinoma.PRESENTATION OF CASEA 74 years old female referred to our institution complaining of vulvar mass associated with bleeding and swelling from external genitals, vaginal burning sensation and dysuria for 5 months. A vulvar–vaginal examination under narcosis reported a right major labium lesion of 5 cm with an irregular and ulcerated surface, easily bleeding on palpation, involving anteriorly the clitoral region and with a histological finding of a poorly differentiated squamous cell invasive carcinoma of the vulva ulcerating the surface epithelium. We performed, after adequate informed consent, a radical vulvectomy with a standard right inguinofemoral lymphadenectomy and a contralateral simultaneous video endoscopic inguinal lymphadenectomy-Leg procedure.DISCUSSIONOur minimally invasive VEIL-Leg approach, performed for the first time in literature in a woman with vulvar cancer, could reduce the presence of high risk factors represented by surgical incision and by procedure-related complications, including wound infection and breakdown, hematoma, cellulitis and hernia formation.CONCLUSIONA multicenter prospective randomized study will be helpful to clarify how this procedure could replace the standard laparotomic approach to inguinal lymphadenectomy in the vulvar cancer treatment and staging.