BackgroundThe vaginal microbiota of healthy women consists of a wide variety of anaerobic and aerobic bacterial genera and species dominated by the genus Lactobacillus. The activity of lactobacilli helps to maintain the natural healthy balance of the vaginal microbiota. This role is particularly important during pregnancy because vaginal dismicrobism is one of the most important mechanisms for preterm birth and perinatal complications. In the present study, we characterized the impact of a dietary supplementation with the probiotic VSL#3, a mixture of Lactobacillus, Bifidobacterium and Streptococcus strains, on the vaginal microbiota and immunological profiles of healthy women during late pregnancy.ResultsAn association between the oral intake of the probiotic VSL#3 and changes in the composition of the vaginal microbiota of pregnant women was revealed by PCR-DGGE population profiling. Despite no significant changes were found in the amounts of the principal vaginal bacterial populations in women administered with VSL#3, qPCR results suggested a potential role of the probiotic product in counteracting the decrease of Bifidobacterium and the increase of Atopobium, that occurred in control women during late pregnancy. The modulation of the vaginal microbiota was associated with significant changes in some vaginal cytokines. In particular, the decrease of the anti-inflammatory cytokines IL-4 and IL-10 was observed only in control women but not in women supplemented with VSL#3. In addition, the probiotic consumption induced the decrease of the pro-inflammatory chemokine Eotaxin, suggesting a potential anti-inflammatory effect on the vaginal immunity.ConclusionDietary supplementation with the probiotic VSL#3 during the last trimester of pregnancy was associated to a modulation of the vaginal microbiota and cytokine secretion, with potential implications in preventing preterm birth.Trial registrationClinicalTrials.gov NCT01367470
Background: Endometrial cell implantation after abdominal surgery, mainly after caesarean section, may result in formation of endometrioma, which is usually described to be of various sizes, and adjacent to the surgical scar. Case: A 36-year old woman complaining of a mass of the abdominal wall with pain during the menstrual period, with a caesarean section 5 years earlier, presented a rounded tumour not contiguous to the Pfannenstiel's laparotomy scar, of hard consistence, fixed and adherent to the deep abdominal wall structures, located on the left paramedian epigastric region. Magnetic Resonance imaging showed the nodule, involving the deep layers of the abdominal wall and the distance from the laparotomic scar. Surgical removal was performed with wide excision of the lesion, causing a large wall defect. After histological confirmation (endometriosis) by frozen section, reconstruction of the abdominal wall required prolene mesh grafting. After twelve months the patient is healthy. Conclusion: When abdominal wall endometrioma is located distant from the scar, perhaps more frequently after Pfannenstiel's laparotomic incision, the differential diagnosis may be more difficult and MRI can help differentiating many of these lesions, and histological confirmation should be obtained intraoperatively, by frozen section, to allow an oncological resection if required.
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