External pancreatic fistulas resistant to conventional endoscopic therapy: endoscopic closure with N-butyl-2-cyanoacrylate (Glubran 2)

External pancreatic fistulas may follow abdominal surgery or injury. While most respond to conservative management or endoscopic intervention, others might require surgery for complete healing. We report four cases of patients with external pancreatic fistulas that failed to respond to conservative management and drainage. N-butyl-2-cyanoacrylate surgical glue (Glubran 2) was directly injected into the fistulous tract. The fistulas closed within 24 hours of the Glubran 2 injection in three cases (75 %). In patients with external pancreatic fistulas that fail to respond to conservative and endoscopic drainage, injection of Glubran 2 directly into the fistulous tract may lead to closure, thus avoiding the need for surgical intervention.

Erectile dysfunction: expectations beyond phosphodiesterase type 5 inhibition

In the last few years the pathophysiological mechanisms of erection have been partially clarified, and the molecular machinery of the cellular components of the corpus cavernosum (CC) has been widely investigated. Since erection is a vascular event and the penis is a vascular organ, there must be an intact endothelium for an erection to occur. The regulation of penile tumescence inside the CC involves a balance between contracting and relaxing factors which regulate the functional state of smooth muscle cells. Recent studies have highlighted the importance of new local factors (i.e. phosphodiesterases, rho-kinases and endothelins), and pharmacological agents are available in the armamentarium of the specialist which are targeted to modulate the function of those mediators of erection. It is now well understood that male erectile dysfunction (ED) is a symptom rather than a disease; for this reason in the near future both general practitioners and specialists in internal medicine would have to interplay with sexual medicine. This review is intended to give the clinician some basic concepts of the pathophysiology of erection with relevance to the clinical practice, and to discuss the newest therapeutic approaches for those patients who do not respond to the treatment with oral inhibitors of phosphodiesterase Type 5.

Model for total evaluation of a phytosanitary intervention in the context of new methodology of <<GREAT CHAIN>>

The model of the "GREAT FILIERA" is proposed for as it concerns the total evaluation of a phytosanitary intervention in the vine-growing and wine-producing sector. This model is essentially based on the application of a new methodology used for the evaluation of a control system (Carbonneau & Cargnello, 2003) already tested in applicatory phase. The total evaluation is determined by an appropriate panel of judges. They have considered and assigned a "weigh" in % in one scale of priority (number that follows the variable) and beyond fifty descriptors of the productive system, constituting the total system.

Activity of natural products against courgette powdery mildew

The effectiveness of several natural products in field trials were tested against powdery mildew on courgette. Sulphur, sodium bicarbonate (alone or in mixture with pinolene, mineral oil or sulphur), sodium silicate in mixture with mineral oil, potassium permanganate, lecithin, Equisetum arvense in mixture with Timus vulgaris, Ampelomyces quisqualis and Reynoutria sachalinensis were evaluated. Generally, in our working conditions (very strong pathogen infection), only some products were effective. Good results were obtained using sulphur and potassium permanganate in the first year and very interesting results about disease control were obtained, in the second year of the trial, using sulphur alone or in mixture with sodium bicarbonate. The products tested did not show any phytotoxic symptoms.

Repercussion of the phytosanitary treatments on various models of foliage management in a Cabernet Sauvignon Vineyard (I note)

This study is the first communication about the repercussion of several phytosanitary treatments in three different training systems, differently managed in foilage, in relation to the usual phytopatologies: botrytis, acid rot, grape mildew and oldium. Particular attention to residuals of the products supplied on the foilage and present in ground and wine is paid. The considered foilage management systems are among those more spread and effective ones for a good quality wine production for Cabernet Sauvignon variety (clone R5). 11. Cordon Spur of Conegliano (C.S.C); 12. Simple Free Espalier Curtain (S.C.S.L); 13. Lyra (Lyra). The phytosanitary interventions for the foilage management systems have been compared between the company's ordinary plan and one with various and numerous active principles. The CG-ECD with Multiresidual analysis has determined the active principles residuals in the ground and in the wines. The characteristics of the wines have been determined by physical- chemical analysis; their organoleptic quality has been valued by panels of producers, oenologists, consumers and restaurant staff. The results point out a difference among the trials for the different presence of residuals. The foilage management justifies the diversity of the analytical composition of the wines. There is a substantial uniformity of judgements for the organoleptic quality. In conclusion, in this prove the judgement on the economic quality highlights the uselessness of the use of more incisive and radical active principles.

Emotional activation of obese and normal women due to imagery and food content of verbal stimuli in a memory task

The aim of this study is to look for correlation between a physiological variable (skin conductance, SCL) and cognitive variables (reaction time, RT and productivity score) obtained in a memory task. Subjects were 17 females, including 7 patients and 10 controls. Patients were recruited among women who went to a clinic for alimentary disorders because of obesity and volunteered for this study; controls were normal women of comparable age without any alimentary problem. Tonic variations of SCL were recorded by a computerized polygraph during the execution of the cognitive task, which consisted of a computerized presentation of frequent, everyday used words evenly divided according to an alimentary/nonalimentary content and to a high/low imagery quality. The acquisition session was followed by an immediate recognition session where subjects were asked to identify the previously presented words among an equal number of similar words not included in the acquisition list. The two session series (acquisition and recognition) were repeated three times to evaluate the learning curve and habituation. This same procedure was separately performed with high imagery alimentary/nonalimentary words and with another list of low imagery alimentary/nonalimentary words. During the recognition tasks, both RT and productivity scores were recorded. A correlation analysis between cognitive and physiological variables was carried out to explore how subjects with different attitudes to food react in cognitive and somatic terms when exposed to verbal stimuli concerning this topic and to neutral verbal stimuli. Results show that obese patients have a different emotional activation in front of these verbal stimuli where both the cognitive activity and the somatic responses are affected by their involvement with the verbal stimuli. On the contrary, the imagery effect does not seem to be influenced by the content and by the idiosyncratic reactions to it of the specific groups of subjects.

Total, technical, economic and social evaluation of a plan for defense of the vineyard according to the methodology of the "GREAT CHAIN"

In another work, proposed in this congress, we have presented the basic methodology of the "GREAT CHAIN" in which a plan of fight to vine diseases is evaluated in the globality using 54 variables, to which a weight (in %) in a scale of priority at technical, economic, social and ethical level has been given. This basic methodology has been favourably accepted at the XIII GESCO Congress (Groupe International Systèmes De Conduite de la Vigne)--February 2003 in Montevideo (Uruguay), and at the congress on "Paysages de Vignes et de Vins" in Fonteyraud (Val de Loire) (Carbonneau, Cargnello, 2003). In this work the results of researches on the total, technical, economic, social and ethical evaluation of a conventional phytopathologic defence plan led in a vineyard of the Latium according to the method of the "GREAT CHAIN" are exposed. These researches have shown that the model of conventional phytopathologic struggle, applied in the Latium, against pests of vine positively answers for how much concerns the plants protection: the answer is good at enterprise level, but negative for all that is defence and safeguard for man and environment, in the widest sense of the term. The researches have gone on the phytopathologic defence of biological and eco-compatible vineyards with very encouraging results.

The orexigram in patients affected by morbid obesity: a preliminary report on daily hunger sensation before bariatric surgery

OBJECTIVE

The present study investigated the orexigram, the time-qualified self-rated estimate of hunger sensation (HS), in patients affected by morbid obesity (MO) with the aim of detecting how daily HS behaves before morbidly obese patients (MOP) undergo bariatric surgery (BS). This article is therefore a preliminary report as it is necessary to make subsequent comparisons with post-BS orexigrams. Preoperative orexigrams may be helpful in selecting the MOPs who are candidates for surgical treatment.

MATERIALS AND METHODS

Ten MOPs (five males and five females, with a mean age of 34 +/- 11 yr and a mean BMI of 49.32 +/- 7.26 kg/m2), and 19 clinically healthy control subjects (CHS: nine males and ten females, with a mean age of 24 +/- 2 yr and a mean BMI of 21.00 +/- 1.70 kg/m2) gave their informed consent to participate in the study. All of the study participants were asked to compile a 24-h orexigram, which was then biometrically analysed by means of: 1) conventional methods for parametric statistics; 2) rhythm analysis for their circadian rhythms; and 3) spectral analysis for their harmonic structure.

RESULTS

The orexigrams of the MOPs had significantly increased mean daily levels (daily hyperorexia), retained their circadian periodicity despite an increase in mesor, and were consistently modified in their ultradian spectral harmonic components.

CONCLUSIONS

The results show that the studied MOPs complain of a daily hyperorexia that is still perceived circadically. This perception is a structured abnormality, as demonstrated by the consistent changes in the spectral analysis, and so MOPs can be diagnosed as being affected by so-called "hyperorectic obesity". It will be interesting to see whether or not presurgical hyperorexia in MOPs is corrected by BS: if so, hyperorexia may become an additional indication, and presurgery orexigrams could be suggested as an additional means of selecting the hyperorectic MOPs who are candidates for surgical treatment.

Organic viticulture: efficacy evaluation of different fungicides against Plasmopara viticola

The restriction on the use of copper salt fixed by the European Community (Reg. EC n. 473/2002) owing to the environment problems due to the copper accumulation in the soil, has stimulated the research to evaluate the possibility to reduce the copper use. This field experiment was carried out to estimate, in an organic vineyard, the effectiveness, against Plasmopara viticola (Berk. et Curt) Berl. et De Toni, of copper compounds at a low rate or alternative copper products. Guideline EPPO/OEPP PP 1/3 (2) has been used. Plots of 18 plants each, repeated 4 times in a randomized design, have been arranged. The obtained results, even if related to circumscribed and extremely favorable field for the development of the grapevine downy mildew, evidenced the impossibility to practice a defense to fixed cadence, succeeding, at the same time, to respect the limits of European Community for copper metal. The reference product, that has guaranteed the best results, determined a total contribution of copper metal of 25.7 Kg/ha that leaves very little possibilities of copper use in the following years, like previewed from the Reg. EC n. 473/2002; therefore a strategy of defense of this type turns out as not usable. The two cupric products characterized by the low metallic content were not completely satisfactory in our operating conditions with high pressure of grapevine downy mildew, but they determined a contribution of copper metal under the limits established by the European Community. Therefore new experiments, using differentiated strategies, should be carried out to improve the effectiveness of these fungicides. About biofungicide, it gave total absence of biological activity against P. viticola. The limits of the used formulations regarding the operating protocol applied, are evidenced, for some of them, by epidemiological results, for the others by the high amount of distributed copper, that causes an accumulation of residual in soil and leaves. Through the examination of the results and considering the particular climatic condition that characterized 2002, we can conclude that the trial must be considerate valid for the stressful situations that affected the vineyard.

Non-invasive vascular imaging for erectile dysfunction

In the era of orally active agents the clinical context of the diagnosis and treatment of erectile dysfunction (ED) has radically changed. There is a general trend oriented towards choosing invasive diagnostic testing and surgical treatment solutions. Along this view, penile pharmacotesting (PPT) may represent an inexpensive and easy diagnostic procedure to be performed in the office setting. However, this procedure provides no direct vascular imaging, has a high percentage of false diagnoses and its accuracy for subsequent treatment decisions remains quite limited. Hence, home testing with orally active agents may provide better information for the patient's goals. In the diagnostic work-up of ED, the combination of PPT plus colour-duplex Doppler ultrasonography (CDDU) has gained more credit because of a higher diagnostic accuracy than PPT alone, so that it should be always performed when possible. It represents an accurate mean to predict cavernous artery inflow and venous leakage when compared to more invasive diagnostic techniques; in fact it allows the measurement of the resistive index when maximal response to vasodilator challenge has occurred. In conclusion, we recommend CDDU to all ED patients with a significant risk of cardiovascular disease, as well as in the presence of penile plaques whereas a frequent involvement of neuro-anatomical structures occurs. Other vascular testing--i.e. natural penile tumescence, cavernosometry/graphy, angiography are reserved to selected patients in whom CDDU alone has provided inconsistent information.

Medical therapy of sexual dysfunction

The recent development of new medications for the treatment of the sexual dysfunction increased the possibility of improving the altered sexual performance. Although initially designed for the treatment of male sexual dysfunction, erectile dysfunction in particular, these substances have now been tested for the therapy of a broad range of sexual dysfunction also in the female. Here we will briefly review the therapeutic options currently available and the potential of new pharmacological treatments for male and female sexual dysfunction.

Natural specific radioactivity in different soils. Transfer in the soil plant food chain

In order to warrant customer's health we must pay attention to the quality of the environment and production processes; that means look all over alimentary chain. Media speak often about this topics, because of the interest of the public opinion regarding agribusiness; Nether the less much is know about soil radioactivity, but often scant attention is directed to the knowledge of the amount what remains in food and arrives to the man who is the last and main user of the product. As a consequence of that, we have done some originals studies concerning specific radioactivity in alimentary chain: soil-plant-food. These studies have been made in relation with geopedologic position of fields in volcanic, clayey, sandy soils of Latium. We have measured radioactive activity over some alimentary chains both annual (like turnip and garden cress) and pluriannual (such as vine). We made comparisons on the same soils studying the following natural markers: K40, Pb214, and Bi214; and Cs137, one of the main natural markers.

Presence of plant protection products in three agricultural areas of Regione Lazio

Aim of the research was to verify the impact of plant protection products on three significant agricultural areas of Regione Lazio: Maccarese, Cisterna di Latina, Sabaudia-Terracina. This research studied the presence of some active ingredients, indicated by technicians as distributed, on soil, water, crop and air samples, the last one in greenhouse; the analysis, carried out by multi-residue methods, allowed to investigate also on a large amount of active ingredients not indicated by technicians. The determinations have been obtained, using internal standards, by GC-NPD, GC-ECD, HPLC-UV, HPLC-DAD, with different columns, conditions and wavelength of adsorption. Taking into account the results we could to assert that only a small part of the molecules searched were found in the samples and that they are typical for the crops and the environment treated. In greenhouse, more persistence was founded in wood greenhouse, treated from the outside, probably for the release of a.i. in time from wood and for a better distribution. The active ingredients more frequently founded must be controlled to avoid possible accumulation or leaching, especially for herbicides in the areas of Maccarese and Cisterna di Latina. Furthermore, the molecule on which more attention must be done when applied, are: linuron on carrots, penconazole on zucchini and cymoxanil, often used inappropriately, particularly on minor crops, like red-radish. Although the number of sampling was limited, it has been possible to outline the situation in the three zones considered, for directing choices, that could be more sensible at sanitary spin-off and at the environment.

The selective estrogen receptor modulator raloxifene regulates osteoclast and osteoblast activity in vitro

Raloxifene is a selective estrogen receptor modulator (SERM) that prevents bone loss. Although it is largely used for the treatment of osteoporosis, the mechanisms by which this compound modulates the activity of bone cells are still poorly understood. In this study we investigate whether raloxifene affects osteoclast and osteoblast activity in vitro. Bone marrow cultures were established from neonatal mice and treated with 1,25(OH)(2) vitamin D(3) (VitD(3), 10(-8) mol/L) to induce osteoclast generation. Similar to 17beta-estradiol, raloxifene significantly reduced the number of osteoclasts in a concentration-dependent manner, with maximal inhibition at 10(-11) mol/L (-48%). However, as for 17beta-estradiol, at a high concentration (10(-7) mol/L), the inhibitory effect of raloxifene was abolished. In a pit assay, raloxifene inhibited bone resorption. A maximal effect was observed at 10(-9) mol/L, and maintained at a high concentration, indicating that inhibition of osteoclast formation and inhibition of bone resorption may be due to activation of, at least in part, different pathways. Osteoblasts from neonatal mice calvariae were also exposed to raloxifene. In these cells, this compound induced a concentration-dependent increase of proliferation, which was blocked by the estrogen-receptor antagonist ICI 164,384. Raloxifene also increased the osteoblast-specific transcription factor Cbfa1/Runx2 and alpha2 procollagen type I chain mRNAs, with a pattern that only partially coincided with that of 17beta-estradiol. Consistent with decreased osteoclastogenesis, raloxifene inhibited the mRNA expression of interleukin (IL)-1beta and IL-6 at a low concentration, but not at a high concentration, whereas 17beta-estradiol had similar effects on IL-6 and inhibited IL-1beta at both concentrations. Furthermore, both compounds were able to inhibit tumor necrosis factor (TNF)-alpha-induced IL-1beta, but not IL-6, increase. In conclusion, these data show that raloxifene negatively modulates osteoclasts, and positively affects osteoblasts, suggesting not only an antiresorptive role, but also an osteoblast stimulatory role.

Patency of anastomoses after bilio-intestinal bypass: radioisotope demonstration

BACKGROUND

Bilio-intestinal bypass (BIB) is effective for the treatment of refractory obesity. BIB permits bile flow into the non-functional jejunum, whereas food transit occurs via the remaining intestine. We used the radioisotope method of 99mTc-Hida cholescintigraphy (HC) in the follow-up of patients.

METHODS

21 patients were studied 3 months to 3 years after BIB with HC. After 3 hours acquisition, images were reviewed by two independent observers. Regions of interest (ROIs) were drawn on images: liver parenchyma, cholecysto-jejunal anastomosis (CC), choledochus (COL). Radioactivity taken up by liver was compared with radioactivity of CC and COL. % radioactivity passing through CC (%CC) and through COL (%COL) were determined. The final parameter, -COL, indicates the radioactive bile which does not pass through the choledochus.

RESULTS

Anastomoses were found patent a few months to 3 years after operation. -COL showed linear correlation with the decrease in cholesterolemia and in body weight in the 1st year after BIB.

CONCLUSIONS

HC shows passage of radioactive bile through anastomoses and provides semiquantitative evaluation of bile flux diversion. Bile flux towards the gallbladder and non-functional jejunal limb far exceeds flux directed towards the duodenum via the choledochus.

Sulphasalazine and 5-aminosalicylic acid in long-term treatment of ulcerative colitis: report on tolerance and side-effects

BACKGROUND

Use of sulphasalazine in ulcerative colitis patients is hampered by a variety of side-effects, including male infertility. 5-aminosalicylic acid is better tolerated and has been increasingly used to treat patients intolerant/allergic to sulphasalazine but it may also be associated with side-effects.

AIM

To evaluate tolerance of long-term treatment with sulphasalazine and 5-aminosalicylic acid in ulcerative colitis.

METHODS

Side-effects to sulphasalazine (2-3 g/day) and 5-aminosalicylic acid (1.2-2.4 g/day) were recorded in 685 patients: 410 patients received only sulphasalazine, 130 only 5-aminosalicylic acid, and 145 both drugs. In patients with side-effects to sulphasalazine, a desensitisation protocol (rechallenge) was attempted to improve tolerance, and patients still presenting side-effects after desensitisation were switched to 5-aminosalicylic acid. Male fertility was also assessed in 42 males on sulphasalazine and on 5-aminosalicylic acid.

RESULTS

Side-effects were observed in 110/555 patients (20%) on sulphasalazine and in 18/275 patients (6.5%) on 5-aminosalicylic acid during a median period of follow-up of 7 and 5 years, respectively. Desensitisation was achieved in 40% of patients intolerant to sulphasalazine. 5-aminosalicylic acid intake induced side-effects in 2/130 patients (1.5%) who had not taken sulphasalazine before versus 4/91 patients (4%) tolerating sulphasalazine and 12/54 patients (22%) intolerant/allergic to sulphasalazine, the difference in incidence of side-effects in the two latter groups being statistically significant (4.4% vs 20.8%, p=0. 001). Fertility was found to be affected in all patients on sulphasalazine but improved when put onto 5-aminosalicylic acid.

CONCLUSIONS

5-aminosalicylic acid should be considered the drug of choice in the treatment of ulcerative colitis bearing in mind that intolerance or allergy may occur in a few patients also on this drug.

Transient estrogen exposure of female mice during early development permanently affects osteoclastogenesis in adulthood

Estrogens modulate bone tissue turnover in both experimental animal models and postmenopausal women. Our previous studies have shown that exposure to diethylstilbestrol (DES) during the perinatal period increases peak bone mass in female mice in adulthood. We investigated whether developmental DES exposure can influence bone mass by affecting osteoclastogenesis. Female mice were injected with 100 microg/kg body weight DES from days 9-16 of gestation or, alternatively, pups received neonatal injections of 2 microg of DES from days 1-5 of life. Animals were weaned at 21 days of age and effects of estrogen on bone cells were evaluated in adulthood. A significant increase in bone mass in female mice was already observed at 2 months, with a maximal effect in older animals. Bone sections from DES-treated animals showed a significant decrease in osteoclast number and tartrate-resistant acid phosphatase (TRAP) enzymatic activity as compared with controls. To verify the importance of the estrogen surge at puberty in this event, a group of control and DES-treated mice were ovariectomized at 17 days to prevent puberty, and potential effect on osteoclastic cells was evaluated in adulthood. As expected, ovariectomy induced an increase of TRAP-positive cells. DES treatment blunted the ovariectomized-dependent increase of the total number of osteoclastic cells, suggesting a role of developmental DES exposure in the process of bone-cell imprinting. Our data indicate, for the first time, that transient changes in estrogen levels during development modulate bone turnover and osteoclastogenesis likely participating in bone-cell imprinting during early phases of bone development, and that this effect could be induced by direct alteration of bone microenvironment.

Leydig cell loss and spermatogenic arrest in platelet-derived growth factor (PDGF)-A-deficient mice

Platelet-derived growth factor (PDGF)- A-deficient male mice were found to develop progressive reduction of testicular size, Leydig cells loss, and spermatogenic arrest. In normal mice, the PDGF-A and PDGF-Ralpha expression pattern showed positive cells in the seminiferous epithelium and in interstitial mesenchymal cells, respectively. The testicular defects seen in PDGF-A-/- mice, combined with the normal developmental expression of PDGF-A and PDGF-Ralpha, indicate that through an epithelial-mesenchymal signaling, the PDGF-A gene is essential for the development of the Leydig cell lineage. These findings suggest that PDGF-A may play a role in the cascade of genes involved in male gonad differentiation. The Leydig cell loss and the spermatogenic impairment in the mutant mice are reminiscent of cases of testicular failure in man.

[Incidental diagnosis of seminoma in male infertility: report of a clinical case]

The aims of the study were to evaluate the association between male infertility and risk of developing testis cancer and to establish guidelines for the early diagnosis of testis neoplasia in subfertile men. 32-year-old infertile man. The patient underwent random testicular biopsy to establish the exact cause of infertility. An incidental diagnosis of seminoma was made and the patient then underwent right testis excision. Anatomopathologic macroscopic examination revealed two nodules, the sizes of which were 0.8 x 0.4 and 0.3 x 0.2 cm, respectively. Histologic examination confirmed the diagnosis of typical seminoma, pT1, with copious lymphocytic struma infiltration. There appears to be a correlation between male infertility and occurrence of seminoma. Diagnosis of testis cancer is often incidental and sometimes occurs in men undergoing testicular biopsy to investigate infertility. Since the biopsy was not specifically targeted in our case, the diagnosis of seminoma was casual. This suggests the need for a careful follow-up, including testicular ultrasonography as a screening test to achieve an early diagnosis of testis cancer in all infertile men, because of their higher risk of developing testis cancer than the normal population.

Analysis of Yq microdeletions in infertile males by PCR and DNA hybridization techniques

Defects in spermatogenesis have been found associated with deletions of different portions of Y chromosome long arm (Yq), suggesting the presence of the azoospermia factor in the control of spermatogenesis. We studied 67 men with idiopathic azoospermia and severe oligozoospermia, cytogenetically normal, for the presence of microdeletions on Yq chromosome. By using polymerase chain reaction (PCR) and Southern blotting techniques we analysed the AZFa, AZFb and AZFc loci on Yq, where deletions have been associated with defects in spermatogenesis. Deletions of a portion of the Y chromosome were detected in five patients. Four of these patients shared deletions in distal Yq11 interval 6, including the DAZ gene, while one patient lacked loci in the proximal Yq11. Testicular histology of two patients bearing distal Yq11 deletions showed two different spermatogenic defects including Sertoli cell-only (SCO) syndrome and maturation arrest, while the patient with microdeletions in the proximal Yq11 showed a SCO phenotype.

Prevention of thromboembolic complications in women undergoing gynecologic surgery

Our objective was to identify those patients particularly at risk of deep vein thrombosis (DVT) before they underwent extensive gynecologic surgery and to control if, a correct diagnostic analysis and a right pre-operative prophylaxis of patients with risk of developing DVT, was enough to improve post-operative prognosis. Of 2704 patients undergoing gynaecological surgery, 74 were pre-operatively considered at risk of developing DVT. Seventy percent of the patients received pre- and postoperative heparin, while 28% of the women received only postoperative heparin. Nonetheless, seven women receiving this prophylaxis developed DVT. The final results of our study demonstrate that there is a close correlation between incidence of DVT and the presence of risk factors. This incidence can be reduced by prophylactic measures such as elastic stockings for the lower legs, early post-operatory mobilization, hematocrit and volemy control, ending with pharmacological therapy with heparin.

Hysterectomy in women with cervical pregnancy complicated by life-threatening bleeding: a case report

A 27-year-old women, gravida 2, para 1 presented with massive vaginal bleeding. After two days of bleeding from the external cervical ostium, intracervical tamponade was performed but the bleeding did not stop. At laparotomy, abdominal hysterectomy with adnexa preservation was done because of malacia tissue and life-threatening hemorrhage. Pathological examination revealed an isthmic pregnancy, gravidic decidua, and chorion villi.