1
|
Lorenzo GD, Mirenda G, Gentile RM, Pozzolo CD, De Santo D, Romano F, Ricci G. Use of Indocyanine Green to Evaluate Ovarian Perfusion After Laparoscopic Detorsion. A Step-By-Step Demonstration Video. J Minim Invasive Gynecol 2024; 31:269-270. [PMID: 38244720 DOI: 10.1016/j.jmig.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/01/2024] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE Demonstrate the usefulness of using indocyanine green after laparoscopic ovarian detorsion to save the ovary. DESIGN A step-by-step video demonstration of a surgical technique. SETTING Ovarian torsion is one of the most common gynecological emergencies, mainly affecting patients younger than 20 years of age [1], and causes 2% to 7% of acute abdomens [2]. It is not advisable to routinely perform ovariectomy even with a necrotic ovary appearance [1]. Furthermore only in a small percentage of cases (16%) necrosis has been confirmed histologically [2]. Some studies have demonstrated that using indocyanine green to evaluate ovarian perfusion is inexpensive, low risk, and easily reproducible [3-5]. INTERVENTIONS A 17-year-old patient was referred to our hospital for acute abdominal pain. Ultrasound revealed ovarian torsion; therefore, the patient underwent surgical treatment. During laparoscopy, the presence of a right ovarian torsion was confirmed. A lesion compatible with a hemorrhagic corpus luteum of 6 cm was present on the ovary affected. Before ovarian detorsion, indocyanine green was administered intravenously at a 0.5 mg/kg dose. The first aspect noted was the total lack of ovarian vascularization; then ovarian detorsion was performed. At this point, using technology of Rubina (KARL STORZ SE & Co. KG, Tuttlingen, Germany), it was possible to highlight the progressive ovarian revascularization. Ovarian reperfusion occurred starting from the ovarian hilum and ending at the periphery. We proceeded with enucleation of the hemorrhagic corpus luteum by stripping technique, with subsequent ovarian reconstruction with continuous 2-0 monofilament suture. Finally, we fixed the ovary to the stump of the right round ligament. The final view highlights good ovarian vascularization. No complications occurred; the patient was discharged on the first postoperative day. A 6-month follow-up ultrasound confirmed the recovery of the vascularization of ovary. CONCLUSION Using indocyanine green represents a valid option to evaluate ovarian perfusion after detorsion. It could help the surgeon decide to save the ovary and thus allow fertility-sparing surgery in more cases.
Collapse
Affiliation(s)
- Giovanni Di Lorenzo
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy (Drs. Di Lorenzo, Mirenda, Davide, Romano, and Ricci)
| | - Giuseppe Mirenda
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy (Drs. Di Lorenzo, Mirenda, Davide, Romano, and Ricci).
| | - Roberta Marie Gentile
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy (Drs. Gentile, Dal Pozzolo, and Ricci)
| | - Chiara Dal Pozzolo
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy (Drs. Gentile, Dal Pozzolo, and Ricci)
| | - Davide De Santo
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy (Drs. Di Lorenzo, Mirenda, Davide, Romano, and Ricci)
| | - Federico Romano
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy (Drs. Di Lorenzo, Mirenda, Davide, Romano, and Ricci)
| | - Giuseppe Ricci
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy (Drs. Di Lorenzo, Mirenda, Davide, Romano, and Ricci); Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy (Drs. Gentile, Dal Pozzolo, and Ricci)
| |
Collapse
|
2
|
Busonero F, Lenarduzzi S, Crobu F, Gentile RM, Carta A, Cracco F, Maschio A, Camarda S, Marongiu M, Zanetti D, Conversano C, Di Lorenzo G, Mazzà D, De Seta F, Girotto G, Sanna S. The Women4Health cohort: a unique cohort to study women-specific mechanisms of cardio-metabolic regulation. Eur Heart J Open 2024; 4:oeae012. [PMID: 38532851 PMCID: PMC10964981 DOI: 10.1093/ehjopen/oeae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 03/28/2024]
Abstract
Aims Epidemiological research has shown relevant differences between sexes in clinical manifestations, severity, and progression of cardiovascular and metabolic disorders. To date, the mechanisms underlying these differences remain unknown. Given the rising incidence of such diseases, gender-specific research on established and emerging risk factors, such as dysfunction of glycaemic and/or lipid metabolism, of sex hormones and of gut microbiome, is of paramount importance. The relationships between sex hormones, gut microbiome, and host glycaemic and/or lipid metabolism are largely unknown even in the homoeostasis status. Yet this knowledge gap would be pivotal to pinpoint to key mechanisms that are likely to be disrupted in disease context. Methods and results Here we present the Women4Health (W4H) cohort, a unique cohort comprising up to 300 healthy women followed up during a natural menstrual cycle, set up with the primary goal to investigate the combined role of sex hormones and gut microbiota variations in regulating host lipid and glucose metabolism during homoeostasis, using a multi-omics strategy. Additionally, the W4H cohort will take into consideration another ecosystem that is unique to women, the vaginal microbiome, investigating its interaction with gut microbiome and exploring-for the first time-its role in cardiometabolic disorders. Conclusion The W4H cohort study lays a foundation for improving current knowledge of women-specific mechanisms in cardiometabolic regulation. It aspires to transform insights on host-microbiota interactions into prevention and therapeutic approaches for personalized health care.
Collapse
Affiliation(s)
- Fabio Busonero
- Institute of Genetic and Biomedical Research (IRGB), National Research Council (CNR), c/o Cittadella Universitaria di Monserrato, SS554 Km 4500, Monserrato, 09042, CA, Italy
| | - Stefania Lenarduzzi
- Institute for Maternal and Child Health—IRCCS ‘Burlo Garofolo’, Via dell'Istria 65/1, Trieste, 34137, TS, Italy
| | - Francesca Crobu
- Institute of Genetic and Biomedical Research (IRGB), National Research Council (CNR), c/o Cittadella Universitaria di Monserrato, SS554 Km 4500, Monserrato, 09042, CA, Italy
| | - Roberta Marie Gentile
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Piazzale Europa 1, Trieste, 34137, TS, Italy
| | - Andrea Carta
- Department of Business and Economics, University of Cagliari, via Università 40, 09124, Cagliari, CA, Italy
| | - Francesco Cracco
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Piazzale Europa 1, Trieste, 34137, TS, Italy
| | - Andrea Maschio
- Institute of Genetic and Biomedical Research (IRGB), National Research Council (CNR), c/o Cittadella Universitaria di Monserrato, SS554 Km 4500, Monserrato, 09042, CA, Italy
| | - Silvia Camarda
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Piazzale Europa 1, Trieste, 34137, TS, Italy
| | - Michele Marongiu
- Institute of Genetic and Biomedical Research (IRGB), National Research Council (CNR), c/o Cittadella Universitaria di Monserrato, SS554 Km 4500, Monserrato, 09042, CA, Italy
| | - Daniela Zanetti
- Institute of Genetic and Biomedical Research (IRGB), National Research Council (CNR), c/o Cittadella Universitaria di Monserrato, SS554 Km 4500, Monserrato, 09042, CA, Italy
| | - Claudio Conversano
- Institute of Genetic and Biomedical Research (IRGB), National Research Council (CNR), c/o Cittadella Universitaria di Monserrato, SS554 Km 4500, Monserrato, 09042, CA, Italy
- Department of Business and Economics, University of Cagliari, via Università 40, 09124, Cagliari, CA, Italy
| | - Giovanni Di Lorenzo
- Institute for Maternal and Child Health—IRCCS ‘Burlo Garofolo’, Via dell'Istria 65/1, Trieste, 34137, TS, Italy
| | - Daniela Mazzà
- Institute for Maternal and Child Health—IRCCS ‘Burlo Garofolo’, Via dell'Istria 65/1, Trieste, 34137, TS, Italy
| | - Francesco De Seta
- Institute for Maternal and Child Health—IRCCS ‘Burlo Garofolo’, Via dell'Istria 65/1, Trieste, 34137, TS, Italy
| | - Giorgia Girotto
- Institute for Maternal and Child Health—IRCCS ‘Burlo Garofolo’, Via dell'Istria 65/1, Trieste, 34137, TS, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Piazzale Europa 1, Trieste, 34137, TS, Italy
| | - Serena Sanna
- Institute of Genetic and Biomedical Research (IRGB), National Research Council (CNR), c/o Cittadella Universitaria di Monserrato, SS554 Km 4500, Monserrato, 09042, CA, Italy
- Department of Genetics, University Medical Center Groningen, Hanzeplein 1, 97123 GZ, Groningen, The Netherlands
| |
Collapse
|
3
|
Stabile G, Gentile RM, Carlucci S, Stampalija T, Biffi S, Oletto G, Guido M, Bruno M. Maternal and fetal outcomes of intraplacental choriocarcinoma complicated by fetomaternal hemorrhage: a systematic review. J Matern Fetal Neonatal Med 2023; 36:2285238. [PMID: 38010764 DOI: 10.1080/14767058.2023.2285238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Intraplacental choriocarcinoma is a gestational trophoblastic neoplasia located within the placenta. Due to the usual silent presentation, more than half of the cases are diagnosed incidentally. It has been demonstrated that this pathology is linked to feto-maternal hemorrhage (FMH), stillbirth, and intrauterine growth restriction. The aim of our review was to establish if there are recurrent signs that might lead to an early diagnosis and better management in cases complicated by FMH. MATERIALS AND METHODS We performed a systematic review of the literature from 2000 up to March 2023. The adopted research strategy included the following terms: (gestational choriocarcinoma obstetrics outcome) AND (intraplacental choriocarcinoma) AND (gestational choriocarcinoma). The MEDLINE (PubMed), Google Scholar, and Scopus databases were searched. RESULTS The research strategy identified 19 cases of FMH coexisting with intraplacental choriocarcinoma (IC), as described in 17 studies. The perinatal mortality rate was 36.8%. In eight cases, histological diagnosis of IC was made post-delivery. Metastatic lesions were found in 75% (6/8) of described cases. One case of maternal death has been described. Chemotherapy was necessary in seven cases. Sporadical prenatal ultrasound signs were described. DISCUSSION The diagnosis of IC is usually delayed, mostly due to aspecific symptoms and signs. Histological analysis of the placenta, when not routinely performed, should be performed when warning symptoms are encountered. The maternal prognosis was good, with a mortality rate of 5.5%. A fertility-sparing approach is always possible even in the presence of metastasis. Chemotherapy seems to be useful in cases of maternal and neonatal metastasis.
Collapse
Affiliation(s)
- Guglielmo Stabile
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Roberta Marie Gentile
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Stefania Carlucci
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Tamara Stampalija
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Stefania Biffi
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giulia Oletto
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy
| | - Maurizio Guido
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Matteo Bruno
- Unit of Obstetrics and Gynecology, San Salvatore Hospital, L'Aquila, Italy
| |
Collapse
|
4
|
Stabile G, Gentile RM, Carlucci S, Restaino S, De Seta F. A New Therapy for Uncomplicated Vulvovaginal Candidiasis and Its Impact on Vaginal Flora. Healthcare (Basel) 2021; 9:healthcare9111555. [PMID: 34828601 PMCID: PMC8625853 DOI: 10.3390/healthcare9111555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 11/18/2022] Open
Abstract
Background: An estimated 75% of women will have one episode of vulvovaginal candidiasis (VCC) during their lifetime, and 40–50% of these will experience further episodes. The high incidence of vulvovaginal candidiasis, combined with the problems of azole resistance and toxicity, highlights the necessity for new strategies for the treatment of this condition. In this context, natural compounds represent promising alternatives. Methods: We enrolled, between January 2020 and April 2021, forty women affected by uncomplicated vulvovaginal candidiasis. Women were divided into two groups. In the first group, we treated 20 women with clotrimazole daily administration for six days. In the second group, 20 women were treated with clotrimazole associated with Unilen® Microbio+, a new product containing Saccharomyces cerevisiae, melatonin, and GLA-14. Women underwent a check at days 15, 30, and 90. A clinical and cultural examination were performed to establish the effect of the treatments on vaginal flora. Results: In the group treated with Unilen® Microbio+, clinical and microbiological cure at 15 and 30 days was observed in 18 women (90%), compared with 16 women (80%) in the group treated only with clotrimazole. The efficacy of the association between clotrimazole and Unilen® Microbio+ in these uncomplicated forms was therefore not inferior to the azole treatment alone. Only four women (20%) in the Unilen® Microbio+ group presented symptomatic recurrences within the 3 months, compared with eight women (40%) in the clotrimazole-only group. Microscopic wet mount analysis at 1 and 3 months demonstrated a significant increase in lactobacillus count and a reduction in the polymorphonucleate cells in the Unilen® Microbio+ group. Conclusions: Unilen® Microbio+ supplementation was demonstrated to cure uncomplicated vulvovaginal candidiasis with clotrimazole, reducing recurrence and improving vaginal flora better than clotrimazole treatment alone.
Collapse
Affiliation(s)
- Guglielmo Stabile
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, 34137 Trieste, Italy;
- Correspondence:
| | - Roberta Marie Gentile
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy;
| | - Stefania Carlucci
- Department of Obstetrics and Gynecology, Azienda Sanitaria Universitaria Giuliano-Isontina, San Polo Hospital, Gorizia-Monfalcone, 34149 Trieste, Italy;
| | - Stefano Restaino
- Department of Maternal and Child Health, University-Hospital of Udine, P.le S. Maria della Misericordia n° 15, 33100 Udine, Italy;
| | - Francesco De Seta
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, 34137 Trieste, Italy;
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy;
| |
Collapse
|