A nationwide prospective registry of bortezomib-based therapy in light chain (AL) amyloidosis.

Until recently, no drug was labeled for AL amyloidosis. In 2011, the Italian Medicines Agency started a program to grant access to upfront bortezomib to patients with AL amyloidosis. All subjects were enrolled in a prospective online registry.

Second cross-clamping after mitral valve repair for degenerative disease in contemporary practice.

Objectives: Scanty data are available on 'second cross-clamping' following mitral valve repair in contemporary practice. The aim of this study was to evaluate the incidence, causes and outcomes of this event in patients referred for mitral repair for severe degenerative mitral regurgitation (MR).

Methods: The study population included 2318 patients with severe degenerative MR referred for mitral repair.

Incidence and Predictors of Postoperative Need for High-Dose Inotropic Support in Patients Undergoing Cardiac Surgery for Infective Endocarditis.

Objective: Patients with infective endocarditis undergoing cardiac surgery are a high-risk population. Few data on incidence and predictors of need for high-dose inotropic support in this setting are currently available.

Design: Retrospective study.

Nonsurgical Strategies to Reduce Mortality in Patients Undergoing Cardiac Surgery: An Updated Consensus Process.

Objective: A careful choice of perioperative care strategies is pivotal to improve survival in cardiac surgery. However, there is no general agreement or particular attention to which nonsurgical interventions can reduce mortality in this setting. The authors sought to address this issue with a consensus-based approach.

The daily-practiced post-partum hemorrhage management: an Italian multidisciplinary attended protocol.

Postpartum hemorrhage (PPH) is one of the most frequent causes of mortality and morbidity in the obstetric population globally, causing about a quarter of maternal deaths yearly, and is the leading cause of maternal death worldwide. The management of PPH remains a topic of great debate, even in view of new diagnostic and therapeutic possibilities in recent years, for which, however, the body of evidence available thus far is still scarce, as the standard values are lacking. The protocol hereby presented was developed after a literature review and during several meetings of an Italian multidisciplinary task group of specialists adopting a modified Delphi method, and is the result of the synthesis of therapeutic operational protocols for the treatment of PPH applied by the different specialties within the team.

Prophylactic arterial catheterization in the management of high risk patients for obstetric haemorrhage.

Objectives: Post-partum haemorrhage still remains one of the major causes of maternal morbidity and mortality. In case of abnormal placentation it is possible to carry out preventive and therapeutic actions. To maintain fertility in reproductive-aged women and to avoid a more radical surgery, embolization has been introduced in patients at high risk for haemorrhage.

Placenta Previa Percreta: A Case Report of Successful Management via Conservative Surgery.

Placenta percreta is one of the most serious complications of placenta previa and is frequently associated with severe obstetric hemorrhage usually necessitating hysterectomy. We present a case of placenta previa percreta diagnosed by ultrasound and magnetic resonance imaging techniques, in which we accomplished conservative management of postpartum hemorrhage. The management we propose includes the following steps: preventive catheterization of the descending aorta via transhumeral access; Stark cesarean delivery; uterotonics drugs; Affronti endouterine square hemostatic sutures; intrauterine application of Bakri balloon and partial filling with 100 mL of normal saline; B Lynch suture, hysterorrhaphy, and filling a Bakri balloon with up to 500 mL of normal saline; reversible radiological embolization; and/or surgical ligation of the uterine arteries.

Cervical ripening prior to hysteroscopy: is the application of misoprostol useful?

Cervical dilatation has to be considered a fundamental step in operative hysteroscopy. Different methods are used to facilitate cervical dilatation. The aim of this review is to evaluate the efficacy of Misoprostol in cervical ripening prior to operative hysteroscopy through the evaluation of published studies.

Intra-abdominal versus free-loop portion Doppler analysis of the umbilical artery: the importance of the choice.

Aim: The aim of this study was to assess the variations in Doppler indexes along the length of the cord from the intra-abdominal portion (IAP) to the free loop portion (FLP) of the umbilical artery (UA).

Methods: UA blood flow velocities were measured at the IAP and FLP in 100 low-risk singleton pregnancies. The peak systolic velocity (PSV), end-diastolic velocity, pulsatility index (PI), resistance index (RI), PS/ED ratio and Delta value (Δ) were calculated.

B-Lynch suture, intrauterine balloon, and endouterine hemostatic suture for the management of postpartum hemorrhage due to placenta previa accreta.

Objective: To report our experience with a new conservative management approach to treat postpartum hemorrhage (PPH) due to placenta previa accreta.

Methods: A retrospective study of 9 patients with placenta previa accreta who underwent a conservative management protocol. The protocol consists of preventive radiological catheterization of the descending aorta, cesarean delivery, use of Affronti endouterine square hemostatic sutures, and placement of an intrauterine Bakri balloon in conjunction with B-Lynch suture.

Ovarian torsion in in vitro fertilization-induced twin pregnancy: combination of Doppler ultrasound and laparoscopy in diagnosis and treatment can quickly solve the case.

Objective: To diagnose and treat adnexal torsion in pregnancy.

Design: Case report.

Setting: Obstetrics and Gynecology Department of Perugia Hospital.

Mesenteric chylous cysts simulating a pelvic disease: a case report.

Mesenteric chylous cysts, also known as retroperitoneal chylomatous cysts, mesenteric lymphangiomas or chyloma of the mesentery, are extremely rare and their aspecific clinical presentation can mimic other diseases. In addition, imaging techniques, which are rarely helpful in the correct diagnosis, can demonstrate aspecific features. The Authors report the case of a 62-year-old woman admitted to the hospital for two incidental abdominal masses diagnosed during a yearly monitoring examination and considered to be large adnexal masses.

[Pharmacological induction of labour: benefits and risks].

Aim: Induction of labour is a very common practice in modern obstetrics. The most used method is based on the use of topical prostaglandins. In this study we aimed to analyse the results of pharmacological induction of labour through the use of dinoprostone, comparing the intracervical gel (Prepidil 0.

Spontaneous dissecting aneurysm of coronary artery in a pregnant woman at term.

We describe a case of spontaneous dissecting aneurysm of the circumflex coronary artery in a 44-year-old primigravida at term with no vascular risk factors. Spontaneous coronary artery dissection is a very rare condition with a greater prevalence in women, postpartum in particular. The left anterior descending artery is the most frequently affected.

[Giant pedunculated clustered uterine fibromyoma in hyaline and cystic degeneration. Limitations of clinical and instrumental diagnosis].

The authors report a case of a 46-year-old woman who was checked by integrated ultrasound examination, i.e. transabdominal and transvaginal, and by abdominopelvic CAT.

[The possibility of using sulprostone during laparoscopic myomectomy in uterine fibromyomatosis. Preliminary studies].

The authors considered sulprostone effects, PGE2 synthetic derivative, on the hematic loss during laparomyomectomy. This drug is been used by intravenous way during the operation in 84 patients affected with uterine myomatosis. The effectiveness and tolerance of the drug is thus evident in the reduction of the hematic intraoperative loss.

[Ultrasonographic monitoring of the endometrium in post-menopausal women asymptomatic or undergoing hormone replacement therapy].

This study evaluated the reliability of ultrasonography in the post-menopausal period for the screening of endometrium pathology in women who are non-symptomatic or undergoing hormone replacement therapy. A total of 152 women were examined, 76 were non-symptomatic and 76 were undergoing estro-progestational therapy. As in previous studies on the subject, we took 0.

[Post-menopausal metrorrhagia. Use of danazol in endometrial hyperplasia].

The Authors, after a careful examination of the literature on endometrial hyperplasias, review the results of a preliminary study on 15 patients affected with postmenopausal metrorrhagia, cured by Danazol (200 mg/die) through 90 consecutive days. Also recognizing the best tolerance to the drug and the low incidence of the side effects, they think the results obtained by Danazol need further confirmation by more protracted controls.

[Lasers and genital (cervico-vulvo-vaginal) pathology].

The authors performed laser vaporization in 240/250 cases for viral pathology of the lower genital tract, obtaining recovery at the first treatment in 232/240 cases and at the second in 238/248 cases.

[Comparative study of short-term antimicrobial chemoprophylaxis in gynecologic surgery: cefotetan versus cefazolin].

The results obtained in 80 patients hospitalized at the University of Obstetrics and Gynecology Clinic in Perugia for abdominal and vaginal hysterectomy are reported and evaluated in a prospective and randomized study of perioperative antibacterial prophylaxis. In the 75 patients available to study a single intravenous dose of 2 g cefotetan was compared with a triple dose of 1 g intravenous cephazolin. A reduction in the incidence of post-operative infections both in abdominal hysterectomy from 24% (cephazolin group) to 11.