The reproductive outcome in 41 consecutive patients with cesarean-induced isthmocele and secondary infertility was evaluated prospectively. Patients included menopausal women (mean SD; 95% CI age, 35 ...4.1; 29-42 years), with fertility duration of 3 to 8 (4.6 28) years with isthmocele, postmenstrual abnormal uterine bleeding, and suprapubic pelvic pain. Transvaginal ultrasound and office hysteroscopy were used to diagnosis isthmocele. Complete fertility tests were performed to exclude other causes of infertility in both female and male participants. Operative hysteroscopy was performed to correct the cesarean scar defect, and histologic findings were evaluated. Correction of isthmocele via operative hysteroscopy was successful in all cases evaluated. Patients became pregnant spontaneously between 12 and 24 months after isthmoplasty. Thirty-seven of the 41 patients (90.2%) delivered via cesarean section, and 4 (9.8%) had a spontaneous abortion in the first trimester. Isthmoplasty resulted in resolution of postmenstrual abnormal uterine bleeding and suprapubic pelvic pain in all patients. Thus, it was concluded that surgical treatment of cesarean-induced isthmocele using a minimally-invasive approach (operative hysteroscopy) restores fertility and resolves symptoms in women with a cesarean section scar and secondary infertility.
The obstetric complications that a cesarean delivery may produce have been known and studied for a long time. In the last few years, new correlations with some gynecologic disturbances also emerged, ...such as postmenstrual abnormal uterine bleeding (PAUB), and with some cases of secondary infertility. This is due to the presence of a diverticulum on the anterior wall of the uterine isthmus or of the cervical canal at the site of a previous cesarean delivery scar. The aim of our study was to assess the effectiveness of a hysteroscopic surgical technique to correct this anatomic defect and therefore eliminate the symptoms.
A prospective study (Canadian Task Force classification III).
Private clinic and university hospital.
Twenty-six patients who previously had 1 or more cesarean deliveries, were evaluated from 2001 to 2005 for postmenstrual uterine bleeding and secondary infertility in 9 patients. All patients had a "niche" (which we defined as "isthmocele") principally on the isthmus-superior third of cervical canal (18/26), but on the lower cervical tract too (8/26). All of them underwent resectoscopic correction of the "isthmocele."
Hysteroscopic resection of the edges and the bottom of the defect until the complete removal of the fibrotic scar tissue showing the muscular tissue below, using a cutting loop and pure cutting current. Aimed electrocoagulation of the bottom of the pouch with a roller-ball to avoid the in situ production of blood.
The anatomic defect in 100% of patients treated (26/26) was repaired, thus solving the symptom. Seven of 9 patients with secondary infertility became pregnant.
The "isthmocele" represents a possible consequence of one or more cesarean deliveries and may be symptomatic in some women. It is a defect that can be easily diagnosed by hysteroscopy and successfully treated by resectoscopic technique.
This paper makes three points relevant to the application of the precautionary principle to the regulation of GMOs. i ) The unavoidable arbitrariness in the application of the precautionary principle ...reflects a deeper epistemological problem affecting scientific analyses of sustainability. This requires understanding the difference between the concepts of 'risk', 'uncertainty' and 'ignorance'. ii ) When dealing with evolutionary processes it is impossible to ban uncertainty and ignorance from scientific models. Hence, traditional risk analysis (probability distributions and exact numerical models) becomes powerless. Other forms of scientific knowledge (general principles or metaphors) may be useful alternatives. iii ) The existence of ecological hazards per se should not be used as a reason to stop innovations altogether. However, the precautionary principle entails that scientists move away from the concept of 'substantive rationality' (trying to indicate to society optimal solutions) to that of 'procedural rationality' (trying to help society to find 'satisficing' solutions).
In this paper we present several concepts related to integrated analysis of societal metabolism across scales. First we introduce the concept of "dynamic energy budget" of human societies, which is ...based on the distinction between exosomatic and endosomatic energy flows and the possibility of establishing autocatalytic loops (egg-chicken patterns) among them. Second, we discuss the nature of the dramatic changes that the industrial revolution induced on the characteristics of societal metabolism. Finally, we discuss methodological problems related to the representation of complex adaptive systems. Dealing with sustainability of human societies requires the parallel use of non-equivalent descriptive domains. This, in turn, requires the ability of "scaling up and down" when moving across levels handling parallel non-reducible assessments.
The crucial challenge for integrated analyses of socioeconomic systems is keeping coherence in their multidimensional representation. Our approach describes the hierarchical structure of ...socioeconomic systems using the profile of allocation of "human activity" over a set of compartments defined at different hierarchical levels (e.g., whole countries, economic sectors, individual households). Compartments are characterized in terms of intensive variables ("intensity" of both "exosomatic energy flows" and "added value flows" per unit of human activity) and the extensive variable "Total Human Activity" ← → "population." In this way, relations of congruence across hierarchical levels can be used to link non-equivalent analyses. That is, changes in demographic variables, economic variables, technical coefficients, indices of environmental loading, institutional settings, and social aspirations are no longer independent of each-other even if described within different scientific disciplines.
This paper is aimed at assessing the comparative importance of constraints in land and labour endowment for energy balance in agriculture, when assessed at the level of national crop production ...systems. The relation between output/input energy ratio of agriculture (output: food energy in crops; input: commercial energy embodied in technical inputs), average labour productivity (food energy (in Joules) produced per hour of labour allocated to agriculture) and land productivity (food energy (in J) produced per hectare of cropped land) has been studied on a 75-country sample using a cluster analysis procedure. A cross-section equation has been developed, explaining output/input ratio in terms of intensity of land and labour-food-energy throughputs. The results suggest that land constraints, with respect to the total population size, rather than labour constraints, tend to be associated with comparatively higher energy requirements in agricultural production. Therefore, the ‘emancipation’ of agricultural production from land shortages implies two ‘biophysical costs.’ That is, for the production of the same amount of food, a consistent increase in demographic density implies both a larger consumption of fossil energy input and a larger environmental impact.
The availability of natural resources and the socioeconomic context in which aquaculture is performed condition the choice of aquacultural production techniques. In this paper, we examine and compare ...the pattern of biodiversity use (the ecological side of the production process) and the technical coefficients (the economic side of the process) that characterize freshwater aquaculture in PR China and in Italy in relation to the role that freshwater aquaculture plays in these societies. The comparison between aquaculture in China and Italy covers the following aspects: (1) history and general statistics of aquaculture; (2) cultivated species and trophic structure of managed freshwater ecosystems; (3) technological characteristics of the production process, including inputs/outputs, yields, labor productivity, and fossil energy use; (4) role of freshwater aquaculture in relation to its socioeconomic context.
In Italy, where socioeconomic constraints (high opportunity cost of labor and a food system dealing with a surplus of nutrients) overwhelm ecological constraints (through imports and technology), freshwater aquaculture operates with densities of nutrient flows outside the range typical of natural aquatic ecosystems. Freshwater bodies used for production are artificial and generally contain only one carnivorous species that depends for its survival on human management of inputs and waste disposal.
In contrast, in China, up to nine different species (mainly herbivores) are kept in the same pond, and efforts are made to maintain as much as possible the natural mechanisms of regulation of matter and energy flows. This results in higher efficiency in terms of use of biological energy (from biological cycles) within the system, lower environmental loading, and less dependence on fossil energy inputs. However, the better biophysical performance of Chinese aquaculture is linked to low labor productivity. This makes it difficult to adopt such an ‘ecologically friendly’ solution in developed countries, such as Italy, where the opportunity cost of labor is high.
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