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Introduction/BackgroundEndometrial cancer is generally associated with a good prognosis, due to an early diagnosis in stage I and II, 75% and 13% respectively. For advanced-stage disease, the recurrence rate is high and the site of the relapse is heterogeneous with localized or spread peritoneal disease. The treatment strategy is based on site of relapse. For non-localized relapse the chances are limited with a poor prognosis.MethodologyWe reported our experience of three cases with peritoneal spread recurrences, in endometrial cancer patients with advanced stage diagnosis.ResultsThe patients had been underwent to multiple lines of chemotherapy including rechallenging with platinum regimens, pegilated liposomal doxorubicin and taxane, with a progression of disease. These patients came at our Department for abdominal distension and breathing difficulty, CA 125 increased and radiology find (CT scan or US scan) of ascites. In these cases, after paracentesis and a single administration of intraperitoneal chemotherapy based on carboplatin (AUC5) were showed quality of life improvement, reduction of fatigue, improved breathing and reduction of anorexia. No complications occurred.ConclusionAlthough only few cases have been reported, the exceptional results and the absence of side effects observed in these cases, strongly warrant future trials to investigate the role that intraperitoneal chemotherapy can have both as palliative treatment of refractory ascites and as salvage therapy in advanced endometrial cancer.DisclosureAll authors declare that they have no conflict of interest and nothing to disclose.

Introduction/BackgroundEndometrial cancer is the most common gynecological malignancy in developed countries.Transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) are widely accepted as imaging tools in preoperative local staging.In this prospective study, we evaluated the diagnostic accuracy of TVUS and MRI for detecting the depth of myometrial invasion and cervical involvement and for measuring tumor volume. We also correlated tumor volume to negative histological prognostic factors.MethodologyWe enrolled women with a histological diagnosis of endometrial carcinoma. The study was conducted from January 2018 to March 2019. All patients were evaluated by TVUS and pelvic MRI with gadolinium, in the absence of any contraindication. We compared the preoperative imaging results with final histopathology.ResultsThe mean age was 63,65±9.79 years. Fifty-four out of the 60 patients resulted suitable for primary surgery. Six patients underwent neoadjuvant chemotherapy for carcinomatosis. Twenty-eight women underwent both TVUS and MRI. The additional 26 patients underwent only TVUS because they were not able to perform MRI.Both TVUS and MRI showed an accuracy of 85.7% for diagnosing presence or absence of myometrial invasion and an accuracy of 100% and 89.3% respectively, for the assessment of deep myometrial infiltration. The accuracy for the cervical involvement was 92.9% and 96.4% for TVUS and MRI respectively. The coefficient of determination (R2) of tumor volume measurement was 0.99, 0.95 and 0.98 using 3-Dimensional (D) TVUS, 2-D TVUS and MRI respectively.A value of tumor volume ≥2 ml showed a positive correlation with negative histological prognostic factors, such as high tumor grade, lymphovascular space involvement (LVSI) and deep myometrial invasion (p<0.05).ConclusionThe accuracy of TVUS and MRI in evaluating deep myometrial invasion, cervical involvement and tumor volume measurement were comparable. A preoperative evaluation of the tumor volume would allow the identification of the patients with a poor prognosis.DisclosureNothing to disclose.

ObjectivesTo evaluate a correlation between pre-surgical condition as predictor of overall, severe complications and 90 days mortality in patients undergoing cytoreductive surgery for advanced ovarian cancer.MethodsConsecutive patients affected by advanced ovarian cancer who have undergone cytoreduction surgery were considered for the study. Patients’ characteristics’ and surgical data were recorded. Modified Frailty Index (mFI) was evaluated. Higher mFI scores indicated more severe comorbidities. Postoperative complications were evaluated and graded according to Accordion score. Logistic regression was used to evaluate the associations between clinical and surgical variables and severe or overall complications.Results263 patients were included. 86 patients developed at least one complication: 70 (26.6%) of these reported mild complications, 13 (4.9%) developed severe complications, 3(1.1%) died within 90 days from surgery. At multivariate analysis logistic regression mFI>3 (OR: 1.67, CI 95% 1.08–2.81;p=0.05) the complexity of surgical procedures performed (OR: 4.15, CI 95% 2.38–7.23; p<0.001) were independent predictors of overall complications, while BMI>30 (OR: 5.13, CI 95%:1.15–22.92, p=0.03), mFI>3 (OR:2.45,CI95%:1.06–5.67;p=0.04),high complexity surgery executed (OR:12.31,CI95%:3.08–47.74;p<0.001) were independent predictors of severe complications.ConclusionsmFI and high complexity surgery are predictive of Severe and Overall Complications. Patients’ pre-operative care profile evaluation may guide specialists in reducing, preventing and managing complications correctly. mFI seems to be effective in identify high-risk patients and represent a valuable tool to help health professionals in providing risk counseling and discussion of management for women undergoing surgery for gynecologic cancer.

Introduction/BackgroundThis study aimed to define the role of combination of preoperative PET/CT scan and SLN biopsy for detection of nodal metastasis in Endometrial Cancer (EC) patients.MethodologyAll patients affected by EC prospectively collected from January 2014 to August 2016 underwent PET/CT scan and SLN mapping using indocyanine green (ICG) as tracer. Patients with suspicious lymph nodes at FDG-PET/CT underwent selective pelvic lymphadenectomy. In case of undetectable SNL, no further lymphadenectomy was performed if PET/CT scan was negative. Basic descriptive statistics were used to describe outcomes.ResultsA total of 83 patients were enrolled in the study. PET/CT scan was suggestive of nodal involvement in 15 patients. SLN were detected bilaterally in 78% of patients. Detection rate was influenced by patient’ BMI and learning curve. Five patients were node positive: of these all had hyper metabolic nodes at PET/CT scan, in 1 patient SLN was not detected. Ten out of 15 patients, with suspicious nodal at PET/CT scan, was node negative. After a median follow up of 24 months (range 14–45) all patients are alive. Four patients experienced recurrent disease. No nodal relapse was recorded.ConclusionLymphatic mapping with sentinel node biopsy is able to reduce morbidity associated with pelvic lymphadenectomy. Detection rate is strongly improved with learning curve and reduced in morbidly obese patients. PET/CT scan shows high sensitivity for nodal metastasis but moderate specificity and may help to avoid nodal dissection in patients with sentinel node failure.DisclosureNothing to disclose.

The effectiveness of ozone treatment for improving (he biodegradability of recalcitrant pollutants has been proved by investigating the ozonation reaction of FAST-VIOLET-B (FVB) a bioresistant chemical intermediate of azo-dyes. Laboratory scale experiments have been carried out, at room temperature, by bubbling, for 90 min, ozonated air (9ppmO3/min) into 0.35 l of an alkaline (pH=11) aqueous solution (50 ppm) of FVB. The experimental results indicate that during the ozonation, even though complete FVB degradation occurs in 10 min, ozone consumption goes on for a further 20 min after which time most degradation reactions are completed. The main ozonation by-products, identified by HPLC, IC, and GC-MS are formaldehyde, acetaldehyde, glyoxal, acetone, acetic-, formic-, oxalic- and carbonic-acid, plus six FVB derivatives scarcely biodegradable. At the end of the ozonation, i.e. after 30 min., the initial values of TOC (35 mgC/l) and COD (103 mgO2/l) are respectively 27 and 25 and correspond to a relative removal of about 23% and 76%. As for FVB solution biodegradability expressed as (BOD5)/COD) ratio, during the first 10 min its value regularly increases from zero up to a maximum of 0.75 that corresponds to an ozone consumption of 2.4 mg per each mg of organic carbon initially present in the solution.

Among the activities appointed by the EC research-project “Integrated water recycling and emission abatement in the textile industry” (Contract: ENV4-CT95-0064), the effectiveness of ozone for improving the biotreatability of recalcitrant effluents as well as for removing from them toxic and/or inhibitory pollutants has been evaluated at lab-scale. Real membrane concentrates (pH=7.9; TOC=190 ppm; COD=595 ppm; BOD5=0 ppm; Conductivity=5,000 μS/cm; Microtox-EC20=34%) produced at Bulgarograsso (Italy) Wastewater Treatment Plant by nanofiltering biologically treated secondary textile effluents, have been treated with ozonated air (O3conc.=12 ppm) over 120 min. The results have indicated that during ozonation, BOD5 increases from 0 to 75 ppm, whereas COD and TOC both decrease by about 50% and 30 % respectively. As for potentially toxic and/or inhibitory pollutants such as dyes, nonionic surfactants and halogenated organics, all measured as sum parameters, removals higher than 90% were achieved as confirmed by the complete disappearance of acute toxicity in the treated streams. The only ozonation byproducts searched for and found were aldehydes whose total amount continuously increased in the first hour from 1.2 up to 11.8 ppm. Among them, formaldehyde, acetaldehyde, glyoxal, propionaldehyde, and butyraldehyde were identified by HPLC.

A design model of sewage sludge incineration plants has been developed to examine the possibilities for energy recovery. It was evident that, without sludge drying, there was a high fuel (methane) consumptions (149–192 Nm3/t sludge cake at 25% concentrations), but considerable amount of electric energy is obtainable (391–515 kWh/t sludge cake). Sizes of boiler and whole exhaust gases treatment line are in this case quite large. On the contrary, fuel consumption can be lowered down to 20 Nm3/t sludge cake at 44% concentration by introducing sludge drying. In this case fuel is needed only in the afterbuming chamber, as the combustion in the fluidized bed furnace is autothermal. Boiler and exhaust gas treatment line are considerably reduced in size when power production is not performed, thus allowing a simpler and smaller plant to be designed.

Results of sludge incineration tests on a demonstrative fluidised bed furnace are reported and discussed. They show that particulate, heavy metals and acidic compounds in the emissions can be easily controlled both when sludge is spiked with chlorinated hydrocarbons up to a chlorine concentration in the feed of 5%, and when the afterburner is switched off. As for organic micropollutants, polynuclear aromatic hydrocarbons (PAH) were much lower than the Italian limits of 10 μg/m3 (no limits are at present considered in the European Directives). Dioxins (PCDDs) and furans (PCDFs) in some tests exceeded the limit of 0.1 ng/m3 (TE) but the concentrations in the fly ashes were much lower, thus evidencing a possible presence of contaminants in gas phase. PAHs and PCDD/PCDFs were not depending on the afterburning operation, the presence of organic chlorine in the feed sludge and the copper addition to sewage sludge.

IntroductionTo compare the efficacy, safety and complications of the trans-obturator midurethral sling from inside to outside (TVT-O) and of the shorter trans-obturator midurethral sling (TVT-Abbrevo) for treatment of female SUI.Materials and methodsOne hundred fifty-eight recruited patients were randomized into either the TVT-O or TVT-Abbrevo group. Preoperative assessment included history and general assessment, urinalysis and urine culture, urogynaecological clinical examination, urodynamic evaluation and urogynaecologic interview by ICIQ-SF-UI, PGI-I and PISQ12. Operative time, perioperative complications, spontaneous voiding, postoperative complications and hospital stay were prospectively recorded in all patients. At 3, 6, 12, 24 and 36 months after surgery, patients were asked to answer urogynaecological interviews by ICIQ-SF-UI, PGI-I and PISQ12. The urodynamic assessment was performed at 12, 24 and 36 months. Success rate was assessed at 12, 24 and 36 months postoperatively.ResultsOverall, 138 of 158 patients (87%) were cured of SUI 36 months after the operation with no significant differences between groups [69 (87%) and 69 (87%) patients in the TVT-O and TVT Abbrevo groups, respectively]. The two groups did not significantly differ in operative time, intraoperative blood loss and length of hospital stay. Nine patients (11%) had postoperative groin pain in the TVT-O group and one patient in the TVT Abbrevo group (p = 0.02). Three-year control demonstrated an equal objective cure rate in both groups. There was a significant improvement in total PISQ-12 and ICIQ-SF-UI scores in both groups at 36 months FU.ConclusionTVT-Abbrevo has similar efficacy and safety compared with TVT-O in women with SUI; the use of a shorter sling reduces postoperative pain.