Home Gravidanza Patologia coccigea post-partum

Patologia coccigea post-partum

Da dottvolpicelli

Il coccige è un osso impari e simmetrico, ultimo tratto inferiore della colonna vertebrale. Residuo rudimentale della coda dei mammiferi nel processo evolutivo della specie umana. Deriva il suo nome dal greco κόκκυξ (kòkkyx), propriamente “cuculo”, per via della somiglianza con il becco di tale uccello. Il primo a utilizzare il termine fu  Galeno  nel II° secolo d.C. E’ formato da 4-6 segmenti fusi tra loro, che però non presentano le normali caratteristiche delle vertebre. Sono, al contrario, soltanto abbozzi di queste ultime; infatti, solo la prima vertebra coccigea presenta ancora qualche caratteristica comune alle vertebre precedenti. Si notano solo in questa gli abbozzi dei processi trasversi e dei processi articolari, definiti corni del coccige, situati posteriormente alla base e che si articolano con i corni dell’osso sacro. Nell’insieme l’osso ha forma triangolare con una base superiore, un vertice inferiore, una faccia anteriore, una posteriore e due margini laterali. La base si articola con l’apice dell’osso sacro. Le facce anteriore e posteriore presentano dei solchi orizzontali che segnano i punti di fusione dei segmenti primitivi. Sul vertice del coccige si attacca il tendine dello sfintere esterno dell’ano.

ARTICOLAZIONE SACRO-COCCIGEA – L’articolazione sacro-coccigea è costituita da una sinfisi che mette in comunicazione il corpo dell’ultima vertebra sacrale con il corpo della prima vertebra del coccige. Essa può essere classificata fra le articolazioni intervertebrali; rispetto alle altre sinfisi intervertebrali, la sinfisi sacro-coccigea   presenta un disco intervertebrale particolare, in quanto più sottile, con uno spessore disomogeneo, nel senso che anteriormente e posteriormente è più spesso che sui lati e più solido di quello delle sinfisi intervertebrali. Il disco fibrocartilagineo posto tra le due faccette articolari affrontate, presenta uno sviluppo variabile e nell’adulto spesso ossifica, divenendo una sinostosi. I mezzi di rinforzo dell’articolazione sono dati da:

  • legamento sacro-coccigeo anteriore: allo stesso modo del legamento longitudinale anteriore delle articolazioni intervertebrali, scende lungo la faccia anteriore (superficie pelvica) dell’osso del sacro, fino all’apice del coccige.
  • legamenti sacro-coccigei laterali: allo stesso modo dei legamenti intertrasversali delle articolazioni intervertebrali, si estendono tra gli angoli infero-laterali del sacro ai processi trasversi del coccige. Dall’estremità inferiore della cresta sacrale al processo trasverso della I vertebra coccigea; si distinguono in esterni, medi e interni. Essi formano in tal modo parte del contorno di un foro che corrisponde a un foro sacrale; questo foro è suddiviso in due parti dal legamento medio; il legamento interno si porta dal margine superiore del processo trasverso del coccige alla parte inferiore del sacro che si trova medialmente alla cresta sacrale laterale allo stesso modo dei legamenti intertrasversali delle articolazioni intervertebrali si estendono tra gli angoli infero-laterali del sacro ai processi trasversi del coccige.
  • legamento sacro-coccigeo posteriore: si divide in un fascio profondo che, allo stesso modo del legamento longitudinale posteriore delle articolazioni intervertebrali, scende lungo la superficie posteriore del corpo della quinta vertebra sacrale a quello del I° segmento coccigeo; in un fascio superficiale che dal contorno dello iato sacrale scende sulla superficie dorsale del coccige completando la parte inferiore della volta del canale sacrale. Il fascio superficiale va dalla cresta sacrale media e dai corni sacrali alla faccia posteriore del coccige e ai corni coccigei, chiudendo lo hiatus sacrale.
  • Legamenti intercornuali: si estendono tra i corni del sacro e quelli del coccige.
  • Ligamento pubo-ano-coccigeo: vi si inserisce il muscolo sfintere esterno dell’ano e costituisce il principale organo di sostegno di vagina, uretra e utero.

 

 

 

 

Durante la fase espulsiva del parto, il movimento di retropulsione del coccige può consentire un allargamento dello stretto inferiore fino a 2-3 cm. ma la stessa del coccige può provocare, soprattutto in caso di sproporzione feto-pelvica, le seguenti patologie:

  1. lussazione  del coccige,
  2. frattura del coccige  o
  3. lacerazione dei legamenti sacro-coccigei,

La lussazione anteriore del coccige o coccige instabile: dislocamento del coccige in avanti; la punta del coccige appare curvato in su più del normale a causa della lussazione dell’ultimo segmento coccigeo. 

La frattura del coccige si evidenzia all’esplorazione rettale e all’esame radiografico. La punta del  coccige appare spostata in avanti.

La lacerazione dei legamenti sacro-coccigei può essere evidenziata con l’esplorazione rettale e l’esame ecografico con sonda rettale.

La sintomatologia in tutti e tre i casi è costituita da intenso dolore che aumenta durante la defecazione o assumendo la posizione seduta e persiste per lungo tempo anche dopo la guarigione. La guarigione è spontanea ma richiede diversi mesi.

Diagnosi: è basata sull’anamnesi, la sintomatologia dolorosa, l’esame dinamico ai raggi X in posizione eretta e seduta, l’esame clinico con eventuale esplorazione rettale (1-3).

 

TERAPIA:

  • riduzione manuale della lussazione; 
  • intervento chirurgico per il riposizionamento del coccige in caso di fallimento della terapia fisica e persistenza del dolore.
  • Agopuntura (11).
  • Riposo: Una frattura del coccige non può essere curata chirurgicamente a causa della estrema difficoltà ad immobilizzare questo rudimentale ossso. Nella quasi totalità dei casi, la frattura del coccige guarisce senza problemi nel giro di 4-8 settimane.
  • Coccigectomia: Nei rari casi in cui il dolore fosse insopportabile e persistesse  per un lungo periodo nonostante i presidi terapeutici messi in atto, è indicata la coccigectomia, intervento di non facile esecuzione e che comunque non garantisce la completa scomparsa

    del dolore che persiste nel 20% dei casi. Si richiedono da 3 a 12 mesi per ottenere una completa guarigione e durante questo periodo si continua a soffrire sil dolore soprattutto in posizione seduta. Inoltre data la vicinanza dell’ano all’incisione chirurgica, sono frequenti le complicanze infettive (6). La tecnica che Gardner introdusse nel 1972 è ancora oggi  la più seguita nelle sue linee principali.  Essa prevede:

  1. Anestesia generale
  2. Paziente in posizione genu-pettorale
  3. Incisione cutanea longitudinale interglutea di circa 6-7 cm partendo dalla sinfisi sacro-coccigea e comunque rispettando una distanza di sicurezza di almeno 4 cm dall’ano allo scopo di diminuire i rischi di infezione.
  4. Incisione dei tessuti sottocutanei fino a raggiungere il coccige;
  5. Incisione e scollamento con garza bagnata dei tessuti e legamenti che circondano il coccige fino a mettere a nudo la sinfisi sacro-coccigea e il coccige salvaguardando la fascia rettale.
  6. emostasi accurata; drenaggio laminare se non si è del tutto sicuri dell’emostasi.
  7. Scollamento della parete anteriore coccigea attraverso lo spazio interdiscale anomalo creato dalla lesione.  Esposizione della punta del coccige, eventualmente aiutandosi con un dito introdotto nel retto.
  8. Resezione dei tralci connettivali della punta del coccige
  9. Rimozione del tratto coccigeo lesionato
  10. Eventuale rimozione del tratto coccigeo residuo se troppo prominente; in tal caso si procede alla incisione della sinfisi sacro-coccigea salvaguardandone una parte se la superficie dell’apice del sacro si presentasse irregolare.

I vantaggi di questa tecnica includono una minima dissezione tissutale, minori rischi infettivi e di lesioni rettali ed una più rapida guarigione (7-10).

Per evitare la sindrome da intrappolamento del plesso nervoso coccigeo, lo si può elettrocoagulare se non si è assolutamente sicuri della sua totale esclusione dai punti di sutura.

La paziente deve evitare la posizione seduta per almeno 4 settimane.

  •  Antidolorifici: sono consigliati i FANS come l’ibuprofene somministrati per os, per via parenterale ma anche in gel da applicare con delicati e frequenti massaggi. Con i cortisonici si ottiene un sollievo immediato dal dolore ma di breve durata; inoltre la terapia a lungo termine con i cortisonici può danneggiare l’articolazione sacro-coccigea accelerandone la calcificazione.
  • Anestesia loco-regionale: iniezione di anestetico locale (lidocaina o bipuvicaina) nel plesso nervoso coccigeo (intreccio delle branche anteriori dei primi due nervi sacrali con il 1° nervo coccigeo prima della loro distribuzione periferica). Esso è detto anche ganglio impari ed è posizionato sulla parete anteriore della sinfisi sacro-coccigea. Per arrivare a questo ganglio, si utilizza un ago ricurvo che, sotto guida fluoroscopica, si fa passare da sotto il coccige lungo la parete anteriore, oppure si utilizza un ago retto che perfora l’articolazione sacro-coccigea partendo dalla parete posteriore (4-5).
  • Blocco semi-permanente del nervo mediante criocoagulazione: utilizzando N2  liquido si ottiene il congelamento del plesso nervoso coccigeo e relativo danneggiamento che blocca la trasmissione del dolore per alcune settimane o mesi finchè le fibre nervose non si rigenerano. Può essere ripetuto, se necessario.
  • Blocco del nervo permanente  mediante rizotomia o neurolisi: solitamente questo è ottenuto con elettrodi alimentati  da corrente ad alta frequenza. Questo metodo e’ ritenuto più accurato rispetto ai vecchi metodi come l’iniezione di alcool, fenolo o glicerina che a volte possono danneggiare gli organi viciniori.  Questa tecnica spesso produce una neurolisi permanente ma sono possibili rigenerazioni spontanee del plesso nervoso con ricomparsa della sintomatologia dolorosa in forma accentuata e necessità di ripetere il trattamento. 
  • Anestesia epidurale a livello di L2 in caso di impossibilità a procedere con la precedente terapia. Ha una scarsa efficacia.
  • sedie e sedili morbidi o  ben imbottiti servono a poco perchè aumentano la pressione sul coccige; meglio utilizzare un cuscino coccigeo o sedersi su una ciambella o sdraiarsi a pancia in su mettendo un cuscino sotto le gambe oppure piegarsi leggermente in avanti per scaricare parte del peso sulle gambe  oppure stare seduti poggiandosi su una sola natica alternativamente.  
  • Immersione per 10-20 minuti della regione anale in un recipiente colmo di acqua calda
  • dieta ricca di fibre, frutta, verdure e molti liquidi per favorire la defecazione

References:

  1. Juhl JH, Crummy AB, Kuhlman JE, et al. Paul and Juhl’s Essentials of Radiologic Imaging . 7th ed. Philadelphia, PA:Lippincott, Williams, and Wilkins;1998.
  2. Low back pain. American Academy of Orthopaedic Surgeons website. Available at: http://www.aaos.org/ . Accessed July 15, 2008.
  3. Rosen P, Barkin RM, Braen GR, et al. Emergency Medicine: Concepts and Clinical Practice . 4th ed. St Louis, MO. Mosby-Year Book, Inc;1998.
  4. Foye PMButtaci CJStitik TPYonclas PP.: “Successful injection for coccyx pain”. Am J Phys Med Rehabil.2006 Sep;85(9):783-4.
  5. Staal JB, de Bie RA, de Vet HC, Hildebrandt J, Nelemans P. Spine: “therapy for subacute and chronic low back pain: an updated Cochrane review”. (Phila Pa 1976). 2009 Jan 1; 34(1):49-59.
  6. Hellberg S, Strange-Vognsen HH: “Coccygodynia treated by resection of the coccyx”. Acta Orthopaedica Scandinavica; 1990 Oct; 61(5): 463-465
  7. Richard C Gardner: “An improved technic of coccygectomy”. Clinical Orthopedics, 85: 143-145, 1972
  8. Shaposhnikov: “Surgical treatment of coccygodynia”. Khirurgiia (Moskva): 1997, 9, 47-8 (Original in Russian)
  9. Valen B; Bringedal K: “Coccygectomy for coccygodynia”. idsskrift for Den norske lægeforening; 1999 Apr, 119:10, 1429-30.
  10. Jean-Yves Maigne, Denis Lagauche, Levon Doursounian:  “Instability of the coccyx in coccydynia”. Journal of Bone and Joint Surgery [Br] 2000;82-B:1038-41
  11. Michael Durtnall: “Chiropractic and acupuncture works for acute and chronic coccyx pain/dislocation”. Original posting, 2003-03-16:

**********************************************************************************************************************

Queste  pagine fanno parte del sito fertilitycenter.it in internet da marzo 2011. I testi, le tabelle, i disegni e le immagini pubblicati in queste pagine sono coperte da copyright ma a disposizione di tutti per copia e riproduzione purchè venga citata la fonte con Link al sito www.fertilitycenter.it.

Ringrazio i lettori per la loro cortese attenzione e li prego di voler comunicare le loro osservazioni e consigli su eventuali errori o esposizioni incomplete.

                  Enzo Volpicelli.

Potrebbe piacerti anche

129 commenti

R4i Gold 12 Aprile 2013 - 10:47

This is a really good read for me, Must admit that you are one of the best bloggers I ever saw.Thanks for posting this informative article.

Rispondi
shoe lifts 13 Aprile 2013 - 0:15

Very nice weblog. Really getting excited about read more. Maintain writing.

Rispondi
hip pain in women aspx 8 Agosto 2013 - 13:58

Hi there, after reading this amazing article i am as well glad to share my experience
here with friends.

Rispondi
Letha 12 Agosto 2013 - 0:59

Everything is very open with a precise description of the challenges.
It was definitely informative. Your site is very helpful.
Thanks for sharing!

Rispondi
online associate degree programs 30 Settembre 2013 - 7:52

Heya! I’m at work browsing your blog from my new apple iphone!
Just wanted to say I love reading through your blog and look
forward to all your posts! Keep up the outstanding work!

Rispondi
pre approval 30 Settembre 2013 - 8:37

Excellent way of explaining, and fastidious piece of writing to obtain facts concerning my presentation
subject matter, which i am going to deliver in university.

Rispondi
dottvolpicelli 4 Ottobre 2013 - 16:45

good luck!

Rispondi
Nike Free Run Kids 30 Settembre 2013 - 14:22

I got this site from my friend who told me about this web page and
at the moment this time I am browsing this website and reading very
informative content here.

Rispondi
art museum chicago 30 Settembre 2013 - 18:34

Thanks for your personal marvelous posting!

I actually enjoyed reading it, you’re a great author. I will
make sure to bookmark your blog and will come back someday.
I want to encourage you to continue your great writing, have a nice evening!

Rispondi
pain of coccydynia 30 Settembre 2013 - 22:09

Its not my first time to pay a visit this site,
i am visiting this website dailly and take fastidious information
from here all the time.

Rispondi
Physiotherapie Longueuil 2 Ottobre 2013 - 16:18

Good article. I’m experiencing many of these
issues as well..

Rispondi
http://www.kitcarsonfootball.com/author/RufusWald 2 Ottobre 2013 - 16:32

I think the admin of this web page is actually working
hard in favor of his site, for the reason that here every
stuff is quality based information.

Rispondi
http://seilhuepfen.de 2 Ottobre 2013 - 23:58

Very soon this website will be famous amid all blogging visitors,
due to it’s good posts

Rispondi
dottvolpicelli 4 Ottobre 2013 - 16:21

Thank you. Cheers

Rispondi
shemale live cam 10 Ottobre 2013 - 6:05

This is the right website for everyone who would like to understand this topic.

You realize a whole lot its almost tough to argue with you (not
that I really would want to…HaHa). You definitely put a new spin
on a subject that’s been written about for many years.

Wonderful stuff, just wonderful!

Rispondi
math game 12 Ottobre 2013 - 15:00

I just like the helpful information you supply in your articles.

I’ll bookmark your blog and check once more right here regularly.
I’m quite sure I’ll be informed many new stuff proper here!
Good luck for the following!

Rispondi
"atari emulators 16 Novembre 2013 - 1:40

Your style is so unique compared to other folks I have
read stuff from. I appreciate you for posting when you’ve got the opportunity, Guess I will just book mark this page.

Rispondi
public liability} 16 Novembre 2013 - 1:50

Very good article. I’m dealing with some of these issues as well..

Rispondi
Florentina 16 Novembre 2013 - 1:59

Thanks for your personal marvelous posting! I certainly enjoyed reading it, you might be a great author.
I will be sure to bookmark your blog and will often come back from now on.
I want to encourage continue your great writing, have a
nice evening!

Rispondi
バッグ 16 Novembre 2013 - 2:00

I don’t even know the way I stopped up here, however
I assumed this post used to be good. I do not understand who you’re however definitely you’re
going to a well-known blogger for those who are not already.
Cheers!

Rispondi
mackeeper review 16 Novembre 2013 - 2:08

Hello would you mind letting me know which webhost you’re utilizing?
I’ve loaded your blog in 3 completely different browsers and I must say this blog loads a lot quicker then most.
Can you recommend a good web hosting provider at a honest price?
Thanks, I appreciate it!

Rispondi
wordpress 16 Novembre 2013 - 10:27

It’s difficult to find knowledgeable people on this subject,
however, you sound like you know what you’re talking
about! Thanks

Take a look at my web-site: wordpress

Rispondi
justhost coupon 16 Novembre 2013 - 10:41

Thanks for every other informative web site. The place
else may just I get that kind of information written in such an
ideal approach? I have a mission that I am just
now running on, and I have been at the look
out for such information.

Rispondi
http://fenetrefrance.wordpress.com 16 Novembre 2013 - 11:05

I am now not positive the place you are getting your info,
but great topic. I needs to spend some time finding out more or understanding
more. Thanks for magnificent information I used to be searching for this info for my mission.

Rispondi
junk food 16 Novembre 2013 - 12:07

Hello to every , since I am genuinely keen of reading this website’s post to be updated regularly.
It contains fastidious stuff.

Rispondi
google api example 23 Marzo 2014 - 17:09

Hello there, I found your blog by the use of Google even as searching for a similar subject, your website got here up, it seems to be good.
I have bookmarked it in my google bookmarks.
Hi there, just changed into aware of your weblog
via Google, and found that it’s truly informative.
I’m going to be careful for brussels. I’ll be grateful when you proceed this in future.
A lot of folks will be benefited out of your writing. Cheers!

Rispondi
european dating sites 4 Giugno 2014 - 22:56

This piece of writing gives clear idea for the new people of blogging, that in fact how to do
blogging and site-building.

Rispondi
Major 10 Giugno 2014 - 0:29

There’s definately a great deal to know about this topic.
I love all the points you have made.

Rispondi
jurassic park builder cheats no download 11 Giugno 2014 - 18:47

We are a group of volunteers and starting a new scheme in our community.

Your website offered us with valuable information to work on. You have done a formidable job and
our entire community will be thankful to you.

Rispondi
Nelle 15 Giugno 2014 - 1:12

Great goods from you, man. I have understand your stuff previous to and you’re just extremely wonderful.
I really like what you’ve acquired here, certainly like what you are stating
and the way in which you say it. You make it entertaining and you still care for to keep it wise.
I cant wait to read much more from you. This is really a terrific site.

Rispondi
best website hosting for actors 16 Giugno 2014 - 7:02

I am genuinely happy to read this blog posts which consists of plenty of useful data,
thanks for providing such information.

Rispondi
best washing machine 18 Agosto 2014 - 18:15

Thanks on your marvelous posting! I certainly enjoyed reading it,
you might be a great author.I will be sure to bookmark your
blog and will often come back at some point.
I want to encourage you to definitely continue your great work, have a nice holiday weekend!

Rispondi
pest control company for sale uk 28 Agosto 2014 - 11:29

Hello! I know this is kinda off topic nevertheless I’d
figured I’d ask. Would you be interested in trading links or maybe guest writing a blog article or vice-versa?
My website addresses a lot of the same topics as yours and I think we could greatly benefit from each other.
If you’re interested feel free to shoot me an email.
I look forward to hearing from you! Fantastic blog by the way!

Rispondi
buy bulk car notes 8 Settembre 2014 - 11:10

Nice post. I learn something totally new and challenging on sites I stumbleupon everyday.
It’s always useful to read through content from other
authors and use something from other sites.

Rispondi
dimethyltryptamine extraction 8 Ottobre 2014 - 10:44

Spot on with this write-up, I seriously believe this web site needs far more attention. I’ll
probably be back again to see more, thanks for the advice!

Rispondi
Damian 14 Ottobre 2014 - 11:07

If you are going for best contents like me, just pay a
quick visit this web site every day as it gives quality
contents, thanks

Rispondi
minecraft hosting 10 Novembre 2014 - 3:59

Hi, I do think this is a great blog. I stumbledupon it 😉
I may return yet again since I book-marked it.
Money and freedom is the best way to change,
may you be rich and continue to help other people.

Rispondi
Tricia 20 Febbraio 2015 - 0:48

Hello to every one, it’s actually a pleasant for
me to pay a quick visit this website, it consists of
useful Information.

Rispondi
essay on advantages and disadvantages of studying abroad 11 Maggio 2015 - 7:01

Pretty nice post. I just stumbled upon your weblog and wanted to mention that
I have really loved surfing around your weblog posts.
In any case I’ll be subscribing for your rss feed and I am hoping you write once
more soon!

Rispondi
ios 8 iphone 5 1 Giugno 2015 - 6:24

Hi there, all is going perfectly here and ofcourse every
one is sharing data, that’s really excellent,
keep up writing.

Rispondi
learnphlebotomynow.com 4 Giugno 2015 - 11:36

I got this website from my pal who told me about this website and now this time I am
browsing this web page and reading very informative posts at this
time.

Rispondi
see page 5 Giugno 2015 - 23:57

I am really thankful to the holder of this web page who has
shared this great post aat at this place.

Rispondi
best video 12 Giugno 2015 - 23:37

This piece of writing presents clear idea for the new users of blogging, that in fact how to do running a
blog.

Rispondi
Chalk pens 21 Giugno 2015 - 19:35

Aw, thhis was an extremely gooid post. Taking
a few mminutes and actual effort to make a really good article… but what can I say… I procrastinate a lot and don’t manage tto get
nearly anything done.

Rispondi
top in VA accident lawyer 22 Giugno 2015 - 22:50

Hmm it seems like your website ate my first comment (it was super long) so I guess I’ll just sum it up what
I submitted and say, I’m thoroughly enjoying your blog.

I as well am an aspiring blog blogger but I’m still new to everything.

Do you have any tips and hints for first-time blog writers?
I’d definitely appreciate it.

Rispondi
virginia personal injury law 22 Giugno 2015 - 23:12

What’s up to every one, because I am genuinely keen of
reading this web site’s post to be updated on a regular basis.

It includes pleasant stuff.

Rispondi
you can look here 23 Giugno 2015 - 0:22

Hello there! I could have sworn I’ve visited this site before but
after looking at a few of the articles I realized it’s new to me.
Anyhow, I’m certainly delighted I found it and I’ll be bookmarking it and checking back regularly!

Rispondi
personal injury fee agreement 23 Giugno 2015 - 1:41

Awesome website you have here but I was curious if you knew
of any user discussion forums that cover the same topics talked about in this article?
I’d really like to be a part of online community where I can get feed-back from other knowledgeable people that share
the same interest. If you have any recommendations, please let me know.
Thanks!

Rispondi
go to this web-site 23 Giugno 2015 - 2:39

Hello there! Do you know if they make any
plugins to help with Search Engine Optimization? I’m
trying to get my blog to rank for some targeted keywords but I’m not
seeing very good gains. If you know of any please
share. Many thanks!

Rispondi
personal injury lawyer fairfax 23 Giugno 2015 - 4:34

Very good blog! Do you have any suggestions for aspiring writers?
I’m hoping to start my own site soon but I’m a little lost on everything.
Would you propose starting with a free platform like Wordpress or go for a paid option?
There are so many choices out there that I’m totally overwhelmed ..
Any suggestions? Thanks!

Rispondi
cedar tree removal 23 Giugno 2015 - 6:10

Great goods from you, man. I’ve understand your stuff previous
to and you’re just too wonderful. I actually like what you have acquired here, certainly like what you’re saying and the way in which you say it.
You make it enjoyable and you still take care of to
keep it wise. I can not wait to read much more from you.

This is actually a tremendous site.

Rispondi
antalya escort bayan 23 Giugno 2015 - 13:23

Hi there, just became alert to your blog through Google,
and found that it is really informative. I’m gonna watch out for brussels.
I will be grateful if you continue this in future. Many people will be benefited from your writing.
Cheers!

Rispondi
nursery rhyme 25 Giugno 2015 - 22:54

You made some decent points there. I checked on the web for more information about the issue and found most people will go along with your views on this web site.

Rispondi
ElouiseSMcquiller 29 Giugno 2015 - 4:30

Wow that was strange. I just wrote an incredibly long comment but after I clicked submit my comment didn’t appear.

Grrrr… well I’m not writing all that over again. Anyways,
just wanted to say excellent blog!

Rispondi
delhi escort 29 Giugno 2015 - 18:24

It’s awesome in support of me to have a web page, which is helpful in support of my know-how.

thanks admin

Rispondi
LorinaGKiffer 29 Giugno 2015 - 23:44

I visited multiple blogs however the audio quality for audio songs present
at this web page is genuinely excellent.

Rispondi
beach body workout reviews 1 Luglio 2015 - 5:43

Good blog you have got here.. It’s difficult to
find excellent writing like yours these days.
I honestly appreciate individuals like you! Take care!!

Rispondi
freelivegame.net 1 Luglio 2015 - 10:31

I have read several good stuff here. Definitely value bookmarking for revisiting.
I surprise how much attempt you put to make such a
excellent informative web site.

Rispondi
Jessica 1 Luglio 2015 - 18:02

This design is steller! You obviously know how to keep a reader entertained.
Between your wit and your videos, I was almost moved to start my own blog (well,
almost…HaHa!) Fantastic job. I really enjoyed what you had to say, and more than that, how you presented it.
Too cool!

Rispondi
AdanPRottman 2 Luglio 2015 - 17:40

This is very interesting, You’re a very skilled
blogger. I’ve joined your rss feed and look forward to seeking more of your excellent post.
Also, I have shared your web site in my social networks!

Rispondi
preparat na trądzik 3 Luglio 2015 - 12:22

Hello, i think that i saw you visited my blog so i came to “return the favor”.I am
trying to find things to enhance my site!I suppose its ok to
use some of your ideas!!

Rispondi
EddieTKelash 4 Luglio 2015 - 17:53

I savour, cause I found exactly what I was having a look
for. You’ve ended my four day lengthy hunt!
God Bless you man. Have a nice day. Bye

Rispondi
Niki 5 Luglio 2015 - 9:54

Searching for High definition video and sound quality.
Those who are more objective about the films are the best to follow as they are looking at the quality of the film and tend to
write what is good about it as well as what is bad about the film.
Try all these to see if it will reduce the occurrence of dropped frames.

Rispondi
YoshieMBeezley 5 Luglio 2015 - 21:00

Does your website have a contact page? I’m having trouble locating it but, I’d like to send you an email.
I’ve got some suggestions for your blog you might be interested in hearing.
Either way, great website and I look forward to seeing it grow over time.

Rispondi
videoclips 8 Luglio 2015 - 14:31

Great site you have here.. It’s difficult to find high-quality writing like yours these days.
I really appreciate individuals like you! Take care!!

Rispondi
Onde Comprar Goji Berry Capsulas 8 Luglio 2015 - 15:02

Yes! Finally someone writes about health.

Rispondi
chalk pen 8 Luglio 2015 - 22:37

Aw, this was an extremely good post. Taking a few minutes and
actual effort to make a very good article… but what
can I say… I procrastinate a lot and don’t manage tto get anything done.

Rispondi
Onde Comprar Goji Berry 8 Luglio 2015 - 23:56

Thanks for finally talking about > Patologia coccigea post-partum
| FertilityCenter < Loved it!

Rispondi
achieve link popularity 9 Luglio 2015 - 20:45

I was suggested this blog by my cousin. I’m not sure whether this post is written by him as nobody
else know such detailed about my difficulty. You are amazing!
Thanks!

Rispondi
click here to search now 10 Luglio 2015 - 14:15

I all the time used to read article in news papers but now as I am a user of internet therefore from now I am using net for articles or
reviews, thanks to web.

Rispondi
continue reading this.. 10 Luglio 2015 - 15:15

When someone writes an paragraph he/she retains the plan of a user in his/her mind that how a user can know it.
So that’s why this article is amazing. Thanks!

Rispondi
googlle maps 10 Luglio 2015 - 17:05

Stunning quest there. What occurred after? Good luck!

Rispondi
additional resources 10 Luglio 2015 - 18:08

Wow! This blog looks exactly like my old one!
It’s on a entirely different topic but it has pretty much the same layout and design. Great choice of colors!

Rispondi
virtual map 10 Luglio 2015 - 18:21

I got this website from my friend who told me on the topic of this
website and at the moment this time I am visiting this
web site and reading very informative articles here.

Rispondi
click here to confirm your email address 10 Luglio 2015 - 18:39

Very nice article, totally what I wanted to find.

Rispondi
mls listings bc 10 Luglio 2015 - 18:59

Hello friends, its enormous article concerning tutoringand fully explained, keep
it up all the time.

Rispondi
real estate west vancouver 10 Luglio 2015 - 19:00

Yes! Finally someone writes about great site for
real estate bargains.

Rispondi
chalk markers 10 Luglio 2015 - 19:39

When someone writes an article he/she maintains the image of a user in his/her
brain that how a uswr can be aware oof it. Therefore that’s why
this post is great. Thanks!

Rispondi
download click here 10 Luglio 2015 - 20:16

Hi there! I simply want to offer you a huge thumbs up for your excellent info you have got right here on this post.
I will be returning to your website for more soon.

Rispondi
click here for 10 Luglio 2015 - 23:19

whoah this weblog is fantastic i really like reading your posts.
Keep up the good work! You know, many individuals are searching around for this information, you can help them greatly.

Rispondi
real estate west vancouver 11 Luglio 2015 - 1:07

Incredible quest there. What occurred after? Take care!

Rispondi
chalk Ink 16 Luglio 2015 - 12:43

hello!,I like your writing so a lot! pecentage we keep in touch extra about
your post on AOL? I require a specialist on this house
to solve myy problem. May be that’s you! Having a look
ahead to look you.

Rispondi
payday loans online bad credit 16 Luglio 2015 - 18:01

They are always ready to help the borrowers as per their need because they don\’t make any delay for them.
The amount borrowed then has to be repaid over a period of 3 months.

Everyone faces financial crisis once in a lifetime and cannot tally his spending with his earnings.

Rispondi
Fat loss Factor 17 Luglio 2015 - 22:46

Hi there to all, how is all, I think every one is
getting more from this website, and your views are nice for new viewers.

Rispondi
escort istanbul 18 Luglio 2015 - 1:27

Do you mind if I quote a few of your articles as long as I provide credit and sources back
to your site? My website is in the very same area of
interest as yours and my users would certainly benefit from some of the information you present here.
Please let me know if this ok with you. Thank you!

Rispondi
pencils charcoal 19 Luglio 2015 - 6:33

Pretty section of content. I just stumbledd upon your sitee and in accession capital
to assert that I gett iin fact enjoyed account your blog posts.
Anyway I will be subscribing to your feeds and even I achievement you access consistently fast.

Rispondi
encrypted proxy site unblockable 19 Luglio 2015 - 15:33

Paragraph writing is also a excitement, if you know after that you can write or else it is complicated to write.

Rispondi
anti inflammatory for dogs arthritis 23 Luglio 2015 - 20:48

Appreciate this post. Let me try it out.

Rispondi
Sharron 24 Luglio 2015 - 18:30

DLNA technology is at times unable to run few formatted programs.

6-inch touch screen display and comes with Touch wiz 2.
The phone has been selling well for Apple, although some question the reliability of
some of those reports.

Rispondi
youtube 25 Luglio 2015 - 19:54

I’m not sure why but this site is loading extremely slow for me.
Is anyone else having this issue or is it a problem
on my end? I’ll check back later and see if the problem still exists.

Rispondi
affordable health insurance alabama 1 Agosto 2015 - 23:58

They are always ready to help the borrowers as per their need because they don\’t make any delay for
them. Everything can be done in the comfort of his home
or office. The borrowers if desire can also seize supplementary time for arrangement but will then are obliged to
forfeit further sum in the form of very well.

Rispondi
asdf 7 Agosto 2015 - 20:48

Yesterday, while I was at work, my cousin stole my apple ipad and tested to
see if it can survive a 30 foot drop, just so she can be a
youtube sensation. My apple ipad is now destroyed and
she has 83 views. I know this is entirely off topic but
I had to share it with someone!

Rispondi
Alba 10 Agosto 2015 - 17:31

Great blog here! Also your site loads up fast!

What web host are you using? Can I get your affiliate link to
your host? I wish my site loaded up as fast as yours lol

Rispondi
cheap hermes 15 Agosto 2015 - 5:19

You really make it seem so easy with your presentation but I
find this topic to be really something which I think I would never understand.
It seems too complex and very broad for me. I am looking forward for your next post, I will try to get the hang of it!

Rispondi
hacklus.com 15 Agosto 2015 - 5:57

Thanks a lot for sharing this with all folks you really realize what you’re
speaking approximately! Bookmarked. Kindly also discuss with my website =).

We could have a hyperlink alternate contract between us

Rispondi
Dwight 25 Agosto 2015 - 8:45

Touche. Solid arguments. Keep up the amazing spirit.

Rispondi
Elektrische zahnburste 25 Agosto 2015 - 17:12

Greetings! Very useful advice in this particular post!
It is the little changes that produce the greatest
changes. Thanks a lot for sharing!

Rispondi
félix's 26 Agosto 2015 - 10:32

Do you mind if I quote a couple of your articles as long as I provide credit and sources back to your site?
My blog is in the very same niche as yours and my visitors would genuinely benefit from some of the information you present here.
Please let me know if this ok with you. Thanks
a lot!

Rispondi
free online casino slot games for fun 1 Settembre 2015 - 0:11

Thoms Stuart always gives support to the other people regarding the
roblems of loans. Everything can be done in the comfort of his home or office.
There are two famous ways of gaining cash but people prefer to go with the online mode.

Rispondi
liana 4 Settembre 2015 - 3:11

Wonderful, what a weblog it is! This website provides helpful data to us, keep it up.

Rispondi
souma 7 Settembre 2015 - 21:27

Excellent article. I am going through some of these issues
as well..

Rispondi
antalya escort 7 Settembre 2015 - 23:21

This is my first time visit at here and i am actually pleassant to read all at
alone place.

Rispondi
chogovadze 10 Settembre 2015 - 2:58

Hello Dear, are you genuinely visiting this web page daily, if so
after that you will definitely obtain good knowledge.

Rispondi
tochilin 10 Settembre 2015 - 3:06

Hi there i am kavin, its my first occasion to commenting anyplace, when i read this piece of writing
i thought i could also make comment due to this brilliant post.

Rispondi
humidificateur 11 Settembre 2015 - 1:36

There’s definately a lot to learn about this topic.
I like all the points you have made.

Rispondi
advance till payday 12 Settembre 2015 - 11:38

to find out more information on our company and payday loan practices.
All that you have to do is to search the online loan market properly before zeroing
on any decision. Payday loans consolidation can bring extremely desirable monetary relief.

Rispondi
blenal 15 Settembre 2015 - 20:49

Hi there, You’ve done an incredible job. I will definitely digg it and personally suggest to my friends.
I’m confident they will be benefited from this site.

Rispondi
pallbearers 22 Settembre 2015 - 11:11

Hi everyone, it’s my first pay a quick visit at this web site,
and post is actually fruitful in favor of me, keep up posting these articles or
reviews.

Rispondi
shiraha 22 Settembre 2015 - 14:13

continuously i used to read smaller posts which as well clear
their motive, and that is also happening with this piece of writing which I
am reading now.

Rispondi
thalk 4 Ottobre 2015 - 21:55

I was recommended this blog via my cousin. I am not sure whether this publish is written by way of him as nobody else know such exact about my difficulty.
You’re amazing! Thanks!

Rispondi
Jerrell 21 Novembre 2015 - 0:45

Verify with zoning laws to locate out if you are allowed to erect
this style of fence. Brace each post with a stake, after they are
properly aligned. They are familiar with all types of materials
for residential fences and can help you choose which style, design and material is
right for your home.

Rispondi
Livre d'or de http://www.comptebrazzersgratuit.fr 19 Dicembre 2015 - 22:31

Cela nous plaît et nous devons actuelle vous un tout nouveau logiciel distinctive produite par notre personnel pour Brazzers Website Web.

Rispondi
kinder eggs 1 Gennaio 2016 - 22:17

My brother recommended I might like this web site. He was once totally right.
This submit actually made my day. You cann’t consider just
how a lot time I had spent for this information!
Thank you!

Rispondi
https://www.reddit.com/r/SFA/comments/3vgats/best_sfa_housing_2015_new_survey_shows_where/ 7 Gennaio 2016 - 17:09

If you are going for best contents like myself, just go to see this website everyday as it
presents quality contents, thanks

Rispondi
best time to do cardio 8 Gennaio 2016 - 4:21

Thank you for the auspicious writeup. It actually was a entertainment account it.
Glance advanced to far added agreeable from you!

By the way, how can we keep in touch?

Rispondi
Rudolf 8 Gennaio 2016 - 8:24

When some one searches for his vital thing, so he/she
needs to be available that in detail, thus that thing is maintained over here.

Rispondi
Jona 10 Febbraio 2016 - 17:31

There is only one issue that you must take very carefully and that is the difficulty of on line scams
because there are lots of on the web frauds happening these days To give a lot more teeth for the lender,
your borrower will have to present a number of collateral.

Rispondi
solar energy projects 14 Febbraio 2016 - 14:42

Howdy would you mind letting me know which webhost you’re working with?

I’ve loaded your blog in 3 completely different web browsers and I
must say this blog loads a lot quicker then most.
Can you suggest a good web hosting provider at a reasonable price?
Cheers, I appreciate it!

Rispondi
http://www.sohbethilal.com/ 15 Febbraio 2016 - 9:17

Can you tell us more about this? I’d like to find out more details.

Rispondi
Online Casino 3 Marzo 2016 - 5:30

Excellent beat ! I wish to apprentice while you amend your
site, how can i subscribe for a blog website?
The account aided me a acceptable deal. I had been a little bit acquainted of this your
broadcast provided bright clear concept

Rispondi
challenge 9 Marzo 2016 - 14:26

I do not even know how I finished up here, however I assumed
this submit was once great. I do not recognise who
you are however definitely you are going to a famous blogger in case you
aren’t already. Cheers!

Rispondi
Domingo 13 Marzo 2016 - 7:52

Very descriptive blog, I liked that a lot. Will there be a part 2?

Rispondi
dildo 15 Marzo 2016 - 21:24

Hello, i think that i saw you visited my site thus i came to “return the favor”.I’m trying to find things to improve
my website!I suppose its ok to use a few of your ideas!!

Rispondi
ww1.theequalizer3movie.com 30 Agosto 2023 - 14:01

I love your blog.. very nice colors & theme. Did you make this website yourself or did you hire
someone to do it for you? Plz reply as I’m looking to construct my own blog and would like to know where u got this from.

thanks a lot

Rispondi
dottvolpicelli 1 Settembre 2023 - 19:32

For the software part I made use of a computer technician.
no help for writing texts.
Thank you very much for your comment
Sincerely
Enzo Volpicelli

Rispondi
mailpoet wordpress 24 Settembre 2023 - 15:28

It’s going to be ending of mine day, however before finish I am reading
this great piece of writing to increase my knowledge.

Rispondi
harga seo website 30 Novembre 2023 - 19:29

Incredible! This blog looks ϳust lіke my օld оne!
It’s on a completely different subject buut it һaѕ pretty mᥙch thee same
layout and design. Greɑt choice of colors!

Also visit my site; harga seo website

Rispondi
free guide istanbul 10 Dicembre 2023 - 21:22

Thanks for sharing your thoughts on free guide istanbul.
Regards

Rispondi
sweepstakes games 7 Gennaio 2024 - 5:49

Heya i am for the first time here. I came across this board and I find It
truly useful & it helped me out much. I hope to give something back and
aid others like you helped me.

Rispondi

Lascia il tuo commento

Inserisci la somma corretta Limite di tempo superato. Si prega di completare nuovamente il captcha.

Il Fertilitycenter.it è un sito informativo al fianco delle coppie per sostenerle ed informarle nel desiderio più grande, quello di avere un figlio.

ULTIMI ARTICOLI

fertilitycenter.it © 2023 All right reserved.

Questo sito Web utilizza i cookie per migliorare la tua esperienza. Supponiamo che tu sia d'accordo con questo, ma puoi annullare l'iscrizione se lo desideri. Accetto Leggi

-
00:00
00:00
Update Required Flash plugin
-
00:00
00:00