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Biomedical subjects

A Artuso

Publications and source records attributed to A Artuso.

At least 19 recordsLinked to original sources

[Postcoital contraception. Dates based on a 5-year use in a private consultation service].

BACKGROUND: The aim of this 5-year retrospective study is to define the efficacy of oestro-progestinic interception. METHODS: An oestro-progestinic mixture (0.05 mg ethinyl estradiol and 0.250 mg dlnorgestrel) was prescribed to 6003 women attending the gynaecological outpatients clinic of AIED (Associazione Italiana per l'Educazione Demografica) in Genoa, Italy, without evidence of any previous contra-indications. The prescription was of two pills at once and two pills 12 hours after. Before examination, the doctor asked for personal and medical history (age, date of onset of menses, unprotected intercourse date and anticonceptional failure); patients were also asked to report the data of the following menses to the clinic. The largest age range was between 20 and 24 years, probably because of their inadequate knowledge of contraceptives. The reasons for post-coital contraception were: sexual intercourse without contraceptive, failure of coitus interruptus and of the condom. RESULTS: Post-coital interception efficacy (monthly oestro-progestinic contraception was 99.5%) according to retrospective statistical analysis, was according to Pearl index 92.9% vs 50% without any contraceptive. CONCLUSIONS: Finally, the efficacy of this method, together with its easy management and low frequency of severe contra-indications, allows us to indicate the "morning after pill" as one of the most useful outpatient strategies to avoid unwanted pregnancies.

Adult

Anatomic pairing of afferent arterioles and renin cell distribution in rat kidneys.

Close afferent arteriolar (AA) connectivity is a prerequisite for hemodynamic interaction between superficial rat nephrons. Studies were conducted in rat, mouse, rabbit, and human renal vasculatures obtained by an HCl maceration-microdissection technique to document the extent of AA connectivity. In rat kidneys, we assessed the possibility for a slow component of internephron coupling, as reflected by arteriolar renin cell distribution after specific immunostaining for renin. In the four species examined, 51% (human) to 60% (mouse) of total AA populations were organized as vascular units consisting of mostly two AA sharing a common origin and a connecting arterial segment. In rat AA pairs, branch lengths were significantly correlated, suggesting coordinated arteriolar growth. The sum of AA branch lengths averaged 278 +/- 6 microns. Rat arteriolar renin status, ranging from no renin cells to renin-recruited midafferent arterioles, distributed in a significantly nonrandom fashion within AA pairs, and 52% of the pairs had equal renin status. Hence, AA pairing is a consistent anatomic characteristic of mammalian kidneys and may constitute an optimal vascular design for hemodynamic as well as endocrine interactions.

Animals

[The conservative treatment of placenta accreta. A clinical case report].

The following description is a clinical case of placenta accreta and its conservative treatment. According to some authors, abnormal adhesion of the placenta depends on the alteration of the equilibrium between the trophoblastic tissue invasion and the reaction of the decidua. Consequently we have various degrees of penetration of the myometrium by chorionic villi into areas of deficit, sparse or absent decidua. Whatever the pathogenetic mechanism, the final clinical picture is slight to deep penetration of the trophoblastic tissue into the uterine wall. That causes absence of the normal plane of cleavage between placenta and maternal decidua, no spontaneous placental detachment during the third stage of labour and no possible manual removal. The patient, primigravida, was admitted at the 36th Week of gestation with PROM and physiologically delivered a neonate weighing 1820 g, after she spontaneously began labour. The newborn was admitted in the neonatal-pathology ward because it was premature although the Apgar score at 1-5 minutes after birth was 5-9. Placental ejection was awaited for 1 hour, then manual exploration of the uterine cavity was undertaken. The normal plane of cleavage between placental tissue and decidua was absent and therefore manual extraction of the placenta was impossible. Surgery was stopped and, after informed consensus was obtained from the patient, a conservative treatment was tried. After cutting the umbilical cord as short as possible and checking for vaginal bleeding, the patient was moved to obstetrics ward.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

[Acute pancreatitis in pregnancy].

This paper describes a case of acute pancreatitis occurring in a patient immediately after delivery and in primigravida. The patient had a family case history of dyslipidemia (Type IV). The pregnancy had been complicated by preeclampsia treated at home with nifedipine tablets (one tablet three times a day) with good results on pressure values; lipidic values were high despite dietary measures taken. The baby at birth weighed 3830 g after physiologic labour and a natural delivery. Acute pancreatitis was diagnosed after observation of epigastralgia with irradiation on the left shoulder, vomiting, symptoms of acute abdomen such as sweating, increased pulse rate, hypotension, abdominal pain on palpation, and absence of peristalsis. An analysis of the blood showed high levels of amylase and hyperglycemia, an increase in XDP, and leucocytosis. Instrumental tests such as pancreatic echography revealed an increase in pancreatic volume, uneven structure of the parenchyma and higher levels of liquid in the peritoneum. The patient was moved to intensive-care, a nasal gastric probe inserted, hydroelectrolytic treatment was begun, vital functions monitored, pain kept under control by medical therapy, and antibiotics administered. Subsequent tests showed an improvement in the parameters of pancreatic functions (amylase, lipase, calcium hematic) and their gradual return to normal values. The computerized tomography of abdomen additionally revealed the presence of pancreatic pseudo-cysts and effusion of peritoneal liquid near the right kidney. The patient was discharged after two weeks in the surgical ward. There are many caused of acute abdomen during and immediately after pregnancy, and one of these is acute pancreatitis, though rare (occurring between 1:3800 and 11.467 according to Rabkin).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease

International incidence of central nervous system tumors in children.

A study of the descriptive epidemiology of central nervous system tumors in children aged 0-14 was undertaken using international incidence data referred to the period 1970-1984. The median incidence rates were found to be 23 per million for males and 19 per million for females. The median cumulative incidence rates were found to be 341 per million for males and 296 per million for females. Males had incidence rates that were about 20 per cent higher than those for females. Variation in incidence rates by age, sex, race, and geographic area are discussed. Data on possible genetic and environmental risk factors for these tumors are reviewed.

Adolescent

[Hysteroscopic diagnosis in patients with abnormal uterine hemorrhage and previous endometrial curettage].

Thirty-four patients, with a history of persistent abnormal uterine bleeding and dilatation and curettage or suction curettage performed within the previous year, were evaluated by office hysteroscopy and biopsy. For 16 patients (47%) the hysteroscopic diagnosis was in agreement with the curettage. Hysteroscopy revealed more information in 18 patients (53%): 8 had polyps, 6 had submucous or pedunculated myoma, 2 had endometrial neoplasia, 1 had myoma and polyp, 2 had endometrial neoplasia and 1 had synechia. Moreover in 3 patients with diagnosis of suspected myoma by curettage, hysteroscopy revealed a normal cavity. The high incidence of missed diagnosis of pathologic conditions by "blind" curettage supports the opinion that diagnostic hysteroscopy is the method of choice in the evaluation of abnormal uterine bleeding.

Dilatation and Curettage

[Ambulatory hysteroscopic diagnosis. Analysis of 425 cases].

The use of outpatient diagnostic hysteroscopy is discussed with reference to a series of 425 women. The test was performed in an outpatient setting with no form of analgesia, anesthesia or premedication in 385 patients (90.6%); the degree of acceptability was very low (intolerable) in 5.5%, supportable in 15.8% and excellent in 78.7% of patients. Fourty-two per cent of patients were aged between 45 and 54 years old, and the mean age was 47.5 years with a range between 18 and 83 years. The indication for the test was pre- or postmenopausal anomalous uterine bleeding in 74% of patients. Hysteroscopic diagnosis was normal in 56% of cases; endometrial polyps were diagnosed in 11.4% of patients; myomas in 11%; low-risk hyperplasia in 9.9% and malignant tumours in 3.6%. The correlation between hysteroscopic diagnosis and histological tests was above 95% in cases of malignant tumours, atrophy and functional endometrium, whereas it was 67% in cases of low-risk hyperplasia. No accidents or complications related to hysteroscopy were reported.

Ambulatory Care

[Colposcopic-histologic results in 97 patients with mild dysplasia shown by Pap test].

Colposcopy and biopsy were performed in 97 patients whose referral smears showed mild dysplasia (CIN 1). Of 97 women, 40 (41.2%) had a biopsy or a colposcopic examination alone considered normal, 36 (37.1%) had CIN 1 or HPV changes, 12 (12.4%) had CIN 2 and 9 (9.3%) had CIN 3. No invasive cancer was detected. This data suggest that, if colposcopy resources are available, repeat smear alone is inadequate to follow women who have a mild dysplasia smear.

Biopsy

[Delivery after previous cesarean section. Experience with 173 patients].

We have taken into consideration the obstetric outcome in 173 women, with prior cesarean section, who were delivered in our hospital between june 1988 and january 1991. This group of patients represented 5.3% of our obstetric population. Overall 64 patients (37%) achieved vaginal delivery and 109 (63%) underwent an iterative cesarean section. Considering the 76 patients (44%) admitted to trial of labour, 64 (84.2%) achieved vaginal delivery and 12 (15.8%) were delivered with iterative cesarean section. No maternal or neonatal complications occurred, even though the silent dehiscence of the uterine scar, found during cesarean section, seems to occur four times (12%) more frequently than that reported in recent literature. It follows that vaginal delivery after prior cesarean section is, in our experience, lacking in risks, and we think that such management may be widely adopted. In 1986 iterative cesarean section represented 35% of cesarean section indications, in 1990 this rate was reduced to 23.7% by the introduction of a policy to allow women to undergo trial of labour.

Cesarean Section

[Topical intranasal cortisone therapy].

Owing to improvements made during the last 15 years in the pathophysiological and pharmacological research, many new corticosteroids have been successfully experimented. They have high activity on the target organ and they are suitable for long term therapies since they have not any systemic and/or local side effects. Nowadays the topical intranasal corticosteroid therapy is indispensable for allergic rhinitis treatment and it is very useful for many nasal and bronchopulmonary diseases (some chronic rhinitis, nasal polyposis, bronchial asthma, chronic obstructive bronchopulmonary diseases). The authors use their personal experience and carefully review the literature to describe the general aspects (pharmacology, pharmacokinetics, toxicology, side effects and contraindications) and to analyze the single drugs currently used in Italy and abroad. Finally, they compare the efficacy of each topical intranasal glucocorticoid among themselves and with other drugs.

Administration, Intranasal

Thyroid carcinoma mimicking a toxic adenoma.

A young woman with a thyroid papillary carcinoma behaving as an autonomously hyperfunctioning nodule is described. Only 17 similar patients have been seen in the past 25 years. It is emphasized that hyperthyroidism does not exclude malignant disease in hot nodules. This possibility suggests that all thyroid nodules, either cold or hot, require careful management. Therefore, in "at risk" cases, surgery could be the most useful treatment.

Adenoma