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Biomedical subjects

A D'Alfonso

Publications and source records attributed to A D'Alfonso.

At least 19 recordsLinked to original sources
PubMed2006

Urinary disorders during pregnancy and postpartum: our experience.

The changes that take place in the pelvic region during birth can give rise to alterations in the genitourinary system which are at the basis of pathologies such as stress urinary incontinence (SUI). The occurrence of this condition has been correlated to a variety of factors including neonatal birth weight and obesity. We studied 120 women, 60 nulliparae, 40 primiparae and 20 multiparae who were divided into three groups on the basis of urinary problems experienced. The first group consisted of women who had reported urinary incontinence during pregnancy (76%). This was found to be significantly correlated to the number of pregnancies and weight gained; 18% of this group reported IUS during the postpartum period. The second group consisted of women who did not experience any urinary incontinence during the pregnancy or postpartum while the third group consisted of women who, although not experiencing any urinary problems during pregnancy, reported urinary incontinence in the postpartum period. These data, although only part of an initial study, reveal a consistent frequency of urinary incontinence in pregnancy and postpartum, and highlight risk factors.

Adult↗
PubMed2006

Cytokine levels in amniotic fluid: a marker of preterm labor?

The aim of this study was to determine levels of Interleukin 6 (IL-6) in amniotic fluid at the beginning of the second trimester and to establish whether IL-6 can be used as a marker for premature birth as it would appear to be an important prenatal marker of chorionic inflammation. Thirty-three patients, between 16 and 19 weeks of gestation, who were undergoing amniocentesis to establish the presence or not of fetal genetic pathologies were enrolled into the study. Amniotic fluid (3 ml) was taken from each patient and used to perform enzyme-linked immunosorbent assays (ELISAs). The results were analyzed using the Mann-Whitney test and Pearson and Spearman coefficient. The patients were divided into three groups on the basis of the levels of IL-6 found: a) up to 450 pg/ml; b) between 450 and 900 pg/ml; c) over 900 pg/ml; These data were then evaluated alongside the date of parturition and the presence of any maternal or fetal pathologies. The results of our analyses, however, were inconclusive: levels of IL-6 were normal in patients presenting pathologies while obstetric pathologies were absent in patients with high levels of IL-6. In conclusion, this data would indicate that a different method or approach is required for the identification of a marker for premature birth.

Adult↗
PubMed2005

Endoventriculoplasty using autologous endocardium for anterior left ventricular aneurysms.

BACKGROUND: There is currently consensus that endoventriculoplasty is the treatment of choice for an anterior left ventricular aneurysm. We describe here a new technique of endoventriculoplasty using autologous endocardium for left ventricular anterior aneurysm. METHOD: From 1990 until 2003, 49 patients underwent endoventriculoplasty using autologous pericardium at the Thoraxcenter of the University Hospital of Groningen in the Netherlands (28 patients) and at the Department of Cardio Thoracic Surgery of the University Hospital of Pisa in Italy (21 patients). Mean logistic EuroSCORE and mean ejection fraction were 15.7 +/- 6.7 and 31 +/- 9 %, respectively. RESULTS: Overall 30-day mortality was 4.1 %. Causes of in-hospital mortality were low output syndrome (1 patient) and ventricular fibrillation (1 patient). Postoperative complications were myocardial infarct (4.1 %), low output syndrome (6.1 %), renal failure (4.1 %), neurological events (2.0 %), atrial fibrillation (14.3 %), ventricular fibrillation or tachycardia (6.1 %), ARDS (4.1 %), re-operation for bleeding (4.1 %), and major wound infection (2.0 %). CONCLUSION: Our analysis shows that endoventriculoplasty with autologous endocardium is a safe procedure and improves the outcome in high-risk patients with ventricular aneurysm.

Aged↗
PubMed2003

[Diagnostic hysteroscopy in the third millennium. Indications and role].

BACKGROUND: The present paper analyses a recent personal series of 284 diagnostic hysteroscopies carried out between May 1999 and December 2001 at the Operating Unit of the University Gynaecology and Obstetrics Department of the Hospital of Avezzano. Emphasis is laid on the description of the indications underlying the investigation and on the hysteroscopic and histological findings in the cases examined. METHODS: The sample was also subdivided into two groups depending on the fertility or postmenopausal status of the patients. In the sample of 284, 89 (31.3%) patients were subjected to local anaesthesia with paracervical block, while the remaining 195 (68.7%) did not receive any form of anaestetic. The hysteroscopies were generally carried out in day surgery, using the commonest and most tried and tested hysteroscopic optic systems and carbon dioxide as a means for distending the uterine cavity. None of the hysteroscopies gave rise to important complications. RESULTS: In both the group of patients in fertile age and in the group of post-menopause patients, the main indication for hysteroscopy was anomalous uterine bleeding (AUB) for which a total of 159/284 hysteroscopies (56%) were carried out, of which 68 (42.8%) in patients in fertile age and 91 (57.2%) in post-menopause patients. In the group of post-menopause patients hysteroscopy was carried out for this indication in 73.4% of cases (91/124) while in fertile age it was performed in 42.5% of cases (68/160). CONCLUSIONS: Underlying AUB in the post-menopause patient endometrial hypo-atrophy was evidenced in 59 of 91 patients examined (64.9%), while in fertile age most of the 68 cases of AUB proved to be of dysfunctional nature: hystological examination showed a proliferative endometrium in 29 cases, secretory in 7 and hyperplastic in 12 cases (11 cases of simple endometrial hyperplasia with atypia and 1 of complex hyperplasia with atypia). Finally, hysteroscopy made it possible to diagnose 6 cases of endometrial adenocarcinoma (6.6% of patients with AUB in post-menopause).

Adenocarcinoma↗
PubMed2003

The adolescent and the gynecologist: our experience.

To evaluate adolescents' knowledge about sex, we conducted a study divided in two parts: 1) Distribution of a questionnaire; 2) Impromptu conversation with adolescents. The sample consisted of 205 questionnaires and 115 talks with students at a high school. The gathered data let us deduce that the relationship with parents was regarded as pleasant and good. As was expected the whole emotional sphere was related to friends. In order to understand which structures can help adolescents our data revealed that the mother holds first place, followed by the school and by friends. Sex education during adolescence should be carried out by other institutions so that a relationship free from conflicts can be established. In this way the figure of the expert takes shape--someone who can communicate within the structure of the school and the family and beyond--the limits of the information given by friends.

Adolescent↗
PubMed2002

Disturbances of humour in postpartum: our experience.

The study was conducted on 64 women who were to give birth. The average age ranged from 31-44 years and the instruments for evaluation consisted of: 1) Individual and psychological questionnaires; 2) Italian version of the Short Form Health Survey Questionnaire (SF-36); 3) Sheehan Disability Scale; 4) Zung self-rating depression scale. Of the women included in the study 27.7% found their humour worsened during their last pregnancy, while 19.15% said that their humour worsened after the birth. In these patients we frequently found obstetric and/or puerperal pathologies. There was also a strong correlation with the premenstrual syndrome and with hyperemesis in the first trimester. On the contrary, there was no correlation with familiarity and socio-demographic characteristics. The data allow us to conclude that any pregnant woman can develop medium or strong symptoms of depression thus calling for great attention to be paid to the psychological dynamics of birth.

Adult↗
PubMed2001

Hemodynamic performance of stented and stentless aortic bioprostheses.

BACKGROUND: This study compares the hemodynamic performance of stented and stentless bioprostheses used for aortic valve replacement in patients with aortic stenosis and small aortic root. METHODS: Between 1995 and 1998, 37 patients with a 21-mm aortic annulus (group 1) underwent aortic valve replacement with either a 21-mm Edwards Perimount or a 23-mm St. Jude Toronto bioprosthesis whereas 47 patients with a 23-mm aortic annulus (group 2) received either a 23-mm Medtronic Mosaic or a 25-mm Edwards Prima bioprosthesis. In each group mean and peak gradients, effective orifice area index, and left ventricular mass index were compared during follow-up. RESULTS: Group 1 patients showed a significant reduction of mean (p < 0.001) and peak gradients (p = 0.001) during follow-up, more evident for St. Jude Toronto versus Edwards Perimount (p = 0.02 and p = 0.05, respectively). Group 2 patients showed a significant reduction of mean and peak gradients (p < 0.001), more evident for Edwards Prima versus Medtronic Mosaic (p < 0.001 and p = 0.07, respectively). Effective orifice area index significantly increased only in group 1 (p = 0.005). Left ventricular mass index significantly decreased in all patients regardless of the type of valve (p < 0.001). Patients with Edwards Prima showed a trend to a higher regression of left ventricular mass index versus Medtronic Mosaic recipients (p = 0.07). CONCLUSIONS: After aortic valve replacement, stented and stentless bioprostheses exhibited similar results with a more evident hemodynamic improvement during follow-up in the stentless valves. Stented bioprostheses of new generation, however, may parallel the hemodynamic performance of stentless valves and appear to be a valid alternative for aortic valve replacement in elderly patients with a small aortic annulus.

Aged↗
PubMed2001

Existence of a genetic risk factor on chromosome 5q in Italian coeliac disease families.

Coeliac disease (CD) is a malabsorptive disorder of the small intestine resulting from ingestion of gluten. The HLA risk factors involved in CD are well known but do not explain the whole genetic susceptibility. Several regions of potential linkage on chromosomes 3q, 5q, 10q, 11q, 15q and 19q have already been reported in the literature. These six regions were analyzed with the Maximum Lod Score method on a dense set of markers. A new sample of 89 Italian sibpairs was available for study. There was no evidence for linkage for any of the regions tested, except for chromosome 5q. For this region, our data, as well as a sample of 93 sibpairs from our first genome screen (Greco et al. 1998), are compatible with the presence of a risk factor for CD with a moderate effect.

Celiac Disease↗
PubMed2001

Evaluation of valve-related complications in patients with Sorin Bicarbon prosthesis: a seven-year experience.

BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate the medium-term results of aortic valve replacement (AVR), mitral valve replacement (MVR) and double valve replacement (DVR) with the Sorin Bicarbon prosthesis. METHODS: A total of 990 patients (568 men, 422 women; mean age 60+/-10 years; range: 20-86 years) was reviewed who received 1,108 Sorin Bicarbon prostheses between 1992 and 1998 at three institutions. AVR was performed in 541 patients (55%), MVR in 330 (33%) and DVR in 119 (12%). Concomitant procedures, mainly coronary artery grafting, were performed in 222 patients (22%). Follow up was 98% complete; total cumulative follow up was 3,091 patient-years. RESULTS: Hospital mortality was 3.7% (n = 37). There were 49 late deaths; actuarial survival at seven years was 88+/-2% after AVR, 86+/-5% after MVR, and 78+/-8% after DVR. At last follow up, 915 survivors were in NYHA functional class I or II. At seven years, actuarial freedom from valve-related deaths, valve thrombosis, embolism and bleeding respectively was 96+/-1%, 99+/-1%, 93+/-2% and 91+/-3% after AVR; 97+/-2%, 97+/-3%, 90+/-3% and 86+/-7% after MVR; and 92+/-6%, 98+/-1%, 64+/-2% and 82+/-2% after DVR. Reoperation was required in 20 patients (due to valve thrombosis in six, endocarditis in five and periprosthetic leak in nine). At seven years, actuarial freedom from reoperation was 97+/-1%, 96+/-2% and 84+/-9% after AVR, MVR and DVR, respectively; actuarial freedom from endocarditis was 99+/-1%, 99+/-1% and 95+/-5%. Nine patients experienced a nonstructural valve dysfunction (all periprosthetic leak), while no cases of structural failure were observed. CONCLUSION: The Sorin Bicarbon prosthesis has shown good medium-term results with regard to clinical improvement, and low incidence of valve-related complications. Thus, it appears to be a reliable valve substitute when the use of a mechanical prosthesis is indicated.

Actuarial Analysis↗
PubMed2000

[Pregnancy in adolescence. Consequences and considerations].

Many authors have pointed out that sexual activity is starting at an increasingly early age in young adolescents. In 1990 pregnancies in under 15-year-olds in the United States accounted for 3% of the total, a figure that has increased by 13% over the past decade. Moreover, pregnancy in adolescence may result in a number of complications, including pre-term birth, PIH, sexually transmitted diseases. The aim of this study was to evaluate the incidence of adolescent pregnancy in our user basin and to analyse the clinical evolution of these cases. The sample included 61 girls aged between 15.4 and 17.9 years old, mean age 16.7. Of these, 65.6% were students. The majority opted for voluntary abortion (85.2%). Those who chose to continue the pregnancy came from small towns with less than 1000 inhabitants (77.7%). They subsequently married their partners and continued to live with their parents. From an obstetric point of view, only one case of pre-term birth was recorded at week 26, and two cases of IUGR. The fact that the percentage of pregnancies in adolescence has remained unchanged over the years in spite of the numerous health and contraception campaigns represents a strong stimulus to investigate the countless facets of this problem.

Adolescent↗
PubMed1999

[High-intensity transcranial Doppler signals in patients wearing heart valve prostheses: a prospective study].

BACKGROUND: Transcranial Doppler sonography (TCD) of the middle cerebral arteries in patients with prosthetic heart valves reveals high-intensity transient signals (HITS) and can detect asymptomatic cerebrovascular microemboli. Both the nature of the underlying embolic material (either gaseous or corpuscular) and its clinical significance remain uncertain. METHODS: Seventy-one patients undergoing heart valve replacement (n = 63) or repair (n = 8) from June 1996 to June 1998 were prospectively evaluated preoperatively and one week, 3 months and 12 months after valve replacement using TCD. At each follow-up interval, clinical assessment was aimed at detecting neurological events. Furthermore, continuous echo-Doppler study of the carotid arteries and TCD of the middle cerebral arteries for a 30-minute period during each following visit was carried out. RESULTS: No HITS were recorded preoperatively in any patient. At one week, HITS were detected in 25 patients (35%): 22 (65%) of these had received a mechanical prosthesis and three (10%) a bioprosthesis. No HITS were recorded in patients with mitral repair. HITS were subsequently detected only in patients with mechanical prosthesis with a positive TCD at one week, the mean number of HITS per patient being 7 +/- 18 at 3 months and 8 +/- 24 at 12 months. No neurological symptoms were evident in any patients during the postoperative evaluation. Multivariate analysis showed mechanical prosthetic valve to be the only independent predictive risk factor for HITS development. CONCLUSIONS: The role of a mechanical prosthetic valve as a risk factor in the pathogenesis of HITS appears evident. However, HITS appear to be unrelated to possible postoperative neurological events. TCD could have more specific clinical applications if associated with methods that would make it possible to ascertain the nature of various embolic materials.

Aged↗
PubMed1999

Prospective evaluation of frequency and nature of transcranial high-intensity Doppler signals in prosthetic valve recipients.

BACKGROUND AND AIM OF THE STUDY: In asymptomatic prosthetic valve recipients, high-intensity transient signals (HITS) observed with transcranial Doppler (TCD) are a phenomenon of obscure clinical relevance which nature has not yet been elucidated convincingly. METHODS: Eighty-three patients without carotid disease, history of cerebrovascular accidents, and with negative preoperative TCD undergoing either valve replacement (mitral, n = 11; aortic, n = 56; mitral + aortic, n = 6; 40 mechanical prostheses, 29 biological prostheses, 10 homografts) or mitral repair (n = 10) were evaluated prospectively by means of TCD at discharge, three months and one year after surgery, to analyze the presence, incidence and characteristics of HITS. Furthermore, in 12 patients positive for HITS, TCD was repeated during a 30-min period of 100% O2 inhalation. RESULTS: Twenty-five patients (30%) were positive for HITS at all postoperative controls, although no neurological symptoms were observed. Mechanical prostheses showed a significantly higher incidence of HITS (85%) than biological prostheses (10%, p <0.001), repaired mitral valves (0%, p <0.001) and homografts (0%, p <0.001). At multivariate analysis the presence of a mechanical prosthesis was the only significant predictor of detection of HITS after valve replacement. During O2 inhalation, a significant decrease in the number of HITS per hour (55 +/- 79 versus 22 +/- 31, p = 0.002) occurred, which returned to initial values when room-air breathing was resumed. CONCLUSIONS: Prosthetic valve replacement, particularly when mechanical devices are used, is associated with the generation of HITS which persist throughout the follow up period, but remain clinically silent. The decrease of HITS during O2 inhalation strongly supports the hypothesis of the gaseous nature of such signals and confirms the validity of this method in helping to differentiate gaseous microemboli from solid microemboli in prosthetic valve recipients.

Adult↗
PubMed1999

[Fetal malformations and chromosome abnormalities diagnosed at the Center of Prenatal Diagnosis of the University of Aquila in the 1995-1998 triennium].

BACKGROUND: Over the past few years numerous techniques have been developed, allowing an evaluation of fetal physiopathology that was unthinkable until recently. The authors describe 20 cases of fetal malformations and chromosomal abnormalities diagnosed by scan and amniocentesis at the Centre for Diagnosis and Obstetric Prophylaxis at L'Aquila University. METHODS: Between January 1995 and April 1998 a total of 1180 amniocentesis and 4000 obstetric scans were performed in a group of 1650 pregnant women. RESULTS: Of the patients examined using ultrasound scan, 8 presented manifest fetal pathologies, of which 5 were associated with chromosome abnormalities: 1) left ventricular hypoplasia, common atrium, tricuspid dysplasia; 2) omphalocele; 3) Morgagni-Stewart-Morel syndrome; 4) plurilobate cystic hygroma; 5) duodenal atresia; 6) Dandy-Walker syndrome; 7) cystic hygroma and hydrops; 8) cystic hygroma, hydrops, cardiopathy and Dandy-Walker syndrome. Among the pregnant women undergoing amniocentesis without a prior diagnosis of fetal malformation, 12 presented pathological fetal karyotypes: 2 cases of Turner's syndrome; 2 cases of Edward's syndrome; 2 cases of Klinefelter's syndrome, of deletion of a stretch of chromosome 8; 1 case of Down's syndrome; 2 cases of supernumerary marker chromosome; 1 twin pregnancy with Klinefelter's syndrome in one twin and paracentric inversion of chromosome 13 in the other; 1 twin pregnancy with a small supernumerary marker chromosome in both twins. CONCLUSIONS: Ultrasonography often enables the diagnosis of congenital abnormalities not associated with chromosome pathologies. However, karyotype studies play an essential role in pregnancies with a high genetic risk.

Adult↗
PubMed1993

[Modification of immunologic parameters in physiologic pregnancy].

Changes in lymphocyte subsets in whole blood of normal pregnant women were examined by flow cytometry. From the first trimester and throughout pregnancy, the count of B cell subset remain unchanged. On the contrary, the percentage of "helper" lymphocytes decreased in the first trimester, increase in the third. These changes of lymphocyte subsets may indicate suppression of immunological activity during pregnancy.

Adult↗
PubMed1992

[Treatment of premenstrual syndrome. Experience and considerations].

The Authors review the scientific literature on premenstrual syndrome (PMS), focusing on the diagnostic standards and the complex symptomatologic pattern. They report, furthermore, the results of a study of 4 groups of patients affected by PMS and treated with different therapeutic programs. The data obtained confirm that treatment of PMS must be personal and valued on the ground of dominant group of symptoms.

Female↗
PubMed1990

[Continuous peridural analgesia-anesthesia during labor. Experiences and considerations].

Fifty pregnant women attending the Obstetrics Department of the University of Aquila were included in the study. Patients were matched for age, weight, height, parity, Bishop index, temperature, arterial pressure, and cardiotopography. Twenty-five patients were assigned to the control group, the remaining twenty-five received peridural analgo-anesthesia during labour and birth so as to create a continuous lumbar epidural block. The results confirmed that this method of anesthesia is an aid against psycho-physical stress and pain in pregnant women.

Adult↗
PubMed1990

[Validity of psychoprophylaxis in obstetrics. Authors' experience].

The Authors report the results based on 20 years of practice on obstetric psycho-prophylaxis (PPO). Data on presence at course, on frequency, on primipares/pluripares ratio, on labour, on timing and mode of delivery, are assembled. Moreover, neonatal status at birth and at 10th day of life, are investigated. The data obtained were compared with a control group, constituted by women without any treatment before delivery. The acquired experience confirm the utility of PPO in the ordinary clinical practice.

Autogenic Training↗