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Biomedical subjects

A Ditto

Publications and source records attributed to A Ditto.

16 recordsLinked to original sources
PubMed2001

Comparison of biochemical markers of bone turnover and bone mineral density in different groups of climacteric women.

In the present study we evaluated plasma levels of two markers of bone turnover (osteocalcin (OC) and urinary pyridinium cross-links) in association with bone mineral density (BMI) in different groups of climacteric women. We have investigated 158 women in pre-, peri- and postmenopause. Blood and urine samples for assay of hormones and markers were collected and bone mineral density (BMD) was measured by DEXA densitometry in the distal tenth of the non-dominant forearm. There was a significant increase in mean absolute levels of both markers in perimenopause and women in natural and surgical menopause, with respect to women in premenopause. There was a significant correlation between OC and deoxypyridoline (DPYR) in peri- and postmenopause groups. In peri- and postmenopause groups, BMD was correlated with an increase in the biochemical markers of bone remodeling. In the present study, OC and DPYR were found to have good sensitivity for identifying perimenopausal women with pathological BMD. The present results reveal a positive and significant correlation between DPYR and OC, inversely proportional to BMD, during hormone replacement therapy. These markers therefore turn out to be sensitive not only for monitoring severe pathology of bone turnover, but also for monitoring slight physiological deficits in bone equilibrium beginning in perimenopause.

Adult↗
PubMed2000

Bone mineral density and biochemical markers of bone turnover in peri- and postmenopausal women.

Bone mineral density (BMD) measured by densitometry is the elective parameter for the diagnosis of osteopenia and osteoporosis. Biochemical markers have been proposed as sensitive indicators of high bone turnover and for monitoring response to antiresorptive treatment. We conducted a retrospective study to investigate the values of biochemical markers of bone metabolism with a view to early diagnosis of osteoporosis and monitoring of hormone replacement and calcitonin therapy. The subjects were 415 women, mean age 51+/-8 years (43-62 years) in peri- and postmenopause, recruited at the Menopause Center of Obstetrics and Gynecology Department of Siena University and divided in five groups. Bone densitometry was performed in all subjects and blood samples were taken for assayed biochemical markers, that is, [osteocalcin (OC), parathyroid hormone (PTH), type 1 procollagen (PICP), and calcitonin (CT)]. Three groups of women were divided into two subgroups: those with normal and those with low BMD (<1 SD). Basal concentrations of PCP1, OC, PTH, and CT were compared in the various groups. Two groups of postmenopausal women with BMD below the normal were treated with estrogen replacement therapy and unmodified eel calcitonin. We evaluated whether some of these biochemical markers of bone turnover could help identify women with low BMD and whether they could be useful for monitoring the results of antiresorptive therapies. Markers of bone formation (PICP and OC) make it possible to distinguish women with high turnover who are at risk for osteoporosis from women with low turnover in menopause. A good correlation was also found between changes in levels of these markers and changes in BMD during treatments, which suggests that the PICP and OC would be useful for monitoring response to antiresorptive therapy.

Absorptiometry, Photon↗
PubMed2000

Prognostic indicators in melanoma of the vulva.

BACKGROUND: The aim of this study was to evaluate the prognostic significance of clinical-pathologic variables in melanoma of the vulva. METHODS: From 1979 through 1995, 40 women with a diagnosis of vulvar melanoma underwent radical surgery. Patient age, tumor size and site, histologic type, ulceration, tumor thickness, lymph node status, and number of positive lymph nodes were assessed for prognostic significance by multivariate analysis. RESULTS: Tumor thickness was a significant predictor of lymph node involvement, but not of survival. The most powerful predictors of survival by multivariate analysis were the lymph node status (P = .002) and the number of positive lymph nodes (P = .00003). CONCLUSIONS: The number of positive lymph nodes represents the strongest prognostic factor in melanoma of the vulva. Because of the lack of effective adjuvant therapies, such prognostic indicators might be used to define the timing and extent of the surgical approach.

Adult↗
PubMed2000

Prophylactic therapy in a pregnant woman with severe factor VII deficiency.

This paper reports a case of factor VII deficiency, a very rare autosomal recessive disorder, in a primipara at 37 weeks of gestation in whom we administered prophylactic therapy with factor VII every 12 h until 24 h after delivery. The prophylactic use of factor VII enabled the woman to deliver without hemorrhagic complications.

Adult↗
PubMed1999

Effects of metformin on gonadotropin-induced ovulation in women with polycystic ovary syndrome.

OBJECTIVE: To evaluate whether pretreatment with metformin improves FSH-induced ovulation in women with clomiphene-resistant polycystic ovary syndrome (PCOS). DESIGN: Randomized prospective trial. SETTING: Department of Obstetrics and Gynecology, University of Siena. PATIENT(S): Twenty women with clomiphene citrate-resistant PCOS. INTERVENTION(S): The women were divided randomly into groups A and B (10 subjects each). Group B received 1,500 mg of metformin for at least a month before a single cycle of FSH stimulation. Group A underwent two cycles of FSH stimulation and then received metformin for a month before undergoing a third cycle. MAIN OUTCOME MEASURE(S): The number of FSH ampules, days of treatment, E2 level on the day of hCG, number of follicles > 15 mm, number of hyperstimulation, and the number of cycles with hCG withheld. RESULT(S): The number of follicles > 15 mm in diameter on the day of hCG administration was significantly lower in cycles performed after metformin treatment. The percentage of cycles with hCG withheld because of excessive follicular development was significantly lower in cycles treated with metformin. Plasma levels of E2 were significantly higher in cycles treated with FSH alone than in those treated with FSH and metformin. CONCLUSION(S): By reducing hyperinsulinism, metformin determines a reduction in intraovarian androgens. This leads to a reduction in E2 levels and favors orderly follicular growth in response to exogenous gonadotropins.

Adult↗
PubMed1999

Total abdominal hysterectomy: a randomized study comparing two techniques.

BACKGROUND: Abdominal hysterectomy is the most frequent operation performed by gynecologists. The most commonly used techniques are intrafascial, extrafascial and supracervical hysterectomy; in our department we mainly use the first method. A variant of this technique, because during the operation we use only an Allis clamp, simplifies the operation and maintains certain anatomical relationships between neighbouring pelvic structures. METHODS: To compare two different surgical techniques between 1/1/1991 and 31/12/95, 262 women were randomized pre-operatively: 133 by the intrafascial technique of Richardson and 129 by the variant hysterectomy technique. The difference between the two techniques (Richardson versus variant hysterectomy technique), as performed in our department, was investigated regarding the clamping of uterine vessels, the resection of uterosacral and cardinal ligament. The two-tailed student test was used for continuous data and chi2 analysis for discrete data. RESULTS: Less blood loss occurred in the variant than in the Richardson group (P<0.01) and no intrasurgical complications occurred as compared to one case of ureter lesion in the Richardson group. There were no differences in the number of days of hospitalization. No particular post-surgical complications occurred in the follow-up period, which has now elapsed. After 36 months of follow-up the variant group showed a reduced incidence (not significant) of vaginal vault prolapse. The patients who underwent the variant hysterectomy technique reported better compliance with regard to sexual intercourse and urinary function than the Richardson group. CONCLUSION: We conclude that the variant hysterectomy technique is as valid as the Richardson technique, giving the surgeon the possibility of maintaining certain anatomical relationships between neighbouring pelvic structures. It also has minor delayed complications.

Adult↗
PubMed1999

Low-dose danazol after combined surgical and medical therapy reduces the incidence of pelvic pain in women with moderate and severe endometriosis.

The most effective therapy for endometriosis is a matter for debate. The aim of the present randomized study was to evaluate the efficacy of low doses of danazol on recurrence of pelvic pain in patients with moderate or severe endometriosis, who had undergone laparoscopic surgery and 6 months of gonadotrophin-releasing hormone analogue (GnRHa) therapy. After surgery, 28 patients with moderate or severe endometriosis underwent therapy for 6 months with GnRHa i. m. every 4 weeks. They were then randomized into two groups: group A (14 subjects) was treated with 100 mg/day danazol for 6 months; group B (14 subjects, control) did not receive any type of therapy. After 12 months of treatment, group A had a significantly (P < 0.01) lower pain score than group B. There was no significant difference between the groups in oestrogen concentrations, bone mineral density or side-effects. The results suggest that low-dose danazol therapy reduces recurrence of pelvic pain in patients with moderate or severe endometriosis, treated surgically, and has few or no metabolic side-effects.

Danazol↗
PubMed1999

Comparison of two malignancy risk indices based on serum CA125, ultrasound score and menopausal status in the diagnosis of ovarian masses.

OBJECTIVE: To evaluate the ability of two malignancy risk indices (RMI 1 and RMI 2) incorporating menopausal status, serum CA125 level and ultrasound findings, to discriminate a benign from a malignant pelvic mass. DESIGN: A retrospective study. SETTING: Department of Obstetrics and Gynaecology, University of Siena, Italy. POPULATION: One hundred and twenty-four women over 30 years of age admitted consecutively between January 1995 and December 1997 for surgical excision of ovarian masses. MAIN OUTCOME MEASURES: The sensitivity, specificity, and positive predictive value of serum CA125, ultrasound findings and menopausal status, separately and combined into the RMI 1 and RMI 2, to diagnose ovarian cancer. RESULTS: The RMI 1 and RMI 2 were more accurate than menopausal status, ultrasound findings, and CA 125 separately in diagnosing cancer. For all cut off values between 80 and 250, RMI 2 performed better than RMI 1. The RMI 2 at a cut off level of 125 gave a sensitivity of 81%, specificity of 90%, and positive predictive value of 74%. CONCLUSIONS: We found that RMI 2 was more reliable in discriminating benign and malignant ovarian disease than RMI 1. RMI is a simple method which can be used in gynaecology clinics and less specialised centres.

Adult↗
PubMed1999

Evaluation of treatment of hyperemesis gravidarum using parenteral fluid with or without diazepam. A randomized study.

OBJECTIVE: Hyperemesis gravidarum is a relatively unknown disease, and is generally self-limiting. In some women the symptoms are so severe as to threaten the health of the mother and fetus. Therapies proposed for hyperemesis gravidarum are therefore rather empirical. Medical treatment includes parenteral fluid replacement and nutrition, electrolytes, antiemetics, vitamins, sedation and psychological counseling. Diazepam and benzodiazepines have been widely studied in pregnancy but the results are contradictory. The aim of the present study was to investigate the efficacy of parenteral fluids with vitamins, with or without diazepam sedation. METHODS: Fifty women with hyperemesis gravidarum were enrolled in the study. They were treated with infusions of normal saline, glucose, vitamins and randomly with diazepam. RESULTS: The results show that the mean stay in the hospital was shorter in the diazepam group: 4.5 +/- 1.9 vs. 6 +/- 1.6 days (p < 0.05) and readmission to the hospital was 4% in the diazepam group versus 27% in other group (p < 0.05). There was a significant reduction in nausea in the diazepam group (p < 0.05). A significant reduction in vomiting was observed in both groups. No side effects or congenital neonatal malformations were found in the diazepam group. CONCLUSIONS: Intravenous administration of fluids and vitamins is the standard treatment for women hospitalized for hyperemesis gravidarum. The addition of diazepam to the treatment is effective in reducing nausea and does not have teratogenic effects.

Adult↗
PubMed1999

Adrenal adenocarcinoma and empty sella syndrome in a 37-year-old woman.

The case of a 37-year-old woman with secondary amenorrhea and clear signs of hyperandrogenism is reported. The patient underwent hormonal evaluation including circadian rhythm of cortisol, gonadotropin-releasing hormone/thyroid-stimulating hormone (GnRH/TRH) test, corticotropic-releasing hormone (CRH) test and dexamethasone suppression test. She also underwent pelvic and adrenal ultrasound examination, adrenal computed axial tomography (CAT) scan and cranial nuclear magnetic resonance (NMR). A mass about 10 cm in size was detected in the left adrenal region. The sella was empty and the pituitary displaced downward. Suspected adrenal adenocarcinoma was confirmed by histological examination after surgical removal of the mass. This case is of interest for physicians because of the mixed androgen and cortisol secretion of the adenocarcinoma in a hyperprolactinemic patient with empty sella. Moreover, it suggests the need to investigate the adrenal gland in patients with hyperprolactinemia and hirsutism.

Adenocarcinoma↗
PubMed1998

Vitamin B12 levels in pregnancy influence erythropoietin response to anemia.

OBJECTIVE: to discover whether vitamin B12 levels influence erythropoietin (EPO) response during pregnancy. STUDY DESIGN: 117 pregnant women after the 27th week were divided into three groups according to log vitamin B12 concentrations. EPO (by enzyme-linked immunosorbent assay), Hemoglobin (Hb) and medium corpuscular Hb concentration (MCHC) were measured in these patients. The tests used were: calculation of simple statistic, regression coefficient and t-independent test with level of significance. An exclusive partitioned cluster method (K-means procedure) was used. RESULTS: For the lowest vitamin B12 levels there is an unexpected lack of difference in plasma EPO levels between anemic and nonanemic patients. In fact EPO levels were high even in nonanemic women. The only parameter of the blood count that seems to change in relation to vitamin B12 concentration is the MCHC. CONCLUSIONS: These results suggest that low vitamin B12 levels inhibit the suppression of EPO response in nonanemic pregnant women probably through MCHC modifications.

Adolescent↗
PubMed1998

Surgical treatment of ovarian dermoid cysts.

OBJECTIVE: To evaluate the efficacy of laparoscopic ovarian cystectomy and to compare the surgical course, post-surgical course and particularly post-surgical pain of the laparoscopic and laparotomic methods. STUDY DESIGN: We conducted a surgical study on dermoid cysts at the Gynecology Department of Siena University between 1 January 1992 and 31 December 1996. The selected cases were randomized into two groups based on surgical approach: via laparotomy (n=22) or laparoscopy (n=22). Surgical times, estimated blood loss, post-surgical pain, time in hospital, speed of recovery and complications were compared. RESULTS: Mean blood loss was significantly less for laparoscopy (58.64+/-30.17 ml versus 103.84+/-38.45 ml, P<0.05). Mean hospitalization was 6.32+/-1.09 days for laparotomy and 3.18+/-0.39 days for laparoscopy (P<0.05). Post-surgical pain was significantly less in laparoscopy patients (P<0.05). The laparoscopic technique had fewer post-surgical complications. CONCLUSIONS: The laparoscopic approach had many advantages. Laparoscopy should be the elective treatment for women with dermoid cysts, because it has many advantages for the patient and lower costs for the national health system.

Adolescent↗
PubMedDate not supplied

Association between cutaneous melanoma and neurofibromatosis type 1: analysis of three clinical cases and review of the literature.

The authors report a rare association between cutaneous melanoma and Von Recklinghausen's disease (NF-1) and analyze the possible meaning of this occurrence. Various types of tumors have been associated with NF-1, in particular those of neuroectodermal origin, such as malignant peripheral nerve sheath tumors (MPNST) and phaeochromocytoma. The development of malignant melanoma in NF-1 patients is rare. Data from the literature is enable to demonstrate an increased incidence of cutaneous melanoma in patients with neurofibromatosis but the association of these two disorders seems reasonable in theory, as both are abnormalities of a neural crest origin. The cases described may represent not only a clinical report of two rarely associated disorders, but may also confirm the biological mechanisms responsible for these infrequent diseases.

Adult↗
PubMedDate not supplied

Sentinel node biopsy in patients with cutaneous melanoma of the head and neck.

Biopsy of head and neck sentinel nodes (SNs) can be technically problematic due to the unpredictable and variable drainage patterns of this anatomic region. The aim of the present study was to evaluate the feasibility of SN biopsy for cutaneous melanoma of the head and neck. We performed SN biopsy in 17 patients affected by stage I cutaneous melanoma of the head and neck on the basis of lymphoscintigraphy, blue dye and gamma probe. A total of 24 procedures were performed. Drainage to more than one lymphatic basin was observed in five patients (two basins in three cases and three basins in two cases) and in all cases SN biopsy was performed in all basins. The biopsy distribution by site was: six cervical nodes, five parotid nodes, four supraclavicular and submandibular nodes, three auricular and axillary nodes. The SN identification rate was 87.5% (21/24); metastases were discovered in four cases, with a positivity rate of 23.6%. At the time of writing, 1 patient is alive with local disease, 3 patients are dead and 13 are alive and free of disease with a follow-up ranging from 1 to 40 months (median, 21 months) following SN biopsy. In our opinion preoperative lymphoscintigraphy and the intraoperative use of a gamma probe are useful for the identification of lymphatic drainage of cutaneous melanoma of the head and neck.

Coloring Agents↗
PubMedDate not supplied

Surgical treatment of gastric metastases from cutaneous melanoma: experience of the National Cancer Institute of Milan.

AIM: To evaluate the role of a surgical approach in patients affected with gastric metastases from cutaneous melanoma. METHODS: A retrospective review of our local melanoma database of 2100 patients identified 31 cases with gastric metastatic deposits. Nine of them were considered candidates for surgical resection. RESULTS: Median overall survival of the 9 patients who underwent surgery was 14.2 months. Six (67%) underwent a local radical resection of disease, and 3 (33%) had a simple exploratory laparotomy. The median survival was 21.6 months (range, 4-32 months) for the subset receiving radical surgery and 3.6 months (range, 2-6 months) for the patients who had no resection. Median follow-up was 14.2 months. No specific correlation of serologic LDH levels and final outcome, as documented elsewhere, was observed. A marked decreased or substantial remission of symptoms with an improvement in quality of life was observed in all radically resected patients. CONCLUSIONS: Patients with gastric metastases from melanoma may benefit from surgery if all macroscopic disease can be removed. In addition, gastric resection in patients with symptomatic melanoma spread to the stomach provides important symptomatic palliation.

Humans↗