Biomedical subjects
Publications and source records attributed to A Restaino.
The authors report the case of a 38-year-old woman who underwent total laparohysterectomy for multiple uterine leiomyomas and right adnexectomy following the intraoperative finding of a right tubal abortion.
The authors describe a case report of a patient affected by congenital thoraco-lumbar scoliosis of a severe degree, aged 32, para 0, gravida 1. She was submitted to orthopedic surgery in childhood. Cesarean section was performed at the 37th week of amenorrhoea. Pregnancy in severe defects of the spine, though becoming more and more uncommon, can still be encountered. Severe congenital scoliosis is a clinical problem; it affects not only the size and shape of the pelvis, but also sometimes results in significant maternal cardiovascular and respiratory complication. The authors, reviewing the literature, evaluate the anatomical and functional (from a biomechanical point of view) derangement of the pelvis, the problem of vaginal delivery and the clinical and radiological assessment of the problem, especially evaluating the cardio-pulmonary function. In conclusion, pregnancy in patients with severe scoliosis can be managed successfully by close monitoring especially of the respiratory function. The decision of the route of delivery is related to clinical assessment and obstetric indications.
A clinical case of a pregnant suffering from hepatic cirrhosis with ascites, splenomegaly and portal hypertension is described. The pregnancy carried on till the 31st week, even though with the repeated use of tocholytic agents. Cesarean section was performed because of the onset of serious jaundice and the decline of general maternal conditions. The infant, who had an Apgar score of 8 at the 1st and 5th minute, died on the 10th day because of accuse haemorrhagic interstitial pneumonitis in premature lungs and hepatopathy associated with widespread jaundice. The mother was discharged on the 25th day of the postpartum period, in light of the net improvement of her general metabolic condition, the sudden regression of the jaundice and the decrease of the cholestasis indices. A review of the literature discussing maternal complications fetal risks, management of pregnancy and delivery and outcome of the newborn are presented.
Mononuclear phagocytes exhibit complex interactions with cancer cells and might contribute to fibrin formation associated with malignancy through the production of procoagulant activity (PCA). We have studied the PCA of peritoneal macrophages in 8 patients with advanced (stages III or IV) ovarian cancer and of macrophages from regional lymph nodes in 14 patients with limited (stages I or II) uterine cancer; peritoneal and lymph-node macrophages from patients with benign gynecological tumors were used as reference cell populations. In all patients, PCA of blood monocytes was also studied. Peritoneal and lymph-node macrophages obtained from patients with ovarian and uterine cancer, respectively, expressed far higher levels of basal PCA than the corresponding cell populations from patients with benign tumors (p less than 0.001). PCA of blood mononuclear cells from patients with ovarian, but not with uterine cancer, was significantly higher (p less than 0.001) than that of control cells. High levels of D-dimer, a specific product derived from plasmin-induced degradation of stabilized fibrin, were found in all ascitic fluids and in all plasma samples but one from patients with ovarian cancer. In contrast, all controls and all uterine cancer patients but one had normal plasma D-dimer. Our findings suggest that local activation of host macrophages for PCA production might contribute to fibrin formation within the tumoral mass. In advanced cancer, blood monocytes may also be activated to produce PCA and thus contribute to activation of intravascular coagulation and, possibly, to thrombo-embolic complications frequently associated with disseminated malignancy.
A case of primary ovarian pregnancy in a patient fitted with an IUD is reported. Anatomic, pathological, clinical, etiological and therapeutical aspects of ovarian pregnancy are discussed with reference to published data. The case study presented in this paper shows the characteristics aspects of this pathology of pregnancy: the patient is a multipara, fitted with an IUD; clinical diagnosis was intraoperatively and adnexectomy was chosen as the most appropriate treatment. Anatomic and pathological tests were used to confirm the diagnosis of ovarian pregnancy.
The Authors studied the presence of some markers in different gynaecological tumours, by radioimmunoassay. Beta-HCG, 1-alfa-FP, CA 125, GICA and TPA were assayed in 76 patients. Eight of the patients were affected by CIN III, 38 presented a cervical carcinoma (10 at stage I, 14 at stage II, 10 at stage III, 4 at stage IV); 14 patients had an endometrial adenocarcinoma (3 at stage I, 7 at stage II, 2 at stage III and II at stage IV); 12 cases consisted of an ovarian carcinoma with 2 patients at stage I, 5 at stage II and 5 at stage III; 2 patients had a peritoneal diffusion, whereas two women presented a vulvar carcinoma; the control group was formed by 10 patients with no malignant or benign pathology. The results show that tumoral markers, studied in the blood of patients affected by malignant gynaecological tumours, represent a great advantage in the evaluation of both the response to the therapy and of an eventual remission or tumoral recurrence.
The Authors report the results obtained in 30 patients affected by ovarian carcinoma and treated with chemotherapy using the parenteral route in 27 cases and the intraperitoneal one in 3 women. Parenteral chemotherapy following surgical staging and extensive tumour removal with the last residual tumour, consisted of a therapeutic scheme of mono- and poli-chemotherapy. The doses of cisplatin (CDDP) in mono-chemotherapy were correlated to the intensive anatomical-radiological-surgical staging. The patients treated with poli-chemotherapy underwent cycles with CDDP + alkylating agents. Moreover, 3 of the patients received low doses of cisplatin by intraperitoneal administration. In 27 cases pre- and post-therapy enzymuria was evaluated: it represents, in fact, the most reliable laboratory test to discover an acute tubulo-toxicity and is able to reveal chronic tubular damage. Our results demonstrate that a suitable nephrologic monitoring of the patients allows a more accurate use of the cisplatin with a better cost-benefit relation.
Different therapy schemes related with the stage of tumours are reported, after general considerations on the topic. We have evaluated various criteria for the choice of methods, pointing out the complications of therapy. Lithium-carbonate action during radiation therapy has been studied, valuing the positive effect on leukopoiesis and the consequent better clinical conditions of the patients in course of treatment. In this study we report our experience with regard to 21 patients affected by cervical neoplasia, histologically diagnosed. The stages of neoplasia in the 21 patients were so distributed: 10 at stage I B, 8 at stage II A, 3 at stage II B. Treatment consisted of three therapeutical techniques: 1) application of radium in the cervical canal and in the vaginal fornices; 2) surgical procedure; 3) application of radium against the vaginal vault. In agreement with other author's results, the histological exam of the surgical specimen confirmed in different cases the complete absence of neoplastic aspects following the pre-operative radiotherapy. Although our experience is limited, we hold that radio-surgical "sandwich" treatment of cervical carcinoma may represent an excellent therapy in young women and in patients with associated systemic diseases. The follow-up of the 21 patients has excluded up to this day any neoplasia. In this program pre-operative intracavitary radiotherapy is a primary step allowing, in the majority of the cases, the reduction of surgical radicality. In so doing, effective therapeutical results associated with a better quality of life are obtained.
We measured the antibody presence of eventual viral infections (Parotiditis, Cytomegalovirus, Herpes Simplex and Hepatitis B) in 51 patients affected by malignant gynaecological tumours. Ninety five women composing the control group not affected by any pathology, underwent the same tests. Even if research has utilized various indirect methods for the antibody dosage of each viral infection, we have not confirmed other Authors' reports. It might be referable to the limited number of cases in our study up to date. In order to make a comparison among different reports we look forward to a uniformity of various laboratory methods. Reliable results will be obtained only by increasing the number of clinical cases and by utilizing the method of determination of viral genome in tumoral cells. The technique is the only reliable among different methods for determining a previous viral infection.
Various ovulation markers in natural cycle (ultrasound measurement of follicular diameter, E2, progesterone, and LH assays) have been studied in 18 women. The patients were divided into two groups. Group 1: women who became pregnant during the same cycle; group 2: women who showed evidence of follicular growth, E2 and a LH midcycle rise, but low P levels in the luteal phase. A weaker increase in these parameters was found in group 2, especially the LH rise. Moreover, an asynchronicity between the endocrinological and morphological events has been observed in the suboptimal cycles. These findings suggest a process of follicular atresia at the end of the maturation phase, as is commonly found in otherwise normal women.
The AA. have made a study of comparison among various gynecological malignancies using TPA. No specificity among the single neoplasm has been verified, but TPA can be of help in monitoring during the follow-up.
Cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) were assayed in ascitic fluid from 27 patients with ovarian carcinoma and 23 patients with liver cirrhosis. The value of these cyclic nucleotides was correlated with standard methods for the clinical evaluation of tumors. No change in the cGMP levels was found in either of these groups. The cAMP content, however, was increased in 23 of the 27 cases of ovarian carcinoma. The high cAMP level was correlated with the cytological findings in only 13 (48.1%) of these cases.
Peripheral blood polymorphonuclear leukocytes of patients with ovarian or uterine-cervix carcinoma were studied during cisplatin chemotherapy for phagocytic oxidative metabolism. In particular, superoxide production by these leukocytes after stimulation with opsonized Zymosan particles was determined. The basal value of oxidative metabolism of leukocytes from neoplastic patients was lower than in normals. Superoxide production decreased after each dose administration, but returned to normal at the end of the entire chemotherapeutic treatment. It is suggested that cisplatin treatment, despite a short-lived depression of oxidative metabolism in polymorphonuclear cells, improves this function, most probably by interfering with neoplastic growth.
The authors present the clinical, pathologic and therapeutic report on 5 cases of ovarian dysgerminoma in patients between 15 and 30 years of age, classified as Stage Iai in 3 cases and Stage III in 2 cases. Treatment was surgical in 4 cases; in 1 case the surgery was followed by radiation and chemotherapy. All the patients survive free of disease from 4 to 11 years. One of these neoplasms showed a particular histologic pattern in some way similar to the "spermatocytic seminoma" of the testis. This should be the first time that such a type of ovarian dysgerminoma has been reported in the literature.
The results obtained by an experimental clinical study about the lymphatic drainage of the uterine cervix by direct intraparenchymal injection of Lipiodol are reported. This study suggests a new approach to the evaluation of cervical carcinoma staging complementary to the peripheral lymphangiography.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.