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A Vimercati

Publications and source records attributed to A Vimercati.

At least 55 records · Page 3Linked to original sources
PubMed1999

Endometrial stromal sarcoma: a clinicopathologic study.

BACKGROUND: This study is a clinicopathologic evaluation of five patients with endometrial stromal sarcoma. PATIENTS AND METHODS: Over a period of 9 years 5 cases of ESS were observed in our Unit. The patients were retrospectively staged according to the FIGO staging system for endometrial cancer. The neoplasm was divided into two groups based on mitotic activity. Patients underwent endouterine curettage, surgery therapy and, except one of them, chemotherapy. RESULTS: Two patients had low-grade ESS stage Ib and Ic. The other three had high-grade ESS, and were in stage IIIa. Treatment was surgery for all patients, and adjuvant chemotherapy for 4 out of 5. Both patients in stage I are alive, clinically free from the disease, 25 and 36 months after diagnosis. In stage III all patients died 14, 25 and 36 months after diagnosis. CONCLUSION: ESS is a rare uterine neoplasm. Histologic grade is the most important prognostic factor.

Adult↗
PubMed1999

[Intratumor flowmetry in endometrial carcinoma. Correlation with the tumor stage].

BACKGROUND: To assess the value of intra-tumoral (endometrial) flow as detected by color Doppler ultrasound in relationship with negative prognostic factors in patients with endometrial carcinoma. METHODS: Fifty-three patients with a previous histological diagnosis of endometrial carcinoma were included in the study. Transvaginal ultrasound with pulsed color Doppler was performed in order to record resistance indexes and vascular density (defined as "high" if > or = 3 vascular spaces were detectable for any given area). All cases were classified according to FIGO after surgery and histology. Prognostic bad factors were considered: FIGO stage (> I), tumor grade (> 1), myometrial invasion (> 50%) involvement of vascular spaces and lymph node metastasis. RESULTS: Both resistance indexes and vascular density in the endometrium related well to more prognostic signs. No relationship was found for lymph node metastasis, probably justified by the small number of positive nodes (2/27). DISCUSSION: Color Doppler ultrasound seems to be a promising technique in pre-surgical staging of endometrial carcinoma. Detection of vascular spaces rather than low resistance indexes is, in personal experience, more significantly related to advanced disease. It is hypothesized that long term follow-up of these patients can show a predictive value of Doppler ultrasound on the outcome of the disease.

Adenocarcinoma↗
PubMed1999

[Impact of counseling on the sexual habits and reproductive decisions in HIV-1-positive subjects].

BACKGROUND: To assess the results of counselling on sexual behavior and reproductive choices of couples discordant for HIV-1, in South-Eastern Italy. SETTING: University Hospital, Apulia region, South-Eastern Italy. METHODS: In the period March 1985-December 1995, one hundred and forty-four HIV-1 discordant couples were enrolled. They were followed up for a median period of 39 months (range 12-60 months). Behavioural counselling was performed at each visit of the infected case and the sexual partner was periodically tested for HIV-1 antibodies. RESULTS: Sixty percent of couples pursued in unprotected sex intercourse, 30 new infections being diagnosed during the study period (cumulative incidence rate = 21%). In addition, 49 pregnancies in 38 women were recorded. Termination was very seldom the choice of pregnant women. CONCLUSIONS: There is a clear indication for a failure in the counselling process. A change in population characteristics is to be pointed out as the main factor of the results. More appropriate counselling modalities need to be introduced for the different targets of sexual behaviour of our population.

Adult↗
PubMed1998

Antenatal diagnosis of isolated lissencephaly by ultrasound and magnetic resonance imaging.

Lissencephaly (agyria) is a cortical dysplasia associated with a disturbance in the migration of neocortical neurons. Because of abnormal sonographic findings in the brain of a 24-week fetus, we carried out serial magnetic resonance imaging (MRI) examinations which raised the suspicion of isolated lissencephaly. In the second trimester, an area of damage depicted as low-intensity signals was identified by MRI inside the cortical parenchyma. In the same cortical area, agyria was detected later in pregnancy, and postnatally calcification was observed by computerized tomography (CT) scan. We believe that ultrasound and targeted MRI examination can improve our understanding of some disorders of neuronal migration and that earlier diagnosis is feasible if both methods are employed and interpreted by sound criteria.

Adult↗
PubMed1998

[Angiogenesis and endometrial carcinoma. Correlations with blood flow analysis by transvaginal color Doppler ultrasonography].

Neoangiogenesis is a basic event in the evolution and spread of several solid neoplasms. Angiogenesis is an active phenomenon in physiological endometrium in the reproductive age and seems to disappear in postmenopause. Endometrial hyperplasia and adenocarcinoma are associated with signs of angiogenetic activity. The factors promoting angiogenesis in endometrial carcinoma are still unknown. Similarly it is not possible to recognize which endometrial carcinoma is potentially angiogenetic, but a relationship between angiogenesis and early metastatic spread has been established. Angiogenesis is definitely a late component of invasive tumour, but an early angiogenetic behaviour of some neoplastic clones, that could be a main prognostic factor for endometrial carcinoma is hypothesized.

Adult↗
PubMed1998

Astroglia-microvessel relationship in the developing human telencephalon.

The telencephalon of 12 and 18 week-old human foetuses was examined for evidence of astroglia-microvessel relationship. Immature astroglia cells (radial glia and astroblasts) and astrocytes were immunostained using antibodies to the cytoskeletal proteins vimentin (VIM) and glial fibrillary acidic protein (GFAP). The microvessels were detected using an antibody to the blood-brain barrier (BBB)-specific glucose transporter GLUT1. Two extracellular matrix (ECM) glycoproteins, laminin (LM), an endothelial-derived molecule, and tenascin-C (TN-C), a glia-derived molecule, were also analyzed. In the two stages examined, VIM- and GFAP-positive fibers of the radial glia establish close relationships with the radial and periventricular microvessels, which are GLUT1-positive and lined by an LM-positive basal lamina-like matrix. At the 18th week, also radial glia transitional forms and immature astrocytes exhibit extensive contacts with the microvasculature. A TN-C-rich ECM is revealed around the vascular plexus of ventricular zones at the 12th week, and around the newly growing radial microvessels and the microvessel branching sites at the 18th week. The observations taken as a whole, suggest that during the telencephalon morphogenesis the immature astroglia cells play a role in the early establishment of the distribution pattern of the neural microvessels and in their growth and maturation.

Abortion, Spontaneous↗
PubMed1998

[Maternal viral and gestational risk factors in vertical transmission of HIV-1 infection].

BACKGROUND: Several risk factors are related to vertical transfer of HIV-1 infection, but the influence of each one separately is controversial. Various risk factors have been evaluated altogether and separately, in order to find a single condition, that is, early in pregnancy predictive of fetal infection. METHODS: A prospective, observational study has been carried out during the period January 1992-January 1997, at the Centre for infectious diseases in pregnancy, University Hospital of Bari, a tertiary reference setting. Forty-four HIV-1 infected mothers have been recruited in early pregnancy, to be followed-up until delivery. Neonates have been evaluated in the Pediatric Department of the same hospital until 18 months of age. Maternal risk factors, such as age, infection in the partner, mode of acquisition of HIV-1, drug addition, life-style and risky behaviour as well as stage of disease, immunological status and antiviral treatment were considered. Obstetrical factors, too, (parity, preterm delivery, rupture of membranes, duration of labour and mode of delivery) were taken into account. Data were analyzed according to Fisher exact test and Draper and Smith multivariate analysis. RESULTS: Thirty cases (9 inadequate for follow-up, 4 ongoing pregnancies, 1 perinatal death before ascertainment of infection) were evaluated for final results. The overall transmission rate was 13.3%. Single factors significantly related to transmission were stage of disease (p < 0.01), mode of maternal infection (p < 0.03) and maternal HCV infection (p < 0.04). Multivariate analysis has shown the stage of disease to be the only positively-related risk-factor. CONCLUSIONS: The data identify a sub-group among HIV-1 infected women, where the more sustained rate of vertical transmission is associated with risky behaviour, as determined both by drug addiction and positivity for another sexually transmitted disease. Maternal compromise and immunological status are, however, the highest-risk conditions for delivering a HIV-1 infected baby.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Transvaginal color Doppler sonography in predicting the response to chemotherapy in advanced cervical cancer.

The role of Doppler ultrasonography in the diagnosis of advanced cervical cancer continues to be controversial. This study was designed to assess the clinical value of the technique in terms of predicting the response to chemotherapy in patients with advanced cervical cancer. Twenty-three patients with cancer of the cervix (FIGO stages Ib bulky-IIIb) and 20 healthy women underwent transvaginal color Doppler assessment of the uterine arteries (both ascending and descending branches) and the intracervical vessels. Statistical analysis was performed by Student's t test for paired and unpaired data. The intracervical vessels were the only site to show significant differences both in the resistance and in velocity parameters. A subgroup of 14 patients, scheduled for neoadjuvant chemotherapy, were evaluated before and at the completion of treatment. A significant increase in resistance and pulsatility index values and a decrease in peak systolic velocity were observed in the ten patients who responded to chemotherapy. Preliminary results of our study suggest that Doppler parameters can be clinically useful in the evaluation of the response to neoadjuvant chemotherapy. More patients, sampled in a prospective way in order to increase the number of non-responders, would be necessary to assess the possible role of Doppler ultrasound in predicting which patients will respond to chemotherapy.

Aged↗
PubMed1997

Transvaginal color Doppler ultrasound for monitoring the response to neoadjuvant chemotherapy in advanced cervical cancer.

BACKGROUND: To evaluate the role of transvaginal color Doppler ultrasound in monitoring the response to neoadjuvant chemotherapy in patients with locally-advanced cervical cancer. METHODS: Fourteen patients with locally-advanced cervical cancer, scheduled for neoadjuvant chemotherapy, were investigated with transvaginal color Doppler ultrasonography before and at the completion of chemotherapy in order to study hemodynamic changes in cervical and intratumoral vessels. Twenty healthy women matched for age and parity served as a control group. Statistical analysis was performed with Student's t test for paired data. RESULTS: Statistically different blood flow recording between patients with cervical cancer and healthy controls could be observed only in intratumoral vessels. A significant increase of RI and PI values, recorded in both cervical artery and intratumoral vessels, have been observed in the group of patients responding to neoadjuvant chemotherapy. In patients with stable disease at the completion of chemotherapy, flow characteristics did not change significantly. CONCLUSION: Preliminary results of our study suggest that transvaginal color Doppler ultrasound evaluation of flow characteristics in the cervical and intratumoral vessels might be useful in monitoring the response to neoadjuvant chemotherapy in patients with invasive cervical cancer.

Aged↗
PubMed1997

Neutropenia in neonates delivered of women with pre-eclampsia.

OBJECTIVE: To show that neutrophil counts are decreased in neonates born of mothers with pre-eclampsia and that pre-eclampsia itself is an independent risk factor for perinatal neutropenia. METHODS: In a tertiary referral centre two groups of patients at high risk to have a neonate with neutropenia. All patients were delivered by elective caesarean section, group 1 because of pre-eclampsia, group 2 because of idiopathic fetal growth restriction. RESULTS: Neutrophil counts were significantly lower in infants of group 1 compared to group 2 and this difference was still present if the sub-group of less premature neonates (> 32 weeks of gestation) was considered. The rate of infections was also raised in the newborns of hypertensive mothers. CONCLUSION: Pre-eclampsia of the mother is an independent risk factor for neutropenia and infections in premature newborns. Early detection and prophylactic treatment of this high risk group of infants are probably necessary.

Adult↗
PubMed1996

Pathological significance of first-trimester fetal nuchal oedema.

The pathological mechanism that causes the transient phenomenon sonographically defined as "nuchal translucency' is still poorly understood. Seven pregnancies in which the fetuses clearly presented this ultrasonic sign at 10-14 weeks' gestation were terminated because of an abnormal fetal karyotype. The pathological specimens, compared by morphometric analysis with normal fetuses of the same gestational age, showed oedema and dilatation of lymphatic capillary vessels. No particular relationship was found with any structural abnormality. We speculate that nuchal oedema is a transient non-specific phenomenon which is probably related to an early disarrangement of lymphatic connections.

Aneuploidy↗
PubMed1996

[Transvaginal color-Doppler sonography for monitoring the response to neoadjuvant chemotherapy in patients with locally advanced cervical cancer].

Changes in blood flow characteristics, observed with transvaginal color-Doppler ultrasonography have recently been reported in patients with advanced cervical cancer. In order to evaluate the reliability of TVCDUS in monitoring the response to neoadjuvant chemotherapy in patients with locally advanced cervical cancer, a prospective study was undertaken on the blood flow characteristics of the cervical vessels. Pulsatility Index (PI) and Resistance Index (RI) of the uterine and cervical arteries of 12 patients with histologically proven advanced cervical cancer, scheduled for neoadjuvant chemotherapy were evaluated at diagnosis, during every cycle of chemotherapy and before surgery. A significantly lower value of mean PI and RI between cervical and uterine arteries was observed in patients with cervical cancer (PI = 1.671 +/- 0.18 vs 2.159 +/- 0.24)-(RI = 0.43 +/- 0.17 vs 0.72 +/- 0.22). Mean RI and mean PI of the descending branches of the uterine arteries were significantly lower in patients with cervical cancer, compared to healthy control women. No difference in blood flow parameters could be detected between stage I vs stage II-III, and between left and right cervical artery in patients with cervical cancer. Both RI and PI values appeared strictly related to the tumor response to chemotherapy. In fact in 8 patients in which treatment resulted in tumor regression, evaluated by pelvic examination and MR imaging, a significant (p < 0.01) increase of resistance indices was observed (PI = 1.671 +/- 0.18 vs 2.158 +/- 0.22)-(RI = 0.43 +/- 0.17 vs 0.79 +/- 0.16). On the other side 4 patients not responding to chemotherapy, had stable values of both PI and RI. Transvaginal color-Doppler ultrasonography might be useful in monitoring the response to neoadjuvant chemotherapy in patients with locally advanced cervical carcinoma.

Aged↗
PubMed1995

[Pharmacologic induction of fetal immobilization for prenatal diagnostic-therapeutic procedures].

Neuro-muscular blocking agents are currently administered to the fetus during intrauterine procedures, in order to freeze fetal movements and to avoid traumatic effects. The authors have evaluated three drug regimens (Pancuronium, Vecuronium, Atracurium), both via the intramuscular and the intravascular route of administration to the fetus. The time lapse between injection and disappearance of movements and the duration of paralysis have shown no significant differences for each group. The duration of fetal immobilization, on the other hand, has resulted excessively long for the necessity of the procedure. The authors speculate that immaturity of fetal metabolism can be responsible for the prolonged action of the drug. No side effect related to paralysis have been recorded at birth and after two years follow-up.

Atracurium↗
PubMed1994

Magnetic resonance imaging in pregnancy: study of fetal cerebral malformations.

This paper reports 15 examinations by magnetic resonance imaging (MRI) performed in pregnant women whose fetuses had cerebral malformations identified by sonography. In all the cases the fetuses were immobilized by ultrasound-guided intravenous or intramuscular curarization. The diagnoses by MRI and ultrasound differed only in one case where an occipital meningocele had first been suggested. No cerebral abnormalities were demonstrated in this case by the MRI study, and this was confirmed at birth. In the remaining 14 cases, MRI confirmed the ultrasound diagnosis of cerebral malformation. In four of these cases, MRI added some additional information to the ultrasound diagnosis of ventriculomegaly by detecting agenesis of the corpus callosum in two fetuses, one Chiari malformation and one triventricular hydrocephalus. Another two ultrasound diagnoses of microcephaly actually proved to be semilobar holoprosencephaly with MRI. In the following cases, the MRI diagnoses concurred with those of ultrasound, and was therefore used unnecessarily despite providing further anatomical details of the lesions: two cases of agenesis of the corpus callosum, one case of anencephaly, a cystic hygroma of the neck, an alobar holoprosencephaly, a Dandy-Walker malformation and a mild isolated hydrocephalus associated with diaphragmatic hernia. In one case of iniencephaly, sonography offered closer approximation to the correct diagnosis. The results obtained unequivocally confirm the high sensitivity of ultrasound examinations in the prenatal screening of cerebral malformations and show that MRI proves to be complementary in uncertain cases or when more accurate anatomical detail is required.

Journal Article↗
PubMedDate not supplied

Mild ventriculomegaly as a counselling challenge.

OBJECTIVE: Our purpose was to evaluate the outcome of a group of fetuses with mild ventriculomegaly. METHODS: We retrospectively collected all cases of antenatally diagnosed mild enlargement of the lateral cerebral ventricles (transverse diameter of the atrium between 10 and 15 mm) between 1992 and 1997. Cases were included in the study if no other ultrasonic anomalies (including soft markers) were found. TORCH screening, karyotyping, search for associated anomalies and neurological examination (including imaging) were performed. Outcome information was available for all cases up to 30 months. RESULTS: Fourteen cases were examined. TORCH was always negative, 1 case with a microdeletion of chromosome 1 was identified. During the course of pregnancy, 2 fetuses showed progression to frank hydrocephalus. Five cases of agenesis of the corpus callosum, 1 of lissencephaly and 1 of heterotopia were eventually diagnosed. After birth 2 syndromes were identified. Three babies died during the follow-up period, among the survivors 4 had severe neurological damage, 2 of them had no associated dysmorphic findings. DISCUSSION: A heterogeneous group of central nervous system disorders may manifest antenatally as mild ventriculomegaly. The current management may not be able to identify dangerous conditions that present subtle dysmorphic features, or be able to predict abnormal outcome in most of the cases.

Adult↗
PubMedDate not supplied

[Ehlers-Danlos syndrome and pregnancy. Report of a case with favourable outcome].

Ehlers-Danlos syndrome is a heterogeneous group of diseases, where connective tissue laxity is the main feature. Several pregnancy and delivery complications, mainly related to vascular and uterine rupture or to soft tissue tears, are described. A case of a full term pregnancy is reported and the clinical value of obstetrical management is discussed.

Adult↗