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Biomedical subjects

D Marchesoni

Publications and source records attributed to D Marchesoni.

At least 37 records · Page 2Linked to original sources
PubMed1999

[The rationalization of the follow-up of hormonal replacement treatment in menopause].

BACKGROUND: Decision making about the opportunity of starting or continuing hormone replacement therapy (HRT) in menopause should rely on an overall evaluation of its risks and benefits for the women's health; the evaluation of HRT cost-benefit ratio, however, should include its possible outcomes from an economical point of view. In this view, and with the certainty that menopausal patients should be protected by proper treatments, our case series has been evaluated in order to improve the quality of our clinical schedules for both their access to HRT and the treatment follow-up. METHODS: Two groups of patients have been considered the first one consisted of 560 women observed during '97 for climacteric symptoms and candicated to begin HRT. The second one consisted of 100 women on HRT for 1 to 6 years. In the first group we considered which test and with which frequency were responsible for stopping or delay the beginning of therapy; while in the second group we evaluated the reasons for stopping treatment. RESULTS AND CONCLUSIONS: On the basis of our experience, the exams required before starting HRT seem to be the following: patient history, mammography, densitometry and endometrial sample as well as the parameters of glucose lipidic, coagulative and hepatic metabolism. Densitometry is useful in the annual follow-up only in patients with bone alterations from the beginning. The same exams seem required for the follow-up, with the exception of bone densitometry which should be performed yearly only in patients with bone demineralization.

Climacteric↗
PubMed1996

Transdermal estroprogestins versus transdermal estrogen plus oral dihydrogesterone replacement in menopause.

We studied 18 early (6 to 36 months) postmenopausal patients with a mean age of 51 years (47-53), who had never undergone hormone replacement therapy before and had no contraindications to hormone replacement. All cases of menopause were spontaneous. The treatment consisted in the continuous transdermal administration of 17-beta-estradiol (50 microg/daily) by skin patch to be replaced every 84 hours. The patients were further treated with a two-week progestogen administration every fortnight. This consisted of transdermal norethisterone acetate (0.25 mg/daily) combined with estradiol in the same patch in the first year, and oral dihydrogesterone (10 mg/daily) in the second year, without wash-out period. Before treatment (T0), and at the 12th (T1) and 24th (T2) month we measured the body mass index, the arterial blood pressure (AP), lipoproteins, coagulation parameters and bone metabolism parameters. The systolic pressure presented mean values (+/-SD) equal to 128.5+/-10.2 mmHg (T0), 131.1+/-7.4 mmHg (T1) and 130.4+/-7.5 mmHg (T2). Diastolic pressure values showed mean value ranging from 85.4+/-8.7 mmHg (T0) to 83.9+/-5.3 (T1) and 83.4+/-5.8 mmHg (T2). The detailed analysis of values of triglycerides, HDL cholesterol, apolipoprotein A1, apolipoprotein B and coagulation parameters at different times of therapy showed no statistically significant changes. With regard to bone metabolism, no statistically significant changes from baseline values were observed in parathormone, alkaline phosphatase, calcitonin, urinary calcium/creatinine ratio, and bone mineral content expressed by the bone density.

20-alpha-Dihydroprogesterone↗
PubMed1995

Gynaecological aspects of primary Sjogren's syndrome.

UNLABELLED: Female patients affected with Sjogren's Syndrome (SS) frequently describe symptoms such as vaginal dryness and dyspareunia; however, only a few controlled studies have regarded clinical involvement of the female external genitalia. OBJECTIVE: The present study was undertaken in order to: (1) Evaluate the involvement of external genitalia in a large number of female patients affected with primary SS (pSS) by semi-quantitative methods covering subjective symptoms and clinical evaluation. (2) Compare pSS patients with a matched healthy control group (pre- and post-menopausal women were separately studied). (3) Correlate the gynaecological involvement with salivary and lacrimal abnormalities in pSS patients. METHODS: We evaluated 36 patients with primary SS (18 pre- and 18 post-menopausal women) and 43 healthy controls using a questionnaire regarding vulvar and vaginal dryness and a complete gynaecological examination. Subsequently, three scores related to vulvar and cervical status plus a global score were obtained. In primary SS patients, salivary and lacrimal involvement was also evaluated. RESULTS: Dyspareunia was present in 61% and vaginal dryness in 55% of SS patients versus 39% and 33% of healthy controls. No significant differences regarding gynaecological scores were found between SS patients and controls, in both pre- and post-menopausal women, nor correlation was observed between gynaecological and lacrimal or salivary involvement. CONCLUSIONS: Our data suggest that although SS patients frequently complain of dyspareunia and vaginal dryness they do not greatly differ from healthy subjects in regard to some major gynaecological aspects.

Adult↗
PubMed1991

Transdermal estrogen therapy in menopause. Eighteen months follow-up.

In this study we evaluated different metabolic parameters and bone mass, before and after 18 months of treatment by transdermal estradiol associated with oral sequential MPA in menopause. We treated 46 physiologically postmenopausal patients (44-55 years old) for at least six months, by TTS/E2 50 mcg for 3 weeks and MPA 10 mg for the last 12 days of estradiol treatment. The fourth week was free of therapy. Before treatment and after 18 months, we evaluated bone density (BMC/BW), body mass index (W/sqH), systolic and diastolic blood tension, lipid parameters, coagulation parameters, mineral metabolism with statistical elaboration of our results. After therapy we found a significant decrease in diastolic blood tension, a significant reduction in triglyceride levels and a slight but significant increase in HDL-cholesterol levels. The only variation in coagulation parameters was a decrease of circulating fibrinogen. No variation occurred in the body mass index, mineral metabolism or bone density. In conclusion even long term transdermal treatment seems metabolically well tolerated and very useful in relieving neurovegetative climacteric symptoms and dystrophic genital ones.

Administration, Cutaneous↗
PubMed1988

Antiblastic chemotherapy and reproductive life.

In the present work the Authors, on the basis of most recent literature have tried to show some general outline with regard to the effects of antiblastic chemotherapy on the "ovarian function" in patients of pre-puberal and fertile age, understood that this would mean complex interference between endocrine and gametogenic; they have besides faced the problem of the gestational capacity of such patients. Notable difficulties have derived from the fact that the data in Literature are often non-comparable among themselves and, at times, discordant. However, although they have been unable to reach unequivocal conclusions, they hope to have made some practical contribution to those who, ever more often, find themselves having to face such problems.

Abnormalities, Drug-Induced↗
PubMed1986

Localized ovarian cancer: surgery plus chemotherapy.

Fifty-four patients were referred to Medical Oncology after operation for "limited" ovarian cancer; 7 were excluded because immediate restaging showed evidence of macroscopic spread to structures outside the true pelvis, and 10 will be considered separately because of microscopic spread shown only by cytology. Thirty-seven patients (31 stage I and 6 stage II) were accordingly accepted as "localized", because peritoneal cytology and diaphragm and omental plus parietal peritoneum histology could rule out the spread to the large abdominal cavity. Some of the referred patients had been operated in nearby hospitals; the Padua GYN Cin. performed 14 of the 37 first surgery operations and 30 of the 37 second look operations. All patients soon after surgery underwent first-line chemotherapy with 5 courses of high dose adriamycin plus cyclophosphamide for 4 months, then surgical second look, and second-line non-cross-resistant chemotherapy for 3 months. During the second look the organ and tissue removal was completed in those 21 patients having received "limited" first surgery. Two patients died within 5 years from admission, so that the overall 5 year actuarial survival from referral is 93% for the entire group with 11 patients still at risk; 87% are disease free 5 years after the second look with 7 at risk. Subdivision of the patients according to "adequate" vs. "limited" first surgery, may select a group (the "adequate" one, composed of 16 patients) completely free from relapses, up to now. The complex therapeutic program described seems to offer long term relapse-free survival to the majority of patients, while the few failures seem closely related with inadequacies of the initial surgical procedure.

Adolescent↗
PubMed1986

Diagnostic breast screening: clinical significance during menopause.

Three-hundred and fifty nine out-patients with no signs of breast disease, who had been seen at the Gynecology and Obstetrics Clinic for problems related to their perimenopausal state, were also screened at the Breast Pathology Center to exclude the presence of hormone-sensitive neoplastic disease, in view of possible hormone therapy. The breast cancer incidence detected (1.7%), and the importance of thermography in evaluating the metabolic-functional aspects of the breast, confirm the utility of breast screening in all perimenopausal patients.

Breast Neoplasms↗
PubMed1985

Diagnostic integrated program in breast pathology: clinical experiences.

1068 patients were examined using a unified diagnostic protocol. 618 patients at high risk were screened out, and underwent further instrumental and surgical investigation. 17 cases of breast cancer were detected, while the remaining patients were addressed to an appropriate, highly reliable and repeatable follow-up for breast care.

Age Factors↗
PubMed1985

Clinical significance of plasma lipid-bound sialic acid (LBSA) and carcinoembryonic antigen (CEA) in gynaecologic cancer patients.

A comparison between plasma lipid-bound sialic acid (LBSA) and carcinoembryonic antigen (CEA) in gynaecologic cancer patients has been performed. The LBSA level appears more specific then the CEA, especially for ovarian cancer. This finding has promoted a longitudinal study to show if LBSA test may prove a reliable marker of disease in ovarian cancer patients.

Breast Neoplasms↗
PubMed1984

Vaginal delivery after previous cesarean section.

The Authors evaluate the percentage of vaginal delivery after previous cesarean section, in a group of 57 patients. Results show that 34% of the patients delivered spontaneously, and when recurring causes are excluded the percentage rises to 39%. The Authors conclude that a careful monitoring of labour can prevent unnecessary cesarean section in patients who underwent previous surgical delivery.

Adult↗
PubMed1984

SHBG pattern during the menstrual cycle.

The Authors evaluate the variation of Sex Hormone Binding Globulin during the menstrual cycle in 17 normal menstruating healthy women. The resulting data seem to show not significant modification in the protein serum level, in agreement with most of the reports in literature. A possible explanation might be the insufficient length of estrogen stimulation in the prolipherative phase. This might lead to hypothesize that in presence of marked impairments of sex steroid metabolism SHBG levels may vary significantly.

Adult↗
PubMed1984

Endometrial hormone-receptor assay: a new tool in the investigation on mastodynia. Preliminary report.

As breast dysfunctional pathology does not appear constantly correlated to significant variations of steroid plasma levels, we purposed to verify whether the control of tissutal mechanism of hormone vehiculation can provide more reliable informations, in order to identify early endocrine disorders and to check more properly the effectiveness of the treatment from both a qualitative and a quantitative standpoint. In this view we assayed the receptors for estradiol and progesterone in the endometrium of women with mastodynia and healthy controls, to verify whether endometrial tissue receptivity may be useful in the control of breast tissue receptivity; in fact, both the tissues are hormone-dependent and equally exposed to the hormones of the menstrual cycle.

Breast Diseases↗
PubMed1983

New trends for pain relief in gynaecologic oncology.

In pre-terminal and terminal gynaecological patients with persistent cancer pain, now it is possible to carry out some anthalgic methods associated or not to parenteral administration of non-narcotic or narcotic analgesic, i.e. intrathecal neurolytic injections and epidural narcotic administration. Many favourable results have been obtained by means of single or repeated 7% phenol in glycerine injections to patients with advanced but not terminal cancer affected by somatic and segmental pain or by perineal pain. In order to control more extensive pains, epidural injections of morphine in saline have been employed in preterminal patients. This method appears to be the best answer to many problems complained by the patients: pain, depression, malaise. As a matter of fact, low doses of epidural morphine induce both complete pain relief and sedation or slight drowsiness.

Autonomic Nerve Block↗
PubMed1983

GnRH-test after high-dose MPA in women with post-menopausal LH-preferential release.

The association between post-climacteric LH-preferential release after GnRH-Test and the occurrence of benign or malignant estrogen dependent diseases makes the Authors evaluate the variations induced in such type of hypophyseal response by MPA, administered in the same doses as in the hormonal therapy of cancer. MPA lowered both the basal gonadotropin secretion and the amplitude of the response to the neurohormone, suggesting the hypothesis of a possible direct inhibitory action of the hormone on the hypophysis. The persistence of LH-preferential release after the ten day treatment with MPA 200 mg daily might be explained by the lack of modifications induced by the hormone on the levels of cytoplasmic E2-receptors, on which seems based LH-preferential release.

Female↗
PubMed1983

Possibilities of clinical utilization of GnRH-test in menopause to identify the woman at risk for hormone-related pathology.

The authors evaluate the reliability of GnRH-Test in menopause in detecting the substratum at risk for the development of endometrial cancer. The study was carried out on 30 women affected with endometrial cancer and 30 controls; the examination of the individual curves of gonadotropin values in each patient led to observe LH preferential release in 23 out of 30 cancer patients and in 10 out of 30 controls. The difference of response between the two groups in highly statistically significant (0.0005 less than p less than 0.001). However, the predictive-value of the Test in relation to the detection of the substratum at risk, is about 70%; this apparently unsatisfactory result may be corrected by the finding that about 30% of endometrial cancers seem to develop independently from estrogens. GnRH-Test in menopause might then prove to be highly reliable in predicting the occurrence of estrogen-dependent endometrial malignancies, and may be particularly useful in detecting the substratum at risk among those women presenting no risk-factors, who otherwise might escape careful medical controls.

Estradiol↗
PubMed1983

Hyperprolactinemia and pregnancy. Clinical series.

We report 15 cases of pregnancy in 11 patients with hyperprolactinemia. These patients initially went to our Gynecologic Endocrinology Center for various menstrual troubles. They were all treated with bromocriptine, except one whose hyperprolactinemia was diagnosed when she had already started a gonadotropin therapy, since HPRL assays performed elsewhere had given normal results. In 6 patients we diagnosed prolactin-secreting pituitary adenoma. Only two patients underwent adenomectomy. All patients gave up bromocryptine as soon as their pregnancy was detected. Two patients had two subsequent pregnancies, another one had three. All pregnancies were single. The only twin pregnancy followed a gonadotropin therapy. One of the 15 pregnancies ended with abortion at the 12th week; another one (twin) with spontaneous delivery at the 37th week; 13 with term-delivery. They all had physiologic courses, except for one case of threatened abortion and one case of diabetes insipidus at the 9th month. None of the 15 newborns (7 SGA and 8 AGA) showed malformations. No sign or symptom of tumour growth was detected in the patients affected by pituitary adenoma.

Adenoma↗