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Biomedical subjects

F Maneschi

Publications and source records attributed to F Maneschi.

At least 37 records · Page 2Linked to original sources
PubMed1993

Radical hysterectomy: a randomized study comparing two techniques for resection of the cardinal ligament.

To compare two different surgical techniques for the resection of the cardinal ligaments during radical operation for cervical cancer, 84 patients with locally advanced cervical cancer (FIGO stages IB-IIA > or = 4 cm, IIB-III) primarily treated with chemotherapy and then eligible for radical surgery underwent radical hysterectomy. Lateral parametria were resected by using the Meigs technique or a modified Magara technique. The procedure to be performed on the right hand side was randomly chosen, consequently the left cardinal ligament was resected with the other technique. Evaluation of the first 35 cases showed that the median size of the parametria resected with the modified Magara technique (52 mm) was significantly greater than that removed with the Meigs technique (34 mm) (P < 0.05). Therefore hemoclips were routinely adopted in the following 49 cases. In 11% of cases hemoclips could not be used due to a deep and narrow pelvis or varicosities of the hypogastric plexus, therefore clamps were necessary. Bleeding complicating parametrial dissection occurred independently of the adopted technique. Five-years DFS is 100, 80, and 52% for stage IB-IIA > 4 cm, IIB and III, respectively. The study showed that the modified Magara technique is feasible and safe and allows for a more radical resection of the parametrial tissue. Furthermore, this approach seems to improve the local control of disease.

Adenocarcinoma↗
PubMed1993

Anatomical and pathological study of retroperitoneal nodes in epithelial ovarian cancer.

The pattern of lymphatic spread was evaluated in 81 previously untreated ovarian cancer patients (Stage I, 35; Stage II, 2; Stage III, 44) undergoing systematic aortic and pelvic lymphadenectomy. Positive nodes were found in 14% Stage I and 68% Stage III patients. Either pre- and paraaortic, or pre- and paracaval nodes were the only aortic node metastasis in 14% of patients. Common iliac nodes were the sole metastasis in pelvic area in 11%, external iliac in 14%, and obturator in 6% of patients. Therefore, the above node groups, which overall were the most frequently involved, may be considered those primarily invaded by the tumor. When data were analyzed according to stage, aortic nodes were the site of metastasis in 6% Stage I and 14% Stage III patients and pelvic nodes in 8% Stage I and 11% Stage III patients. Both aortic and pelvic areas were positive in 43% Stage III patients. The median number of positive nodes/patient was 2 (range, 1-3) and 4 (range 2-46) in Stages I and III, respectively. Lymphatic spread was ipsilateral to the tumor in all Stage I and in 40% Stage III patients. In Stage III metastases were also observed in intercavoaortic, retrocaval, retroaortic, internal iliac, and presacral nodes. In apparent Stage I, lymphatic metastasis seemed to be limited to one ipsilateral group, and the removal of the primary nodes ipsilateral to the tumor may be considered an adequate procedure. In Stage III, the presence of metastasis beyond the primary nodes and the frequent bilateral involvement suggest that all lymphatic tissue surround the aorta, the cava, and the pelvic vessels should be removed if a cytoreductive intent is pursued.

Adult↗
PubMed1993

Ovarian cortex surrounding benign neoplasms: a histologic study.

OBJECTIVE: Our purpose was to assess the functional morphologic features of the ovarian cortex surrounding benign cysts. STUDY DESIGN: Fifty-four specimens (13 mature teratomas, nine benign cystadenomas, and 32 endometriomas) were obtained from the area of maximum distention of the ovarian cortex overlying benign cysts from 48 patients. The type and number of follicles were scored on a semiquantitative scale (0 to 4). Alterations of the cortical stroma that were related to the primary tumor were investigated. The vascular network was assessed by means of monoclonal antibodies directed against endothelial cells (anti-VW, QBEND/10) and scored on a scale from 0 to 2. The chi 2 and Mann-Whitney U test were used for statistical analysis. RESULTS: Morphologic patterns similar to those of the normal ovarian cortex were observed in the cortical tissue surrounding mature teratomas, benign cystomas, and endometriomas in 92%, 77%, and 19% (p < 0.01) of specimens, respectively, and a regular vascular network was observed in 84%, 78%, and 22% (p < 0.01). Although microscopic endometriosis was observed surrounding the endometrioma in the stroma of 82% of specimens, stromal alterations related to the ovarian tumor were absent in the cortex surrounding mature teratomas and cystadenomas. CONCLUSIONS: The study shows that the ovarian cortex, which is stretched and thinned by the growth of a benign tumor, is not morphologically altered in the presence of teratomas or benign cystadenomas. Endometriomas are associated with microscopic stromal implants and reduced follicular number and activity.

Adolescent↗
PubMed1993

Results of the combination of cisplatin, adriamycin and cyclophosphamide in the treatment of ovarian carcinoma.

Forty-seven women affected by Stage Ic-IV epithelial carcinoma of the ovary were treated with the combination of cisplatin, adriamycin (40-50 mg/m2 day 1), and cyclophosphamide (800 mg/m2 day 1) (CAP). Two different schedules of cisplatin were used: 20 mg/m2 day 1-->5 (CAP 5), or 80 mg/m2 on day 1 (CAP 1). In the group of patients with measurable disease the overall response rate was 52%, with a 19% complete response rate. The mean disease-free survival of patients without measurable disease was 24.0+ months. The mean survival of the whole group was 29.2+ months. The mean survival of patients with measurable disease and those without measurable disease was 21.7+ and 35.0+ months respectively. The schedule of cisplatin employed did not influence disease-free survival since the difference between the CAP 1 (21+ months) and the CAP 5 (25+ months) groups was not statistically significant. However the CAP 5 schedule seemed to be better tolerated since it of allowed the delivery be 99% of the planned dose of CDDP, while in the CAP 1 group the dose of CDDP given was only 74% of that planned.

Adult↗
PubMed1992

Estradiol, progesterone, 17-hydroxyprogesterone, androstenedione and CA125 in patients with ovarian carcinoma.

Estradiol, progesterone, 17-hydroxyprogesterone, androstenedione and CA125 were assayed in 25 women (12 oophorectomized before entering the study) with ovarian carcinoma. The data from patients were ordered according to the presence or absence of the gonads. The patients with ovaries (Group A) showed significantly higher levels of estradiol (p less than 0.01), progesterone (p less than 0.01) and 17-hydroxyprogesterone (p less than 0.01) than controls. This difference was not observed between oophorectomized patients (Group B) and controls. CA125 levels were significantly higher in patients that in controls (p less than 0.001) irrespective of the ovarian status of the patients. Eleven patients were followed during chemotherapy. Significant reductions of estradiol (p less than 0.01) and CA125 (p less than 0.001) levels after three courses of chemotherapy were observed. These data confirm that women with ovarian carcinoma produce an abnormal amount of steroids. Nevertheless, a marked difference between patients with and without ovaries was observed, suggesting that reported data might be biased by the presence of gonadal tissue. Thus the clinical application of steroids as tumor markers in unselected patients is limited.

17-alpha-Hydroxyprogesterone↗
PubMed1992

Surgical pathological staging of endometrial carcinoma and results of treatment.

114 women with endometrial carcinoma at clinical stage 1 to 3 were treated with surgery as first line of treatment. Patients were classified as being low or high risk on the basis of the surgical pathological patterns of the tumor. Disease limited to the uterine body, G1-G2 tumors and myometrial invasion of less than 1/3, identified low risk patients which received no adjuvant therapy. All the others were considered high risk and treated with radiation therapy. Patients were retrospectively restaged according to 1988 FIGO guidelines and survival was analyzed. Cox's proportional hazards method was employed to identify independent prognostic factors. Disease free survival (DFS) was 90% for stage 1, 83% for stage 2, and 43% for stage 3 patients. Lymphatic spread was associated to the poorer prognosis. Proportional hazards model showed that tumor grading, myometrial invasion and lymphatic spread were significantly related to the time of relapsing. Low risk patients showed better outcomes despite not having received adjuvant treatment, thus post-operative therapy is not indicated in this subset of patients. Radiation adjuvant therapy for high risk patients did not give satisfactory results. Failures were observed both locally and distantly calling for new adjuvant strategies. Surgical pathological staging of endometrial cancer is currently mandatory. Retroperitoneal lymph node sampling is indicated in patients with high risk pre- (advanced clinical disease, undifferentiated tumors) or intra-operative (deep myometrial invasion, enlarged pelvic nodes) prognostic factors. All prognostic indicators must be obtained from surgery and pathology in order to assess the risk of relapse.

Adult↗
PubMed1991

Pubertal maturation in girls treated for childhood acute leukaemia.

Eleven girls treated during childhood for acute leukaemia were followed up during their pubertal development. At each examination weight, height, pubertal stage, FSH, LH, oestradiol, testosterone, androstenedione and dehydroepiandrosterone sulphate levels were evaluated. Clinical and endocrinological studies were performed according to age and pubertal stage and compared to those of healthy girls matched for age and pubertal stage. Results showed that pubertal maturation and gonadal function were not affected by oncotherapy; however menarche was attained earlier. Early menarche was explained by the overweight of treated girls during early puberty. No evidence of early hypothalamic activation was found, but endocrine patterns showed a faster hypothalamopituitary-ovarian axis maturation in patients than controls. Cranial irradiation showed no correlation with pubertal onset and age at which menarche was attained. Adolescent menstrual and endocrine patterns were normal.

Age Factors↗
PubMed1991

Reproductive performance in women with complete septate uteri.

Of 11 women with a diagnosis of complete septate uterus, 7 did not undergo any surgical correction, whereas 4 underwent metroplasty. The diagnosis was made in eight cases (73%) for reasons not related to the anomaly. In only three cases did the patients present with infertility complaints. Eight patients, one of whom was subsequently treated, had a total of 13 pregnancies, 3 (27%) of which ended in abortion, 4 (31%) in premature delivery and 6 (42%) in term births, for a live birth rate of 61.5%. The cumulative pregnancy rate was 80% at 12 months. The cumulative probability of carrying a pregnancy to term and giving birth to a live infant was 75% and 88%, respectively, for the second pregnancy. After metroplasty one patient still did not conceive, while three had a total of five pregnancies, one of which ended in abortion and four at term, for a live birth rate of 80%. With a complete septate uterus the ability to conceive is preserved, and the gestational ability is impaired only moderately. Metroplasty, if indicated, can yield good results in terms of the live birth rate.

Abortion, Spontaneous↗
PubMed1989

[Androgenic evaluation of women with late-onset or persistent acne].

The authors have studied the androgenic patterns in 29 women with late-onset persistent acne vulgaris. Clinical evaluation of acne, menstrual history and serum determinations of SHBG, total-T, free-T, DHEAS, delta 4A have been carried out. A mild and heterogeneous hyperandrogenism was found in 70% of women, thus, a greater steroid bioavailability for peripheral conversion and/or a direct stimulation of the pilosebaceous unit can be postulated. Androgenic evaluation in women with late-onset or persistent acne vulgaris is useful, mainly for hormonal management.

Acne Vulgaris↗
PubMed1989

[Usefulness and limitations of the evaluation of sex-hormone-binding globulin in women with a female pattern of androgen-induced baldness].

Sex-hormone binding globulin (SHBG) and androgen serum levels have been evaluated in a homogeneous group of women with female pattern of androgenetic alopecia (AA), stage II, without any clinical or anamnestic evidence of acne, hirsutism, irregular menses. Results did not show any significant difference between patients and controls. Since SHBG levels are androgen-dependent, the discordant results of previous published series regarding women with AA could be related to the presence of a variable number of patients with clinical and/or anamnestic evidence of a "cryptic" hyperandrogenism in some series, and to their absence in others. Statistically significant low average SHBG values could have been sustained by a mild, heterogeneous and not significant androgen excess. In our opinion the genetically-determined response of the target organ to androgens seems to play the major pathogenetic role in AA, at least when the woman does not reveal any clinical or anamnestic evidence of cryptic or clear hyperandrogenism.

Adult↗
PubMed1987

Changes in plasma growth hormone in diabetic and nondiabetic subjects during the glucose clamp.

A group of 22 newly diagnosed noninsulin-dependent diabetic subjects and seven nondiabetic subjects underwent a glucose clamp at plasma glucose 100 mg/dL with insulin infusion rates of 1.0 and 10 mU/kg/min. During both insulin infusion rates, there was a sustained rise in plasma growth hormone (GH) above basal in 18 of the 22 diabetic subjects. Basal GH values were 2.37 +/- 0.67 ng/mL, rising above basal during the lower insulin infusion (6.1 +/- 3.3 ng/mL, P = 0.05) with a further rise at the higher insulin level (8.58 +/- 2.0 ng/mL, P less than 0.001). There was no rise in GH in any of the nondiabetic subjects. In neither group was there any rise above basal in cortisol, prolactin, glucagon, or somatostatin (SRIH). In a group of three nondiabetic subjects, a rise in GH similar to that seen in the diabetic group was induced by elevating the plasma glucose to 200 mg/dL for 60 minutes prior to the euglycemic clamp procedure. However, it is unlikely that changes in plasma glucose account totally for the changes in plasma GH described in the diabetic subjects since a rise in plasma GH was also seen in four diabetic subjects clamped at their fasting plasma glucose. We conclude that in newly diagnosed noninsulin-dependent diabetic subjects there is a rise in plasma GH during the euglycemic clamp procedure, which may be due to both the prior lowering of plasma glucose and the high plasma insulin levels.

Adult↗
PubMed1987

[Hepatitis B virus infection in habitual sexual partners].

Habitual heterosexual contacts of chronic HBV infection carriers show high prevalence of infection markers that does not result to be sex related, and results significantly associated to increase of age, presumably as a consequence of duration of exposure. Concomitance of habitual sexual contacts does not represent in an infected family setting a risk factor of higher prevalence of HBV infection, in respect of multitude of occurrences of unperceivable expositions to contagion.

Adult↗
PubMed1984

Growth hormone response to hyperinsulinaemia in insulin-dependent diabetics. Comparison of patients with and without retinopathy.

Growth hormone levels were measured in glucose clamp studies on 13 insulin-dependent diabetic patients with retinopathy and 9 age, sex, and weight matched patients without retinopathy. Four non-diabetic subjects were used as controls. The glucose was kept constant at 12 +/- 0.85 mmol/l (mean +/- S.D.) in the diabetic groups, and at 6 mmol/l in the non-diabetic controls. Insulin was infused at sequential rates of 0.3, 1.0, and 10 mU/kg/min. Basal levels of growth hormone were not significantly different in those with and without retinopathy (5.7 +/- 4.9, 9.4 +/- 10.6 mU/l p = 0.21). Growth hormone levels were compared in each group during a 60 minute steady state period for each insulin infusion rate. At all 3 infusion rates, the diabetics with retinopathy produced a rise in growth hormone, while the non-diabetics did not (1.24 +/- 0.6 mU/l). The patients with retinopathy produced more growth hormone than those without at each infusion rate (12.2 +/- 11.5 vs. 2.8 +/- 5.1, p = 0.03; 10.6 +/- 11.1 vs. 1.6 +/- 1.7, p = 0.02; 19.7 +/- 20.6 vs. 4.2 +/- 4.8, p = 0.03). These data confirm that insulin alone can stimulate growth hormone secretion in insulin-dependent diabetics with retinopathy. Evidence is provided indicating that patients with retinopathy produce more growth hormone than those without.

Adult↗
PubMed1983

Insulin resistance and insulin deficiency in diabetic retinopathy of non-insulin-dependent diabetes.

To assess the role of insulin resistance and insulin deficiency in the pathogenesis of diabetic retinopathy in non-insulin-dependent diabetes mellitus, 13 patients with and 12 patients without retinopathy were studied. The glucose clamp technique was used to measure insulin resistance and insulin response to glucose. During the euglycemic clamp, at comparable steady-state levels of glucose and insulin, the mean glucose infusion rate, which indicates the rate of glucose utilization, was lower in the retinopathy group than in the nonretinopathy group (6.1 +/- 0.5 versus 8.1 +/- 0.7 mg . kg-1 . min-1, P less than 0.02). Growth hormone (GH) concentrations were higher in the retinopathy group 8.4 +/- 2.5 versus 2.5 +/- 0.7 microIU/ml, P less than 0.05), but they did not correlate significantly with insulin resistance, expressed as mean glucose turnover. During the hyperglycemic clamp (+7 mmol/L above the fasting plasma glucose), the insulin response in the two groups of diabetics was similar. Increased insulin resistance represents an additional factor, which together with other factors, may be important in the pathogenesis of diabetic microvascular complications.

Blood Glucose↗
PubMed1983

Quantitative evaluation of fluorescein angiograms: microaneurysm counts.

This study describes a method for quantifying microaneurysms (MA) from fluorescein angiograms. The method was validated by the reproducibility of the number of MA in 30 angiograms read twice each by two independent observers; and by the absolute difference in MA counts between two readings by the same observer, and difference in numbers counted by two different observers. The precise location of each MA on two readings was also studied and the reproducibility of location varied from 60 to 71%, depending on the quality of the angiograms. Clinicians and technicians working in the same or in different centers obtained similar results. The coefficient of correlation between observers and between readings was satisfactory, r greater than 0.9. The method is easy to learn and the reproducibility allows for its use in clinical trials.

Aneurysm↗
PubMed1982

Insulin secretory response to oral glucose load, diabetic microangiopathy and diabetic control: a study in non-insulin dependent diabetics.

To study the importance of the residual insulin secretion for the degree of diabetic control and for the development of microangiopathy 55 patients with non-insulin-dependent diabetes mellitus (NIDDM) were studied. A 1 hr oral glucose tolerance test was performed at diagnosis and 5-10 yr later. At diagnosis all patients were free of microangiopathy, at reassessment 24 patients had evidence of microangiopathy, i.e. retinopathy, neuropathy or nephropathy, alone or in combination. The glucose induced increments of insulin levels (delta IRI) at reassessment correlated inversely with the degree of diabetic control, measured by Haemoglobin A1 (r = -0.466, p less than 0.01), and with the mean fasting blood glucose throughout the follow up period (r = -0.491, p less than 0.01). delta IRI at diagnosis was similar in patients with and without microangiopathy, and at reassessment, although lower in the microangiopathy group (11.2 +/- 2.1 vs. 16.4 +/- 2.1 microunits/ml, p less than 0.1). The difference between the 2 groups did not reach statistical significance. When patients were separated into those treated with diet alone and those treated with oral antidiabetic agents, delta IRI at reassessment was significantly lower in patients on oral agents (10.5 +/- 1.9 vs. 17.2 +/- 2.2 microunits ml, p less than 0.01), but the prevalence of microangiopathy was not different between 2 groups (37% and 52%, respectively). These findings show that in patients with NIDDM the residual beta cell function is important for the degree of diabetic control, but a direct relationship between the degree of insulin deficiency and the presence of diabetic microangiopathy is not established.

Administration, Oral↗
PubMed1981

Twenty-four hour variations of von Willebrand factor and factor VIII-related antigen in diabetic retinopathy.

Factor VIII/von Willebrand factor (vWF) could play a role in the pathogenesis of diabetic microangiopathy. It has been suggested that its biologic activity is controlled by hormonal and metabolic mechanisms. To verify this hypothesis, vWF was monitored over a 24 hr period in 9 insulin treated patients with diabetic retinopathy, together with factor VIII-related antigen (VIII-RAG), plasma glucose, growth hormone (GH) and prolactin. vWF levels oscillated during the 24 hr, the mean values being higher during the day than at night-time, p less than 0.01. Compared to a group of normal controls in whom blood samples were taken randomly between 9.00 and 13.00, the levels of vWF were significantly increased at 11.00, p less than 0.02, and at 13.00, p less than 0.02, but at no other time. VIII-RAG values were also higher during the day than at night-time, p less than 0.01. The mean 24 hr levels of vWF correlated with those of VIII-RAG, p less than 0.01, with the age of the patients, p less than 0.01, and with the duration of disease, p less than 0.01. The levels of plasma glucose were higher during the day, while GH and prolactin rose at night-time. No correlations were found between vWF or VIII-RAG and plasma glucose, GH or prolactin, nor between the mean 24 hr levels of all these parameters and ponderal index, daily insulin dose, degree of metabolic control, severity of retinopathy. Insulin treated diabetics with microangiopathy show circadian variations in their plasma concentrations of vWF and VIII-RAG which should be taken into account when measuring these factors for clinical or research purposes.

Adult↗