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Biomedical subjects

G Del Priore

Publications and source records attributed to G Del Priore.

At least 19 recordsLinked to original sources
PubMed2006

The role of supracervical hysterectomy in benign disease of the uterus.

The aim of this study was to investigate the type of hysterectomy that gynaecological surgeons and female hospital staff would choose for benign disease of the uterus, and to investigate the most influential factors in that choice. We performed a prospective survey of 369 gynaecological surgeons and 370 female staff members of a large teaching hospital. Our survey found that 88% of UK gynaecological oncologists and 50% of US gynaecological oncologists responding would perform a supracervical hysterectomy (SCH) over a total abdominal hysterectomy (TAH) for benign disease of the uterus. A total of 72% of the female staff surveyed would choose a SCH for benign disease of the uterus. In conclusion, our study has given gynaecological and prospective patient approval to support the idea of replacing total hysterectomy with supracervical hysterectomy for benign disease of the uterus.

Attitude of Health Personnel↗
PubMed2001

Uterine transplantation, abdominal trachelectomy, and other reproductive options for cancer patients.

More and more women with cancer issues are now raising fertility concerns as survival improves and childbearing is delayed. Pregnancy is no longer contraindicated in cancer patients including breast and endometrial cancer survivors. In fact, survival in patients treated for breast cancer who subsequently become pregnant is actually higher than that in patients who do not become pregnant. "Therapeutic" abortions are no longer recommended. Assisted reproductive technology (ART) have been associated with ovarian neoplasms, but the association is probably not causal. Neither ART nor hormone replacement is contraindicated in cancer patients. Our institution is very supportive of patients and the difficult decisions cancer survivors face. Using a program of counseling and close collaboration between oncologists, perinatologists, and reproductive endocrinologists, informed patients are offered every possible option, including ART and uterine transplantation, to achieve their family planning objectives.

Breast Neoplasms↗
PubMed2001

A critical birth weight and other determinants of survival for infants with severe intrauterine growth restriction.

Our objective was to assess the perinatal management and neonatal outcomes of premature, severely intrauterine growth-restricted (IUGR) neonates. A cohort of neonates <1000 grams, < or = first percentile for weight, and <37 weeks' gestation was identified and matched 2:1 to two control sets of premature, appropriate-for-gestational age (AGA) infants-one with similar gestational age (AGA-GA group) and the other with similar birth weight (AGA-BW group) to determine the effect of IUGR on the outcome of the premature infant. The IUGR group was then examined in detail for descriptive statistics. Data were analyzed by t-tests and Chi-square analyses where appropriate. The IUGR infants had worse outcomes than AGA-GA controls but had somewhat better results than the AGA-BW controls. In the IUGR group, a birth weight less than 550 grams was significantly associated with neonatal death (p < 0.001). However, increasing gestational age was not associated with neonatal survival (p = 0.661) if birthweight remained below 550 grams. Classical cesarean delivery was associated with neonatal death (p = 0.003). Neonatal variables associated with poor outcome included patent ductus arteriosus (p = 0.034), feeding intolerance (p = 0.046), and failure to thrive (p = 0.05). Overall, neonatal survival was 73%. Of the surviving neonates, 69% had evidence of neurodevelopmental delay when tested at 6 and 12 months. Premature, growth-restricted neonates with birth weights of <550 grams versus those of >550 grams have dismal outcomes despite a gestational age that is compatible with survival.

Adult↗
PubMed2001

Endometrial brush biopsy for the diagnosis of endometrial cancer.

OBJECTIVE: To evaluate a new technique for processing endometrial cytology for the diagnosis and exclusion of endometrial cancer. STUDY DESIGN: All women at risk for endometrial cancer with clinical indications for endometrial biopsy were evaluated by endometrial brush biopsy (Tao Brush, Cook OB-GYN, Bloomington, Indiana) and Pipelle (Cooper Surgical, Shelton, Connecticut) endometrial biopsies during one office visit. Patients were followed longitudinally for the development of endometrial cancer or until undergoing dilatation and curettage or hysterectomy. All comparisons were analyzed using the chi 2 or t test. RESULTS: One hundred one women (mean age, 58; range, 35-86) had endometrial biopsies performed. Median follow-up was > 21 months (range, 3-29). Twenty-two had cancer or atypia, while the remaining had benign diagnoses. When correlated with the final diagnosis, the Tao Brush had 95.5% sensitivity and the Pipelle, 86% sensitivity. Both devices had 100% specificity, positive predictive value of 100% and negative predictive value of 98%. When the results of the two biopsy devices are considered together, the positive and negative predictive value for detecting or excluding endometrial cancer was 100%. Based on 1998 Medicare reimbursements, a simultaneous second office biopsy using the Tao brush could save approximately $67 per case as compared to a sonohistogram and much more when compared to dilatation and curettage. CONCLUSION: Endometrial cancer can be reliably detected and excluded using these two distinct office biopsy devices simultaneously during one office visit. In patients with an indication for endometrial biopsy, no further diagnostic test may be necessary to exclude or diagnose endometrial cancer or atypia.

Adult↗
PubMed2000

Treatment of cervical carcinoma in situ in HIV positive women.

OBJECTIVES: To evaluate the safety and effectiveness of hysterectomy vs. cone biopsy in HIV seropositive patients with carcinoma in situ of the cervix (CIS). METHODS: We performed a retrospective case-control study of all HIV seropositive patients diagnosed with carcinoma in situ of the cervix from 1989 to 1995. A control group of HIV(-) women with CIS was also ascertained matched for date of diagnosis of CIS, race and age. RESULTS: There were 439 patients with CIS, of which 45 were HIV seropositive (10.3%). Nine were treated by hysterectomy, 30 by cone biopsy, and six remained untreated. Overall, 63% of HIV(+) patients did not receive any follow-up Pap smear (44% of hysterectomy patients, 50% of cone biopsy patients, and 83% of untreated patients; chi(2) P=0.41). According to Pap smear results, 67% (10/15) cone biopsy patients and 60% (3/5) hysterectomy patients had an abnormal Pap smear after treatment (P=0.9). Median time to recurrence was 12 months in hysterectomy patients vs. 14 months in cone biopsy patients. Deaths occurred in 22% of hysterectomy patients, 17% of cone biopsy patients, and 50% of untreated patients, none due to cervical cancer. Median time to death from presentation was 27.5 months for hysterectomy patients, 11 months for cone biopsy patients, and 7 months for untreated patients (P<0.05). There were no complications in the hysterectomy group, however, two patients were readmitted after cone biopsy for bleeding. When compared to HIV(-) women with CIS, HIV(+) patients were more likely to be treated by hysterectomy (chi(2) P=0.01). CONCLUSION: All patients diagnosed with CIS should be counseled regarding HIV prevention and testing because of a significant seropositive rate. Compliance with gynecologic follow-up is very poor in this patient population. Special efforts should be made to enhance compliance. Cone biopsy and hysterectomy appear to be equally safe and effective in the treatment of CIS. CIS in HIV patients is a poor prognostic indicator for death from any cause.

Adolescent↗
PubMed1999

Ovarian cancer: comparison of observer performance for four methods of interpreting CT scans.

PURPOSE: To assess the effects of four interpretative methods on observers' mean sensitivity and specificity by using computed tomography (CT) of ovarian carcinoma as a model. MATERIALS AND METHODS: CT scans in 98 patients with ovarian carcinoma and 49 women who were disease free were retrospectively reviewed by four experienced blinded radiologists to compare single-observer reading, single-observer reading with an anatomic checklist, paired-observer reading (simultaneous double reading), and replicated reading (combination of two independent readings). Confidence level scoring was used to identify three possible disease forms in each patient: extranodal tumor, lymphadenopathy, and ascites. Patient conditions were then categorized as abnormal or normal. RESULTS: There were no significant improvements in sensitivity or specificity for classification of patient conditions as abnormal or normal when comparing single-observer interpretation with single-observer interpretation with a checklist or paired-observer interpretation. Although there was no significant improvement in the mean sensitivity (93% vs 94%) by using the replicated reading method, there was a statistically significant improvement in mean specificity (85% vs 79%) for the replicated readings compared with single-observer interpretations (P < .05). CONCLUSION: Diagnostic aids such as checklists and paired simultaneous readings did not lead to an improved mean observer performance for experienced readers. However, an increase in the mean specificity occurred with replicated readings.

Female↗
PubMed1998

Maternal syphilis and vertical perinatal transmission of human immunodeficiency virus type-1 infection.

OBJECTIVES: To identify risk factors for vertical HIV transmission that may provide opportunities for the prevention of future pediatric HIV infection. STUDY DESIGN: A prospective cohort of 44 pregnant HIV(+) women and their 53 offspring was followed between July 1989 and July 1996. RESULTS: Secondary and latent maternal syphilis infection was diagnosed in four pregnancies with VDRL titers > or = 1:128. Concurrent maternal syphilis infection was associated with 100% vertical HIV transmission (4/4), compared to 21% (3/14) deliveries that occurred in 13 women with only a history of treated sypillis (P = 0.01) and 14% (5/35) deliveries in women with no history of syphilis (P = 0.0015). Among non-Zidovudine exposed pregnancies, 100% (3/3) patients with concurrent syphilis transmitted HIV to their infants vs. 0% (0/8) patients with only a history of syphilis (P = 0.006). A history of treated syphilis did not increase subsequent transmission risk compared to women with no history of syphilis (3/14 vs. 5/35, P = 0.41). One patient delivered twice during the study and received Zidovudine prophylaxis during both pregnancies. Her first pregnancy VDRL titer was > or = 1:128, during which she delivered an HIV infected child. Following successful treatment for syphilis (VDRL titer, 1:1), she conceived again and delivered an uninfected infant 11 months later. Additional risk factors significantly associated with vertical HIV transmission were prematurity and low birth weight. Variables studied but not statistically-related to HIV transmission included: other sexually transmitted diseases, maternal age, race, intravenous drug or cocaine use, prenatal care, route of delivery, duration of HIV(+) status, and CD4 count. CONCLUSION: Among HIV(+) women, concurrent syphilis infection, but not a history of syphilis, is significantly associated with vertical perinatal HIV transmission. Frequent screening and prompt treatment of syphilis in non-pregnant HIV(+) women may help prevent subsequent HIV infected pregnancies.

Adult↗
PubMed1997

Treatment of continuous data as categoric variables in Obstetrics and Gynecology.

OBJECTIVE: To assess the treatment of continuous data in a sample of obstetric and gynecologic literature. METHODS: We reviewed articles in Obstetrics and Gynecology published in the first 4 months of 1985 and 1995. Data were tabulated on a data form created specifically for this purpose and reviewed for accuracy. RESULTS: The sample set included 170 variables in 102 original articles from Obstetrics and Gynecology published from January to April 1995, inclusive (group A, contemporary articles), and 117 variables in 89 articles published between January and April 1985, inclusive (group B, historic articles). Fifty-three variables (31% of total variables) in group A and 27 variables (23% of total variables) in group B (chi 2, P = .05) were continuous predictor variables. The historic-period articles (63%) were significantly more likely to represent continuous data only as categoric variables than were articles in the contemporary period (38%) (Fisher exact test, P = .037). Correlation coefficients, r values, were provided where possible in ten articles in the contemporary period (83%) and four articles in the historic period (31%) (Fisher exact test, P = .008). In articles in which continuous predictors were treated only as categoric variables, an emphasis was placed on the findings based only on categories in four of 12 (33%) of these articles in 1995 and nine of 13 (69%) in 1985 (Fisher exact test, P = .05). CONCLUSIONS: The treatment of continuous data has improved over the time period reviewed. However, clinicians should be aware that continuous data may be mischaracterized as categoric variables in some journal articles. We hope that in the future, editors will consider requesting r values for all continuous data relations. The quality-of-care implications of using discrete cutoffs of continuous data for patient care should be investigated.

Data Collection↗
PubMed1997

Abdominal radical trachelectomy: a new surgical technique for the conservative management of cervical carcinoma.

Traditionally radical hysterectomy has formed the mainstay of treatment for early stage cervical carcinoma. More recently radical trachelectomy and laparoscopic lymphadenectomy have been introduced to allow preservation of fertility. We present a new approach to fertility-sparing surgery, namely abdominal radical trachelectomy. The technique is similar to a standard radical hysterectomy and lymphadenectomy. In our technique the ovarian vessels are not ligated and, following lymphadenectomy and skeletonisation of the uterine arteries, the cervix, parametrium and vaginal cuff are excised. The residuum of the cervix is then sutured to the vagina and the uterine ateries re-anastomosed.

Anastomosis, Surgical↗
PubMed1996

Postmenopausal bartholin gland enlargement: a hospital-based cancer risk assessment.

OBJECTIVE: To assess the risk of Bartholin gland carcinoma in postmenopausal women. METHODS: A referral patient population from a tertiary care cancer center and a hospital-based regional tumor registry was used in a case-control and retrospective cohort study. We searched for data on any discharge diagnosis or procedures involving the Bartholin gland, including excision, cystectomy, or marsupialization, and pathology reports confirming cancer diagnoses from a hospital-based regional tumor registry and a tertiary hospital's medical records department and operating room log. RESULTS: A total of 284 patients were identified, 161 patients from the hospital-based tumor registry and 123 from the tertiary hospital data bases. Pathology reports from 104 of the 161 patients with vulvar cancer were available and revealed two primary adenocarcinomas in postmenopausal women, one squamous cell carcinoma of the Bartholin gland in a postmenopausal woman, and two squamous cell carcinomas of the Bartholin gland in premenopausal patients over a 24-year period. Based on local New York State Department of Health census data, the incidence of Bartholin gland carcinoma was 0.023 per 100,000 woman-years in premenopausal women and 0.114 per 100,000 woman-years in postmenopausal women (incidence rate ratio 5.01, 95% confidence interval [CI] 0.67-25.1). The overall incidence rate of squamous cell vulvar carcinoma was 0.42 per 100,000 woman-years in premenopausal and 4.72 per 100,000 woman-years in postmenopausal women (odds ratio [OR] 11.55, 95% CI 7.82-17.14). The ratio of Bartholin gland cancer to other vulvar cancers was two per 37 in premenopausal women versus three per 124 in postmenopausal women (OR 2.3, 95% CI 0.39-17.9). Of thirteen postmenopausal patients (mean age 65.4 years) with Bartholin gland enlargement admitted to the tertiary care center, only four (30.8%) had excisions, whereas the remainder (69.2%) had drainage or marsupialization. None of the patients treated with drainage or marsupialization were listed subsequently in the tumor registry as developing Bartholin gland cancer during a median surveillance of 10.3 years (range 1.7-14.4). CONCLUSION: Bartholin gland cancer is exceedingly rare in all women, including postmenopausal women. We were unable to find evidence that would justify excision as the initial treatment of a Bartholin gland enlargement in postmenopausal women. Drainage and selective biopsy may be sufficient as initial management.

Adult↗
PubMed1996

A comparison of once-daily and 8-hour gentamicin dosing in the treatment of postpartum endometritis.

OBJECTIVE: To evaluate whether once-daily gentamicin dosing is as effective as the traditional 8-hour regimen for the treatment of postpartum endometritis. METHODS: Postpartum women with endometritis were randomized to receive gentamicin 5 mg/kg as a single daily dose or 1.75 mg/kg every 8 hours. All subjects also received clindamycin. Each participant had a peak serum gentamicin level of at least 5.0 micrograms/mL within the first 24 hours. The dosing regimens were compared by analyzing the number of hours that patients were febrile, the length of hospital stay, occurrence of complications, pharmacy costs, and nursing time required to administer the regimens. RESULTS: The study group (n = 62) and the control group (n = 65) were similar in demographic characteristics and the presence of endometritis risk factors. No differences were found between the groups in the number of patients who completed therapy without complications, required changes in antibiotics, or required readmission for endometritis. The groups did not differ in the number of hours that patients remained febrile after the start of therapy or in the length of hospital stay. No patient in the study group had an initial peak serum concentration less than 5.0 micrograms/mL, whereas 24 patients in the control group had initial peak serum concentrations less than 5.0 micrograms/mL and required dose adjustment, a statistically significant difference (P < .001). Pharmacy costs averaged $16.12 +/- 5.68 for the study group and $41.75 +/- 17.41 for the control group, also a significant difference (P < .001). Nurse tasking time averaged 13.62 +/- 2.56 minutes for the study group and 28.06 +/- 8.77 minutes for the control group (P < .001). CONCLUSION: In patients with postpartum endometritis, once-daily gentamicin dosing provides consistently high peak serum levels of gentamicin, requires less nurse tasking time, costs less, and is as effective as the 8-hour dosing regimen.

Adult↗
PubMed1996

Interstitial pregnancy complicated by rectal bleeding.

An interstitial pregnancy complicated by rectal bleeding is described. Despite modern imaging modalities, confounding features made preoperative diagnosis difficult. The pregnancy ruptured into the ileum. Ossified fetal skull bones and degenerated placental tissue were the only remains from the pregnancy.

Adult↗