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Biomedical subjects

G Putignano

Publications and source records attributed to G Putignano.

At least 19 recordsLinked to original sources
PubMed2005

Cervical squamous intraepithelial lesions of low-grade in HIV-infected women: recurrence, persistence, and progression, in treated and untreated women.

BACKGROUND: Human immunodeficiency virus (HIV)-infected patients are more predisposed than HIV-negative women to develop squamous intraepithelial lesions (SIL) of the uterine cervix, and cervical dysplasia may be of higher grade in HIV-positive women than in HIV-negative subjects, with more extensive and multi-centric involvement of the lower genital tract by human papillomavirus (HPV)-associated lesions. Moreover, recurrence and progression rate of cervical intraepithelial neoplasia (CIN) is particularly higher in immunocompromised women. DESIGN: Retrospective case-control study of HIV-positive women and HIV-negative controls, all affected by low-grade SIL of the uterine cervix, treated by loop excision or followed-up without treatment. Correlation of progression and recurrence of SIL with HIV status and CD4+ count. PATIENTS: From September 1990 to October 1997, 75 HIV-positive low-grade-SIL patients, 47 treated and 28 followed-up without treatment, and 75 HIV-negative low-grade-SIL controls, 45 treated and 30 followed-up. RESULTS: Among treated patients, 17/47 (36.2%) HIV-positive and 5/45 (11.1%) controls had recurrence (P < 0.0101, O.R. = 4.53, 95% CI = 1.5-13.7), progression of untreated lesion was seen in 15/28 (53.6%) HIV-positive and 7/30 (23%) controls (P < 0.05, O.R. = 3.79, 95% CI = 1.23-11.69). The risk of recurrence or progression of low-grade SIL linked to HIV seropositivity is about 4-5 times higher in comparison with seronegative counterpart, matched for age, risk factors and lesion size. More significantly, considering the cut-off of 200 CD4+/mm(3) in HIV-positive women, 13/17 cases of recurrence (P < 0.05, O.R. = 4.88, 95% CI = 1.28-18.58) and 10/15 cases with progression (P < 0.05, O.R. = 6.67, 95% CI = 1.24-35.73) were immunocompromised (<200 CD4+/mm3), with a significant higher risk of recurrence or progression linked to immunodeficiency status. Considering time of progression or recurrence, during follow-up, Kaplan-Meier curves shows that HIV-positive status and immunodeficiency are correlated with more rapid evolution of cervical dysplasia and HPV-related lesions: comparison of recurrence in treated patients report P < 0.005 and progression in untreated P<0.05 (Mantel-Haenszel log-rank test). CONCLUSIONS: Immunological status seems to be a determinant factor in prognosis of cervical SIL, HIV-positive women affected by this lesion, even if low-grade, need more aggressive management than the immunocompetent counterpart. Strict cytologic and colposcopic screening is recommended and CD4+ count and HPV-DNA testing may be useful risk indicators. Excisional procedures are preferred, while ablative treatments or wait and see policy may expose to some risk this type of population with poor compliance to follow-up.

Case-Control Studies↗
PubMed2003

The effect of a soy rich diet on the vaginal epithelium in postmenopause: a randomized double blind trial.

BACKGROUND: A traditional asiatic phytoestrogen-rich diet is associated with a lower incidence of estrogen-dependent cancers and clinical consequences of postmenopausal estrogen deficiency. First Wilcox in 1990, showed an increase of the vaginal cell maturation with phytoestrogens on postmenopausal women, but this has not been confirmed in some subsequent studies. METHODS: In this study, we analyzed the effects of a 6-month soy-rich diet on the vaginal epithelium of asymptomatic postmenopausal women in a randomized clinical trial. 187 women were recruited for the study and divided into three groups: a phytoestrogen rich diet group; a hormonal replacement group, and a control group. A vaginal sample for hormonal cytology was taken before and at the end of the study, and sent unnamed to a cytologist. RESULTS: The karyopycnotic index (KI) increased significantly in the diet group and in the HRT group but not in the control group. The maturation value (MV) had an identical trend to the KI. CONCLUSION: We conclude that a soy rich diet is efficacious in increasing the maturation indices of vaginal cells. This effect could be a useful marker of the efficacy of a dietary intervention with phytoestrogen rich foods, and should be considered during preventive interventions against menopausal effects and vaginal atrophy.

Adult↗
PubMed2001

Malignant mixed mullerian tumor of the ovary: report of four cases.

INTRODUCTION: Malignant mixed mullerian tumor (MMMT) of the ovary is an extremely rare gynaecologic neoplasm that represents 1% of the malignances of this organ. Stage I disease is rare because it is asymptomatic in early stage. We describe four cases. CASE REPORTS: In the Department of Obstetrics and Gynecology of the University of Bari four cases of MMMT of the ovary were diagnosed. Three patients were in stage IIIC and one of them was a homologous MMMT; the fourth patient was affected by a heterologous stage IV MMMT. All women were treated with surgery and chemotherapy. Two patients are alive 14 and 12 months after diagnosis. The other two died after 37 months and one month, respectively. CONCLUSIONS: The malignant mixed mullerian tumor (MMMT) of the ovary is a particularly aggressive tumor, especially in advanced stages. The survival rate is very low in spite of surgery, chemotherapy and radiotherapy. The optimal treatment for this neoplasm is unknown because of its rarity. Our experience, when considering survival, seems to confirm the use of cisplatin and ifosfamide and to give new horizons to taxol.

Combined Modality Therapy↗
PubMed2001

Successful treatment of cervical and simultaneous cervico-isthmic pregnancy with methotrexate.

OBJECTIVE: To describe the monitoring of a case of cervical and simultaneous cervico-isthmic pregnancy. SETTING: University of Bari (Italy), Department of Obstetrics and Gynecology. PATIENT: A 30-year-old white woman, nulliparous, at 8 weeks of amenorrhoea. INTERVENTION: Methotrexate and folinic acid administered systemically. MAIN OUTCOME MEASURE: Treatment success was defined as elimination of the cervical and cervico-isthmic pregnancy, with non-invasive treatment and preservation of the uterus and normal ovarian activity restored. RESULT: Methotrexate and folinic acid were administered, elimination of a twin pregnancy with declining serum beta-hCG levels and with ultrasound was observed. The patient had only occasional dark vaginal bleeding and temporary movement of the transaminase. CONCLUSION: This case report shows that methotrexate is a valid, conservative and non-invasive treatment for a patient affected by cervical pregnancy who wishes to keep fertility.

Abortifacient Agents, Nonsteroidal↗
PubMed2000

Primary peritoneal carcinoma: a report of twelve cases and a review of the literature.

Primary peritoneal carcinoma (PPC) is rare tumor histologically identical to epithelial ovarian carcinoma (EOC); it is differentiated from EOC based on the extent of gross ovarian involvement and microscopic invasion of the cortex. We report 12 cases of PPC which were diagnosed in our Department during a 9-year period. Total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy were performed in 9 patients, while 3 underwent only explorative laparotomy with bilateral salpingo-oophorectomy. All patients were treated with postoperative platinum-based chemotherapy. After a median follow-up of 42 months, only 5 patients are alive without disease. PPC is a rare tumor currently managed in the same way as ovarian cancer. Primary debulking surgery and chemotherapy represent the cornerstones of treatment. Considering the limited number of patients with PPC, no definitive conclusion can be drawn concerning the prognostic factors for survival.

Adult↗
PubMed2000

Serum progesterone, estradiol-17beta and testosterone at the time of relapse in patients with epithelial ovarian cancer.

Raised levels of steroid hormones may be detected in women with ovarian cancer at the time of diagnosis. The goal of this study was to investigate the levels of progesterone, testosterone and estradiol-17beta in patients with relapsed epithelial ovarian cancer. We studied 52 patients with a histologic diagnosis of ovarian cancer; 46 of 52 patients were affected by epithelial tumors, two patients had sexcord-stromal tumors, one patient had a germ cell tumor and three patients had a metastatic cancer from the bowel. Of 34 patients with disease relapse, none had elevated serum testosterone levels (>1 ng/ml), one patient (2.9%) had an elevated serum progesterone level (>1.24 ng/ml) and two patients (5.9%) had elevated estradiol-17beta levels (>28 pg/ml). The relationship between the three hormone levels at the time of initial treatment and at relapse was tested using the Students's t-test. At the time of initial treatment venous concentrations of progesterone, estradiol-17beta and testosterone were higher and statistically different (p<0.05) from samples obtained at the time of relapse in the same patients. No significant differences were found between patients studied at the time of relapse and the control group. Measurement of progesterone, estradiol-17beta and testosterone is not helpful in detecting disease relapse in patients with epithelial ovarian cancer.

Adult↗
PubMed1999

Spontaneous and induced release of prostaglandins, interleukin (IL)-1beta, IL-6, and tumor necrosis factor-alpha by placental tissue from normal and preeclamptic pregnancies.

PROBLEM: The objective of this study was to clarify the role of the main proinflammatory cytokines (interleukin [IL]-1, IL-6, tumor necrosis factor [TNF]-alpha) in the pathogenesis of preeclampsia and how these cytokines affect one another and the production of prostaglandins (PGs). METHOD OF STUDY: The concentrations of cytokines and PGs in supernatants of placental tissue from preeclamptic and normal women were determined by enzyme-linked immunosorbent assay. RESULTS: The concentrations of the PGs from unstimulated preeclamptic placental tissue were significantly higher compared to the concentrations of PGs from normal unstimulated placental tissue. Significant levels of IL-1beta were observed only in the supernatants of preeclamptic placental tissue. Of interest, an increase in TNF-alpha production was detected in the supernatants of IL-1-stimulated preeclamptic placental tissue. CONCLUSIONS: The overproduction of TNF-alpha may be related not only to the effect of a stimulant like IL-1beta, but mainly to the lack of mechanisms down-regulating the production of TNF-alpha.

Dinoprost↗
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↗
PubMed1997

Exocervical pregnancy.

A case of cervical pregnancy with implantation of the fertilized ovum on the exocervix is described. This pregnancy was mistaken for an endometriotic lesion and treated by simple surgical excision. Discussion is centered on etiology, predisposing factors and management.

Adult↗
PubMed1991

[Incidence of ectopic pregnancy at the 1st Clinic of Obstetrics and Gynecology of Bari during the past 10 years. Clinico-statistical considerations].

The Authors, in the period 1979-1988, discovered 175 ectopic pregnancies out of a total of 16.641 pregnancies: a rate of incidence of 1 in 95 (1.05%); 28 patients were fitted with an IUD. In accordance with published data, they recognize an increase in the incidence of ectopic pregnancies and emphasize the importance of a precocious clinical diagnostic, to reconcile timeliness of operation with the need of conservative surgery, the indication for which should take into account many factors (the age, the general condition, the parity, the wish for a pregnancy, the state and condition of the tube on each side) since it seems to predispose to recurrent ectopic pregnancies. They indicate the negative effects on the tube for patients fitted with an IUD.

Female↗
PubMed1990

[A case of primary ovarian pregnancy in an IUD-wearing patient].

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.

Adnexa Uteri↗
PubMed1988

Valuation of some markers in the malignant neoplastic pathology of the female genital tract.

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.

Biomarkers, Tumor↗
PubMed1988

Chemotherapy with CDDP.

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.

Adult↗
PubMed1988

Role of radiotherapy in the management of cervical carcinoma.

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.

Adult↗
PubMed1988

Virus in gynaecological oncology.

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.

Aged↗
PubMed1981

[The prune-belly syndrome. Antenatal diagnosis (author's transl)].

The authors describe an unusual case of the Prune-Belly Syndrome which was diagnosed antenatally using ultra-sound. They note at the same time that the urinary tract dilated very rapidly in the last weeks of pregnancy and that it was pointless to empty the fetal bladder repeatedly.

Adult↗