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Biomedical subjects

Gary Ventolini

Publications and source records attributed to Gary Ventolini.

13 recordsLinked to original sources
PubMed2006

Vulvovaginal candidiasis from non-albicans species: retrospective study of recurrence rate after fluconazole therapy.

OBJECTIVE: To investigate the recurrence rate of vulvovaginal candidiasis from non-albicans species after fluconazole therapy. STUDY DESIGN: A retrospective cohort of 127 patients with symptomatic vulvovaginal candidiasis by nonalbicans species referred from primary care physicians were evaluated between 1995 and 2004. Complete history, physical examination, basic metabolic panel, and bacterial and fungal cultures were performed. All patients received a daily dose of fluconazole for 30 days. Follow-up evaluations were done at 1, 3, 6, and 12 months. RESULTS: The recurrence rate for all non-albicans vulvovaginitis was 40.2%, 46.5%, 50.4% and 54.2% at 1, 3, 6, and 12 months, respectively. Patients with symptomatic recurrences were more likely to be younger than 35 years of age, older than 65, nulliparous and fastidious vulvar cleaners and were more likely to have concomitant bacterial infections. CONCLUSION: The recurrence rate of symptomatic vulvovaginal candidiasis colonized by non-albicans species after fluconazole therapy was 50.4% at 6 months and 54.2% at 12 months. Nulliparity and age <35 or > 65 years and fastidious vulvar cleaning were positively associated with symptomatic recurrent episodes.

Adult↗
PubMed2006

Perinatal outcome associated with sonographically detected globular placenta.

OBJECTIVE: To evaluate the association between the sonographic appearance of globular placenta and perinatal outcome. STUDY DESIGN: We prospectively followed the pregnancy course and perinatal outcome in women with globular placentas (hyperechoic, thick and highly vascular placentas with edges that lack the typical "tapering" appearance) during routine sonographic study. RESULTS: Fourteen women were included. In 7 women the globular appearance of the placenta normalized spontaneously, and perinatal outcome was good. The other 7 experienced poor perinatal outcomes. There were no significant differences between the 2 groups. Among pregnancies in which the globular placental appearance persisted, 3 resulted in fetal demise; 3 women had severe intrauterine growth restriction and oligohydramnios and underwent cesarean deliveries at 26, 27 and 31 weeks, respectively; and 1 patient had premature preterm rupture of membranes and underwent a cesarean delivery due to placental abruption. CONCLUSION: In half the pregnancies complicated by the sonographic appearance of a globular placenta, this shape spontaneously normalized, and the perinatal outcome was normal. However, when the globular appearance of the placenta persisted, the condition was associated with a poor perinatal outcome. Pregnancies complicated by a globular placenta should be followed closely.

Female↗
PubMed2006

Pregnancy-related changes in the size of uterine leiomyomas.

OBJECTIVE: To describe the effects of pregnancy on the growth of leiomyomas using sonographic measurements of leiomyomas taken longitudinally during pregnancy. STUDY DESIGN: The study population included asymptomatic gravidas with singleton pregnancies in whom we identified uterine leiomyomas. We included all women whose leiomyomas were measured at least twice during the pregnancy. In a subgroup of women we also compared the size of leiomyomas before and after the index pregnancy. Using real-time sonography, we measured each leiomyoma in 3 axes and averaged the measurements. During subsequent studies we calculated the percent change in the size of each tumor. We assessed complications related to the presence of these tumors. RESULTS: We evaluated 137 leiomyomas in 72 women (average, 2.3 +/- 1.8 per woman). Each underwent an average of 3.7 +/- 2.1 scans. The average gestational age at the time of first assessment was 14.4 +/- 5.4 weeks. The average diameter of the leiomyomas at the first study was 34.2 +/- 23 mm. On average, there was no significant change in the size of leiomyomas during pregnancy. We found that the size, location and our ability to visualize leiomyomas varied significantly during pregnancy. Four of the 72 women had obstetric complications related to the presence of leiomyomas. CONCLUSION: The findings of our longitudinal sonographic assessment of 137 uterine leiomyomas suggest that despite the commonly held belief that they tend to enlarge during the course of pregnancy, this phenomenon is in fact quite rare.

Adult↗
PubMed2005

Post-menopausal recurrent vaginal candidiasis: effect of hysterectomy on response to treatment, type of colonization and recurrence rates post-treatment.

INTRODUCTION: Post-menopausal patients are still susceptible to be colonized by fungal organisms despite being estrogen-deprived. Symptomatic vulvovaginal candidiasis, although a rare occurrence in post-menopausal patients, can be diagnosed in about one third of the patients. The purpose of our study was to investigate in post-menopausal patients with recurrent vulvovaginal candidiasis the effect of hysterectomy on response to treatment, the type of colonization and the recurrence rates after treatment. MATERIALS: Forty-seven menopausal patients with symptomatic recurrent vulvovaginal colonization were evaluated between January 1995 and August 2002. The study was a retrospective cohort chart review and included complete history and physical examination, basic metabolic blood panel, colposcopy, wet mount, bacterial and fungal cultures. Twenty-three patients had hysterectomy and 24 were not hysterectomized. All the patients received daily fluconazole therapy for 30 days. They were then re-evaluated at 1, 3 and 6 months and retreated if symptomatic and culture positive. RESULTS: The 2 groups of patients were comparable regarding age, number of years of recurrent colonization, number of previous antifungal treatments and previous, current use of hormone replacement therapy. None used vaginal douching. The 2 groups of patients showed statistical differences regarding: colonization by Candida albicans (P<0.01), colonization by Candida glabrata (P<0.05), colonization by Candida stelloidea (P<0.01), recurrence after 3 months (P<0.05) and 6 months (P<0.05), response to one course of therapy (P<0.02) and need for multiple treatments (P<0.03). CONCLUSIONS: Hysterectomized post-menopausal patients with recurrent vulvovaginal fungal colonization seems to be more propense to harbor more aggressive and resistant fungi. Post-menopausal recurrent vaginal candidiasis: effect of hysterectomy on response to treatment, type of colonization and recurrence rates post-treatment.

Antifungal Agents↗
PubMed2005

Endometriosis in adolescence: a long-term follow-up fecundability assessment.

OBJECTIVE: A long-term, follow-up study comparing mild and severe forms of endometriosis and their fecundability, on 28 women diagnosed with endometriosis in adolescence. METHODOLOGY: Twenty-eight patients were identified from a prospective cohort of 52 adolescents (ages 12 to 18 years) with operative diagnosis of endometriosis between July 1993 and December 1995. All patients presented with chronic pelvic pain unresponsive to conservative medical management. Diagnosis of pregnancy was made by sonographic identification of intrauterine pregnancy, positive serum human chorionic gonadotropin or pathological confirmation of products of conception. Patients were categorized as fertile or sub-fertile by having > 12 months of unprotected intercourse without conception. Follow-up was done for 8.6 years. RESULTS: Staging of endometriosis was performed according to the American Society for Reproductive Medicine standards. Stage I = 14.3%; Stage II = 39.3%; Stage III = 42.8%; Stage IV = 3.6%. Fecundability rates in each stage were statistically significant: Stage I (75%), Stage II (55%), Stage III (25%), Stage IV (0%) (p < .05). Rates of spontaneous abortion were not statistically significant. CONCLUSION: In our cohort, even at the earliest point in the natural life cycle of endometriosis there is an inverse relationship between stage of disease at diagnosis and fecundability.

Adolescent↗
PubMed2005

Shortening increases spontaneous contractility in myometrium from pregnant women at term.

OBJECTIVE: The purpose of this study was to determine whether shortening alters spontaneous contractility in myometrial strips that are obtained from pregnant women. STUDY DESIGN: Isometric contractions were measured in myometrial strips that were obtained at cesarean delivery from 14 pregnant women at term. After 2 hours of stretching, the strip lengths were decreased by 4%, 6%, or 8%. Spontaneous contractility was measured for 120 minutes with or without prostaglandin synthase inhibitor indomethacin (10 -5 mol/L), and the cumulative concentration response to oxytocin was determined. RESULTS: Contractility was increased by 29% and 34% in strips that shortened by 4% and 6%, respectively. Preincubation with indomethacin increased contractility by 15% in stretched strips and decreased contractility by 30% and 19% in 4% and 6% strips, respectively. Contraction frequency was increased by 26% and 53% for the strips that were shortened to 6% and 8%, respectively. These increases were prevented by indomethacin. The oxytocin responses were similar at all lengths. CONCLUSION: Shortening of myometrial strips from pregnant women at term increases spontaneous contractility by a mechanism that apparently involves prostaglandins.

Analysis of Variance↗
PubMed2004

Magnesium sulfate induces translocation of protein kinase C isoenzymes alpha and delta in myometrial cells from pregnant women.

OBJECTIVES: The purpose of this study was to determine the effect of magnesium sulfate on protein kinase C (PKC) translocation in myometrial cells from pregnant women. STUDY DESIGN: Myometrium was obtained at the time of cesarean delivery from women at term before labor. Cultured myometrial cells were treated with magnesium sulfate (3, 5, and 10 mmol/L), oxytocin (0.1 micromol/L), or 12-O-tetradecanoylphorbol-13-acetate (TPA, 0.1 micromol/L). The translocation of PKC isozymes alpha (calcium dependent) and delta (calcium independent) from cytosol to membrane fractions was assessed with use of Western blot analysis. RESULTS: In unexposed control cells, the majority of PKC alpha and delta was located in the cytosol fraction. Exposure to magnesium sulfate for 60 minutes induced translocation of both PKC alpha and delta at concentrations as low as 5 and 3 mmol/L, respectively. The magnitude of magnesium sulfate induced translocation for PKC delta is similar to that seen after oxytocin or TPA exposure but less for PKC alpha. Exposure to oxytocin for 30 minutes and 60 minutes induced translocation of PKC alpha and delta, respectively. Exposure to TPA for 5 and 30 minutes induced translocation of PKC alpha and PKC delta, respectively. In calcium-free media, only TPA induced translocation of these two isoenzymes. CONCLUSION: Magnesium sulfate stimulates PKC translocation in cultured myometrial cells from pregnant women. Magnesium sulfate and oxytocin require extracellular calcium to induce translocation of both PKC alpha and delta.

Cells, Cultured↗
PubMed2004

Placental findings in low-risk, singleton, term pregnancies after uncomplicated deliveries.

Should all placentas be sent to pathology for examination after delivery room triage? A cohort of 88 placentas was prospectively obtained and examined from low-risk, singleton, term pregnancies after uneventful delivery. All patients had a normal prenatal testing and anatomy ultrasound. Fifty-one placentas (58%) were normal. Thirty-seven of the placental cohort (42%) had abnormal findings. Thirteen of the abnormal placentas (35.1%) showed pathology unassociated with fetal compromise. Twenty-four of the placentas (27.3% of the total cohort and 64.9% of the abnormal placentas) showed findings associated with fetal compromise. The most common pathologies were marginal cord insertion, chorioamnionitis, and abruption. Routine placental examination is not indicated, according to our data, in low-risk, singleton, and term pregnancy unless the placenta is determined to be abnormal at delivery examination.

Adult↗
PubMed2004

Decreasing infectious morbidity in cesarean delivery by changing gloves.

OBJECTIVE: To assess whether changing the entire surgical team's gloves intraoperatively, after delivery of the placenta, would reduce the rate of postcesarean wound infection. STUDY DESIGN: Women who underwent cesarean delivery were randomized to a group where the surgical team changed the surgical gloves after delivery of the placenta or to a control group, where surgical gloves were not changed during the cesarean procedure. RESULTS: Ninety-two patients were randomized to 2 groups of 46 patients each. The group where the surgical team changed their gloves had significantly less serosanguineous drainage 24 hours after surgery (3 vs. 8 patients, 8.3% vs. 22.2%, P = .2, RR 2.7, CI 0.7, 12.4) and fewer wound infections (2 vs. 9 women, 5.5% vs. 25%, P = .05, RR 4.5, CI 0.982, 29.8). CONCLUSION: Obstetricians may decrease the number of postcesarean wound infections by having the entire team change surgical gloves after delivery of the placenta.

Adult↗
PubMed2003

Adhesions caused by umbilical piercing.

A 31-year-old woman experienced chronic pelvic pain, unresponsive to medical therapy. History, physical examination, and laboratory analyses were noncontributory except for multiple body piercings. Diagnostic laparoscopy revealed an umbilical adhesion from the small bowel to the anterior abdominal wall. The patient removed the umbilical piercing but declined surgery for adhesiolysis.

Adult↗
PubMed2003

Natural history of cervical intraepithelial neoplasia 1 in primigravida.

OBJECTIVES.: The purpose of our prospective cohort study was to determine whether cervical intraepithelial neoplasia (CIN) 1 regresses, persists, or progresses during pregnancy. Eighty-four primigravid patients, ages 16 to 32 years old (mean 26), with no history of abnormal Pap smear, had abnormal Pap test results during their prenatal care between August 1995 and December 1998. The initial Pap results on these patients were: 57 (67.8%) atypical squamous cells of undetermined significance; 21 (25%) low-grade squamous intraepithelial lesions (LSIL); and 6 (7.2%) high-grade squamous intraepithelial lesions. Colposcopy and directed biopsies performed showed: 21(25%) normal; 6 (7.2%) acute cervicitis; 9 (10.7%) chronic cervicitis; 39 (46.4%) CIN 1; 7 (8.3%) CIN 2; and 2 (2.4%) CIN 3. RESULTS.: Thirty-nine patients with LSIL were seen for follow-up colposcopy and biopsy in the second and third trimesters of pregnancy and postpartum. Twenty-eight patients (71.8%) had a repeat normal (regression) as follows: 2 (7.1%) in the second trimester, 4 (14.3%) in the third trimester, and 22 (78.6%) postpartum. Three patients (7.7%) had progression. Eight patients (20.5%) had persistent CIN 1. CONCLUSIONS.: Our study found that more than 70% of CIN 1 was associated with pregnancy regression in primigravidas. Our study suggests the need for postpartum follow-up of all the patients diagnosed with CIN 1 during pregnancy. The follow-up should include a Pap smear. Patients without regression of LSIL by Pap smear at the postpartum visit should be thoroughly investigated and treated.

Journal Article↗