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Biomedical subjects

L Fedele

Publications and source records attributed to L Fedele.

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

Phantom endometriosis of the sciatic nerve.

OBJECTIVE: To assess the efficacy and diagnostic value of GnRH agonist (GnRH-a) therapy in cases of hidden sciatic nerve endometriosis. DESIGN: Case report. SETTING: Academic tertiary referral center for endometriosis treatment. PATIENT(S): Three patients with cyclic, catamenial sciatica associated with pelvic endometriosis who had electromyographic evidence of sciatic nerve damage but negative computed tomography and magnetic resonance imaging findings. INTERVENTION(S): Monthly administration of the GnRH-a leuprolide acetate plus daily transdermal E2 (25 microg). MAIN OUTCOME MEASURE(S): Relief of pain symptoms and improvement in motor function. RESULT(S): All three patients had clear decreases in pain and partial amelioration of claudication. CONCLUSION(S): Endometriosis of the sciatic nerve may be hard to diagnose with the use of current imaging techniques but may be proved by clinical response to GnRH analogue treatment and may be more frequent than previously thought.

Administration, Cutaneous↗
PubMed1999

The Vecchietti procedure for surgical treatment of vaginal agenesis: comparison of laparoscopy and laparotomy.

OBJECTIVE: Our goal was to describe the outcomes of women with vaginal agenesis who had surgical creation of a neovagina using the Vecchietti technique over a 20-year period. We also sought to determine whether the laparoscopic approach would result in similar outcomes as laparotomy. METHOD: Retrospective analysis of 76 women with vaginal agenesis treated at the University of Verona Hospital between 1976 and 1996 with the Vecchietti procedure. Operative and postoperative records were reviewed, and sexual histories were obtained. Data were analyzed based on surgical approach and postoperative sexual satisfaction. Continuous data were analyzed with student's t-test, and categoric data were analyzed using Fisher's exact test. RESULT: Those who underwent the Vecchietti procedure with a laparoscopic approach (N = 7) had similar complication rates (0% vs. 13.0%, P = 0.59) and postoperative neovaginal depth (74.9 mm vs. 73.7 mm, P = 0.93) as those with laparotomy (N = 69). Similar proportions of women reported inadequate vaginal lubrication (28.6% vs. 17.4%, P = 0.61) and sexual satisfaction (100% vs. 78.3%) in the laparoscopy and laparotomy groups as well. Operative complications, neovaginal depth, or degree of lubrication were not good predictors of sexual satisfaction. CONCLUSION: Outcomes in those women who underwent the Vecchietti technique via the laparoscopic approach are comparable to those who underwent laparotomy.

Female↗
PubMed1999

Laparoscopic creation of a neovagina in women with pelvic kidney.

Laparoscopic modification of Vecchietti's technique for creating a neovagina was carried out in four women with Rokitansky syndrome and renal anomalies. All four patients had pelvic kidney, and in two it was associated with contralateral renal agenesis. The procedure was specifically modified to reduce the risks inherent in the most difficult step, passing the thread-bearing cutting needle from the abdominal wall to the retrohymenal fossa, through the vesicorectal space. In all patients this was done successfully on the side contralateral to the pelvic kidney or in the hemipelvis in which the ureter was absent. Our experience proves that Vecchietti's technique for creating a neovagina, performed by laparoscopy, is feasible in patients with pelvic kidney, and laparotomy is unnecessary. (J Am Assoc Gynecol Laparosc 6(3):327-329, 1999)

Abnormalities, Multiple↗
PubMed1999

Transrectal ultrasonography in the assessment of congenital vaginal canalization defects.

Our aim was to evaluate the reliability of transrectal ultrasonography in the preoperative assessment of congenital vaginal canalization defects. We studied nine patients, six with suspected Rokitansky syndrome and three with suspected complete transverse septum. Before corrective surgery all the patients underwent pelvic examination, transabdominal and transrectal ultrasonography. The ultrasonographic findings were compared with the surgical ones. Transrectal ultrasonography provided an accurate map of the pelvic organs showing the precise distances between the urethra and bladder anteriorly, rectum posteriorly, retrohymenal fovea caudally, and pelvic peritoneum cranially. Transrectal ultrasonography produced a picture that corresponded perfectly with the real anatomical situation. Conversely, abdominal ultrasonography provided inadequate images in six of our nine patients, and magnetic resonance imaging was responsible for a mistaken diagnosis in one patient with suspected transverse vaginal septum. In conclusion, if our results are confirmed in larger series, transrectal ultrasonography could be considered as a diagnostic procedure of choice in the assessment of vaginal canalization defects.

Abdomen↗
PubMed1999

Lumbar pain and fin swimming.

BACKGROUND: It was hypothesised that fin swimming have unique physiopathologic features in particular concerning low back involvement. METHODS: Retrospective study. SETTING: elite competitive fin swimmers. PARTICIPANTS: 17 males and 14 females aged from 16 to 23 years. INTERVENTION: piroxicam, sport interruption for a week, proper warming-up and wearing suggestions during out-of-water exercises in the symptomatic group. Absence of intervention in the asymptomatic one. MEASURES: anthropometric measures (weight, height, legs length discrepancy), isokinetic measures (trunk flexor/extensor ratio) and conventional radiological investigation were taken for all subjects. RESULTS: Low back pain was present in 14 subjects during off season but only 7 referred discomfort in competitive season. 78.5% of symptomatic subjects showed radiological abnormalities while imaging changes were present in 52.9% of the asymptomatic group. Flexor/extensor ratio isokinetically evaluated was less than one in 6 athletes complaining back discomfort. Non steroid medication, physiotherapy, training and wearing cares was suggested. Authors report a pain free return to competition in 57% and a partial resolution in 28% of those symptomatic cases who were not used to training cares (in particular proper "out-of-water" warming up) and wearing precautions (complete wiping and suitable thermic clothing after swimming). CONCLUSIONS: In fin swimming low back pain can be related to the existence of environmental and intrinsic factors. In our series no significant difference in imaging changes was pointed out among asymptomatic or painful athletes. Therefore a cyclic load on the column, in absence of training precautions can make spine abnormalities (in particular schisis, facet derangement and pars lesion) symptomatic.

Adolescent↗
PubMed1998

Bladder endometriosis: deep infiltrating endometriosis or adenomyosis?

OBJECTIVE: To describe the anatomopathologic characteristics of endometriosis infiltrating the bladder detrusor. DESIGN: Descriptive anatomopathologic study. SETTING: Tertiary care center for endometriosis. PATIENT(S): Four patients, aged 22-38 years, who underwent laparotomy for bladder endometriosis. INTERVENTION(S): Surgical excision and pathologic analysis of bladder endometriotic nodules in four patients. MAIN OUTCOME MEASURE(S): Gross and microscopic characteristics of endometriotic nodules. RESULT(S): A nodule of adenomyosis on the anterior wall of the uterus, in continuity with the detrusor lesion, was excised in three patients. In the other patient, bladder endometriosis was continuous with a nodule that infiltrated the left parametrium and extended as far as the posterior leaf of the ipsilateral broad ligament. Microscopically, all of the lesions had a similar histologic pattern: foci of endometriosis scattered in the bladder wall. The main feature was the paucity of endometrial-type stroma, particularly in the bladder submucosa, where glands were almost always dilated and cystlike and were lined by flattened cells. CONCLUSION(S): Analysis of our patients, although it does not pinpoint the pathogenesis of the disease, seems to exclude the hypothesized intraperitoneal origin of endometriotic lesions of the bladder detrusor.

Adult↗
PubMed1998

Transrectal ultrasonography in the assessment of rectovaginal endometriosis.

OBJECTIVE: To evaluate the validity of transrectal ultrasonography in the assessment of rectovaginal endometriosis. METHODS: We compared the findings of transrectal ultrasonographic examination performed before surgery with the operative and pathologic findings in 140 women who underwent laparoscopy or laparotomy for suspected endometriosis. The ultrasonographer was asked to investigate whether any deep endometriotic lesions were present in the rectovaginal septum and to define the lateral extension on the basis of involvement of the uterosacral ligaments. In addition, infiltration of the rectal and vaginal walls was evaluated. RESULTS: Thirty-four women had endometriosis infiltrating the rectovaginal septum confirmed by combined operative and pathologic findings. Ultrasonography showed a sensitivity and specificity of 97% and 96%, respectively, in the diagnosis of the presence of rectovaginal endometriosis. The sonographer identified infiltration of the rectal and vaginal walls correctly in all cases in whom it was present, but also reported rectal infiltration in three cases not confirmed by the surgeon and pathologist. The sensitivity and specificity in the diagnosis of uterosacral ligament infiltration were 80% and 97%, respectively. CONCLUSION: If our preliminary results are confirmed by a larger series, transrectal ultrasonography will be considered a valid diagnostic tool in the evaluation of rectovaginal endometriosis.

Adult↗
PubMed1998

Intramesosalpingeal injection of oxytocin in conservative laparoscopic treatment for tubal pregnancy: preliminary results.

The objective of this study was to evaluate the efficacy of the local use of oxytocin as adjuvant treatment in conservative surgery for tubal pregnancy. The patients were 25 women with laparoscopic diagnosis of tubal pregnancy who were candidates for salpingotomy. Before salpingotomy, each patient was randomly allocated to intramesosalpingeal injection of 20 IU oxytocin diluted to 20 ml with saline solution or 20 ml saline solution. The surgeon then proceeded with salpingotomy and removal of the pregnancy according to the usual technique. The main outcome measures were bleeding during salpingotomy, ease of removal of the pregnancy, bleeding at the site of the pregnancy, and need for recourse to salpingectomy. Twelve women were randomized to the oxytocin group and 13 to the control group. Examination of the surgeons' assessments of the difficulties encountered at the different stages of surgery revealed statistically significant differences between the oxytocin group and controls in each variable. In particular, the amount of endosalpingeal bleeding after removal of the pregnancy was less in the oxytocin group. In one control patient, persistent bleeding due to incomplete trophoblast removal forced the surgeon to perform salpingectomy. Our results indicate that intramesosalpingeal injection of oxytocin facilitates the performance of conservative laparoscopic treatment for tubal pregnancy.

Adult↗
PubMed1998

Surgical treatment of recurrent endometriosis: laparotomy versus laparoscopy.

The objective of this study was to clarify which is the better surgical conservative treatment for recurrent endometriosis. We compared two consecutive surgical series at a tertiary care centre for the cure of endometriosis. The patients were 81 women with recurrent endometriosis, 41 reoperated at laparotomy from 1986 to 1991 and 40 reoperated at laparoscopy from 1992 to 1996. Follow-up after the second operation included clinical and ultrasound examinations performed at least once a year to evaluate the recovery of fertility and the reappearance of symptoms and signs of the disease. The cumulative probability of recurrence of dysmenorrhoea (34 and 43 respectively), and the frequency of recurrence of pelvic pain and dyspareunia and of clinical findings suggestive of the disease were not significantly different in the two groups. The rate of recurrence of dyspareunia was higher in the patients operated at laparotomy as was the number requiring a third operation. However, this could be due to the longer follow-up of this group. No significant difference was observed between the cumulative pregnancy rates at 24 months in the two groups (45 in the laparotomy and 54 in the laparoscopy group). We conclude that operative laparoscopy seems as efficacious as conservative surgery at laparotomy in the treatment of recurrent endometriosis.

Adult↗
PubMed1998

Coffee consumption and risk of hospitalized miscarriage before 12 weeks of gestation.

In order to analyse the association between drinking coffee in pregnancy and risk of spontaneous abortion, a case-controlled study was conducted in Milan, Northern Italy. Cases were 782 women with spontaneous abortion within the 12th week of gestation. The control group was recruited from women who gave birth at term (> 37 weeks gestation) to healthy infants on randomly selected days at the same hospitals where cases had been identified: 1543 controls were interviewed. A total of 561 (72%) cases of spontaneous abortion and 877 (57%) controls reported coffee drinking during the first trimester of the index pregnancy. The corresponding multivariate odds ratios of spontaneous abortion, in comparison with non-drinkers, were 1.2, 1.8 and 4.0, respectively, for drinkers of 1, 2 or 3, and 4 or more cups of coffee per day. No relationship emerged between maternal decaffeinated coffee, tea and cola drinking in pregnancy, as well as paternal coffee consumption, and risk of spontaneous abortion. With regard to duration in years of coffee drinking, the estimated multivariate odds ratios of spontaneous abortion were, in comparison with non-coffee drinkers, 1.1 (95% confidence interval (CI) 0.9-1.4) and 1.9 (95% CI 1.5-2.6) for women reporting a duration of coffee consumption < or = 10 or > 10 years. In conclusion, coffee drinking early in pregnancy was associated with an increased risk of abortion. This has biological implications, but epidemiological inference on the causality is difficult and still open to debate.

Abortion, Spontaneous↗
PubMed1998

Induced abortion in the first trimester of pregnancy and risk of miscarriage.

OBJECTIVE: To analyse the relation between induced abortion and risk of subsequent miscarriage. DESIGN: Case-control study conducted between February 1990 and May 1995. PARTICIPANTS: Case group included 782 women (median age 32 years, range 14-46) admitted for spontaneous abortion (within the 12th week of gestation) to a network of obstetric departments in the greater Milan area. The control group was recruited among women who gave birth at term (> 37 weeks of gestation) to healthy infants on randomly selected days at the hospitals where cases had been identified. A total of 1543 controls (median age 30 years, range 14-45) were interviewed. RESULTS: A total of 102 cases (13%) and 181 controls (12%) reported one or more induced abortions. No clear relation emerged between miscarriage and induced abortions. In comparison with women reporting no induced abortion the odds ratio (OR) for miscarriage were 1.1 (95% CI 0.8-1.4) in women reporting one induced abortion and 0.9 (95% CI 0.4-1.8) in women reporting two or more. Likewise, there was no association between time since last and age at first induced abortion and risk of miscarriage. CONCLUSIONS: This study did not find any strong association between induced and spontaneous abortion.

Abortion, Induced↗
PubMed1998

A new laparoscopic procedure for the correction of vaginal vault prolapse.

PURPOSE: We verified the feasibility and results of a new laparoscopic technique for repairing vaginal vault prolapse. MATERIALS AND METHODS: Laparoscopic repair of vaginal vault prolapse was done in 12 women 46 to 82 years old. Stage 1 consisted of culdoplasty similar to that of Moschowitz. Stage 2 included a transverse incision of the peritoneum covering the vaginal vault to expose the vaginal fascia. Two sutures were then fixed to the vaginal corners, passed through the subperitoneal connective tissue and attached to the fascia of the abdominal muscles with multiple stitches. RESULTS: No intraoperative or postoperative complications occurred and anatomical repair was complete in all women. Followup ranged from 9 to 28 months. Sexual function was recovered in all cases. CONCLUSIONS: If these results are confirmed in larger series with a longer followup, our laparoscopic approach would be considered a valid alternative to current surgical techniques.

Aged↗
PubMed1997

Treatment of adenomyosis-associated menorrhagia with a levonorgestrel-releasing intrauterine device.

OBJECTIVE: To evaluate the efficacy and tolerability of treatment with a levonorgestrel-releasing intrauterine device (IUD) in women affected by adenomyosis-associated menorrhagia. SETTING: Tertiary care center. DESIGN: Prospective, open, noncomparative study. PATIENT(S): Twenty-five women aged 38 to 45 years with recurrent menorrhagia associated with adenomyosis diagnosed at transvaginal ultrasonography participated in this study. INTERVENTION(S): An IUD releasing levonorgestel 20 mcg/day was inserted in each patient within 7 days of the start of menstrual flow. All of the patients were requested to compile a pictorial blood loss assessment chart each month. They underwent clinical and transvaginal ultrasound examinations 3, 6, and 12 months after IUD insertion. MAIN OUTCOME MEASURE(S): Menstrual pattern; serum hemoglobin, ferritin, and iron level changes. RESULT(S): One patient experienced IUD expulsion 2 months after device insertion and another requested removal of the IUD 4 months after insertion because of persistent irregular blood loss. Six months after IUD insertion, amenorrhea was observed in 2 patients and oligomenorrhea in another, spotting occurred occasionally in 7, and 13 had scanty but regular flow. One year of follow-up has been completed by the remaining 23 women: 2 with amenorrhea, 3 with oligomenorrhea, 2 with spotting, and 16 with regular flows. Significant increases in hemoglobin, hematocrit, and serum ferritin have been observed, but the lipid metabolism and clotting variables have remained unchanged. CONCLUSION(S): Our findings indicate that marked and safe relief from adenomyosis-associated menorrhagia can be obtained with the use of a levonorgestrel-releasing IUD.

Adult↗
PubMed1997

Double uterus, blind hemivagina, and ipsilateral renal agenesis: 36 cases and long-term follow-up.

OBJECTIVE: To review the experience of the Milan University First Department of Obstetrics and Gynecology in patients with double, didelphic, of bicornuate uterus, blind hemivagina, and ipsilateral renal agenesis, and to consider the frequently unsatisfactory surgical approach. METHODS: Thirty-six women with double, didelphic, or bicornuate uterus, blind hemivagina, and ipsilateral renal agenesis were identified from clinical records for the period 1962 to 1992. We evaluated demographic data, disease, symptoms, correctness of therapeutic approach, and definitive treatment. RESULTS: Seventeen patients previously had undergone incomplete surgery in other hospitals and 19 were treated by us for the first time. Total hysterectomy was performed on two of the 36 women and hemihysterectomy and hemicolpectomy were performed on four. In the other 30, the vaginal septum was excised and marsupialization was done. The pregnancy rate in the 15 women wanting children was 87% and the live birth rate was 77%. Serial biopsy specimens were obtained from the lateral fornix after the excision of the septum in 13 of the non-hysterectomized patients over 1-9 years and revealed progressively more extensive areas of squamous metaplasia of müllerian epithelium. In some isolated cases, papillary hyperplasia, mild dysplasia, and vaginal adenosis were found. At the end of follow-up, 16 patients still did not want children. Follow-up was possible in 34 cases. CONCLUSION: Early accurate diagnosis after menarche followed by excision and marsupialization of the blind hemivagina offers complete relief of symptoms and preserves reproductive potential. Partial morphologic changes are evident but metabolic modifications comparable to those of the adjacent normal vagina have not yet been documented.

Abnormalities, Multiple↗
PubMed1997

Dietary habits, reproductive and menstrual factors and risk of dysmenorrhoea.

In order to analyze risk factors for dysmenorrhoea, we conducted a case-control study. Cases were 106 women (median age 27 years) with moderate or severe dysmenorrhoea lasting 12 months or more. Controls were 145 women (median age 26 years) without dysmenorrhoea, admitted for routine gynecological examination at the outpatient gynecological services of the same clinic where cases had been identified. In comparison with women reporting short menstrual cycles (every 25 days or less) the relative risk (RR) of dysmenorrhoea was 2.0 and 2.6, respectively, in those reporting their menstrual cycles of 26-30 days and of 31 days or more, and the RR was 3.6 (95% confidence interval (CI): 1.0-13.4) for women reporting totally irregular menstrual cycles. The estimated RRs were, in comparison with women reporting menstrual flows lasting 4 days or less, respectively 2.2 and 1.9 in those reporting menstrual flows lasting 5 and 6 days or more. Fourty-four (58%) cases but only seven (5%) controls reported heavy menstrual flows (RR in comparison with women reporting slight or normal menstrual flow 12.6, 95% CI: 5.0-32.1). As regards dietary factors, no associations emerged between the various food items, with the exception of cheese and eggs, which tended to be more frequently consumed by cases than controls. The results of this study suggest that the risk of dysmenorrhoea is higher in women with irregular, long and heavy menstrual flows. No association emerged between reproductive history and dysmenorrhoea. Likewise, no clear relationship emerged between intake of several dietary factors and risk dysmenorrhoea.

Adult↗
PubMed1997

Pre-operative assessment of bladder endometriosis.

The aim of our study was to verify the reliability of transvaginal ultrasonography in the pre-operative evaluation of bladder endometriosis. Six patients with suspected bladder endometriosis were studied. At referral to our department all six women underwent magnetic resonance imaging (MRI), transabdominal and transvaginal ultrasonography, cystoscopy and descending urography. Subsequently all the women underwent transperitoneal cystotomy and excision of endometriotic lesion at laparotomy. In three patients the bladder endometriotic lesions were continuous with adenomyosis in the anterior uterine wall. Histological examination confirmed the endometriotic nature of bladder nodule in all cases. Abdominal ultrasonography visualized the detrusor neoformation in all the patients but was less precise than transvaginal ultrasonography and MRI in defining the size of the lesions, infiltration of the detrusor and continuity with extravesical lesions. Transvaginal ultrasonography was more accurate and versatile than abdominal ultrasonography. The better image resolution allowed an accurate structural analysis of the bladder wall lesion. Furthermore, involvement of the uterovesical septum could be evaluated and adjacent myometrial infiltration recognized. MRI, although very precise, was less versatile than transvaginal ultrasonography and less accurate in establishing the margins of the lesions as perilesional fibrosis is visualized less clearly than areas containing haematic material. Urography was aspecific but still useful to evaluate the integrity of the upper urinary tract and ureters. In conclusion, in our patients transvaginal ultrasonography was found to be the most accurate technique in the diagnosis of bladder endometriosis.

Adult↗
PubMed1997

Determinants of risk of spontaneous abortions in the first trimester of pregnancy.

Several factors, such as socioeconomic status, obstetrical and menstrual history, and contraceptive methods, have been associated with risk of spontaneous abortion. We conducted a hospital case-control study to analyze risk factors for spontaneous abortion during the first trimester. Cases were 782 women admitted for spontaneous abortion. Controls included 1,543 women who gave birth at term in the same hospitals. Adjusted odds ratios (ORs) for spontaneous abortion were 0.9 and 0.6, respectively, for women reporting 7-11 and > or = 12 years of schooling, compared with women reporting < 7 years of education. A history of pelvic inflammatory disease increased the odds ratio fivefold [OR = 5.1; 95% confidence interval (CI) = 1.0-26.2]. The OR for spontaneous abortion was 1.7 (95% CI = 1.4-2.1) in women reporting previous spontaneous abortions.

Abortion, Spontaneous↗