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Biomedical subjects

L Fedele

Publications and source records attributed to L Fedele.

At least 55 records · Page 3Linked to original sources
PubMed1996

Danazol versus a gonadotropin-releasing hormone agonist as preoperative preparation for hysteroscopic metroplasty.

OBJECTIVE: To compare the efficacy of danazol and a GnRH agonist as preoperative preparation for hysteroscopic metroplasty in women with septate uterus. DESIGN: Prospective randomized clinical study. SETTING: Tertiary care center. PATIENTS: Thirty patients with septate uterus. INTERVENTIONS: The patients were randomized to treatment with danazol 600 mg/d for 2 to 4 weeks (n = 15) or with leuprolide acetate depot 3.75 mg for 2 months (n = 15) as preoperative therapy for hysteroscopic metroplasty. MAIN OUTCOME MEASURES: At the intervention the hysteroscopist evaluated difficulty in dilation of the cervical canal, presence of endometrial fragments, bleeding, difficulty in maneuvering the resectoscope, and operating time. RESULTS: Both the treatments were well tolerated. Metroplasty was simpler overall in the danazol group and also faster in introducing the resectoscope through the cervical canal and maneuvering it in the uterine cavity were both easier. Bleeding was modest in both groups and the anatomic outcome of the operation was similar. CONCLUSION: Short preoperative preparation with danazol results in favorable operating conditions at limited costs with minimal side effects.

Adult↗
PubMed1996

A new laparoscopic procedure for creation of a neovagina in Mayer-Rokitansky-Kuster-Hauser syndrome.

OBJECTIVE: To evaluate the results of a new laparoscopic technique for the creation of a neovagina in women with Rokitansky syndrome. DESIGN: Open noncomparative clinical study. SETTING: Tertiary care center. PATIENT(S): Fourteen patients with Rokitansky syndrome, aged 15 to 34 years, desiring to have sexual relations. INTERVENTION(S): The patients underwent creation of a neovagina at laparoscopy by a modification of Vecchietti's technique. MAIN OUTCOME MEASURE(S): At the clinical examinations performed during the follow up (ranging from 6 to 24 months), the patients reported the frequency, satisfaction, and any difficulties found at intercourse. At each examination, the depth and diameter of the neovagina was determined. The characteristics of the neovaginal mucosa were investigated by vaginoscopy. RESULTS(S): No intraoperative and postoperative complications were observed. The patients considered the discomfort caused by the Vecchietti's device and the daily tractions acceptable. In all the patients the mucosa was pink, trophic, and moist 3 months after the operation. Two fingers were introduced easily into the neovagina in all cases, and the mean length was 8.1 +/- 1.1 cm. All but one patient defined their sexual intercourse as satisfying within 6 months from the intervention. CONCLUSION(S): In light of the results obtained in the present series, we consider that, because of its efficacy, rapidity, and safety, the laparoscopic surgical method used by us may be suggested as the treatment of choice to correct Rokitansky syndrome.

Adolescent↗
PubMed1996

Coffee and alcohol intake, smoking and risk of multiple pregnancy.

We analysed the relationship between coffee and alcohol intake, smoking and risk of multiple pregnancies using data from a case-control study on risk factors for multiple births conducted in Italy. Cases were 133 women who delivered multiple births not related to treatment for infertility (33 monozygotic and 100 dizygotic twins). Controls were 395 women admitted for normal delivery at the same clinic where cases had been identified. The odds ratios (OR) of multiple pregnancy were 1.5[95% confidence interval (CI) 0.8-2.8] and 2.0 (95% CI 1.0-3.7) for women drinking respectively one to two or three or more cups of coffee per day in comparison with non-coffee drinkers. Considering separately dizygotic and monozygotic pregnancies, the estimated OR were respectively for women drinking three or more cups of coffee, 1.7 and 3.1 for dizygotic and monozygotic pregnancies. The risk of multiple pregnancy tended to be higher in women drinking >or= 15 alcohol drinks per week: in comparison with tea-totallers the estimated OR for drink > or = 15 glasses per week were 2.3 and 2.6 respectively for dizygotic and monozygotic pregnancies. Heavy smokers (> or = 10 cigarettes per day) were at increased risk of multiple pregnancy: in comparison with never smokers, the estimated OR for multiple pregnancy was 1.6 (95% CI 0.9-2.7). Considering separately the two groups of multiple pregnancy, the OR of dizygotic and monozygotic pregnancy were 1.4 (95% CI 0.8-2.5) and 2.4 (95% CI 0.9-6.1) for women smoking > or = 10 cigarettes/day, but the trend in risk with number of cigarettes smoked per day and duration of the habit was not significant.

Adult↗
PubMed1996

Residual uterine septum of less than 1 cm after hysteroscopic metroplasty does not impair reproductive outcome.

The objective of this study was to ascertain if incomplete correction leaving a residual uterine septum of < or = 1 cm affects fertility outcome. Reproductive outcome in 17 women with a residual septum of between 0.5 cm and 1 cm after hysteroscopic metroplasty was compared to that in 51 women with no residual septum or one of < 0.5 cm. Septal lysis was performed with microscissors or resectoscope. One month after operative hysteroscopy, abdominal ultrasonography was performed on all the women and those with a residual septum of > 1 cm then underwent a second operative hysteroscopy to complete the lysis. The cumulative pregnancy and birth rates were calculated and the curves compared using the log-rank test. The cumulative 18 month probability of becoming pregnant was 44.5% in the patients with residual septum and 52.7% in those with no residual septum (not significantly different), and the cumulative 18 month probability of giving birth to a child was 27.5 and 36% respectively (also not significant). The presence of a residual uterine septum of between 0.5 and 1 cm as shown by ultrasonography appears not to worsen the reproductive prognosis compared with that in women in whom the septum has been completely or almost completely corrected.

Abortion, Habitual↗
PubMed1996

Intrauterine adhesions: detection with transvaginal US.

PURPOSE: To evaluate the reliability of transvaginal ultrasonography (US) in the diagnosis of uterine adhesions. MATERIALS AND METHODS: Transvaginal US was performed before hysteroscopy as part of the routine diagnostic work-up in 77 women who had repeated spontaneous abortions. The sensitivity, specificity, and positive and negative predictive values were calculated for transvaginal US in the diagnosis of uterine adhesions. Hysteroscopic findings were considered the reference. RESULTS: Uterine adhesions were correctly identified with transvaginal US in 10 of 11 women in whom this finding was subsequently confirmed at hysteroscopy. The adhesions were minimal in 10 instances and moderate in one. The sensitivity of transvaginal US was 91%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 98.5%. CONCLUSION: Transvaginal US, which is a noninvasive and relatively inexpensive procedure, seems to be effective in screening for uterine adhesions in a population at risk.

Abortion, Spontaneous↗
PubMed1996

Urinary tract anomalies associated with unicornuate uterus.

PURPOSE: We investigated the association between the various subclasses of the unicornuate uterus and urinary tract anomalies. MATERIALS AND METHODS: We studied the urinary tract of 37 patients with a unicornuate uterus by urography and/or ultrasonography. Unicornuate uterus was diagnosed at laparoscopy or laparotomy. RESULTS: A total of 15 patients (40.5%) had urinary tract anomalies, including ectopic kidney in 4, renal agenesis in 6, double renal pelvis in 2, horseshoe kidneys in 2 and unilateral medullary sponge kidney in 1. No differences were observed in the frequency of urinary anomalies among the various subclasses of unicornuate uterus. CONCLUSIONS: Our results indicate the need to suspect a urinary tract anomaly, particularly of the kidney, in all women with a unicornuate uterus.

Abnormalities, Multiple↗
PubMed1996

Ultrastructural aspects of endometrium in infertile women with septate uterus.

OBJECTIVES: To evaluate the endometrial surface morphology in patients with septate uterus and primary infertility in an attempt to throw light on the question of whether endometrial anomalies are involved in the pathogenesis of infertility in women with mullerian malformations. DESIGN: Endometrial biopsies were performed in eight women with septate uterus and primary infertility during hysteroscopy scheduled in the preovulatory phase of the cycle (when a follicle > 17 mm was identified by ultrasonography and E2 levels were >200 pg/mL [conversion factor to SI unit, 3.671]). Two samples were obtained from each patient, one from endometrium covering the septum and the other from endometrium lining the lateral wall of the uterus. All specimens were examined by scanning electron microscopy. MAIN OUTCOME MEASURES: The number of glandular ostia, the ciliated:nonciliated cell ratio, and the number of cilia on ciliated cells were analyzed in endometrial specimen from both the covering of the septum and the corresponding uterine lateral wall. RESULTS: In five patients septal endometrium showed the following defective preovulatory changes with respect to endometrium of the lateral uterine wall: a reduced number of glandular ostia, irregular nonciliated cells with rare microvilli, incomplete ciliogenesis on ciliated cells, and decrease in the ciliated:nonciliated cell ratio (1:52 +/- 11 versus 1:21 +/- 8). CONCLUSIONS: Our results indicate a decrease in the sensitivity of endometrium covering the septa of malformed uteri to preovulatory hormonal changes. This could play a role in the pathogenesis of primary infertility in patients with septate uterus.

Adult↗
PubMed1996

Uterine myomas and smoking. Results from an Italian study.

OBJECTIVE: To evaluate the relationship between smoking and uterine myomas requiring surgery. STUDY DESIGN: We conducted a case-control study in Milan between 1986 and 1992. Cases were 476 patients under 55 years of age with histologically confirmed myomas. Controls were 1,283 women admitted to the hospital for a spectrum of acute, other-than-gynecologic, hormonal or neoplastic conditions (30% trauma, 25% nontraumatic orthopedic conditions, 25% surgical, 20% other miscellaneous). RESULTS: Cases were less frequently current smokers (22%) than controls (32%). In comparison with never smokers, the multivariate relative risk (RR) for myomas was 0.5 (95% confidence interval [CI], 0.4-0.7) in smokers. Ex-smokers were 10% of cases versus 7% of controls (RR 1.2, 95% CI 0.9-1.8). No clear trend in risk was observed with the number of cigarettes smoked per day or duration of smoking and risk of fibroids. The estimated RRs were largely consistent when separate analyses were performed in strata of age and other selected covariates, including indices of body weight. CONCLUSION: Current smoking seems to reduce the risk of myomas.

Adult↗
PubMed1996

Pelvic inflammatory disease and risk of ovarian cancer.

We analyzed the association between history of pelvic inflammatory disease (PID) and the risk of subsequent epithelial ovarian cancer, using data from a large case-control study conducted between 1983-1991 in Italy. Data were collected from a network of hospitals, including the main teaching and general hospitals in the greater Milan area, Northern Italy. The cases studied were 971 women below the age of 75 years (median age, 54 years) with histologically confirmed epithelial ovarian cancer, diagnosed within 1 year before the interview. Control subjects were 2758 women admitted to the same hospitals where cases were identified for acute, nonmalignant, nonhormone-related conditions, who had not undergone bilateral oophorectomy. The median age of the control group was 52 years (range, 23-74). A total of 14 (1.4%) cases and 72 (2.6%) controls reported a history of PID/ salpingitis, the corresponding multivariate relative risk being 0.7 (95% confidence interval, 0.4-1.3). A separate analysis of the association between history of PID/salpingitis and risk of ovarian cancer in strata of parity and education confirmed the results based on the whole series. In conclusion, although based on limited numbers of cases and controls with PID, this studies was able to exclude, at the conventional 95% confidence limit, an increased risk of ovarian cancer of over 30% in women with previous PID in this population.

Adult↗
PubMed1996

Superovulation and intrauterine insemination vs. superovulation alone in the treatment of unexplained infertility. A randomized study.

OBJECTIVE: To assess whether intrauterine insemination (IUI) improves the fertility rates in women with unexplained infertility. STUDY DESIGN: We recruited 68 women with unexplained infertility and allocated them randomly to treatment with three to five cycles of superovulation plus IUI (36 patients) or superovulation alone (32 patients). Superovulation was obtained with clomiphene citrate, human menopausal gonadotropins and human chorionic gonadotropins. RESULTS: The cycle fecundity rate was 10% in patients who underwent superovulation alone and 19% in those treated with superovulation plus IUI (P < .05). CONCLUSION: Our results demonstrate that superovulation plus IUI is more effective than superovulation alone in the treatment of unexplained infertility.

Adult↗
PubMed1995

Effects on bone mineral density of 12-month goserelin treatment in over 40-year-old women with uterine myomas.

We evaluated the effects on bone mineral density (BMD) of a 12-month treatment with goserelin depot, a gonadotropin-releasing hormone agonist, in a group of women with symptomatic uterine myomas requiring hysterectomy. Sixteen women, mean age 45.6 +/- 5.0, reporting menorrhagia associated with uterine myomas, candidates for hysterectomy, were scheduled to be treated with goserelin depot for 12 months. BMD was measured at the vertebral (L2-L4) and proximal femur level (femoral neck and trochanter) at the start of therapy and 6, 12, and 18 months later using dual energy X-ray absorptiometry (Hologic QDR 1000/W). The patients were followed for a minimum of 6 months after the end of treatment. Thirteen of the 16 women enrolled completed the treatment and three suspended it after 5, 6, and 7 months, respectively, because of side effects (hot flashes, insomnia, depression). Of the 13 women who completed the treatment, three underwent hysterectomy because of myoma regrowth and the recurrence of symptoms 3-18 months later; four reached the menopause 5-16 months later, and six were all menstruating normally with a follow-up varying from 6 to 18 months. After 12 months of therapy we observed a bone loss at vertebral, femoral neck, and trochanter of 4.4% (P < 0.05 versus baseline; P = not significant versus 6 months), 7.5% (P < 0.01 versus baseline, P < 0.01 versus 6 months), and 7.6% (P < 0.001 versus baseline, P < 0.05 versus 6 months), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Mitogen-induced lymphocyte proliferation and peripheral blood mononuclear cell beta-endorphin concentrations in primary dysmenorrhoea.

Dysmenorrhoea is a recurrent painful disease which causes physical and psychological stress. The purpose of the present study was to investigate whether there was a measurable derangement of immune cells and immune responses in women with severe primary dysmenorrhoea. On day 26 of one cycle and on days 1 and 3 of the following cycle we measured polyclonal, mitogen-induced lymphocyte proliferation and beta-endorphin concentration in peripheral blood mononuclear cells obtained from 16 infertile women with normal pelvis, of whom eight had and eight did not have the disorder. In women with dysmenorrhoea, polyclonal mitogen-induced lymphocyte proliferation was lower than in controls on all 3 days considered, but the difference was statistically significant only on day 26 (43,605 +/- 9876 micrograms/ml versus 67,305 +/- 15,249 micrograms/ml; P < 0.01). Monocyte beta-endorphin concentrations in the patients with dysmenorrhoea were significantly elevated on day 3 compared to controls (67.8 +/- 24.3 pg/10(6) cells versus 29.7 +/- 6.9 pg/10(6) cells; P < 0.05). Our results demonstrate that immune responses are modified in patients with primary dysmenorrhoea. These effects are independent of circulating hormone concentrations and are consistent with the role of dysmenorrhoea as a stressful event.

Adult↗
PubMed1995

Recurrence of fibroids after myomectomy: a transvaginal ultrasonographic study.

Frequency of recurrence of fibroids after myomectomy has been evaluated in 145 women (median age 38 years, range 21-52) who underwent myomectomy. After surgery all women returned for follow-up visit every 12 months after surgery. Transvaginal ultrasound examination was performed routinely in every patient at 24 and 60 months and at 12, 36 and 48 months if there were any abnormal pelvic findings or suspicious symptomatology. A total of 39 (27%) women gave birth after myomectomy. For the whole series, the cumulative probability of recurrence (CPR) increased constantly during the study period reaching 51% in 5 years. The 5-year CPR decreased with parity after myomectomy, being 55% for women with no childbirth after surgery and 42% (based on 13 recurrences, P < 0.01) for those who gave birth.

Adult↗
PubMed1995

Tight underpants and trousers and risk of dyspermia.

The association between the wearing of tight underpants and trousers and risk of dyspermia has been analysed using data from a case--control study. Cases included infertile men with a diagnosis of unexplained dyspermia. Normospermic men of infertile couples were eligible as controls. In comparison with men usually wearing loose underpants, the odds ratio (OR) of dyspermia was 1.9 (95% confidence interval, CI, 0.9-4.1) in those wearing tight underpants. Likewise, the OR of dyspermia was 1.6 (95% CI 0.9-3.0) in men reporting usually wearing tight trousers (including jeans), in comparison with those wearing loose trousers.

Adult↗
PubMed1995

Histological impact of medical therapy--clinical implications.

The medium- and long-term effects of gestrinone and danazol on the endometrium were examined in 36 patients with endometriosis. Endometrial biopsies were taken from each patient before treatment and after 3 and 6 months of treatment with 600 mg danazol daily (n = 17) or with 2.5 mg gestrinone twice weekly (n = 19). Endometrial samples were analysed by light, scanning and transmission electron microscopy. At 3 months' treatment the endometria of patients treated with danazol appeared more atrophic than those of the women treated with gestrinone; some cell organelle involution was evident in all patients. After 6 months of treatment a marked atrophy was observed in patients of both treatment groups. A complete involution of cytoplasmic organelles with cytoplasmic collapse and a shift of nucleoplasmic ratio in favour of the nucleus occurred in patients treated with danazol; the cytoplasmic organelle involution was less marked in patients treated with gestrinone. Compared with gestrinone, danazol induces more rapid endometrial atrophy, with greater impairment of the cytoplasm and cell secretory activity.

Adult↗