PubMed Health⌕ Search

Biomedical subjects

L Fedele

Publications and source records attributed to L Fedele.

At least 73 records · Page 4Linked to original sources
PubMed1995

Pelvic endometriosis: reproductive and menstrual risk factors at different stages in Lombardy, northern Italy.

AIM: To analyse the relationship between reproductive and menstrual factors and different stages of pelvic endometriosis. METHODS: Between 1987 and 1990 a case-control study of risk factors for pelvic endometriosis was conducted. Cases comprised 376 women (median age 32 years) with pelvic endometriosis confirmed by laparoscopy or laparotomy admitted to any one of three clinics in Lombardy, northern Italy. A total of 129 (34.3%) of these women were at stage 1, 76 (20.2%) at stage 2, 96 (25.5%) at stage 3, and 75 (19.9%) at stage 4, according to the American Fertility Society revised classification of endometriosis. Controls comprised 522 women admitted to hospital for acute conditions. RESULTS: The risk of endometriosis decreased with increasing number of births. The estimated odds ratios (OR) were similar in different stages of the disease: for example, compared with nulliparous women, the OR of endometriosis at stage 1 was 0.1 in women who reported two or more births and the corresponding values were respectively 0.1, 0.2, and 0.2 for endometriosis at stages 2, 3, and 4. Cases reported fewer induced abortions than controls: the estimated ORs compared with no induced abortion were 0.4, 0.5, 0.2, and 0.2 in women who reported one or more induced abortions for subsequent stages of endometriosis. Women with irregular menstrual cycles were at less risk of the disease: compared with women who reported lifelong regular cycles the estimated ORs were 0.3, 0.5, 0.5, and 0.3 for disease stages 1-4 respectively. No consistent association emerged between the ages at menarche and at first delivery and the risk of endometriosis. CONCLUSIONS: This analysis provides further evidence that reproductive and menstrual factors are associated with the risk of endometriosis. The observation that early and late stages of the disease share similar epidemiological characteristics suggests an epidemiological (and pathogenetic) continuum between various stages of the disease.

Abortion, Induced↗
PubMed1995

Comparative efficacy of diclofenac dispersible 50 mg and ibuprofen 400 mg in patients with primary dysmenorrhea. A randomized, double-blind, within-patient, placebo-controlled study.

Sixty female out-patients suffering from moderate to severe primary dysmenorrhea, aged 14-40 years (mean 27 years), entered this randomized, double-blind, 3-period, within-patient study, evaluating the efficacy and tolerability of diclofenac dispersible 46.5 mg (equivalent to 50 mg of diclofenac sodium), ibuprofen 400 mg and placebo taken up to 4 times daily for a maximum of 3 days. Pain relief was evaluated on a verbal rating scale (0 = none, 1 = slight, 2 = moderate, 3 = considerable, 4 = complete) at 0.5, 1,2,3,4,5 and 6 hours after the first dose; the weighted sum of pain relief scores over the 6-hour observation period was also investigated (TOTPAR-6). Pain intensity was assessed on a verbal rating scale (0 = nil, 1 = mild, 2 = moderate, 3 = severe) at baseline and at the above mentioned time points; the weighted sum of pain intensity differences at each time point was also analyzed (SPID-6). A rescue medication was permitted 1 hour or more after the intake of the test drug: in such cases the last value of pain intensity/relief scores was carried forward and used for the analysis. A global evaluation of efficacy and of trial medication as compared to her usual medication was performed by the patient at the end of each treatment period. Finally, adverse experiences were recorded throughout the study period. Analysis of covariance and Koch's adaptation of the Wilcoxon-Mann-Whitney rank sum test were used, where appropriate, for statistical analysis. Mean TOTPAR-6 values for diclofenac dispersible, ibuprofen and placebo were 16.5, 17.8 and 14.7, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Hysteroscopic metroplasty for septate uterus.

Reproductive results in women with a septate uterus include increased incidence of spontaneous abortion, premature birth, and abnormal fetal presentations. Septate uterus is seen most often in women with reproductive wastage. This article discusses the diagnosis, indications for surgery, surgical technique, results, and complications for treating patients with a septate uterus.

Abortion, Spontaneous↗
PubMed1995

Habitual abortion: endocrinological aspects.

Endocrine disorders are among the potential causes of repeated spontaneous abortion although their role is uncertain. These disorders most frequently associated with repeated spontaneous abortion are corpus luteum insufficiency, polycystic ovary syndrome, diabetes mellitus, and hypo- and hyperthyroidism. The best method of diagnosing corpus luteum insufficiency has not yet been established. It seems that treatment for this condition cannot be based on simple supplementation with progesterone, but ovulation induction preceded by pituitary suppression and human chorionic gonadotropin administration might be more successful. There is increasing evidence that polycystic ovary syndrome is a cause of repeated spontaneous abortion, but possibly only in the presence of oligomenorrhea and luteinizing hormone hypersecretion. Diabetes, if well controlled by treatment, and thyroid dysfunction, probably play a minor role.

Abortion, Habitual↗
PubMed1994

Postsurgical medical treatment of advanced endometriosis: results of a randomized clinical trial.

OBJECTIVE: Our purpose was to investigate the efficacy of postsurgical treatment with nafarelin in women with advanced endometriosis. STUDY DESIGN: Eligible for trial were women < or = 38 years old with unexplained infertility with or without chronic pelvic pain and stage III or IV endometriosis according to the American Fertility Society, revised, classification who underwent laparotomy as first surgical treatment for debulking or radical surgery of endometriotic lesions. Patients were assigned according to a randomization list to nasal nafarelin, 400 micrograms/day (36 subjects) or placebo nasal spray (39 subjects) for 3 months. Pelvic pain was assessed before first surgery and at the 12-month follow-up visit in women with pelvic pain by means of a multidimensional score system and a 10-point linear pain scale. RESULTS: No marked differences in pain scores emerged among women allocated to different treatments. The mean reduction of the multidimensional score was 3.6 and 4.0, respectively, in women allocated to nafarelin and placebo and of the 10-point linear scale scores was 7.0 and 6.9. These differences were not statistically significant. Within 1 year from randomization, of the 36 women allocated to nafarelin and the 39 allocated to placebo, seven (19%) and seven (18%), respectively, became pregnant. CONCLUSION: This study suggests that medical treatment with nafarelin does not markedly improve pelvic pain and short-term reproductive prognosis in women with stages III and IV endometriosis.

Administration, Intranasal↗
PubMed1994

Laparoscopic creation of a neovagina in Mayer-Rokitansky-Küster-Hauser syndrome by modification of Vecchietti's operation.

A neovagina was created by a laparoscopic modification of Vecchietti's operation in two women with Mayer-Rokitansky-Küster-Hauser syndrome. A plastic olive was applied to the vaginal dimple and pulled upward by two threads passed through the potential neovaginal space at laparoscopy, without the need for laparotomy or dissection of the vesicorectal space. In both cases we obtained very good results in anatomic and sexual functional terms.

Adult↗
PubMed1994

Immunotherapy and recurrent abortion: a randomized clinical trial.

We conducted a randomized trial comparing expectant management versus immunotherapy with paternal leukocytes to improve obstetric outcome in women with unexplained recurrent abortion. Eligible for the study were women with unexplained recurrent abortion (three or more miscarriages and no live birth), negative findings of immunological screening and no inhibition of the mixed lymphocyte culture. These women were seen for the first time between October 1988 and March 1991 in a network of obstetric departments in Northern Italy. Subjects positive for HLA DR3 or with a partner positive for hepatitis virus B antigen were not eligible. A total of 44 women entered the study. Patients were randomly allocated to immunotherapy (22 women) or expectant management (22 women). Women allocated to immunotherapy were given 200 x 10(6) purified paternal lymphocytes before pregnancy. Median follow-up was 24 months (range 10-39) in the immunotherapy group and 25 months (range 11-38) in the expectant management group. Out of the 22 women randomized to immunotherapy, 16 became pregnant and the corresponding value was 14 in the expectant management group. Spontaneous abortion occurred in six out of the 16 pregnancies observed in the treated women. Among the 14 pregnancies observed in the expectant management group, two aborted and one late fetal death occurred. The cumulative proportions of women who became pregnant over 4 years were 37 and 45% in the immunotherapy and expectant management groups respectively; this difference was not significant. No adverse effect was observed in treated women.

Abortion, Habitual↗
PubMed1994

Cigarette smoking, alcohol consumption, and risk of primary dysmenorrhea.

We analyzed the relation between cigarette smoking, alcohol consumption, and risk of dysmenorrhea using data from a case-control study in Milan, Italy. With never-smokers as the reference category, the relative risk (RR) of dysmenorrhea was 1.9 [95% confidence interval (CI) = 0.9-4.4] for women smoking 10-30 cigarettes per day. The risk of dysmenorrhea increased with duration of smoking in women who smoked for less than 10 years (RR = 1.3, 95% CI = 0.6-2.6) and in those who smoked for 10-20 years (RR = 2.8, 95% CI = 1.3-6.2). In comparison with teetotalers, the age-adjusted RR of dysmenorrhea was 0.8 (95% CI = 0.4-1.5) for alcohol drinkers.

Adolescent↗
PubMed1994

Relief of dysmenorrhea associated with septate uteri after abdominal or hysteroscopic metroplasty.

We analyzed the postoperative modifications of dysmenorrhea in 90 patients with septate or subseptate uterus, but no other genital or pelvic disorders, who underwent metroplasty according to Tompkins (n = 28) or hysteroscopic metroplasty (n = 62). The frequency of dysmenorrhea fell from 50% to 32.1% after the Tompkins' procedure and from 54.8% to 17.7% after hysteroscopic metroplasty. The severity of dysmenorrhea evaluated with two scales, one linear and one multidimensional, showed a significant postoperative decrease in both the groups. In view of the limited cost and low risks of hysteroscopic metroplasty, primary dysmenorrhea associated with septate or subseptate uterus may be considered an indication for this intervention.

Dysmenorrhea↗
PubMed1993

Buserelin acetate in the treatment of pelvic pain associated with minimal and mild endometriosis: a controlled study.

OBJECTIVE: To evaluate the changes of pain symptoms induced by buserelin acetate, a gonadotropin-releasing hormone agonist, in a group of patients with endometriosis. DESIGN: Thirty-five infertile patients with one or more of the following symptoms (dysmenorrhea, pelvic pain, deep dyspareunia, and endometriosis stage I or II) were allocated randomly to treatment with buserelin acetate 1,200 micrograms/d IN for 6 months (n = 19) or expectant management (n = 16). Pain symptoms were recorded by the women themselves using a questionnaire that included two scales for pain evaluation: one analogue and one multidimensional. The treated and untreated patients were followed for a minimum of 18 and 12 months from the time of randomization, respectively. RESULTS: Buserelin acetate markedly reduced dysmenorrhea, pelvic pain, and dyspareunia during the treatment and also for the 12 subsequent months. During follow-up of the expectant management group, dysmenorrhea resolved in 19% (3/16) of the cases, and pelvic pain did not recur after diagnostic laparoscopy in one of the three women affected nor did deep dyspareunia in two of the five who reported the symptom before laparoscopy. CONCLUSION: Buserelin acetate induced a significant improvement of pain symptoms that persisted in approximately half of the patients even after withdrawal of the drug. However, symptoms associated with endometriosis showed a spontaneous remission in approximately one fifth of the untreated patients.

Buserelin↗
PubMed1993

Vaginal patterns during danazol and buserelin acetate therapy for endometriosis: structural and ultrastructural study.

OBJECTIVE: To evaluate histologic and ultrastructural changes of the vaginal mucosa in patients given buserelin acetate or danazol treatment for endometriosis. DESIGN: Controlled clinical study. SETTING: Infertility clinic of an academic unit. PATIENTS: Infertile women with endometriosis randomized to receive buserelin acetate or danazol and undergoing vaginal biopsies during treatment were selected. INTERVENTIONS: Buserelin acetate was administered IN 400 micrograms three times per day and danazol orally 600 mg/d. Vaginal biopsies were performed baseline and at 3 and 6 months of treatment, and specimens were examined by light microscopy and scanning electron microscopy. 17 beta-Estradiol and P levels were determined in each patient at the time of each biopsy. MAIN OUTCOME MEASURE: Structural and ultrastructural patterns of vaginal mucosa after 3 and 6 months of treatment. RESULTS: Buserelin acetate treatment induced early, marked hypotrophy of the vaginal mucosa with aspects typical of the menopause. The modifications caused by danazol occurred mainly in the intermediate layer, which was weakly hypotrophic only at the end of the treatment. CONCLUSION: Vaginal mucosa undergoes constant and well-defined modifications during both buserelin acetate and danazol treatment for endometriosis. The modifications are compatible with the biological effects of the drugs.

Biopsy↗
PubMed1993

Fertility after conservative surgery for adenomyomas.

Reproductive performance was evaluated after conservative surgery for uterine adenomyoma in a prospective, observational study. Twenty-eight women with histologically proven adenomyomas had conservative surgery in the period 1985-1990. Eighteen patients wanting children were regularly followed for a mean +/- SD period of 53.2 +/- 23.5 months. Crude and cumulative pregnancy rates were calculated after the operation. Thirteen (72.2%) women conceived, for a total of 18 pregnancies: nine (50%) ended in term deliveries, seven (38.8%) in spontaneous abortions, one (5.6%) in ectopic pregnancy and one (5.6%) in a pre-term delivery with neonatal death. The cumulative pregnancy rate at 36 months of follow-up was 74.7%. This analysis of a small series indicates that conservative surgery for adenomyomas is associated with a good reproductive prognosis.

Adenomyoma↗
PubMed1993

Risk factors for multiple births.

STUDY OBJECTIVE: To analyze risk factors for multiple births. DESIGN: A case-control study. Cases were 103 women (median age 31 years, range 20-44) who delivered multiple births not related with treatment for infertility at the 'Clinica Luigi Mangiagalli' of Milan. A total of 27 women delivered monozygotic twins and 76 dizygotic ones. Controls were 308 women (median age 30, range 17-45) admitted for normal delivery on selected days to the same clinic where cases had been identified. RESULTS: Cases tended to be less educated than controls and the relative risk of multiple pregnancy, compared with women reporting seven years of schooling or less, was 0.4 in those reporting 7-11 and 12 or more years of education. When the analysis was done separately for dizygotic and monozygotic multiple pregnancies, this relationship was restricted to dizygotic multiple pregnancies (chi 2 (1) trend for dizygotic pregnancies = 3.82, p = 0.05). A family history of multiple pregnancies was reported in 36 women (48%) with dizygotic multiple pregnancy and 13 (52%) monozygotic ones and 88 (30%) controls. The corresponding relative risks (RR) were 2.2 and 2.5 respectively for dizygotic and monozygotic pregnancies. Compared with nulliparae, the estimated RR of dizygotic multiple pregnancies was 0.5 in women reporting two or more births, but the trend in risk with number of births was not statistically significant. No relationship emerged with spontaneous or induced abortions, body mass index, oral contraceptive or IUD use, age at menarche and risk of multiple pregnancies. CONCLUSIONS: This study confirms the role of familiarity in the risk of multiple pregnancies and suggests some different epidemiological characteristics in dizygotic and monozygotic multiple pregnancies.

Adolescent↗
PubMed1993

Gonadotropin releasing hormone agonist for chronic anovulatory uterine bleeding and severe anemia.

Twenty-three women with chronic heavy anovulatory uterine bleeding and severe iron-deficiency anemia received six months' treatment with goserelin, a gonadotropin releasing hormone agonist, administered as a monthly subcutaneous depot. After two months of treatment, all patients were amenorrheic and subsequent spotting was reported on only nine occasions. Laboratory results showed the following values: mean hemoglobin before treatment, 7.9 g/dL-13.8 g/dL at six months (+75%); mean hematocrit, 26.3%-41.6% (+58); mean serum iron, 19.8 micrograms/dL-63.3 micrograms/dL (+134%) and mean serum ferritin, 6.2 ng/mL-35.3 ng/mL (+469%). The endometrial hyperplasia observed in 11 subjects showed regression at follow-up suction biopsy. Gonadotropin releasing hormone agonists administered in a depot formulation for a few months in highly selected patients with severe anemia associated with heavy anovulatory uterine bleeding are practical, safe and effective, may avoid blood transfusions and could be used as a first line of treatment.

Adult↗
PubMed1993

Reproductive prognosis after hysteroscopic metroplasty in 102 women: life-table analysis.

OBJECTIVE: To evaluate reproductive prognosis after hysteroscopic metroplasty. DESIGN: The cumulative proportions of women who became pregnant and gave birth, subdivided according to previous obstetric history, were calculated by the product limit method and compared using the log rank test. SETTING: Outpatient infertility clinic of Milan University. PATIENTS: One hundred two consecutive patients with complete (n = 23) or partial septate uterus (n = 79) referred because of infertility or repeated abortion. INTERVENTION: Hysteroscopic metroplasty performed by microscissors (n = 80), argon laser (n = 10), or electroresectoscope (n = 12). MAIN OUTCOME MEASURES: Postoperative cumulative pregnancy and birth rates. RESULTS: At 36 months the cumulative pregnancy and birth rates were 89% and 75%, respectively, in the septate uterus group and 80% and 67% in the subseptate uterus group. CONCLUSIONS: Reproductive prognosis after hysteroscopic metroplasty was favorable and not influenced by the malformation subclass.

Adolescent↗