Biomedical subjects

L Fedele

Publications and source records attributed to L Fedele.

At least 127 records · Page 7Linked to original sources

PubMed1990

Timing of ovulation in spontaneous and induced cycles.

We studied 30 spontaneous cycles, 30 cycles induced with clomiphene citrate, and 30 cycles induced with human menopausal gonadotropin-human chorionic gonadotropin to evaluate the pattern of the following parameters and their predictive value in timing ovulation: basal body temperature; cervical mucus; mean follicular diameter; serum LH and 17-beta-estradiol; and urinary LH. Compared with the spontaneous cycles, in the cycles induced with clomiphene citrate the cervical score was significantly lower on the 4 days preceding ovulation, serum LH was higher in the early follicular phase, and serum 17-beta-estradiol was significantly higher in the pharmacologically treated cycles. The highest predictive values in all groups of cycles were obtained by considering the following combinations of parameters: serum 17-beta-estradiol and LH concentrations; mean follicular diameter as shown by ultrasonography and urinary LH as determined by a rapid method.

Adult↗

PubMed1990

Laparoscopy in the diagnosis of gynecologic chronic pelvic pain.

Laparoscopy was performed on 126 women with undiagnosed chronic pelvic pain. Abnormalities were demonstrated in 62.7% of the cases. Endometriosis was present in 32.5% of the women. Laparoscopy is useful in the differential diagnosis of chronic pelvic pain and is indicated when symptoms persist for over 6 months.

Adolescent↗

PubMed1990

Stage and localization of pelvic endometriosis and pain.

We analyzed the prevalence of dysmenorrhea, pelvic pain, and dyspareunia in relation to the disease stage in 160 women with endometriosis but no other associated pelvic disease who underwent their first gynecologic surgery (laparoscopy or laparotomy) at the First Obstetric and Gynecology Clinic of the University of Milan between 1985 and 1987. Dysmenorrhea was reported by 78% of the patients, pelvic pain by 39%; and deep dyspareunia by 32%. No relation was found between severity of the pain symptoms and stage of the disease or site of the endometriotic lesions.

Adolescent↗

PubMed1990

Structural and ultrastructural defects in preovulatory endometrium of normo-ovulating infertile women with minimal or mild endometriosis.

To investigate whether a primary endometrial factor is involved in the pathogenesis of infertility in patients with minimal or mild endometriosis, we compared light, scanning, and transmission electron microscopic studies of preovulatory endometria of 15 endometriotic patients with 12 normal controls. All the women were infertile and normo-ovulating by standard criteria. Six morphometric indexes were considered. The scanning electron microscopic analysis revealed heterogeneity of the endometrial surface epithelium in 77% of the patients with endometriosis and in 16% of the controls. Glandular and stromal mitoses, basal vacuolated cells, and the ciliated:nonciliated cell ratio was significantly reduced in the endometriosis group compared with the controls. Further studies are needed to clarify the role of the observed endometrial anomalies in the pathogenesis of infertility associated with endometriosis.

Adult↗

PubMed1990

Laparoscopic ovarian puncture for correct staging of endometriosis.

Small, deep ovarian endometriomas are not easily diagnosed. In 52 infertile patients, laparoscopy demonstrated enlarged ovaries (maximum diameter 3.5 to 5 cm) with a smooth whitish surface and no mature follicles, corpora lutea, or other cysts. Ovarian puncture was performed, and endometriotic material aspirated in 25 women (48.0%). Cyst diameter was calculated using the geometric formula r = 3 square root of 3V/4 pi where r = radius and V = volume of liquid aspirated. Eight patients with apparently normal pelvis had endometriosis, and 14 with apparent minimal or mild endometriotic lesions were restaged. Laparoscopic ovarian puncture of enlarged ovaries was important for correct diagnosis and staging of endometriosis.

Adult↗

PubMed1990

Medical treatment of mild endometriosis in infertile women: analysis of a failure.

The easy access to the pelvis of infertile women by laparoscopy favours early diagnosis of endometriosis in an increasing number of subjects with minimal and mild disease. These initial forms have been associated with and considered as the cause of infertility despite the absence of relevant scientific evidence. Various hormone therapies, some with severe side-effects and high costs, have been used by numerous authors. However, no study comparing medically treated with untreated women has ever shown any drug to be more effective than expectant management. The possible explanations of treatment failures are reviewed.

Buserelin↗

PubMed1990

Treatment with GnRH agonists before myomectomy and the risk of short-term myoma recurrence.

Twenty-four women with symptomatic multiple uterine myomas were allocated randomly to treatment with buserelin, 1200 micrograms/day intranasally, for 3 months followed by myomectomy (n = 8) or to immediate myomectomy (n = 16). Pre-operative treatment with buserelin reduced the mean uterine volume from 432 (SD 165) to 242 (SD 82) ml (P less than 0.01) but intra-operative blood loss and postoperative morbidity were not significantly less in this group. Six months after operation, pelvic examination was normal in all the patients. However, ultrasonography with transvaginal probe demonstrated the presence of myomas of less than 1.5 cm in five women (63%) treated pre-operatively with the analogue and in two women (13%) who underwent immediate surgery (P less than 0.05). Induction of a period of hypo-oestrogenism before myomectomy seems to favour short-term recurrence of uterine myomas, limiting the efficacy of surgery.

Adult↗

PubMed1990

Reproductive prognosis after abdominal metroplasty in bicornuate or septate uterus: a life table analysis.

Reproductive prognosis after abdominal metroplasty was assessed in 73 women with a septate and 71 with a bicornuate uterus who underwent metroplasty at the First Obstetric and Gynecologic Clinic of the University of Milan between 1972 and 1985. The overall cumulative 5-year delivery rates were respectively 70% and 73% in women with septate and bicornuate uterus, rising constantly with time. The number of previous miscarriages did not affect the reproductive prognosis: the 5-year probability of giving birth was 64% and 75% in the women with septate uterus and respectively fewer than two or more previous miscarriages, and the corresponding values were 66% and 73% in the bicornuate uterus subgroup. The miscarriage rate (about 20%) was similar with both types of malformation.

Abortion, Spontaneous↗

PubMed1990

Maternal and paternal moderate daily alcohol consumption and unexplained miscarriages.

The relation between parental moderate alcohol consumption and the risk of miscarriage was analysed using data from a case-control study in Milan between January 1987 and June 1988. Cases were 94 women who had two or more 'unexplained' miscarriages (after exclusion of genetic, endocrine and Müllerian factors) and without full-term pregnancies, admitted or referred to the First Obstetric and Gynecologic Clinic of the University of Milan. A total of 176 women admitted for normal delivery on selected days to the same university clinic and without previous miscarriages were chosen as controls. Compared with non-drinkers the risk of recurrent miscarriage was 0.9 for regular drinkers. The point estimates were 0.9 for women reporting one drink per day and 0.8 for those reporting two or more. Compared with non-drinkers, the relative risk estimates for drinking by fathers were slightly above unity, being 1.7 for less than three drinks and 1.4 for three or more drinks per day, but the trend in risk was not statistically significant.

Abortion, Habitual↗

PubMed1990

Maternal cohort, time of stillbirth, and maternal age effects in Italian stillbirth mortality.

STUDY OBJECTIVE: The aim of the study was to investigate factors in stillbirth mortality in Italy. DESIGN: Italian stillbirth data from 1955 to 1979 were analysed using a log-linear Poisson model with arbitrary constraints on the parameters to identify the effects of maternal birth cohort, calendar period of stillbirth and maternal age. SETTING: Stillbirth data for the whole of Italy were obtained from the Italian Central Institute of Statistics for the years under examination. During this period the criteria for defining stillbirth did not change and the quality of birth registration was similar. MAIN RESULTS: Decreases in stillbirth mortality were marked and steady, starting for the generations born since 1920. A period effect in stillbirth trends was shown, but this was apparently smaller than the cohort trend. CONCLUSIONS: The cohort trend suggests that long term improvements in socioeconomic and general health conditions may be important factors in the diminishing stillbirth rates, as well as short term advances in obstetric care. Alternatively the cohort effect could be attributed, at least in part, to an age-period interaction, since the downward trends were more pronounced in younger women.

Adolescent↗

PubMed1990

Evaluation of histological and ultrastructural aspects of endometrium during treatment with gestrinone in women with amenorrhea or spotting.

Nineteen patients with a laparoscopic diagnosis of endometriosis were treated with gestrinone at a dosage of 2.5 mg twice a week for 6 months. In 7 who reported spotting in the first 3 months, the dose was increased to 2.5 mg three times a week during the second trimester. An endometrial sample was obtained from each patient at the time of laparoscopy (basal) and at 3 and 6 months of treatment. Endometrial structure and ultrastructure were studied. Areas of hemorrhage and of loss of surface epithelium and a lesser degree of involution of the surface epithelium were observed in the 3-month samples of 7 patients with spotting, compared with 12 with amenorrhea. It is hypothesized that incomplete endometrial involution could be due to differences in gestrinone pharmacokinetics in individual patients, in the quality and/or quantity of endometrial cytosolic receptors for sex steroids, or in endocrine compensation to administration of the drug.

Adult↗

PubMed1990

Use of goserelin depot, a gonadotropin-releasing hormone agonist, for the treatment of menorrhagia and severe anemia in women with leiomyomata uteri.

Menorrhagia is the most frequent symptom in women with leiomyomata uteri. We induced transient hypoestrogenism with a gonadotropin-releasing hormone agonist, goserelin (Zoladex, I.C.I.), in a depot formulation, to resolve severe anemia in 16 women with uterine myomas. Subcutaneous administration of goserelin 3.6 mg was repeated every 28 days for 6 months. Thirteen patients became amenorrheic in 5 weeks and 3 reported scanty bleeding. Estradiol fell to postmenopausal levels after one month's treatment with hormonal surges on only three occasions. Uterine volume decreased by 49% after 3 months' treatment but subsequent reduction was not achieved. Mean hemoglobin rose from 7.4 g/dl pretreatment to 13.2 g/dl at 3 months (+78.3%) and mean hematocrit from 26.1% to 39.8% (+52.4%) without any further improvement. Serum ferritin increased constantly during the 6 months. Goserelin depot therapy in severely anemic patients with leiomyomas and menorrhagia is practical, safe and may avoid the need for preoperative transfusion.

Adult↗

PubMed1990

Magnetic resonance imaging of unicornuate uterus.

Five patients with a hysterosalpingographic diagnosis of unicornuate uterus underwent magnetic resonance imaging (MRI) and subsequently laparoscopy/laparotomy to evaluate the ability of MRI to identify the various subclasses of this malformation. The method was demonstrated to be valid, since in all 5 cases (one subclass A1b, two subclass A2, two subclass B) were correctly diagnosed. Compared with laparoscopy, MRI is less expensive, less invasive, and can be performed in women in whom laparoscopic examination is risky. However, unlike laparoscopy, MRI can not detect the presence of minimal and mild endometriosis and does not allow assessment of the tubal conditions.

Adult↗

PubMed1990

Endometrial patterns during danazol and buserelin therapy for endometriosis: comparative structural and ultrastructural study.

We studied endometrial structure and ultrastructure in serial biopsy specimens from patients with endometriosis treated with danazol (N = 19) or intranasal buserelin (N = 13) for 6 months. Biopsies were performed before and at 3 and 6 months of treatment. The specimens were studied by light, scanning, and transmission electron microscopy. Six morphometric indices were evaluated. Danazol produced a progestational effect on endometrial glands and stroma associated with marked hypotrophy of the mucosa, and buserelin treatment resulted in weakly proliferative or inactive mucosa. Both drugs induced noncyclicity and hypotrophy of endometrium although with different mechanisms of action, and it is suggested that they may have similar effects on ectopic endometrium. Because the atrophic effect of danazol appeared earlier than that of buserelin, the former could be recommended for short-term therapy.

Adult↗

PubMed1990

Magnetic resonance imaging in Mayer-Rokitansky-Küster-Hauser syndrome.

Six girls with suspected Rokitansky syndrome underwent magnetic resonance imaging (MRI) and then sonography and laparoscopy to confirm the clinical diagnosis and define the precise characteristics of the malformation. The uterus was missing in all; four had müllerian rudiments in place of the uterus, which were cavitary in two as shown by sonography and in one by MRI. Both ovaries were present in all cases, normally located in four and extrapelvic in two; they were correctly identified by MRI in all cases and by sonography in four. Partially canalized vaginal rudiments were recognized by MRI in two girls and by sonography in one. One patient had unilateral renal agenesis, demonstrated by both MRI and sonography. Magnetic resonance imaging was more precise than laparoscopy and sonography in defining the anatomical characteristics of Rokitansky syndrome, and is less invasive and expensive than laparoscopy.

Abnormalities, Multiple↗

PubMed1990

Repair of the uterine cavity after hysteroscopic septal incision.

We performed a follow-up hysteroscopy with multiple biopsies at different intervals after surgery in 19 women who underwent hysteroscopic septal incision. Seven days after operation the sectioned areas were very evident and not epithelialized (3 patients). At 14 days, the incised zone was depressed with scattered epithelialization (5 subjects). At 1 month, the sectioned surfaces were still depressed and uniformly covered by thin endometrium (5 cases). After 2 months the uterine cavity was almost normal with minimal tendency to central fundal adhesions (6 women). Thus, spontaneous healing processes after hysteroscopic metroplasty progressed regularly and completely and there is probably no reason to delay attempts at pregnancy for longer than two cycles after surgery.

Abortion, Spontaneous↗

PubMed1990

Endometrium of cavitary rudimentary horns in unicornuate uteri.

The rudimentary horns removed from ten patients with unicornuate uterus, subclass A1b, were studied by light and scanning electron microscopy. Seven of the horns removed were small in volume (range 7.5-15.7 mL) and three were larger (range 20.8-39.7 mL). In four cases the endometrial cavity communicated with the tubal lumen, hematometra was present in three cases, and endometriosis was diagnosed in six. In six of the seven rudimentary horns without hematometra, the endometrial mucosa did not correspond to the cycle phase of the endometrium of the hemiuterus; however, in the three rudimentary horns with hematometra, the endometrium presented cycle-phase characteristics similar to those of the hemiuterus. The endometrio-myometrial junction, the underlying myometrium, and the arcuate arterioles were always altered. We consider that the absence of cyclic changes in the endometria of the smaller horns may be attributed to reduced vascular supply, to the absence of any isthmocervical structure, and to the qualitative and/or quantitative differences in endometrial mucosal receptors.

Adolescent↗

PubMed1989

Successful in vitro fertilization and embryo transfer after limited surgical treatment for tubal adenocarcinoma.

A 29-year-old woman with tubal adenocarcinoma stage IA was treated only with bilateral salpingectomy, pelvic lymphadenectomy, and omentectomy. Two years later the patient successfully underwent in vitro fertilization and embryo transfer, and at 39 weeks gave birth to a healthy son by cesarean section. The result of oncologic follow-up 3 years after surgery is negative.

Adenocarcinoma↗