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Biomedical subjects

L Fedele

Publications and source records attributed to L Fedele.

At least 145 records · Page 8Linked to original sources
PubMed1989

Dental elements in mature teratomas of the ovary: scanning electron microscope ultrastructure.

Seventy-two teeth from 10 ovarian mature teratomas and 12 unerupted and erupted teeth from subjects aged 8 to 21 years were examined at the scanning electron microscope to evaluate the morphologic and histogenetic differences. The ultrastructure of the teratomatous teeth was similar to that of the corresponding orthotopic tissues. Despite this similarity the morphology of the teratomatous teeth was much less well defined, attesting to the inductive effect of the contiguous tissues that are normally present in the oral cavity.

Adolescent↗
PubMed1989

Buserelin versus danazol in the treatment of endometriosis-associated infertility.

A total of 62 infertile women with a laparoscopic diagnosis of endometriosis were allocated randomly to two treatment groups, one of which (32 patients) received oral danazol 600 micrograms/day and the other (30 patients) received intranasal buserelin 1200 micrograms/day for 6 months. Suppression of serum levels of estradiol was greater with the gonadotropin-releasing hormone agonist treatment. Pain symptoms improved markedly during treatment in both groups. At the end of treatment a repeat laparoscopy was performed only in the patients who agreed to it (12 in the buserelin group and 13 in the danazol group), and it did not reveal significant differences in the effects of the two treatments on the endometriotic implants. All of the patients were followed up for at least 12 months, during which pregnancy was attempted. At 18 months the cumulative pregnancy rate was 48% in the patients treated with buserelin and 43% in those treated with danazol. Pain recurrence was observed in about half of the patients in each group 1 year after treatment suspension. The side effects were more frequent and more severe in the danazol-treated patients, whereas those given buserelin generally reported only symptoms of hypoestrogenism. The results of this study suggests that buserelin is at least as effective as danazol in the treatment of endometriosis when the outcome is considered in terms of restored fertility, and its side effects are less severe.

Adult↗
PubMed1989

Barrier methods of contraception and the risk of cervical neoplasia.

The relationship between the use of barrier contraception methods and the risk of cervical neoplasia was analyzed using data from a case-control study conducted in the greater Milan area, northern Italy. A total of 367 cases of invasive cancer under 60 years of age were compared with 323 subjects in hospital for acute conditions unrelated to any of the established or suspected risk factors for cervical cancer, and 316 cases of cervical intraepithelial neoplasia were compared with 258 outpatient controls. Ever-use of barrier methods (condom and diaphragm) was reported by 6% of the cases of invasive cancer and 12% of hospital controls. Corresponding values for intraepithelial neoplasia were 16% for cases and 22% for outpatient controls. Considering the total use of barrier methods, compared to never use, the relative risk of invasive cervical cancer was 0.4 (95% confidence interval 0.2-0.9) and decreased with duration of use (chi 2(1), trend = 5.18, p = 0.02). Likewise, use of barrier methods lowered the risk of intraepithelial neoplasia; the estimated relative risks were 0.9 in users for less than two years and 0.6 for two or more (chi 2(1), trend = 4.61, p = 0.03). Although the protection for invasive cancer appeared to be greater at older ages and in multiparous women, the relative risks were not significantly heterogeneous in various strata of parity, number of sexual partners, oral contraceptive use and history of Pap smears.

Adolescent↗
PubMed1989

Enhanced pre-ovulatory progesterone levels in fertile cycles during clomiphene citrate treatment.

We compared ovulatory changes in fertile and preceding infertile cycles in 21 patients with unexplained infertility conceiving after clomiphene citrate treatment. No significant differences were observed in follicular growth, cervical score and follicle stimulating hormone (FSH) levels. Progesterone was higher (P less than 0.05) in the 2 days preceding ovulation in fertile cycles, luteinizing hormone (LH) higher (P less than 0.05) the day before, and 17-beta-estradiol lower (P less than 0.05) 4 days before. Stimulating progesterone secretion by systematic LH administration before ovulation could improve secretory endometrial transformation and thus reproductive prognosis.

Adult↗
PubMed1989

What is the source of elevated serum levels of CA 125 in patients with endometriosis?

The presence of CA 125 was investigated in endometriotic tissue and endometrial mucosa using two different immunohistochemical methods, indirect immunofluorescence and the avidin-biotin immunoperoxidase technique. Neither of the methods revealed the antigen in the 12 endometriotic fragments studied. The endometrial mucosa both of patients with endometriosis and of the control subjects was positive with indirect immunoperoxidase staining in all cases, whereas with indirect immunofluorescence it was positive in 75 and 67%, respectively. Thus the mechanism(s) responsible for distribution of the antigen in different tissues and its reported high serum levels in advanced endometriosis is still unclear.

Adult↗
PubMed1989

Gestrinone versus danazol in the treatment of endometriosis.

Thirty-nine infertile patients with laparoscopic diagnosis of endometriosis were allocated randomly to treatment with gestrinone 2.5 mg twice weekly (20 patients) or danazol 600 mg/day (19 patients) for 6 months. If amenorrhea was not obtained after 1 month of treatment, the gestrinone dose was increased to 2.5 mg three times a week (7 patients) and the danazol dose to 800 mg/day (2 patients). One month after the end of the treatment, a repeat laparoscopy was performed only in the women who agreed (7 of the gestrinone treated group, 9 of the danazol group). All of the patients were followed for at least 12 months after the end of the treatment, during which time they attempted to conceive. There was a marked improvement of pain symptoms during the treatment in the patients of both groups. The repeat laparoscopy did not reveal significant differences between the two groups in the reduction of the disease extent. Eighteen months after treatment suspension, the cumulative pregnancy rate was 33% in the patients treated with gestrinone and 40% in those treated with danazol. Pain symptoms recurred during the follow-up in 57% of the gestrinone and 53% of the danazol group. The side effects were more frequent and severe with the danazol treatment, whereas those caused by gestrinone were mostly weight gain and acne. The results of this study suggest that gestrinone is as effective as danazol in the treatment of infertility associated with endometriosis and is better tolerated.

Adult↗
PubMed1989

Reproductive factors and the risk of invasive and intraepithelial cervical neoplasia.

The relation between reproductive factors and cervical neoplasia was evaluated in a case-control study of 528 cases of invasive cancer compared with 456 control subjects in hospital for acute conditions unrelated to any of the established or suspected risk factors for cervical cancer, and of 335 cases of cervical intraepithelial neoplasia compared with 262 outpatient controls. The risk of invasive cervical cancer increased with number of livebirths, the estimated multivariate relative risk (RR) being 4.39 in women with five or more births compared with nulliparous women. There was also an inverse relation with age at first livebirth (RR = 0.42 for greater than or equal to 30 vs. less than 20 years) which, however, disappeared after inclusion of parity in multiple logistic regression analysis. Likewise, cases of invasive cervical cancer tended more frequently to report induced abortions. However, this association was not statistically significant after allowance for confounding factors, including parity. No relation emerged with number of spontaneous abortion and age at last pregnancy. When the interaction between parity and sexual habits was analysed, the relative risk increased in subsequent strata of parity with increasing number of sexual partners or decreasing age at first intercourse, thus suggesting an independent effect of sexual and reproductive factors, and hence multiplicative on the relative risk of invasive cervical cancer. No consistent association emerged between the risk of intraepithelial cervical neoplasm and parity, number of abortions and age at first or last birth.

Abortion, Induced↗
PubMed1989

Comparison of cyproterone acetate and danazol in the treatment of pelvic pain associated with endometriosis.

Twenty-three patients with laparoscopically diagnosed endometriosis and pelvic pain were allocated randomly to treatment with cyproterone acetate 27 mg plus ethinyl estradiol 0.035 mg/day (11 patients) or danazol 600 mg/day (12 patients). All women received treatment for 6 months, except for one in the cyproterone group who suspended treatment for nonmedical reasons and was excluded from analysis of the results. The clinical condition and pain symptoms were monitored in all patients for 1 year after treatment suspension. The intensity of pelvic pain at diagnosis, during treatment, and at follow-up was evaluated by a multidimensional verbal score and an analogue scale. At the end of treatment, a repeat laparoscopy was performed in those patients who agreed (four in the cyproterone group, five in the danazol group); the results showed a partial regression of endometriotic lesions in both groups, with no significant differences between them. Dysmenorrhea disappeared in all patients during treatment. At 6 months after suspension, dysmenorrhea recurred in 66% of the cyproterone group and 58% of the danazol group, and at 1 year in 89 and 92%, respectively. Intermenstrual pelvic pain improved markedly during treatment in both groups; 6 months after treatment withdrawal it was present in four cyproterone subjects and four danazol group patients, whereas after 1 year, only one woman in the danazol group did not have this symptom. Deep dyspareunia was less affected by treatment, and 6 months later had recurred in all the women.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Enhanced preovulatory progesterone levels in clomiphene citrate-induced cycles.

We measured basal body temperature, cervical mucus, follicular diameter, and serum LH, FSH, 17 beta-estradiol, and progesterone daily in 40 spontaneous ovulatory cycles in 27 infertile women and in 40 clomiphene citrate-induced ovulatory cycles in 31 women. The cervical score was significantly lower and the serum FSH, LH, and 17 beta-estradiol levels were significantly higher during the follicular phase in induced compared with spontaneous cycles. Serum progesterone was significantly higher on the 3 days preceding ovulation and the day of ovulation in the induced cycles. These increased preovulatory serum progesterone levels could contribute to the lower cervical mucus score in the induced compared with spontaneous cycle, whereas their effect on the endometrium is still unclear.

Adult↗
PubMed1989

Pregnancies in septate uteri: outcome in relation to site of uterine implantation as determined by sonography.

Sonography was used to study the site of uterine implantation of 12 pregnancies in eight patients with complete septation of the uterus. The purpose was to determine the incidence of septal implantation in these patients and its relation to the outcome of the pregnancies. The live-birth rate in the 12 pregnancies was 33%. Three pregnancies (25%) went to term and ended in live neonates. One (8%) resulted in a premature delivery and the neonate survived. Eight (67%) ended in abortion. Sonograms showed that in all four pregnancies that were not aborted, implantation was in the lateral wall of the uterus. In comparison, in the eight pregnancies that terminated in abortion, implantation was septal in six, mixed in one, and undetermined in one. Our experience with this small group of patients suggests that pregnancies in septate uteri have a poor prognosis and that abortion is related to septal implantation.

Adult↗
PubMed1989

Laparoscopy in the diagnosis of chronic pelvic pain in adolescent women.

Chronic pelvic pain (CPP) in adolescent women is a frequent complaint. We assessed the value of laparoscopy in the differential diagnosis of CPP in 47 adolescents 11-19 years old after six months or more of cyclic or acyclic pelvic pain. No pelvic abnormalities were detected in 19 patients (40.4%), endometriosis was detected in 18 (38.3%) (frequently with nonpigmented or "nonclassic" lesions), partially obstructive genital tract malformations were found in 4 (8.4%), and other types of pathology were discovered in 6 (12.8%). Nearly 60% of the patients had a treatable pelvic disease. Laparoscopy is an invaluable tool in the diagnosis of CPP in adolescents and should be performed before starting a psychiatric evaluation or prescribing long-term medical treatment.

Adolescent↗
PubMed1989

Value of intrauterine device insertion and estrogen administration after hysteroscopic metroplasty.

Hysteroscopic metroplasty seems the treatment of choice for septate uterus. Little information is available on the possible usefulness of postoperative intrauterine device (IUD) insertion and estrogen administration in preventing fusion of a freshly cut septum and intrauterine adhesion formation. A hysteroscopic incision in a uterine septum was made in 20 women. Postoperatively an IUD was inserted in ten of them and conjugated estrogens administered for 30 days with medroxyprogesterone acetate on days 26-30 (group I); the other ten were given no other therapeutic measures (group II). On follow-up hysterography five women in group I had a normal uterine cavity, and five had a residual fundal notch greater than or equal to 1 cm. In group II four had a normal uterine cavity, and six had a residual fundal notch greater than or equal to 1 cm. No intrauterine adhesions were detected in any of the patients. IUD insertion and hormonal therapy after hysteroscopic metroplasty do not seem to be needed to prevent septal fusion.

Abortion, Habitual↗
PubMed1989

Magnetic resonance evaluation of double uteri.

A total of 18 infertile patients with hysterosalpingographic diagnosis of bifid uterus underwent magnetic resonance imaging (MRI) and subsequent laparoscopy or laparotomy to evaluate the capability of MRI to differentiate among the various classes of the malformation. Magnetic resonance imaging identified both bicornuate uteri correctly, both didelphic uteri, nine of the 12 partial septate uteri, and both complete septate uteri. The method demonstrated a sensitivity of 100% and a specificity of 78.6% in demonstrating cervical prolongation of the spur. Compared with laparoscopy, MRI is less expensive and less invasive, and can also be performed in patients with extensive adhesions. However, it has the disadvantage of not providing information on tubal conditions or on the presence of minimal and mild endometriosis.

Evaluation Studies as Topic↗
PubMed1989

Recovery of Chlamydia trachomatis from the endometria of women with unexplained infertility.

Fifty-two women with unexplained infertility and 55 controls with recently proved fertility were screened for Chlamydia trachomatis (CT) infection in the blood and genital tract. Serum antibody titration was performed with indirect fluorescence. Cell cultures were performed to screen for CT in urethral and endocervical swabs, in endometrial samples taken without endocervical contamination and in salpingeal and/or peritoneal fluid samples. Anti-CT serum antibodies were detected in 36.5% of the patients; CT was isolated in urethral cultures in 26.9%, endocervical cultures in 23.1%, endometrial cultures in 25% and endosalpingeal and/or peritoneal fluid cultures in 1.9%. Comparison of the results in the patients and controls showed a significant difference in the incidence of CT infection in endometrial, urethral and endocervical cultures. Chlamydial endometritis could have been the direct cause of infertility in the patients studied or merely might have indicated endosalpingitis that was not detectable at laparoscopy.

Adult↗
PubMed1989

Ectopic pregnancy and recurrent spontaneous abortion: two associated reproductive failures.

The association between spontaneous abortion and ectopic pregnancy was evaluated in a case-control study conducted on 161 women (cases) with recurrent spontaneous abortions (two or more consecutive spontaneous abortions) and 170 control subjects who delivered normal infants. The risk of ectopic pregnancy in women with a history of recurrent spontaneous abortion was about fourfold that of controls (relative risk adjusted for age and number of pregnancies = 4.3; 95% confidence interval 1.4-14.7). This association was confirmed by comparing the observed number of extrauterine pregnancies in women with recurrent spontaneous abortions with the expected number computed from regional data on the frequency of ectopic pregnancies; the estimated relative risk was 3.7, with a 95% confidence interval of 2.2-7.0. The present report found an association between spontaneous abortions and ectopic pregnancies, suggesting some common risk/etiologic factors for these two reproductive failures.

Abortion, Habitual↗
PubMed1989

Endometrial reconstruction after hysteroscopic incisional metroplasty.

Endometrial reconstruction after hysteroscopic metroplasty of a septate uterus was studied by light microscopy and scanning electron microscopy when the uterus was removed 13 days after metroplasty for a histologic diagnosis of leiomyosarcoma. We observed a retraction of the margins of the incised septum, which could prevent the formation of intrauterine adhesions. Reepithelialization of the cut surface seemed to proceed both centripetally, by proliferation of the surrounding normal endometrium, and centrifugally from the bottom of the glands present at the base of the septum.

Adult↗