Biomedical subjects

Luigi Nappi

Publications and source records attributed to Luigi Nappi.

12 recordsLinked to original sources

PubMed2006

Four chamber view plus three-vessel and trachea view for a complete evaluation of the fetal heart during the second trimester.

OBJECTIVE: To test the efficacy of a recently introduced ultrasonic scanning plane (three vessel and trachea view -3VTV- plus color flow mapping -3VTVC) on a low-risk population for detection of congenital heart disease (CHD). PATIENTS AND SETTING: Antenatal clinic dealing with local low-risk population. All antenatal patients having a second trimester scan in a 1 year period. All patients had a 3VT plus 3VTC views added to routine four chamber view. Postnatal examinations were performed according to standard hospital protocol. RESULTS: 2847 patients were examined. The plane was achievable in all 23 fetuses with CHD detected, three false negative (aortic coarctation) and two false positive. Sensitivity of the examination was 88.5%, as high as more sophisticated and difficult targeted cardiac scanning. The extra time necessary to perform the test was minimal. CONCLUSION: 3VTV and 3VTCV were satisfactory used as imaging planes in a busy antenatal clinic in a low-risk population. They could be easily added to the four chamber view as routine screening for CHD and increase the detection rate to 90%.

Coronary Vessels↗

PubMed2005

Patients' obstetric history in mid-trimester termination of pregnancy with gemeprost: does it really matter?

OBJECTIVE: The objective was to investigate the importance of previous obstetric history for termination of pregnancy in the second-trimester with gemeprost alone. STUDY DESIGN: A consecutive series of 423 mid-trimester inductions of abortion at our teaching hospital was reviewed. Termination of pregnancy was carried out with 1mg of vaginal gemeprost every 3h up to three doses over a 24-h period, repeated the following day if necessary. Failed induction was defined as women undelivered by 96 h. The study population was then stratified by gestational age, parity, gravidity and previous uterine scars. Main outcome parameters were failed induction and complication rates. Statistical analysis was performed using the chi(2) test or Fisher's exact test for categorical data, and the t-test and linear regression for continuous variables. RESULTS: No significant differences were found in the primary outcome parameters with regard to the obstetric parameters considered. The failed induction rate was 1.2% with an overall incidence of complications of 7.4%. Parity was the main factor that affected clinical response (time to abortion interval and number of pessaries). CONCLUSION: Patients' obstetric history does affect the clinical response to gemeprost, but its safety and effectiveness are preserved. These data provide clinicians with important information for correct counselling.

Abortifacient Agents, Nonsteroidal↗

PubMed2005

Is the occurrence of the empty follicle syndrome a predictor that a subsequent stimulated cycle will be an unfavourable one?

Several hypotheses have been advanced to explain empty follicle syndrome (EFS) but it remains a controversial topic. This paper reports experience with three IVF cycles in which no oocytes were collected. In all cases, an additional IVF cycle was performed. The ovarian stimulation protocol, ultrasound and hormonal surveillance methods, human chorionic gonadotrophin timing and oocyte retrieval technique were similar in all patients. The assessment of additional cycles demonstrated a poor response in terms of oocyte quality, since the number of mature oocytes was low despite the high number of oocytes collected. Thus, the data suggest that in these patients, EFS should be considered as a borderline form of poor response to ovarian stimulation. If this is confirmed, EFS should be a recurrent event and an empty cycle could be a good predictor that a subsequent stimulated cycle will be an unfavourable.

Adult↗

PubMed2005

Hysteroscopy and menopause: past and future.

PURPOSE OF REVIEW: The main aim in investigating post-menopausal women is to exclude endometrial cancer. The purpose of this review is to define up-to-date clinical guidelines for the management of all post-menopausal women (asymptomatic as well as symptomatic). RECENT FINDINGS: Thanks to improvements in both the technology and the technique, hysteroscopy has become a simple and painless procedure that can easily be performed in an office or outpatient setting without any particular discomfort for the patient. The new, easier procedure, well tolerated by patients, has excellent diagnostic and surgical accuracy. Assuming that office hysteroscopy could offer a better visualization of the uterine cavity without increasing patient discomfort if compared to ultrasound, various authors have recently proposed the use of hysteroscopy as a first-line procedure in the approach to the menopausal patient. This could be defined as a change in strategy that has yielded very interesting results in terms of a better understanding of the appearance of the uterine cavity and the clinical value of small intra-cavitary pathologies (and their related treatment), particularly in asymptomatic women. SUMMARY: Hysteroscopy can be considered a routine outpatient method providing immediate results and causing minimal discomfort, especially when performed with the vaginoscopic approach. This technique has ushered in a new era of very-low-cost hysteroscopy, because only the hysteroscope is required in the outpatient procedure, with no need for additional instruments, medication, extra personnel or dedicated theatre. The time taken is comparable to that required for transvaginal sonography.

Endometrial Neoplasms↗

PubMed2004

Office hysteroscopy.

The indications for hysteroscopic procedures in gynecologic practice are ample and clearly charted: hysteroscopy is considered the gold standard not only for visualizing the cervical canal and the uterine cavity, but also for treating many different kinds of benign pathologies localized to that region. This article summarizes the authors' experience with this technique during the last 14 years, which have been devoted to improving the procedure by creating new instruments and modifying the technique.

Ambulatory Care↗

PubMed2004

The role of office hysteroscopy in menopause.

We evaluated the efficacy of office hysteroscopic treatment of benign intrauterine pathologies using 5F mechanical instruments (scissors, grasping forceps). Subjects were 4863 women who underwent the procedure without analgesia or anesthesia. We treated cervical and endometrial polyps (0.2-3.7 cm), intrauterine adhesions, and anatomic impediments. At 3 months postoperatively, pathology persisted in 364 women (5.6%). Many operative procedures may be performed in the office setting with simple instruments, provided that correct indications are observed.

Adenocarcinoma↗

PubMed2004

Simultaneous bilateral tubal pregnancies and intrauterine pregnancy with five fetuses.

A 28-year-old woman with severe right lower abdominal pain and vaginal bleeding at 7 weeks' (+/- 2 days') gestation was seen in the emergency room of our institution. The pregnancy was the result of natural conception after ovarian stimulation with gonadotropins. Transvaginal sonography revealed five intrauterine gestational sacs containing five live embryos. A positive fetal heartbeat was detected in the fallopian tube on the right. Laparoscopic findings disclosed the enlarged uterus with the unruptured right ectopic pregnancy in the ampullary region and an extrauterine pregnancy in the left tube as well. A linear salpingotomy was performed on the right tubal pregnancy. We decided to perform salpingectomy on the left tube because it was impossible to preserve the tube, and exploration of it showed the existence of another gestational sac. It is necessary to decry inappropriate and injudicious use of assisted reproductive technologies, especially by individuals with little or no training in monitoring the agents and treatments prescribed. In 2003, still waiting for official legislation from the Italian Parliament on assisted reproductive technology, we have to face dramatic situations, such as this very unique case of heterotopic pregnancy.

Adult↗

PubMed2003

Comparison of hysteroscopic and hysterectomy findings to assess the diagnostic accuracy of office hysteroscopy in tamoxifen-treated patients with breast cancer.

STUDY OBJECTIVE: To assess the diagnostic accuracy of office hysteroscopy by comparing hysteroscopic findings with histologic findings on hysterectomy specimens in postmenopausal women with breast cancer treated with tamoxifen. DESIGN: Retrospective clinical study (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Thirty-three women. INTERVENTION: Record review. MEASUREMENTS AND MAIN RESULTS: Compared with histologic diagnoses of uteri, hysteroscopic findings showed diagnostic sensitivity of 97%, specificity of 100%, positive predictive value of 100% and negative predictive value of 96%. The diagnostic accuracy of hysteroscopy is the same in patients taking tamoxifen as in the general population. CONCLUSION: Hysteroscopy is a powerful method for diagnosing endometrial disease because it provides a direct view of the uterine cavity, reveals focal lesions, and enables targeted biopsies to be performed at the same time.

Ambulatory Surgical Procedures↗

PubMed2003

Evidence of apoptosis in human primordial and primary follicles.

BACKGROUND: Apoptosis may operate the 'selection' between follicles destined for atresia and follicles that will remain available for ovulation. The aim of this study is to assess the expression of apoptosis in quiescent follicles. METHODS: Ovarian cortex samples from women of reproductive age, fixed in formalin, were used for immunohistochemical and terminal deoxynucleotidyl transferase-mediated deoxy-UTP nick end labelling (TUNEL) methods. In histological sections the follicles were classified as primordial, primary, secondary and antral. Follicle density was defined as the total number of follicles/0.5 cm(2) of ovarian cortical tissue. Mab DO-7 (anti-p53) and Mab 124 (anti-bcl-2) were used in the immunohistochemical study. RESULTS: TUNEL was positive in 23.4% of the primordial follicles, and in 23.2% of the primary follicles, both in oocytes and granulosa cells, whereas all secondary follicles were negative. Bcl-2 activity was expressed in 75% of secondary follicles. p53 was negative in all samples. CONCLUSIONS: Apoptosis could be the process responsible for atresia of quiescent follicles and hence depletion of the ovarian germ stockpile. Follicular cells expressing Bcl-2 may therefore be the viable cells that escape the apoptotic process. Negative p53 patterns may be a favourable prognostic finding showing genome integrity in the replicating follicular cells of women of reproductive age.

Adult↗

PubMed2003

What does 'diagnostic hysteroscopy' mean today? The role of the new techniques.

PURPOSE OF REVIEW: Visual examination of the uterine cavity and contextual operative facilities have provided the gynecologist with the perfect 'diagnostic' tool, making it possible to examine the cavity and biopsy suspected areas under direct visualization. RECENT FINDINGS: The approach used to insert the scope, together with the diameter of the hysteroscope and the distention of the uterine cavity, are of extreme importance in reducing patient discomfort to a minimum during an outpatient examination. The vaginoscopic approach (without speculum or tenaculum) has definitively eliminated patient discomfort related to the traditional approach to the uterus. One of the major problems for endoscopists is passing through the internal cervical os; the new generation of hysteroscopes, with an oval profile and a total diameter between 4 and 5 mm, are strictly correlated to the anatomy of the cervical canal. Miniaturized instruments have enabled the physician not only to perform targeted hysteroscopic biopsies, but also to treat benign intrauterine pathologies, such as polyps and sinechiae, without any premedication or anesthesia. This has been defined as a 'see & treat' procedure: there is no longer a distinction between the diagnostic and operative procedures, but a single procedure in which the operative part is perfectly integrated in the diagnostic work-up. SUMMARY: Diagnostic hysteroscopy has long paid the price of being a purely visual method of investigation. Today, thanks to recent advances in instrumentation and to modified techniques related to the simultaneous use of the scope and of instruments, hysteroscopy is finally achieving the full accuracy that has been awaited for the last 20 years.

Female↗

PubMed2003

Toxoplasmosis in pregnancy is still an open subject.

OBJECTIVE: To assess the consequences of a systematic screening for toxoplasma infection in pregnant women in a potentially high risk population. METHODS: We have investigated all consecutive women with likely toxoplasma seroconversion in a referral center setting. Data were obtained from 68 women for whom an acute infection during pregnancy was considered likely or definite. They were all treated with antibiotics in the first instance and offered, if in the first or second trimester, amniocentesis for detection of vertical transmission (PCR and IFAT). Third trimester seroconversions and positive cases after amniocentesis were offered more aggressive antibiotic treatment. RESULTS: Five fetuses/neonates (7%) were found to be infected. Four of them were diagnosed prenatally at amniocentesis, two women decided for termination of pregnancy, two were treated and gave birth to seronegative, normally developing children. One case was found postnatally, after a third trimester conversion; this developed into hydrocephalus with neurologic impairment. DISCUSSION: Prenatal screening and antibiotic treatment of mothers infected with toxoplasmosis showed good feasibility in our infection-susceptible population. However, there were some weak points; for example, the high number of invasive procedures and the questionable prevention of mother to child transmission in the second to third trimester.

Amniotic Fluid↗

PubMedDate not supplied

Combined medical-hysteroscopic conservative treatment of a viable cervical pregnancy: A case report.

Cervical pregnancy (CP) is an uncommon ectopic pregnancy that accounts for approximately less than 1% of extrauterine gestations. This case report describes a case of a viable ectopic CP successfully treated with systemic methotrexate therapy combined with hysteroscopic local endocervical resection of the heterotopic gestational sac. This approach, if validated, could be considered the treatment of choice to preserve the uterus in these young patients.

Abortifacient Agents, Nonsteroidal↗