Biomedical subjects

M Franchi

Publications and source records attributed to M Franchi.

At least 73 records · Page 4Linked to original sources

PubMed1998

A randomized comparison of vaginal prostaglandin E2 with oxytocin plus amniotomy for induction of labour in women with intermediately ripe cervices.

OBJECTIVE: To compare the effects of oxytocin and amniotomy or vaginal prostaglandin E2 (PGE2) for induction of labour. STUDY DESIGN: We conducted a randomized clinical trial. Eligible for the trial were women with normal pregnancy, parity 0-3, with intact membranes, >40 weeks of gestation documented by ultrasound examination before 20 weeks gestation, observed in a network of 13 general and teaching hospitals in Italy. Inclusion criteria were cervical Bishop's score 5-7, less than six uterine contractions per hour, single pregnancy, cephalic presentation, no history of cesarean section and uterine surgery. Eligible women were randomly assigned by phone to oxytocin plus amniotomy (163 women) or vaginal PGE2 2 mg, two doses at 6-h intervals (157 women). RESULTS: Overall, 50 women (15.6%) delivered by cesarean section, 22 (13.5%) randomized to oxytocin, and 28 (17.8%) randomized to PGE2 (not significant). Twelve hours after randomization, induction had failed in 26 women of the 163 randomized to oxytocin plus amniotomy (21.6%) and 34 out of the 157 randomized to PGE2 (15.9%): the difference was not significant. Neonatal outcome was similar in the two groups. CONCLUSIONS: This study did not find marked differences in labour and neonatal outcome between women randomized to oxytocin plus amniotomy or vaginal PGE2. A shorter induction delivery interval in the group receiving amniotomy and oxytocin after PGE2 priming was observed.

Administration, Intravaginal↗

PubMed1998

Peripartum complications in grand multiparous women: para 6-9 versus para > or =10.

OBJECTIVE: To assess the importance of birth order and advanced maternal age on maternal and peripartum complications. STUDY DESIGN: The study population consisted of 12 296 multiparous women (six deliveries or more) with singleton gestation. Patients were classified into two groups according to the birth order: grand multiparous (between six and nine deliveries) and huge multiparous (ten or more deliveries). Peripartum complication was defined when at least one of the following conditions occurred: massive hemorrhage, uterine rupture, abruptio placentae, dysfunctional labor or malpresentations. Logistic regression analysis was used to evaluate the relationship between birth order and maternal age and peripartum complications. RESULTS: Among the study population, 9587 (78%) were grand multiparous and the remaining 2709 were huge multiparous women. The rate of peripartum complications was higher in huge multiparous than in grand multiparous women: malpresentation (6.2% versus 5%, P<.005), massive hemorrhage (0.7% versus 0.4%, P<.001) and dysfunctional labor (6.4% versus 3.5%, P<.001). Huge multiparous women also had a higher rate of the following complications than grand multiparous women: cesarean section (14.4% versus 10.4%, P<.01), chronic hypertension (7.9% versus 3%, P<.001), severe pregnancy induced hypertension (2.6% versus 1.1%, P<.01), diabetes class A (10.7% versus 7.5%, P<.005), diabetes class B-R (4.3% versus 2%, P<.01) congenital anomalies (3.3% versus 2.6%, P<.05) and large for gestational age infant, (17% versus 12.4%, P<.01). When adjusted for maternal age, high birth order remained strongly associated with the occurrence of peripartum complications. CONCLUSIONS: Huge multiparity was associated with a higher rate of maternal and peripartum complications than grand multiparity. Higher birth order remained an independent risk factor for peripartum complications after adjustment for maternal age.

Abruptio Placentae↗

PubMed1998

Collagen fibril arrangement and size distribution in monkey oral mucosa.

Collagen fibre organisation and fibril size were studied in the buccal gingival and hard palate mucosa of Macacus rhesus monkey. Light and electron microscopy analysis showed connective papillae exhibiting a similar inner structure in the different areas examined, but varying in distribution, shape and size. Moving from the deep to surface layers of the buccal gingival mucosa (free and attached portions), large collagen fibril bundles became smaller and progressively more wavy with decreasing collagen fibril diameter. This gradual diameter decrease did not occur in the hard palate mucosa (free portion, rugae and interrugal regions) where the fibril diameter remained constant. A link between collagen fibril diameter and mechanical function is discussed.

Animals↗

PubMed1998

A randomized clinical trial of two surgical techniques for cesarean section.

The Joel-Cohen incision followed by nonclosure of pelvic and parietal peritoneum has been advocated as an alternative method to the Pfannenstiel incision with peritonealization at cesarean section. A randomized trial was designed to compare intra- and postoperative morbidity between the two techniques. Women to undergo a cesarean section were randomly allocated to have either the Joel-Cohen incision with the parietal and pelvic peritoneum left open (group 1) or to have the Pfannenstiel incision with both peritoneal layers sutured (group 2). The myometrium was closed with 1-0 polyglactin 910 suture using a continuous single-layer nonlocking technique. Patients in group 2 had the peritoneum approximated with 2-0 polyglactin 910 suture. The fascia was sutured with continuous 1-0 polyglactin 910 suture in all cases. Opening time was defined as the interval from skin incision to the opening of the uterine cavity. Febrile morbidity was defined as a temperature > or =38 degrees C on two occasions 4 hours (hr) apart excluding the first postoperative day. Endometritis was defined as postpartum temperature > or =38 degrees C on two occasions 4 hr apart, with uterine tenderness and/or foul-smelling lochia. One hundred forty-nine and 150 patients were allocated to group 1 and to group 2, respectively. A shorter median (range) opening time [4 min (2-21) vs. 6 min (2-19), respectively, p < 0.01] and a shorter median (range) operative time [30 min (10-65) vs. 40 min (20-110), respectively, p < 0.01] were observed in group 1. No difference was found in terms of intraoperative complications, proportion of patients who required transfusion, endometritis, sepsis, febrile morbidity, and urinary tract infections. A higher rate of wound infections was found in group 2 than in group 1 [14 of 150 (9.3%) vs. 2 of 149 (1.3%), respectively, p < 0.01]. The Joel-Cohen incision without peritonealization resulted in a shorter opening and total operative time than the Pfannenstiel laparotomy with peritonealization. This was accomplished with a reduction of wound infections.

Adult↗

PubMed1998

Acid fast filaments in stool samples from an AIDS patient.

The presence of filamentous bacteria morphologically similar to Nocardia in a fresh stool sample from an AIDS patient with pulmonary nocardiosis is here reported. The material was submitted to our laboratory for a parasitologic examination and was stained by the Kinyoun method, revealing numerous delicate, irregularly stained, branching acid-fast filaments. Nocardia asteroides had been isolated from sputum samples of this patient. The patient was a 32 year-old HIV+ female admitted to our center on June 1997 because of productive cough, right-sided thoracic pain and weight loss. Chest X rays showed the presence of right superior lobe excavated pneumonia. This was the first time we had observed filamentous bacteria similar to Nocardia in a stool sample submitted to parasitologic examination. For similar cases, and when its presence was not detected in other specimens collected from the same patient, intestinal endoscopy and biopsy should be performed for eventual lesions and smear examination repeated with Kinyoun stain and cultures for Nocardia.

AIDS-Related Opportunistic Infections↗

PubMed1997

Nonclosure of peritoneum at radical abdominal hysterectomy and pelvic node dissection: a randomized study.

OBJECTIVE: To compare closure and nonclosure of the peritoneum at radical abdominal hysterectomy and pelvic node dissection with respect to postoperative morbidity. METHODS: Women with uterine cancer who underwent radical abdominal hysterectomy and node dissection type II or III of Piver-Rutledge were assigned randomly to have a standard closure of pelvic and parietal peritoneum and placement of a T-shaped suction drain or to have the peritoneum left open but the vagina closed and two abdominal drains placed. Adjuvant radiotherapy was given to patients with risk factors. The postoperative incidence of lymphocysts (within 8 weeks from the operation and after 1 year) and infection-related and non-infection-related complications were analyzed. RESULTS: One hundred twenty subjects were enrolled, of whom 59 had peritoneal closure and 61 did not. Both groups were similar with regard to age, weight, nodes removed, nodal metastases, operative time, type of surgery, need for transfusion, and incidence of postoperative radiotherapy. The median follow-up was 36 months (range 11-72). Eleven patients died, four because of treatment-related complications. The amount of drainage was significantly higher in the closed group than in the unclosed group (median 740 mL, range 50-5980 versus median 340 mL, range 40-4000; P < .005). The incidence of asymptomatic lymphocysts was similar in the closed and open groups at 2 weeks (17 of 59 versus 15 of 6, respectively), at 8 weeks (eight of 56 versus ten of 61, respectively), and after 1 year (one of 21 versus four of 22, respectively). No difference was found between closed and open groups in terms of symptomatic lymphocysts (one of 59 versus two of 61, respectively), wound and pelvic infection (seven of 59 versus 11 of 61, respectively), febrile morbidity (two of 59 versus 11 of 61, respectively), and obstruction (zero of 59 versus one of 61, respectively). CONCLUSION: Nonclosure of the peritoneum at radical abdominal hysterectomy and node dissection is not hazardous and is not associated with an increased incidence of infection- or adhesion-related complications.

Adult↗

PubMed1997

Involvement of chromosome 6 in endometrial cancer.

Cytogenetic investigation was performed on direct preparations of 15 endometrial cancers showing different histotypes. Clonal abnormalities were found in 11 out of 13 analysable cases. The modal chromosome number was near diploid in all cases. The abnormal karyotypes contained relatively simple numerical or structural aberrations in the majority of tumours. In contrast, two neoplasms with serous papillary and mixed mullerian morphological features shared multiple complex changes as well as cytogenetic evidence of intratumoral heterogeneity. The most frequent chromosome abnormality in our series of endometrial neoplasms was 6q deletion, which was detected in serous papillary, endometrioid and mixed mullerian tumours. The loss of the 6q region, which is also frequently involved in ovarian carcinoma, suggests a relationship between endometrial and ovarian cancers based on a common histogenesis.

Adenocarcinoma↗

PubMed1996

Early involvement of 6q in surface epithelial ovarian tumors.

Complex karyotypes are often seen in primary surface epithelial ovarian tumors (SEOTs). Conventional cytogenetic as well as fluorescence in situ hybridization analyses coupled with loss of heterozygosity studies identified abnormalities of chromosome 6 as one of the most frequent lesions in these types of tumors. We performed cytogenetic analysis of direct preparations from 40 SEOTs, including borderline tumors and low-, intermediate-, and high-grade carcinomas to verify the frequency of chromosome 6 alterations. We also carried out fluorescence in situ hybridization analysis with a chromosome 6 library and yeast artificial chromosome clones from a region of the same chromosome (6q27). Chromosome 6 abnormalities were identified in 30 of 32 analyzable SEOTs. Twenty-five of 32 cases showed a deletion of 6q irrespective of their histological grade. We wish to underline that this is the first report proving that del(6q) was the most frequent chromosome anomaly in near-diploid SEOTs and that it was the sole anomaly observed in four SEOTs with diploid complement. Our findings suggest that abnormalities of the telomeric region of chromosome 6 (6q27) may be considered one of the earliest lesions in the pathogenesis of ovarian carcinomas.

Aneuploidy↗

PubMed1996

Octreotide in the management of bowel obstruction in terminal ovarian cancer.

Intestinal obstruction is a common and distressing clinical complication in ovarian cancer. The aim of our study was to assess vomit control in terminal ovarian cancer patients with inoperable gastrointestinal obstruction, using a symptomatic pharmacological treatment with octreotide which obviates the need for nasogastric tube placement. We studied 13 patients, all of whom had advanced ovarian cancer FIGO stage IIIc. Seven patients were treated in the Gynecology Department of S. Raffaele Hospital, at the University of Milan, and 6 were managed in the University of Varese Hospital. Octreotide was administered at doses starting with 0.3 up to 0.6 mg (mean 0.44 mg) a day by subcutaneous bolus or continuous infusion. Octreotide controlled vomiting in all cases to grade 0 on the WHO emesis scale. Complete relief of symptoms was achieved within 3.07 days (range 1-6 days). Vomiting stopped within 2-3 days of starting treatment in most patients. In 8 patients with a nasogastric tube, drainage decreased from 2000 to under 100 ml/day after the start of octreotide treatment. No side effects were reported. All patients died with minimal distress or pain.

Adolescent↗

PubMed1996

Modulation of venous endothelial activity and transcellular calcium transport by defibrotide: the adenosine hypothesis.

Defibrotide is a polydeoxyribonucleotide that possesses profibrinolytic and cytoprotective activities. These properties have been associated with its capacity to induce the release of prostacyclin and tissue plasminogen activator (t-PA) from endothelial cells. In the present study, the bolus administration of defibrotide in humans was able to induce (100-800 mg) a dose-dependent decrease in plasminogen activator inhibitor (PAI) (from 19.4 +/- 7.11 to 7.20 +/- 6.41 AU/mL) and an increase in t-PA (from 3.70 +/- 0.96 to 4.50 +/- 1.20 IU/mL) and in the stable prostacyclin derivative 6-keto-PGF1 alpha (from 18.83 +/- 3.83 to 26.75 +/- 8.48 pg/0.1 mL) in the venous blood. In a second part of the study, defibrotide has been shown to inhibit dose-dependently (10-100 microns) neutrophil activation in vitro: it decreased lysosomal enzyme release and superoxide anion and chemiluminescence production induced by the oligopeptide fMLP and the ionophores A23187 and ionomycin. The increase in extracellular calcium concentration from 0.5 to 2 mm antagonized the inhibitory effect of the drug. Defibrotide was able to reduce the cytosolic free calcium increase induced by specific stimuli by blunting calcium entry. Such an inhibitory activity of defibrotide was antagonized by theophylline, an adenosine receptor antagonist. The study confirms some pharmacological activities of defibrotide (release of t-PA and prostacyclin in vivo), and it also suggests that the compound blocks Ca2+ entry into the cells, possibly by interfering with the adenosine receptors.

Adenosine↗

PubMed1995

Management of adnexal masses by operative laparoscopy.

STUDY OBJECTIVE: To assess the efficacy of operative laparoscopy to confirm the diagnosis of benign adnexal masses, and treat the lesions. DESIGN: Consecutive patients evaluated for this indication between January 1989 and December 1993, who met the inclusion criteria. SETTING: The Jan Palfijn General Hospital, Antwerp, Belgium, and the Department of Obstetrics and Gynecology, University of Varese, Varese, Italy. PATIENTS: One hundred twenty-one women with a clinical, biochemical, and ultrasound diagnosis of benign adnexal mass. INTERVENTIONS: Operative videolaparoscopy was carried out in all patients using the carbon dioxide or argon laser, electrical, or mechanical means. MEASUREMENTS AND MAIN RESULTS: Depending on the patient's age and the appearance of the adnexal mass aspirate, biopsy, cystectomy, or adnexectomy was performed. The conversion rate to laparotomy was 2.4%. A pathologic diagnosis was made in all cases. In this series no malignancy was encountered. CONCLUSION: Operative laparoscopy is safe and effective for treating adnexal masses provided that the preoperative diagnosis indicates that the lesions are benign.

Adnexa Uteri↗

PubMed1995

Evidence of an adenosine-dependent mechanism in the hypotensive effect of L-arginine in man.

1. The hypothesis that endogenous adenosine could play a role in the haemodynamic response to L-arginine is investigated. 2. The study has been divided into two parts. The first part was a single blind, randomized, placebo-controlled study in which L-arginine i.v. infusion (0.07 mmol/kg per min) in five healthy volunteers caused a significant fall in systolic (-14.2%, from 129.0 +/- 8.2 to 110.6 +/- 8.5 mmHg; F = 62.89, P < 0.01), diastolic (-16%, from 80.0 +/- 7.9 to 67.2 +/- 7.0 mmHg; F = 18.97, P < 0.01) and mean (-15.5%, from 96.4 +/- 6.7 to 81.4 +/- 6.5 mmHg; F = 28.78, P < 0.01) arterial blood pressure, with a concomitant increase of plasma adenosine concentration (from 244.0 +/- 32.2 to 637.0 +/- 43.4 nmol/L; F = 79.3 P < 0.01). Maximal effects were obtained at the end of L-arginine infusion: haemodynamic parameters returned to basal values in about 30 min while adenosine concentrations normalized in about 15 min. Saline infusion had no effect on these parameters. 3. In the second study the effect of L-arginine i.v. infusion on arterial blood pressure, lower limb blood flow and plasma adenosine, before and after theophylline treatment (1000 mg/day for 3 days, p.o.) was examined.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗

PubMed1995

Temperature dependence of toothbrush bristle morphology. An ultrastructural study.

In this study, it was demonstrated that the original forms of toothbrush bristle ends undergo morphological changes during the preparatory procedures required prior to their examination by scanning electron microscopy (SEM). In particular, the distance of the specimens from the cathode of a traditional sputter-coater and the time of gold-palladium coating influence the temperature inside the vacuum compartment. Moreover, the temperature influences the original morphology of toothbrush bristles. 2 segments of each toothbrush head with nylon or ultralon bristles were cut off the brush: one was mounted vertically and one horizontally on stubs for SEM analysis. Different temperatures were measured inside the sputter-coater at the level of the bristle ends, during coating with gold-palladium alloy. The temperature at the level of the bristles that were placed horizontally was about 38 degrees C, and 59 degrees C when they were placed vertically. SEM analysis of the specimens showed that the same toothbrush has end-rounded bristles at about 59 degrees C and non-acceptable irregular bristles at about 38 degrees C. Retraction of bristles (which appeared shortened and with increased diameters) and superficial cracks were particularly present in the vertically placed ultralon bristles.

Alloys↗

PubMed1995

Diagnosis of pelvic masses with transabdominal color Doppler, CA 125 and ultrasonography.

BACKGROUND: The objective of this study was to test the accuracy of transabdominal color Doppler imaging in the prediction of malignancy of adnexal tumors when integrated in combination with CA 125 levels and two-dimensional ultrasound. METHODS: We considered 129 consecutive patients with a suspected adnexal mass at clinical examination and transabdominal and transvaginal two-dimensional ultrasound. Serum CA 125 was measured in all cases. All the patients underwent color Doppler imaging to measure the Resistance index of the tumor associated blood flow profile and then surgery and histologic diagnosis. RESULTS: The median age of the patients was 44 years (range 12-91), 64.3% were premenopausal and the prevalence of malignancy was 28.7%. The sensitivity of color Doppler mapping was 75.7%, specificity 71.7%, positive predictive value 68.3% and negative predictive value 93.0%, compared with 75.7%, 68.5%, 49.1% and 87.5% for CA 125 and 83.8%, 83.7%, 67.4% and 92.8% for two-dimensional ultrasound. Blood flow was undetectable by color Doppler imaging in 17 of the 129 cases (13.2%). In 55 patients with three concordant tests, the positive and negative predictive values were 100%. When CA 125 values and two dimensional ultrasound results were discordant (35 patients), the color Doppler diagnosis was correct in 88.6% of the cases (93% in premenopausal women). CONCLUSION: Color Doppler imaging alone is not better than two-dimensional ultrasound in predicting malignancy of pelvic masses. Its use together with CA 125 and two-dimensional ultrasound may improve the accuracy of predictions when the three tests are concordant or when the other two are discordant.

Adnexa Uteri↗

PubMed1995

[Hemostasis in patients at high hemorrhagic risk].

Surgical treatment in patients with heavy coagulation disorders needs measures that minimize immediate and post-surgical hemorrhagic risk. Besides the subjects afflicted with constitutional coagulation pathologies such as haemophilia A, B, C, AB, Von Willebrand disease, platelet disorders and others, too many are the patients that need pharmacological therapy to impede the creation of intra-vascular coagula. Today, surgical treatment of these patients is possible with the use of human fibrin glue (Tissucol) that permits excellent surgical and post-surgical hemostasis without therapy suspension, independently of coagulation disorder. The purpose of this study is a clinical evaluation of a surgical procedure based on the use of human fibrin glue in association or not with suture, hemostatic sponge and lyophilized dura mater in patients with coagulation disorders. In a group of 309 patients in oral anticoagulant therapy have been done a total of 822 operations such as root fragments extraction with mucoperiosteal flap elevation, teeth or roots simple extractions, third molar extractions, cyst removal, apicoectomies. Only patients with PA over 20% have been treated. All the operations have been leaded with minimal trauma; after the extractions, alveolar margins have been regularized to improve flaps adaptation. Hemostatic sponge or dura mater have been used like basis for the flaps and the fibrin glue, that was injected in the residual cavity after surgical suture. In a few cases, for example with little extraction wounds, only fibrin flue without suture or sponge has been used. In all cases and after all operations, the presence or absence of bleeding has been evaluated after 2 hours, 24 hours, 7 days after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Dental↗

PubMed1995

[Estrogens and bone metabolism].

The authors present a review referring to cellular and biochemical control systems of bone remodeling as well as the effect of estrogens on modulation of bone metabolism. Systemic and local control factors such as PTH, calcitonin, vitamin D, prostaglandins, insulin-like growth factor-1, transforming growth factor-beta are analyzed as possible indirect targets for the estrogen induced inhibition of bone resorption. A direct receptor-linked action of estrogens on the osteoblast-lining cell unit, the most important modulator or bone metabolism, is furtherwise examined. The precise mechanism of the beneficial effect of estrogens for the prevention of postmenopausal bone loss and the treatment of established osteoporosis has not yet been clearly identified, but it seems likely that multiple mechanisms may be involved since postmenopausal osteoporosis itself appears as a heterogenic clinical condition related to multiple pathogenetic factors.

Adult↗

PubMed1994

Pelvic exenteration in gynecologic oncology. Review.

Pelvic exenteration is still indicated in the treatment of gynecological cancer, in patients with pelvic resectable disease, after the failure of standard treatment. The reported survival ranges from 20 to 60% and has been increasing in the last 15 years; the prognostic factors more frequently described are margin status, time from diagnosis or radiotherapy, lesion size, preoperative side-wall fixation. The role of palliative exenteration in patients with non-resectable disease and/or nodal metastases is discussed. Survival and morbidity in elderly patients are comparable to the younger group and age cannot be considered as an exclusion criteria. Gastrointestinal, urinary and infectious complications are still considerable, but morbidity and mortality have been reduced by surgical and intensive care developments. New surgical techniques, i.e. vaginal reconstruction and continent urinary diversions, have improved quality of life, especially in younger patients, with longer expected survival.

Aged↗

PubMed1994

Composite resin-amalgam compound restorations.

Extensive silver amalgam restorations in premolars and molars occasionally require sacrifice of healthy unsupported enamel walls or cusps. A posterior composite resin-amalgam compound technique has been proposed to conserve these structures. Microleakage was high at the enamel-amalgam interface, moderate at the composite resin-silver amalgam and dentin-composite resin interfaces, and minimal between the inner enamel and the composite resin. Light microscopy and scanning electron microscopy demonstrated that marginal adaptation of the silver amalgam to the composite resin of the cusps was acceptable and that penetration of the inner etched enamel to the composite resin was complete.

Bicuspid↗