Biomedical subjects

M Moscarini

Publications and source records attributed to M Moscarini.

At least 19 recordsLinked to original sources

PubMed2006

Prediction of persistent vaginal intraepithelial neoplasia in previously hysterectomized women by high-risk HPV DNA detection.

AIM: To estimate the incidence and latency of Vaginal Intraepithelial Neoplasia (VAIN) in women previously hysterectomized for benign/malign pathology and to evaluate the role of high risk HPVs in the prediction of persistent or recurrent disease. SUBJECTS AND METHODS: 830 women with prior hysterectomy for benign/malign pathologies followed by cytological scraping and vaginal colposcopy. Forty-four patients presented VAIN lesions confirmed by histopathological diagnosis. HPV DNA test was performed at the time of diagnosis. Patients were treated by Laser CO(2) vaporization and underwent follow-up by cytology, colposcopy for a mean period of 3 years. HPV DNA test was performed at 6 months after treatment and every years. Persistent or relapsed disease was confirmed by histopathology. RESULTS: Incidence of VAIN in women hysterectomized for benign pathologies did not differ significantly from the malign group. VAIN degree was more severe in the hysterectomized patients with cervical malignancy and subsequently radiated respect to non-radiated patients. The HPV DNA test at 6 months after VAIN treatment showed fifteen positive cases: twelve HPV 16 (80%) and three HPV 18 (20%). In five cases HPV DNA test was positive with a persistent negative cytological smear during the years. Positivity to high-risk HPV (either 16 or 18) was significantly higher in the patients with relapse to VAIN (10/44, p<0.002). CONCLUSIONS: We suggest to include HPV DNA test in addition to cytology in the follow-up of patients previously treated for VAIN, in order to predict VAIN persistence or progression in vaginal carcinoma before cytology becomes abnormal.

Adult↗

PubMed2006

Oocytes cryopreservation: state of art.

In the present review article we sought to analyze, on the basis of a systematic review, the indications, rationale of oocytes cryopreservation, as well as the techniques that improved the aforementioned procedure in order to higher the pregnancy rate in women undergoing that procedure. Moreover, we pointed out the importance of oocytes cryopreservation in the research field as oocyte banking may be of utmost importance to increase the availability of oocytes for research applications such as genetic engineering or embryo cloning. Oocyte freezing has 25 year of history alternating successes and setbacks. Human oocytes have a delicate architecture but are freezable. Clinical efficiency remains low, but healthy children have been born, indicating that chromosomally normal embryos can originate from frozen oocytes. Freezing protocols are not yet optimal and it is now desirable to combine empirical and theoretical knowledge.

Cryopreservation↗

PubMed2006

Regression rate of clinical HPV infection of the lower genital tract during pregnancy after laser CO2 surgery.

The objective of the study was to evaluate the effects of laser CO2 surgery during pregnancy to prevent clinical HPV infection recurrence after delivery and vertical infection. A case-control study was performed on 280 pregnant women affected by clinical HPV infection treated during pregnancy with 256 women treated three months after delivery. Follow-up was performed for a minimum of three colposcopic examinations for two years. Recurrence rates were calculated considering the number of positive findings for at least one colposcopic examination confirmed by biopsy after a negative control in a year. Statistical comparison of rates was performed by chi-squared and Fisher's exact test. Recurrence rates were higher in the women treated in postpartum (p < .01) than in the group treated during gestation (p < .005). Clinical HPV infections treated during the second trimester of pregnancy showed a sensitive decrease in recurrence-rate of infection. Rarity of respiratory papillomatosis makes conclusions inconsistent for the prevention of vertical infection.

Carbon Dioxide↗

PubMed2006

Serum CA125 level modifications in women undergoing repeated IVF cycles.

In the present paper, serum CA125 modifications in patients undergoing their first IVF cycle were compared with those of patients in their second attempt. A significant increase of this marker was detected in each group of patients at day 14 after embryo transfer. However, the level of CA125 monitored in the patients in their second attempt was significantly higher than that determined in patients undergoing their first ovarian stimulation. This condition does not influence either ovarian response or oocyte and embryo quality. Moreover similar IVF outcome was obtained. Therefore we propose that patients undergoing repeated assisted reproductive technology (ART) cycles may suffer from ovarian surface epithelial damage and/or altered cellular growth rate.

Adult↗

PubMed2004

Anti human papillomavirus vaccine: the checkmate to human papillomavirus?

Cervical cancer is the second most frequently found neoplasia in women worldwide. At least 95% of cervical cancers contain viral DNA which, in 80% of cases, belongs to one of the human papillomavirus (HPV) viral types at high oncogenic risk: 16, 18, 31 and 45. HPV is, at this point, considered the first "necessary cause" of cervical cancer, against which primary prevention with a reduction in the risk of infection can be carried out. Numerous molecular biological studies have been conducted to identify the biological markers of this infection and to refine an effective and well tolerated vaccine capable of preventing HPV infection as well as possibly treating those cases in which the infection has already caused an HPV-related disease of the genital tract. In the near future, the real primary prevention of this disease will be conducted, similar to what occurred for Hepatitis B, using immunoprophylaxis with an anti-cancer vaccine.

Female↗

PubMed2003

Pelvic relapses in ovarian cancer. Role of CA-125, transvaginal ultrasound and color Doppler.

From January 1995 to January 2001, 40 patients with epithelial ovarian cancer were treated at our Institution. Fourteen of these, with a clinical CR after surgery and platinum-based chemotherapy, were evaluated monthly by gynecological examination, Ca-125 RIA assay, pelvic ultrasound with transabdominal and transvaginal probe and color Doppler. Six pelvic relapses, from 1.5 to 3.0 cm, were detected by transvaginal ultrasound (US). They showed a rich neovascularization with low resistance, high flow, PI from 0.3 to 1.0 and RI < 0.5 in all cases. US did not reveal any sign of relapse in the remaining eight patients. In all cases of pelvic relapses ultrasonic signs of recurrence preceded the increase of Ca-125 by one to six months (average 3.8).

Aged↗

PubMed2002

A new molecular and cytogenetic approach to sterility. A review of the literature.

In the therapeutic procedure of conjugal fertility, the use of intracytoplasmic sperm injection (ICSI) has opened new possibilities when conventional in vitro fertilization (IVF) techniques are unsuccessful. Cytogenetic studies showed the presence of genetic anomalies in foetuses conceived with this technique. Starting from these considerations, through a data collection of the literature, the authors report the latest scientific findings on this problem. They show the limits of the knowledge about genetic risks linked to these techniques, increasingly imposing rigorous medical behavior and conscious choices of the couple.

Cytogenetics↗

PubMed2001

[Ectopic pregnancy after in vitro fertilization and embryo transfer. Analysis of literature].

The incidence of ectopic pregnancy has dramatically increased in the last decade. The triggering factors may be different and among them there is the introduction of medical assisted procreation techniques. Tubal pathologies in 80% of women undergoing artificial insemination techniques, the transfer in the womb of more than one embryo and the method of the same embryo-transfer may influence the onset of an ectopic pregnancy. This study aims to detect the factors that can prevent or reduce thc incidence of this pathology, after a close examination of the literature.

Embryo Transfer↗

PubMed2000

Surgical treatment of invasive carcinoma of the vulva. Our experience.

OBJECTIVE: The purpose of this study was to investigate the clinical findings, treatment and outcome of patients with vulvar carcinoma in the L'Aquila area. METHODS: Fifteen cases of vulvar carcinoma seen between September 1991 and December 1999 at the Department of Obstetrics and Gynecology of the University of L'Aquila were reviewed. Clinical, pathologic, surgical and follow-up data were collected from patient records. Mean age at diagnosis was 66.4 years. All patients were evaluated through a careful medical history and physical examination, vulvoscopy, abdomino-pelvic CT or MR, urethrocystoscopy, rectocolonscopy and SCC, and CEA determination. Radical surgery included six patients treated by the Taussig-Way operation. Modified radical surgery accounted for nine patients treated by the Byron three-incision approach. RESULTS: The major early complication was groin wound breakdown which occurred in four cases. The major late complication was chronic leg edema which was reported in six patients. The average number of nodes removed per patient was 19.5. Seven patients (46.7%) had a T2N0M0 pathologic stage, four (26.7%) were T2N1M0, four (26.7%) T1N0M0. Five patients died of local and distant recurrences within 37 months after surgical treatment; ten patients are alive, nine are apparently free from disease whereas one presented local and systemic recurrence within 18 months after surgery. CONCLUSIONS: Vulvar carcinoma predominantly affects older women. Most patients in our series (11/15) had tumors more than 2 cm in diameter. Although the vulva is an external organ and early detection should be achieved, many patients presented with extensive primary lesions due to both patient and physician delay. Stage of disease, tumor size, and nodal metastases are potential prognostic factors useful in selecting patients for a more conservative surgical approach.

Aged↗

PubMed2000

[Isolated inguinal endometriosis. Report of a clinical case].

The case of a patient with inguinal isolated endometriosis in whom laparoscopy revealed no evidence of pelvic endometriosis is presented. Following the observation of this case and the published reports by other authors on frequency, pathogenesis, diagnosis and therapy, the article supports the hypothesis that inguinal endometriotic lesions are likely associated with lymphatic spread of endometrial cells.

Abdominal Neoplasms↗

PubMed2000

[Pregnancy in adolescence. Consequences and considerations].

Many authors have pointed out that sexual activity is starting at an increasingly early age in young adolescents. In 1990 pregnancies in under 15-year-olds in the United States accounted for 3% of the total, a figure that has increased by 13% over the past decade. Moreover, pregnancy in adolescence may result in a number of complications, including pre-term birth, PIH, sexually transmitted diseases. The aim of this study was to evaluate the incidence of adolescent pregnancy in our user basin and to analyse the clinical evolution of these cases. The sample included 61 girls aged between 15.4 and 17.9 years old, mean age 16.7. Of these, 65.6% were students. The majority opted for voluntary abortion (85.2%). Those who chose to continue the pregnancy came from small towns with less than 1000 inhabitants (77.7%). They subsequently married their partners and continued to live with their parents. From an obstetric point of view, only one case of pre-term birth was recorded at week 26, and two cases of IUGR. The fact that the percentage of pregnancies in adolescence has remained unchanged over the years in spite of the numerous health and contraception campaigns represents a strong stimulus to investigate the countless facets of this problem.

Adolescent↗

PubMed2000

[Antibiotic prophylaxis of infective complications after cesarean section. Our experience].

BACKGROUND: The efficacy of a single dose of antibiotic vs multiple doses of the same drug, in reducing maternal infections following the cesarean section, is evaluated. METHODS: A total of 206 pregnant women undergoing elective or emergency cesarean section from 1st June 1998 to 30 June 1999, at the Department of Obstetrics and Gynecology of the University of L'Aquila, were included in a randomized study to compare the efficacy of prophylaxis with a single dose of piperacillin sodium (2 g i.v. after the umbilical cord clamping; group A) vs triple doses of the same antibiotic (2 g i.v. at 6 hourly intervals, beginning from the umbilical cord clamping; group B). RESULTS: The incidence of infective morbidity in group A was 7.3%, with a 2% wound infections, 1% urinary infections and 4.16% febrile morbidity. The incidence of infective morbidity in group B was not much higher (9%), with 2.7% wound infections, 1.8% urinary infections and 4.5% febrile morbidity. CONCLUSIONS: In order to obtain a useful antibiotic prophylaxis in cesarean sections, the single-dose seems to be preferable to the multiple-doses, since the single-dose not only has equal efficacy, but also less cost, smaller risk of super-infections by resistant organisms and it involves smaller care from the-medical and nursing staff.

Adult↗

PubMed1999

[Apropos of a case of Dandy-Walker syndrome associated with chromosome abnormalities].

A case of Dandy-Walker syndrome associated with chromosome abnormalities (46,XX,-21, +der(13)t(13;21)(q22;q11), diagnosed during pregnancy is reported. This is a pathology characterized by malformations of the central nervous system, mainly of the cerebellum. Due to several aspects and different prognosis between classic Dandy-Walker and its variants, many clinical and therapeutic problems may raise.

Abortion, Induced↗

PubMed1999

[Hysteroscopic vs histologic diagnosis. Study of 222 cases of abnormal uterine hemorrhage].

BACKGROUND: AUB (abnormal uterine bleeding) is one of the most common pathologies. It is therefore important to use a method that is easy to carry out in order to ensure a rapid and reliable diagnosis. Hysteroscopy may represent the elective method for the study of the uterine cavity. METHODS: A total of 222 women suffering from AUB were studied between January 1996 and June 1997 at the Department of Surgery, Gynecology Clinic of L'Aquila University. Their age ranged between 30 and 74 years old. The exclusion criteria for the study were as follows: presence of a genital infection in active or latent phase, pregnancy in progress or abortion. All patients underwent operative hysteroscopy with targeted biopsy accompanied, when necessary, by endometrial ablation. All biopsies underwent histological analysis and the results of hysteroscopic diagnosis and histological diagnosis were then compared. RESULTS: There was a 85% correspondence between results. The main difficulties were encountered in the identification and selection of the characteristics of hyperplasia. Moreover, during the study it was found that hysteroscopy was both diagnostic and also therapeutic since it enabled the removal of polyps and intracavitary fibroma or endometrial ablation if required. CONCLUSIONS: Hysteroscopy was therefore found to be a totally reliable method for the study of abnormal uterine bleeding compared to the histological tests carried out.

Adult↗

PubMed1999

Colposcopy, cytology and histology in the diagnosis of squamous intraepithelial lesions of the cervix.

OBJECTIVE: To compare colposcopic findings to cytologic and histological diagnoses in women with colposcopic reports of ANTZ and/or HPV infection. METHODS: Among 791 hospitalized women referred for colposcopic examination, colposcopy showed ANTZ grade 0-2 and/or HPV infection in 271 patients (34.26%). Only 153 were fully investigated by colposcopy, cytology (under colposcopic observation) and histology (target punch biopsy: 109 patients; surgical specimens of hysterectomy: 42 patients; conization: 2 patients). Cytological and histological diagnoses were reported according to the Bethesda System. RESULTS: 132/153 Pap smears were estimable for sampling adequacy; 44/63 resulted as normal and were histologically positive for LSIL [1]. Five LSIL-positive Pap tests were negative on histology (false negative and false positive rate of 33.33% and 3.78%). The pap test was diagnostic for intraepithelial neoplasia in 34/65 cases (53.3%) and for invasive cancer in 6/11 cases (54.5%). In 67/132 cases (50.8%) adequate-for-sampling Pap smears could not predict the exact diagnosis. On the other hand, 108/141 patients with colposcopic evidence of ANTZ/cancer showed histological SIL or invasive neoplasm (76.59%): ANTZ 1 was associated to LSIL and HSIL in 74.1% and 2.4%; ANTZ 2 to LSIL, HSIL and invasive cancer in 41%, 30.76% and 10.3%. Colposcopic suspicion of invasive cancer in 8 patients was histologically demonstrated in 7 (87.5%); colposcopic diagnosis of HPV infection was confirmed in 10/12 (83.4%). CONCLUSION: A better correspondance was shown between colposcopy and histology than between cytology and histology in the diagnosis of SIL. We suggest a routine colposcopy investigation for all patients admitted to a gynecological clinic and we believe it is very important to take Pap smears under colposcopic observation if colposcopy and cervical smears are performed in the same sitting.

Adult↗

PubMed1999

[Fetal malformations and chromosome abnormalities diagnosed at the Center of Prenatal Diagnosis of the University of Aquila in the 1995-1998 triennium].

BACKGROUND: Over the past few years numerous techniques have been developed, allowing an evaluation of fetal physiopathology that was unthinkable until recently. The authors describe 20 cases of fetal malformations and chromosomal abnormalities diagnosed by scan and amniocentesis at the Centre for Diagnosis and Obstetric Prophylaxis at L'Aquila University. METHODS: Between January 1995 and April 1998 a total of 1180 amniocentesis and 4000 obstetric scans were performed in a group of 1650 pregnant women. RESULTS: Of the patients examined using ultrasound scan, 8 presented manifest fetal pathologies, of which 5 were associated with chromosome abnormalities: 1) left ventricular hypoplasia, common atrium, tricuspid dysplasia; 2) omphalocele; 3) Morgagni-Stewart-Morel syndrome; 4) plurilobate cystic hygroma; 5) duodenal atresia; 6) Dandy-Walker syndrome; 7) cystic hygroma and hydrops; 8) cystic hygroma, hydrops, cardiopathy and Dandy-Walker syndrome. Among the pregnant women undergoing amniocentesis without a prior diagnosis of fetal malformation, 12 presented pathological fetal karyotypes: 2 cases of Turner's syndrome; 2 cases of Edward's syndrome; 2 cases of Klinefelter's syndrome, of deletion of a stretch of chromosome 8; 1 case of Down's syndrome; 2 cases of supernumerary marker chromosome; 1 twin pregnancy with Klinefelter's syndrome in one twin and paracentric inversion of chromosome 13 in the other; 1 twin pregnancy with a small supernumerary marker chromosome in both twins. CONCLUSIONS: Ultrasonography often enables the diagnosis of congenital abnormalities not associated with chromosome pathologies. However, karyotype studies play an essential role in pregnancies with a high genetic risk.

Adult↗

PubMed1999

Preterm delivery: predictive value of cervico-vaginal fetal fibronectin.

OBJECTIVE: This study aimed to evaluate the risk of preterm delivery in the asymptomatic obstetric population of L'Aquila by means of fetal fibronectin immunoassay in cervicovaginal secretions. METHODS: In this prospective study, 60 asymptomatic pregnant women at low-risk for preterm delivery were followed-up. Fetal fibronectin cervical swabs from the esocervix and posterior vaginal fornix were obtained every second week from 24 to 36 weeks of gestation. Fetal fibronectin concentrations were measured by an enzyme-linked immunosorbent assay with a cutoff level set at 50 ng/ml. RESULTS: Twelve patients (20%) had at least one positive fetal fibronectin test result. Six women in our study group (10%) were delivered spontaneously < 37 weeks; 4 of these (66%) had at least one positive fetal fibronectin test result (positive predictive value: 33%; sensitivity: 66%) and 3 of these women (75%) had a positive test result between 24 and 26 weeks. The remaining 8 patients with at least one positive fetal fibronectin test were delivered at term or post-term. Forty-eight women always had negative tests and 46 (95.8%) of these were delivered at term (specificity 82%), whereas 2 (4.2%) were delivered prematurely. The negative predictive value of fetal fibronectin as a predictor of term delivery in this low-risk population in 95% with odds ratio = 11.5 (95% confidence interval 1.44 to 110.4), relative risk = 8 (95% confidence interval 1.38 to 59.2) and Fisher Exact Test p < 0.024. CONCLUSION: In a population of asymptomatic patients at low risk for prematurity, the occurrence of a positive cervical or vaginal fetal fibronectin test result defines a subgroup at increased risk for preterm delivery, mostly at low gestational age.

Adult↗

PubMed1999

[Osteoporosis: DEXA versus conventional radiography, comparison of 2 techniques. Preliminary study].

BACKGROUND: Osteoporosis is the most wide-spread metabolical illness in the world, affecting from 30-40% of white women and 13% of white men over 50 years of age. Recently, the DEXA technique (Dual Energy X-ray Absortiometry) has proven to be a method, which is accurate, precise, low-cost, low-risk in terms of exposition to radiation and fast in terms of execution times. METHODS: The results obtained by comparing 54 DEXA examinations with the same number of conventional X-ray examinations are presented. 54 women in menopause were submitted to a computerized bone mineral evaluation with a 2.0 version DEXA EUROMOX TBS at the level of the lumbar region (L1-L5) and the left femur, at the Gynecology and Obstetrics Clinic of the University of L'Aquila. During the same session the women were subjected to X-rays of the lumbar column, pelvis and femurs. RESULTS: A diagnosis of osteoporosis was reported in 59% of the women in both the lumbar and femoral regions with DEXA, while conventional radiography showed osteoporosis in 33% of the examinations of the spinal column and in 51% of the femurs. CONCLUSIONS: Thus, it was demonstrated that the presence of a disorder at the level of the spinal column can lead to an interference in the diagnosis, while the association of the femoral region, which is less subject to related disorders leads to a more accurate diagnosis of osteoporosis in doubtful cases.

Absorptiometry, Photon↗