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N Vendola

Publications and source records attributed to N Vendola.

18 recordsLinked to original sources
PubMed2001

[Low concentration Ropivacaine in labor epidural analgesia. A prospective study on obstetric and neonatal outcome].

BACKGROUND: Epidural analgesia effectively alleviates labor pain. However controversy exists about the effect of epidural analgesia on labor outcome. The aim of this study is to assess the effect of a low concentration local anesthetic (ropivacaine 0.08%) in labor epidural analgesia (LEA) on labor pain relief, on the incidence of cesarean sections and instrumental vaginal deliveries, and on neonatal outcome. METHODS: In the period April 1998 - July 2000, 323 women in active labor with live, singleton and in vertex presentation fetuses at term of gestation were included in this prospective study. Women with pre-gestational and/or obstetric diseases or previous caesarean deliveries were excluded. One-hundred and five patients requiring - by written informed consent - LEA were allocated to receive standardised protocol of a low concentration local anesthetic (ropivacaine 0.08%) coadministered with opioid (sufentanil): ropivacaine group. The remaining 239 parturients who didn't require LEA were included in the control group. RESULTS: The demographic characteristics of the two groups were similar; 12 (10.4%) patients receiving LEA delivered by cesarean section, 17 (14.8%) by vacuum extractor whereas 86 (74.8%) had a spontaneous delivery. The risk of cesarean section (adjusted for age, BMI, parity, neonatal weight and gynecologist) resulted lower, even if not significantly, in the ropivacaine group (OR 0.9; 95% IC: 0.6-1.3), while a significant increased instrumental vaginal delivery rate has been reported, although little numbers reduce statistical significance. Neonatal outcome was unaffected by the use of LEA. CONCLUSIONS: The conclusion is drawn that a lower concentration of ropivacaine (0.08%) in LEA produces good labor pain relief with no detectable adverse effects on mother and neonate, and without significantly increasing cesarean section rate.

Adult↗
PubMed1995

Ureteral drainage with double-J catheters in obstructive uropathy during pregnancy. A report of 3 cases.

Acute dilatation of the upper urinary tract during pregnancy is a common cause of renal colics and urinary tract infections, leading, rarely, to renal insufficiency. We describe 3 cases with symptomatic hydronephrosis at 28 weeks of gestation who underwent placement of an internal urinary drainage by so-called double-J ureteral stents which rapidly reduced obstruction and symptoms and allowed pregnancies to continue to term. We conclude that double-J ureteral stenting is an effective, simple, safe, and economical method to treat acute hydronephrosis during pregnancy.

Drainage↗
PubMed1993

Endometriosis and ovarian cancer.

In 556 patients undergoing surgery for ovarian cancers the frequency of endometriosis ranged from 3.6% to 5.6% in serous, mucinous, and miscellaneous neoplasms versus 26.3%, 21.1%, and 22.2%, respectively, in endometrioid, clear cell, and mixed subtypes; the differences were statistically significant (chi 2 heterogeneity 50.0, p < 0.001) and consistent in strata of age, parity, menopausal status, and disease stage.

Adenocarcinoma↗
PubMed1993

Gonadotropin releasing hormone agonist treatment before hysterectomy for menorrhagia and uterine leiomyomas.

OBJECTIVE: To investigate the effect of gonadotropin releasing hormone agonist (goserelin) treatment before hysterectomy for leiomyomata-associated menorrhagia. DESIGN: Prospective, comparative, nonrandomized study. SETTING: A teaching hospital of Milano University. PATIENTS: Anemic women requiring hysterectomy for myoma-associated menorrhagia. INTERVENTION: Six months' preoperative goserelin treatment (41 cases) or immediate surgery (92 controls). MAIN OUTCOME MEASURES: Abdominal/vaginal hysterectomy rate, number of transfusions, operating time, blood loss, complications, febrile morbidity, and days in hospital. RESULTS: In the goserelin group mean hemoglobin rose (8.5 versus 13.3 g/dl) and mean uterine volume decreased (528 versus 251 ml). At preoperative pelvic exploration abdominal hysterectomy was indicated in 22 (54%) cases and 74 (80%) controls and vaginal hysterectomy in 19 (46%) and 18 (20%) (relative risk 3.6, 95% confidence interval 1.6 to 7.7; p = 0.001). No case required a transfusion whereas 51% of controls needed a total of 127 packed red cell units. CONCLUSIONS: In anemic women with menorrhagia and leiomyomas, gonadotropin releasing hormone agonist treatment before hysterectomy limited transfusion requirements and increased the vaginal procedure rate.

Adult↗
PubMed1993

Multifocal endometriosis. A case report.

Disseminated endometriosis of the urinary, genital and intestinal systems was treated successfully with conservative surgery. We hypothesize that this unusual presentation may have derived from retrograde menstruation, pooling of endometrial cells in the dependent anterior and posterior cul-de-sacs with subsequent passage across the peritoneal mesothelium, and dissemination by clockwise intraabdominal currents.

Adult↗
PubMed1993

Abnormal uterine bleeding associated with iron-deficiency anemia. Etiology and role of hysteroscopy.

We reviewed the clinical and histologic records of 61 consecutive premenopausal women with abnormal uterine bleeding and moderate to severe iron-deficiency anemia investigated in a tertiary care and referral center. Excessive bleeding was caused by benign lesions in 67% of the cases and by anovulation in 25% and was unexplained in 8%. Hysteroscopy revealed an organic intrauterine lesion (submucous myomas in 38%, endometrial polyps in 13%, submucous adenomyomas in 3%) that could be treated endoscopically in more than half the patients. In populations without nutritional deficiencies, a woman of reproductive age with sideropenic anemia and no other evident cause of blood loss or systemic disease should be considered menorrhagic until proven otherwise. Hysteroscopy should be included in evaluations of abnormal uterine bleeding.

Adenomyoma↗
PubMed1993

Gonadotropin releasing hormone agonist for chronic anovulatory uterine bleeding and severe anemia.

Twenty-three women with chronic heavy anovulatory uterine bleeding and severe iron-deficiency anemia received six months' treatment with goserelin, a gonadotropin releasing hormone agonist, administered as a monthly subcutaneous depot. After two months of treatment, all patients were amenorrheic and subsequent spotting was reported on only nine occasions. Laboratory results showed the following values: mean hemoglobin before treatment, 7.9 g/dL-13.8 g/dL at six months (+75%); mean hematocrit, 26.3%-41.6% (+58); mean serum iron, 19.8 micrograms/dL-63.3 micrograms/dL (+134%) and mean serum ferritin, 6.2 ng/mL-35.3 ng/mL (+469%). The endometrial hyperplasia observed in 11 subjects showed regression at follow-up suction biopsy. Gonadotropin releasing hormone agonists administered in a depot formulation for a few months in highly selected patients with severe anemia associated with heavy anovulatory uterine bleeding are practical, safe and effective, may avoid blood transfusions and could be used as a first line of treatment.

Adult↗
PubMed1993

Hysteroscopic metroplasty with resectoscope or microscissors for the correction of septate uterus.

During 1990, we performed hysteroscopic incision of uterine septum in 23 women with repeated abortion. The patients were allocated randomly to metroplasty with resectoscope (12 patients in group 1) or microscissors (11 patients in group 2) to compare surgical feasibility and anatomic results with these instruments. The uterine cavity was distended by instillation of sorbitol and mannitol solution under manometric control. Two patients in group 1 and three in group 2 had a complete septum. In group 1, the mean operating time, plus or minus standard deviation (S.D.), was 22 +/- 6 minutes compared with 17 +/- 5 minutes in group 2 (p = 0.06). The mean amount of distension medium used, plus or minus S.D., was 890 +/- 153 milliliters in group 1 versus 671 +/- 170 milliliters in group 2 (p = 0.003). One woman in group 1 with complete uterine septum had a uterine perforation that was managed conservatively. Postoperative morbidity for the entire series was negligible. At follow-up ultrasonography and hysteroscopy performed two months postoperatively, a residual fundal notch > or = 1 centimeter deep was detected and corrected in four patients in group 1 and two in group 2. Our findings indicate that, in terms of operating time and efficacy, the resectoscope and microscissors are equally valid instruments to correct a septate uterus, with a feasibility rate of 100 percent.

Abortion, Habitual↗
PubMed1993

A gonadotropin-releasing hormone agonist versus a low-dose oral contraceptive for pelvic pain associated with endometriosis.

OBJECTIVES: To evaluate the efficacy of goserelin versus a low-dose cyclic oral contraceptive (OC) in improving pelvic pain in women with endometriosis and to compare recurrence of symptoms during follow-up. DESIGN: Open-label, randomized trial. SETTING: University hospital endometriosis center. PATIENTS: Fifty-seven women with moderate or severe pelvic pain and laparoscopically diagnosed endometriosis. INTERVENTIONS: Six-month treatment with goserelin depot (n = 29) or a low-dose cyclic OC (n = 28) followed by 6-month follow-up. MAIN OUTCOME MEASURES: Variation in severity of symptoms during treatment and at the end of follow-up as shown by a linear analog scale and a verbal rating scale. RESULTS: At 6 months of treatment, a significant reduction in deep dyspareunia was observed in both groups, with goserelin superior to the OC at linear analog scale assessment. Nonmenstrual pain was diminished on both scales without differences between treatments. Women taking the OC experienced a significant reduction in dysmenorrhea. At the end of follow-up, symptoms reappeared without differences in severity between the groups. CONCLUSIONS: Low-dose cyclic OCs may be a valuable alternative for the treatment of dysmenorrhea and nonmenstrual pain associated with endometriosis. Symptoms recurred in most subjects 6 months after drug withdrawal.

Adolescent↗
PubMed1992

Veralipride for hot flushes during gonadotropin-releasing hormone agonist treatment.

Hot flushes are the commonest symptom induced by gonadotropin-releasing hormone agonists (GnRHa). We performed an open observational trial to evaluate the efficacy of veralipride, an antidopaminergic drug, in reducing hot flushes in 25 premenopausal women treated with a GnRHa for endometriosis (8 subjects) or menorrhagia (17 subjects). The patients received goserelin depot for 6 months and veralipride was added for the third month. Hot flushes, severe in all women at 2 months, improved in both frequency and intensity in 92% of the subjects during veralipride administration. The benefit obtained persisted until the end of the GnRHa treatment.

Adult↗
PubMed1992

Laparoscopic aspiration of ovarian endometriomas. Effect with postoperative gonadotropin releasing hormone agonist treatment.

In the period 1988-1990 this prospective study of 33 women with moderate or severe endometriosis who underwent laparoscopy for infertility and/or chronic pelvic pain, was conducted to evaluate the efficacy of aspirating endometriotic cysts followed by administration of a gonadotropin releasing hormone (GnRH) agonist in reducing the size of ovarian endometriomas. The cysts (mean diameter, 4.5 cm; range, 2-7; unilateral, 21 cases; bilateral, 12 cases) were punctured, aspirated, washed and emptied completely. After laparoscopy, 15 subjects received goserelin administered as a 28-day subcutaneous depot for three months, whereas 18 patients undergoing simple observation constituted internal controls. Ultrasound scans were performed before and at one, three and six months after laparoscopy. One case and three controls requested surgery between the four- and five-month follow-up scans and did not complete the study. All the other women had recurrent cysts at the six-month scan. There were no significant differences in mean endometrioma diameter between the two groups at any observation time nor between prelaparoscopic and six-month ultrasound examinations within each treatment group. We conclude that aspiration and washing of endometriotic cysts, combined with postoperative administration of GnRH agonists or not, is ineffective.

Adult↗
PubMed1991

Reliability of the visual diagnosis of ovarian endometriosis.

The visual diagnosis of endometrioma at laparotomy in 245 women operated on for ovarian cysts demonstrated a sensitivity of 97%, specificity of 95%, positive and negative predictive value of 98% and 94%, respectively, and overall accuracy of 96%. Because the visual detection of endometriomas is remarkably accurate, ovarian biopsy, although desirable in some cases, would seem dispensable for a correct laparoscopic diagnosis and staging of the disease.

Adult↗
PubMed1991

Conservative surgical treatment for severe endometriosis in infertile women: are we making progress?

Conservative surgery for severe endometriosis in infertile women is one of the most challenging situations for the pelvic surgeon. The second half of the 1980s saw an increase in the supporters of laparoscopic treatment even for more extensive disease. Two opposing factions were thus created: traditional gynecologic surgeons who accuse endoscopists of imprudence and technical inadequacy and enthusiastic supporters of operative laparoscopy who consider laparotomy obsolete and its associated morbidity needlessly high for the patient and health service. In the present review of the literature data we analyze laparotomy and laparoscopy techniques and compare the postoperative results in terms of reproductive success in an attempt to clarify whether conservative endoscopic treatment of severe endometriosis is only an inappropriate proposal with no future or whether, due to its efficacy, it will eventually limit interventions via laparotomy to exceptional circumstances.

Bias↗
PubMed1991

Peritoneal endometriosis. Morphologic appearance in women with chronic pelvic pain.

A prospective study analyzed the prevalence and severity of dysmenorrhea, intermenstrual pain and deep dyspareunia in relation to morphologic features of peritoneal disease in 73 consecutive women with endometriosis but no associated pelvic pathology, previous pelvic surgery or hormonal treatment. All underwent their first laparoscopy for chronic pelvic pain at the First Department of Obstetrics and Gynecology, University of Milan, Milan, Italy, between 1986 and 1989. Gynecologic pain symptoms were evaluated with a verbal score and visual analog scale. Peritoneal lesions were classified as typical (black nodules, yellow-brown patches, stellate scars), atypical (clear vesicles, clear or red papules, red polypoid lesions) or mixed. When the three types of lesions were considered together, a statistically significant association was observed only with deep dyspareunia (P less than .01). Moreover, a significantly higher prevalence of deep dyspareunia was revealed in patients with typical versus atypical lesions (P less than .01) and in those with mixed versus atypical lesions (P less than .05). Fresh, papular, atypical lesions exposed to peritoneal fluid might cause functional pain, whereas "old," black nodules immersed in infiltrating scars might provoke mainly organic pain.

Adolescent↗
PubMed1991

Inguinal endometriosis: pathogenetic and clinical implications.

In six women with a preoperative diagnosis of incarcerated hernia, surgical exploration of the groin revealed inguinal endometriosis and no hernia. The affected structure was always the extraperitoneal portion of the round ligament. Six of the seven lesions were on the right. Intraperitoneal endometriosis was demonstrated in all patients. Catamenial pain was the pathognomonic symptom in the differential diagnosis of the inguinal mass. Gynecologists and surgeons should bear in mind the possibility that endometriosis may be the cause of symptoms of a suspected incarcerated inguinal hernia. Should this disease be detected at inguinal exploration, a laparoscopy is indicated during the same operation.

Adult↗
PubMedDate not supplied

[The need for urodynamic tests].

Two hundred forty women were studied, who underwent symptomatological anamnesis, clinical examination and urodynamic investigations for female urinary incontinence. Our aim was to distinguish among the three main forms of incontinence (stress, urge and mixed incontinence). When only symptomatological anamnesis is considered, there is an incidence of error in nearly a third of the cases and, when further factors like menopause, prolapse and parity are considered, the incidence of error does not reduce. A correct diagnosis can be determined only by a combined use of clinical assessment and urodynamic investigations. (As regards clinical examination, a positive stress test leads to a diagnosis of stress incontinence. As regards urodynamic investigations a cystometry positive for instability of the detrusor muscle leads to a diagnosis of urge incontinence. If both clinical examination and urodynamic investigations are positive, the diagnosis is of mixed incontinence.) Our findings suggest that routinely it is sufficient to execute only cystometry among urodynamic investigations.

Adult↗