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Biomedical subjects

Nicola Ragni

Publications and source records attributed to Nicola Ragni.

At least 19 recordsLinked to original sources
PubMed2007

Transfascial vaginal tape (TFT): a simple, safe and cost-effective procedure for stress urinary incontinence. A preliminary study.

OBJECTIVE: To analyse prospectively the effectiveness of a new simple, minimally invasive, and cost-effective technique for the treatment of female urinary stress incontinence: the transfascial vaginal tape (TFT). MATERIALS AND METHODS: In a prospective study, we enrolled 45 women undergoing TFT with or without hysterectomy and/or another pelvic reconstructive procedure between 1st December 2003 and 31st December. TFT consists of a tension-free urethrosuspension using a sling located at the mid-urethral level and placed laterally in the endopelvic fascia previously perforated. Follow-up evaluations were established at 3 and 6 months and at 1 year after the operation. During each follow-up, women underwent cough stress test and they answered to the "Incontinence quality of life questionnaire" (I-QOL), to the Patient Global Impression of Severity (PGI-S) and of Improvement (PGI-I) questions. RESULTS: Thirty-nine patients (88.9%) had a follow-up examination 1 year after surgery. Of these, 30 (76.9%) were defined cured, 6 (15.4%) improved and 3 (7.7%) failed. CONCLUSIONS: TFT procedure can be considered a simple, safe and cost-effective procedure for the treatment of stress urinary incontinence and can be an alternative to tension-free vaginal tape or transobturator route for sub-urethral tape procedures.

Adult↗
PubMed2006

Dyspareunia and quality of sex life after laparoscopic excision of endometriosis and postoperative administration of triptorelin.

This observational cohort study examined the effect of laparoscopic full excision of endometriosis combined with postoperative triptorelin treatment on deep dyspareunia (DD) and quality of sex life. One year after completing the postoperative treatment, 45.9% of the patients had no DD and 34.7% reported a decrease in DD intensity; an increase in the frequency of sexual intercourse was reported by 62.2% of the women; objective improvements in several aspects of sex life were observed.

Adult↗
PubMed2006

Uterine sarcoma occurring in a premenopausal patient after uterine artery embolization: a case report and review of the literature.

OBJECTIVE: We report a case of uterine leiomyosarcoma occurring after uterine artery embolization and review the previously published cases. We estimate the incidence of sarcoma after UAE, the mean diagnostic delay in young women undergoing this procedure and review the potential and limits of preoperative procedures in diagnosing uterine sarcomas. CASE REPORT: A 35-year-old woman had an early failure after UAE. She underwent surgery 13 months after the procedure. Final pathologic report was consistent with uterine leiomyosarcoma. CONCLUSION: Incidence of uterine sarcomas after UAE is low, probably similar to that of misdiagnosed leiomyosarcomas in women undergoing surgery for presumed symptomatic leiomyomas. Therefore a relation between the procedure and the malignancy seems to be very unlikely. Diagnostic delay in menstruated women younger than 50 undergoing UAE for presumed symptomatic leiomyoma ranges between 13 and 15 months. The safest procedure for women who fail the conservative management of leiomyoma with UAE is surgical, allowing for definitive pathologic exclusion of malignancy.

Adult↗
PubMed2006

The efficacy of 2002 CDC guidelines in preventing perinatal group B Streptococcal vertical transmission: a prospective study.

OBJECTIVES: The aim of the current study is to evaluate the differences in the rate of perinatal group B streptococcal vertical transmission between women who correctly underwent the CDC 2002 guidelines and women who did not. METHODS: Two study groups: women who correctly underwent the CDC 2002 guidelines (study group 1) and women who did not (study group 2). Intrapartum chemoprophylaxis (IC) was administered to all pregnant women identified as GBS carrier. All newborns received, in the first hour of life, a culture based screening for GBS colonization. RESULTS: One thousand six hundred and sixty nine women were enrolled in the study. The 2002 CDC guidelines were correctly applied in 1273 (76.3%) subjects. There was no early-onset GBS disease. No statistically significant difference in the total number of colonized newborns between study group 1 (4.1%) and study group 2 (3.3%) was found. When the analysis was limited to women with positive GBS screening, a significant difference (P < 0.001) was observed in the number of colonized newborns between mothers who received IC during at least 4 h (group 1; 3.7%) and those who received an IC during less than 4 h (group 1; 12.3%). CONCLUSION: The accurate application of the 2002 CDC guidelines is strongly supported but, to furthermore reduce the risk for GBS colonization and sepsis in the newborns, it appears desirable to identify additional and new prevention strategies.

Adolescent↗
PubMed2006

Multislice CT enteroclysis in the diagnosis of bowel endometriosis.

This prospective study aims to evaluate the efficacy of multislice computed tomography combined with colon distension by water enteroclysis (MSCTe) in determining the presence and depth of bowel endometriotic lesions. Ninety-eight women with symptoms suggestive of colorectal endometriosis underwent MSCTe; locations, number of nodule/s, size of the nodule/s and depth of bowel wall infiltration were determined. Independently from the findings of MSCTe, all women underwent laparoscopy. MSCTe findings were compared with surgical and histological results. Abnormal findings suggestive of bowel endometriotic nodules were detected by MSCTe in 75 of the 76 patients with bowel endometriosis. MSCTe identified 110 (94.8%) of the 116 bowel endometriotic nodules removed at surgery; 6 nodules missed at MSCTe were located on the rectum. MSCTe correctly determined the degree of infiltration of the bowel wall in all of the 34 serosal bowel nodules identified at MSCTe. In six nodules reaching the submucosa, the depth of infiltration was underestimated by MSCTe. MSCTe had a sensitivity of 98.7%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 95.7% in identifying women with bowel endometriosis. MSCTe is effective in determining the presence and depth of bowel endometriotic lesions.

Adult↗
PubMed2006

Images of children born following infertility treatment.

OBJECTIVE: This cross-sectional survey investigates patients' attitudes towards the use of photos of children born following infertility treatment. MATERIALS AND METHODS: Each partner of 270 infertile couples independently completed a standardized questionnaire investigating patients' attitudes towards the presence of photos of children born following infertility treatment in fertility clinics, Internet websites, brochure, and videos. RESULTS: Subjects (77.4%) were pleased to provide a photo of their child to hang on the walls of the fertility centre, a lower percentage of subjects desired to exhibit the photo in the fertility centre website, brochure, and video. Among subjects wishing to hang the photo of their child in the infertility centre, 60.3% wanted the name of the child on the photo and 15.3% wanted both the name and surname of the child on the photo. If a photo is explicitly requested by a member of the fertility team, 30.9% of the subjects feel to have the duty to give it. No significant difference was observed in the desire to provide a photo of the child to hang on the walls of the fertility centre according to sex of the patient. CONCLUSION: The majority of infertile patients are pleased to exhibit a photo of their babies in the fertility centre. Members of the fertility team should avoid asking explicitly the photo because parents may feel to have the duty to give it.

Adult↗
PubMed2006

Atherosclerosis in women with endometriosis.

OBJECTIVE: This study aims to determine whether women with endometriosis have greater subclinical atherosclerosis than the general population. STUDY DESIGN: This case-control study included 66 women with endometriosis and 66 controls matched for age and body mass index. All subjects were >or=35 years old. Exclusion criteria were obesity, diabetes, hypertension, hyperlipidemia, renal or metabolic diseases. Before laparoscopy, all patients underwent a measurement of intima-media thickness (IMT) and distensibility coefficient (DC) on the common carotid artery. In addition, blood samples were taken to determine the levels of lipids, fibrinogen, C-reactive protein, homocysteine, fasting glycemia, antithrombin III, plasminogen, protein C, protein S, and activated protein C resistance. RESULTS: All the biochemical parameters evaluated had similar levels in the two study groups. IMT was similar in women with endometriosis and in controls both on left (p=0.330) and right (p=0.648) carotid artery. Similarly, no significant difference was observed in the DC between women with endometriosis and controls both on left (p=0.539) and right (p=0.178) carotid artery. No significant difference was observed in IMT and DC between women with mild and severe endometriosis. CONCLUSION: Women with endometriosis do not have more subclinical atherosclerosis than the general population.

Adult↗
PubMed2006

What is the desired menstrual frequency of women without menstruation-related symptoms?

INTRODUCTION: This study aimed to investigate the desired menstrual frequency of subjects without menstruation-related symptoms. MATERIALS AND METHODS: The study included 270 women of reproductive age. Women with menstrual headache, dysmenorrhea, hypermenorrhea and/or premenstrual syndrome were excluded. The study subjects completed a standardized questionnaire. RESULTS: Of the women, 75.6% declared that menstrual periods interfere with their sexual life, 28.8% preferred not having their menstrual period when at work and 48.4% reported that menstrual periods interfere with practicing sports. Given the choice, 28.5% of the women would desire amenorrhea and 27.8% would prefer a reduction in the frequency of menstrual periods. Of the 152 women desiring to reduce menstrual frequency, 73.0% declared that they would accept to use a drug to reduce menstrual frequency. CONCLUSIONS: Over 50% of women without menstruation-related symptoms would like to lessen the frequency of menstrual periods and about 50% of them would desire amenorrhea.

Adult↗
PubMed2006

Vaginal ultrasonographic and hysterosonographic evaluation of the low transverse incision after caesarean section: correlation with gynaecological symptoms.

AIM: We investigated whether there is a correlation between morphological changes of the lower uterine segment after caesarean section (CS), visualized by means of either a transvaginal sonography (TVS) or a sonohysterography (SHG), and the frequency of abnormal uterine bleedings reported by the women. METHODS: By means of a random selection of our population, anamnesis, medical records, and TVS and SHG images of the lower uterine segment were collected in 217 women (116 with previous CS and 101 with previous vaginal birth), and an observational case-control study was performed. RESULTS: The uterine incision was identified in almost all women after CS (102/116) using TVS. It was observed that abnormal uterine bleeding was significantly more frequent in the CS group in comparison with the group of women who delivered vaginally. A correlation between the presence of abnormal uterine bleeding and the presence of significant sonographic findings in the lower uterine transverse incision in the women after CS was found. In the CS group, TVS findings were confirmed by those obtained by SHG, and, with this technique, a triangular anechoic area at the presumed site of incision (the niche) was identified in 69 of the 116 women (59.5%). CONCLUSIONS: In this study, we found a correlation between abnormal uterine bleeding and sonographic findings in women after CS. This correlation appears to be more significant in women who had CS 5-10 years ago. A significant difference exists between the CS group and the group of women who delivered vaginally for both frequency of abnormal uterine bleeding and sonographic findings.

Adult↗
PubMed2006

Uterine myomas, dyspareunia, and sexual function.

OBJECTIVE: To determine the prevalence of deep dyspareunia (DD) and characteristics of sexual life in women with uterine myomas. DESIGN: Cross-sectional survey. SETTING: University hospital. PATIENT(S): Three hundred seven sexually active premenopausal women who underwent surgery because of uterine myomas (group M, n = 132), uterine myomas and ovarian cysts (group MC, n = 84), ovarian cysts (group C, n = 67), and tubal sterilization (group S, n = 24). Exclusion criteria were as follows: endometriosis, pelvic inflammatory disease, interstitial cystitis, and preoperative treatment with GnRH analogues. INTERVENTION(S): Before surgery, patients underwent transvaginal ultrasound; number and characteristics of myomas were recorded. MAIN OUTCOME MEASURE(S): The presence and intensity of DD were determined. Patients completed a sexual-function questionnaire. RESULT(S): Patients included in the four groups had similar DD prevalence and DD intensity. No significant difference was observed in DD prevalence and pain intensity according to the number, position, and size of myomas. Deep dyspareunia intensity was higher in women with fundal and anterior myomas than in those with other myoma positions. No significant difference was observed in sexual function among the four study groups. CONCLUSION(S): Women with uterine myomas do not have increased prevalence or severity of DD; their sexual function is not impaired.

Comorbidity↗
PubMed2006

Transfascial vaginal tape for surgical treatment of stress urinary incontinence.

INTRODUCTION: In the past decade, two minimally invasive, mid-urethral sling procedures have been developed to correct stress urinary incontinence: the tension-free vaginal tape and the transobturator tape. Using similar surgical principles, we describe the placement of a sling located at the mid-urethral level and placed laterally in the previously perforated endopelvic fascia. This technique was termed transfascial vaginal tape. TECHNICAL CONSIDERATIONS: A 2 to 3-cm-long vertical incision was made at the mid-urethral level. A suburethral tunnel was created bilaterally in the anterior vaginal wall until the endopelvic fascia and retropubic space were reached. A 1.5 x 8-cm monofilament polypropylene mesh was placed under the mid-urethra and laterally in the previously perforated endopelvic fascia. Bilaterally, the sling was sutured to the urethropelvic ligaments. CONCLUSIONS: We describe a new, simple, safe, minimally invasive, tension-free, and cost-effective technique for the treatment of female stress urinary incontinence.

Fascia↗
PubMed2006

Effect of presurgical local infiltration of levobupivacaine in the surgical field on postsurgical wound pain in laparoscopic gynecological surgery.

BACKGROUND: To maintain a high standard of patient care, it is essential to provide adequate pain management in patients who undergo laparoscopic surgery. METHODS: We randomly enrolled 74 women who underwent laparoscopic surgery for gynecological benign diseases. Patients in the levobupivacaine group (n=37) were injected with 7 ml of 5 mg/ml levobupivacaine at all incisional areas patients in the control group (n=37) were injected with an equal volume of physiologic saline solution. In the postoperative period the following variables were assessed for each group: decline of hemoglobin concentration, consumption of analgesics, time of ambulation, length of postoperative ileus, length of postoperative hospital stay, and VAS scores at 6, 12, and 24 h after surgery. RESULTS: Mean pain intensity at 6 and 12 h after surgery was significantly lower in the levobupivacaine group than in the control group (p<0.01). Analgesic requirement was significantly lower (p<0.01) in the levobupivacaine group (0.3 phial+/-0.2) than in the control group (2.1 phial+/-1.0). The mean time of ambulation was significantly lower (p<0.05) in the levobupivacaine group (16+/-4) than in the control group (22+/-6). No significant difference was observed between the two groups in mean pain intensity 24 h after surgery, decline of hemoglobin concentration, length of postoperative ileus, or length of postoperative hospital stay. CONCLUSIONS: Our results suggest that presurgical infiltration of levobupivacaine in addition to general anesthesia and standard analgesic therapy significantly decreases the intensity of postsurgical pain, especially for the first 12 h after surgery, and reduces analgesic consumption after surgery.

Adolescent↗
PubMed2006

A prospective, randomized trial comparing immediate versus delayed catheter removal following hysterectomy.

BACKGROUND: A prospective, randomized study was used to assess whether the immediate removal of an in-dwelling catheter after hysterectomy affects the rate of recatheterization, symptomatic urinary tract infections, time of ambulation, and hospital stay. METHODS: We randomly assigned 96 women who underwent hysterectomy [44 vaginal hysterectomy (VH), 37 abdominal hysterectomy, and 15 laparoscopic assisted VH) to three groups. The in-dwelling catheter was removed immediately (group A), at 6 hr (group B), or at 12 hr (group C) after the operation. The association between clinical variables and the length of catheterization was assessed by Chi-square analysis. RESULTS: Recatheterization occurred in six patients (18.8%) of group A, all after VH under spinal anesthesia. All patients in the groups B and C could spontaneously void the bladder after catheter removal. Symptomatic urinary tract infection occurred in one patient in group A, compared with four patients in group B, and five in group C. The mean time to ambulation was 4.3 hr in group A, 6.5 hr in group B, and 9.4 hr in group C. Patients with immediate removal of urinary catheter had a shorter hospital stay. CONCLUSIONS: There could be an association between necessity of recatheterization and the type of surgery (VH) or the type of anesthesia (spinal). Despite recatheterization rate, early removal of in-dwelling catheters immediately after uncomplicated hysterectomy seems to decrease first ambulation time and hospital stay.

Adult↗
PubMed2006

Fetal risks related to the treatment of multiple sclerosis during pregnancy and breastfeeding.

In women with multiple sclerosis, pregnancy does not have a long-term adverse effect on lifetime disability; however, there is an increased risk of relapses during the postpartum. Therapies taken during pregnancy may have adverse effects on pregnancy outcome. The small number of pregnancies included in most studies, particularly those evaluating the risks related to the administration of immunomodulating drugs, do not allow firm conclusions to be drawn with regards to their safety. Therefore, until more information regarding safety is available, glatiramer acetate, mitoxantrone and interferon-beta should be discontinued before an anticipated pregnancy. By contrast, glucocorticoids can be used to treat acute relapses during pregnancy.

Breast Feeding↗
PubMed2005

The association between p53 expression, stage and histological features in endometrial cancer.

OBJECTIVE: Alterations of the p53 gene have been widely suggested to be relevant to the development of endometrial carcinoma. However, contradictory results have been reported when immunohistochemical determination of p53 expression has been correlated with stage and histological features of the tumours. STUDY DESIGN: Pathology findings were reviewed and p53 immunoperoxidase staining was performed in 240 cases of endometrial carcinoma. RESULTS: Uterine papillary serous adenocarcinomas showed significantly higher p53 overexpression than uterine endometrioid adenocarcinomas (100.0% versus 61.0%, p<0.005). p53 overexpression was significantly higher in the secretory variant (85.7%) than in the typical endometrioid carcinoma (60.0%) (p<0.05). p53 expression did not differ between early (stage I) and advanced (stage II-IV) carcinomas. Likewise, no difference was observed in p53 expression among different architectural grades. The incidence of metastasis to lymph nodes was similar in p53 positive (13.7%) and in p53 negative tumours (12.5%). CONCLUSION: In the present series, p53 immunostaining did not differ between cases with different FIGO stages or histologic characteristics of the tumours. No simple relationship exists between the immunohistochemical determination of p53 expression and the biological aggressiveness of endometrial carcinomas.

Adult↗
PubMed2005

The value of sonohysterography in detecting intracavitary benign abnormalities.

The aim of this retrospective study was to assess the diagnostic value and the usefulness of sonohysterography in the detection of uterine intracavitary benign abnormalities, compared with other diagnostic methods (transvaginal ultrasonography and diagnostic hysteroscopy). From January 2003 to December 2003, a total of 73 patients (47 premenopausal (middle age 38.9) and 26 postmenopausal women (middle age 60.5)) underwent transvaginal ultrasonography (TVS) and sonohysterography (SHG), consisting of an intrauterine infusion of saline solution during transvaginal ultrasound. The women referred to our Ultrasonography Center because of intermenstrual (38) or postmenopausal bleeding (19), or an abnormal or a poorly defined endometrial interface (16) as seen as baseline ultrasonography. The findings at TVS and SHG were compared with hysteroscopy (HS). In one case, the SHG was technically impossible to perform. In premenopausal group the sensitivity of SHG had been 100% in detecting submucosal fibroids, endometrial polyps and hyperplasia and 75% in detecting normal uterus. The specificity had been always 100%. In postmenopausal group the sensitivity of SHG had been 75% in detecting submucosal fibroids, 93.8% in endometrial polyps and 100% in hyperplasia and normal uterus. The specificity had been 100% in submucosal fibroids and hyperplasia and had been 90.0 and 95.5% in endometrial polyps and normal uterus, respectively. SHG allows to obtain a precise diagnosis of benign uterine pathology and it is more accurate in the diagnosis of intracavitary abnormalities than that obtained by TVS. Preoperative use of SHG may assist in choosing the best surgical treatment for the patient.

Adult↗
PubMed2005

Transvaginal sonohysterographic evaluation of uterine malformations.

OBJECTIVE: The aim of this study was to assess the diagnostic value and the usefulness of sonohysterography (SHG) in the detection of uterine anomalies, compared with other diagnostic methods. STUDY DESIGN: From January 2002 to December 2003, we collected 54 patients with a history of primary or secondary infertility or repeated spontaneous abortion and with a clinically or sonographically suspected abnormal uterus. All patients had previously undergone hysterosalpingography (ISG). All patients were examined by standard transvaginal ultrasound. Sonohysterography was then carried out by the intrauterine injection of an isotonic saline solution. Suspected uterine anomalies were also confirmed by hysteroscopy (HS) and/or laparoscopy. RESULTS: Sonohysterography was able to detect all the anomalies. The sensitivity and specificity of sonohysterography were the same as for hysteroscopy. However, there was no significant difference between the diagnostic capabilities of the methods analyzed. CONCLUSIONS: Transvaginal sonohysterography with saline solution is a low-cost, easy, and helpful examination method for uterine malformations. We propose that sonohysterography should be performed for the primary investigation of infertility and repeated miscarriages.

Abortion, Habitual↗