Biomedical subjects

P Fioretti

Publications and source records attributed to P Fioretti.

At least 37 records · Page 2Linked to original sources

PubMed1994

Haemostasis profile in smoking and nonsmoking women taking low-dose oral contraceptives.

The effects of oral contraceptives on coagulation in 258 nonsmoking and in 190 smoking women were determined. In smokers and in nonsmokers taking oral contraceptives, fibrinogen and fibrinopeptide A concentrations were higher than in oral contraceptive nonusers. In nonsmokers, oral contraceptives increased antithrombin III activity. The effects on coagulation of oral contraceptives with a different ethinylestradiol content (from 35 mcg to 20 mcg) were then evaluated in 333 of these women. The biggest changes in coagulation were observed in smokers taking the preparation with the highest estrogen content. Reduction of the ethinylestradiol dose caused a decrease of the changes in coagulation induced by oral contraceptives both in smokers and nonsmokers. These results might suggest that during oral contraception the coagulation system is affected mainly in smokers and that the decrease of the estrogen dose might lower the effects of the association of smoking and oral contraception on coagulation.

Adolescent↗

PubMed1994

Clinical comparison of two low-dose oral contraceptives, Minulet and Mercilon, in women over 30 years of age.

A comparative study of two low-dose oral contraceptives, gestodene (GES) 75 mcg/ethinyl oestradiol (EE) 30 mcg and desogestrel (DES) 150 mcg/EE 20 mcg, was conducted in women over 30 years of age. This randomised, open-label study was organised in Denmark, Italy, New Zealand and United Kingdom. A total of 505 women received GES/EE and 501 received DES/EE for 6 consecutive menstrual cycles. The two groups were comparable in terms of demographic and gynaecologic characteristics at baseline. However, the menstrual flow length was slightly longer in the GES/EE group before the start of the treatment. The mean age (+/- SD) was 35 +/- 4 years in the GES/EE group and 35 +/- 5 years in the DES/EE group. The subjects in the GES/EE group contributed data for a total of 2800 cycles and those in the DES/EE group, data for 2796 cycles. There were no pregnancies on medication with either preparation. The results showed that there were significantly more normal cycles in the GES/EE group for cycles 1 to 6. Irregular bleeding between withdrawal bleeds occurred in 10% of GES/EE and 18.5% of DES/EE cycles. Absence of all bleeding was reported in 29 (1%) and 63 (2%) cycles, respectively. The incidence of missed pills was low in both groups (11% of cycles). No significant differences were observed in cycle length or withdrawal bleeding episode length. Withdrawal bleeding mean intensity was statistically significantly greater with GES/EE. However, for both preparations, the mean intensity was close to light bleeding. No clinically significant differences were noted in weight, blood pressure, Papanicolaou smears or laboratory data. Sixty-eight (13.5%) subjects in the GES/EE group and 64 (12.8%) in the DES/EE group discontinued before the end of the study. Among them, 37 (7%) and 40 (8%) in the respective groups withdrew because of adverse reactions. There was no difference between groups in terms of primary reasons for withdrawal. The most frequently reported complaints that led to discontinuation in both groups were headache, nausea and metrorrhagia. Breast tenderness led to the discontinuation of 1 subject in the GES/EE group and 3 in the DES/EE group. These results show excellent cycle control, efficacy and very low rate of side effects with both GES/EE and DES/EE. These low-dose oral contraceptives could be well suited to healthy nonsmoking women requiring contraception up to the age of menopause.

Adult↗

PubMed1994

Hormone replacement therapy in perimenopausal women with a low dose oral contraceptive preparation: effects on bone mineral density and metabolism.

In a 2-year longitudinal, calcium-controlled study we evaluated bone density and metabolism in perimenopausal women with initial ovarian failure, and the effects of hormone replacement with a low dose oral contraceptive preparation (OC). In perimenopausal oligomenorrhoic women (n = 16) a significant (P < 0.01) increase in cycle length and plasma FSH levels as well as a parallel decrease in plasma estradiol levels (P < 0.01) were evident. In this group, despite the calcium supplementation (500 mg/day), a significant (P < 0.001) increase in the biochemical markers of bone remodelling paralleled a significant (P < 0.001) decrease (-3.4% after 24 months) in bone density. Conversely, in premenopausal oligomenorrhoic women treated with a low dose oral contraceptive (OC) formulation (30 mcg ethinyl estradiol plus 75 mcg gestodene, n = 16), bone markers showed a significant (P < 0.01) decrease, that paralleled a slight but significant (P < 0.01) increase (+1.71%) in bone density. These data suggest that premenopausal administration of OC can prevent the acceleration of bone turnover and reverse the decrease in bone density that follows the premenopausal impairment of ovarian function.

Administration, Oral↗

PubMed1994

Bone loss in perimenopausal women: a longitudinal study.

A longitudinal evaluation of bone mineral density (BMD) and metabolism was performed in premenopausal women. During the 2-year observation period, the menstrual pattern, plasma estradiol and FSH levels as well as the values of bone markers and BMD did not show any significant modification in a group of eumenorrhoic women (n = 37). Conversely, in age-matched oligomenorrhoic women (n = 37) a significant (P < 0.05) increase in the cycle length with a concomitant significant (P < 0.05) increase in circulating plasma FSH and parallel decrease of plasma estradiol levels (P < 0.05) was evident. In this group a significant (P < 0.05) increase in both urinary excretion of OH-P/Cr and plasma BGP levels paralleled a significant (P < 0.05) decrease in radial BMD. These data suggest that premenopausal impairment of ovarian function can lead to a bone loss in a significant proportion of women in which prevention should be considered before menopause.

Adult↗

PubMed1994

Quantitative coronary angiography in the estimation of the functional significance of coronary stenosis: correlations with dobutamine-atropine stress test.

OBJECTIVES: The purpose of this study was to determine the predictive value of quantitative coronary angiography in the assessment of the functional significance of coronary stenosis as judged from the development of left ventricular wall motion abnormalities during dobutamine-atropine stress echocardiography. BACKGROUND: Coronary angiography is the reference method for assessment of the accuracy of noninvasive diagnostic imaging techniques to detect the presence of significant coronary stenosis. However, use of arbitrary cutoff criteria for the interpretation of angiographic data may considerably influence the true diagnostic accuracy of the technique investigated. METHODS: Thirty-four patients without previous myocardial infarction and with single-vessel coronary stenosis were studied with both quantitative angiography and dobutamine-atropine stress echocardiography. Two different techniques of quantitative angiographic analysis--edge detection and videodensitometry--were used for measurement of minimal lumen diameter, percent diameter stenosis and percent area stenosis. Two-dimensional echocardiographic images were collected during incremental doses of intravenous dobutamine and later analyzed using a 16-segment left ventricular model. Angiographic cutoff criteria were derived from receiver-operating curves to define the functional significance of coronary stenosis on the basis of dobutamine-atropine stress echocardiography. RESULTS: The angiographic cutoff values with the best predictive value for the development of left ventricular wall motion abnormalities during dobutamine-atropine stress echocardiography were minimal lumen diameter of 1.07 mm, percent diameter stenosis of 52% and percent area stenosis of 75%. Minimal lumen diameter was found to have the best predictive value for a positive dobutamine stress test (odds ratio 51, sensitivity 94%, specificity 75%). CONCLUSIONS: Automated quantitative angiographic measurement of minimal lumen diameter is a practical and useful index for determining both the anatomic and functional significance of coronary stenosis, and a value of 1.07 mm is the best predictor for a positive dobutamine stress test.

Adult↗

PubMed1994

The couvade syndrome.

The couvade syndrome can be considered to be the psychosomatic equivalent of primitive rituals of initiation into paternity. Various symptoms have been described in the husbands of pregnant women with an incidence from 11% to 65%. The most common of these are: variations in appetite, nausea, insomnia and weight gain. Seventy-three couples with the women in the last month of pregnancy were given a questionnaire; as a reference group, 73 men without pregnant wives or children under 1 year of age were taken. An emotional involvement connected with pregnancy was reported in 91.78% of the men. This involvement was expressed as changes in sexual habits in 87.67% of cases, fear and anxiety in 36.98% and curiosity in 47.94%. With the exception of nausea, physical symptoms were less frequent in the men with pregnant wives than in those without pregnant wives. These data cannot confirm the existence of the couvade syndrome with its own physical symptoms but we think that some male experiences, which constitute a peculiar imaginary and behavioral reality of the father-to-be, do exist.

Adult↗

PubMed1994

The relationship between maternal relaxation and plasma beta-endorphin levels during parturition.

beta-endorphin (beta-EP) levels increase in maternal plasma starting from the 10th to the 12th week of pregnancy and reach a peak during labor and at delivery. Respiratory autogenous training (RAT) has been acclaimed as one of the most effective non-pharmacological methods of obtaining hypoalgesia and relaxing perineal muscles during labor. In order to study the effects of the RAT method in both maternal and fetal beta-EP levels during labor, 28 pregnant women were enrolled in this study. Fourteen attended a RAT program, while the others (control group) did not. beta-EP levels in both groups were measured in maternal plasma at early and late labor, at delivery and on the 4th day of the puerperium and in umbilical cord blood at birth. From late labor on, beta-EP maternal plasma levels increased significantly less in the RAT group than in the control group. The gap in the beta-EP levels between both groups was still significant at puerperium and in umbilical cord blood. In conclusion, the RAT method favorably modulates the secretion of beta-EP during labor and at delivery. This result supports the effectiveness of the RAT method in reducing both maternal and fetal stress during labor.

Adult↗

PubMed1994

Immunohistochemical detection of p185 product, p21 product, and proliferating cell nuclear antigen (PCNA) in formalin-fixed, paraffin-embedded tissues from ovarian carcinomas. Preliminary data.

Immunohistochemical techniques for the detection of oncogene products and the assessment of cell kinetics can represent promising investigational tools in clinical oncology. In the present paper the immunohistochemical expression of p185, p21 and proliferating cell nuclear antigen (PCNA) was retrospectively assessed in formalin-fixed, paraffin-embedded tissue samples taken from 28 primary ovarian carcinomas at first surgery. Positive immunostaining for p185 was found in 0% of 6 Stage I and 23% of 22 Stage III-IV tumors. Positive immunostaining for p21 was observed in 0% of early and 41% of advanced carcinomas; this immunohistochemical finding correlated significantly with histologic grade (G3 vs G1-2 = 47% vs 9%, p = 0.042). Elevated PCNA immunoreactivity was detected in 33% of Stage I and 50% of Stage III-IV tumors. Among the 20 patients with advanced carcinoma who underwent cisplatin or carboplatin based chemotherapy followed by second-look laparotomy, the pathologic complete response (pCR) rate was 36% for patients with low PCNA expression and 0% for those with elevated PCNA expression. A tendency towards a higher pCR rate was also found for patients with negative immunostaining for p185 or for p21. The prognostic value of the immunohistochemical detection of p185, p21, and PCNA in ovarian carcinoma deserves to be further investigated.

Adenocarcinoma, Mucinous↗

PubMed1994

Therapeutic experience of the North-West Oncology Group (GONO) on ovarian carcinoma.

The North West Oncology Group is a cooperative group that has carried out several clinical trials on the treatment of ovarian carcinoma in the last 10 years. In a randomized study of advanced ovarian carcinoma patients, the combination of cisplatin plus cyclophosphamide (PC) came out as superior to cisplatin plus cyclophosphamide plus doxorubicin in terms of complete clinical and pathological response rates and 8-years progression free survival (PFS). A randomized trial showed that PAC and cyclophosphamide plus doxorubicin plus carboplatin (CAC) were equivalent in terms of objective response (OR) rates, pathologic complete response (pCR) rates, median survival (S) and median PFS. After PAC or CAC therapy, patients with pCR or minimal residual disease were included in a randomized trial comparing abdominopelvic radiotherapy (RT) versus 3 more courses of the chemotherapy they had received before. This study was stopped early because of a clear advantage in S and PFS for chemotherapy arm. Patients with macroscopic residual disease at second-look surgery and patients with progressing or relapsing disease after first line chemotherapy crossed to an alternative analogue: from PAC to carboplatin and from CAC to cisplatin. An OR was obtained in 25% of the patients of the cisplatin arm and in only 9% of the patients of carboplatin arm. Randomized clinical trials analyzing the role of intraperitoneal administration of chemotherapy and the role of biological response modifiers such as interferons in the treatment of patients with advanced epithelial ovarian carcinoma are currently ongoing.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1994

The association of ovarian dysgerminoma and gonadoblastoma in a phenotypic female with 46 XY karyotype.

Dysgerminoma is the most common malignant germ cell tumor of the ovary. It can be found either in a pure form or mixed with other germinal elements. It has also been reported arising from gonadoblastoma, which may be regarded as an in situ germ cell malignancy. We describe the case of an 18-year-old patient who had a dysgerminoma arising from the left ovary and a gonadoblastoma replacing the right ovary. She was a nonvirilized phenotypic female, with 46, XY genotype. The patient underwent bilateral salpingo-oophorectomy with total hysterectomy, appendicectomy, infracolic omententectomy, selective pelvic and para-aortic lymphadenectomy, peritoneal random biopsies. The surgical-pathological stage of dysgerminoma was retroperitoneal stage III. The patient received postoperative radiotherapy on the whole pelvis and para-aortic lymph nodes and precautional radio therapy on the mediastinum and supraclavicular lymph nodes. She is currently alive with no evidence of disease after 46 months from surgery.

Adolescent↗

PubMed1994

Percutaneous nephrostomy in patients with advanced or recurrent cervical cancer.

Thirteen percutaneous nephrostomies were performed in 10 patients with advanced (no = 4) (group A) or recurrent (no = 6) (group B) cervical cancer. Urinary diversion was unilateral in 7 patients and bilateral in 3 patients. The catheter was kept in place for 4 months in mean (range: 1-7 months). A normalization of renal function was achieved in 4 out of 4 patients of group A, and in 3 out of 6 patients of group B. Of the 4 patients of group A, who afterwards underwent antineoplastic integrated treatments, 2 patients are currently alive with no evidence of disease after 48 and 20 months from the diagnosis, respectively, while the other 2 died of disease after 10 and 14 months, respectively. Of the 6 patients of group B, 5 patients died within 7 months, while another patient is currently undergoing chemotherapy. The present data seem to confirm that percutaneous nephrostomy can be of clinical benefit for patients with advanced cervical cancer, having a chance of prolonged palliation or cure. Conversely, this technique seems to be of little use for patients with recurrent disease, for whom no effective salvage therapy is generally available.

Adult↗

PubMed1994

Longitudinal evaluation of perimenopausal vertebral bone loss: effects of a low-dose oral contraceptive preparation on bone mineral density and metabolism.

OBJECTIVE: To characterize the pattern of biochemical markers of bone metabolism and vertebral bone mineral density in eumenorrheic and oligomenorrheic perimenopausal women and to assess the effects of a combined oral contraceptive (OC) preparation on bone mass and metabolism. METHODS: Bone biochemical markers and vertebral bone density were evaluated in a longitudinal 2-year follow-up study conducted in healthy, normally menstruating perimenopausal women, perimenopausal oligomenorrheic women, and age-matched oligomenorrheic OC-treated women (20 micrograms ethinyl estradiol [E2] plus 0.15 mg desogestrel) (n = 27 in each group). The results were analyzed by factorial or repeated-measures analysis of variance, as appropriate. RESULTS: During our observation period, there were no significant modifications in menstrual cycle, plasma FSH and E2 levels, biochemical markers of bone turnover, and vertebral bone density in normal women. Conversely, oligomenorrheic women showed an increase in the cycle length with a concomitant decrease of plasma E2 and a corresponding rise in circulating plasma FSH levels (P < .05). In this group, an increase in both urinary excretion of hydroxyproline and plasma osteocalcin levels paralleled a significant decrease in vertebral bone density (P < .0001). In OC-treated women, the pattern of osteocalcin showed no modification, whereas urinary excretion of hydroxyproline showed a decrease, which paralleled a significant (P < .001) increase in vertebral bone density. CONCLUSION: Perimenopausal OC administration can prevent the increase in bone turnover and the decrease in bone density that follow the perimenopausal impairment of ovarian function.

Adult↗

PubMed1994

Times and sites of relapses after negative second look in advanced epithelial ovarian cancer.

In the present work the Authors analyse the role and significance of second-look laparotomy in the management of epithelial ovarian cancer. Eighty-three patients with advanced epithelial ovarian cancer (stage III-IV) followed at the Institutes of Gynecology of Padua and Pisa Universities underwent a negative second-look at a median time of 6 months after first surgery. The incidence of relapse after the negative second-look was 45.8% and the mean time of relapse was 27.4 months. Advanced surgical-pathological stage, the presence of residual disease > 2 cm and serous histotype are risk factors for relapse after a negative second-look. These data confirm that, because of its poor prognostic value, a negative second-look laparotomy should not influence the choice of second line chemotherapy and, consequently is no longer routinely performed in our Institutes.

Adult↗

PubMed1993

Noninvasive assessment of reperfusion and reocclusion after thrombolysis in acute myocardial infarction.

The clinical significance of ST-segment changes and of the time course of appearance in serum of different cardiac proteins has been reviewed for the diagnosis of coronary reperfusion and reocclusion after thrombolysis. In particular, the value of serial 12-lead electrocardiographic (ECG) studies, of Holter monitoring, and of continuous multilead computer-assisted ECG monitoring is compared. Regarding the serum proteins, the clinical significance of reperfusion indices described so far for serum creatine kinase (CK), its isoenzyme serum creatinine kinase MB, the CK isoforms, and myoglobin is reviewed. Emphasis is placed on (1) the calculation method used for deriving the reperfusion indices; (2) the sensitivity and the specificity of the reperfusion indices; (3) the minimum turn-around time needed to produce the reperfusion indices (depending on the practicability of the analytical and calculation methods and their applicability in an emergency laboratory); (4) the ability of the indices to produce reliable estimates of reperfusion efficacy of the thrombolytic agents under study; and (5) the ability of the marker proteins to detect reinfarction as well as the suitability of the markers to detect real-time necrosis.

Coronary Circulation↗

PubMed1993

[The treatment of myocardial infarction during the hospital stage and shortly thereafter: now and 10 years ago].

OBJECTIVE: Comparison between the early and the late eighties of the application of thrombolysis and revascularisation in the acute phase of a myocardial infarction. LOCATION: University Hospital, Rotterdam. DESIGN: Prospective with historical comparison. METHODS: All patients admitted between May 1987 and May 1990 with a myocardial infarction and aged up to 71 years were included (n = 430). Numbers of procedures and survival during the following year were compared with data of patients admitted from 1981 to the end of 1983 (n = 706). RESULTS: In 1981-1983 thrombolytics were administered to 9% of the patients, in 1987-1990 to 40%. Revascularisation procedures during the next year were performed in 17% and 50% of the patients respectively. Hospital mortality decreased from 14% to 10% (p < 0.05), one-year survival increased from 75% to 83% (p < 0.05). For patients from 1987-1990 one-year survival was higher after thrombolysis treatment: 90% versus 78% without (p < 0.01), and after revascularisation: 94% versus 87% without (p < 0.01). CONCLUSION: Compared with 1981-1983 the treatment is at present more directed towards reperfusion and revascularisation of the ischaemic myocardium, resulting in invasive treatment in 50% of the patients now as opposed to 25% in the early eighties. The survival rate during the first year has improved.

Aged↗

PubMed1993

Pretreatment plasma levels of fibrinopeptide-A (FPA), D-dimer (DD), and von Willebrand factor (vWF) in patients with operable cervical cancer: influence of surgical-pathological stage, tumor size, histologic type, and lymph node status.

The preoperative plasma levels of fibrinopeptide A (FPA), D-dimer (DD), and von Willebrand Factor (vWF) were measured in 38 patients with cervical cancer undergoing radical hysterectomy with pelvic lymphadenectomy. The surgical-pathological stage of disease was Ib in 17 patients, IIa in 9 patients, and IIb in 12 patients. The tumor size was < or = 4 cm in 20 patients and > 4 cm in 18 patients. The histologic type was squamous cell carcinoma in 32 patients and adenocarcinoma in 6 patients. Positive pelvic lymph nodes were found in 10 patients. When compared to controls, FPA, DD, and vWF levels were significantly raised in patients with surgical-pathological stage IIb disease but not in patients with stage Ib or IIa disease. The values of FPA, DD, and vWF were related to surgical-pathological stage (stage IIb vs stage Ib-IIa: P < 0.005, P < 0.001, and P < 0.001, respectively) and tumor size (> 4 cm vs < or = 4 cm: P < 0.05, P < 0.005, and P < 0.02, respectively), but not to histologic type. vWF values were also related to lymph node status (positive vs negative lymph nodes: P < 0.02). FPA and DD levels were higher in patients with positive lymph nodes than in patients with negative lymph nodes, but the difference did not reach the statistical significance even due to the small number of patients involved. In conclusion, increased fibrin production and degradation seem to occur in patients with stage IIb cervical cancer. The biological meaning of this hemostasis activation deserves further investigation.

Adenocarcinoma↗

PubMed1993

Effects of ipriflavone administration on bone mass and metabolism in ovariectomized women.

The aim of the present study was to assess the effects of ipriflavone administration in the prevention of the rapid bone loss that follows ovariectomy in women. After 10-30 days from bilateral ovariectomy, patients received either the sole calcium supplementation (500 mg/day, n = 16) or ipriflavone (600 mg/day, n = 16) in addition to the same daily calcium supplement for 12 months. In calcium-treated subjects urinary hydroxyproline excretion, serum alkaline phosphatase and plasma bone Gla protein levels showed a substantial (p < 0.01) increase, while radial bone density significantly (p < 0.01) decreased 6 months after surgery. In ipriflavone treated group the patterns of biochemical markers indicated that ipriflavone can restrain the bone remodeling processes and radial bone density showed no significant modification during the 12 month study period. These results demonstrate that ipriflavone administration prevents the rapid bone loss that follows ovariectomy. Thus, ipriflavone can represent an attractive alternative for the prevention of osteoporosis in postmenopausal women who present contraindications to the estrogen replacement therapy.

Bone Density↗

PubMed1993

Clinical and endocrine effects of flutamide in hyperandrogenic women.

OBJECTIVE: To investigate the clinical and endocrine effects of the antiandrogen flutamide in hirsute women. DESIGN: Hirsutism was assessed before and after 3 months of treatment with flutamide 500 mg/d. Endocrine evaluations were performed before and during the 2nd month of treatment with flutamide 500 mg or 750 mg/d. SETTING: Department of Obstetrics and Gynecology, Pisa, Italy. PARTICIPANTS: Eighteen hirsute women were studied: nine women were hyperandrogenic, and the other 9 had an idiopathic hirsutism. INTERVENTIONS: Women were randomly treated with flutamide 500 mg/d (9 patients) or 750 mg/d (9 patients) for 3 and 2 months, respectively. Six received placebo 1 month before flutamide treatment. MAIN OUTCOME MEASURES: Hirsutism was assessed by measuring hair diameter. Follicle-stimulating hormone and LH responses to GnRH were evaluated. Basal plasma levels of T, androstenedione (A), 17-hydroxyprogesterone (17-OHP), DHEAS, cortisol (F), and sex hormone-binding globulin (SHBG) were evaluated. The same hormones were determined after a single dose of flutamide (250 or 500 mg) or placebo throughout a 12-hour period and in samples collected 60 and 120 minutes after ACTH intravenous injection. RESULTS: Hair diameter was reduced by 30%. Both dosages of flutamide did not change basal and stimulated gonadotropin, T, A, 17-OHP, F, and SHBG levels. Both dosages reduced stimulated DHEAS levels. CONCLUSIONS: Flutamide may have a beneficial effect on hirsutism. This effectiveness is mainly due to its peripheral antiandrogen action. However, an effect on the adrenal gland seems to be present.

17-alpha-Hydroxyprogesterone↗