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P La Torre

Publications and source records attributed to P La Torre.

At least 19 recordsLinked to original sources
PubMed2003

Cross-sectional and longitudinal evaluation of uterine artery Doppler velocimetry for the prediction of pre-eclampsia in normotensive women with specific risk factors.

OBJECTIVE: To evaluate the performance, in the prediction of pre-eclampsia, of (1) an abnormal mean uterine artery resistance index (RI; cross-sectional index) at 24 weeks of gestation, (2) the individual longitudinal flow pattern of results observed at 16, 20 and 24 weeks of gestation and (3) a multiple logistic regression model including the individual longitudinal flow pattern and the mean RI at 24 weeks. METHODS: A total of 144 normotensive pregnant women with risk factors for pre-eclampsia were evaluated with uterine artery color Doppler at 16, 20 and 24 weeks' gestation. The following indices were obtained: (1) cross-sectional index: the mean RI of both uterine arteries at 24 weeks' gestation was calculated for each patient and considered abnormal when >/= 0.58; (2) longitudinal indices: the individual longitudinal flow pattern of mean RI of both the main uterine arteries at 16, 20 and 24 weeks' gestation was derived for each subject and defined as (a) the typical physiological flow pattern, with a trend of decrease in values or (b) the non-physiological flow pattern. The probability of having a pregnancy complicated by pre-eclampsia was also calculated by means of a multivariate logit model. The log-odds was modeled as a function of variables related to maternal characteristics, the individual longitudinal flow pattern indicator, and of the mean RI at 24 weeks' gestation as a continuous variable. RESULTS: Pregnancies had a physiological course in 108 (75%) women, while 36 (25%) women developed pre-eclampsia during the third trimester. For the prediction of pre-eclampsia, the use of an abnormal uterine artery RI index (> or = 0.58) at 24 weeks showed a sensitivity of 77.8%, a specificity of 67.6%, a positive predictive value (PPV) of 44.4% and a negative predictive value (NPV) of 90.1%, with a likelihood ratio (LR) for an abnormal test of 2.4; with the longitudinal flow pattern indicator, sensitivity was 88.9%, specificity 82.4%, PPV 62.7% and NPV 95.7%, with a LR for an abnormal test of 4.9; the use of a logit model yielded a sensitivity of 72.2%, a specificity of 90.7%, a PPV of 72.2% and a NPV of 90.7%, with a LR for an abnormal test of 8.0. CONCLUSIONS: In this study the use of an individual longitudinal flow pattern indicator resulted in improving accuracy in the prediction of pre-eclampsia as compared with the traditional cross-sectional mean RI at 24 weeks. A further increase in specificity and PPV was obtained using a logit model that includes the longitudinal flow pattern indicator and the cross-sectional RI at 24 weeks. Since both the longitudinal flow pattern indicator and the logit model showed a high performance in predicting pre-eclampsia in women with risk factors for impaired placentation, they might be used to identify a high-risk population in which preventive measures and/or therapeutic options might be tested.

Adult↗
PubMed2001

Third-trimester maternal glucose levels from diurnal profiles in nondiabetic pregnancies: correlation with sonographic parameters of fetal growth.

OBJECTIVE: To assess the 24-h glucose levels in a group of nondiabetic, nonobese pregnant women and to verify the presence of correlations between maternal glucose levels and sonographic parameters of fetal growth. RESEARCH DESIGN AND METHODS: A total of 66 Caucasian nonobese pregnant women with normal glucose challenge tests (GCT) enrolled in the study; from this population, we selected 51 women who delivered term (from 37 to 42 weeks completed) live-born infants without evidence of congenital malformations. The women were requested to have three main meals and to perform daily glucose profiles fortnightly from 28-38 weeks without modifying their lifestyle or following any dietary restriction. All subjects were taught how to monitor their blood glucose by using a reflectance meter. Fetal biometry was evaluated by ultrasound scan according to standard methodology at 22, 28, 32, and 36 weeks of pregnancy. RESULTS: The overall daily mean glucose level during the third trimester was 74.7 +/- 5.2 mg/dl. Daily mean glucose values increased between 28 (71.9 +/- 5.7 mg/dl) and 38 (78.3 +/- 5.4 mg/dl) weeks of pregnancy. We found a significant positive correlation at 28 weeks between 1-h postprandial glucose values and fetal abdominal circumference (AC). At 32 weeks, we documented positive correlations between fetal AC and maternal blood glucose levels 1 h after breakfast, 1 and 2 h after lunch, and 1 and 2 h after dinner. At 36 weeks, there was a positive correlation between fetal AC and 1- and 2-h postprandial blood glucose levels. In addition, there was a negative correlation between head-abdominal circumference ratio and 1-h postprandial blood glucose values. CONCLUSIONS: This longitudinal study first provides a contribution toward the definition of normoglycemia in nondiabetic, nonobese pregnant women; moreover, it reveals significant correlations of postprandial blood glucose levels with the growth of insulin-sensitive fetal tissues and, in particular, between 1-h postprandial blood glucose values and fetal AC.

Adult↗
PubMed2000

Thyroid autoimmunity and its association with non-organ-specific antibodies and subclinical alterations of thyroid function in women with a history of pregnancy loss or preeclampsia.

Following the observation that non-organ-specific antibodies are related with pregnancy loss and preeclampsia, the role of organ-specific antibodies is currently being extensively investigated. The aim of this study was on the one hand to evaluate the incidence of antithyroid antibodies in a study group of 69 women with a history of early pregnancy loss (subgroup 1), foetal death (subgroup 2) or preeclampsia (subgroup 3) and in a control group, on the other hand to assess the possible association of these autoantibodies with non-organ-specific antibodies and subclinical alterations of thyroid function in the study group. Antithyroid antibodies were present in 26/69 (37.7%) women of the study group (37.9% in subgroup 1; 40.9% in subgroup 2; 33.3% in subgroup 3) and in 10/69 (14.5%) of controls, the difference being statistically significant. A significant difference in the distribution of antibodies to thyroglobulin and thyroid peroxidase was found in subgroup 2. In the study group, the incidence of antiphospholipid antibodies was not significantly different in women positive (26.9%) and negative (34.9%) for antithyroid antibodies. Also, the overall incidence of subclinical alterations of thyroid function in the study group was significantly different in women positive (53.8%) and negative (16.2%) for thyroid autoimmunity (P<0.02). The results of this study seem to confirm the association between thyroid autoimmunity and obstetric complications and suggest the usefulness of undertaking prospective studies in order to evaluate the reproductive outcome of women with a history of recurrent abortion, foetal death or preeclampsia and positivity for antithyroid antibodies.

Abortion, Habitual↗
PubMed2000

What degree of maternal metabolic control in women with type 1 diabetes is associated with normal body size and proportions in full-term infants?

OBJECTIVE: To assess what degree of maternal metabolic control in women with type 1 diabetes is associated with normal fetal growth and results in normal neonatal body proportions in a group of full-term infants. RESEARCH DESIGN AND METHODS: We investigated the anthropometric characteristics of 98 full-term singleton infants born to 98 Caucasian women with type 1 diabetes enrolled within 12 weeks of gestation. The type 1 diabetic mother-infant pairs were divided into three groups on the basis of the daily glucose levels reached during the second and third trimesters of pregnancy (group 1: 37 mother-infant pairs with an average daily glucose level during the second and third trimesters of < or =95 mg/dl; group 2: 37 mother-infant pairs with an average daily glucose level during the second trimester of >95 mg/dl and during the third trimester of < or =95 mg/dl; group 3: 24 mother-infant pairs with an average daily glucose level during the second and third trimesters of >95 mg/dl; control group: 1,415 Caucasian mother-infant pairs with full-term singleton pregnancies and normal glucose challenge test screened for gestational diabetes. RESULTS: Infants of diabetic mothers in group 1 were similar to those of the control group in birth weight and in other anthropometric parameters. In contrast, offspring of diabetic mothers of groups 2 and 3 showed an increased incidence of large-for-gestational-age infants, significantly greater means of ponderal index and thoracic circumferences, and significantly smaller cranial/thoracic circumference ratios with respect to the control group. CONCLUSIONS: The results of our study suggest that, in diabetic pregnancies, only overall daily glucose values < or =95 mg/dl throughout the second and third trimesters can avoid alterations in fetal growth.

Adolescent↗
PubMed2000

[Acute pericarditis in pregnancy. Report of a case].

In this study the authors describe a case of acute pericarditis occurring at 26 weeks' gestation in a woman affected by Wolff-Parkinson-White Syndrome and with a history of Hodgkin's Lymphoma and autoimmune hypothyroidism. The patient was first admitted to the 4th Medical Pathology Unit of the University of Florence, where moderate pericardic effusion with no evidence of heart tamponade was documented by ultrasound scan. Subsequently the patient was cared for on outpatient basis at the Centre of Perinatal Medicine of the Department of Obstetrics and Gynaecology of the University of Florence. Since all examinations and tests aimed at defining the etiology of pericardial effusion were negative, an idiopathic acute pericarditis was diagnosed. The patient was given prednisone at a dose of 75 mg per day; owing to episodes of paroxystic atrial fibrillation, propaphenon was also administered intravenously to treat acute episodes and orally as prophylaxis. The patient underwent close control of both heart function (by means of ultrasound scans of the heart and dynamic EKG) and pregnancy (blood tests, ultrasound scans and Doppler velocimetry). At 36.5 weeks' gestation a healthy fetus was spontaneously delivered. Three months after delivery, the patient underwent an ultrasound scan that demonstrated the complete reabsorption of the effusion.

Acute Disease↗
PubMed1999

Usefulness of screening for congenital or acquired hemostatic abnormalities in women with previous complicated pregnancies.

Activated protein C resistance (APCR) is a common cause of familial thrombophilia and venous thrombosis. The aim of the study was to investigate the prevalence of APCR associated with factor V Leiden mutation and its relevance in comparison to other risk factors for thromboembolic disorders in women with a history of previous complicated pregnancies (history of fetal loss in the second and third trimester n = 34, preeclampsia n = 46). The frequency of APCR was significantly higher in women with a history of fetal loss and preeclampsia (23.5 and 26.1%, respectively) compared with a control group (3.8%). The prevalence of antithrombin, protein C and protein S deficiencies and the presence of antiphospholipid antibodies were also investigated: the prevalence of at least one disorder was 41.2% in the group with previous fetal loss, 37.0% in the group with previous preeclampsia and 7.5% in the control group.

Activated Protein C Resistance↗
PubMed1998

[Kidney transplantation and pregnancy. Report of a case].

The aim of this study was to evaluate the extent to which the presence of a transplanted kidney conditions the physiological renal and maternal cardiocirculatory adaptation to pregnancy. For this purpose, we compared the trend of cardiocirculatory and renal hematochemical parameters in a kidney-transplant patient to a group of 100 physiological pregnant women followed longitudinally. M. G., aged 36, primigravida, who underwent renal transplantation ten years before, was carefully monitored throughout gestation. Pregnancy was free of complications and ended at 38 weeks with an elective caesarian section. The trend of the parameters mirrored the physiological pattern, even if the values for some renal parameters were completely different. This type of comparison enabled us to evaluate the adaptation of the transplanted organ and the body to pregnancy and to formulate a prognostic judgement halfway through pregnancy regarding the outcome.

Adult↗
PubMed1997

[Glycemic thresholds in spontaneous abortion during the first trimester in pregnant women with insulin dependent diabetes].

BACKGROUND AND AIM: To evaluate the hypothesis that insulin-dependent diabetic (IDDM) pregnant women have a threshold of glycemic control during the first trimester of pregnancy for an increased risk of spontaneous abortion. MATERIALS AND METHODS: Seventy IDDM pregnant women were enrolled before the 9th week of gestation and monitored throughout pregnancy. Fifteen pregnancies (21.4%) led to spontaneous abortion within the first trimester (study group) and 55 (76%) continued until term (control group). In order to evaluate the differences between the study group and the control group variance analysis and Student's t-test were used for constant variables and chi 2 and Fisher's exact test for discrete variables; p < 0.05 was considered statistically significance. RESULTS: Mean levels of glycosylated hemoglobin (HbA1c) and fructosamine at the initial prenatal visit were significantly higher in the study group (p < 0.03) compared to the control group. The threshold for an increased risk of spontaneous abortion in the first trimester was found to be initial concentrations > 8% for HbA1c and > 300 mmol/l for fructosamine. CONCLUSIONS: Pregnant women suffering from IDDM with initial HbA1c levels higher than 8% and fructosamine > 3 mmol/l have an increased risk of spontaneous abortion in the first trimester of pregnancy. Below this threshold the risk of spontaneous abortion during the first trimester of pregnancy is similar to that for non-diabetic pregnant women.

Abortion, Spontaneous↗
PubMed1997

[Zinc blood levels in 73 puerperal women. Correlation with obstetric and neonatal complications].

BACKGROUND: Low plasma zinc concentrations in pregnant women have been associated with certain obstetric and foetal complications. However, there is no agreement in previous studies and mediterranean populations have not been extensively studied. METHODS: The plasmatic zinc was tested in 73 mothers, within 24 hours post-partum, in order to evaluate an association between plasmatic zinc and various obstetric and fetal complications. The women were all from the Florence province and were admitted for delivery at the II Maternity Ward of the University of Florence (Third level Center); mothers of twins and foreign mothers were excluded. Subjects were consecutively included in the study. The values pointed out in a control group (n = 28) were compared with the hematic zinc of a) women who delivered by cesarean section (CS) for acute fetal distress or by operative delivery with vacuum extractor (n = 9), b,c) mothers whose children weighted over the 90th (LGA: n = 11) or under the 10th percentile (SGA: n = 13), and d) mothers who delivered prematurely (n = 12). The subjects included in two or more groups, were not considered. RESULTS: The plasmatic zinc of the control group has been significantly higher than that of mothers who delivered by vacuum extractor or by urgent CS (p < 0.0001) and than that of mothers whose newborns were LGA (p < 0.0024). The hematic zinc of the control group is not higher than that of mothers with SGA or premature children. CONCLUSIONS: The conclusions is drawn that even a relative zinc deficiency may negatively potentiate certain obstetric abnormalities in fetal development or in delivering.

Adult↗
PubMed1997

[Intensive care of insulin dependent diabetic pregnant women. Perinatal outcome in relation to gestational age at the initial visit].

BACKGROUND AND AIM: To correlate the perinatal outcome of insulin-dependent diabetic (IDDM) pregnant women with the quality of metabolic control defined as gestational age at initial visit, extent and duration. MATERIALS AND METHODS: A total of 64 pregnant women classified from White's class B to class R were included in the study: 55 pregnant women joined the study before the 9th week (early control group), 9 after the 26th week (late control group). On the basis of perinatal outcome, the 55 pregnant women in the early control group were then subdivided into a further two groups: 34 patients with optimal outcome and 21 with non-optimal outcome. RESULTS: In the early control group of pregnant women, overall mean daily glycemia was significantly lower in the group with optimal outcome compared to that with non-optimal outcome during the 1st and 2nd trimester, but not in the 3rd. Compared to the early control group, during the 3rd trimester patients in the late control group showed significantly higher levels of: overall mean daily glycemia, glycosylated hemoglobin and fructosamine. In the early control group maternal morbidity (p < 0.05), neonatal morbidity (p < 0.03) and perinatal mortality (p < 0.05) were significantly lower than in the late control group. CONCLUSIONS: The achievement of optimal glycometabolic control in the 2nd trimester appears to be a prerequisite for improving maternal-fetal outcome in the early control group compared to that in the late control group in which the attainment of good glycemic control during the 3rd trimester does not seem to be efficacious in reducing overall morbidity and mortality.

Diabetes Mellitus, Type 1↗
PubMed1996

[Acute abdomen in the third trimester].

The authors report a case of acute abdomen in the third trimester of pregnancy as observed at the II Obstetrics and Gynecologic Department of Florence University. Emphasis is laid on the frequent abnormality of the symptomatology and therefore the difficult of early diagnosis. The conclusion is reached that a greater semeiologic accuracy on behalf of the specialist as well as memorization of the several clinical charts responsible for such pathology, allow an earlier diagnosis with consequent improvement of maternal and fetal prognosis.

Abdomen, Acute↗
PubMed1989

[Adenocarcinoma of the duodenum associated with skin neurofibromatosis and Caroli's disease].

A case of primary adenocarcinoma of the duodenum associated with Recklinghausen's disease and Caroli's disease provides the opportunity to review the literature. Malignant tumours of the duodenum are extremely rare and even rarer is their association with R's and Caroli's diseases. It should not be forgotten that in Recklinghausen's disease gastro-intestinal involvement is possible. Caroli's disease is diagnosed anatomopathologically. Surgical resection remains the sole satisfactory treatment when the tumour has not spread locally or at a distance. If it has, treatment must be palliative.

Adenocarcinoma↗
PubMed1982

Examination of the cervix with the naked eye using acetic acid test.

Examination of the cervix was carried out on 2,400 patients, by use of acetic acid test with the naked eye and the colposcope. The physiologic transformation zone was clearly identified both with the naked eye and the colposcope in 1,568 of 1,594 (99%) cases. Colposcopic examination was unsatisfactory in 108 of the 264 (41%) patients in whom the cervix was completely covered by normal squamous epithelium. An atypical transformation zone (ATZ) was identified with the naked eye as white epithelium in 98.4% and as "suspicious" in 1.6% of 312 colposcopically controlled cases. An unsatisfactory colposcopic examination occurred in 39 of the 312 (12.5%) patients with an ATZ. Final histologic diagnosis for 312 ATZs was benign lesion in 169 of 312 (54.2%), cervical intraepithelial neoplasia (CIN) grades 1 and 2 in 81 of 312 (26%), grade 3 CIN in 56 of 312 (17.9%), and preclinical invasive carcinoma in 6 of 312 (1.9%). The detection of intraepithelial or preclinical invasive cervical neoplasias should not depend on the possession of a colposcope. On the other hand, the use of a colposcope is essential for the selection of CIN that can be treated with ultraconservative therapy or with colposcopically directed conization.

Acetates↗
PubMed1982

A case of Charcot-Marie-Tooth disease mimicking Friedreich's ataxia: is there any association between friedreich's ataxia and Charcot-Marie-Tooth disease?

The authors report a case of Charcot-Marie-Tooth disease that mimicked Friedreich's ataxia and featured impaired tendon reflexes in the limbs, incoordination mimicking cerebellar disease in the extremities, extensor plantar responses on both sides, bilateral foot deformity, imparied position sense in the toes, absent vibratory sense in the distal parts of the legs and minimal distal weakness with wasting. Motor conduction velocity in the upper limbs was substantially reduced. Other cases similar in nature reported in the literature resemble spino-cerebellar degeneration in general, and Friedreich's ataxia, in particular. It is emphasized that the natural history, EMG, motor conduction velocity studies and examination of other affected members of the family permit the correct diagnosis to be made in such cases. It is also emphasized that patients similar to the one reported here may also resemble, and should be differentiated from, cases of familial dorsal column ataxia (Biemond type). Stress is put upon the fact that when Charcot-Marie-Tooth disease mimicks spino-cerebellar degeneration, substantial slowing of motor conduction in the upper limbs is generally sufficient to establish the diagnosis. The relation between Friedreich's ataxia an Charcot-Marie-Tooth disease is reviewed and it is concluded that these two disorders are distinct clinical and pathological entities.

Adolescent↗
PubMed1980

[Splenic artery aneurysm. Considerations on 2 cases].

Two cases of splenic artery aneurysm, their etiopathogenesis, complications and surgical treatment are presented. When serious technical problems are present the necessity of distal pancreatectomy, is underlined. Postoperative course is normally satisfactory.

Aged↗
PubMed1977

[Clinical and therapeutic aspects of duodenal diverticula].

The Authors present 33 cases of duodenal diverticula, 12 of which underwent surgical therapy. They analyse the clinical and therapeutic problems entailed in this surgica entity with particular reference to the frequency and gravity of emorrhagis complication. Concerning the surgical approach of ampullar and iuxta ampullar diverticula, Authors experience seems to advise indirect operations.

Adult↗