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P Paparella

Publications and source records attributed to P Paparella.

At least 19 recordsLinked to original sources
PubMed2003

Classical and nerve-sparing radical hysterectomy: an evaluation of the risk of injury to the autonomous pelvic nerves.

Radical hysterectomy represents the treatment of choice for FIGO stage IA2-IIA cervical cancer. It is associated with several serious complications such as urinary and anorectal dysfunction due to surgical trauma to the autonomous nervous system. In order to determine those surgical steps involving the risk of nerve injury during both classical and nerve-sparing radical hysterectomy, we investigated the relationships between pelvic fascial, vascular and nervous structures in a large series of embalmed and fresh female cadavers. We showed that the extent of potential denervation after classical radical hysterectomy is directly correlated with the radicality of the operation. The surgical steps that carry a high risk of nerve injury are the resection of the uterosacral and vesicouterine ligaments and of the paracervix. A nerve-sparing approach to radical hysterectomy for cervical cancer is feasible if specific resection limits, such as the deep uterine vein, are carefully identified and respected. However, a nerve-sparing surgical effort should be balanced with the oncological priorities of removal of disease and all its potential routes of local spread.

Aged↗
PubMed1999

Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: a prospective, randomized, multicenter study.

OBJECTIVE: The objective of this study was to evaluate short-term results of laparoscopically assisted vaginal hysterectomy with those of total abdominal hysterectomy in a prospective, randomized, multicenter study. STUDY DESIGN: One hundred sixteen patients referred for abdominal hysterectomy were randomized to either laparoscopically assisted vaginal hysterectomy (58 patients) or abdominal hysterectomy (58 patients). Inclusion criteria were one or more of the following, where a vaginal hysterectomy would be traditionally contraindicated: uterine size larger than 280 g, previous pelvic surgery, history of pelvic inflammatory disease, moderate or severe endometriosis, concomitant adnexal masses or indication for adnexectomy, and nulliparity with lack of uterine descent and limited vaginal access. An upper limit of uterine size was set at 16 weeks' gestation (ie, 700 g). RESULTS: There were no differences in terms of patient's age, parity, preoperative hemoglobin levels, mean uterine weight, and total operating time between the 2 groups. Estimated blood losses and postoperative day 1 hemoglobin drop were significantly lower for laparoscopically assisted vaginal hysterectomy than for abdominal hysterectomy (P<.05). There were 1 major and 2 minor complications in the laparoscopically assisted vaginal hysterectomy group compared with 2 major and 5 minor complications in the abdominal hysterectomy group (P not significant). Postoperative pain was lower for laparoscopically assisted vaginal hysterectomy than for abdominal hysterectomy on postoperative days 1, 2, and 3 (P<.05). Postoperative hospital stay was significantly shorter for laparoscopically assisted vaginal hysterectomy than for abdominal hysterectomy (P<.001). CONCLUSIONS: The present study demonstrates that, given adequate training in laparoscopic surgery, laparoscopically assisted vaginal hysterectomy may replace abdominal hysterectomy in most patients who require a hysterectomy and have contraindications to vaginal hysterectomy, with all the benefits associated with the vaginal route.

Adult↗
PubMed1999

Differential effect of transdermal estrogen plus progestagen replacement therapy on insulin metabolism in postmenopausal women: relation to their insulinemic secretion.

OBJECTIVE: To evaluate the impact on glucose and insulin metabolism of transdermal estrogen patches before and after the addition of cyclic dydrogesterone in postmenopausal women. DESIGN: We studied 21 postmenopausal women seeking treatment for symptomatic menopause. All patients received transdermal 50 micrograms/day estradiol for 24 weeks. After 12 weeks of treatment, 10 mg/day dydrogesterone were added. METHODS: During both regimens, insulin and C-peptide plasma concentrations were evaluated after an oral glucose tolerance test (OGTT); insulin sensitivity was evaluated by a hyperinsulinemic euglycemic clamp technique. Insulin and C-peptide response to OGTT were expressed as area under the curve (AUC) and as incremental AUC; insulin sensitivity was expressed as mg/kg body weight. Fractional hepatic insulin extraction (FHIE) was estimated by the difference between the incremental AUC of the C-peptide and insulin divided by the incremental AUC of the C-peptide. Plasma hormone and lipid concentrations were assessed at baseline and at 12 and 24 weeks of treatment. RESULTS: Nine patients proved to be hyperinsulinemic and 12 were normoinsulinemic. Transdermal estrogen treatment significantly decreased the insulin AUC (P < 0.05) and the insulin incremental AUC in hyperinsulinemic patients; addition of dydrogesterone further decreased both the AUC and incremental AUC of insulin. Estrogen alone and combined with dydrogesterone evoked a significant increase in C-peptide AUC in hyperinsulinemic (79.2%) and normoinsulinemic (113%) patients. The treatment increased the values for FHIE and insulin sensitivity in all patients (P < 0.04) and in the hyperinsulinemic group (P < 0.01), whereas it did not affect such parameters in normoinsulinemic patients. CONCLUSIONS: Transdermal estrogen substitution alone and combined with cyclical dydrogesterone may ameliorate hyperinsulinemia in a selected population of postmenopausal women.

Administration, Cutaneous↗
PubMed1998

[Efficacy of estrogen therapy in urinary incontinence. A meta-analytic study].

OBJECTIVE: To analyze by meta-analysis the results of randomized controlled clinical trials on the efficacy of estrogen treatment in menopausal patients with urinary incontinence. STUDY DESIGN: Meta-analysis. MATERIALS AND METHODS: Randomized controlled clinical trials, published from January 1965 to December 1996, on estrogen therapy in patients with urinary incontinence, were selected. They included: trials with placebo vs estrogen therapy, studies on menopausal patients with confirmed diagnosis of urinary incontinence based on clinical and/or urodynamic tests, studies with sufficient statistical informations on the results obtained and with information about subjective and objective outcome. RESULTS: Out of 72 articles reviewed, 7 were selected and only 4 were considered on the basis of the requested criteria. Subjective outcome was statistically different in patients treated with estrogen therapy compared with patients treated with placebo. Objective clinical and urodynamic outcome was not statistically different in the two types of treatment (estrogen vs placebo treatment). CONCLUSIONS: There were few published randomized controlled studies on estrogen therapy in patients with urinary incontinence in medical literature. Different results between subjective and objective outcome showed by meta-analysis, could be explained either by an estrogen induced unperceivable improvement not registered by clinical and instrumental parameters or by insufficient systems used to collect subjective data. Therefore, it is suggested that, for future research, randomized controlled clinical trials on topical or transcutaneous systemic estrogen treatment with a more than 6 months follow-up will be carry out.

Estrogens↗
PubMed1995

Maternal ultrasound bone density in normal pregnancy.

OBJECTIVES: The aim of the study was to investigate the effect of pregnancy on maternal bone mineral density by an ultrasound device. STUDY METHODS: Two hundred and thirty consecutive healthy pregnant women were evaluated by ultrasound densitometry during the 1st (n=45), the 2nd (n=56) and the 3rd (n=129) trimester of pregnancy, measuring the velocity (SoS) and frequency attenuation (BUA) of an ultrasound wave as it passes through the os calcis. Speed of sound (SoS) and Broadband Ultrasound Attenuation (BUA) values are combined in order to express a relational variable (Stiffness), indicator of bone quality. RESULTS: Statistically significant reductions in SoS, BUD and Stiffness values were observed during the 3rd trimester vs the 1st and the 2nd trimesters. Negative statistically significant relations were found between the gestational age and ultrasound densitometry parameters. CONCLUSION: A linear reduction of ultrasound bone density was observed throughout pregnancy, reaching a statistical significance in the 3rd trimester, when the greatest calcium transfer from the mother to the fetus occurs.

Bone Density↗
PubMed1994

Effect of ketorolac, ketoprofen and nefopam on platelet function.

Ketorolac, ketoprofen and nefopam are often used in the treatment of postoperative pain. While nefopam is a non-narcotic, non-opioid central analgesic agent, ketorolac and ketoprofen are non-steroidal anti-inflammatory drugs, which, due to their prostaglandin-synthetase inhibiting activity, have antiplatelet effects. In this study we investigated the effect of ketorolac, ketoprofen and nefopam on platelet function by performing bleeding time and in vitro platelet aggregation in 30 healthy volunteers (10 for each treatment) before and 3 h after drug administration. Nefopam did not affect bleeding time and platelet aggregation, while ketorolac and ketoprofen significantly prolonged bleeding time without significantly inhibiting platelet aggregation in response to adenosine diphosphate. The prolongation of bleeding time observed after ketorolac and ketoprofen may have clinical relevance and suggests that nefopam could be more safely administered for the treatment of postoperative pain, especially in patients with haemostatic defects or after high bleeding risk surgery.

Bleeding Time↗
PubMed1994

[Treatment in the event of antibiotic prophylaxis failure in gynecologic surgery. A retrospective study of 20 cases].

A retrospective study was performed of the type of treatment used in 20 patients undergoing gynecological surgery in whom antibiotic prophylaxis with Mezlocillin (2 g i.v.) had failed. Patients were subdivided into three groups: A) Initial therapy with Mezlocillin (8 patients, 2 g/die i.m.) or Cefotetan (2 patients, 2 g/die i.m.) and subsequent addition of Gentamicin (8 patients, 240 mg/die i.m.) or Tobramycin (2 patients, 200 mg/die i.m.) and subsequently Metronidazole (7 patients, 1.5 g/die per os). B) Therapy with Imipenem/Cilastatin (6 patients, 1.5 g/die i.m.). C) Therapy with Imipenem/Cilastatin (4 patients, 1.5 g/die i.m.) after a variety of antibiotics: Cotrimoxazole (Trimethoprim 160 mg/die and sulphamethoxazole 800 mg/die per os), Pefloxacin (800 mg/die per os), Cefotetan (2 g/die i.m.) and Mezlocillin (2 g/die i.m.). Time taken to lower temperature was shorter in Group B (3.5 days) compared to Group A (6.8 days) and Group C (10 days). Postoperative hospital stay was also shorter in Group B (9 days) compared to Group C (16.5 days) and Group A (11.1 days). The immediate administration of an antibiotic active against Gram+ and Gram- germs, aerobes and anaerobes is therefore useful in the event of failure of antibiotic prophylaxis, rather than the use in succession of associations of antibiotics with a limited spectrum.

Adult↗
PubMed1989

2,3-diphosphoglycerate in normal and pathologic pregnancy: relationship to neonatal weight.

2,3-Diphosphoglycerate levels were assayed in 154 pregnant women in third trimester (61 normal, 52 diabetic, 19 with gestational hypertension, 7 with fetal macrosomia, and 15 with idiopathic fetal underdevelopment). A correlation was found between 2,3-diphosphoglycerate levels and birth weight (absolute and relative birth weight or birth weight expressed as percentile), which was negative in normal patients evaluated in the last 7 days before delivery (r = 0.38; p = 0.04) and positive in diabetic patients (evaluated in the third trimester and in the last 7 days before delivery) and in patients with gestational hypertension (evaluated in the third trimester) (r and p values differ according to whether birth weight is expressed as absolute, relative, or a percentile). No correlation was found between 2,3-diphosphoglycerate levels and birth weight in patients with neonatal underdevelopment or macrosomia of unknown origin. On the basis of these results we hypothesize that in some conditions the fetus can influence maternal 2,3-diphosphoglycerate levels and hence its own oxygen supply and growth in utero.

2,3-Diphosphoglycerate↗
PubMed1980

Water and ion metabolism in placenta (III). Net movement of water, monovalent and divalent cations in slices from rabbit placenta, at different periods of gestation, incubated under metabolically favorable conditions.

Rabbit placenta slices incubated at 38 degrees C in oxygenated medium, in the presence of endogenous substrates +5 mM glucose, after a period of preincubation of 120 min at 0--1 degrees C, show a net accumulation of potassium and extrusion of water, sodium and calcium. The movement of potassium, sodium and calcium appears to be related to the rate of oxygen consumption of the slices and to be inversely proportional to the age of the tissue. The efficiency of cations movement is also dependent on the nature and composition of the incubation medium. In this respect the potassium concentration of the medium plays a major role. The movement of water, on the other hand, seems to be completely independent from both the rate of respiration and the age of the tissue. The results are discussed in terms of relation between placenta age and senescence, and efficiency of the mechanisms devoted to the cell regulation of water and ions content.

Animals↗
PubMed1979

Water and ion metabolism in placenta. II. Water compartments and electrolytes in slices of rabbit placenta, at different periods of gestation, incubated at 0-1 degree C.

The movement and the distribution of water, sodium, potassium, chloride, magnesium and calcium have been studied in slices prepared from rabbit placentae at different periods of gestation, incubated in condition of depressed metabolism (0-1 degree C). In these conditions the tissue takes up water from the external medium up to a maximum of about 2.0 kg/kg d. wt., which represents 30 per cent of the initial H2O content of the fresh tissue. The extracellular compartment swells progressively and proportionally to the age of the placenta. The sodium and chloride content of the tissue increases while that of potassium decreases and their intracellular concentration reaches, after 120 min, that of the external medium. Magnesium does not show appreciable changes and calcium, too, despite its extreme variability, does not seem to undergo significant variations during the cold incubation. The results obtained show that placenta, like most of other mammalian cell systems, possesses specific metabolism-dependent mechanisms responsible for the maintenance of water distribution and ion gradients among the different tissue compartments. The characteristics and the regulation of these mechanisms are discussed in detail.

Animals↗
PubMed1977

The behaviour of microsomal mono-electron carriers in adult and fetal liver and in placenta throughout pregnancy.

The activities and contents of microsomal mono-electron carriers (NADPH-cytochrome c reductase, NADH-cytochrome b5 reductase, cytochrome P-450 and cytochrome b5) in the liver of 160 pregnant rabbits and their response to phenobarbital (PB) administration were found to be different to that of non pregnant animals and to vary depending on the period of gestation. In fetal liver and in placenta the activities and contents of mixed function oxidase system enzymes are very low and increase from the mid-gestation up to the term of pregnancy. PB has either effect or decreases the enzyme levels. The variations of enzyme content and activity in maternal liver and the different response to PB are related to the hormonal modifications of pregnancy. The behaviour of mono-electron carriers in fetal liver can be related to the process of maturation of this organ. The effect of PB can be due to the interference of the drug with steroid metabolism. The behaviour of mixed function oxidase system enzymes in placenta can be related to the processes of maturation and ageing of organ.

Animals↗
PubMed1977

Water and ion metabolism in placenta. I. water and ion content of rabbit placenta in different periods of gestation.

Total tissue water of rabbit plancenta decreases by 18% between the 9th day and the end of gestation. In the same period intracellular water decreases by 40% and the extracellular compartment swells. Total tissue sodium and chloride content increase by 34% and 27% respectively from the 16th to the 33rd day while potassium decreases by 30%. The intracellular concentration of these ions does not vary greatly during gestation. Moreover the total tissue magnesium content decreases by about 23% at the end of gestation while its intracellular concentration does not show marked changes. Calcium content of rabbit placenta substantially increases during gestation and intracellular calcium shows a fivefold increase from the 16th to the 33rd day of gestation. The results are discussed in terms of relation between water and ion content and placental tissue growth and aging.

Animals↗
PubMed1976

The behaviour of microsomal mono-electron carriers in human placenta during late pregnancy.

The activities and the content of enzymes involved in mixed function oxidase systems (cytochromes P-450 and b5, NADPH-cytochrome c reductase and NADH cytochrome b5 reductase) in microsomes from 114 human placentae were found to increase from the 34th up to the 38th-39th week of gestation and later to decrease until the 43rd week. Such a process can be related to the following: (i) the phospholipid content of microsomal membranes; (ii) the protein synthesis possibly induced by steroids such as androstenedione and testosterone.

Biological Transport↗