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Biomedical subjects

P de Grandi

Publications and source records attributed to P de Grandi.

At least 19 recordsLinked to original sources
PubMed1997

Pressure transmission ratio: is it a reliable parameter in increased urethro-vesical junction mobility?

Our objective was to investigate any correlation between the degree of urethro-vesical junction (UVJ) mobility and the pressure transmission ratio (PTR) values. Five hundred and nineteen patients suffering from stress urinary incontinence were divided into four groups according to their degree of UVJ mobility assessed by the Q-tip test method: group 1 (N = 86), urethral axis at stress (UAS) < 30 degrees; group 2 (N = 191), UAS 31-60 degrees; group 3 (N = 214), UAS 61-90 degrees; and group 4 (N = 28), UAS > 90 degrees. A urethral pressure profile at stress was determined in the supine and standing positions, and PTR was calculated in the middle region of urethral functional length. PTR values for groups 2-4 were compared with those for group 1. In the supine position, the values for groups 3 and 4 were lower than for group 1, while in the standing position, only the values for group 3 were different. The incidence of normal PTR values (i.e., > 90%) was the same in all four groups. Overall correlation between PTR values and degree of UVJ mobility was weak (r = 0.14). We conclude that PTR values does not correlate with UVJ mobility in those patients with a Q-tip test of < 60 degrees. This correlation is inconstant when the Q-tip test was > 60 degrees. Also, 14-30% of patients in all four groups had normal standing PTR values. This may be explained by well-preserved innervation with severe alteration of the anchoring bladder neck structures.

Adult↗
PubMed1996

Stress urinary incontinence due to a low-pressure urethra: a socially invalidizing disease.

To compare the quality of life and clinical findings of patients with low-pressure urethra (LPU: < or = 20 cm H2O) with those of stress urinary incontinent (SUI) patients without LPU, and to compare the quality of urethral sphincter (US) muscle innervation parameters in LPU patients with those in control continent patients. Historical, clinical, urodynamic, and US muscle innervation parameters were compared in 38 LPU (group 1), 241 SUI (group 2), and 7 control patients (group 3). In comparison with group 2, the incidence of previous surgery and daily incontinence episodes, SUI severity, and pad test values were significantly higher in group 1, whereas the incidence of previous traumatic deliveries was the same in both groups. The mobility of the bladder neck assessed by the Q-Tip test was significantly reduced in group 1. In comparison with group 3, US motor unit potential (MUP) duration and pudendal motor latencies to the urethral sphincter (PMLUS) were increased in LPU group 1 patients, whereas there was no difference in these parameters between LPU patients with or without previous incontinence surgery. Fifty-three percent of our LPU patients had normal PMLUS, but showed signs of abnormal reinnervation on quantitative electromyography. Three nullipara LPU patients had normal MUP durations and PMLUS values, but a decreased area in response to pudendal nerve stimulation. Apart from a rare form of LPU in nullipara patients, probably due to a dysgenesis of their US muscle, LPU patients suffer from neuro-muscular damage responsible for a severe urinary invalidity. Previous incontinence surgery, as well as previous vaginal deliveries, may be responsible for such US damage.

Adult↗
PubMed1996

Abdominal actinomycosis associated with intrauterine device: CT features.

Abdominal actinomycosis is a severe and progressive peritoneal infection, due to an anerobic gram-positive bacterium, Actinomyces israelii. The presence of a long-standing intrauterine device (IUD) is a well-known risk factor in young women. We report two cases of pelviperitoneal actinomycosis appearing in two young women with acute low abdominal pain. Abdominal CT demonstrated multiple solid or encapsulated peritoneal masses with marked contrast enhancement and infiltration of the adjacent mesenteric fat. Laparoscopy confirmed the presence of intraperitoneal abscesses which contained Actinomyces israelii. High doses of amoxicillin and clavulanic acid (Augmentine) were given and following CT scan after 2 and 6 weeks showed a slow, but complete, resolution of the lesions. Although the radiologic presentation of actinomycosis is nonspecific, the diagnosis should be raised in the presence of pseudotumoral mesenteric infiltration, particularly in young women with an IUD. Abdominal CT is a useful method for diagnosis and for follow-up.

Actinomyces↗
PubMed1995

A recombinant Salmonella typhimurium vaccine induces local immunity by four different routes of immunization.

Immunization of mice with an attenuated Salmonella typhimurium strain (Phopc) carrying a plasmid encoding a hybrid form of the hepatitis B virus core antigen (HBc) induced specific antibody responses against the bacterial lipopolysaccharide (LPS) and HBc. Different mucosal routes of immunization, i.e., oral, nasal, rectal, and vaginal, were compared for their ability to induce a systemic as well as a mucosal response at sites proximal or distant to the site of immunization. Anti-LPS and anti-HBc immunoglobulin A (IgA) antibodies were measured in saliva, in feces, and in genital, bronchial, and intestinal secretions. Specific antibodies in serum and secretions were observed after immunization via all routes; however, the response to LPS was independent of that against HBc. In serum, saliva, and genital and bronchial secretions, high amounts of anti-HBc IgA were obtained by the nasal route of immunization. Vaginal immunization resulted in two different responses in mice: high and low. We observed a correlation between the level of specific immune response and the estrous status of these mice at the time of immunization. Rectal immunization induced high amounts of IgA against HBc and LPS in colonorectal secretions and feces but not at distant sites. These data suggest that S. typhimurium is able to invade different mucosal tissues and induce long-lasting local IgA responses against itself and a carried antigen after a single immunization.

Animals↗
PubMed1993

Birth trauma: its effect on the urine continence mechanisms.

Birth trauma is the most important etiological factor in the genesis of stress urinary incontinence in women (SUI). There is a high incidence of SUI during pregnancy, and after delivery SUI persists in a small percentage of women (2-3%). Almost all studies on perineal muscle function reveal decreasing intravaginal pressures in the days after delivery which rarely return to predelivery levels. A few urodynamics studies have demonstrated reduced urethral closure pressures and functional length after vaginal delivery, but the importance of such findings in the genesis of SUI is controversial. Better consensus has been found when pelvic floor neurophysiology was carried out: there is electromyographic evidence of a denervation-reinnervation pattern in the striated urethral sphincter muscle and occasionally prolonged pudendal conduction times when the pudendal nerves are directly stimulated. Histomorphologic studies of the pelvic floor have demonstrated that, in some women, abnormal collagen types are responsible for vaginal prolapse and accompanying SUI. Finally, the great importance of perineal reeducation by electromyostimulation and biofeedback in patients with traumatic pelvic floor pathology may be emphasized, but the importance of its role in the prevention of late SUI development remains to be established by more prospective studies.

Adult↗
PubMed1990

[Hematological parameters and prognosis in established or imminent HELLP syndrome. Apropos of 12 case reports].

We describe the clinical and biological characteristics of 12 pregnant women with the HELLP syndrome as defined by Weinstein in 1982 (H for hemolysis, EL for elevated liver enzymes and LP for low platelet count). The data demonstrate that this syndrome is an obstetric emergency threatening the lives of both mother and child. However, if delivery is prompt the prognosis is good. The suspicion of gestosis requires a hematological assessment (complete blood count and close examination of blood film, evaluation of hemostasis) as an essential component in therapeutic decisions.

Adult↗
PubMed1990

Why lose an in vitro fertilization cycle when stimulation fails?

Different protocols using agonists of GnRH-a have been proposed for the ovarian stimulation in IVF cycles. In case of stimulation failure with the flare-up protocol, we have investigated whether an immediate switch to pituitary blockade by the long-acting analog may avoid the cycle to be canceled. This procedure allows a rescue of cycles among poor responders and does not have any deleterious effect on the recruitment of follicles, oocyte quality, fertilization, and pregnancy rates.

Adult↗
PubMed1990

[Anamnestic, clinical and urodynamic comparative data from a group of patients with urinary stress incontinence].

Two hundred and seventy seven patients presenting genuine USI were divided into 3 groups based on a positive history for USI (group I), positive history and clinic for USI (group II), and positive history, clinic and urethral profile of USI (group III). When compared to a group of women without USI, the values for the FL and MUCP diminish progressively from group I to group III, giving evidence of increasingly severe impairment of the muscular-elastic environment in the urethra. Only in group III is the transmission factor (F) reduced, attesting a loosening/distension of the posterior pubo-urethral ligaments. The tonomeric values calculated for the patients with recurring USI following previous surgical correction (group IV) are comparable to values for group III. A scoring of severity of USI is proposed serving as a basis for establishing the criteria determining the indication for surgery and the post-operative prognosis before an intervention to correct USI is undertaken.

Female↗
PubMed1989

[Dosimetry comparison of pelvimetry methods using conventional radiologic technic and x-ray scanner].

The aim of this study is to compare conventional and CT-scan X-ray pelvimetry. Doses have been measured on the surface and in deep tissues as well as total doses received by the patients. With CT the fetus and the mother were exposed to 1/10th of the total dose delivered using conventional X-rays. The method is acceptable and the high quality of the films achieved make CT-scanning pelvimetry safer than X-ray pelvimetry.

Female↗
PubMed1989

[Cervical infection caused by Chlamydia trachomatis at a family planning center: prevalence, analysis of risk factors, prediction model].

Chlamydia trachomatis (CT) was detected by culture in 111/600 patients aged 15 to 55; overall prevalence 18.5%, 17% among asymptomatic (52/306) and 20% (59/294) among symptomatic patients. The difference is not significant. Contraceptive practices have no significant influence upon CT prevalence, except for the obvious protective effect of barrier methods. From the history, the clinical and paraclinical findings, four factors (history of genital infection, partner with urogenital symptoms, ectopy, inflammatory changes on a smear) can be combined to produce an index for predicting CT cervical infection. Others factors (age, no pregnancies, mucopus from the cervical os, inflammatory or dysplasic Pap smear, and signs of upper genital tract infection) are indicators of presumption and can be useful to selectively screen asymptomatic or symptomatic patients.

Adolescent↗
PubMed1986

[Early diagnosis of premalignant and malignant lesions of the endometrium. Evaluation of a device for collecting intrauterine samples (the Inocurette) compared with exploratory curettage].

Screening methods for detecting more accurately carcinoma of the endometrium is becoming increasingly important because of the rising incidence of the condition. Inocurette has recently been invented to combine a scraping action with suction. This study investigates 385 patients who were admitted for diagnostic curettage or hysterectomy to which were added a series of 120 patients who were examined as out patients. Inocurette has a sensitivity of 86% and a specificity of 99%. It therefore can be considered as a reliable method of screening for the limits within which fractional diagnostic curettage should be used. Marked pain and great difficulty in introducing the apparatus made its use limited in respectively 15% and 14.5% of cases. So, the method is acceptable and useful within these limits. The results could be improved if on the one hand a thinner apparatus could be designed and on the other hand a substance could be found to soften the cervix so that it became easier to introduce the apparatus.

Adenocarcinoma↗
PubMed1985

[Prenatal echographic diagnosis of fetoplacental anasarca].

Ultrasound is becoming more and more important in the routine care of antenatal patients. It makes it possible to diagnose a certain number of fetal abnormalities and in particular fetoplacental oedema whether it is caused by immunological or other factors. If oedema is associated with fetal cardiac arrhythmic conditions it can in certain cases be treated and cured in utero. This work analyses 11 cases of fetal oedema diagnosed by routine ultrasound in the years between 1977 and 1984.

Adult↗
PubMed1985

[Cystometry: comparative values of water manometry and the "Mikro-Tip" method in the assessment of urinary stress incontinence].

Urethro-cystometry carried out on 20 patients with urinary stress incontinence which was clinically apparent gives quite different results if it is carried out using the water manometry technique of Bech-Heidenreich or using a Mikro-Tip technique without perfusion. Comparing the two techniques shows: --little or no difference in the measurement of the functional length of the urethra and the maximum pressure of closure of the urethra. --no difference between the form of the urethral surface at rest and the bladder surface on effort. --on the other hand it shows a very definite difference in the urethral surfaces on effort which depends on the large differences occasioned by the transmission factor. The latter is weak with the Heidenreich method and corresponds to the clinical state; it is raised with the micro-tip method, which contradicts the clinical evidence.

Adolescent↗