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Biomedical subjects

R Milani

Publications and source records attributed to R Milani.

At least 19 recordsLinked to original sources
PubMed1996

Prevention of postoperative urinary stress incontinence after surgery for genitourinary prolapse.

OBJECTIVE: To compare cystopexy alone versus cystopexy with posterior pubourethral ligaments plication for the occurrence of postoperative stress incontinence after prolapse surgery, and to compare the two surgical series in terms of complications and urodynamic effects. METHODS: One hundred two continent patients randomly underwent cystopexy alone (N = 52) or cystopexy with posterior pubourethral ligaments plication (N = 50). All had a urethrocystocele grade 2 or greater and a negative stress test with the prolapse repositioned. A full urodynamic investigation was repeated 6 months after surgery. RESULTS: Twelve (23%) and 14 (28%) patients (P = .73) required intermittent self-catheterization for 11.1 +/- 5.1 and 16.5 +/- 11.1 days, respectively (cystopexy alone versus cystopexy with posterior pubourethral ligaments plication, P = .002). Long-lasting difficulties in voiding were present in zero and five (10%) patients (P = .02). One subject receiving posterior pubourethral ligaments plication underwent urethral dilation for complete urinary retention. At 1 year follow-up, four patients (8%) in each series developed postoperative stress incontinence (P = .62). Symptomatic detrusor instability complicated the postoperative course in one patient (2%) of each group. CONCLUSION: Cystopexy alone implied lower morbidity in terms of resumption of spontaneous voiding and long-lasting difficulties in voiding. The procedure could be recommended as an effective and safe treatment for continent patients with severe urethrocystocele. Additional plication of the posterior pubourethral ligaments did not seem superior to cystopexy alone in preventing the postoperative occurrence of stress incontinence.

Aged↗
PubMed1996

Functional activation of somatostatin- and neuropeptide Y-containing neurons in the entorhinal cortex of chronically epileptic rats.

The in vitro release of somatostatin and neuropeptide Y, their tissue concentration and immunocytochemical pattern were examined in the entorhinal cortex of chronically epileptic rats. A systemic administration of 12 mg/kg kainic acid causing generalized tonic-clonic seizures for at least 3 h after injection was used to induce, 60 days later, a chronically enhanced susceptibility to seizures in the rats. The release of both peptides under depolarizing conditions was significantly reduced by 15% on average from slices of the entorhinal cortex two days after kainic acid-induced status epilepticus. At 60 days, the spontaneous and 30 mM KCl-induced release of somatostatin was significantly enhanced by 30% on average. The release induced by 100 mM KCl was raised by 70%. The spontaneous, 30 mM and 100 mM KCl-induced release of neuropeptide Y from the same slices was increased, respectively, by 120%, 76% and 36%. The late changes were associated with an increased tissue concentration of neuropeptide Y but not of somatostatin. This was confirmed by immunocytochemical evidence showing that neuropeptide Y-, but not somatostatin-immunoreactive neurons were increased in the entorhinal cortex of kainic acid-treated rats. These results indicate that neurotransmission mediated by somatostatin and neuropeptide Y, two peptides previously shown to play a role in limbic epileptogenesis, is enhanced in the entorhinal cortex of chronically epileptic rats.

Animals↗
PubMed1996

A randomized comparison of Burch colposuspension and abdominal paravaginal defect repair for female stress urinary incontinence.

OBJECTIVE: Our aim was to compare Burch colposuspension and paravaginal repair for success rates, complications, and urodynamic effects when the procedures are used in the treatment of stress urinary incontinence. STUDY DESIGN: Thirty-six patients were enrolled. A full urodynamic evaluation was repeated 6 months postoperatively. RESULTS: Twelve (67%) and 17 (94%) subjects (Burch colposuspension vs paravaginal repair) voided spontaneously before discharge (p = 0.04). One patient receiving the Burch procedure underwent urethral dilation for urinary retention. Follow-up was for 1 to 3 years. Differences in subjective and objective cure rates favored the Burch colposuspension over the paravaginal repair: 100% versus 72% (p = 0.02) and 100% versus 61% (p = 0.004), respectively. The paravaginal repair did not produce significant modifications in profilometry. Postoperatively, cotton swab tests had negative results in all patients with the Burch operation and in 33% of those with the paravaginal repair (p = 0.01). CONCLUSION: Paravaginal repair is not recommended for the treatment of stress incontinence, although it was accompanied by a more immediate resumption of voiding.

Adult↗
PubMed1996

The Burch colposuspension for women with and without detrusor overactivity.

OBJECTIVE: To compare the results of the Burch colposuspension in women with stress urinary incontinence and detrusor overactivity with those obtained in women with stress incontinence and stable bladders. Additionally, to analyse the value of two detrusor instability indexes and of standard cystometric parameters in predicting the surgical outcome. DESIGN: Retrospective cohort study. SETTING: Secondary referral centre Urodynamics Unit, San Gerardo Hospital, Monza. SAMPLE: Forty-four women with detrusor overactivity (21 with low compliance bladder and 23 with detrusor instability) and 44 with stable bladders. They were matched for age, parity, dystocia, menopause, body mass index, previous vaginal surgery, heavy work, urethral functional length and maximum urethral closure pressure. RESULTS: At two years follow up, the cure rate of stress incontinence was 95% in the control group (patients with stable bladders) and 75% in detrusor overactivity group (odds ratio 0.1, 95% confidence interval 0.01-0.9, P = 0.02). No significant differences were observed between cured and failed patients according to both detrusor instability indexes. Likewise, mean pre-operative standard cystometric values of cured and failed patients showed no differences. CONCLUSIONS: Although results were better in women with stable bladders, we believe that the success of the Burch colposuspension in cases with mixed incontinence should be considered satisfactory. No pre-operative cystometric parameter consistently predicting the surgical outcome on stress incontinence was identified.

Cohort Studies↗
PubMed1995

Chromocystoscopy in the urological monitoring of patients with cancer of the cervix.

OBJECTIVE: To determine whether chromocystoscopy could be used for the urological monitoring of cervical carcinoma. METHODS: The absolute ejaculation time (AET, the interval of time between the intravenous injection of dye and the ejaculation of dyed urine in the bladder from either of the ureters) and the relative ejaculation time (RET, the difference of time between the two ejaculations) were retrospectively studied in relation to intravenous urography (IVU) and radionuclide renography (RR) in 141 patients. RESULTS: A significant probability of normal IVU and RR was found when the AET was < or = 7 min or the RET < or = 4 min and when no interval occurred between the two ejaculations. Pathological IVU and RR were found when there was no ejaculation from one or both ureters after 12 min. CONCLUSIONS: Chromocystoscopy could be used for monitoring cervical cancer patients. An abnormal chromocystoscopy could indicate the need for further radiological examinations.

Cystoscopy↗
PubMed1995

Repair of the perineal defect after radical vulvar surgery: direct closure versus skin flaps reconstruction. A retrospective comparative study.

From 1987 to 1990, 72 consecutive patients with primary untreated vulvar cancer underwent radical vulvar surgery with skin flaps reconstruction of the perineal defect. Postoperative complications, anatomical and functional results of this group of patients were compared with those of an historical control group of 77 patients submitted, at the same institution, to radical vulvectomy without reconstructive procedure from 1982 through 1986. The time of operation was significantly longer (180 minutes +/- 15 versus 120 minutes +/- 20) (p = 0.05) for patients submitted to the reconstructive procedure, while there was no statistically significant difference in intraoperative blood loss and hospital stay between the 2 groups. In comparison with direct closure, reconstructive procedures resulted in a significant lower rate of wound dehiscences (26% versus 64%) (p = 0.0001), vaginal introitus stenosis (2 versus 8) (p = 0.0001), sexual dysfunction (10% versus 50%) (p = 0.0001) and misdirection of the urinary stream (1 versus 5) (p = 0.001). It was concluded that skin flaps reconstruction is simple, reduces postoperative morbidity, and provides better anatomical and functional results than direct closure of the perineal defect.

Adult↗
PubMed1994

Burch colposuspension versus modified Marshall-Marchetti-Krantz urethropexy for primary genuine stress urinary incontinence: a prospective, randomized clinical trial.

OBJECTIVE: Our purpose was to compare the effects of the Burch colposuspension with those of the modified Marshall-Marchetti-Krantz urethropexy. STUDY DESIGN: Eighty women underwent the two types of operation. A full urodynamic investigation was repeated 6 months after surgery. RESULTS: Clinical follow-up continued for 2 to 7 years. Differences in subjective and objective cure rates were not statistically significant (respectively, 92% and 80% for the Burch colposuspension and 85 and 65% for the modified Marshall-Marchetti-Krantz urethropexy). The latter induced a longer hospital stay (7.4 vs 6.3 days, p = 0.001), a later resumption of spontaneous voiding (13.8 vs 8.5 days, p = 0.002), and was associated with considerable complications (one case of blood replacement for retropubic hematoma, one case of severe voiding difficulty, one case of further treatment for stress incontinence, and three cases of symptomatic de novo detrusor instability). CONCLUSION: For its high cure rate, short time to resumption of spontaneous voiding, short hospital stay, and low associated morbidity, the Burch colposuspension should remain the procedure of choice for stress incontinence.

Female↗
PubMed1994

Pefloxacin in the treatment of severe infections in gynecological cancer patients.

Infections often complicate the medical or surgical treatment of hospitalized cancer patients. In these cases, a broad-spectrum antibiotic treatment is necessary before the microbiological results are available. The aim of the present study is to verify the efficacy of pefloxacin as empirical antibiotic therapy in controlling infectious complications induced by surgery, chemotherapy or radiotherapy in female patients with gynecological cancer. To this purpose, 58 hospitalized patients with gynecologic malignancy and severe infectious complications were treated with intravenous pefloxacin at the dosage regimen of 400 mg every 12 hours. In all, 49 (or 91%) of the 54 evaluable patients were cured. The mean duration of successful treatment was 5.9 +/- 2.1 days (ranging 4-13 days). No side effects or clinical laboratory abnormalities requiring reduction or discontinuation of therapy were observed. We conclude that pefloxacin may be considered a first choice, broad-spectrum, single antibiotic for use in the empirical therapy of infections in gynecological cancer patients.

Adult↗
PubMed1994

[Dosimetric and qualitative evaluations of the use of rhodium filtration in mammography].

The value of rhodium filtration in mammography was compared with that of conventional molybdenum; dosimetric and qualitative tests were performed on a phantom and in vivo on informed and consenting patients. Phantom dosimetric tests confirmed a dose reduction with rhodium filtration changing according to thickness and primary beam energy. With rhodium filtration the dose decreased by 40% on the average topping 67% in breasts thicker than 6.5 cm. No significant differences were observed between rhodium and molybdenum filtration in clinical and phantom qualitative tests. Four radiologists--three of them in double blind--studied 29 mammograms repeated in the same technical setting and expressed a very slight preference for molybdenum also in thick and dense breasts. The slight preference was not based on higher diagnostic yield and therefore clinically irrelevant. Preferences appeared to be subjective, differing from one radiologist to another. In conclusion, the authors suggest the use of rhodium filtration in thick breasts because of the lower administered dose and of shorter exposure time with direct magnification.

Breast Neoplasms↗
PubMed1992

Psychological, behavioral and biochemical risk factors for coronary artery disease among American and Italian male corporate managers.

Differences in psychological, behavioral and biochemical risk factors for coronary artery disease (CAD) among male corporate managers of 2 countries (United States and Italy), with very different age-specific rates of mortality for CAD were evaluated. In all, 129 American (mean age 43 +/- 7 years) and 80 Italian (mean age 45 +/- 7 years) managers volunteered to participate in this study. Each subject was administered several questionnaires assessing various psychological and behavioral risk factors for CAD, and all 129 Americans and 55 of 80 Italians had their blood drawn between 8:00 and 9:30 AM after overnight fasting for the measurement of plasma levels of dehydroepiandrosterone-sulfate (DHEA-S), total cholesterol, triglycerides, and apolipoproteins A-I and B. Italian managers reported significantly more cynicism and hostility, and less enjoyment in leisure activities than did American ones. Furthermore, 40 Italian (51%) and only 18 American (14%) managers were smokers (this difference being statistically significant). Although no significant differences were found in factors positively related with CAD (cholesterol, triglycerides and apolipoprotein B), there were clear differences in parameters inversely correlated with the incidence of CAD. Italian managers had significantly lower levels of plasma DHEA-S and apolipoprotein A-I than did American ones. In conclusion, this study found that Italian managers had a significantly more unhealthy psychological and behavioral profile than did American ones, and had lower levels of those biochemical parameters (apolipoprotein A-I and DHEA-S) thought to have a protective role against development of CAD.

Administrative Personnel↗
PubMed1992

Evidence for a genetic duplication involving alcohol dehydrogenase genes in Ceratitis capitata.

An Adh duplication is described in the medfly Ceratitis capitata. Evidence is presented for two separate Adh1 and Adh2 structural loci mapping at a distance of 0.49 recombination unit from each other. By deletion mapping the Adh region has been cytologically located near the free end of the left arm of the second chromosome within an area between 2C;3A segments of the polytene chromosome. The genetic analysis of the region around Adh has identified seven neighboring genes (Acon1, Mpi, Est6, Aox, Xdh, Mdh2, Lsp1) which identify the linkage group D. The orientation of loci with regard to the centromere sets the origin of the map of the left arm of the second chromosome close to the two Adh loci.

Alcohol Dehydrogenase↗
PubMed1991

Genetic variability and gene flow in geographical populations of Ceratitis capitata (Wied.) (medfly).

Two African populations of Ceratitis capitata (Kenya and Réunion Isl.) and two Mediterranean ones (Sardinia and Procida Isl.) have been studied for genetic variability at 25 loci by electrophoresis. Wright's FST, Slatkin's Nm* gene flow estimator, Nei's distance (D) together with measures of variability such as H, P, A have been used to compare the population from Kenya with the other three. Parameters using gene frequencies (FST, D, Nm*) indicate the presence of substantial geographic heterogeneity, largely attributable to genetic drift and correlated with dispersion of the medfly from its source area (Subsaharan Africa) to the periphery. The Kenyan population has high genetic variability (assessed by H, P and A), as might be expected given its native status. Significant gene flow estimates between Kenya and the derived Mediterranean populations supports the hypothesis of recent colonization. Part of the geographic heterogeneity is related to the presence of fixed alleles in the more differentiated Réunion population although it maintains the genetic attributes of the ancestral population. Selection or other forces may have played an important role in the differentiation of this population.

Alleles↗
PubMed1991

Aspirin-induced decline in prostacyclin production in patients with coronary artery disease is due to decreased endoperoxide shift. Analysis of the effects of a combination of aspirin and n-3 fatty acids on the eicosanoid profile.

BACKGROUND: It was the purpose of this study to determine the effects of the combination of aspirin (ASA) and fish oil, which is rich in n-3 polyunsaturated fatty acids, on the eicosanoid profile of patients with coronary artery disease. Specifically, we wanted to determine whether the ASA-induced reduction in prostacyclin production is due to inhibition of endothelial cell cyclooxygenase or to reduced endoperoxide shift from platelets and whether ASA negates the potentially beneficial effects of fish oil on the eicosanoid profile. METHODS AND RESULTS: Fourteen patients with clinically stable but advanced coronary artery disease received 12 g (n = 8) or 16 g (n = 6) of fish oil concentrate containing 6 or 8 g of n-3 fatty acids for 6 weeks. In addition to the fish oil, patients received increasing daily doses of ASA (50 mg, 100 mg, 325 mg, and 1,300 mg; the latter in four divided doses). Each dose was taken for 2 weeks. With fish oil supplementation, red blood cell phospholipid fatty acid content of arachidonic acid (AA) decreased and of eicosapentaenoic acid (EPA) increased so that EPA as a percent of AA increased from 2% to 26%. Serum thromboxane B2, which represents the production of TXA2 by maximally stimulated platelets, was suppressed by 38% on fish oil alone and by 97% or greater on all doses of ASA. Excretion of PGI2-M, the main urinary metabolite of PGI2 (derived from AA), fell from 50 +/- 4 ng/g of creatinine to 42 +/- 2 ng/g on fish oil alone (p = 0.02). On 50 mg of ASA per day, PGI2-M excretion was 26 +/- 2 ng/g of creatinine (p less than 0.001 versus fish oil alone). On 100 mg and 325 mg of ASA per day, PGI2-M was 24 +/- 3 ng/g and 27 +/- 3 ng/g, respectively (p V NS versus value on 50 mg per day). PGI3-M, the main urinary metabolite of PGI3 (derived from EPA), increased from 0.2 +/- 0.1 ng/g of creatinine to 4.9 +/- 0.7 ng/g on fish oil alone (p less than 0.001). In contrast with the marked ASA-induced decline in PGI2-M, PGI3-M excretion was not affected by the addition of ASA, even at the higher doses (4.6 +/- 0.7 ng/g and 4.9 +/- 0.5 ng/g on 325 mg per day and 325 mg four times daily, respectively). CONCLUSIONS: Moderate-dose (325 mg per day or less) ASA taken once daily has no effect on PGI3 production despite significantly reducing PGI2 production. This suggests that endothelial cell cyclooxygenase is minimally inhibited by such doses of ASA and that a large percent of the PGI2 produced in patients with advanced coronary artery disease derives from the transfer of prostaglandin endoperoxides from activated platelets to endothelial cells. The loss of these substrates accounts for the decrease in PGI2 with moderate-dose ASA. Thus, the ASA-induced decrease in PGI2 may in large part be an unavoidable consequence of ASA-induced platelet cyclooxygenase inhibition. ASA does not negate the potentially beneficial effects of n-3 fatty acids on the eicosanoid profile.

Aged↗
PubMed1990

Atrial natriuretic peptide in Cushing's disease.

Atrial Natriuretic Peptide (ANF), is secreted by atrial myocytes in response to atrial stretch. Its plasma levels have been found elevated in conditions leading to salt and fluid repletion and consequent atrial distention. Recently, it has been demonstrated that dexamethasone can enhance ANF secretion, by acting on ANF gene expression and mRNA synthesis. High plasma levels of ANF have been observed in normal man after administration of cortisol and ACTH. In the case of glucocorticoid excess, as in Cushing's disease, limited and conflicting data are available. Therefore, we measured ANF basal values and ANF response to postural changes and volume expansion in eight patients with Cushing's disease. In our patients ANF values were higher than normals. ANF responded to volume expansion, 47.8 +/- 5.1 pg/ml before sodium load and 69.9 +/- 7.0 pg/ml after sodium load, and changed minimally after postural manoeuvres, 47.3 +/- 3.2 pg/ml supine and 41.7 +/- 5.1 pg/ml upright. These data indicate that ANF secretion is enhanced in Cushing's disease, and its regulation is partially altered. Since in this condition hypervolemia has not been certainly demonstrated, a direct relationship between elevated ANF and glucocorticoid excess could be suggested.

Adult↗
PubMed1989

Sulbactam/ampicillin versus cefotetan in the treatment of obstetric and gynecologic infections.

In an open, randomized clinical study, the safety and efficacy of sulbactam/ampicillin was compared to that of cefotetan in 95 hospital patients with gynecologic or obstetric infections. Sulbactam/ampicillin (1 g:2 g), was administered intravenously every 8 h to 46 patients, and cefotetan (2 g) was administered intravenously every 12 h to 49 patients. All 23 patients with obstetric infections and 18 of the 23 patients with gynecologic infections treated with sulbactam/ampicillin were evaluated as cured. All 21 patients with obstetric infections and 23 of the 28 patients with gynecologic infections treated with cefotetan were evaluated as cured. No side effects requiring discontinuation of therapy or reduction of the dose administered, were observed.

Adult↗
PubMed1986

A double-blind trial of fentonium bromide in the treatment of incontinent unstable bladder.

The effects of fentonium were compared with those of placebo in a double-blind, cross-over trial involving 28 incontinent women with unstable bladder. Fentonium bromide proved significantly more effective in reducing urgency and urge incontinence (p less than 0.05), in reducing detrusor pressure rise during bladder filling (p less than 0.01) and in increasing bladder volume at first stimulus (p less than 0.05). Well tolerated, fentonium bromide proved useful in the treatment of unstable bladder.

Adult↗