Biomedical subjects

Secondo Guaschino

Publications and source records attributed to Secondo Guaschino.

29 records · Page 2Linked to original sources

PubMed2003

Assessment of pelvic floor muscle function after vaginal delivery. Clinical value of different tests.

OBJECTIVE: To evaluate the efficacy of different tests in identifying pelvic floor dysfunction after vaginal delivery. STUDY DESIGN: One hundred ninety-seven primiparae were investigated 2 months after vaginal delivery. They underwent pelvic floor muscle assessment by digital test, vaginal manometry and uroflowmetric stop test. Puerperae were divided into continent and incontinent subpopulations. Variables were subjected to Student's t test and Fisher's exact test to verify the difference between the subpopulations. Kappa values were used to correlate the tests. RESULTS: Perineal performance in incontinent primiparae was weaker in all the tests; only the urine stream interruption test score showed significantly different values (P = .0026), but it did not correlate with the other two tests. CONCLUSION: A simple, objective, noninvasive and low-cost technique, such as the urine stream interruption test, is useful in assessing pelvic floor performance after vaginal delivery but reflects urethrovesical support function rather than pelvic muscle function in toto.

Adult↗

PubMed2002

Postpartum urinary symptoms: prevalence and risk factors.

OBJECTIVES: To assess the prevalence of urinary symptoms, the relationship between urinary symptoms and vaginal descent, and the association between urinary symptoms and obstetric factors. STUDY DESIGN: Five hundred and thirty-seven women were interviewed and underwent a urogynaecological evaluation 3 months after vaginal delivery. Quantitative-type variables were subjected to Student's t test. Simple logistic regression analyses were carried out on the symptoms studied as a function of risk factors. RESULTS: 8.2% of primiparae showed stress urinary incontinence and multiparae in 20% (P=0.0001); urge incontinence was present in 5.5% of primiparae and in 13% of multiparae (P=0.004). Significant correlations were found among operative vaginal delivery, dysuria (P=0.048) and frequency (P=0.036). Urinary incontinence appeared associated with induced labour with prostaglandins (P=0.018) and with general maternal factors, such as parity (P=0.001) and elevated weight at the beginning of pregnancy (P=0.019). CONCLUSIONS: It is likely that the pathogenesis of postpartum urinary incontinence includes not only the effects of pelvic floor trauma on urethrovesical mobility under stress, but also a deficiency in urethral resistance caused by drugs, such as prostaglandins.

Adult↗

PubMed2002

Correlation of local interleukin-8 with immunoglobulin A against Gardnerella vaginalis hemolysin and with prolidase and sialidase levels in women with bacterial vaginosis.

Mucosal immune system activation may represent a critical determinant of adverse consequences associated with bacterial vaginosis (BV), such as sexual human immunodeficiency virus transmission, upper genital tract infections, postsurgical infections, and adverse pregnancy outcomes. Concentrations of sialidase, prolidase, and anti-Gardnerella vaginalis hemolysin (Gvh) immunoglobulin A (IgA) were higher in vaginal fluids of 75 fertile women with BV, compared with concentrations in vaginal fluids of 85 healthy control subjects. Interleukin (IL)-8 levels were positively associated with anti-Gvh IgA response and inversely correlated with high levels of prolidase and sialidase in women with BV. IL-8 concentration was strongly associated with leukocyte count in both healthy and BV-positive women. The absence of leukocytes in most women with BV likely is due to lack of IL-8 induction. Parallel impairment of innate and adaptive mucosal immune factors, likely through microbial hydrolytic effects, may allow for the ascent of microorganisms to the upper genital tract and may facilitate viral infections.

Adult↗

PubMed2002

Immediate postpartum perineal examination as a predictor of puerperal pelvic floor dysfunction.

OBJECTIVE: To determine the relation between postpartum perineal trauma and the development of puerperal pelvic floor dysfunctions. METHODS: A prospective study was conducted on 218 primiparae immediately after vaginal delivery. Women were divided in three groups according to perineal trauma: group A (n = 171) intact perineum or superficial tear, group B (n = 39) perineal muscle tears, group C (n = 8) anal sphincter tears with or without disruption of the rectal mucosa. Two months later, each woman was questioned about urogynecologic symptoms and examined by digital test, vaginal perineometry, and uroflowmetric stop test score. RESULTS: No significant difference was found among the groups with regard to the incidence of stress incontinence, frequency/urgency, and urge incontinence, whereas anal incontinence was found more commonly in group C (group C versus group A: P =.003, odds ratio 18.78). No significant difference was found for digital test, perineometry, and uroflowmetric stop test. CONCLUSION: Immediate postpartum perineal examination is not a good predictor of stress incontinence and pelvic floor weakness but could identify women at risk for anal dysfunctions: intact perineum does not exclude the appearance of symptoms related to perineal trauma after vaginal delivery.

Adult↗

PubMed2002

Correlation of local interleukin-1beta levels with specific IgA response against Gardnerella vaginalis cytolysin in women with bacterial vaginosis.

PROBLEM: Mucosal immune system activation may represent a critical determinant of adverse sequelae correlated with bacterial vaginosis, as HIV sexual transmission, upper genital tract infections, cervicitis, endometritis, postsurgical infections, and adverse pregnancy outcomes as preterm delivery (PTD), low birth weight (LBW). METHOD OF STUDY: Levels of interleukin-1beta (IL-1beta), anti-Gardnerella vaginalis hemolysin (Gvh) IgA, pH, Nugent score, and number of leukocytes were measured in vaginal fluids of 60 fertile women with bacterial vaginosis and of 64 healthy controls. RESULTS: Vaginal IL-1beta levels were nearly 13-fold higher in women with bacterial vaginosis (BV) and were associated with anti-Gvh IgA response. IL-1beta was positively correlated with leukocyte counts in the smear both in healthy and bacterial vaginosis positive women. CONCLUSIONS: Induction of the proinflammatory cytokine IL-1beta may be a necessary event to elicit an innate immune response to control anaerobic genital tract infections. High levels of vaginal IL-1beta are associated with mounting of an antigen-specific mucosal immune response in women with bacterial vaginosis. Parallel induction of innate and adaptive immune response may be associated with protection from ascent of micro-organisms to the upper genital tract, and from acquiring viral infection through the vaginal tract.

Adult↗

PubMed2002

How, and how efficiently, can we treat Chlamydia trachomatis infections in women?

Several antichlamydial active drugs are available for both non-pregnant and pregnant women, potentially allowing effective prevention of the consequences and transmission of infection. The choice of treatment regimen not only has to consider efficacy, but also side-effects, compliance and the cost of antibiotic drugs. In recent years there have been no significant changes to the guidelines for treating Chlamydia trachomatis infection as no new antibiotic has been included. Inclusion of a new antichlamydial drug in the guidelines must be supported by suitable, randomized trials. Furthermore, how much it will be used in clinical practice will also depend on considerations of a pharmacoeconomic nature.

Anti-Bacterial Agents↗

PubMed2002

Perineal ultrasound evaluation of urethral angle and bladder neck mobility in women with stress urinary incontinence.

OBJECTIVES: 1. To assess the reproducibility of an electronic ultrasonographic technique for the measurement of urethral angulation; 2. to test the ability of measurement of the urethral angle and bladder neck mobility to predict genuine stress incontinence; 3. to compare ultrasound variables in stress incontinent women and in controls. DESIGN: Case-control study. POPULATION: Twenty-three incontinent women and 50 controls. METHODS: Electronic measurements of the distance between the bladder neck and the symphysis pubis, the bladder neck and the symphysis pubis line and the midline of the symphysis (alpha angle) and the angle between the proximal and distal urethra (beta angle) by means of perineal ultrasonography with a comfortably full bladder at rest, during the Valsalva manoeuvre and during maximal pelvic floor contraction. The same procedure was performed by a second investigator. Repeatability was evaluated by the technique described by Bland and Altman. Statistical analysis was performed using Student's t test and the two-tailed paired t test. MAIN OUTCOME MEASURES: To test the possible role of the urethral angle in maintaining female continence. RESULTS: Ultrasound analysis showed good repeatability between the two observers and is not influenced by vesical volume. Beta angle and urethrovesical mobility are inversely proportional, both in continent and in incontinent women. Urethral angle identifies genuine stress incontinence better than urethrovesical mobility (sensitivity 96% vs 87%; specificity 92% vs 68%; positive predictive value 85% vs 55%). There are significant differences in all ultrasound variables between incontinent women and continent controls. CONCLUSIONS: This study suggests a significant role of the urethral angle in maintaining female continence (in incontinent women it is lower at rest and lowers with straining). Measurement of the urethral angle can provide useful additional information to that provided by ultrasound evaluation of bladder neck mobility.

Adult↗

PubMed2002

Prevalence of bacterial vaginosis and vaginal flora changes in peri- and postmenopausal women.

Our aim was to evaluate the prevalence of bacterial vaginosis and decrease in lactobacillus colonization in women 40 years old or older in relation to menopausal status by evaluation of Gram-stained smears. A total of 1,486 smears from Italian Caucasian women aged 40 to 79 years were examined. Women were classified as follows: fertile (regular cycles) (n = 328), perimenopausal (irregular cycles) (n = 237), and postmenopausal (n = 921), including 331 women on estroprogestinic hormone replacement therapy (HRT). The prevalences of bacterial vaginosis (assessed as a Nugent score of >or=7) in fertile (9.8%) and perimenopausal (11.0%) women were not statistically different, whereas the prevalence was significantly lower overall in postmenopausal women (6.0%) (P = 0.02). Specifically, 6.3% of postmenopausal women without HRT and 5.4% of postmenopausal women with HRT were positive for bacterial vaginosis. The Nugent score system was not adequate for evaluating the normal and intermediate vaginal flora in women over the age of 40 years. High numbers of peri- and postmenopausal women had no lactobacilli and no bacterial-vaginosis-associated microorganisms. This nonpathological absence of lactobacilli in women with a Nugent score of 4 was scored as 4*, and this group was considered separately from the intermediate flora group. A score of 4* was obtained for 2.1% of fertile women, 11.4% of perimenopausal women, 44.1% of postmenopausal women without HRT, and 6.9% of postmenopausal women with HRT. The physiological reduction in lactobacillus colonization of the vagina in postmenopausal women does not cause an increase in bacterial-vaginosis prevalence. Reversion of lactobacillus flora to premenopausal levels due to HRT does not increase the prevalence of bacterial vaginosis in postmenopausal women.

Adult↗

PubMed2002

Facts and myths on recurrent vulvovaginal candidosis--a review on epidemiology, clinical manifestations, diagnosis, pathogenesis and therapy.

Approximately three-quarters of all women will experience an episode of vulvovaginal candidosis at least once in their life and 5-10% of them will have more than one attack. Women suffering from three to four attacks within 12 months will be diagnosed with recurrent vulvovaginal candidosis (RVVC). This review covers the large number of proposed aetiological factors for RVVC. The diagnosis of the condition made by conventional means by health providers is often false and is also often misdiagnosed by the affected woman herself. The review covers various methods of diagnosing RVVC and the current knowledge on potential pathogenetic mechanisms proposed for genital candida infections. Treatment of RVVC, including local and systemic antimicrobial therapy and behaviour modification to decrease the risk of recurrences, are discussed. Recent knowledge on drug resistance in candida is also included.

Antifungal Agents↗

PubMed2002

Perineal evaluation in the puerperium. Role of testing with a cotton-tipped swab.

OBJECTIVE: To verify the applicability and significance of testing with a cotton-tipped swab in postpartum evaluation. STUDY DESIGN: One hundred seventy-eight puerperas were examined two months after vaginal delivery and underwent testing with a cotton-tipped swab, digital test, vaginal manometry and uroflowmetric urine stream interruption test. Statistical analysis was performed using Student's t test to evaluate the difference between mean values of continent and incontinent puerperas and the Bravais-Pearson coefficient to test the correlation between all the tests used in the study. RESULTS: Incontinent puerperas and multiparas had significantly higher swab test values than did continent and primiparas, who demonstrated a swab test mean value of 39.5 degrees during the Valsalva maneuver. The sensitivity of the swab test for stress urinary incontinence was 82.5%, while its specificity and positive predictive value were, respectively, 31.1% and 25.8%. CONCLUSION: Perineal damage occurs not only in symptomatic puerperas but most women. The swab test was unable to assess stress urinary incontinence in postpartum women, also, and demonstrated only urethral hypermobility. The swab test in the puerperium does not add significant information about pelvic floor performance and should not be used routinely postpartum.

Adult↗

PubMedDate not supplied

Visual function in menopause: the role of hormone replacement therapy.

OBJECTIVE: To assess the effects of hormone replacement therapy (HRT) on visual function after menopause. DESIGN: This study was conducted on 80 postmenopausal women aged 52 to 70 years. Women were randomly divided into two groups: 40 women were treated by oral HRT (equine conjugated estrogens 0.625 mg/day + dydrogesterone 5 mg/day in a continuous combined regimen), and 40 women were not treated with hormones (control group). Each woman underwent a contrast sensitivity test, a Schirmer test, and an evaluation of intraocular pressure before starting the study and 1 year after the beginning of the study. Statistical analysis was performed by Student's test and Fisher's exact test. RESULTS: Contrast sensitivity function was significantly improved in all spatial frequencies (1.5, 3, 6, and 12 cycles per degree) with the exception of 18 cycles per degree in the HRT group 1 year after the beginning of treatment, whereas the control group demonstrated significant impairment at the lowest spatial frequencies (1.5, 3, and 6 cycles per degree). Tear production was significantly improved in the HRT group 1 year after the beginning of treatment, and intraocular pressure was similar in the two groups before and after the beginning of the study. CONCLUSIONS: HRT improves visual function, promoting a better contrast sensitivity and a higher tear production, but does not modify intraocular pressure.

Aged↗