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Biomedical subjects

A Schiano

Publications and source records attributed to A Schiano.

At least 19 recordsLinked to original sources
PubMed2003

[Management of other ectopic pregnancies (cornual, interstitial, angular, ovarian)].

OBJECTIVES: To provide recommendations for management of interstitial and ovarian pregnancies. MATERIALS AND METHODS: A Medline search was conducted and discussed by a study group of experts. RESULTS: Ovarian and interstitial pregnancies are rare forms of ectopic pregnancy. Diagnostic criteria and methods are described on the basis of a review of the literature. Surgery is the usual management of interstitial pregnancy. Conservative treatment has replaced hysterectomy. Laparoscopy is an attractive way to manage interstitial pregnancies but laparotomy may still be used. Cornual resection is required. Medical treatment with methotrexate is another alternative. Local MTX seems to be more efficient than systemic administration. Management of interstitial pregnancy under laparoscopic control is an attractive way if feasible. Strong recommendations cannot be established due to the small number of reported cases reports. The pre therapeutic score cannot be used as doses are still not clear for interstitial pregnancies. For ovarian pregnancy, management is often surgical. Laparoscopy is more and more used for small gestational sacs. Methotrexate has also been used for ovarian pregnancies. Laparoscopic treatment associated with systemic MTX seems to be the more efficient way. CONCLUSION: Because of limited data it is very hard to establish recommendations from low power studies (NP 5).

Abortifacient Agents, Nonsteroidal↗
PubMed1999

[The value of hysteroscopy after repeated implantation failures with in vitro fertilization].

OBJECT: we attempt to determine the usefulness of uterine re-assessment by hysteroscopy in women with two unsuccessful IVF-ET attempts. MATERIAL AND METHOD: This retrospective study concerns seventy-three infertile women who have had a repeat uterine hysteroscopy after two implantation failures in IVF. RESULTS: In half the cases, an abnormality was diagnosed. Cervical abnormalities (synechia, polyp, false passage) and hormono-dependent abnormalities (polyp, hyperplasia, submucous myoma) were the most frequent findings. The rate of pregnant women raises to twenty-two percent after treatment of these abnormalities. CONCLUSION: Regarding our experience, it seems legitimate to perform hysteroscopy in women who have had two IVF-ET failures before attempting a third procedure.

Adult↗
PubMed1998

Evidence for a postnatal doubling of neuron number in the developing human cerebral cortex between 15 months and 6 years.

The generalization of the finding of no postnatal neurogenesis in non-human primates to humans may be incorrect because: (1) rhesus macaques belong to a superfamily that diverged more than 25 million years ago from the superfamily including the genus Homo; (2) the pulse thymidine labeling method, which demonstrates DNA synthesis rather than mitosis per se, is less reliable than some have assumed. This study examines changes in the number of neurons in a column underneath a cortical surface area of 1 mm2, extending through all cortical layers (mm2-column) for 35 gyri (representing about 73% of the human cerebral cortex) based on the data of J.L. Conel (1939 to 1967). We corrected these data, derived from his measures of cortical neuronal packing density, somal breadth and height, and cortical layer thickness at postnatal ages 0, 1, 3, 6, 15, 24, 48, and 72 months, for shrinkage and stereological errors. In all 35 gyri, neuron number/mm2-column: (1) initially declines (mu = 46% decline, sigma = 8%), 95% of which is due to surface area expansion (mean age of nadir value = 15.8 months); (2) then increases to age 72 months by 70% (mu = 1.7-fold increase, (mu rate = 1.1% per month). Because of a a concomitant 1.3-fold increase in cortical surface from 15 to 72 months, total cortical neuron number increases 2.2-fold. The close agreement between neuron number/mm2-column for Conel's age 72-month data to the corresponding values reported by others for adult human and primate cortex using more modern methods suggests the finding is not an artifact. Neuronal proliferative fate-determining factors provide at least four mechanisms for increasing cortical neuron number postnatally, with or without DNA synthesis.

Aging↗
PubMed1998

Congenital megalourethra associated with urethral duplication and imperforate anus.

A newborn with a prenatal diagnosis of right hydroureteronephrosis and enlarged penis is presented. At birth, the baby had an imperforate anus (IA) with a megalourethra; radiologic and ultrasonographic studies showed a left polycystic kidney and right hydroureteronephrosis, right vesicoureteral reflux, and an incomplete urethral duplication with dilatation of the posterior urethra. The IA was corrected on the 1st day of life and a vesicostomy was performed at 1 month. At 1 year of age the valve obstructing the ventral posterior urethra was resected and the vesicostomy was closed. At 14 months the baby underwent a urethroplasty with a vertical preputial tubularized island flap and excision of the penile urethral duplication. Exact knowledge of the malformation was essential in planning the appropriate surgical treatment.

Anus, Imperforate↗
PubMed1994

Serum levels of interleukin 1-beta, tumor necrosis factor-alpha, soluble interleukin 2 receptor and soluble CD8 in seronegative spondylarthropathies.

Seronegative spondylarthropathies are disorders with the same predisposing antigen, namely HLA B27, a class I molecule of the HLA system. The mechanisms of the different diseases are unknown, and there is no proof of immune system participation. We have investigated patients with spondylarthropathies in order to search for an immunological component in the pathophysiology of these disorders, by measuring the serum level of two inflammatory cytokines--IL1 beta and TNF alpha--by a radioimmunological assay and the serum level of two soluble T cell activation markers--soluble IL2 receptor and soluble CD8--by an enzyme-linked immunosorbent assay. The choice of soluble CD8 can be explained by the strong link between HLA B27 and spondylarthropathies. Our series compared 24 patients to 24 healthy matched controls. A similar IL1 beta serum level was observed in both groups, while in the patients there was a nonsignificant increase in the TNF alpha level, a significant decrease in the soluble IL2 receptor level and a significant increase in the soluble CD8 serum level. The normal or moderately increased serum IL1 beta and TNF alpha levels in the disease group do not exclude a local role for these cytokines in the synovium or other inflammatory areas. However, we found a higher soluble CD8 serum level in the patient group. Most of these patients were in clinical exacerbation of their disease. As the serum level of soluble CD8 is well correlated with T CD8 lymphocyte activation, our data suggest that this lymphocyte subset is stimulated and consequently probably involved in seronegative spondylarthropathies.

Adult↗
PubMed1993

Early-stage avascular necrosis of the femoral head: MR imaging for prognosis in 31 cases with at least 2 years of follow-up.

Thirty-one cases of stage 1 or 2 osteonecrosis (ON) of the hip in 27 patients were studied with T1-weighted coronal magnetic resonance (MR) imaging. Three quantitative parameters were measured on the contiguous MR sections, corresponding to the 2-cm-wide median portion of the femoral head: the angle filled by ON (alpha), the percentage of weight-bearing femoral cortex involved with ON (WB), and the percentage of femoral head surface involved with ON. The clinical and radiologic courses were assessed after at least 2 years of follow-up (mean, 46 months). Core decompression was performed in 12 cases of ON. Values were strikingly lower in the group with good clinical or radiologic outcome versus poor outcome, with very little overlapping. WB was the more reliable parameter. Outcome of hips treated with versus without core decompression appeared closely related with these MR parameters and not with the treatment procedure. Thus, a quantitative approach to determination of extent and location of the lesion on the initial MR image appears accurate for use in the prediction of long-term outcome of ON. Effectiveness of core decompression should be reevaluated on this basis.

Adult↗
PubMed1992

[Aspects and role of spinal MRI in the assessment of solitary plasmacytoma and multiple myeloma. Apropos of 11 cases].

Spinal MRI was performed in 9 multiple myeloma and 2 solitary plasmacytoma, using sagittal, T 1-weighted (TR: 350-550 ms/TE: 15-26 ms) and T 2-weighted (TR: 2,000-2,500 ms/TE: 60-120 ms) sequences, with additional gadolinium injection in 3 cases. MRI features were the following: 1) round, patchy lesions with low T 1 signal highlighted by gadolinium and bright T 2 signal were present in 10 of the 11 patients: all osteolytic lesions seen on plain X-rays corresponded to such lesions and biopsy performed in 4 cases showed massive marrow replacement by plasma cells. 2) overall marrow signal was dramatically decreased in 3 patients (2 of whom had a high tumoral mass). 3) extra-dural compression was present in 4 cases. 4) 25 vertebral compression fractures (10 of whom with a "benign" appearance) and focal fat deposition were seen. 5) postradiation treatment examination seemed predictive of the outcome in the 2 solitary plasmacytomas. MRI proved to be more sensitive than plain X-rays or bone scintigraphy. Number and size of focal tumor-like lesions did not correlate with the low marrow signal appearance. Both correlated poorly with overall tumoral mass but diffuse abnormalities were associated with rapidly fatal outcome in three cases. These features might reflect qualitative rather than quantitative patterns of the disease (nodular or diffuse macroscopic marrow replacement). These findings are in agreement with those of the few previous studies. MRI is valuable for spinal cord damage assessment. It appears less accurate in benign versus malignant vertebral compression fracture determination than it does in bone metastasis. Its prognostic value is still questionable.

Aged↗
PubMed1992

[Brucella osteomyelitis of the upper end of the humerus: contribution of magnetic resonance imaging].

The authors report a case of brucella osteomyelitis of the upper end of the humerus in a 77-year-old patient, presenting as a large swelling of the soft tissues of the shoulder, present for a year. The diagnosis was made by isolation of the organism and specific serology. The authors stress the value of magnetic resonance imaging, which provided confirmation of the diagnosis of osteomyelitis as well as an accurate topographic assessment.

Aged↗
PubMed1992

[Complete and dissociated forms of Poland's syndrome (5 cases)].

The authors report 5 cases of aplasia of pectoralis major including 2 associated with a malformation of the hand falling within the context of Poland syndrome, which is a relatively common congenital malformation consisting of an association in varying degrees of hypoplasia of pectoralis major and a complex malformation of the homolateral hand. The pathogenesis of this malformation is gradually emerging and while familial cases have been reported, the majority of Poland syndromes are sporadic. The hypothesis involving interruption of the embryonic blood supply of the subclavian arteries during a critical period of embryonic development at about the 46th day is the most attractive. This hypothesis also enables extension of the manifestations seen to other congenital malformation syndromes. However, it could be disproved in one of our cases and the notion of early embryonic damage was more plausible.

Adolescent↗
PubMed1991

[Stress fractures during fluoride therapy. Physiopathological value of histomorphometry].

Bone histomorphometry was carried out in 11 women, aged 53 to 80 (mean = 69.6), treated with fluoride for vertebral osteoporosis for more than 6 months and having suffered one or more stress fractures (1 to 4 sites, mean = 1.7 sites) during that time. Classical contraindications were complied with in all cases but 2 patients did not have any combined calcium supplement. In 6 cases, histomorphometry showed no sign (notably hyperosteoidosis) of the effects of fluoride on bone. Bone trabecular volume was markedly below the fracture threshold in 4 patients. This group refractory to fluoride included the two patients who had received no calcium supplement. In 5 cases, histomorphometry showed hyperosteoidosis of normal or low thickness, with a normal mineralisation rate, reflecting the effects of fluoride on bone. However, bone trabecular volume remained below the fracture threshold in all cases. In all 11 cases, bone structure studied in polarised light was lamellar and there was no increase in cortical porosity. These results suggest that the imputability to fluoride of peripheral bone accidents must be viewed very relatively (the persistence of an insufficient bone trabecular volume being the feature usually found) or, at any event, that its possible iatrogenic effect is not linked to bone remoulding abnormalities.

Aged↗
PubMed1991

[MRI in osteoporotic and metastatic vertebral compressions: apropos of 60 cases].

Magnetic resonance imaging (MRI) was performed in 60 patients with vertebral compression fractures caused by either bone metastasis (BM) or osteoporosis (OP). In the BM group (20 patients, 62 BM with 22 compression fractures), the signal was decreased on T1-weighted images in all cases and was usually increased on T2 sequences, in the whole vertebral body or in patchy areas. The vertebral body showed a diffuse posterior bulging in 85% of patients; malignant infiltration often involved pedicles, posterior arch or soft tissues. In the OP group (40 patients, 160 vertebral fractures): a significant recession of one of the corners of the vertebral body, different from metastatic bulging, was observed in 37% of patients; the spinal cord signal depended on the stage: during the first 4 months, the signal was low on T1 and high on T2 sequences, with a characteristic band disposition, which may involve most of the vertebral body even in mild fractures; the modifications extended to the pedicles in 5 cases; after 6 months, the signal was normal. MRI specificity was 92% between malignant versus benign compression fractures. MRI had a better sensitivity than bone scan for depicting vertebral BM. In OP, MRI signal modifications disappeared several months before increased uptake of technetium. This study emphasizes the value of MRI for the diagnosis of osteoporotic versus metastatic vertebral compression fractures when morphological and chronological parameters are added to the signal intensity analysis.

Adult↗
PubMed1990

[Bone infarction, or idiopathic metaphyseal and diaphyseal aseptic osteonecrosis of the long bones. Update and contribution of new imaging technics].

Twenty patients with "idiopathic" bone infarction were studied. There were 18 men and 2 women, age 30 to 69 years, at the time of the diagnosis (mean age = 49 years). Sixty-five lesions were recorded with a marked predominance to the lower extremities (77 p. cent are located around the knees) and to the metaphysis (only three pure diaphyseal lesions). Considered asymptomatic, these lesions were painful in 6 patients. They are multiple, and in this case symmetrical, in 12 patients (60 p. cent). X-Rays disclose the classic heterogeneous ball-like, smoke twirled or encapsulated calcifications. A periosteal thickening opposite the lesions was observed in 6 patients; this may be the only radiological sign. Finally, 18 of the 65 lesions were not visible on standard X-Rays, and obvious on MRI. The MRI aspect is characteristic and may be superposed on the basic lesions already described in the course of aseptic osteonecroses of the femoral head. This is, besides, the most sensitive test, snowing a larger number of more extended necroses than the other examinations. CT scanning as well as scintigraphy present a limited advantage. More than half of the patients also present epiphyseal aseptic osteonecroses, often multiple (55 sites for 13 patients), and often unrecognized. The etiological factors are in fact common to both of these diseases: steroid therapy, alcoholism, dyslipidemia, idiopathic forms. Among the possible causes, the literature mentions lupus erythematosus, renal transplant, cytosteatonecrosis, arteriopathies while there is no post-traumatic form. All of the characteristics of these bone infarctions determine a topographic form of the osteonecrotic disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Neurologic complications of osteoporotic vertebral compression. 3 new cases and critical analysis of the literature].

Three new cases of neurological complication by osteoporotic compression are reported. They are: a medullar compression by compression of D12 in a 66 year old woman, a deficient cruralgia by compression of L1 in a 67 year old man, and another deficient cruralgia due to the compression of L3 and L4 in a 55 year old woman. The literature presents 16 cases of neurological compressions by vertebral compressions attributed to the osteoporosis: two in 1958, and the others as from 1987. The only recently recognized feature of these complications can be explained by the axiom according to which "there are no neurological complications in the course of osteoporotic compressions" and by the introduction of new diagnosis techniques. However, the critical analysis of the published cases enables us to retain only 11 indisputable cases which, with our three observations, allows us to define certain features: the osteoporosis does not have any particularity compared to the uncomplicated form; the dorsolumbar junction is preferentially affected; the neurological complication occurs progressively and belatedly; the usual mechanism is the recoil of one of posterior vertebral corners, different from the globally convex bulging of tumoral compressions: it could be an element of the differential diagnosis. The surgical treatment gives better results.

Aged↗