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Biomedical subjects

C Nappi

Publications and source records attributed to C Nappi.

At least 73 records · Page 4Linked to original sources
PubMed1999

Topical anesthesia for office hysteroscopy. A prospective, randomized study comparing two modalities.

OBJECTIVE: To compare the efficacy of two modalities of local anesthesia for diagnostic hysteroscopy in different steps of the procedure in terms of pain control and time required for the examination. STUDY DESIGN: One hundred eighty women undergoing diagnostic hysteroscopy were included in the study and randomly allocated to one of two groups. Group A (n = 88), treated with prilocaine plus lidocaine cream, and group B (n = 92), treated with lidocaine spray, were compared with group C, a control group (n = 165), including all the hysteroscopies performed without anesthesia in the same period. Duration of the hysteroscopic examination was recorded; intensity of pain induced by the procedure and shoulder pain 10 minutes after the end of the examination were recorded for all patients on the basis of a four-point pain scale. RESULTS: Duration of the procedure required was two minutes in a significantly lower percentage of patients in group A as compared to groups B and C. Furthermore, in group A we found a significant reduction in pain at placement of the tenaculum in comparison to groups B and C. In groups A and B, no patient experienced a "very painful" grade of pain versus 4.8% in group C. The vasovagal reaction rate was also significantly lower in both treated groups in comparison to the control group. Furthermore, the intensity of shoulder pain was significantly lower in the group receiving prilocaine plus lidocaine cream as compared to the other two groups. CONCLUSION: Local anesthesia has a beneficial effect, at least in those hysteroscopies presumed to be, for whatever reasons, more cumbersome to perform. Prilocaine plus lidocaine cream was more effective than lidocaine spray in decreasing pain at placement of the tenaculum and shoulder pain after the procedure.

Adult↗
PubMed1998

A clinical trial of the effects of tibolone administered with gonadotropin-releasing hormone analogues for the treatment of uterine leiomyomata.

OBJECTIVE: To evaluate the effects of tibolone therapy in association with GnRH-a on uterine leiomyomata, on climacteric-like symptoms, on bone metabolism, and on the lipid profile. DESIGN: A prospective, randomized, double-blind, placebo-controlled, clinical trial. SETTING: Department of Gynecology and Obstetrics, University of Naples "Federico II," Naples, Italy. PATIENT(S): Fifty women with symptomatic uterine leiomyomata. INTERVENTION(S): Six months of treatment with leuprolide acetate (3.75 mg every 28 days IM) combined with daily placebo tablets (group A) or with 2.5-mg of tibolone per os (group B). MAIN OUTCOME MEASURE(S): Uterine and uterine leiomyomata sizes, lumbar spine bone mineral density, biochemical markers of bone metabolism, lipid profile, and myoma-related symptoms were measured at baseline and after 6 months of treatment. Daily symptom diary in which hot flushes and vaginal bleeding episodes were recorded. RESULT(S): No differences between the 2 groups in uterine and uterine leiomyomata size and myoma-related symptoms were detected. After 6 months of treatment, there were statistically significant changes from baseline in bone mineral density and in biochemical markers of bone metabolism in group A but not in group B. Vasomotor symptoms were significantly lower in group B than in group A. There was a statistically significant increase (P<.01) in serum total cholesterol, high-density lipoprotein cholesterol, and triglycerides in group A after 6 months of treatment in comparison with baseline values. The difference in serum total cholesterol and triglyceride levels after 6 months of treatment in group B was not statistically significant in comparison with baseline values, but was statistically significant in comparison with group A values (P<.01). In group B, levels of high-density lipoprotein cholesterol were significantly lower after 6 months of therapy in comparison with baseline values and in comparison with group A values (P<.01). There were no statistically significant changes at baseline and after 6 months of treatment in the level of low-density lipoprotein cholesterol in either group. CONCLUSION(S): Administration of tibolone in association with GnRH-a reduces vasomotor symptoms and prevents bone loss, without compromising the therapeutic efficacy of GnRH-a alone.

Adult↗
PubMed1998

Postoperative pain control after microlaparoscopy in patients with infertility: a prospective randomized study.

OBJECTIVE: To evaluate the efficacy of intraperitoneal subdiaphragmatic instillation of lidocaine and trocar site infiltration of bupivacaine to minimize postoperative pain after diagnostic microlaparoscopy performed under local anesthesia with conscious sedation. DESIGN: Prospective randomized study. SETTING: Day-surgery unit of Endogyn Service, Naples, and Department of Gynecologic and Pediatric Sciences, Reggio Calabria University, Catanzaro, Italy. PATIENT(S): Sixty-one women with infertility. INTERVENTION(S): All patients received local anesthesia and conscious sedation before surgery. After the microlaparoscopy, the treatment group was given 40 mL of intraperitoneal subdiaphragmatic 0.5% lidocaine and 5 mL of 0.5% bupivacaine that was infiltrated into the trocar insertion sites. The control group received no treatment. When necessary, ketoprofene or ketorolac were administered IM after surgery. MAIN OUTCOME MEASURE(S): Postoperative pain was evaluated with the use of a visual analog scale with scores ranging from 1-10 immediately after surgery and over the next 48 hours. The rate at which patients were discharged from the hospital 2 hours after surgery also was recorded. RESULT(S): The treatment group had significantly lower pain scores both immediately after surgery and 1, 3, and 6 hours afterward. The need for postoperative analgesics also was significantly lower in the treatment group. The rate at which patients were discharged 2 hours after surgery was significantly higher in the treatment group. CONCLUSION(S): Postoperative intraperitoneal lidocaine administration and bupivacaine infiltration of the trocar sites is beneficial for patients undergoing microlaparoscopy. The effect of these drugs is temporary, but they can significantly decrease postoperative pain for approximately 6 hours and reduce the need for additional analgesics. Most important, the rate at which patients can be discharged from the hospital only 2 hours after surgery is increased significantly.

Adult↗
PubMed1998

Pain control after microlaparoscopy.

STUDY OBJECTIVE: To evaluate the efficacy of intraperitoneal subdiaphragmatic instillation of 0.5% lidocaine and 0.5% bupivacaine infiltration of cannula sites to control pain after diagnostic microlaparoscopy. DESIGN: Prospective, randomized study. (Canadian Task Force classification I). SETTING: Day surgery unit of Endogyn Service, Private Endoscopic Associates, Naples, and Department of Gynecologic and Pediatric Sciences, Reggio Calabria University, Catanzaro, Italy. PATIENTS: Forty women treated for infertility. INTERVENTIONS: The treated group received 0.5% intraperitoneal subdiaphragmatic lidocaine 40 ml and 0.5% bupivacaine 5 ml infiltration of cannula insertion sites. The control group received no treatment. In all patients the procedure was performed with atropine 0.5 mg, fentanyl 0.1 mg, droperidol 5 mg, and local anesthesia. Postoperatively, depending on the need, ketoprofene 100 mg or ketorolac 30 mg was administered intramuscularly. MEASUREMENTS AND MAIN RESULTS: Postoperative pain score was evaluated by visual analog scale immediately postoperatively and 1, 3, 6, 12, 24, 36, and 48 hours afterward. The treated group had significantly lower pain scores at the end of surgery and at 1-, 3-, (p <0.01), and 6-hour intervals (p <0.05). No significant differences in scores between groups were observed starting from 6 hours postoperatively. CONCLUSION: Postoperative intraperitoneal lidocaine and bupivacaine infiltration of cannula sites offered a detectable benefit to women undergoing diagnostic microlaparoscopy. The effect was temporary, but induced a significant decrease in the postoperative pain for approximately 6 hours.

Adult↗
PubMed1998

Prenatal diagnosis of congenital granular cell epulis.

Congenital granular epulis is a benign tumor that has rarely been diagnosed prenatally, although there have been numerous reports on its postnatal diagnosis. We report a case of large granular epulis diagnosed at 31 weeks' gestation in a woman whose previous anomaly scan had been normal. The lesion was 2.5 cm in diameter, pedunculated, and arose from the maxilla. It was completely surgically removed following preterm vaginal birth and histologically examined. The tumor did not prevent deglutition of the amniotic fluid and did not interfere with feeding or respiration, but prevented complete closure of the lips. We discuss the fetal management and the theories of histogenesis, and highlight the importance of early diagnosis and treatment.

Adult↗
PubMed1998

Ultrasonographic measurement of endometrial thickness during hormonal replacement therapy in postmenopausal women.

The objective of this study was to measure endometrial thickness by transvaginal ultrasonography during two regimens of hormonal replacement therapy (HRT) in postmenopausal women and to compare these data with endometrial histology. Transvaginal ultrasonographic evaluation of endometrial thickness and endometrial biopsy were performed in 80 postmenopausal women before and after 6 months of HRT (between the 24th and the 28th day of the cycle). The group was randomized so that 40 women (Group A) were treated with a continuous sequential regimen consisting of 5 micrograms/day of estradiol continuously and 5 mg/day of medrogestone from the 17th to the 28th day of the cycle; and 40 women (Group B) were given continuous administration of 50 micrograms/day estradiol and 5 mg/day medrogestone. Prior to therapy, there was no significant difference in mean endometrial thickness between the groups. After 6 months of therapy, endometrial thickness was significantly increased in comparison with basal values in both groups. The mean value was significantly higher (p < 0.001) in Group A (8.5 +/- 3.7 mm) than in Group B (3.6 +/- 1.3 mm). In Group A, endometrial thickness was < or = 4 mm in 16.7% of patients and < or = 8 mm in 69.5% of patients. In Group B, 91% of patients had an endometrium of < or = 4 mm. In both groups, the thickness of the atrophic endometrium was less than that of the other histological types of endometrium (4.1 +/- 0.3 mm for Group A and 3.5 +/- 1.2 mm for Group B). In Group A, the difference in mean endometrial thickness between the proliferative and secretory endometrium was not statistically significant. In both groups, the transvaginal ultrasonographic measurement of endometrial thickness of < or = 4 mm had a high sensitivity for detecting atrophic endometrium (83.3% for Group A and 93.7% for Group B).

Biopsy, Needle↗
PubMed1997

Gonadotropin-releasing hormone agonists administration in polycystic ovary syndrome. Effects on bone mass.

Women with amenorrhea and polycystic ovaries (PCO) seem to present a relative degree of protection against bone loss caused by hypoestrogenism. We treated 20 patients affected by polycystic ovary syndrome (PCOS) with a gonadotropin-releasing hormone agonist (GnRH-a) for 6 months. After treatment mean bone mineral density (BMD) significantly decreased. We concluded that patients with PCOS have to be considered at risk of developing osteopenia when treated with GnRH-a. The relative protection against osteoporosis, that is present in amenorrheic patients with PCO, might be attributed to the characteristics of amenorrhea in these patients.

Acne Vulgaris↗
PubMed1997

Increased concentrations of renin, aldosterone and Ca125 in a case of spontaneous, recurrent, familial, severe ovarian hyperstimulation syndrome.

We report for the first time increased concentrations of aldosterone and renin in a case of spontaneous, recurrent, familial, severe ovarian hyperstimulation syndrome (OHSS). High concentrations of Ca125 were also found. Our patient was a 26 year old woman, gravida 2, para 1, affected by severe OHSS, who denied having ever consumed any ovulation drug. Both the patient and her only sister had suffered from a similar condition in their previous pregnancies. The patient was treated with i.v. fluid therapy. Paracentesis was performed on one occasion. The patient was dismissed after 25 days in good condition. Blood count and blood chemistry confirmed the severity of the clinical picture. We conclude that spontaneous OHSS, although very rare, may have been underestimated so far. It can be recurrent and may also be familial. The intra-ovarian prorenin-renin-angiotensin system may play a role in its aetiopathogenesis.

Adult↗
PubMed1997

An overview on the effectiveness of natural family planning.

Recent years have witnessed important developments in natural family planning (NFP), which is based on the observation of fertile and infertile periods of the menstrual cycle, so that the couple is able to know when sexual intercourse may lead to a pregnancy. A review of the main studies regarding the effectiveness of NFP showed a decrease in the Pearl Index and life table values from the early 1980s to date, indicating that progress both in the teaching and in the application of these contraception, methods has been achieved. The main cause of lack of success seems to be the misapplication of NFP rules, whereas the errors due to the method itself are few. Furthermore, it seems that the symptothermal method might give better results than the ovulation method, even though no comparative study has been carried out, and that the first studies on the lactational amenorrhea method show encouraging results. Finally, it seems that NFP is best suited for 'spacers' of pregnancies, rather than for 'limiters'. Indeed, the former are more likely to show good compliance, since the sexual abstinence periods are limited and an unwanted pregnancy is not regarded as a completely negative event.

Clinical Trials as Topic↗
PubMed1997

[Postmenopausal osteoporosis: therapeutic approaches].

The preventive and therapeutical measures to be implemented the post-menopausal osteoporosis are varied, although there is no clear, single protocol of intervention. ESTROGENS AND PROGESTOGENS: It si verify that the administration of estrogens and/or progestogens prevents bone loss with an action on mineral components of bone and on collagenic metabolism. BIPHOSPONATES: Operate inhibiting mineralization and, particularly, bone reabsorption. At present its use, in low dosages, is reserved to "fast bone loser" patients. CALCITONIN: It increases bone mass and significantly reduces the frequency of fractures in comparison with only calcium, but its use is limited by high costs. IPRIFLAVONE: Anti-reabsorption effects has on bone and stimulates osteoblastic activity; besides, it seems to developed the effect of estrogens on the bone. FLUORIDES: Fluorides also operate on both components of bone turnover, with a most important action on bone formation. An interesting approach is the association of low doses of monofluorophosphate with calcium. However, further confirmation of the "quality" of neoformed bone is necessary. CALCIUM: Calcium supplementation is obligatory where the alimentary supply of calcium is lower then 1 g/die or where an osteomalacic component coexists; only dosages higher than 15 g/die can produce/pharmacological effects on bone turnover. CALCITRIOL: The use is still disputed. The calcitriol-calcium association seems convincing haveved. ORG: OD 14. The efficacy of this synthetic steroid to prevent bone loss is probably superimposable on the efficacy of classic estrogen therapy.

Anabolic Agents↗
PubMed1997

Pregnancy and delivery in Ehlers-Danlos syndrome type V.

Ehlers-Danlos syndrome (EDS) is a hereditary dysplasia of connective tissue with an abnormal collagen synthesis. It is characterized by hyperelasticity and fragility of the skin, joint hyperlaxity and fragility of the blood vessels. We describe the problems reported during pregnancy and delivery in women with EDS. Our patient had a type V syndrome. Accurate monitoring during the course of pregnancy is necessary. We believe cesarean section more appropriate than vaginal delivery in order to avoid the risks related to the rupture of the pelvic and perineal vessels which may be difficult to suture.

Adult↗
PubMed1996

Late complications after systemic methotrexate treatment of unruptured ectopic pregnancies: a report of three cases.

BACKGROUND: The use of methotrexate (MTX) by systemic administration in the treatment of unruptured ectopic pregnancy has been reported as a safe and effective method. CASES: We report three cases (one hematosalpinx and two pelvic hematocoeles) of complications after the use of MTX in the treatment of unruptured ectopic pregnancies. All three cases came to our observation for pelvic pain, abnormal bleeding and a pelvic mass after an interval of 3-5 months, subsequent to the disappearance of symptoms and normalization of serum human chorionic gonadotropin beta-subunit (beta-hCG) levels. CONCLUSIONS: These findings suggest that: (a) such complications should be considered before selecting the mode of treatment for ectopic pregnancy; and (b) that an early ultrasonographic control should be performed after MTX treatment even when the decline in beta-hCG levels suggests a successful resolution. This would permit an early diagnosis of these late complications.

Adult↗
PubMed1996

Fetal fibronectin as a screening test for premature delivery in multiple pregnancies.

OBJECTIVE: To evaluate fetal fibronectin as a screening test for premature delivery in asymptomatic women with multiple pregnancies. METHODS: In the mid-second trimester, the concentrations of fetal fibronectin in the cervical and vaginal secretions of 68 patients with multiple gestations were sampled weekly by monoclonal antibody immunoassay in order to predict preterm labor. RESULTS: The results for the prediction of preterm labor differ according to whether we consider a single positive result (fetal fibronectin > 50 ng/ml) as predictive of preterm labor or whether we only consider at least two consecutive positive results as predictive of perterm labor. The fetal fibronectin test had a sensitivity for preterm birth before 37 weeks of 90.9% and 86.6%, respectively, with a specificity of 68.5% vs. 78.9% and a positive and negative values of 73.1% vs. 76.4% and 88.8% vs. 88.2%, respectively. Similar results were obtained for perterm birth before 34 weeks. CONCLUSIONS: In a condition such as multiple pregnancy which is already at risk for premature delivery the possibility of raising the specificity of the test with virtually no decrease in sensitivity guarantees better recognition of patients likely to develop premature labor. This possibility can be achieved simply by considering two positive consecutive samples as predictive of preterm labor.

Female↗
PubMed1996

Salmon calcitonin plus intravaginal estriol: an effective treatment for the menopause.

OBJECTIVE: Intravaginal estriol (E3) effectively improves postmenopausal genito-urinary disturbances, without stimulating endometrial proliferation. The aim of the present study was to evaluate the effect of intravaginal estriol (E3) plus nasal spray salmon calcitonin (sCT), to improve neurovegetative symptoms and to prevent the decline of bone mineral density (BMD) of postmenopausal women. METHODS: Two hundred and fourteen (214) healthy postmenopausal women were treated for 12 months with: (1) E3 (0.5 mg every other day) + Ca (0.5 g/day); (2) E3 + Ca + sCT (50 IU x 2/day); (3) sCT + Ca; (4) Ca. Climacteric complaints, such as hot flushes and sweating, BMD at the distal 1/10 of the radius, analyzed by dual photon absorptiometry, urinary excretion of hydroxyproline and serum alkaline phosphatase were evaluated at baseline and every 6 months. At the same time, patient compliance and drug tolerability were evaluated. RESULTS: E3 but not sCT, improved hot flushes and sweating. E3 blunted but not completely counteracted the BMD decline observed in women treated with only Ca, and reduced urinary hydroxyproline excretion. sCT markedly increased BMD values and reduced both urinary hydroxyproline excretion and serum alkaline phosphatase. These effects were not potentiated by E3 coadministration. All treatments were well tolerated. CONCLUSIONS: Present data indicate that the combined administration of intravaginal E3 and sCT may represent an alternative therapeutic regimen for those postmenopausal women who do not accept or have contraindications to classical hormone replacement therapy.

Absorptiometry, Photon↗
PubMed1996

Finasteride in the treatment of hirsutism: new therapeutic perspectives.

OBJECTIVE: To determine of the clinical and hormonal effects of finasteride (Proscar; Merck, Sharp, and Dohme, Rahway, NJ) in the treatment of idiopathic hirsutism and hirsutism in patients with polycystic ovary syndrome (PCOS). DESIGN: Controlled clinical study. SETTING: Istitute of Obstetrics and Gynecology, University of Naples "Federico II." PATIENTS: Ten women affected by idiopathic hirsutism and 15 women with PCOS. INTERVENTIONS: Finasteride was administered orally at a daily dose of 5 mg for a period of 6 months. MAIN OUTCOME MEASURES: Rating of hirsutism with the Ferriman-Gallwey method; serum androgen assays. RESULTS: Finasteride produced a reduction in the average hirsutism scores ( > 50% in all patients), whereas no change was observed in serum T, androstenedione, and DHEAS levels. A significant reduction was measured in serum dihydrotestosterone and 3 alpha, 17 beta-androstenediol glucuronide levels. CONCLUSIONS: This study demonstrates that symptomatic hirsutism has to be considered as a skin disease associated with the increased activity of the 5 alpha-reductase. It also indicates that the selective 5 alpha-reductase inhibitor, finasteride, is very effective and well tolerated in the treatment of both idiopathic hirsutism and of hirsutism in patients with PCOS.

Adult↗
PubMed1996

Changes of plasma calcitonin gene-related peptide levels in postmenopausal women.

OBJECTIVE: Our purpose was to investigate whether the secretion of a cardiovascular hormone, calcitonin gene-related peptide, is modified in climateric women according to cardiovascular adaptive responses. STUDY DESIGN: Plasma calcitonin gene-related peptide levels were measured in climateric women in a basal condition (n = 15), in response to an upright position (n = 8), and during hot flushes (n = 12). The effect of hormonal replacement therapy on plasma calcitonin gene-related peptide was also studied (n = 9). Plasma calcitonin gene-related peptide levels were measured by a specific radioimmunoassay after an acidic extraction. RESULTS: Plasma calcitonin gene-related peptide levels in postmenopausal women were significantly lower than in the control group (p < 0.01). After the women assumed an upright posture, a lack of plasma calcitonin gene-related peptide increase was observed in control fertile women, who showed the typical significant hormonal increase (p < 0.01). In all patients the occurrence of hot flushes was associated with a significant and rapid increase of plasma calcitonin gene-related peptide levels. After 3 months of hormonal replacement therapy basal plasma calcitonin gene-related peptide levels returned to the range of healthy fertile women. CONCLUSIONS: The current data show that the secretion of plasma calcitonin gene-related peptide is lower in postmenopausal women and its response to postural stimulus is impaired. Vasomotor changes are associated with an increase of plasma levels of this cardiovascular hormone. An effect of hormonal replacement therapy on calcitonin gene-related peptide secretion has been shown.

Calcitonin Gene-Related Peptide↗