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Biomedical subjects

C Romanini

Publications and source records attributed to C Romanini.

At least 145 records · Page 8Linked to original sources
PubMed1993

Second-trimester uterine artery flow velocity waveform and oral glucose tolerance test as a means of predicting intrauterine growth retardation.

The absence of a rise in maternal serum glucose level during the course of a 3-h glucose tolerance test was noted in pregnancies that resulted in growth-retarded infants. It was postulated that this response to an oral glucose load, in association with increased impedence to uterine artery blood flow, as demonstrated by color flow Doppler waveforms, could select the pregnancies at greater risk of developing intrauterine growth retardation. One hundred and four uncomplicated primigravidae and 88 multigravid women considered to be at high risk of developing intrauterine growth retardation were monitored longitudinally from the 24th week of gestation. The right and left uterine artery resistance indices (RI) were measured at 24 weeks by means of pulsed Doppler with color flow imaging, and the results were averaged. The following week, an oral glucose tolerance test (OGTT) was performed. Serum glucose was measured immediately prior to the ingestion of 100 g glucose, and again after 60, 120 and 180 min. The OGTT results were classified as normal, impaired glucose tolerance, gestational diabetes mellitus, and flat. This last result was indicated by a less than 20% rise in serum glucose compared to the fasting value.A notch in the uterine artery waveform and/or an RI greater than 0.58 (> 2 SD above the mean) was found in 39 (20.3%) women. A flat response to the OGTT was seen in 31 (16.1%) cases. Of the 16 women in whom both a high RI and a flat OGTT response curve were demonstrated, 15 (93.7%) delivered low-birth-weight babies due to intrauterine growth retardation. Eight of these 16 women developed hypertension. In the group with a flat OGTT response curve but normal uterine artery RI, two of the 15 women (13.3%) had growth-retarded babies. The positive predictive value of an increased RI with a flat OGTT response curve was 94%, while the predictive values of each individual method were 62% and 55%, respectively, for development of intrauterine growth retardation.Increased resistance to blood flow in the uteroplacental circulation in conjunction with a flat response curve to an oral glucose load might identify a group of pregnant women at risk of having a growth-retarded infant with or without the development of hypertension.

Journal Article↗
PubMed1993

Effects of maternal hyperoxygenation on ductus venosus flow velocity waveforms in normal third-trimester fetuses.

On the basis of the data obtained in sheep fetuses showing a high interdependence between umbilical vein oxygenation and ductus venosus flow, we investigated the effect of maternal hyperoxygenation on ductus venosus velocity waveforms in normal third-trimester human fetuses. Ductus venosus velocity waveforms were recorded by using color and pulsed Doppler ultrasonography before and after 15 min of maternal administration of humidified 60% oxygen. During maternal hyperoxygenation, there was a significant increase of both estimated peak velocities during systole, diastole and atrial contraction and the mean temporal velocity during the total cardiac cycle and systolic and diastolic portions. On the other hand, during maternal hyperoxygenation, no significant changes were found in fetal heart rate or in the ratios between peak velocities and mean temporal velocities during systole and diastole. These findings suggest a close relationship between fetal oxygenation and ductus venosus velocity waveforms that may be useful in monitoring fetal hypoxemia.

Journal Article↗
PubMed1993

Doppler velocimetry of the uterine artery as a screening test for gestational hypertension.

Doppler ultrasound was used to study the main uterine artery flow velocity waveforms in an unselected population of 272 primiparous women at 22 weeks' gestation. The incidences of subsequent complications were as follows: gestational hypertension alone, 4.4%; intrauterine fetal growth retardation alone, 4%; and gestational hypertension with intrauterine growth retardation, 3.6%. The flow velocity waveform was considered abnormal when the resistance index in the uterine artery was greater than 0.58. This identified 9.5% of the population as 'at risk' and predicted either of the above outcomes with an overall sensitivity of 74% (kappa index, 0.72). The sensitivity of prediction for gestational hypertension alone was 50% while for proteinuric gestational hypertension it was 88%. The best result was obtained for the prediction of pregnancies affected by both gestational hypertension and intrauterine growth retardation, where the sensitivity was 100%.

Journal Article↗
PubMed1993

The development of abnormal heart rate patterns after absent end-diastolic velocity in umbilical artery: analysis of risk factors.

OBJECTIVES: Our objectives were to evaluate the time interval elapsing between the occurrence of absent end-diastolic velocity in the umbilical artery and either the development abnormal fetal heart rate patterns or delivery and to establish the maternal and fetal factors that may affect this interval. STUDY DESIGN: Thirty-seven fetuses free of structural and chromosomal abnormalities in which the development of absent end-diastolic velocity in umbilical artery was evidenced by serial Doppler recordings were studied. At the first occurrence the following factors were considered: gestational age, presence of hypertension or preeclampsia, amniotic fluid index, severity of growth retardation, and 10 different Doppler indices calculated from extracardiac and intracardiac vascular districts. Actuarial statistical methods were applied, with the occurrence of antepartum late heart rate deceleration as the censoring variable. RESULTS: The interval between the first occurrence of absent end-diastolic velocity in umbilical artery and delivery ranged from 1 to 26 days. Indications for delivery were the development of antepartum late heart rate decelerations in 23 fetuses (62.1%) and different maternal or fetal complications in the remaining 14 fetuses. Multivariate analysis revealed that gestational age and the presence of hypertension and pulsations in umbilical vein were the dominant factors in determining the length of this time interval. CONCLUSION: The duration of the time interval between the occurrence of absent end-diastolic velocity in umbilical artery and abnormal heart rate pattern differs considerably among fetuses, and it is mainly determined by gestational age and presence of maternal hypertension and pulsations in umbilical vein.

Blood Flow Velocity↗
PubMed1993

Analysis of risk factors influencing imminent distress in growth-retarded fetuses undergoing oxygen test.

We previously demonstrated a prognostic significance of maternal oxygen test in predicting imminent fetal distress. The purpose of this study was to investigate eventual other factors related to the length of the time interval elapsing between the Doppler diagnosis of brain sparing effect and abnormal fetal heart rate patterns. To this end we considered 101 growth-retarded fetuses free of structural and chromosomal abnormalities with a ratio between the pulsatility indices of umbilical and middle cerebral artery above the 95th centile in presence of a normal fetal heart rate pattern. The factors, other than the oxygen test, analyzed for a potential influence on this time interval were gestational age, presence of hypertension or preeclampsia, amniotic fluid index, severity of growth retardation (centile of the ultrasonographic estimated fetal weight) and 9 different Doppler indices calculated from extra- and intracardiac districts. Statistical actuarial methods were used to determine the effect of these prognostic factors on the duration of this time interval. The occurrence of abnormal fetal heart rate patterns (antepartum late heart rate decelerations) was used as censoring variable. The time interval between the entry in the study and delivery ranged from 1 to 39 days. Indications for delivery were fetal distress in 53 fetuses (52.4%) and different maternal or fetal complications in the remaining 48 fetuses.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1993

Natural killer cell activity and progression-free survival in ovarian cancer.

A longitudinal evaluation of the natural killer (NK) cell activity of peripheral blood lymphocytes was performed in 17 patients with advanced ovarian cancer (treated surgically and with subsequent multiagent chemotherapy) for a median follow-up period of 32 months. At the time of primary treatment, the mean value of NK cell activity was significantly lower in patients who then had disease progression (p < 0.05) than in patients with progression-free survival. During the follow-up period, no significant modifications of the NK cell activity were observed; only at the time of clinical disease progression did the NK cell activity show a significant reduction. We conclude that the NK cell activity is a potentially important prognostic factor.

Adenocarcinoma↗
PubMed1993

The trend of erythrocyte sodium parallels the pattern of diastolic blood pressure in preeclampsia.

OBJECTIVE: To describe the trend of intracellular sodium in patients who develop preeclampsia. STUDY DESIGN: In this longitudinal study, we determined intraerythrocyte sodium (Nai) in 303 primigravid pregnancies every fourth week from gestational week 10 through week 38. The study group included 274 normotensive and 29 chronic hypertensive gravidae. During the study, 26 normotensive and six chronic hypertensive pregnant women developed preeclampsia. RESULTS: Chronic hypertensives showed higher baseline intraerythrocyte sodium, compared to the normotensives. The women who developed preeclampsia demonstrated a significant increase in Nai concentration from 26-30 weeks onward. Data from blood pressure recordings paralleled data from Nai. CONCLUSION: Due to the possible role of Nai on intracellular free calcium mobilization, our findings support a possible involvement of defective cell membrane function in the development of preeclampsia.

Blood Pressure↗
PubMed1993

Uterine artery Doppler velocity waveforms in twin pregnancies.

OBJECTIVE: To compare uterine artery resistance index values in twin and singleton pregnancies, to examine eventual modifications of these values in twin pregnancies complicated by gestational hypertension and preeclampsia, and to determine whether resistance index values in twin pregnancies could predict the development of gestational hypertension and preeclampsia. METHODS: In a cross-sectional study, reference limits for gestation were constructed for the uterine artery resistance index (higher, lower, and mean values) in 96 uncomplicated twin pregnancies and compared to the reference limits constructed from 315 normal singleton pregnancies. Uterine artery resistance indexes obtained in 53 twin pregnancies complicated by either gestational hypertension or preeclampsia were compared with the newly established nomograms. The clinical efficacy of the uterine artery resistance index to predict hypertensive complications was evaluated prospectively in 64 twin pregnancies studied at 20-24 weeks' gestation. RESULTS: In both singleton and twin pregnancies, uterine artery resistance indexes decreased linearly with advancing gestation. However, twin pregnancies showed significantly different slopes and constant values, resulting in lower resistance indexes at all gestational ages examined. No significant differences were found when comparing resistance indexes in all patients with gestational hypertension or preeclampsia to the reference limits. Statistically significant differences were obtained for the higher (P < or = .05) and mean (P < or = .01) resistance indexes when the comparison was restricted to preeclamptic patients. In the twin pregnancies studied at 20-24 weeks' gestation, the diagnostic efficacy of the uterine artery resistance index for predicting the development of gestational hypertension and/or preeclampsia was disappointingly low (k < 0.10). CONCLUSIONS: Resistance index values in the uterine artery are lower in twin pregnancies than in singleton pregnancies. Gestational hypertension and preeclampsia may occur in twin pregnancies despite normal uterine artery velocity waveforms, suggesting a limited role of this measurement in the management and prediction of hypertensive complications in twin pregnancies.

Arteries↗
PubMed1993

Cultured human trophoblast cells reproduce the initial events of placental biology.

OBJECTIVE: The objective of this study was to determine whether cultured trophoblast cells shared the same morphological and biological properties observed in trophoblast, in vivo. STUDY DESIGN: Trophoblast cells from human term placenta were cultured, morphologically, biochemically and immunochemically monitored for as long as 30 days. RESULTS: Single cells progressively aggregated and fused into a syncytio, the Ca2+ and the Ca(2+)-ATPase activity drooped, and the 72 kDa collagenase (MMP-2) was consistently expressed. CONCLUSIONS: Term placenta trophoblast cultures can be viewed and used as a model system mimicking morphological and biochemical events of placenta biology and differentiation.

Calcium↗
PubMed1993

Altered lipid composition, increased lipid peroxidation, and altered fluidity of the membrane as evidence of platelet damage in preeclampsia.

OBJECTIVE: To assess lipid composition, lipid peroxidation, and fluidity of the membrane of platelets from preeclamptic women. METHODS: We studied 40 primigravid women at 28-32 weeks' gestation; 20 were preeclamptic and 20 were normotensive. After preparing platelet membranes, we extracted lipids, measured cholesterol and phospholipid concentrations, and calculated the proportion of unsaturated to saturated fatty acids. Lipid peroxides expressed as conjugated dienes were determined by spectrophotometry. Membrane fluidity was determined by means of fluorescent lipophilic probes. Statistical analysis was performed by the Student t test, with significance at P < .05. RESULTS: Cholesterol concentration, cholesterol-to-phospholipid ratio, the amount of unsaturated fatty acids, conjugated dienes, and membrane fluidity significantly increased in platelets from preeclamptic patients as compared with the normotensive women. CONCLUSIONS: The discrepancy between cholesterol increase and membrane fluidity increase is consistent with the increase in unsaturated fatty acid content. In the platelet membrane, unsaturated fatty acids constitute the larger substrate for lipid oxidation and can also take part in the formation of thromboxane. Therefore, platelet membrane damage in preeclampsia, through imbalance of thromboxane A2/prostacyclin production, may contribute to the onset or maintenance of vasoconstriction and hypertension.

Adult↗
PubMed1993

Natural killer cell activity in endometriosis: correlation between serum estradiol levels and cytotoxicity.

OBJECTIVE: To evaluate the correlation between natural killer cell activity and serum estradiol (E2) levels in patients with different stages of endometriosis. METHODS: Natural killer cell activity of peripheral blood lymphocytes and serum E2 levels were evaluated in 73 women who underwent laparoscopy for pelvic pain, infertility, and benign adnexal masses. RESULTS: The 33 patients (45%) with endometriosis showed a significant decrease in natural killer cell activity in relationship to an increase in disease stage (correlation coefficient r = -0.83, P < .001). A significant inverse relationship was observed between cytotoxicity and serum E2 levels (correlation coefficient r = -0.89, P < .001). CONCLUSION: The relationship between natural killer cell activity and serum E2 levels suggests that an immunoendocrine interaction plays an important role in the progression of endometriosis.

Adult↗
PubMed1993

Endometrioid carcinoma of the ovary. Retrospective study.

From 1985 to 1991, 9 patients with endometrioid carcinoma of the ovary were treated and followed at the University of Ancona, Department of Gynecology and Obstetrics. Four patients (44.4%) had Stage I disease, 1 (11.1%) Stage II, 1 (11.1%) Stage III and 3 (33.3%) Stage IV. Six patients (66.6%) had grade 2 of the disease and 3 (33.3%) grade 3. Two of the patients (22.2%) had synchronous endometrial carcinoma while 3 had histologic evidence of endometriosis at the time of presentation. All the patients received treatment of combination of surgery, polychemotherapy, hormone and/or immunotherapy. The overall survival rate after a median follow up of 26.6 months was 66.6%. A high survival (100%) was observed for patients with associated endometriosis.

Adenocarcinoma↗
PubMed1992

Changes in membrane fluidity and Na+/K(+)-ATPase activity during human trophoblast cell culture.

The human placenta plays an essential role in embryo development, in particular regulating the transport of ions, nutrients and immunoglobulins from the maternal to the fetal circulation. Trophoblast organization into a syncytial layer involves structural and functional steps that may be monitored and elucidated by in vitro studies. The structural stages by which the syncytial trophoblast is formed are not yet understood. In order to clarify the mechanism of trophoblast development, we studied the morphological characteristics of the syncytial trophoblast formation in culture and the functional changes (transport properties and membrane microviscosity) accompanying the structural modifications. By using both 5-nitroxystearate and 16-nitroxystearate as spin labels, we observed an initial increase in membrane order over 0-24 h of culture, which can be associated with two events: recovery of cell membranes from trypsin and initial aggregation of cytotrophoblasts. The similar behaviour of the order parameters determined with both probes indicates that membrane order changes both inside and in the outer part of the lipid bilayer. The subsequent decrease in membrane order observed at 36-48 h might be related to the process of cellular fusion. The increase in sodium/potassium pump activity in the first 24 h of culture might be an expression of cell recovery following trypsin treatment. The subsequent decrease might represent an adaptive mechanism by which metabolic energy is mainly used for morphogenetic changes.

Cells, Cultured↗
PubMed1992

Modifications in platelet membrane transport functions in insulin-dependent diabetes mellitus and in gestational diabetes.

The pathogenesis of plasma membrane alterations present in diabetes mellitus is unclear. To add new insights to the question, platelet membrane properties were evaluated in 16 women presenting impaired glucose tolerance at the 28-29th week of gestation (GDM) and in 8 women with insulin-dependent diabetes mellitus (IDDM). 15 healthy pregnant women (HPW) and 21 healthy non-pregnant (HNPW) women were the control group for GDM and IDDM, respectively. Pregnancy (HPW vs. HNPW) provoked an increase in Ca(2+)-ATPase activity and a decrease in membrane fluidity; in contrast, Na+/K(+)-ATPase, intracellular free Ca2+ concentrations, membrane cholesterol and phospholipid content did not vary. Both GDM and IDDM showed lower Na+/K(+)-ATPase activity and higher Ca2+ concentration, compared to HPW and HNPW, respectively, whereas Ca(2+)-ATPase activity was higher only in IDDM; furthermore, membrane fluidity was lower in GDM and higher in IDDM. Finally, GDM showed higher membrane cholesterol content. Both GDM and IDDM showed a very good metabolic control so that variations reported cannot be due to hyperglycemia; it is tempting to suggest that membrane variations are present before the clinical metabolic alteration. Furthermore, both GDM and IDDM were on insulin therapy, therefore: (i) insulin may be the pathogenetic factor of higher intracellular free Ca2+ concentrations and lower Na+/K(+)-ATPase activity since they both varied accordingly in GDM and IDDM, but not of (ii) changes in Ca(2+)-ATPase, membrane fluidity and cholesterol content which did not vary accordingly in GDM and IDDM.

Adult↗
PubMed1992

Amiodarone treatment in pregnancy for dilatative cardiomyopathy with ventricular malignant extrasystole and normal maternal and neonatal outcome.

Amiodarone treatment in pregnancy might be difficult to handle because of the long half-life of the drug (14-28 days up to 2 months) and because it reduces maternal and neonatal thyroid activity. Although short-term use in pregnancy has been described in cases of fetal supraventricular tachycardia, there are few reports on the chronic use of the drug. In this paper we describe our experience with amiodarone treatment in two pregnant sisters with familial dilatative cardiomyopathy and ventricular malignant extrasystole. Prolonged administration of amiodarone (400-200 mg/die) since the beginning of pregnancy did not have any adverse effects; maternal and neonatal thyroid function was normal, as was the neurological and motor development of the neonates.

Adult↗
PubMed1992

Uterine motility in patients with bicornuate uterus.

This study analyzes uterine motility in 12 women with a bicornuate uterus using the results of the recordings of endo-uterine pressure, obtained with two balloon-closed catheters. Seven patients had symmetric uterine cavities, while the rest (5 patient) had very dissimilar ones. The registration of the uterine motility was carried out during various phases of the cycle and after the administration of two drugs (oxitocin and methylergobasine), with the following results: the bicornuate uterus has a spontaneous activity similar to that of a normal uterus. A similar contractile response was observed in the uteri with two anatomically symmetric horns, whereas a dissimilar response was typical of the uteri with marked anatomic differences between the two horns.

Catheterization↗