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Biomedical subjects

C Romanini

Publications and source records attributed to C Romanini.

At least 163 records · Page 9Linked to original sources
PubMed1992

Inferior vena cava flow velocity waveforms in appropriate- and small-for-gestational-age fetuses.

Reference ranges of inferior vena cava flow velocities were constructed from a cross-sectional study of 118 appropriate-for-gestational-age fetuses of 18 to 40 weeks of gestation. Blood flow velocity waveforms were recorded with color and pulsed Doppler equipment. Peak velocities and time velocity integrals were measured from inferior vena cava during systole, early diastole, and atrial contraction. The systolic-to-diastolic ratios between the peak velocities and time velocity integrals were calculated, and the reverse flow with atrial contraction was quantified as the percentage of forward flow (percentage of reverse flow). Recordings were also obtained from 79 small-for-gestational-age fetuses free of structural and chromosomal abnormalities, divided into three groups according to umbilical artery velocity waveforms: normal pulsatility index values (group 1, n = 26), pulsatility index greater than 95th percentile of our reference limits but presence of end-diastolic velocities (group 2, n = 33), and absence of end-diastolic velocities (group 3, n = 20). Fourteen fetuses of groups 2 and 3 were also studied at weekly intervals until the onset of antepartum late heart rate decelerations. In appropriate-for-gestational-age fetuses no changes were evident in peak velocities and time velocity integrals ratios, whereas the percentage of reverse flow significantly decreased with gestation. No significant differences were found between these values and those obtained in small-for-gestational-age fetuses of group 1. A significant increase of peak velocities and time velocity integrals ratios and of percentage of reverse flow was evidenced in fetuses of both group 2 and 3. The fetuses of groups 2 and 3 with a percentage of reverse flow above the 95% confidence interval showed a poorer perinatal outcome when compared with the fetuses of the same groups but with values inside the normal range. In the 14 fetuses longitudinally followed up until the onset of late heart rate decelerations a significant and progressive increase of peak velocities and time velocity integrals ratios and percentage of reverse flow was evidenced in spite of minimal changes in the pulsatility index from both umbilical artery and different peripheral fetal vessels. This study presents evidence that in small-for-gestational-age fetuses with abnormal Doppler-measured placental resistance the modified flow velocity patterns in the inferior vena cava seem to deteriorate progressively with advancing gestation.

Blood Flow Velocity↗
PubMed1992

Umbilical vein pulsations: a physiologic finding in early gestation.

OBJECTIVES: The purpose of this study was to establish the incidence of umbilical vein pulsations in normal early pregnancies and to evaluate whether these pulsations are related to Doppler-measured vascular resistances in umbilical artery or central venous flow patterns. STUDY DESIGN: We performed a cross-sectional study on 257 uneventful pregnancies at 7 to 16 weeks of gestation by means of transvaginal color and pulsed Doppler ultrasonography. Blood flow velocity waveforms were recorded from the umbilical artery, umbilical vein and, in 48 cases, also from fetal inferior vena cava. RESULTS: Pulsations in the umbilical vein were evidenced in all cases until 8 weeks. From this gestational age on pulsations progressively disappeared, becoming completely absent at greater than or equal to 13 weeks. The incidence of pulsations in the umbilical vein was unrelated to umbilical artery pulsatility index values, the incidence of absent end-diastolic flow in umbilical artery, and fetal heart rate. In the inferior vena cava, reverse flow during atrial contraction was significantly higher (p less than or equal to 0.002) in cases with umbilical vein pulsations than in those cases without pulsations at a similar gestational age. CONCLUSIONS: Pulsations in the umbilical vein are physiologically present during the first trimester of pregnancy and seem to be related to inferior vena cava flow patterns.

Adult↗
PubMed1992

Magnesium pyrrolidone carboxylate infusion reduces angiotensin II pressor response in pregnant women at risk for hypertension.

OBJECTIVE: Our objective was to investigate the possible restoring action of magnesium on vascular sensitivity to angiotensin II in pregnancy. STUDY DESIGN: We studied intraplatelet free calcium and the pressor response to angiotensin II in 10 primigravid women (28 to 32 weeks' gestation) at risk for pregnancy induced hypertension on the basis of altered uteroplacental blood velocity waveforms at 20 weeks' gestation, before and after the infusion of 1 gm of magnesium pyrrolidone carboxylate. After the effective pressor dose was achieved or a maximum of 32 ng/kg per minute was reached, we infused 1 gm magnesium pyrrolidone carboxylate and repeated the test. Intraplatelet free calcium was measured by means of fluorescent probes at the beginning and the end of both tests. RESULTS: Six women were classified as refractory to angiotensin II and four as sensitive (effective pressor dose < 10 ng/kg per minute). After magnesium pyrrolidone carboxylate infusion, the four sensitive women became refractory and the effective pressor dose was significantly enhanced to 32 in all six refractory women. Intracellular free calcium increased significantly during the first angiotensin II infusion, whereas after magnesium pyrrolidone carboxylate administration it did not change significantly. CONCLUSIONS: Magnesium pyrrolidone carboxylate enhances the vascular refractoriness and intracellular free calcium mediates the pressor response to angiotensin II in pregnancy.

Adult↗
PubMed1992

Nifedipine treatment in preeclampsia reverts the increased erythrocyte aggregation to normal.

OBJECTIVES: Our objectives were to assess erythrocyte aggregation in hypertensive pregnancy and to evaluate the effect of the antihypertensive treatment on it. STUDY DESIGN: The mean entity of erythrocyte aggregation was determined by an automatic aggregometer in 57 pregnant women: 20 normotensive, seven chronically hypertensive, 10 chronically hypertensive with superimposed preeclampsia, and 20 with preeclampsia. Ten of the latter were subsequently treated by 40 mg/day oral nifedipine; the other 10 by 400 mg/day oral labetalol, to keep diastolic blood pressure < 90 mm Hg. Also, patients with superimposed preeclampsia were treated with 40 mg/day oral nifedipine. RESULTS: Erythrocyte aggregation was increased in all the hypertensive pregnant patients compared with the normotensive pregnant controls, regardless of both the onset (chronic or pregnancy-induced) of hypertension and the status of plasma macromolecules. Antihypertensive treatment with labetalol significantly reduced the aggregability of erythrocytes, whereas treatment with nifedipine reverted it to normal. CONCLUSIONS: Increased erythrocyte aggregation may be due to either conformational changes of the membrane occurring during hypertension or a redistribution of the ionic charges on the two surfaces of the membrane. The effect of nifedipine by restoring the ionic charges may be due to this latter event.

Erythrocyte Aggregation↗
PubMed1992

Placental villi-decidua interactions in normal and hypertensive pregnancies: a morphological quantitative study.

The decidual response to the implantation of the embryo is characterized by physical modifications to the uterine wall, with proliferation of the stromal cells which later change into decidual cells. We performed associated morphological and morphometrical studies to assess how the placental villi and decidua intersect, both in normal terminal pregnancy and in hypertensive patients in whom microenvironmental modifications induced by hypertension may cause significant alterations in mother-fetus relationships. In placentas of hypertensive women our morphometric analyses showed a higher number of chorionic villi-decidua interactions (p less than 0.05) with a more clumped distribution (p less than 0.05) and a smaller surface area of single interaction (p less than 0.001), in association with a higher number (p less than 0.005), and greater areas (p less than 0.01) of decidual cells. These data demonstrate how the placenta can enhance mother-fetus contacts impaired as the result of a hypertensive condition.

Chorionic Villi↗
PubMed1992

Natural killer cell activity in patients with gynecologic malignancies: correlation with histologic grading and stage of disease.

Basal natural killer (NK) cell activity in peripheral blood lymphocytes (PBLs) of 29 patients with gynecologic malignancy and 10 healthy controls was performed using K 562 cell line. A significant decrease of NK cell activity was observed in patients with gynecologic malignancy (p = 0.003). The NK cell activity of patients with poorly differentiated tumor or with stage IV of disease was significantly reduced with respect to patients at any other lower grade or earlier stage. We conclude that in patients with gynecologic malignancies there is a decrease of basal NK cell activity of PBLs, which is more significant in cases of distant tumor dissemination or poorly differentiated tumor (p less than 0.001).

Adult↗
PubMed1992

Lymphocyte subset and NK activity in cervical intra-epithelial neoplasia.

We have studied the systemic T-lymphocyte subset and, in particular, the natural-killer (NK) activity in 23 patients with cervical intra-epithelial neoplasia (CIN), and 11 controls (a history of normal cervical PAP smears and colposcopy patterns). The lymphocyte phenotypes were studied using a panel of monoclonal antibodies, and NK activity was evaluated as the percentage lysis of K 562 target cells. In patients with CIN we found a significant decrease in NK activity (p = 0.002) which was directly correlated with the grade of CIN, with no alterations in the absolute number of NK cells.

Adult↗
PubMed1992

Decrease of cellular growth potential in "in vitro" culture of amnions with premature rupture of membranes.

The "in vitro" cellular growth of 8 amniotic membranes from preterm deliveries with premature rupture of membrane (PROM) in absence of risk factors as cervical or vaginal infection (microbiologic negativity), cervical incontinence and other mechanical factors, was compared with cellular growth of 9 amnions from preterm deliveries without PROM. Amniotic membranes were set up in the Eagle basal medium with Earle salts and heat-inactivated fetal bovine serum (10%), gentamicin 50 micrograms/ml and amphotericin B 0.5 micrograms/ml. The results suggested that the growth potential of the cells (epithelial cells and fibroblasts) obtained from amnions with PROM was lower than that of cells obtained from amnions without PROM. We postulated that the premature rupture of membranes in patients without risk factors for PROM, would be conditioned by an intrinsic decrease of cellular growth potential.

Amnion↗
PubMed1992

Lymphocyte subset in HPV infection.

The outcome of HPV infection and its progression to neoplastic disease may be conditioned by the immune status of patients. In the present study we observed the systemic lymphocyte subset, with particular regard to NK cells and NK activity in 7 patients with HPV infection. The lymphocyte phenotypes in peripheral blood were studied using a panel of monoclonal antibodies, while NK activity was evaluated as percentage of lysis of K 562 target cells. We noticed a significant decrease of basal NK activity especially in patients with HPV 16-18 infection (p less than 0.001), without any difference in the absolute number of these cells.

Adolescent↗
PubMed1992

Paget's disease of the vulva: advantages of demolitive surgery.

Four patients with vulvar Paget's disease were analysed retrospectively. In all cases the clinical manifestation was typical, with pruritus and visible lesion. None of the cases had a palpable cutaneous or subcutaneous mass but at the histologic exam a minimally invasive Paget's disease was detected. Treatment consisted of total vulvectomy and subsequent new reconstructive time; only one patient with clinically localized disease was treated with simple vulvectomy. Postoperative complications were minimal, thanks to the reconstructive time that assured a rapid recovery of the surgical injury and reconstruction of the urethral and vaginal meatuses. In all cases we obtained the complete removal of the lesion (negativity of resection margins), except in one case that was also the only one to have a recurrence after 40 months. The patients have been followed for an average of 58 months. Considering the results, we suggest demolitive surgery with subsequent reconstructive time in the treatment of vulvar Paget's disease.

Aged↗
PubMed1992

Immuno-biologic integration for therapeutic approach in ovarian carcinoma.

The "in vitro" cell growth of 14 ovarian carcinomas was evaluated and related with the clinical-pathologic stage (FIGO) and grade of histologic differentiation of disease, with the patients' immunological pattern and with the relapse and survival rates. We identified 4 different patterns of "in vitro" cell growth (P1, P2, P3 and P4). Their correlation with the clinical-pathologic stages of disease as well as with the recurrence and survival rates was strong: 75% of recurrences in pattern P3 and 100% in pattern P4, while tumours with patterns P1 and P2 did not relapse. Similar results were obtained for survival, in fact 2 of the 3 patients who died from disease had cell growth pattern P4, and the other a P3. A significant correlation was found with basal natural killer cell activity of peripheral blood lymphocytes too: in patients with P1 neoplasia the basal NK cell activity was significantly higher (p < 0.05) while it was significantly lower (p < 0.05) in patients with P4 neoplasia in comparison with the others. We conclude that the "in vitro" biological behaviour of ovarian neoplasia can be regarded as prognostic factors even if patients' basal NK activity represents the most significant prognostic element, directly related to the recurrence rate (p = 0.002).

Adolescent↗
PubMed1992

Accelerated cardiac growth and abnormal cardiac flow in fetuses of type I diabetic mothers.

OBJECTIVES: To determine the growth patterns of the fetal heart and the development of cardiac function during gestation in fetuses of diabetic mothers, and to compare these findings with those of normal fetuses. METHODS: Serial M-mode and Doppler echocardiographic recordings were made at 4-week intervals in 14 fetuses of well-controlled type I insulin-dependent diabetic mothers and in ten control fetuses at 20-36 weeks' gestation. The following variables were measured: interventricular septal thickness, left ventricular wall thickness, right ventricular wall thickness, ratio between the peak velocities during early passive ventricular filling and active atrial filling at the level of the atrioventricular valves, peak velocities, and time to peak velocity at the level of the ascending aorta and pulmonary artery. RESULTS: In both groups of fetuses, all of the indices increased linearly with gestation. However, fetuses of diabetic mothers showed significant differences in the slope and intercept values for the function describing the growth of the interventricular septum (P less than or equal to .001) and the right and left ventricular wall thicknesses (P less than or equal to .01), resulting in accelerated cardiac growth. The function describing the development of the ratios between early and active ventricular filling showed differences in slope and intercept values at the level of both the mitral (P less than or equal to .001) and tricuspid valves (P less than or equal to .001), resulting in a lower rate of increase during diabetic pregnancy when compared with control fetuses. Significantly higher intercept values were found in the functions describing the increase of peak velocities in the aorta and pulmonary artery in fetuses of diabetic mothers (P less than or equal to .01), whereas the slopes were similar to those of control fetuses. No differences were found in the time to peak values between the groups of fetuses. No relationships were found between the echocardiographic results and the metabolic control of pregnancy or fetal characteristics. CONCLUSIONS: This study suggests that strict maternal diabetes control does not exclude accelerated fetal cardiac growth and abnormal development of cardiac function.

Adult↗
PubMed1992

Changes of pulsatility index from fetal vessels preceding the onset of late decelerations in growth-retarded fetuses.

Thirty-six growth-retarded fetuses selected from a population of 214 cases were studied by Doppler ultrasonography at weekly intervals for at least 4 weeks between the diagnosis of Doppler abnormalities suggestive of the existence of the brain-sparing effect (ie, ratio between umbilical artery and middle cerebral artery pulsatility indexes [PIs] above the 95th percentile of our reference limits) to the onset of antepartum late fetal heart rate (FHR) decelerations. Recordings were made from the umbilical artery, descending aorta, renal artery, internal carotid artery, and middle cerebral artery and the PIs were calculated. Statistically significant changes in PI occurred in all the vessels studied. However, different trends were found when the modifications in cerebral vessels were compared with those in fetal peripheral vascular beds and in the umbilical artery. In cerebral arteries, a nadir of vasodilatation was reached 2 weeks before the onset of antepartum late FHR decelerations, whereas significant changes in the peripheral and umbilical vessels occurred close to the onset of abnormal FHR patterns. This study demonstrates that despite a brain-sparing effect, there are further Doppler-detectable modifications in fetal circulation that differ between the cerebral and peripheral vascular beds.

Cerebrovascular Circulation↗
PubMed1992

Efficacy of leuprorelin acetate depot in symptomatic fibromatous uteri: the Italian Multicentre Trial.

A total of 110 nonmenopausal women (mean age 42.1 years) presenting with symptomatic uterine leiomyomata and/or fibromatous uteri have been enrolled in this trial to evaluate the efficacy of the depot formulation of leuprorelin acetate in decreasing uterine volume and minimizing menorrhagia, dysmenorrhoea and pressure over the bladder. All patients were treated with an intramuscular injection of leuprorelin acetate depot 3.75 mg every 4 weeks for 16 weeks. Clinical examinations and hormonal and ultrasound determinations were performed before, during and at the end of treatment. Appropriate follow-up is still ongoing for most patients. At the end of the treatment period, of 88 women with enlarged fibromatous uteri, 33 (37.5%) showed a decrease in uterine volume of greater than or equal to 50% of the original size, while nine (10.2%) remained with unchanged uterine volume. Of 80 fibromas measurable separately, 47 (52.8%) decreased by greater than 50% of the initial volume and 16 (18%) remained unchanged or even increased. During treatment, clinically advantageous effects were observed in the associated symptomatology, mainly in the production of amenorrhoea and restoration of normal haemoglobin levels. Most of the patients were affected by irregular menstrual blood loss with consequent anaemia that in 29 patients was expressed by low levels of haemoglobin (mean 9.2 g/dl; SD 1.5; range 4.5-11.8 g/dl). By the end of the treatment, only one patient still had moderate vaginal blood loss. Haemoglobin levels rose to a mean value of 11.8 g/dl (SD 1.3; range 8.5-14.1 g/dl). Three patients (2.7%) failed to complete the 16-week treatment protocol, because of headache (one patient) and increased blood pressure (two patients). As a result of the treatment, of the 107 patients who were candidates for surgery and who were included in this study, only nine (8.4%) required surgery during leuprorelin acetate treatment. Of these, four operations were vaginal excision of the submucous myomata protruding into the cervix during treatment, and in five hysterectomy performed because of persistence of symptoms. In most patients the achievement of amenorrhoea minimized the fear of surgical emergency, facilitating an increased awareness of their clinical condition. With the exception of the three patients who dropped out, side effects were mild in all patients, consisting mainly of hot flushes, which were easily tolerated. In the following 8-12 months, the regrowth of uterine volume to original size has been usual in most of the 82 patients now in follow-up.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1992

Endometrioid carcinoma arising in endometriosis. Case report.

Malignant transformation arising in endometriosis has been reported in some cases. Following Sampson's criteria, about 0.7%-1% of all cases of endometriosis undergo malignant transformation and the ovary is the most frequent site. A case is reported of a patient with endometriosis which, after 10 years, grew into ovarian endometrioid carcinoma. The relationship between endometriosis and cancer suggests a radical treatment of endometriosis and a careful assessment of postmenopausal woman presenting reactivation signs.

Adenocarcinoma↗
PubMed1991

Doppler ultrasonography in early pregnancy does not predict adverse pregnancy outcome.

A transvaginal color and pulsed Doppler study was performed on 330 pregnancies at 7-16 weeks of gestation. Blood flow velocity waveforms were recorded from the main uterine arteries and their branches (arcuate and trophoblastic vessels) and from the umbilical arteries. The systolic/diastolic velocity ratio and the pulsatility index were calculated as indices of vascular resistance, respectively, at uterine and umbilical levels. A total of 282 patients had an uneventful pregnancy outcome, 19 developed an early pregnancy failure (missed abortion, n = 8; anembryonic pregnancy, n = 11) and 29 developed later complications such us hypertension (n = 10), fetal growth retardation (n = 13) or both n = 6). In normal pregnancies, Doppler-measured vascular resistances significantly decreased with advancing gestation at the level of both uterine and umbilical circulations. When the Doppler indices of the patients with early pregnancy failure or with later complications were compared to those of normal pregnancies, no evident differences were found in either of the vascular districts considered. However, in the patients who developed hypertension and/or fetal growth retardation, abnormal velocity waveforms were frequently present in uterine and umbilical arteries during second- or third-trimester examinations. Our results suggest a limited clinical value of Doppler velocimetry in early pregnancy.

Journal Article↗
PubMed1991

Cardiac function in fetuses of type I diabetic mothers.

Cardiac function was cross-sectionally studied by means of M-mode and Doppler echocardiography in 40 fetuses of mothers with well-controlled insulin-dependent diabetes at 20 to 38 weeks of gestation. These variables were measured: interventricular septal thickness, ratio between the peak velocities during early passive ventricular filling and active atrial filling at the level of the atrioventricular valves, peak velocities, and the time to peak velocity at the level of the ascending aorta and the pulmonary artery. The values obtained were compared with our reference limits for gestation. A significant increase of interventricular septal thickness that was unrelated to maternal glycosylated hemoglobin levels was evidenced. Early passive ventricular filling/active atrial filling ratios were significantly lower in fetuses of diabetic mothers than in control fetuses. These differences were significantly related to interventricular septal thickness. No significant modifications were found in either aortic or pulmonary peak velocities or in time to peak velocity values. These findings suggest that in spite of an adequate metabolic control an interventricular septal hypertrophy that affects cardiac diastolic function develops in fetuses of diabetic mothers.

Adult↗