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Biomedical subjects

E Cittadini

Publications and source records attributed to E Cittadini.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

Immunologic recurrent abortion: comparison between immunotherapies.

The Authors record the results in a group of patients with immunologic recurrent abortion (IRA) treated with two different immunoprophylaxis regimen. The first one is an active prophylaxis therapy with preparation and administration from donor mononucleates. According to their previous original experience, the Authors started giving high doses of IV-Ig (HD IV-Ig) in a second group of pregnant patients with the same diagnosis of immunologic recurrent abortion (IRA). The results of this not randomized study show better reproductive outcome in the group treated with use of HD IV-Ig.

Abortion, Habitual↗
PubMedDate not supplied

Assessment of blocking activity in patients with at least two consecutive spontaneous abortions.

The activity of the blocking factor (BF) was studied in 88 patients affected by recurrent abortion syndrome (RAS) by means of the determination of lymphocyte proliferation rate (LPR) in one-way mixed maternal-paternal lymphocyte cultures (MLC). Forty patients (45.5%) showed inadequate blocking activity (LPR greater than 80%). Pearson's correlation did not reveal any link between patient age and LPR (m2 = 0.031), or between LPR and number of aborted pregnancy (m20.058). Fifteen of the 88 patients had had only two consecutive abortions, but Pearson's correlation did not result in any particular differences in the link between LPR and number of abortions in this group; we therefore felt perfectly justified in extending the study to these subjects.

Abortion, Habitual↗
PubMedDate not supplied

The use of GnRH agonists depot for the treatment of dysfunctional uterine bleeding.

The Authors report their experience with the use of GnRH analogue (Goserelin) in 35 women with abnormal uterine bleeding due to low-risk hyperplasia of the endometrium. A hysteroscopic and histopathological follow-up was performed at 2 months and 6 months after treatment. The results show a significantly effectiveness of Goserelin in treating dysfunctional uterine bleeding.

Adult↗
PubMedDate not supplied

New developments in the treatment of male sub-fertility by means of assisted fecundation techniques.

In the second bimester of 1990 we have performed IVF/ET in a group of patients who had previously been excluded from the IVF/ET programme for severe dyspermia and negative Pellet Swim-up Test (PST). This group consisted of 101 cases of whom 38 underwent semen treatment with Centrifugation on a Discontinuous Percoll Gradient (CDPG) and 63 with Pellet Swim-up (PS); the control group was made up of 31 normospermic patients where the semen was treated by PS. Furthermore, in the same period, we performed Tubal Embryo Stage Transfer (TEST) on 5 normospermic and on 2 dyspermic cases, as well as Zygote Intra-Fallopian Tubal Transfer (ZIFT) on 2 normospermic patients. In all these cases the sperm was always treated with PS. We obtained disappointing IVF/ET results in the dyspermic patients with negative PST where the semen was treated with PS, with only one pregnancy (pregnancy rate 1.6% per patient). Unexpected results were obtained in cases of severe dyspermia where the semen was treated with CDPG (5 pregnancies out of 38 cases; pregnancy rate 13.1% per patient) (chi square = 7.03, p 0.01). We obtained remarkable Test results: 4 pregnancies out of 5 cases of unexplained infertility and one pregnancy out of 2 cases of dyspermia. Moreover we obtained one pregnancy in the two ZIFT's performed. The use of CDPG, possibly associated with Test, will open new horizons in the treatment of dyspermic patients by means of assisted fecundation techniques.

Humans↗
PubMedDate not supplied

Endometrial ablation: principles and technique.

Uterine bleeding may be caused either by benign organic pathology as well as different dysfunctional conditions. Medical treatment with progestins, danazol or GnRH analogues is usually used as the first choice therapy. Where the symptoms persist, hysterectomy is generally proposed; it has been calculated that from 500,000 to 700,000 such operations are performed annually in the United States. The authors review the state of the art of the endometrial ablation as an alternative to hysterectomy and other medical therapy. Endometrial ablation either by means of the YAG-laser or with the resectoscope, would seem to play a role in well-selected cases of dysfunctional uterine bleeding. In the authors opinion a multicenter study on large numbers of patients is needed in order to confirm these preliminary results.

Electrosurgery↗
PubMedDate not supplied

New perspectives for the therapeutic management of recurrent immunological abortion.

Up to now the only effective therapy for recurrent abortion syndrome due to the absence of the so-called blocking-factor has been active immunotherapy with partner or third-party donor mononucleates. The Authors report their in vivo and in vitro experience with high-dose intravenous gammaglobulin (i IV Ig) in order to treat women with recurrent abortion syndrome. In the Authors opinion there are sufficient experimental reasons for continuing this research with IV Ig obtained from multiparous women plasma pools.

Abortion, Habitual↗
PubMedDate not supplied

Immunological problems in the recurrent abortion syndrome.

The recurrent abortion syndrome has been considered a serious obstetrical problem, since it was not possible to diagnose the causes in over 40% of the cases. Great progress has now been made with the knowledge of the immunological mechanisms involved in the maintenance of pregnancy. The disorders of such immunological mechanisms, both due to auto- or alloimmune problems, are demonstrated in about 40% of the cases of recurrent abortions. The Authors have studied a group of 56 patients with recurrent abortion syndrome in a complex diagnostic work-up involving: 1) The research of an autoimmune cause; 2) The research of the presence of the Blocking-factors by means of one-way mixed lymphocyte cultures; 3) The research of an altered antipaternal lymphocytotoxic activity or of an excessive HLA-sharing. According to the results of the investigations, several forms of therapeutic management have been used: 1) Steroids-aspirin-calcic heparin for Autoimmune cases. 2) Active immunotherapy for the cases due to the lack of blocking factors. 3) Calcic heparin for the altered antipaternal lymphocytotoxic activity. At the moment it is difficult to evaluate the results of pregnancy rate with this type of therapeutic management because of the too short follow-up.

Abortion, Habitual↗
PubMedDate not supplied

The effect of female serum antisperm antibodies on in vitro fertilization and embryo transfer.

Twenty-nine women with serum antisperm antibodies underwent in vitro fertilization and embryo transfer. Half the oocytes from each patient were treated with patient-serum-supplemented medium with antibodies (medium A), and the other half with donor-serum-supplemented medium without antibodies (medium B). In 9 cases the antibodies were against the sperm head and these showed a significant difference in the number of embryos obtained between the two media (p = 0.001): 10.5% of fertilization of type 3 and/or 4 oocytes with medium A and 81.2% with medium B. A lower rate resulted also when the antibodies were against the middle and main portion of the tail, but fertilization did not seem to be affected when they were directed against the tail tip. No definite conclusions are possible, however, since the number of cases studied was too small.

Adult↗
PubMedDate not supplied

Infertility in advanced reproductive age. Results of in vitro fertilization and embryo transfer according to the woman's age.

The Authors discuss the phenomenon of the gradual decline of a woman's fecundability with the passing of time and particularly the potential causes of infertility in advanced reproductive age and the most efficient therapeutic management. They conclude that more advanced aided conception techniques such as IVF/ET, GIFT, ZIFT and IPI should be preferred to surgery for women over a certain age, especially where the infertility problem is of more than five years standing, and discuss the effect of the subject's age on the various stimulation techniques available. The Authors then report their experience with IVF/ET in 806 induction cycles using five different stimulation protocols at the Foundation for Studies on Human Reproduction in Palermo.

Adult↗
PubMedDate not supplied

Gamete intrafallopian transfer: different routes of transfer.

The Authors report their own experience and results using different approaches to oocyte pick-up and gamete transfer for gamete intrafallopian transfer (GIFT). The overall pregnancy rate of GIFT is 35.86% (66 pregnancies on 184 cases of GIFT). The Protocol I (Laparoscopic oocyte retrieval and gamete transfer) is presently the more used and gives better clinical results (pregnancy rate of 37.7%); in the Author's opinion, the protocols III (echographic pick-up + IVF + laparoscopic delayed zygote intrafallopian transfer (ZIFT), and VII (Laparotomic pick-up and transfer) are interesting complementary techniques for GIFT.

Adult↗
PubMedDate not supplied

Treatment of endometrial hyperplasia with levonorgestrel releasing intrauterine devices.

The effectiveness of a new levo-norgestrel releasing intrauterine device is assessed in fourteen patients with histologically confirmed hyperplastic lesions of the endometrial mucosa. The morphologic response of the hyperplastic endometria to the action of the levo-norgestrel in this study explains the regression of the cases so treated.

Adult↗
PubMedDate not supplied

Comparison between IVF and GIFT using the GnRH agonist protocol.

After a short discussion on the rationale for the use of GnRH agonists in the stimulation protocols of GIFT and IVF/ET cycles, the authors discuss their own experience with the use of Buserelin in these cases. Buserelin was administered nasally starting on day 21 of the cycle preceding the stimulation cycle. FSH and/or HMG were administered starting on day 3 of the cycle, until the proper moment for administration of HCG. 34 cycles of GIFT and 40 cycles of IVF were studied and it was possible to observe minor endogenous LH interferences with respect to control cycles. The number of harvested ovocytes was greater, the quality of ovocytes was clearly better and both the fertilization rate and pregnancy rate were higher. The authors stress the interest of pituitary temporary ablation as first choice treatment for IVF and GIFT protocols.

Administration, Intranasal↗
PubMedDate not supplied

Direct intraperitoneal insemination (DIPI) for the treatment of refractory infertility unrelated to female organic pelvic disease.

344 couples with infertility unrelated to female organic pelvic disease underwent Direct Intraperitoneal Insemination (DIPI) for a total of a 429 DIPI cycles. Pregnancy per couple was 16.5% and per DIPI cycle 13.2%. DIPI was particularly effective in cases of infertility due to cervical mucus insufficiency and unexplained infertility with results respectively of 33.7% and 30.4% per couple and 30.7% and 28.7% per DIPI cycle. On the contrary, the results regarding male subfertility were 12.5% per couple and 10.5% per DIPI cycle. A significant difference was found (X2 A = 16.48, p less than 0.001) between these results and those of the group composed of cases of cervical mucus insufficiency and unexplained infertility. In cases of antisperm iso- and autoimmunization the results were on the whole poor, and were in any case influenced by corticosteroid pretreatment. The Pellet Swim-up Test (PST) proved to be a good prognostic sign for success of DIPI, since a significant difference was found between the PST group greater than or equal to 1.5 X 10(6)/ml (pregnancy per couple was 19.7% and per DIPI cycle 17.2%) and PST group less than 1.5 X 10(6)/ml (pregnancy per couple was 6.8% and per DIPI cycle was 4.5%) (X2 = 11.4. P less than 0.001).

Autoimmune Diseases↗
PubMedDate not supplied

Immuno-bead test (IgG-IgA-IBT) in cervical mucus for the diagnosis of antisperm isoimmunization in female infertile patients with negative or doubtful PCT.

57 infertile women belonging to infertile couples with negative or doubtful PCT underwent the following tests: Sperm Cervical Mucus Contacts Test (SCMC-Test), IgG-IgA-Immuno-Bead Test (IgG-IgA-IBT) in cervical mucus, Micro Sperm Immobilizing Test (Micro-SIT) in cervical mucus and Sperm Immobilizing Test (SIT) in serum. Et least one of the tests gave a positive result in 49.1% of the patients examined and there was a significant difference between the SCMC-Test and the IgG-IgA-IBT: the former was positive in 26 out of 45 patients (57.7%), while the latter was positive in 13 cases (28.8%), (chi 2 = 6.48, p less than 0.05). On the other hand, there was no significant difference between the cervical mucus IgG-IgA-IBT, cervical mucus Micro-SIT and serum SIT; these were positive in respectively 14 (24.5%), 18 (31.5%) and 17 (29.8%) in the 57 patients who underwent all the tests at the same time. Three of the four cases with a mildly positive result of the cervical mucus IgG-IgA-IBT, where the beads were located at the tail-tip, showed negative results to all the other tests performed. Cervical mucus IgG-IgA-IBT is therefore a fairly specific method for the determination of antisperm isoantibodies in the cervical mucus as long as the assessment of those cases with low positivity and beads located mainly at the tail-tip is performed carefully. It is advisable in these patients to take into consideration the results of more classical tests such as cervical mucus Micro-SIT.

Adult↗
PubMedDate not supplied

First trimester fetal blood sampling.

The authors report 8 diagnostic cordocentesis performed at the end of the first trimester. The indication was thalassemia (5 cases) and karyotyping (3 cases). The technique requires that the operator holds both the probe and the needle (25 G X 90 mm); the fetal blood sample ranged between 0.25 and 0.35 cc, sufficient in all cases for the diagnosis. 1 pregnancy was terminated on the basis of the diagnostic result; no complications reported at a 3-weeks follow-up in the remaining 7 patients. The first trimester cordocentesis offers several advantages if compared to CVS, especially for thalassemia prenatal diagnosis; furthermore it opens new perspectives for intrauterine transplantations. More experience is required to assess the safety of the procedure.

Blood Specimen Collection↗
PubMedDate not supplied

Indirect immuno-bead test in the seminal plasma and in the serum for the diagnosis of antisperm autoimmunization in male infertile patients.

125 male subjects belonging to infertile couples with negative or doubtful PCT underwent the following tests: IgG MAR Test, seminal TAT, indirect IgG-IgA-IgM-IBT in the seminal plasma, serum TAT, serum SIT, serum IgG-IgA-IgM-IBT. There was no significant difference in the incidence of autoimmunized patients and those resulting from classical testing methods (IgG MAR Test, seminal and serum TAT, serum SIT) (16%), and the results of the indirect IBT in the seminal plasma and in the serum (16.8%). The IBT showed an increase which was not, however, statistically significant in subjects with concomitant local and general autoimmunization, compared to the classical methods, (13.6% in the subjects examined versus 10.4%). There was a statistical significant difference between the results of the indirect IgA-IBT in the seminal plasma and those of the IgG MAR Test, (19 versus 12 positive patients, chi2 = 6.05, p less than 0.05). Furthermore, in 88.2% of the cases with concomitant positivity, the indirect IgA-IBT in the seminal plasma showed higher values than the indirect IgG-IBT in the seminal plasma. There was no significant difference between the results of the classical methods and the serum IBT, whereas both in the semen and in the serum the beads adhered mainly to the tail plus the tail up considering only the nemaspermic portion with the highest relative rate of adhered beads.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗