Biomedical subjects
Publications and source records attributed to E Cittadini.
The authors report their experience on 140 diagnostic cordocenteses performed in the early trimester of pregnancy (technique, indications and complications). Furthermore the Authors report preliminary data concerning various fetal blood biochemical parameters (22) obtained by cordocentesis at 18-19 weeks of pregnancy (42 cases). Fetal and maternal values are compared.
12 couples, with infertility due to male subfertility, female antisperm isoimmunization, male antisperm autoimmunization, cervical mucus insufficiency or unexplained infertility underwent intrauterine A.I.H. with capacitated sperm and controlled ovarian stimulation. The pregnancy percentage was of 41.6% per woman treated and of 31.2% per treatment cycle; five pregnancies were obtained, of which two resulted in abortions. Five cases of oligoasthenospermia were treated, three severe and two moderate; two pregnancies occurred in the former and one in the latter. S.I.T. and S.I.T.-cap. were performed on the serum, and Micro-S.I.T. and Micro-S.I.T.-cap. on the cervical mucus in order to exclude the possibility that intrauterine A.I.H. with capacitated sperm might have caused capacitated or non-capacitated antisperm immunization. Intrauterine A.I.H. would seem to be a useful alternative to G.I.F.T. and to I.V.F./E.T. or at least a technique which should be performed before these two in cases of infertility not caused by female organic pelvic disease; it is cheap, simple and extremely well-accepted by the patient.
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16 couples belonging to couples with negative or doubtful PCT were selected according to the presence of antisperm immunization. 12 patients, 5 male and 7 female, showed both localized and generalized immunization. The former was diagnosed by means of a positive IgG MAR-Test, direct IgG Immunobead-Test, direct IgG Immunobead-Test and seminal TAT in the male patients, and Micro-SIT in the cervical mucus of the female patients, while for the latter there was simultaneous positivity of both serum TAT and SIT, except for two cases, in which the SIT only was positive. The 4 remaining patients, 2 male and 2 female, did not show any signs of antisperm immunization. The evaluation of the antisperm antibodies by means of the ZER ELISA Antisperm Kit in the serum of the 16 patients examined showed that there were no significant statistical differences between the serum TAT and the SIT. The former showed agreement of the results in 93.75% of the cases, and the latter in 81.25%. A strict correlation was observed between the ELISA for serum antisperm antibodies (ELISA-AS-Abs) and the local immunitary situation, with agreement in 93.75% of the cases. The ELISA-AS-Abs seems to bring the advantage of eliminating the need for fresh semen for antibody titration and also means that there is no subjective interference with the evaluation of the results.
From January 1985 to December 1985 we have performed 83 GIFTS for various indications such as unexplained infertility, immunological problems, endometriosis, male factor, fimbrial pathology. In 82 women out of 83, oocytes and sperm have been transferred and 31 pregnancies (37.8%) have been obtained. Twelve women have delivered 17 babies; 11 pregnancies are ongoing, 7 have been interrupted by an abortion and 1 by a tubal pregnancy. The present and future roles of GIFT in the treatment of infertility is discussed.
The impact of human papillomavirus (HPV) infection in genital pathology has been clarified relatively recently and its relevance appears to be parallel to the liberalization of sexual customs. Aside from some aspects of the infection grossly evident to the naked eye, an increasing number of sub-clinical lesions, that can be colposcopically identified as "flat condylomata" is commonly revealed by cytologic screenings. The Authors report their experience in the diagnosis of this frequent pathology in gynecologic practice, underlining the importance of more fine laboratory investigations, mostly ultrastructural and immunohistochemical.
A new, non invasive method for IVF/ET is discussed. Twenty infertile patients were involved in an outpatient procedure; less risk for them, because of local anaesthesia and low costs for the clinic are the most remarkable advantages of this procedure. Four normal ongoing pregnancies followed this treatment.
The Gamete Intrafallopian Transfer (GIFT) was carried out in 12 couples with unexplained infertility, in 2 cases with infertility associated with mild endometriosis, in 1 case of hostile mucus and 3 cases in which phymosis of the ampulla and/or periadnexal adhesions were previously identified. In 7 couples GIFT was carried out after several AID cycles for husband azoospermia or severe oligospermia. Three different protocols were used for the controlled ovarian hyperstimulation. In all cases an adequate follicular growth was obtained and mature oocytes were recovered. At first attempt 12 ongoing pregnancies (1 triplet, 1 twin) were obtained with a present pregnancy rate of 48%.
Patients with septate uterus usually undergo reproductive failures with recurrent abortions and premature deliveries. Up till now surgical therapy for such a defect has relied on different abdominal metroplasty procedures reflecting the need to establish normal anatomy and physiology of the uterus. Nowadays, wide experience accumulated in hysteroscopic management of intrauterine adhesions, has allowed the incision of the uterine septa with the hysteroscopic technique. In this report the Authors describe the surgical technique of the hysteroscopic metroplasty in eleven cases. Initial results are encouraging: surgical outcome is good, with no intra- or postoperative morbidity; if the pregnancy outcome rate confirms these results, then the traditional abdominal surgical approach should become an out-moded therapy, so making hysteroscopic metroplasty the treatment of choice for the uterine septa.
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The possibility of a correlation between biological (E2) and morphological (U.S.) parameters, in view of obtaining a correct prevision of follicular maturation and ovulation is discussed. In this study normal patients with a tubal sterility were treated with clomiphene citrate and clomiphene plus H.M.G. The statistical analysis was performed by means of the linear correlation (r) and the relative test of significance (Student T.). The data obtained in this study show that notwithstanding that the rising plasma concentration of E2, which precedes ovulation, is the first and more constant marker of follicular maturation, because of its wide range of variability its usefulness in prediction of ovulation is nearly limited to spontaneous cycles. In fact in stimulated cycles the rising plasma-E2 concentration is rather an independent variable regarding the growth of single follicles (F.D.).
The Authors describe their experience with a new type of intratubal mechanical device to be inserted under hysteroscopic control. Up to present time, 1471 cycles without any other form of contraception have been observed. Although the promising results of this preliminary report in the field of hysteroscopic reversible tubal sterilization, the Authors underline that this new technique is still evolving and will be improved with further experience.
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The Authors report their experience in the diagnosis and management of intrauterine adhesions in a group of 23 patients using the microhysteroscope. This new model of hysteroscope makes it possible to diagnose clinically suspected cases and to perform lysis of the adhesions in the out-patient department, without cervical dilatation and anesthesia. The technical features of the microhysteroscope made a double evaluation of adhesions possible: a) the macroscopic classification of the site and extension of the synechiae and b) their microscopic in vivo observation to identify the less vascularized areas and to perform adhesiolysis under direct visual control. Monthly hysteroscopic examinations were performed in order to follow the results of therapy and to remove residual or newly formed adhesions. In the authors' experience the microhysteroscope may be successfully used in the early diagnosis and subsequent best management of intrauterine adhesions in patients with previous medical history of curettage in a recent pregnant uterus.
The present study was carried out to investigate the influence of inhibitor factors on the immunological response of the mother. Using a FIVET program (in vitro fertilization and embryo-transfer) we were able to detect in vitro the modulation of lymphocyte response by hormones, utilizing subjects receiving hormone therapy. A new assay has been used to study the antibody response. The lymphocytes were adhered during the culture to the plastic surface of microplates, and the modulation of the expression of the surface IgG was detected with an E.L.I.S.A. assay in the same culture plate. Many hormones were tested in vitro using this assay. The addition to the lymphocyte cultures of hCG and oestradiol give a variable effect. This effect is concentration dependent and whilst in all instances the higher dosages were inhibitory, in same subjects the lower dosages had a stimulatory effect, but if the subjects were treated in vivo with hCG, then an inhibitory effect was observed in vitro even using very low concentrations of hormones. This could suggest that these hormones have an inhibitor effect on the lymphocyte response, inhibition that was enhanced when the lymphocytes were "primed" in vivo.
After a review of the main problems related to metroplastics (i.e. frequency of malformations, their importance in maintaining infertility, clinical classifications, diagnostic techniques, the Authors discuss the problem of their surgical treatment. The results obtained in 54 cases from a cooperative study (Audebert 17 cases; Cittadini 25 and Cognat 12) are presented. In 50 out of 54 cases the Bret-Palmer technique has been performed and in several cases complementary operations such as adhesiolysis, salpingoplastics, ligamentopexies, myomectomies, cystectomies, wedge resections of ovaries, were performed. On the basis of their experience, the Authors affirm that the results of metroplastics are better when their indications are strictly selective and they stress that the overall results may be considered as favourable.