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Biomedical subjects

E Ferrazzi

Publications and source records attributed to E Ferrazzi.

At least 19 recordsLinked to original sources
PubMed1996

Sonographic endometrial thickness: a useful test to predict atrophy in patients with postmenopausal bleeding. An Italian multicenter study.

Eighteen centers took part in this prospective study into which 930 eligible patients were recruited. The selection criteria for admission were atypical bleeding after at least 6 months of postmenopausal amenorrhea, and absence of hormonal therapies for at least 6 months. The sonographic measurement of the maximum bi-endometrial thickness was made in a longitudinal plane. Sonographic measurements were always performed within 3 days prior to histological evaluation. In these patients the mean number of years from menopause (25-75th centile) was 6 (range 2-16). The prevalence of endometrial carcinoma was 11.5% and the prevalence of atrophy was 49.2%. The area under the receiver operator characteristic curves generated by sonographic thickness measurements reached the level of 85%, both for cancer and atrophy. The likelihood ratio for cancer, yielded by an endometrial thickness of < or = 4.0 mm, was 0.05, and for atrophy it was 7.1. This cut-off of > 4.0 mm yielded a sensitivity for the detection of cancer of 98% and a negative predictive value of 99%. The overall sensitivity and positive predictive value for atrophy achieved by this cut-off were 57.2% and 87.3%, respectively. A multivariate logistic model showed that age and body mass index were independent variables associated with a significantly higher risk of endometrial cancer. The post-test probabilities for cancer and atrophy were recalculated on the basis of the integration of age, body mass index and endometrial thickness. The estimated reduction of invasive procedures on the basis of this integration was 31%. Transvaginal sonographic measurement of endometrial thickness, integrated with individual risk factors, can help in the management of postmenopausal patients with atypical bleeding, with regard to either the need for histological evaluation in high risk cases, or the choice of possible expectant management. We have shown that an endometrial thickness of < or = 4.0 mm safely predicts endometrial atrophy and justifies expectant management when the patient understands the need for proper follow up. This could be achieved with a reduction in the use of invasive procedures without unwanted delay in cancer diagnosis.

Aged↗
PubMed1995

Color-Doppler velocimetry of uterine arteries in pregnant and nonpregnant patients during multiovulation induction for IVF.

OBJECTIVES: To evaluate uterine artery resistance during multiovulation induction in relation to the implantation rate in patients attending in vitro fertilization (IVF) cycles. PATIENTS: Multiovulation induction for IVF was monitored by daily determination of the pulsatility index (PI) of the uterine arteries, obtained by a transvaginal probe (6.5 MHz) implemented with color-flow imaging. Doppler data were obtained from 5 days before hCG administration to the day of follicular aspiration. One IVF cycle was monitored in 70 patients. In 17 patients, 41 IVF cycles were monitored until a successful attempt occurred. RESULTS: In the 70 patients studied during one IVF attempt, the PI of the uterine arteries significantly varied (P < 0.001) in the different phases of the cycle. In the 24 patients who conceived, a significantly lower PI (P < 0.03) was found throughout the cycle. This result was mainly due to a highly significant difference of PI values observed the day after hCG administration (P < 0.005). In the 17 patients who conceived after 1 to 4 negative in vitro fertilizations, no significant difference in PI was observed in the uterine artery resistance in cycles in which implantation was or was not successful. CONCLUSIONS: Uterine artery resistance varies significantly during phases of the induction therapy. Uterine artery resistance is lower throughout the course of multiovulation induction in patients with higher pregnancy rates. The PI on the day after hCG administration was the best index of pregnancy rate. Low uterine artery resistance was present even in negative attempts in patients who eventually achieved a successful implantation. PI values < or = 3 can be considered a favorable prognostic factor for future IVF cycles.

Adult↗
PubMed1995

Laparoscopically assisted vaginal removal of ovarian dermoid cysts.

Dermoid cysts were diagnosed by transvaginal sonography in 19 patients who subsequently underwent laparoscopy to confirm the nature and extent of the lesion and the mobility of the adnexa. Eighteen patients underwent surgery after the ovary was exteriorized through a posterior colpoceliotomy. No intraoperative complications were observed, and sonographic follow-up at 3 and 6 months after surgery showed a normal sonographic ovarian pattern. Laparoscopically assisted vaginal removal of dermoid cysts should be considered as an alternative to laparotomy and operative laparoscopy in cases when adnexal mobility is proven and vaginal extraction is feasible.

Adult↗
PubMed1995

Peak velocity of the outflow tract of the aorta: correlations with acid base status and oxygenation of the growth-retarded fetus.

OBJECTIVE: To correlate the peak velocities of the aortic outflow tract of growth-retarded fetuses with fetal acid base status and oxygenation measured in utero. METHODS: Thirty-one growth-retarded fetuses with abnormal umbilical pulsatility index (PI) measurements underwent fetal blood sampling. Blood pH, carbon dioxide pressure (PCO2), oxygen pressure (PO2), oxygen saturation, lactate concentration, and hemoglobin concentration were measured. Using color Doppler equipment, we measured the peak velocities of the outflow tract of the aorta, pulmonary artery, and ductus arteriosus before fetal blood sampling. RESULTS: The peak velocities measured in the outflow tract of the aorta, pulmonary artery, and ductus were significantly lower in growth-retarded fetuses than in 140 normal fetuses of comparable weight. The correlation observed between pulmonic and aortic peak velocities was significant (r = 0.84), as was that between pulmonic and ductal peak velocities (r = 0.74). Growth-retarded fetuses with abnormal aortic peak velocities had significantly lower values of PO2, oxygen content and pH, and had higher lactate concentration and PCO2 than did growth-retarded fetuses with normal peak velocities. Estimated fetal weight and umbilical PI (mean +/- standard deviation) were not significantly different in these two groups. Moreover, significant direct correlations were found between proximal aortic peak velocities and lactate concentrations (correlation coefficient 0.71, P < .0001) and O2 content (P < .02, r = 0.42). CONCLUSION: For growth-retarded fetuses, Doppler peak velocity in these vessels is significantly lower than in normal fetuses of comparable weight. Aortic, pulmonic, and ductal peak velocity correlated significantly. Growth-retarded fetuses with abnormally low peak velocity in the outflow tract of the aorta have a higher risk of acidemia and hypoxia than those with normal velocities.

Aorta↗
PubMed1995

Performance of Doppler ultrasonography as a screening test in low risk pregnancies: results of a multicentric study.

To assess the efficacy of the Doppler velocimetry of the uterine and umbilical arteries as a screening test for preeclampsia and fetal growth retardation, we studied 916 low risk pregnancies. The S/D ratios of the uterine and umbilical arteries were obtained at 19 to 24 weeks and at 26 to 31 weeks of gestational age. Mean values, receiver operator curves, and the diagnostic accuracy of the tests were calculated for the following end-points: (1) pregnancy-induced hypertension, (2) low birth weight for gestational age, (3) small for gestational age with abnormal outcome, (4) pregnancy-induced hypertension needing preterm delivery. The prevalences for these outcomes were 3.4%, 4.6%, 1%, and 0.7%, respectively. The study was blinded. The umbilical and uterine artery S/D ratios were significantly higher in the abnormal than in the normal outcome group. When uterine arteries were studied at 19 to 24 weeks, sensitivity was 59% in the detection of pregnancy-induced hypertension, 11% in the detection of small for gestational age fetuses, 33% in the detection of small for gestational age fetuses with abnormal outcome, and 83% in the detection of pregnancy induced hypertension needing preterm delivery; the corresponding values for specificity were 69%, 94%, 94%, and 68%. At 26 to 31 weeks the sensitivity values were respectively, 69%, 58%, 75%, and 100% and specificity values were 80%, 59%, 39%, and 79%. When umbilical arteries were studied at 19 to 24 weeks, sensitivity was 38% in the detection of pregnancy-induced hypertension, 46% in the detection of small for gestational age fetuses, 78% in the detection of small for gestational age fetuses with abnormal outcome, and 67% in the detection of pregnancy-induced hypertension needing preterm delivery. The corresponding values of specificity were 74% for all four groups. At 26 to 31 weeks the sensitivity values were 38%, 43%, 87%, and 67%, respectively, and specificity values were 80% for all four groups. We concluded that Doppler examinations of the uterine and umbilical arteries can detect, at midpregnancy, the severe forms of pregnancy-induced hypertension and small for gestational age fetuses but they cannot be used to screen a low risk population in which the prevalence of the disease is low, and hence the positive predictive value is low.

Adult↗
PubMed1993

Diagnostic value of blood sampling in fetuses with growth retardation.

BACKGROUND: Fetuses with intrauterine growth retardation are delivered if they have evidence of distress, as manifested by abnormalities in the fetal heart rate and umbilical-artery blood flow. We studied whether umbilical-blood sampling might provide further information useful for management. METHODS: We measured hemoglobin and lactate concentrations, oxygen content, pH, blood gas levels, and base deficit in umbilical-vein blood and correlated these measurements with the heart rate and umbilical-artery wave forms recorded by Doppler velocimetry in 56 fetuses with growth retardation. Twenty-one fetuses had normal heart rates and normal results of velocimetry, 24 had normal heart rates and abnormal results of velocimetry (indicative of decreased diastolic flow), and 11 had abnormal heart rates and abnormal results of velocimetry. RESULTS: None of the 21 fetuses with normal heart rates and velocimetry had hypoxia or acidemia. Of the 24 fetuses with normal heart rates and abnormal velocimetry, 4 (17 percent) had moderate lactic acidosis, 1 (4 percent) had a low pH value, and 3 (12 percent) had hypoxia. Of the 11 fetuses with abnormal heart rates and velocimetry, 7 (64 percent) had lactic acidosis, low blood oxygen content, and low pH values. The absence of end-diastolic flow increased the risk of hypoxia and acidemia. The proportion of fetuses with elevated hemoglobin concentrations was similar among the three groups. CONCLUSIONS: Assessment of fetal oxygenation and acid-base balance is not indicated in fetuses with growth retardation if their heart rates and the results of velocimetry are normal. If the results of velocimetry are abnormal, fetal-blood sampling can distinguish fetuses that have growth retardation alone from those that also have hypoxia and acidosis, and thus may aid in determining the optimal time of delivery.

Acidosis↗
PubMed1993

Intra-amniotic pressure is not affected by amniocentesis between 13 and 18 weeks of gestation.

Changes in amniotic fluid pressure before and after amniocentesis fell within the range of +/- 5 mmHg, except when uterine contractions were present. Intra-amniotic pressure is not affected by amniocentesis between 13 and 18 weeks of gestation. Amniotic fluid pressure was recorded in 82 pregnancies of patients undergoing genetic amniocentesis to determine whether sampling of amniotic fluid between 13 and 18 weeks changed intra-amniotic pressure. Pressures were recorded through a needle and saline filled catheter with a zero-level at the needle tip. Amniotic fluid pressure was unrelated to gestational age (P = 0.962) during the weeks we performed our measurements. Fluid samples of 12.6% of the total volume in a group of early genetic amniocentesis (n = 65) and of 7.5% of the total volume in a group of late genetic amniocentesis (n = 17) did not change significantly amniotic fluid pressure values. An increase in pressure of more than 5 mmHg only occurred in cases where uterine contractions were present. Other than these cases, all pressure change values fell within the range of +/- 5 mmHg. No difference in pregnancy outcome were present within the two groups. An argument for a standard method for stationing pressure is presented.

Amniocentesis↗
PubMed1993

Phase I-II intraperitoneal mitoxantrone in advanced pretreated ovarian cancer.

36 previously treated patients (25 with anthracyclines) with advanced epithelial ovarian cancer have been treated with intraperitoneal (i.p.) mitoxantrone (M) at increasing doses. The response was evaluated through repeated laparoscopy with multiple biopsies and serial measurement of Ovarian Cancer Antigen 125 (CA 125); 11/36 patients had a complete (6 patients) or partial (5 patients) response. Toxicity (both local and general) was observed starting from 25 mg/m2 of M per cycle. The amount of drug reaching systemic circulation was monitored by measuring M plasma value after i.p. treatment. This study showed wide variations in serum levels obtained after i.p. doses ranging from 23 to 36 mg/m2. The area under the curve (AUC) of mitoxantrone plasma samples, did not correlate with the i.p. administered dose. Conversely, a correlation seems to exist between the plasma AUC and the responder status. Patients who showed clinical responses to i.p. treatment with mitoxantrone had AUCs and plasma peak levels of the drug that were significantly higher than those in non-responders (P = 0.03, Fisher's exact test).

Adult↗
PubMed1992

Deflazacort and fluoximesterone in advanced, pretreated breast cancer.

A very simple, low dose, orally administered regime (10 to 15 mg of fluoximesterone + 6 mg of deflazacort daily for periods of 1 to several months) resulting in mild-acceptable toxicity (essentially some weight gain) determined subjective improvement in 2/3 of 34 evaluable patients (out of 36 treated) and an objective measurable tumor reduction in 1/3, although most patients had been previously treated with chemotherapy and hormone treatment and proved primarily or secondarily refractory. The receptor status at the beginning of fluoximesterone+deflazacort treatment was not known, except in one negative-receptor patient, who responded to the combination after becoming resistant to tamoxifen (see photo). In some patients the condition of hormone refractoriness would suggest a no-treatment policy, but a trial with this regime is always convenient as it may improve both duration and quality of life.

Adult↗
PubMed1991

Doppler velocimetry: critical analysis of umbilical, cerebral and aortic reference values.

Cross-sectional reference standards of the umbilical flow velocity waveforms were investigated from 18 to 38 weeks of gestation on 482 normal pregnancies. A significant decrease in the pulsatility index (PI) and systolic/diastolic (SD) ratio was observed during gestation. This phenomenon was confirmed in a longitudinal study on 150 patients of the same population. The two slopes of cross-sectional and longitudinal data were not significantly different. A bimodal distribution of PI and S/D ratio was observed. Six per cent of data fell above the vast majority of cases. The dimension of the population studied allowed us to consider these findings not as outliers but as an interesting transient phenomenon of very low end-diastolic velocities which can occur in normal fetuses, without concomitant variations on the thoracic aorta and middle cerebral artery. Cross-sectional reference ranges were studied for these vessels on the same population from 26 to 38 weeks of gestation. A significant decrease in the PI of the middle cerebral artery was observed versus a significant increase in the PI of the thoracic aorta. These latter indices could be used to obtain indirect information on the normal redistribution of blood flow in the human fetus in the third trimester of gestation. However, the great variability observed should warn against the risks of a simplistic clinical use of these observations.

Aorta, Thoracic↗
PubMed1991

DNA damage and cytotoxicity induced by metabolites of anthracycline antibiotics, doxorubicin and idarubicin.

This study assessed the ability of major metabolites of two types of anthracycline antibiotics, doxorubicin and idarubicin (4-demethoxydaunorubicin) to damage DNA in mouse fibrosarcoma 935.1 cells. Since DNA lesions by anthracyclines may be mediated by topoisomerase II, we also characterized the ability of the drugs to inhibit this enzyme. The C-13 alcohol and aglycone metabolites of doxorubicin and idarubicin were compared to the parent drugs in terms of induction of DNA single strand breaks measured by filter elution. In whole cells, the maximal DNA strand breakage induced by the C-13 alcohol metabolites was similar to that of their respective parent drugs. In isolated nuclei, however, the alcohol metabolites were two times more potent than the parent drugs. The aglycone metabolites produced very little damage in either whole cells or nuclei. The doxorubicin compounds differed markedly from idarubicin drugs in the way their ability to induce DNA breaks was related to cytotoxic activity. Doxorubicin and doxorubicinol cytotoxic effects (50% cell growth inhibition at 0.2 and 4 microM, respectively) coincided (in terms of drug concentrations) with the induction of significant breakage of cellular DNA. In contrast, the concentrations of idarubicin and idarubicinol needed to produce 50% growth inhibition (0.005 and 0.006 microM, respectively) were about 20 times lower than drug levels that induced significant DNA damage. All six compounds inhibited the catalytic activity of isolated topoisomerase II. While the alcohol metabolites produced this inhibition at concentrations similar to those of their parent drugs (5-10 microM), the aglycones were again much less active.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Role of umbilical Doppler velocimetry in the biophysical assessment of the growth-retarded fetus. Answers from neonatal morbidity and mortality.

We compared umbilical Doppler velocimetry with biophysical parameters, obstetrical management, and neonatal morbidity. The study of 85 pregnancies was prospective and blind both to the obstetric and pediatric staff. Our results show that under the same biophysical diagnosis, ie, abnormal fetal growth, oligohydramnios, and nonreactive cardiotocographics, the prevalence of neonatal morbidity was significantly higher in fetuses with associated abnormal umbilical pulsatility index (PI) in utero. Newborns with abnormal PI were delivered earlier, mostly for fetal indication, and were smaller and more asymmetrical than newborns with a normal PI in utero. The analysis of morbidity for homogeneous classes of weight showed that in the group of newborns between 1500 and 2500 g, newborns with normal umbilical PI did show only metabolic disturbances and one respiratory distress syndrome. On the contrary, newborns of the same gestational age and of the same weight with abnormal PI had more severe morbid episodes. In the class of weight between 1500 and 1000 g not only the severity but also the prevalence of neonatal morbidity was significantly higher in newborns with an abnormal PI in utero. None of the newborns delivered below 1000 g had a normal umbilical PI. Five died in the early neonatal period. Three suffered from mild neuromotor sequelae. Practical consequences of these findings on fetal management are the scheduled frequency of biophysical examinations, which must be closer and on an inpatient basis whenever abnormal, and the interpretation of other abnormal biophysical parameters, which must be considered as more severe whenever associated with an abnormal umbilical velocimetry.

Biophysical Phenomena↗
PubMed1990

Lactate metabolism in normal and growth-retarded human fetuses.

Lactate concentration and oxygen content were measured in 21 normal (AGA) and 34 intrauterine growth-retarded (IUGR) infants at the time of elective cesarean section. Maternal lactate and umbilical arterial and venous lactate concentrations were significantly higher in IUGR infants compared with AGA infants. However, when IUGR patients were subdivided according to pulsatility index (PI) measurements of the umbilical artery, no differences were detected between AGA and IUGR patients with PI less than 4 SD, whereas IUGR patients with PI greater than 4 SD had higher lactate concentrations in maternal arterial blood and umbilical arterial and venous blood from both other groups. There was a significant inverse linear relationship between umbilical arterial lactate concentration and umbilical venoarterial differences for both lactate concentrations and for lactate/oxygen quotients. These relationships were significantly different in IUGR fetuses with PI greater than 4 SD compared with AGA and IUGR fetuses with PI less than 4 SD. AGA and IUGR fetuses with PI less than 4 SD have arterial lactate concentrations less than 2 mM even at low oxygen concentrations (O2 content less than 2 mM, O2 saturations less than 20%). At comparable levels of oxygenation, IUGR fetuses with PI greater than 4 SD have a marked lactacidemia. The data suggest that coupling Doppler assessment of flow velocimetry with biochemical analyses of fetal blood can be useful in identifying a subset of IUGR human fetuses at risk of intrauterine hypoxia.

Female↗
PubMed1989

Umbilical flow waveforms versus fetal biophysical profile in hypertensive pregnancies.

The pulsatility index (PI) of the umbilical arteries was measured in 40 hypertensive pregnancies. Doppler-velocimetric data were kept unknown to the clinical staff. An abnormal PI was found in 79% of cases in which an abnormal fetal growth in utero had been diagnosed by ultrasonographic measurements. Serial PI findings showed worsening figures in most of the cases with an abnormal fetal growth, irrespective of the last absolute value. Amniotic fluid estimation and PI data were significantly correlated. PI values were markedly abnormal in fetuses with non-reactive heart-rate tracings. A high sensitivity and an optimal specificity were found for umbilical PI versus the diagnosis of fetal growth retardation made by the coexistence of different biophysical criteria. However, false normal results may occur. 62% of the newborns weighed below the 5th percentile. The sensitivity of abnormal PI values to detect these light fetuses resulted to be only 67%. However the prevalence of neonatal morbidity in fetuses with abnormal PI values was 74%, while morbidity occurred only in 14% of cases with normal PI values. In hypertensive pregnancies, this simple velocimetric parameter proved to correlate with abnormal biophysical monitoring and complicated neonatal outcomes.

Birth Weight↗
PubMed1989

Spectral analysis of antepartum heart rate variability.

The present paper illustrates the basic methodological aspects of the power spectral analysis applied to fetal ECG starting from a gestational age around the 25th week of gestation until term. An abdominal ECG signal is recorded and fetal and maternal QRSs are recognised through selective digital filtering and averaging techniques. Power Spectral Density (PSD) of the discrete R-R series is then calculated through an autoregressive (AR) technique. In analogy with what happens in adult human subjects, fetuses manifest variability in correspondence to particular bands in the spectrum which are sensitive to the sympatho-vagal balance which controls many cardiovascular functions and respiration in different physiological conditions. Such a method is easily implemented on a personal computer and may be used to asses the development of the autonomic nervous system in fetuses as well as to show the physiopathological reasons which perturbate the relevant control mechanisms.

Cardiotocography↗
PubMed1989

Power spectral analysis of the heart rate of the human fetus at 26 and 36 weeks of gestation.

The fetal electrocardiogram (ECG) was recorded from the maternal abdomen together with sonographic detection of fetal states in four pregnant patients at 26 and 36 weeks of gestation. Computerised algorithms obtained a good recognition of maternal ECG and fetal ECG. The corresponding power spectral density (PSD) was estimated during epochs of quiet or breathing movements for 256 consecutive heart beats. At 36 weeks of gestation the PSD analysis showed heart rate variability components similar to an adult heart. A low frequency component was observed together with a high frequency component in the range of fetal breathing movements. This high frequency component (0.6 - 0.9 Hz) disappeared from the PSD analysis during epochs of apnea. To our knowledge this is the first demonstration of such a mechanism in the human fetus in utero. At 26 weeks no respiratory component was observed in the PSD analysis. The maturation of control mechanisms could be responsible for this difference.

Electrocardiography↗
PubMed1989

Prenatal diagnosis and management of congenital heart disease.

Thirty-two fetuses were diagnosed as having congenital heart disease (CHD). The major indications for level II echocardiography other than suspected cardiac abnormalities were fetal malformations, nonimmune hydrops and cardiac arrhythmia. Only three patients had a previous history of fetal CHD. No false-abnormal diagnosis of severe CHD was made. Aortic arch anomalies represented the major diagnostic problem among the six correct but incomplete diagnoses. Sixty-one percent of the fetuses were growth retarded, thus confirming the severity of their CHD. Chromosomal anomalies and extracardiac malformations were associated in 19% and 44% of the fetuses, respectively. Obstetric management and fetal prognosis in cases of extracardiac malformations were greatly influenced by the diagnosis of CHD. The poorest perinatal outcome was associated with heart failure. The only intrauterine deaths occurred in that group, and only one neonate survived. The outcome was more favorable in neonates without other malformations or heart failure. Four of ten (40%) of those neonates survived, while the overall perinatal survival rate was 24%.

Chromosome Aberrations↗