Biomedical subjects
G Scarselli
Publications and source records attributed to G Scarselli.
Role of vaginal surgery in the 1st stage endometrial cancer. Experience of the Florence School.
The role of vaginal surgery in first stage endometrial carcinoma is reviewed. Out of total of 231 patients with endometrial cancer, observed at the Gynecologic Clinic of Florence from 1977 to 1981, 187 were at Stage I and 180 of them were submitted to surgery. During the period 1977-1979, the treatment protocol recommended vaginal hysterectomy; since 1980 abdominal surgery has prevailed. Depending on risk factors, adjunctive radiotherapy was employed. No statistically significant difference was observed in the actuarial survival curves between different surgery routes. However, severe complications and operative mortality was significantly lower in patients operated by vaginal hysterectomy. The vaginal route may be considered an adequate alternative therapy for endometrial carcinoma Stage I.
Clinico-pathological profile of endometrial carcinoma in young women (under 40 years of age).
Twenty primary endometrial carcinomas in 40 year-old or younger women were collected from a series of 845 carcinomas and newly re-evaluated. The typical histological profile was well-differentiated adenocarcinoma (30%) or adenoacanthoma (35%); however, a case of adenosquamous carcinoma and an exceptional malignant mixed mesodermal tumor were also observed. No tendency for myometrial infiltration (M0) was displayed by 11 (55%) of the cases, while 6 were M1 and 3 were M2 infiltrating neoplasias. Adenomatous hyperplasia was associated with cancer in 53% of the 15 assessable cases. Histopathological diagnostic problems were elicited in 5 cases only. Typical Stein-Leventhal syndrome occurred in 7 patients (35%), while polycystic ovaries were observed in 15 cases (75%). Usually, the patients were obese (40%) and nulligravida (65%). All but one case were stage I disease. Prognosis seems to be excellent following surgery.
Correlation between endometrial biopsy and luteal phase plasma progesterone in women complaining for couple infertility.
One hundred forty-three women complaining for couple infertility (more than 2 yr), were investigated for luteal phase deficiency (i.e. insufficient endometrial luteinization) by endometrial biopsy and serial determinations (in days -10, -7 and -4 respect the onset of the next menses) of plasma progesterone during luteal phase. One hundred-three women had the first endometrial biopsy in phase (IP), 36 had the biopsy "out of phase" (OOP). Among them 13 did not repeat endometrial biopsy, 12 had the second biopsy out of phase (and then classified as Luteal Phase Deficiency) and 11 had the second biopsy "in phase". Only the women affected by luteal phase deficiency had the plasma progesterone (mean of 3 samples) significantly lower than that of infertile women with normal endometrial luteinization. However the majority of the individual progesterone values of these two groups overlapped. The endometrial biopsy seems to be the most practicable method for investigating luteal phase deficiency in women complaining for couple infertility.
Levo-norgestrel-nova-T and precancerous lesions of the endometrium.
The authors report the preliminary data on the topical treatment of endometrial hyperplasia by an intrauterine device releasing Levo-norgestrel (LNG-Nova-T), in a series of 31 patients. The patients examined so far by endometrial biopsies performed at predetermined intervals showed a complete histological regression of the hyperplasia, regardless of its pattern.
Measurement of glucuronometabolites of 17 beta-estradiol and progesterone in diluted overnight urine. An approach to the study of luteal insufficiency.
The determination of the concentrations of estrone-3-glucuronide, pregnanediol-3-glucuronide and luteinizing hormone has been performed in early morning urine samples of 14 normal menstruating women using a timed and measured volume urine collection procedure. In order to investigate the variability of the urinary hormonal concentrations due to day-to-day differences in diuresis, the absolute hormonal concentrations have been corrected either for the urinary creatinine excretion or for the volume of urine voided during the night. The results demonstrate that both correction factors are able to reduce substantially the coefficient of variation values in comparison to the absolute hormonal concentrations. The urinary test of ovarian function has been performed in 11 infertile women affected by luteal insufficiency using the same procedure, and the hormonal profiles showed some alterations in both estrone-3-glucuronide and pregnanediol-3-glucuronide concentrations in comparison to the hormonal profiles of the normal subjects. Such alterations were significant in the single subject when integrated values of the hormonal data in defined time intervals were investigated.
Analysis of the action of corticosteroid treatment in immunologic infertility: a preliminary report and an alternative hypothesis.
The presence of sperm antibodies can be demonstrated in 8-10% of the male partners of infertile couples. The therapeutic schedule with which the highest pregnancy rate has been obtained in these cases is that proposed by Shulman, which uses methylprednisolone (MP). If treatment with corticosteroids (CS) is effective, the way in which it acts is not entirely clear. In this study we report the results of 16 treatment cycles with CS administered to eight male patients having sperm antibodies in their serum, in which several parameters of humoral immunity were evaluated. The results are conflicting: several parameters (such as IgG concentration) underwent only slight variations after 7 days of therapy, whereas in 12 cycles out of 16, the Tray agglutination test (TAT) indicated that a reduction or disappearance of the antibodies had been obtained. This confirms the usefulness of CS in immunological infertility, and allows us to hypothesize that the beneficial effect may be found in a reduction of inflammation rather than in a suppression of the immunological response, since CS are well known to have these two kinds of effect.
Perioperative chemotherapy in the treatment of carcinoma of the uterine cervix.
Two hundred forty-eight women from 1969-71 who underwent surgery for carcinoma of the cervix and were treated with triaziquone (0.2 mg i.v. daily) from day 2-5 after the operation, are compared to a group of 301 conventionally treated patients examined over the 3 following years. Survival rates after 5 years did not differ significantly between the 2 groups of patients, considered either globally or divided according to their clinical or surgical-pathological stage. The incidence of complications in the "treated" patients was not significantly higher, particularly considering local and general post-operative recovery. A prospective randomized study using drugs with a high cytotoxic activity in patients with tumors limited to the cervix and unfavorable prognostic factors, could in the future help evaluate the possibility of using surgical adjuvant chemotherapy in carcinoma of the cervix.
Tamoxifen and oligospermia.
Thirty normogonadotropic oligospermic males were administered Tamoxifen (20 mg/day) for 4 months. A complete evaluation of seminal parameters before and after treatment was performed. An increase of both mean sperm concentration and total sperm count was noted after treatment with Tamoxifen (p less than 0.05), whereas no variation was observed for semen volume, sperm morphologic characteristics, or sperm motility. Hormonal patterns of 5 of these subjects before, during, and after 3 months of treatment with Tamoxifen showed a progressive increase of gonadotropin (especially LH) and 17 beta E2 values; testosterone variations were minimal, and PRL showed a slight decrease.
[Clinical experience with a new type of intra-tubal device].
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Comparative pharmacokinetic evaluation of ceftriaxone and cefotaxime in coincidence for short-term antimicrobial prophylaxis in surgery.
In 48 patients undergoing elective gynecological, urological and otorhinolaryngological surgery a pharmacokinetic study after 1 g dose of ceftriaxone or cefotaxime was done. Concentrations of the two antibiotics were studied in interstitial fluid with the suction blister technique and in some tissues collected during the operation. The mean tissue levels were generally higher after ceftriaxone administration than after cefotaxime and for both drugs they were lower than the contemporary drug levels in interstitial fluid. However at the concentrations found almost all aerobic and anaerobic bacteria causing postoperative wound infections are inhibited.
Hysteroscopic evaluation of endometrial cancer.
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Polychemotherapy in ovarian cancer: treatment with Adriamycin, BCNU and cyclophosphamide vs. Adriamycin and cyclophosphamide.
The authors compared both therapeutic efficacy and toxicity of two different treatment regimens: ABC = adriamycin, nitrogen mustard (BCNU) and cyclophosphamide (CTX) vs. AC = adriamycin and cyclophosphamide in ovarian cancer. Thirty-one patients were entered under treatment plan ABC and 26 under treatment plan AC simultaneously. Therapeutic evaluation was subdivided into different risk groups (adjuvant therapy, residual disease less than or greater than 2 cm). A similar result could be noted in the two different treatment regimens. Toxicity was more severe and frequent in the group treated with BCNU. The AC regimen was preferred because of its lower incidence of side-effects and for its easier mode of administration.
The microcolposcopy in the management of the cervical intraepithelial neoplasia.
The authors report their experience with the microcolpohysteroscope of Hamou. This instrument allows a magnification from 0 to 150 times. Its fine caliber (4 mm) allows to work easily also in the interior of the cervical canal, without preventive dilatation. The instrument allows the in vivo vision of the cellular arrangement at the superficial level, after vital staining. The purpose of this research is the discussion of the potentiality of the microcolpohysteroscopy as complementary mean to colposcopy, citology and histology in the management of the Cervical Intraepithelial Neoplasia (CIN). The authors conclude showing the advantages of this technique underlining as this method does not interfere with the natural evolution of the pathologic process, allowing at the contrary to determine the nature and the extension of the lesion. Then, without opposing or to citology or to colposcopy or to histology, it is not only a valid complementary diagnostic mean, but in particularly it contributes to a more rational therapeutic decision.
Cone: its possible diagnostic and therapeutical role in microcarcinoma.
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Pre-neoplastic lesions of vulvar cancer.
The monitoring of potentially neoplastic lesions is based on the determination of the histopathologic characteristics of the lesion, which is done either by large surgical resection of the lesions "in toto" or by biopsy of the lesion. Chronic vulvar dystrophy may develop into carcinoma, the supposed likelihood varying according to the various Authors. The lesion which is histologically defined as atypical keratoacanthoma is the most frequent precursor of carcinoma. Most Authors agree in believing that lichen scleroatrophic does not often develop into carcinoma. It is, nevertheless, the most frequent precursor of leukoplakia which is, on the other hand, a risk lesion. However, any chronic vulvar irritation may increase the risk of cancer and must therefore be carefully monitored by multiple biopsies to be examined at regular intervals.
Estradiol and progestin receptors, 17-beta-hydroxysteroid-dehydrogenase and histopathologic grade in endometrial carcinoma.
The possible correlation between steroid receptor systems, 17-beta-HSD and histopathologic examinations were investigated. The well-differentiated tumors showed higher steroid receptor and 17-beta-HSD values than undifferentiated carcinomas. The steroid receptors did not present a statistically significant correlation with 17-beta-HSD. Nevertheless, some neoplastic endometria (29%) show higher values of progestin receptors and 17-beta-HSD, with a progestin:estrogen receptor ratio greater than one.