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Biomedical subjects

G Zanconato

Publications and source records attributed to G Zanconato.

14 recordsLinked to original sources
PubMed1999

Comparison of transdermal estradiol and tibolone for the treatment of oophorectomized women with deep residual endometriosis.

STUDY OBJECTIVE: To compare the effect of HRT with transdermal estradiol and that of treatment with tibolone in post-menopausal women with residual endometriosis. MATERIALS AND METHODS: 21 women with residual pelvic endometriosis after bilateral oophorectomy with or without hysterectomy were enrolled in the study and were randomized to HRT with transdermal estradiol 50 mg twice weekly (n = 10) associated with cyclic medroxyprogesterone acetate 10 mg daily in women who preserved uterus, and to treatment with tibolone 2.5 mg administered orally once a day (n = 11). The duration of both treatments was scheduled to last at least 12 months. Residual endometriosis was located in the bowel wall in four patients, in the rectovaginal septum in six and deeply in the retroperitoneal pelvic space in six. All women were symptomatic before oophorectomy. RESULTS: All the women were followed for 12 months. No patient suspended therapy because of side effects. Four patients of the estradiol group experienced moderate pelvic pain during treatment compared with only one patient in the tibolone group. One patient in the estradiol group reported severe dyspareunia. CONCLUSION: Although our series is very small, it seems that tibolone may be a safe hormonal treatment for post-menopausal women with residual endometriosis.

Administration, Cutaneous↗
PubMed1999

Phantom endometriosis of the sciatic nerve.

OBJECTIVE: To assess the efficacy and diagnostic value of GnRH agonist (GnRH-a) therapy in cases of hidden sciatic nerve endometriosis. DESIGN: Case report. SETTING: Academic tertiary referral center for endometriosis treatment. PATIENT(S): Three patients with cyclic, catamenial sciatica associated with pelvic endometriosis who had electromyographic evidence of sciatic nerve damage but negative computed tomography and magnetic resonance imaging findings. INTERVENTION(S): Monthly administration of the GnRH-a leuprolide acetate plus daily transdermal E2 (25 microg). MAIN OUTCOME MEASURE(S): Relief of pain symptoms and improvement in motor function. RESULT(S): All three patients had clear decreases in pain and partial amelioration of claudication. CONCLUSION(S): Endometriosis of the sciatic nerve may be hard to diagnose with the use of current imaging techniques but may be proved by clinical response to GnRH analogue treatment and may be more frequent than previously thought.

Administration, Cutaneous↗
PubMed1999

Laparoscopic creation of a neovagina in women with pelvic kidney.

Laparoscopic modification of Vecchietti's technique for creating a neovagina was carried out in four women with Rokitansky syndrome and renal anomalies. All four patients had pelvic kidney, and in two it was associated with contralateral renal agenesis. The procedure was specifically modified to reduce the risks inherent in the most difficult step, passing the thread-bearing cutting needle from the abdominal wall to the retrohymenal fossa, through the vesicorectal space. In all patients this was done successfully on the side contralateral to the pelvic kidney or in the hemipelvis in which the ureter was absent. Our experience proves that Vecchietti's technique for creating a neovagina, performed by laparoscopy, is feasible in patients with pelvic kidney, and laparotomy is unnecessary. (J Am Assoc Gynecol Laparosc 6(3):327-329, 1999)

Abnormalities, Multiple↗
PubMed1999

Transrectal ultrasonography in the assessment of congenital vaginal canalization defects.

Our aim was to evaluate the reliability of transrectal ultrasonography in the preoperative assessment of congenital vaginal canalization defects. We studied nine patients, six with suspected Rokitansky syndrome and three with suspected complete transverse septum. Before corrective surgery all the patients underwent pelvic examination, transabdominal and transrectal ultrasonography. The ultrasonographic findings were compared with the surgical ones. Transrectal ultrasonography provided an accurate map of the pelvic organs showing the precise distances between the urethra and bladder anteriorly, rectum posteriorly, retrohymenal fovea caudally, and pelvic peritoneum cranially. Transrectal ultrasonography produced a picture that corresponded perfectly with the real anatomical situation. Conversely, abdominal ultrasonography provided inadequate images in six of our nine patients, and magnetic resonance imaging was responsible for a mistaken diagnosis in one patient with suspected transverse vaginal septum. In conclusion, if our results are confirmed in larger series, transrectal ultrasonography could be considered as a diagnostic procedure of choice in the assessment of vaginal canalization defects.

Abdomen↗
PubMed1998

Paternal and maternal smoking habits before conception and during the first trimester: relation to spontaneous abortion.

PURPOSE: This study examined the association between maternal smoking before and during the first trimester of pregnancy and spontaneous abortion. METHODS: We have been conducting a hospital-based case-control study on risk factors for spontaneous abortion in the greater Milan area. We collected information from 782 cases of spontaneous abortions and 1543 controls (women who delivered at term healthy infants). RESULTS: With respect to never smokers, the odds ratio (OR) were 0.7 (95%, confidence interval (CI), 0.5-1.0) for women who quit smoking and 1.3 (95% CI, 1.0-1.6) for those who continued during pregnancy. Women who smoked more than 10 cigarettes/day in the first trimester were at increased risk of miscarriage, with an OR of 1.4 (95% CI, 1.0-2.1). No relationship was evident between the number of cigarettes smoked before conception and the risk of abortion. Likewise, no association emerged between paternal smoking and miscarriage. Moreover, no significant interaction or modification effect was obtained when strata of age and other major characteristics were investigated. CONCLUSIONS: The risk of abortion associated with cigarette smoking during the first trimester of pregnancy was measurable and noticeable in this population, and accounted for 9% (95% CI, 6-13%) of all cases. The increased risk of spontaneous abortion in women smoking during pregnancy is a further reason to encourage pregnant women to quit.

Abortion, Spontaneous↗
PubMed1998

Intramesosalpingeal injection of oxytocin in conservative laparoscopic treatment for tubal pregnancy: preliminary results.

The objective of this study was to evaluate the efficacy of the local use of oxytocin as adjuvant treatment in conservative surgery for tubal pregnancy. The patients were 25 women with laparoscopic diagnosis of tubal pregnancy who were candidates for salpingotomy. Before salpingotomy, each patient was randomly allocated to intramesosalpingeal injection of 20 IU oxytocin diluted to 20 ml with saline solution or 20 ml saline solution. The surgeon then proceeded with salpingotomy and removal of the pregnancy according to the usual technique. The main outcome measures were bleeding during salpingotomy, ease of removal of the pregnancy, bleeding at the site of the pregnancy, and need for recourse to salpingectomy. Twelve women were randomized to the oxytocin group and 13 to the control group. Examination of the surgeons' assessments of the difficulties encountered at the different stages of surgery revealed statistically significant differences between the oxytocin group and controls in each variable. In particular, the amount of endosalpingeal bleeding after removal of the pregnancy was less in the oxytocin group. In one control patient, persistent bleeding due to incomplete trophoblast removal forced the surgeon to perform salpingectomy. Our results indicate that intramesosalpingeal injection of oxytocin facilitates the performance of conservative laparoscopic treatment for tubal pregnancy.

Adult↗
PubMed1998

Coffee consumption and risk of hospitalized miscarriage before 12 weeks of gestation.

In order to analyse the association between drinking coffee in pregnancy and risk of spontaneous abortion, a case-controlled study was conducted in Milan, Northern Italy. Cases were 782 women with spontaneous abortion within the 12th week of gestation. The control group was recruited from women who gave birth at term (> 37 weeks gestation) to healthy infants on randomly selected days at the same hospitals where cases had been identified: 1543 controls were interviewed. A total of 561 (72%) cases of spontaneous abortion and 877 (57%) controls reported coffee drinking during the first trimester of the index pregnancy. The corresponding multivariate odds ratios of spontaneous abortion, in comparison with non-drinkers, were 1.2, 1.8 and 4.0, respectively, for drinkers of 1, 2 or 3, and 4 or more cups of coffee per day. No relationship emerged between maternal decaffeinated coffee, tea and cola drinking in pregnancy, as well as paternal coffee consumption, and risk of spontaneous abortion. With regard to duration in years of coffee drinking, the estimated multivariate odds ratios of spontaneous abortion were, in comparison with non-coffee drinkers, 1.1 (95% confidence interval (CI) 0.9-1.4) and 1.9 (95% CI 1.5-2.6) for women reporting a duration of coffee consumption < or = 10 or > 10 years. In conclusion, coffee drinking early in pregnancy was associated with an increased risk of abortion. This has biological implications, but epidemiological inference on the causality is difficult and still open to debate.

Abortion, Spontaneous↗
PubMed1997

Reproductive characteristics and post-abortion health consequences in women undergoing illegal and legal abortion in Maputo.

In the Maputo Central Hospital 103 women undergoing induced legal abortion (LA), 103 women with confirmed, recent illegal abortion (IA), and 100 randomly recruited antenatal clinic (AC) attenders were compared in order to find characteristic features regarding obstetric history, reproductive performance and contraceptive knowledge, attitude and practice. Women with IA were younger, had almost never undergone LA, had more often their first sexual intercourse and their first pregnancy below 20 years of age, had less knowledge of contraceptives and more often had never used contraceptives, had fewer previous spontaneous abortions and fewer previous stillbirths than LA women. There were three maternal deaths, all in the IA group. The most frequent illegal abortionist was a health worker (38%). It is concluded that, in this first comparative African study on IA and LA regarding reproductive profile and post-abortion health consequences, the former are at a disadvantage regarding early unprotected sexual intercourse with first pregnancy at a young age and with almost no experience of safe, legal abortion.

Abortion, Illegal↗
PubMed1997

Fetal macrosomia and management of delivery.

During the period 1988-1966, 737 pregnancies, in which the infant birth weight was > or = 4000 grams were studied. During the same period there were 11,631 newborns, and 6.3% of them were infants with a birth weight > or = 4000 grams. Normal vaginal delivery occurred in 583 cases (79.1%), vacuum extraction in 24 cases (3.3%) and caesarean section in 130 cases (17.6%). Regarding the caesarean section, 38 (29.2%) of them were elective and 92 (70.8%) were done in different periods of the labour. In these macrosomic babies perinatal death never occurred, but different pathological neonatal outcomes were observed and the majority of these were clavicle abruptions (39 cases: 5.3%). Maternal morbidity observed in the 607 (82.4%) cases with vaginal delivery is characterized by: 60 cases (9.8%) of vaginal and perineal tears, 4 cases (0.6%) of cervical tears, and 2 cases (0.3%) of pubic symphysis traumatic diastasis. Shoulder dystocia is the most likely outcome in fetal macrosomic delivery; for this reason we considered the diagnostic and therapeutic management of this obstetrical complication. Because the normal outcome of neonatal births actually encourages the preference for normal vaginal delivery, we concluded that mothers with macrosomic fetuses can safely be managed expectantly unless there is a high maternal and fetal risk.

Adolescent↗
PubMed1994

Audit of uterine rupture in Maputo: a tool for assessment of obstetric care.

Records of 96 women who had rupture of the uterus in labor were audited to find circumstances significantly associated with pregnancy outcome. The prevalence was 1 rupture in 424 deliveries. In 74 cases (77.1%) uterine rupture occurred after hospitalization, the remaining 22 cases being emergency transfers with rupture secondary to a delivery attempt elsewhere. History of a previous cesarean section was present in 46%, whereas 54% of the women had an unscarred uterus. Maternal mortality was 7.3% whilst perinatal mortality was 62.9%. Adverse outcome for the mother was associated with ruptures occurring in unscarred uteri (p < 0.02) and outside the Maternity (p < 0.01); this latter condition also contributed to higher fetal mortality (p < 0.002). The findings confirm that delay in reaching medical care is an aggravating factor in the evolution of uterine rupture in developing countries and suggest the need for better medical attention and timely diagnosis in laboring women with unscarred uterus.

Adolescent↗
PubMed1993

Prevalence of syphilis infection in Mozambican women with second trimester miscarriage and women attending antenatal care in second trimester.

OBJECTIVES: To elucidate whether recent syphilis infection is significantly more prevalent among women with mid-trimester miscarriage than among antenatal care attenders in midtrimester pregnancy. DESIGN: Two categories of pregnant women were compared regarding serological signs of syphilis. Rapid Plasma Reagin (RPR) analyses were done in Mozambique and Veneral Disease Research Laboratory (VDRL) tests in Sweden. In case of RPR and/or VDRL positivity, Treponema pallidum haemagglutination (TPHA) and Captia Syphilis-M were performed. SETTING: A suburban antenatal care clinic and the emergency ward at the Department of Obstetrics and Gynecology at the Central Hospital in Maputo, Mozambique, were studied June-August 1991. SUBJECTS: Randomly selected women seeking antenatal care in midtrimester pregnancy (N = 202) were compared with 114 women consecutively entering with clinical signs of midtrimester miscarriage. RESULTS: Among antenatal care attenders, 37/202 (18.3%), and among women with midtrimester miscarriage, 37/114 (32.5%), had syphilis confirmed with the Treponema pallidum haemagglutination test (p < 0.01). Significant titres of IgM antibodies tended to be more prevalent among women with miscarriage (7.0%) than among women attending antenatal care (4.5%), though the difference only approached statistical significance. CONCLUSION: The findings suggest a potential association between syphilis seropositivity and midtrimester miscarriage. Present findings justify more extensive studies to establish whether or not recent syphilis infection is a risk factor for midtrimester miscarriage.

Abortion, Spontaneous↗
PubMed1992

[Obstetric-gynecologic problems in the developing countries].

The integrated health programmes in the developing countries give priority to the improvement of women's living conditions and of maternal and child health medical attention. The Authors, as specialists in Obstetrics and Gynecology active in an African country, present the most frequent pathological situations which, in their experience, can lead to the death of the pregnant woman. The social reality of the underdeveloped world and the high Total Fertility rates, due partly to the absence of a contraceptive culture, too often see the woman of reproductive age threatened by the complication deriving from abortion, ectopic pregnancy and labour. The obstetrician needs to know how to solve these emergencies and how to train the local personnel in order to guarantee as much as he can the essential obstetrical functions.

Child Health Services↗
PubMed1979

A syndrome of apparent mineralocorticoid excess associated with defects in the peripheral metabolism of cortisol.

A syndrome is described whose features, suggestive of primary mineralcorticoid excess, included hypertension, hypokalemia, low PRA, and responsiveness to spironolactone. Aldosterone levels were subnormal but as yet there has been no evidence of overproduction of other mineralocorticoids by chemical analysis or by bioassay of plasma and urinary extracts. The steroidal abnormalities that were observed involved peripheral matabolism rather than secretion. One patient exhibited a transient delay in reduction of the 3-keto group in the A ring, and both patients exhibited a decrease in the metabolism of cortisol to biologically inactive cortisone. This was shown by the marked decrease in the excretion of urinary metabolites bearing an 11-keto group and a decrease in the oxidation of 11 alpha-[3H]cortisol to tritiated water. The defect appeared not to be a deficiency of the 11 beta-oxidoreductase system itself, since the reverse reaction of conversion of cortisone to cortisol proceeded normally, but, rater, an alteration in the equilibrium position of 11 beta-oxidoreduction in favor of the reduced form. This was also expressed by a prolongation of the half-time of disappearance of cortisol. The decrease in the MCR permitted the maintenance of normal cortisol plasma levels and normal glucocorticoid function at a diminished rate of secretion. The decreased rate of conversion of cortisol to cortisone serves as a biochemical marker of this hypertensive syndrome.

17-Hydroxycorticosteroids↗