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Biomedical subjects

H Valensise

Publications and source records attributed to H Valensise.

At least 37 records · Page 2Linked to original sources
PubMed2000

Maternal cardiac systolic and diastolic function: relationship with uteroplacental resistances. A Doppler and echocardiographic longitudinal study.

OBJECTIVE: To test the hypothesis of the existence of a relationship between central and peripheral hemodynamic parameters by the longitudinal evaluation of maternal echocardiographic and uteroplacental resistance modifications during normal pregnancy. METHODS: Forty-three healthy normotensive primigravidae were evaluated at 12 +/- 1, 21 +/- 1, and 33 +/- 1 weeks of gestation with uterine artery color Doppler and maternal echocardiographic examinations to identify morphologic, systolic, and diastolic variables. RESULTS: Cardiac output and stroke volume significantly increased during pregnancy. Uterine resistance index (RI) decreased from the first to the second trimesters (0.72 +/- 0.10 versus 0.54 +/- 0.09, P < 0.001). Left atrial dimensions increased during pregnancy (33.8 +/- 1.9 cm, 38.1 +/- 1.8 cm, 39.3 +/- 2.1 cm, P < 0.001). Left atrial function also increased. Left ventricular mass increased (132 +/- 18 g, 162 +/- 16 g, 174 +/- 27 g, P < 0.001). Diastolic function parameters showed significant modifications: E wave velocity and E/A ratio decreased; A wave velocity and deceleration time of the E wave (DtE) increased; the left ventricular isovolumetric relaxation time (IVRT) decreased significantly (88.7 +/- 6.7 ms, 75.6 +/- 7.7 ms, 71.1 +/- 5.0 ms, P < 0.001) showing a correlation with left atrial dimensions and RI (r = -0.38, r = 0.47, respectively; P < 0.001). CONCLUSIONS: Diastolic cardiac function varies during pregnancy. A relationship between preload (left atrial enlargement), afterload (RI reduction), morphologic, and diastolic function modifications (IVRT reduction, DtE prolongation) appears to exist as a consequence of the hemodynamic modifications which occur during physiologic pregnancy. Diastolic function analysis maybe useful to identify women who fully adapt to pregnancy, and to understand the mechanisms that might be involved in women who show abnormal uterine artery Doppler waveforms.

Adult↗
PubMed2000

Multifrequency bioelectrical impedance analysis in women with a normal and hypertensive pregnancy.

BACKGROUND: An increase in total body water is common in normal pregnancy. It is thought to be an important mechanism of maternal adaptation to pregnancy. OBJECTIVE: The aim of the present study was to assess longitudinal changes in body water compartments in pregnant women and to correlate these measurements with the course of pregnancy. DESIGN: One hundred seventy-three pregnant women with apparently normal, single pregnancies participated in this longitudinal study. Anthropometric measurements and multifrequency bioelectrical impedance were performed during the first, second, and third trimesters of pregnancy. RESULTS: One hundred three of the women completed all of the measurements; 50 of the women had a normal pregnancy and 13 had gestational hypertension. Total body water, extracellular water, and intracellular water values in normal pregnancies showed a significant, progressive increase throughout pregnancy. In women with gestational hypertension, total body water, extracellular water, and intracellular water values showed an opposite trend, suggesting a lack of plasma volume expansion through fluid-retention mechanisms. CONCLUSIONS: Our results show that multifrequency bioelectrical impedance analysis can be used to monitor variations in body water compartments in normal pregnancy and detect gestational hypertension.

Adult↗
PubMed2000

Mild thyroid abnormalities and recurrent spontaneous abortion: diagnostic and therapeutical approach.

PROBLEM: The aim of this study is to evaluate the role of mild thyroid abnormalities in recurrent spontaneous abortion, and to assess the effects of two different therapeutical protocols. METHOD: A prospective study in the population of recurrent aborters with mild thyroid abnormalities, evaluating the obstetric outcome in 42 patients. Sixteen thyroid autoantibodies positive patients were treated with thyroid replacement therapy, while 11 patients received intravenous immunoglobulins (IVIG). Fifteen patients, characterized by negative antithyroid antibodies, and having underlying thyroid pathology, were treated with thyroid replacement therapy. RESULTS: Among patients with thyroid antibodies, 6 out of the 11 pregnancies (54.5%) treated with IVIG ended in live birth. In the thyroid supplementation group, 13 out of 16 pregnancies (81.2%) ended in live birth. Only one pregnancy loss occurred among patients with a mild underlying thyroid pathology treated with thyroid replacement therapy. CONCLUSIONS: Mild thyroid abnormalities are associated with an increased rate of miscarriage. This poor obstetrical prognosis seems to be related to an impaired thyroid adaptation to pregnancy. Thyroid replacement therapy appears to be more effective than IVIG in preventing a new miscarriage.

Abortion, Habitual↗
PubMed2000

High frequency of antithyroid autoantibodies in pregnant women at increased risk of gestational diabetes mellitus.

BACKGROUND: Thyroid autoantibodies (ThyAb) and subclinical hypothyroidism occur more frequently in pregnant women with insulin-dependent diabetes mellitus than in healthy pregnant women. Few studies have investigated the presence of ThyAb in women with gestational diabetes mellitus (GDM), and no significant association between diabetes in pregnancy and thyroid function has been reported. OBJECTIVE: To assess the thyroid biochemical profile and estimate the prevalence of ThyAb in a group of pregnant women at increased risk of GDM due to family and personal risk factors, and to investigate the relationship between a positive family history of diabetes or thyroid diseases and the eventual presence of ThyAb during pregnancy. METHODS: Oral glucose tolerance, serum ThyAb and thyroid function were evaluated in 181 pregnant women with increased risk for GDM (study group). Seventeen healthy pregnant women without risk factors for GDM and with a normal glucose tolerance were recruited as controls. RESULTS: The women who developed GDM showed a mean free thyroxine concentration significantly lower than that observed in the healthy pregnant women and in those with impaired gestational glucose tolerance and normal glucose tolerance. Twenty-nine of the 181 women in the study group (16%) were ThyAb positive. However, the risk of being ThyAb positive during pregnancy was three times greater in the women with positive family history of both diabetes mellitus and thyroid disease than in those with no family history of these conditions. CONCLUSIONS: This study showed that women with increased risk of GDM, mostly those with family history of diabetes mellitus and thyroid disease, also have an increased risk of being ThyAb positive during pregnancy. It also highlighted the importance of evaluating thyroid function in pregnant women with impaired glucose tolerance, in view of their increased risk of subclinical hypothyroidism.

Adult↗
PubMed1999

24-hour ambulatory blood pressure monitoring: a comparison between transdermal glyceryl-trinitrate and oral nifedipine.

The objective of the present study is to compare the effectiveness of transdermal glyceryl-trinitrate versus oral nifedipine in lowering blood pressure in patients affected by pregnancy-induced hypertension (PIH). Thirty-six consecutive pregnant women have been evaluated at different gestational ages after the diagnosis of PIH or preeclampsia (PE). After a 24-h ambulatory blood pressure monitoring, patients were allocated to three groups: those receiving oral nifedipine and those receiving transdermal glyceryl-trinitrate in a continuous (24 h/day) or intermittent (16 h/day) administration. A second blood pressure monitoring was performed after 2 weeks of treatment. Systolic and diastolic blood pressure were compared by using the Cosinor method looking at mesor, amplitude, and acrophase. Baseline systolic and diastolic blood pressure was similar among the three groups. Neither the transdermal glyceryl-trinitrate administered for 24 or 16 h nor oral nifedipine affected systolic and diastolic blood pressure. Analysis of variance showed that the posttreatment values were similar among the groups. Further studies are needed to verify the possible use of transdermal glyceryl-trinitrate as an antihypertensive drug during pregnancy.

Administration, Cutaneous↗
PubMed1998

A two-stage screening test for pregnancy-induced hypertension and preeclampsia.

OBJECTIVE: To assess the benefit of uterine artery Doppler ultrasound examination with ambulatory 24-hour blood pressure (BP) monitoring as a two-stage screening test for women at risk for pregnancy-induced hypertension, preeclampsia, or fetal growth restriction (FGR). METHODS: Uterine artery Doppler ultrasound was performed at 20-22 weeks' gestation on women at risk for pregnancy-induced hypertension, preeclampsia or FGR who were referred to our antenatal clinics. Abnormal findings were rechecked at 24 weeks' gestation. We selected 180 subjects (90 with abnormal uterine Doppler and 90 with normal uterine Doppler) for 24-hour BP monitoring with a portable automated device, immediately after recruitment, and the midline estimating statistics of rhythm of systolic and diastolic BPs were calculated. RESULTS: The highest incidence of pregnancy-induced hypertension and preeclampsia, with or without FGR, occurred in patients with abnormal uterine Doppler and a systolic midline estimating statistic of rhythm of at least 111 mmHg or a diastolic midline estimating statistic of rhythm of at least 68 mmHg. The specificity and positive predictive value of abnormal uterine Doppler ultrasound alone were low (55 and 27%, respectively), whereas the association of abnormal Doppler ultrasound with both systolic and diastolic midline estimating statistics of rhythm equal or above the selected cutoff values increased the specificity and positive predictive value to 93 and 63%, respectively. CONCLUSION: In clinical practice, a first-stage test with uterine artery Doppler ultrasound at 20-24 weeks' gestation, followed by a second-stage test with ambulatory 24-hour BP monitoring in patients with abnormal uterine Doppler, might indicate women at risk of developing pregnancy-induced hypertension or preeclampsia.

Adult↗
PubMed1998

The efficacy and fetal-maternal cardiovascular effects of transdermal glyceryl trinitrate in the prophylaxis of pre-eclampsia and its complications: a randomized double-blind placebo-controlled trial.

OBJECTIVES: Pre-eclampsia continues to be a major cause of maternal and perinatal mortality. A disorder of the nitric oxide system is implicated in the pathogenesis of this condition and preliminary studies have suggested a possible therapeutic role for nitric oxide donors in women with established pre-eclampsia. The aim of this study was to determine whether pre-eclampsia and its complications could be prevented by the long-term use of nitric oxide donors in a group of women identified to be at risk on the basis of abnormal uterine artery Doppler measurements. STUDY DESIGN: We enrolled 40 healthy normotensive women at high risk of pre-eclampsia selected on the basis of abnormal uterine artery Doppler waveforms at 24-26 weeks of gestation. Women were randomly allocated to receive transdermal glyceryl trinitrate 5 mg-patches or equivalent placebo patches in a double-blind randomized study. The primary outcome measures were pre-eclampsia, fetal growth restriction, preterm delivery or small for gestational age/fetal growth restriction rates. Patches were worn daily from recruitment for 10 weeks or until delivery. RESULTS: The primary outcomes were not significantly different in the placebo compared to the glyceryl trinitrate group. However, survival analysis of adverse events with gestation in both groups showed a significantly reduced risk of an adverse event in the glyceryl trinitrate group (p = 0.004), equating to a 73% reduction in hazard. There was no difference in maternal systolic and diastolic blood pressure, mean uterine artery resistance index and fetal umbilical and middle cerebral artery pulsatility indices between the groups. CONCLUSIONS: Low-dose prophylactic transdermal glyceryl trinitrate commenced late in the second trimester did not reduce the incidence of pre-eclampsia, preterm delivery or fetal growth restriction, but may increase the likelihood of a complication-free pregnancy. Transdermal glyceryl trinitrate (5 mg/day) did not affect maternal cardiovascular, uterine artery or fetal arterial Doppler parameters.

Administration, Cutaneous↗
PubMed1998

Reduction of serum citrulline levels in women at term toward the day of labor onset.

OBJECTIVE: To test the hypothesis that labor onset could be the result of a reduced release of nitric oxide (NO). STUDY DESIGN: Out of 91 consecutive healthy nulliparous women at term serum citrulline (Cit) and arginine (Arg) levels were measured at least twice in 37 subjects, by the means of HPLC with fluorometric detection. Twenty cases underwent a spontaneous onset of labor (group A) while in 17 cases labor was induced (group B) because of pregnancy prolongation or amniotic fluid reduction. RESULTS: Cit and Arg levels were unaffected by the gestational age. In group A, Cit levels undergo a progressive decrease toward the day of labor (from 32.9+/-4.7 microM/L the day - 18,-5 to 27.7+/-7.8 the day -4,0; p=0.012) whilst they remained stable in group B (from 33.3+/-7.7 to 34.2+/-9.2). No significant changes were observed in Arg levels. Cit/Arg ratio remained stable in group A whereas it showed a trend to increase in group B. CONCLUSION: These data indirectly suggest a reduced release of NO toward term. This phenomenon could play a permissive role in the spontaneous onset of labor of healthy nulliparous women.

Arginine↗
PubMed1998

[Spontaneous heterotopic pregnancy with live embryos: an insidious echographic problem in the first trimester. Therapeutic problems. A clinical case and review of the literature].

A case of spontaneous heterotopic pregnancy (simultaneous intra- and extrauterine) with living embryos is described. A 26 year old primigravida, affected by threatened abortion at 7 weeks gestation with right pelvic pain underwent a transvaginal sonography which allowed a certain diagnosis. A minilaparotomy with right salpingectomy was performed at the 8th week of gestation. Intrauterine pregnancy was uneventful and a healthy female infant was delivered at term weighting 3200 g. The international literature concerning heterotopic pregnancy is reviewed. Diagnostic and therapeutic aspects are discussed in the light of this case. Heterotopic pregnancy is an insidious pathology with a constant increase of incidence that should be considered as a diagnostic possibility in all cases at risk. Minilaparotomic salpingectomy in general anesthesia is probably the safest treatment for the patient and the least traumatic for a good outcome of her intrauterine pregnancy.

Adult↗
PubMed1997

Role of antepartum computerized fetal heart rate analysis in the prediction of fetal distress during labor.

OBJECTIVE: To ascertain the diagnostic ability of a computerized fetal heart rate (FHR) analysis system in the identification of patients at risk of fetal distress in labor. STUDY DESIGN: Five-hundred and seventy-seven healthy term pregnancies were enrolled in a prospective, cross-sectional study and subdivided into two groups, with (n = 90) or without (n = 487) fetal distress in labor. Computerized FHR recordings were performed periodically and regression analysis was performed in a univariate and multivariate way to assess the ability of the last FHR recordings in the prediction of subsequent fetal distress. RESULTS: The two groups showed a significant difference in almost all of the FHR parameters studied. The multivariate analysis showed that only the FHR baseline and the percentage of small acceleration were independently and significantly related to the labor outcome. The combination of these two parameters reaches a sensitivity of 45%, specificity of 91%, positive predictive value of 48% and negative predictive value of 90%, with an overall accuracy of 84%. CONCLUSIONS: The increase in FHR baseline and in small FHR accelerations can be major factors in the prediction of subsequent fetal distress in healthy term fetuses.

Computers↗
PubMed1997

Thyroid autoimmunity in pregnant women at risk for GDM.

Presence of antithyroid autoantibodies (ThyAb) during pregnancy is strictly related to the risk of developing post partum thyroiditis (PPT) and this risk is increased in IDDM pregnant women. Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable severity that begins, or is first diagnosed, during pregnancy. GDM is considered a risk factor for both type 1 and type 2 diabetes and various non-organ specific autoantibodies have been found to be associated with GDM, although there is little information on the association of GDM with thyroid autoimmunity. In this study oral glucose tolerance and prevalence of ThyAb were evaluated in a group of 41 pregnant women at increased risk of developing GDM and in a healthy control group. Our results showed that 22% of GDM risk group had impaired glucose gestational tolerance (IGGT) or GDM at the time of oral glucose tolerance test (OGTT). Moreover, ThyAb prevalence found in the women at increased risk of GDM (14.6%) was similar to that observed in healthy pregnant controls (12.5%). Nevertheless ThyAb frequency was higher in those GDM risk women with family history of diabetes (30.7%).

Adult↗
PubMed1996

Increased expression of low-affinity insulin receptor isoform and insulin/insulin-like growth factor-I hybrid receptors in term placenta from insulin-resistant women with gestational hypertension.

Gestational hypertension is associated with insulin-resistance; insulin and insulin-like growth factor-1 (IGF-1), acting through their receptors, play a role in the growth of the feto-placental unit. Since both receptors are exposed to the maternal circulation, it has been suggested that maternal metabolic abnormalities might affect placental insulin (HIR) and IGF-1 (IGF-1R) receptors. To clarify this issue, we characterized HIR and IGF-1R in placenta at term from normal women, normoinsulinaemic women with gestational hypertension (NGH), and hyperinsulinaemic women with gestational hypertension (HGH). Insulin binding was decreased in HGH women (B/T 0.12 +/- 0.03) compared to control and NGH women (B/T 0.18 +/- 0.07, p < 0.036; and 0.22 +/- 0.5, p < 0.009 respectively). Receptor affinity was lower in HGH women (ED50 0.95 +/- 0.32 nmol/l) than control and NGH women (ED50 0.42 +/- 0.19 nmol/l, p < 0.01; and 0.40 +/- 0.1 nmol/l, p < 0.007, respectively), whereas low-affinity Ex11+ isoform was higher in HGH women (Ex11+ 50 +/- 7, %) than in control and NGH women (Ex11+ 34 +/- 9%, p < 0.001; and 39 +/- 4%, p < 0.01, respectively). Increased expression of Ex11+ isoform was correlated with ED50 (r = 0.71; p < 0.002) and insulinaemia (r = 0.70, p < 0.002). IGF-I binding was increased in HGH women (B/T 0.17 +/- 0.03) compared to control and NGH women (B/T 0.09 +/- 0.05, p < 0.002; and 0.11 +/- 0.03, p < 0.002, respectively). IGF-IR affinity was similar in the three groups. The percentage of insulin/IGF-I hybrid receptors was increased in HGH women (85 +/- 3%) compared to control and NGH women (68 +/- 7%, p < 0.001; and 63 +/- 9%, p < 0.001, respectively), and was positively correlated with insulinaemia (r = 0.62, p < 0.018), ED50 of insulin binding (r = 0.62, p < 0.05), and maximal IGF-I binding (r = 0.69, p < 0.004); whereas it was inversely correlated with maximal insulin binding (r = -0.69, p < 0.004). Results provide the first evidence for altered expression of insulin/IGF-I hybrids found in insulin-resistance states.

Adult↗
PubMed1995

Normal fetal growth in women with antiphospholipid syndrome treated with high-dose intravenous immunoglobulin (IVIG).

Antiphospholipid antibodies are associated with fetal distress and fetal death. Although different therapeutic regimens have been used, the incidence of fetal growth retardation varies between 30 and 60 per cent of reported cases. We report the evolution of fetal growth in patients with antiphospholipid antibody syndrome treated with high-dose intravenous immunoglobulins (IVIG). Fourteen patients with a history of recurrent spontaneous abortion and immunological diagnosis of antiphospholipid syndrome were followed longitudinally. Intravenous immunoglobulin at a dose of 0.5 g/kg body weight for two consecutive days was started from the fifth week of pregnancy and repeated every 4 weeks until the 33rd week of gestation. Fetal biometry was evaluated longitudinally from the appearance of the gestational sac at 4 weekly intervals. In the period between 26 and 34 weeks, the frequency of evaluation was increased to every 14 days. Data obtained were compared with a control group of 70 fetuses with uneventful pregnancies matched for gestational age. Neonatal weight is shown in relation to the centiles for the normal population. One patient out of 14 (7.1 per cent) developed gestational hypertension and abruptio placentae. No other pregnancy complications were seen. No proteinuria was found. The mean maternal age was 31.2 +/- 3.8 years. Median birth weight was 3433 g +/- 287. The median centile of the birth weight was 65.3 +/- 18.6. Mean gestational age at delivery was 1.3 weeks. No fetal or neonatal growth retardation was seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Habitual↗
PubMed1994

Influence of neoadjuvant polychemotherapy on natural killer cell activity in patients with locally advanced cervical squamous carcinoma.

Peripheral blood natural killer (NK) cell activity against K562 tumor line was monitored in 16 patients with locally advanced squamous cervical carcinoma (II and III FIGO stages) during neoadjuvant polychemotherapy (cisplatin at 80 mg/m2 and bleomycin at 30 mg/m2). There was a significant progressive decrease in NK activity during the three cycles of antiblastic treatment (P = 0.008) without significant depletion of NK cell (CD56 and CD16 monoclonal antibody positive cell percentage and absolute number). A significant relationship was shown between basal NK activity levels and response to polychemotherapy; in fact, nonresponder patients had a significantly lower mean value of NK activity before polychemotherapy than responders (P = 0.044). In conclusion, NK activity declines as a result of antiblastic therapy; although polychemotherapy reduces tumor spread, its antineoplastic action may be affected by this decreased immune reactivity.

Adult↗