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Biomedical subjects

L Cravello

Publications and source records attributed to L Cravello.

At least 55 records · Page 3Linked to original sources
PubMed1999

Serum glucagon concentration and hyperinsulinaemia influence renal haemodynamics and urinary protein loss in normotensive patients with central obesity.

OBJECTIVES: Insulin-resistance syndrome and hyperinsulinaemia are linked with cardiovascular disease (CVD) in the obese population. In particular, cardiovascular risk is more frequent in central obesity and is associated with microalbuminuria (MA). MA and changes of glomerular permeability to proteins in obesity might be related with renal haemodynamic modifications (that is glomerular hyperfiltration). Since glucagon is physiologically involved in renal haemodynamic regulation, the purpose of this study was to examine whether changes of circulating glucagon levels might haemodynamically induce MA and proteinuria in patients with central obesity. SUBJECTS: Forty normotensive obese out-patients, 22 with central (CO group) and 18 with peripheral (PO group) body fat distribution and 11 healthy subjects. MEASUREMENTS: Serum insulin and glucagon concentrations (fasting and after oral glucose tolerance test (OGTT)) by radio immuno assay (RIA); glomerular filtration rate (GFR, isotopic); total clearances and urinary excretion rates of albumin (AER), IgG (IgGER) and alpha1 microglobulin (computerized immunonephelometry). RESULTS: GFR and insulin concentrations (fasting and during OGTT) were higher in the CO than the PO group. Fasting glucagon concentrations were increased, and not physiologically suppressed during OGTT in patients with CO (fasting, P<0.05; OGTT 60 and 120 min, P<0.001 vs PO group). Moreover, glucagon concentrations were significantly correlated with GFR in the CO group (fasting, r=0.49, P<0.05; 60 min after OGTT, r=0.58, P<0.01); whereas no correlations were found in the PO group. Higher AER (P<0.001), IgGER (P<0.001) and alpha1 microglobulin (P<0.05) urinary concentrations were found in patients with CO than in the PO group. CONCLUSIONS: The increase of serum glucagon concentrations may be associated with the enhancement of GFR in patients with central obesity. Glomerular hyperfiltration might influence the development of MA and of proteinuria by means of a haemodynamic mechanism so contributing to increase the risk of renal microvascular complications and of CVD in central obesity.

Adult↗
PubMed1999

Dehydroepiandrosterone sulfate enhances natural killer cell cytotoxicity in humans via locally generated immunoreactive insulin-like growth factor I.

Experimental and clinical investigations suggest the hypothesis that dehydroepiandrosterone sulfate (DHEAS) can positively influence natural killer (NK) immunity via locally produced insulin-like growth factor I (IGF-I) from NK cells. In the present study, the NK cell cytotoxicity (NKCC) and IGF-I levels in the supernatant of NK cells were studied at baseline and after exposure to various molar concentrations of DHEAS (from 10(-5)-10(-8) mol/L x mL/7.75 x 10(6) NK cells) in healthy subjects of young and old age. DHEAS-induced NKCC was also determined after DHEAS coincubation with somatostatin-14 (10-6) mol/L x mL/7.75 x 10(6) NK cells) and with interleukin-2 (IL-2; 100 IU/mL x 7.75 x 10(6) NK cells). NK cells were previously isolated by Ficoll-Hypaque density gradient and then by immunomagnetic procedure; the purity obtained was 97 +/- 1%. NKCC was determined against K562 tumoral targets. We observed that the increase in NKCC after DHEAS exposure was dose dependent and was correlated with the amount of IGF-I released in the supernatant of cultured NK cells. NKCC and IGF-I generation from NK cells were more elevated in healthy elder subjects than in healthy young subjects. The coincubation of DHEAS with somatostatin-14 significantly suppressed NKCC and IGF-I release from NK in both groups, whereas higher NKCC was found after DHEAS plus IL-2 exposure than after incubation with DHEAS alone. Taken together, this study suggests a role for NK-generated IGF-I in the modulation of NKCC by DHEAS in humans. Although DHEAS may contribute to the IL-2-mediated NKCC, its activity on NK cytolytic function can be dependent on a autocrine mechanism (IGF-I-mediated), probably independent of cytokine activation. The higher NKCC response to DHEAS found in old subjects than in younger might counterbalance the age-dependent decline in circulating DHEAS, thus contributing to maintain the pattern of NK immunity during aging.

Adult↗
PubMed1999

[Vaginal hysterectomy for non-prolapse uterus].

Vaginal hysterectomy in the treatment of non prolapsed uterus without malignant disease is a well codified technique. Per operative complications, post operative morbidity are less frequent and less serious than by abdominal surgery and convalescent time is less extended. Financial cost is lower compared with laparoscopic hysterectomy. The successful result of the vaginal way is determined by anatomic factors: volume and mobility of the uterus, accessibility of the vagina, but above all by the training of the surgeons. A rate of seventy per cent of hysterectomies performed by the vaginal way in the case of this indication is a realistic aim in a hospital center.

Adult↗
PubMed1999

[Impact of adenomyosis on results of endometrial ablations].

The authors report the results of a retrospective series concerning 121 patients who presented abnormal uterine bleeding resistant to progestogen therapy. These patients were adenomyosis carriers and who underwent loop endometrial ablation. Over a maximum period of 8 years, the success rate was 56% following one endometrial resection and 67% following one or two resections. The study recorded a repeat resection level of 11%. Seventeen hysterectomies (19%) were performed because of the recurrence of abnormal uterine bleeding. These results are comparable to those observed in endometrial ablation performed for menorrhagia, all benign etiology included. Adenomyosis does not appear to be a factor in the failure of endometrial ablation, except in the case of deep adenomyosis which is difficult to diagnose pre-operatively.

Adult↗
PubMed1999

[Evaluation of direct hospital and extra-hospital cost of operative hysteroscopy and vaginal hysterectomy].

The objective of this work was to evaluate hospital and postoperative costs associated with gynecologic surgery for benign uterine pathologies. We studied operative hysteroscopy and vaginal hysterectomy. Hospital costs were broken down into several categories: operating room, postoperative hospitalization, pharmacy surgical instruments, sterilization of reused equipment, food and laundry, indirect costs. The mean total costs for the hospitalization time were 4609.8 francs for hysteroscopic surgery and 7920.3 francs for vaginal hysterectomy. Medical charges in recovery time were calculated with the help of the Social Security. These charges represented 5% of the total cost associated with the procedure.

Direct Service Costs↗
PubMed1999

[Pelvic endometriosis with urologic involvement. Therapeutic principles: apropos of 2 cases].

The authors report 2 clinical cases of vesicopelvic endometriosis. The urinary symptoms and the radiological appearance of endometriosis of the bladder are nonspecific. The diagnosis was established by histological examination of the resection specimen. The authors describe the therapeutic approach based on radical surgery designed to eradicate the endometriosis, while remaining as conservative as possible in order to allow subsequent pregnancy, and the place of urological surgery combined with medical treatment with LHRH analogue.

Adult↗
PubMed1999

[Evaluation of two methods for endometrial sampling during diagnostic hysteroscopy].

OBJECTIVE: To compare two endometrial sampling devices, pipelle and vacurette, performed during hysteroscopy, based on the quality of material obtained and pain during the sampling. PATIENTS AND METHODS: During the period from 01.03.96 to 01.12.97, 200 patients were consecutively randomized in a single blind prospective study. Efficacity was evaluated on the quality of material obtained and pain was graded on a scale of 0 to 5. RESULTS: On the average the Vacurette was more painful (1.6 vs 1.1, p = 0.01). Vacurette biopsy was more effective than pipelle biopsy (64% vs 48%, p = 0.05). There was a significative difference of efficacity in the post-menopausal group (34% vs 13%, p = 0.05), but not in the pre-menopausal group (76% vs 64%, p > 0.05). When hysteroscopy diagnosed endometrial atrophy, there was no significative difference of efficacity (29% vs 23%, p > 0.05), whereas vacurette was significatively more effective when there was an other hysteroscopy diagnosis (78% vs 62%, p = 0.05). Both procedures were less effective in post-menopausal women (p = 0.001), and in case of endometrial atrophy (p = 0.001). CONCLUSION: Both procedures were acceptable during ambulatory hysteroscopy. In our study, vacurette was more painful than pipelle. Vacurette was more effective but insufficient tissue for histologic evaluation was important in both procedures. This might be explained by the population included and the histologic method used.

Biopsy↗
PubMed1998

[Contribution of hysteroscopic surgery for the treatment of postmenopausal metrorrhagia].

OBJECTIVES: Determine the effectiveness of hysteroscopic surgery in persistent postmenopausal bleeding. PATIENTS AND METHODS: Transcervical resection was performed in 176 women between the ages of 46-74 years. A benign cause was noted in 135 cases (polyps in 80 and submucous fibroids in 55); 37 patients had no significant disease and 4 had endometrial atypical hyperplasia missed in the preoperative evaluation. Patients underwent resection of polyp, resection of fibroid or endometrial ablation. Major operative complications were rare and included 3 perforations and one case of fluid overload. Patients were followed for 1-10 years after treatment (mean follow-up 52 months). RESULTS: 167 patients completed the study. Clinical manifestations disappeared in 85.2% of the patients; 15 patients had hysterectomy after the hysteroscopic procedure and 11 had repeat transcervical resection. CONCLUSION: Hysteroscopic treatment can be effective in carefully selected patients with postmenopausal bleeding or abnormal uterine bleeding on hormone replacement therapy. The operative criteria should take the causes of bleeding and not just the age of patient into account.

Aged↗
PubMed1998

[Role of diagnostic hysteroscopy in the exploration of postmenopausal metrorrhagia].

DIAGNOSIS: Diagnostic hysteroscopy is an effective method for identifying the causes of postmenopausal bleeding. It evaluates the uterine cavity and visualizes pathologic conditions such as endometrial polyps, submucous fibroids, and focal endometrial abnormalities including adenocarcinoma and its precursors. FURTHER INFORMATION: With directed biopsy, diagnostic hysteroscopy also ensures the recognition of these lesions.

Clinical Protocols↗
PubMed1998

Prenatal diagnosis of fetal corpus callosum agenesis by ultrasonography and magnetic resonance imaging.

Corpus callosum agenesis (CCA) was evaluated by ultrasound examination and magnetic resonance imaging (MRI) in 14 cases. Ultrasonography was able to suspect CCA by indirect signs but a definitive diagnosis of CCA was achieved in only four cases. MRI was able to diagnose complete CCA in 13 cases and showed absence of the posterior portion of the corpus callosum in one case. Additional neurological abnormalities including heterotopia, gyration anomaly, asymmetry of the cerebral hemispheres, and Dandy-Walker variant were documented in five cases, as well as an ocular anomaly which was present in one case, by MRI examination. Prenatal counselling for fetal agenesis of the corpus callosum is difficult as the prognosis is uncertain. The association with other cerebral abnormalities increases the likelihood of a poor outcome and ultrasonographic assessment of the fetal brain is limited. We found MRI to be a safe and useful additional procedure to complement ultrasonographic diagnosis or suspicion of CCA.

Adult↗
PubMed1998

[Surgical hysteroscopy in the treatment of septate uterus: systemic treatment or selective indications].

OBJECTIVES: A retrospective study to evaluate the fertility rate after endoscopic hysteroplasty in the case of a septate uterus. METHOD: From 1st January 1988-31st December 1996, 93 patients showing a septate uterus were treated by endoscopic hysteroplasty. The hospitalisation is short: one day surgery or out office. A control of uterine cavity by hysteroscopy did next to two months. RESULTS: Patients were evaluated after a period in excess of 6 months (6 months-8 years). 63 pregnancies were achieved amongst the 84 patients to be reviewed (75%). The fertility rate achieved is higher amongst infertile patients (80.3%) compared with that of sterile patients (64%). CONCLUSION: In the presence of septate uterus the endoscopic hysteroplasty is an efficient treatment in the case of secondary infertility and of unexplained sterility.

Adult↗
PubMed1998

[Birth after two cesarean sections: the role of trial of labor].

OBJECTIVE: To study the management of labor following two cesarean sections, we evaluated maternal and neonatal morbidity subsequent to this attitude. PATIENTS AND METHODS: A retrospective study was conducted over a 6-year period (1-1-1990 to 31-12-1995) in 184 women presenting two uterine scars. Trial of labor was allowed in 96 cases with cephalic presentation and a normal pelvis. RESULTS: The rate of vaginal birth was 65%. Three patients presented a uterine scar dehiscence and in one of them hemostasis hysterectomy for uterine atony was performed. Neonatal outcome was good in all cases. CONCLUSION: Trial of labor after two cesarean sections is possible in the majority of cases. Rate of vaginal birth is high and maternal and fetal morbidity is low.

Female↗
PubMed1998

[Vaginal myomectomy].

The authors present a retrospective study of 26 patients who have benefited from vaginal myomectomy after culdotomy in the Conception hospital in Marseille between 1992 and 1997. The myomectomy whom technic is described, was performed unically through the vagina or laparoscopically assisted. The mean operating time was 94 mn. The myoma mean weight was 184.3 g. Three patients experienced an abdominal surgery, twice because of a vaginal inaccessness. The immediate and mean-term post-operative period was uncomplicated in most cases. For screened patients, vaginal myomectomy appears as an interesting alternative to abdominal or laparoscopic surgery.

Adult↗