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Biomedical subjects

L Selvaggi

Publications and source records attributed to L Selvaggi.

At least 19 recordsLinked to original sources
PubMed2001

Intramedullary spinal cord metastasis from ovarian carcinoma.

BACKGROUND: Intramedullary spinal cord involvement by ovarian carcinoma is extremely rare. CASE: A patient with stage IV serous cystadenocarcinoma of the ovary presented with neurologic complaints 16 months after primary treatment. Magnetic resonance imaging demonstrated a metastatic lesion in the intramedullary area of the spinal cord. No other site of metastatic disease was observed. The patient received three cycles of carboplatin with complete resolution of the neurologic symptoms and a remarkable reduction of the lesion. Following chemotherapy she was given radiotherapy on the spinal cord, but died 10 months later for disseminated abdominal disease, without neurologic symptoms. CONCLUSION: Spinal cord involvement is unusual in ovarian carcinoma; multidisciplinary treatment, including chemotherapy and radiotherapy, may offer good palliation of the symptomatology.

Antineoplastic Agents↗
PubMed2001

Diagnostic inadequacy of dilatation and curettage.

OBJECTIVE: To assess the diagnostic inadequacy of dilatation and curettage (D&C) by comparing histologic findings with this technique with those obtained after hysterectomy. DESIGN: Retrospective clinical study. SETTING: University-affiliated hospital. PATIENT(S): Three hundred ninety-seven patients with abnormal uterine bleeding who underwent D&C and, within 2 months, hysterectomy because of histologic findings or persistence of symptoms. MAIN OUTCOME MEASURE(S): Comparison of histologic findings on D&C with those obtained after hysterectomy. RESULT(S): In 248 of 397 patients (62.5%), D&C failed to detect intrauterine disorders subsequently found at hysterectomy; the sensitivity was 46%, the specificity was 100.0%, the positive predictive value was 100.0%, and the negative predictive value was 7.1%. CONCLUSION(S): Dilatation and curettage is an inadequate diagnostic and therapeutic tool for all uterine disorders; this technique missed 62.5% of major intrauterine disorders, and all endometrial disorders were still present in the removed uterus.

Atrophy↗
PubMed2001

Polycystic ovary syndrome: relationship between insulin sensitivity, sex hormone levels and ovarian stromal blood flow.

Polycystic ovary syndrome (PCOS) is the most common cause of menstrual disorders, and is characterized by chronic anovulation, hyperandrogenism and infertility. In recent years, it has become apparent that PCOS is also associated with hyperinsulinemia that is probably central to the pathogenesis of PCOS. As a peculiar vascular pattern has been reported to be present in PCOS, the aim of this study was to investigate intraovarian stromal vascularization in PCOS patients and its possible correlation with sex hormones, gonadotropins and insulin levels. Twenty-eight oligomenorrheic or amenorrheic patients with PCOS and 14 eumenorrheic women with a PCOS-like ovarian pattern undergoing endocrine screening and ultrasound color Doppler intraovarian blood flow were recruited to the study. Ten healthy women with regular menses represented the control group. Hormonal assays (follicle-stimulating hormone (FSH), luteinizing hormone (LH), androstenedione, testosterone, sex hormone-binding globulin (SHBG) and estradiol), oral glucose tolerance test (OGTT), baseline and glucose-induced insulin levels, and transvaginal ultrasonographic and color Doppler analysis (pulsatility index (PI), resistance index (RI) and velocity (Vmax) of ovarian stromal flow) were performed in all participants in the early proliferative phase. Endocrine values showed significant differences in PCOS patients compared with PCOS-like women and controls, while PI and RI indices were significantly higher in controls. PCOS patients were divided into hyperinsulinemic (n = 16) and normoinsulinemic (n = 12). Androstenedione was significantly higher (p < 0.01) in the hyperinsulinemic than in the normoinsulinemic patients and controls, while SHBG was significantly (p < 0.01) lower in the hyperinsulinemic group. Analysis of color Doppler intraovarian vascularization showed a significantly lower RI and a higher Vmax in the hyperinsulinemic subjects than in the normoinsulinemic PCOS patients and controls. An increased stromal blood flow was observed in the PCOS and PCOS-like patients by transvaginal color Doppler evaluation, but this technique is not able to differentiate these two similar ovarian patterns. However, hyperinsulinemic PCOS patients had an increased vascularity of the ovarian stroma. A strong correlation between hyperinsulinemia, hyperandrogenism and low SHBG levels was evidenced, and a hyperinsulinemia-induced mechanism for ovarian stromal angiogenesis is discussed.

Adult↗
PubMed2001

Transforming growth factor-beta 1 and insulin-like growth factor-1 expression in ovarian endometriotic cysts: a preliminary study.

Increased concentrations of TGF-beta 1 in endometriotic tissue are considered important in the pathophysiology of endometrial diseases since TGF-beta 1 may inhibit natural killer activity and induce angiogenesis and proliferation of endometrial stromal cells. In the present study we report on TGF-beta 1, IGF-1 and their receptor localization, as detected by Northern hybridization and immunohistochemistry, in ovarian endometriotic tissues removed during surgical procedures. We detected comparable expression of IGF-1 and IGF-1 receptor in the stromal and epithelial compartments, thus confirming disregulated expression of the IGF system in ovarian endometriosis. On the contrary, strongly increased TGF-beta 1 steady state level mRNA expression was detected in all endometriotic samples. In addition, we demonstrated weak TGF-beta 1 immunohistochemical expression in the epithelial lining and intense expression in the cellular stroma of ovarian endometriomas, thus suggesting that TGF-beta 1 could have an important role in the maintenance and propagation of the disease. On the basis of these preliminary results we can assume that TGF-beta 1, IGF-1 and their receptors may play an important role in the pathogenesis of endometriosis.

Adult↗
PubMed2000

Reversal of foetal hydrops and foetal tachyarrhythmia associated with maternal diabetic coma.

Foetal hydrops is always a challenge for the clinician. We report a case of tachycardia associated with hydrops and hydramnios in a pregnancy complicated with diabetic coma at 28 weeks gestation. Normal foetal heart rate was recorded immediately after correction of maternal acidotic status and hydrops eventually disappeared. The woman was delivered at 32 weeks and the baby had an uncomplicated postnatal course. We hypothesise that maternal ketoacidosis has been the precipitating factor of tachycardia and congestive heart failure and that this case is conceptually similar to the "late death" phenomenon, reported in cases of poorly controlled maternal diabetes.

Adult↗
PubMed2000

Surgical decompression and radiation therapy in epidural metastasis from cervical cancer.

Spinal cord compression by epidural metastasis is considered an exceptional complication in patients with cervical carcinoma. We report three patients treated for a cervical carcinoma who developed epidural metastasis with spinal cord compression at 9, 25 and 48 months after primary treatment of the uterine malignancy. All patients had poorly-differentiated adenocarcinomas with lymphovascular space invasion, and two had lymph node metastasis. All patients underwent emergency decompressive laminectomy followed by radiotherapy and a partial recovery of the neurological function was achieved. In two patients the spinal cord was the only site of recurrent disease, whereas the other had lung and brain metastasis at the time of epidural involvement diagnosis. All three patients, however, died of disseminated disease. Surgical decompression followed by radiation therapy may result in a complete preservation of the neurologic functions in patients with spinal cord compression secondary to metastatic carcinoma of the uterine cervix. Considering the propensity for disseminated disease, long term survival might be achieved only with the use of effective chemotherapy.

Adenocarcinoma↗
PubMed2000

Immunological markers in HIV-infected pregnant and non-pregnant women.

OBJECTIVE: To assess the influence of pregnancy on the course of HIV infection by comparing the behaviour of total lymphocyte counts and lymphocyte subsets (CD4(+) and CD8(+) and their ratio) in a cohort of infected pregnant women. SETTING: Tertiary referral centre for high risk obstetrics and infectious diseases in pregnancy. PATIENTS AND METHODS: A prospective study was designed, HIV infected women being enrolled at the beginning of pregnancy and sampled each trimester and in the puerperium. As controls, a group of non-pregnant HIV-infected women, cross-matched for age, risk factors and stage of disease were included and similarly evaluated in the same period. RESULTS: All the parameters, when longitudinally evaluated, were stable during gestation. Compared with non-pregnant subjects, patients had higher CD4(+) counts at the beginning and increased values of total lymphocytes count and subsets during the puerperium. Antepartum and postpartum risk factors such as drug abuse, smoking, antiretroviral therapy, length of gestation, maternal complications and HIV status of the neonate were not influential on the total lymphocytes counts and subsets. DISCUSSION: According to this data, pregnancy per se seems to have a negligible influence over the course of HIV infection, at least as far as immune parameters are concerned.

Adult↗
PubMed2000

Maternal complications after caesarean section in HIV infected women.

OBJECTIVE: To assess the intervention related risk in HIV-infected women, undergoing caesarean section (CS). SETTING: Tertiary care center for high risk obstetrics and infectious diseases in pregnancy. PATIENTS AND METHODS: Thirty-three HIV-positive women and one hundred and sixty-eight controls, cross matched for age, weight, parity, obstetrical characteristics at delivery and indication for CS, were prospectively recruited for the study. Infection related characteristics, as mode of acquisition, drug abuse, immune status and stage of disease were also recorded. Complications of the intervention were evaluated according to infectious status and risk factors. RESULTS: Post-operative complications were significantly more frequent among HIV-infected mothers. More advanced disease and maternal age were the risk factors statistically related to complications. DISCUSSION: According to our data, CS carries a higher chance of post-operative complications in HIV-infected women, these complications being also related with the severity of infection (stage and duration of the disease). Given the characteristics of the population in the study (mode of acquisition, prevalence of early stage of the disease), the rate of complication is still relatively low compared to non-western, malnourished, drug-abusers groups.

Adult↗
PubMed2000

Primary peritoneal carcinoma: a report of twelve cases and a review of the literature.

Primary peritoneal carcinoma (PPC) is rare tumor histologically identical to epithelial ovarian carcinoma (EOC); it is differentiated from EOC based on the extent of gross ovarian involvement and microscopic invasion of the cortex. We report 12 cases of PPC which were diagnosed in our Department during a 9-year period. Total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy were performed in 9 patients, while 3 underwent only explorative laparotomy with bilateral salpingo-oophorectomy. All patients were treated with postoperative platinum-based chemotherapy. After a median follow-up of 42 months, only 5 patients are alive without disease. PPC is a rare tumor currently managed in the same way as ovarian cancer. Primary debulking surgery and chemotherapy represent the cornerstones of treatment. Considering the limited number of patients with PPC, no definitive conclusion can be drawn concerning the prognostic factors for survival.

Adult↗
PubMed2000

Endoscopic examination of the fetus in early pregnancy.

OBJECTIVE: To assess if fetal examination is feasible by endoscopy in the late first-early second trimester. SETTING: Tertiary referral center for high risk obstetrics and genetics. PATIENTS AND METHODS: Patients (total number 9) submitted to pregnancy termination for social reason (7) or for chromosomal abnormality (2) between 10 and 14 weeks of pregnancy. Visualisation of the foetus by a transabdominally introduced endoscope (19 gauge) under local anaesthesia. Step by step examination of the foetal contour and double check of the recordings by a senior Pathologist. RESULTS: Patients complained no serious discomfort. Visualisation was accomplished in all cases with ease and the images were judged satisfactory by the Pathologist. Fetal examination was found easier at 10-12 weeks of gestation rather than at 13-14 weeks. DISCUSSION: Endoscopy is a simple and well tolerated procedure, which enables precise visualization of external fetal anatomy as early as the first trimester of gestation. Therefore it can be proposed before surgical termination of pregnancy.

Female↗
PubMed2000

Legionnaire's disease complicating pregnancy: a case report with intrauterine fetal demise.

OBJECTIVE: Legionnaire's disease complicating pregnancy is an unusual event that can seriously compromise both the mother and the fetus. CASE REPORT: We describe one case of such association, with an unfavourable intrauterine fetal outcome, secondary to acute placental insufficiency, related to infection. DISCUSSION: It is important in these high risk pregnancies complicated by acute pneumonia to take into consideration the diagnosis, as early as possible, and the appropriate treatment or the careful monitoring of fetal wellbeing.

Adult↗
PubMed2000

Predictive value of serum androstenedione basal levels on the choice of gonadotropin or laparoscopic ovarian electrocautery as ovulation induction in clomiphene citrate-resistant patients with polycystic ovary syndrome.

Therapeutic approaches to chronic anovulation from polycystic ovaries in clomiphene-resistant infertile patients are under debate. This study discusses evidence that supports the possible predictive value of serum basal level of androstenedione in the choice of the better therapy between laparoscopic ovarian electrocautery and ovulation induction. Lower androstenedione levels seem to be correlated with a better ovarian response after ovulation induction with gonadotropins, while high androstenedione levels are associated with a higher incidence of conception after laparoscopic ovarian electrocautery. Obesity does not seem to represent a hindrance to laparoscopic treatment.

Adult↗
PubMed2000

[Combination of cisplatin and vinorelbin in the neoadjuvant treatment of locally advanced cervical carcinoma. Phase II study].

BACKGROUND: Aim of this phase II study is to evaluate the cytoreductive efficacy and the toxicity of a regimen consisting of cisplatin and vinorelbine as neoadjuvant chemotherapy for three cycles every 21 days in patients with locally-advanced cervical carcinoma. METHODS: Between April 1996 and December 1998, 33 untreated patients with locally-advanced cervical carcinoma received neoadjuvant chemotherapy with cisplantino 80 mg/m2 (day 1) plus vinorelbine 25 mg/m2 (day 1 and 8). Within 28 days from completion of chemotherapy patients in complete or partial response were submitted to radical hysterectomy plus pelvic lymphadenectomy. RESULTS: Twenty-six patients (79%) were submitted to radical surgery; four patients were not submitted to surgery because of poor response to treatment, two for anesthesiological contraindications and one refused surgery. The combination of cisplatin plus vinorelbine in this phase II study induced a clinical overall response rate of 90%, with 8 pathologic complete response (24%). CONCLUSIONS: The association of cisplatin and vinorelbine as neoadjuvant chemotherapy in locally-advanced cervical carcinoma showed to be safe and effective with a low cost and poor toxicity.

Adult↗
PubMed2000

Splenic involvement in ovarian cancer. Description of three cases.

Metastatic involvement of the spleen in patients with ovarian cancer is unusual. Solitary splenic metastasis in the absence of disseminated disease are rare. Three cases of advanced ovarian cancer with splenic involvement are reported. The splenectomy was adopted in two patients.

Adult↗
PubMed2000

[Reconstructive surgery in oncological gynecology. Our experience].

BACKGROUND: Personal experience in reconstructive surgery for gynecologic oncology is reported. These techniques are playing, during last years, a leading role since it is necessary to assure a good treatment and top quality lifestyle to oncologic patients. METHODS: A retrospective study was made on 357 major surgical treatments for neoplastic disease at the IInd Clinic of Obstetrics and Gynecology, University of Bari. For each disease the technique, the length of surgery and possible complications have been reported. In total 50 reconstructive procedures on 357 surgical interventions for gynecologic neoplastic disease (14%) were made. RESULTS: There was no rate of mortality, and the complications were found only in 5 patients (10%). CONCLUSIONS: Reconstructive surgery can increase surgical radicality, improve the quality of life of the patients and reduce the postoperative complications.

Endometrial Neoplasms↗