Biomedical subjects

M Franchi

Publications and source records attributed to M Franchi.

At least 37 records · Page 2Linked to original sources

PubMed2001

[The use of hormonal contraception in perimenopause is still a hazard?].

The need for contraception in a period of life characterized by irregular menstrual cycles as the perimenopause represents a social and biological event for each woman and a challenge for the gynecologist. The use of oral contraceptives in perimenopause has been vastly discussed in the last decade. Several investigators have focused their attention on the risks related to hormonal administration to older women neglecting all the advantages. The introduction of new lower-dose formulations and progestin-only preparations as implants or intra-uterine system has deeply changed the indications for hormonal contraception allowing their use in patients in whom it was previously contraindicated. Cumulative evidence has demonstrated that the use of hormonal contraception during the perimenopausal period does not offer only advantages in term of cycle control but also gives an important protection against the development of gynecological malignancies. However, in clinical practice the use of hormonal contraceptives in older women has not been accepted by a large number of physicians who continue to consider hormonal contraception in women over forties a tabù. The aim of this review is to discuss lights and shadows of the use of hormonal contraception in perimenopause.

Adult↗

PubMed2000

Clinical value of intraoperative gross examination in endometrial cancer.

We present the largest multicenter study evaluating whether intraoperative visual estimation can accurately assess the depth of myometrial invasion in patients with endometrial cancer. The study population consisted of 403 consecutive women who underwent total hysterectomy for endometrial cancer. After the uterus was removed, a visual estimate of depth of gross myometrial invasion was recorded. The uterus was opened, the endometrial cavity was inspected, and one or more full-thickness incisions were made through the tumor, myometrium, and serosa. An intraoperative estimation of gross myometrial invasion was made and classified as more or less than 50% of the uterine wall. Gross visual estimation accurately identified the microscopic myometrial invasion in 85.3% (344/403) of cases. Sensitivity, specificity, and positive and negative predictive values of gross estimation in determining a microscopic myometrial invasion greater than 50% were 73.0, 92.5, 85.0, and 85.5%, respectively. Among patients in whom the myometrial invasion was underestimated at gross examination the tumoral invasion was limited to the inner two thirds of the myometrium in 45% (18/40) of cases and the distance from the tumor-myometrial junction to the uterine serosa was greater than 3 mm in 65% (26/40) of cases. We conclude that gross estimation of myometrial invasion is a reliable and inexpensive method for evaluating the invasiveness of uterine carcinomas and that deciding to perform an extensive surgical staging upon gross estimation will be in accordance with the final histopathologic report in about 9 of 10 cases.

Aged↗

PubMed2000

Estroprogestin vs. gonadotrophin agonists plus estroprogestin in the treatment of endometriosis-related pelvic pain: a randomized trial. Gruppo Italiano per lo Studio dell'Endometriosi.

OBJECTIVE: This is a randomized clinical trial comparing estroprogestin (E/P) pill given for 12 months vs. gonadotrophin releasing hormone agonist (GNRHa) given for 4 months followed by E/P pill treatment for 8 months in the relief of endometriosis-related pelvic pain. METHODS: Eligible for the study were women with laparoscopically confirmed endometriosis and pelvic pain lasting 3-12 months after diagnosis. Eligible women were randomly assigned to treatment with E/P pill (gestroden 0.75 mg and ethynlestradiol 0.03 mg) for 12 months (47 patients) vs. tryptorelin 3.75 mg slow release every 28 days for 4 months followed by E/P pill for 8 months (55 patients). RESULTS: At baseline, dysmenorrhea was reported in 46 women allocated to E/P pill only (97.9%), and in all the 55 women allocated to GNRHa+E/P pill. The corresponding value at the 12 months follow-up visit was 14 subjects (35.9%) and 16 subjects (34.8%). The baseline median values of the multidimensional and analog scale were for dysmenorrhea 4 and 6 in the EP only and 3 and 6 in the GNRHa+E/P group. The corresponding value at the 12 months follow-up visit were 2 and 6 and 0 and 5. Non-menstrual pain was reported, respectively, at baseline and 12 month visit by 46 (97.9%) and 15 (38.5%) subjects in the E/P pill group and 49 (89.1%) and 17 (37.0%) of the GNRHa+E/P pill one. The baseline median values of the multidimensional and analog scale were for non-menstrual pain 3 and 5 in the E/P only and 2 and 6 in the GNRHa+E/P group. The corresponding values at the 12 month follow-up visit were 0 and 4 and 0 and 4. These differences between the two groups were not statistically significant. CONCLUSIONS: 1 year after randomization, the two treatment schedules show similar relief of pelvic pain in women with endometriosis.

Adult↗

PubMed2000

Microlaparoscopy: a new approach to the reassessment of ovarian cancer patients.

BACKGROUND: The purpose of the work was to determine the feasibility and accuracy of microlaparoscopy as diagnostic method for the reassessment of ovarian cancer patients. METHODS: Eight patients scheduled for second-look laparoscopy who had undergone primary surgery for ovarian cancer followed by 6 cycles of chemotherapy were included in the study. Microlaparoscopy was performed using a 2.8 mm laparoscope followed by conventional 10-mm laparoscopy. Three additional 5-mm ancillary trocars were inserted to perform intraabdominal biopsies. Pelvic washings were performed in all cases. RESULTS: Microlaparoscopy was feasible in all cases and as accurate as conventional laparoscopy in seven cases. In one case the procedure was terminated before conventional laparoscopy because of positive biopsies at frozen section examination. There were no intra-operative complications related to microlaparoscopy. The median time from skin incision to the removal of the microlaparoscope was 47 minutes (range 30-70). CONCLUSION: Microlaparoscopy seems to be a safe, accurate, minimally invasive method and therefore we suggest its use as primary approach to the reassessment of ovarian cancer patients.

Aged↗

PubMed1999

Microsatellite instability in endometrial cancer: relation to histological subtypes.

Fifty-one endometrial cancers were analyzed with regard to whether or how microsatellite instability (MI) was associated with the development of different types of endometrial malignant neoplasms. We investigated 6 loci previously reported as informative for colorectal cancer and a group of 8 loci located on 6q. Replication error (RER+) phenotype was detected in 10 of 51 (19.6%) endometrial cancers (ECs), all but one of which showed endometrioid differentiation. On the contrary, the RER+ phenotype was not detected in serous carcinomas and malignant mixed Müllerian tumors. MI was present in both early and advanced stage ECs. No correlation was found between age, grade, stage, familial pattern, mitotic index, and the RER+ phenotype of ECs. Only 1 of 8 endometrial carcinomas showing MI was associated with mutant p53 expression, while the majority of RER+ tumors were positive for estrogen and progesterone receptors. Our findings suggest that MI plays an early role in endometrial tumorigenesis and is significantly correlated with adenocarcinomas showing endometrioid features (EAs). The frequent involvement of the telomeric region of chromosome 6 in the MI of EA is an indication that this region may be crucial in the process of EA tumorigenesis.

Aged↗

PubMed1999

Early feeding compared with nasogastric decompression after major oncologic gynecologic surgery: a randomized study.

OBJECTIVE: To evaluate the feasibility, safety, and tolerance of early feeding in patients undergoing surgery for gynecologic malignancies. METHODS: Patients were stratified according to operative time and type of tumor and were randomized into two arms: A) early oral feeding and B) nasogastric decompression followed by feeding at the first passage of flatus. Variables assessed included nausea, vomiting, time to first passage of flatus and stool, time elapsed before adequate tolerance of a regular diet, postoperative stay, and complications. RESULTS: Sixty-one patients were randomized into each arm. The types of tumor, the surgical procedures performed, and the operative times were similar in both groups. Early oral feeding in patients in arm A was associated with a significantly faster resolution of postoperative ileus (P < .01), with a more rapid return to a regular diet (P < .01), with an earlier first passage of stool (P < .01), and with a shorter postoperative stay (P < .05) than patients in arm B. Rates of nausea and vomiting were similar in both arms. Hindered deglutition and nasal soreness caused by the nasogastric tube were observed in 88% of patients in arm B. Insertion of a nasogastric tube was necessary in six patients in arm A (10%), and three of these had postoperative complications. Thus, early feeding was feasible in 95% of patients and did not seem to be related to preoperative chemotherapy, tumor type, or lymphadenectomy. CONCLUSION: Early feeding is feasible and well tolerated and is associated with reduced postoperative discomfort and a more rapid recovery in patients undergoing major surgery for gynecologic malignancies.

Adult↗

PubMed1999

Endometrial thickness in tamoxifen-treated patients: an independent predictor of endometrial disease.

OBJECTIVE: To assess the independent contribution of transvaginal ultrasound in identifying women at risk for endometrial disorders, and determine whether a cutoff value identifies women who need endometrial histologic assessment. METHODS: Postmenopausal women with breast cancer who were receiving tamoxifen, with ultrasonographic endometrial thickness greater than 4 mm or vaginal bleeding, had hysteroscopy with selective endometrial biopsies. Endometrial thickness, duration of tamoxifen therapy, and endometrial histology were studied. Parametric and nonparametric tests and logistic regression and receiver operating characteristic curves were used for statistical analysis. RESULTS: The study population consisted of 163 women, 46 with vaginal bleeding. The proportion of women with abnormal histologic findings was greater among those with endometrial thicknesses exceeding 9 mm compared with those with endometrial thicknesses 9 mm or less (60% versus 6.1%, P < .001) and among women who received tamoxifen for more than 27 months than those who received it for less time (46% versus 16%, P < .005). Logistic regression showed that endometrial thickness greater than 9 mm and vaginal bleeding were independent predictors of abnormal findings at hysteroscopy. CONCLUSION: In women taking tamoxifen, sonographic endometrial thickness exceeding 9 mm and the presence of vaginal bleeding are independent predictors of endometrial disease. If either exists, hysteroscopy and biopsy should be done.

Antineoplastic Agents, Hormonal↗

PubMed1999

Cusp fracture resistance in composite-amalgam combined restorations.

OBJECTIVE: To evaluate the in vitro resistance to fracture and microleakage in composite-amalgam combined restorations. METHODS: Seventeen Class I cavities with unsupported enamel walls prepared in extracted permanent molar teeth were treated with a bonding agent (Scotchbond MP, 3M Dental), the buccal cusps were reinforced with a composite resin (Z-100, 3M Dental) and the cavities were then restored with amalgam (Permite, Oral B). All teeth were load tested using a special fatigue-stress apparatus, immersed in a dye solution and then sectioned for examination by stereomicroscopy and scanning electron microscopy (SEM). RESULTS: Fractures in enamel supported by composite were present in 11 cases while 12 specimens included fractures in enamel supported by bonded amalgam. Microleakage was observed in 16% of the enamel-amalgam interfaces, 10% of the dentin-amalgam interfaces, 7% of the amalgam-composite interfaces, 4% of the composite-enamel interfaces and 11% of the composite-dentin interfaces. CONCLUSIONS: Bonded amalgam appears to be as effective as bonded composite in supporting undermined enamel in terms of resistance to fracture, but composite may have better marginal adaptation to enamel compared to bonded amalgam. Good marginal adaptation may be observed between amalgam and composite in composite-amalgam restorations.

Adult↗

PubMed1999

Sonographic measurement of the umbilical cord and fetal anthropometric parameters.

OBJECTIVE: To determine reference ranges for the diameter and the cross-sectional area of the umbilical cord during pregnancy and to determine if umbilical cord morphometry is related to fetal size. METHODS: A prospective cross-sectional study was designed to assess the sonographic cross-sectional diameter and area of the umbilical cord. The sonographic umbilical cord measurements were obtained in a plane adjacent to the insertion of the cord into the fetal abdomen. Nomograms for the umbilical cord diameter and area were computed. Fetal biometry included: biparietal diameter, abdominal circumference, and femur length. Polynomial regression analysis was conducted. RESULTS: Five hundred and fifty seven patients were included into the study. The regression equation for the umbilical cord diameter (y) according to gestational age (x) was y=-10.0563+1.4265x+0.0194x2 and for the umbilical cord area (y') was y'=91.6-3.3x+0.03x2-0.00007x3. A significant relationship was found between umbilical cord measurements and fetal anthropometric parameters. CONCLUSION: Reference ranges for umbilical cord diameter and area have been generated. The sonographic diameter and cross-sectional area of the umbilical cord increase as a function of gestational age and both diameter and area correlate with fetal size.

Anthropometry↗

PubMed1999

Clay-nucleic acid complexes: characteristics and implications for the preservation of genetic material in primeval habitats.

The equilibrium adsorption of three nucleic acids: chromosomal DNA, supercoiled plasmid DNA, and 25S rRNA, on the clay minerals, montmorillonite (M) and kaolinite (K), were studied. Adsorption of the nucleic acid on the clays was rapid and maximal after 90 min of contact time. Chromosomal DNA was adsorbed to a greater extent than plasmid DNA and RNA, and the adsorption was also greater on M than on K. Adsorption isotherms were of the L type, and a plateau was reached with all the complexes, with the exception of chromosomal DNA adsorbed on M. To deterine where nucleic acids are adsorbed on clay minerals and the nature of the interaction, complexes were studied by X-ray diffraction (X-RD), electron microscopy, and Fourier transform infrared (FT-IR) spectroscopy. X-RD showed that nucleic acids did not penetrate the clay, indicating that the adsorption occurred primarily on the external surfaces of clay particles, as also suggested by electron microscopy observations. FT-IR spectra of clay-tightly bound nucleic acid complexes showed adsorption bands that indicate a variation of the nucleic acids status as a consequence of their adsorption on clay. Data obtained suggested that the formation of clay-nucleic acid complex could have an important role in the preservation of genetic material in primeval habitats.

Adsorption↗

PubMed1999

Prenatal diagnosis of a lean umbilical cord: a simple marker for the fetus at risk of being small for gestational age at birth.

OBJECTIVE: The purpose of this study was to investigate whether the prenatal diagnosis of a 'lean' umbilical cord in otherwise normal fetuses identifies fetuses at risk of being small for gestational age (SGA) at birth and of having distress in labor. The umbilical cord was defined as lean when its cross-sectional area on ultrasound examination was below the 10th centile for gestational age. METHOD: Pregnant women undergoing routine sonographic examination were included in the study. Inclusion criteria were gestational age greater than 20 weeks, intact membranes, and singleton gestation. The sonographic cross-sectional area of the umbilical cord was measured in a plane adjacent to the insertion into the fetal abdomen. Umbilical artery Doppler waveforms were recorded during fetal apnea and fetal anthropometric parameters were measured. RESULTS: During the study period, 860 patients met the inclusion criteria, of whom 3.6% delivered a SGA infant. The proportion of SGA infants was higher among fetuses who had a lean umbilical cord on ultrasound examination than among those with a normal umbilical cord (11.5% vs. 2.6%, p < 0.05). Fetuses with a lean cord had a risk 4.4-fold higher of being SGA at birth than those with a normal umbilical cord. After 25 weeks of gestation, this risk was 12.4 times higher when the umbilical cord was lean than when it was of normal size. The proportion of fetuses with meconium-stained amniotic fluid at delivery was higher among fetuses with a lean cord than among those with a normal umbilical cord (14.6% vs. 3.1%, p < 0.001). The proportion of infants who had a 5-min Apgar score < 7 was higher among those who had a lean cord than among those with normal umbilical cord (5.2% vs. 1.3%, p < 0.05). Considering only patients admitted in labor with intact membranes and who delivered an appropriate-for-gestational-age infant, the proportion of fetuses who had oligohydramnios at the time of delivery was higher among those who had a lean cord than among those with a normal umbilical cord (17.6% versus 1.3%, p < 0.01). CONCLUSION: We conclude that fetuses with a lean umbilical cord have an increased risk of being small for gestational age at birth and of having signs of distress at the time of delivery.

Adult↗

PubMed1999

Prenatal assessment of Wharton's jelly in umbilical cords with single artery.

OBJECTIVE: To investigate whether the amount of Wharton's jelly in non-malformed fetuses with a single umbilical artery is different from that of fetuses with a normal umbilical cord. METHODS: We evaluated patients with singleton pregnancies, non-malformed fetuses and single umbilical artery undergoing sonographic evaluation at a gestational age ranging from 19 to 41 weeks' gestation. The cross-sectional areas of the umbilical cord and of the umbilical vessels were measured. The amount of Wharton's jelly was calculated by subtracting from the total cross-sectional area of the umbilical cord the areas of the artery and of the vein. The umbilical cord cross-sectional area, the umbilical artery and vein areas as well as the amount of Wharton's jelly were plotted on previously published nomograms. RESULTS: Twenty-two patients met the inclusion criteria. The umbilical cord cross-sectional area was within the normal range in 20 (90.1%) cases. The umbilical artery and vein areas were above 2 standard deviations from the mean in 20 cases and in 11 cases (50%), respectively. The amount of Wharton's jelly was below 2 standard deviations from the mean in all cases. An abnormal insertion of the umbilical cord (marginal, velamentous) was present in five cases (22.7%). CONCLUSIONS: A reduction of Wharton's jelly is frequently present in cases of single umbilical artery. The increased perinatal morbidity and mortality observed in cases of single umbilical artery, even in the absence of congenital or chromosomal abnormalities, could be in part the consequence of a reduced amount of Wharton's jelly.

Adult↗

PubMed1999

Prenatal assessment of the Hyrtl anastomosis and evaluation of its function: case report.

The presence of a communicating vessel, the Hyrtl anastomosis, between the umbilical arteries is well described in pathological studies. Using different injection techniques, it has been speculated that this vessel acts as a pressure-equalizing mechanism between the different lobes of the placenta. However, its detection during fetal life has never been reported. We report on two cases of ultrasonographic detection and Doppler assessment of the Hyrtl anastomosis during pregnancy. A pulsatile blood flow from the umbilical artery with higher resistance to that with lower resistance has been demonstrated at the level of the Hyrtl anastomosis, which was confirmed after delivery. In addition, this report supports the hypothesis that the anastomosis plays an important role in regulating the blood pressure in the placental lobes and in equalizing the blood pressure between umbilical arteries.

Adult↗

PubMed1999

[The role of antenatal courses in preventing the onset of altered pelvic statics and urinary incontinence].

BACKGROUND AND AIMS: This study was prompted by the frequent finding of urinary incontinence in peri- and postmenopausal women. In an attempt to reduce this incidence, the authors evaluated the role of antenatal courses as an important preventive and operative means of providing information aimed at preventing the onset of alterations to pelvic statics and urinary incontinence. The clinical data of 40 puerperae, of whom 45% had followed our antenatal course, were examined for this purpose. METHODS: A functional examination of the perineum was made in all subjects on discharge after birth and 6 months later. RESULTS: These findings appear to indicate that antenatal courses play an important role in preventing obstetric perineal complications. CONCLUSIONS: During the courses all women were given useful advice on hygiene and diet, including guidelines for suitable regular exercise, the need to drink about 1 litre of unsweetened liquid daily, a balanced diet and advice regardingf perineal relaxation. Subsequently, all subjects were advised to continue exercising after birth to ensure the correct rehabilitation of the perineal floor and they were also given a sheet containing the different learnt during the antenatal courses. In this way these subjects increased their awareness of the need not to underestimate the early symptoms of urinary incontinence should they occur after birth.

Adult↗

PubMed1999

[Perineal modification in pregnancy and puerperium, risk of urinary incontinence].

UNLABELLED: Pregnancy and delivery are important etiopathological factors in the alteration of pelvic equilibrium; in particular and the first delivery is the decisive factor in terms of perineal sequelae affecting pelvic equilibrium and urinary continence. Epidemiological studies have identified a number of pathogenic risk factors related to pregnancy (abnormal increase in maternal weight, diabetes in pregnancy and macrosoma) and the newborn (cranial circumference, newborn weight). Mechanical stress caused by the passage of the fetus may lead to the overstretching of the pelvic floor and the failure to recognise muscular damage even in the absence of macroscopic lesions. In the immediate postpartum or after a number of years these may damage the function of the musculo-aponeurotic structures of the perineum and foster the onset of alterations to pelvic equilibrium and urinary incontinence. In this study the authors have evaluated the modifications to the perineum and continence during pregnancy and puerperium. METHODS: Clinical data were analysed for 40 puerperae all of whom underwent a through perineal examination to assess the function of perineal muscles, both on discharge and 6 months after delivery. RESULTS: The authors tried to identify the main risk factors which predisposed the onset of changes to pelvic equilibrium and urinary continence. On the basis of the contemporary outcome of the Q-TIP test and TP, all women were divided into 4 groups: Group A (TP < 3 and positive Q-TIP test) (22.5%). CONCLUSIONS: In the light of these results, the authors affirm that during gestation it is important to concentrate preventive action on these risk factors.

Adult↗

PubMed1999

[Hypertension in pregnancy. Retrospective epidemiologic study].

BACKGROUND: Pregnancy hypertension today has not a valid etiological explanation. It's possible however that the association of more factors could determine the symptoms. The pregnancy hypertensive disorders are not uncommon, with an incidence estimated from 6 to 8%. Epidemiological studies have shown hypertension in pregnancy increases fetal and maternal mortality and morbidity. Preterm delivery is more common in women with hypertension in pregnancy. The aim of this retrospective study was to verify some epidemiological aspects of pregnancy hypertension at the IV Divisions of I Institute of Obstetrics and Gynaecology of the "La Sapienza" University of Rome. METHODS: 1926 pregnant women have been hospitalised at the IV Division from January 1993 to December 1997. Of these 101 had hypertension. Age, hypertension degree, type of job, smoking, parity, previous hypertension developed by patients and their relatives, birthweight, stage of development of hypertension and delivery procedures have been evaluated in this group. RESULTS: The main data obtained from this study are: strong correlation of primiparity and hypertension (55, 45% of observations); increased risk to have hypertension induced by pregnancy in women that have just incurred in hypertension in previous pregnancy; the high incidence of caesarean section in the group considered with respect to the general population (70.9%). CONCLUSIONS: Hypertension is still a frequent disorder in pregnancy which may lead to serious complications.

Adult↗

PubMed1999

[Stark's method of cesarean section. Advantages compared to the traditional method].

BACKGROUND AND AIM: The increased incidence of caesarean section has led, over the past few years, to the revision of surgical methods in order to reduce fetus extraction time and the total costs of surgery, without detracting from cosmetic advantages. Stark devised a surgical technique for this purpose which aims to reduce operating trauma and duration of surgery and to ensure a faster recovery and greater well being. METHODS: We performed a retrospective study in all patients undergoing caesarean section using Stark's technique and we evaluated their postoperative progress based on body temperature and any complications involving the suture (infections, hematoma, adhesions, pain). The results were compared to those obtained by other authors using traditional caesarean section. RESULTS: It was found that patients undergoing traditional caesarean section showed an incidence of wound infection which was higher than that observed in the Stark group (8.75%). Likewise, in relation to the onset of hypothermia, only 3 cases (3.75%) were observed in this study. CONCLUSIONS: Reduced short- and long-term maternal morbidity was obtained using this technique, together with a lower incidence of febrile morbidity and wound infection, less pain and a decreased risk of visceral adhesion.

Cesarean Section↗

PubMed1998

Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation.

OBJECTIVE: To assess the efficacy of two laparoscopic methods for the management of endometriomas with regard to pain relief, pregnancy rate, and disease recurrence. DESIGN: Prospective, randomized clinical trial. SETTING: Tertiary care hospital. PATIENT(S): Sixty-four patients with advanced stages of endometriosis. INTERVENTION(S): Patients were randomly allocated at the time of laparoscopy to undergo either cystectomy of the endometrioma (group 1) or drainage of the endometrioma and bipolar coagulation of the inner lining (group 2). MAIN OUTCOME MEASURE(S): Pain relief and pregnancy rate. RESULT(S): Thirty-two patients were enrolled in each group. The 24-month cumulative recurrence rates of dysmenorrhea, deep dyspareunia, and nonmenstrual pelvic pain were lower in group 1 than in group 2 (dysmenorrhea: 15.8% versus 52.9%; deep dyspareunia: 20% versus 75%; nonmenstrual pelvic pain: 10% versus 52.9%). The median interval between the operation and the recurrence of moderate to severe pelvic pain was longer in group 1 than in group 2 (19 months [range, 13.5-24 months] versus 9.5 months [range, 3-20 months]). The 24-month cumulative pregnancy rate was higher in group 1 than in group 2 (66.7% versus 23.5%). CONCLUSION(S): For the treatment of ovarian endometriomas, a better outcome with a similar rate of complications is achieved with laparoscopic cystectomy than with drainage and coagulation.

Adult↗