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Biomedical subjects

P Bistoletti

Publications and source records attributed to P Bistoletti.

34 records · Page 2Linked to original sources
PubMed1988

Cytological diagnosis of endometrial cancer and preinvasive endometrial lesions. A comparison of the Endo-Pap sampler with fractional curettage.

The value of the Endo-Pap endometrial cell sampling device in the cytological assessment of the endometrium was compared with fractional curettage. 318 symptomatic women were studied consecutively, among whom were 42 with malignant tumors of the uterus. Satisfactory material for cytological diagnosis of the endometrial state was obtained in 96%, whereas only 91% of the histopathological material was suitable for interpretation. 35 of 36 women with primary cancers of the corpus uteri had atypical endometrial cytology (sensitivity 0.97). Of 42 uterine cancers, including one metastatic ovarian carcinoma, two adenocarcinomas and three squamous carcinomas of the cervix, 40 were detected by endometrial cytology (sensitivity 0.95). All 5 cases of high grade cytological atypia in endometrial polyps or endometrial hyperplasia could be diagnosed by abnormal endometrial cytology and 4 of 5 patients with adenomatous endometrial hyperplasia were diagnosed correctly. Endometrial cytology obtained with the Endo-Pap sampler is a simple and cheap diagnostic method with which to detect endometrial cancer. It is also effective for diagnosis of preinvasive endometrial lesions with highgrade cytological atypia. Clinicians should recognize that out-patient investigation of the endometrial state by endometrial cell sampling with the Endo-Pap is reliable and can usually replace fractional curettage.

Curettage↗
PubMed1986

Fetal weight prediction by ultrasound measurements. A prospective study.

Fetal weight prediction with ultrasonic measurements of biparietal diameter (BPD) and abdominal circumference (AC) using the equation by Shepard et al. [1982] was tested prospectively in 310 fetuses. Fetuses of all weight categories were included. The error of weight prediction was in the range of +684 to -880 g. One SD of prediction error was 242 g or 8.5% of birth weight. An overestimation was seen in a fetus with a birth weight of less than 2,500 g (1 SD = 183 g or 10% of birth weight). An underestimation could be observed in a fetus with a birth weight of more than 4,000 g (1 SD = 259 g or 5.7% of birth weight). The use of a combination of BPD and AC is more accurate than the use of each of these parameters. In a fetus with a birth weight of less than 2,500 g, the equations by Thurnau et al. [1983] and Weinberger et al. [1984] are of equal clinical value. The method of Shepard et al. should be complemented with measurements of the 'cephalic index' to exclude fetuses with brachycephaly or dolichocephaly, but one should be aware that the variability of weight prediction is high (2 SD = 11.4-19.8% of birth weight).

Birth Weight↗
PubMed1986

Comparison of oral and vaginal metronidazole therapy for nonspecific bacterial vaginosis.

A prospective, randomized, nonblind study was performed to compare the efficacy of a 7-day vaginal regimen with 500 mg metronidazole (Flagyl) once a day and that of oral treatment with 400 mg metronidazole twice daily for 7 days in the treatment of nonspecific bacterial vaginosis. No treatment was given to the sexual partners and there was no restriction of sexual intercourse. 38 women completed the study and at follow-up after 4 weeks, women receiving vaginal therapy had a cure rate of 79% compared with 74% in the women on oral therapy. Cure rates were lower among users of an intrauterine contraceptive device (57 versus 88% among nonusers). The occurrence of lactate-producing bacteria (lactobacilli and aerobic streptococci) in the vagina was significantly higher in women after vaginal compared with oral therapy. Gardnerella vaginalis was isolated in 58% of the women after vaginal and in 44% of the women after oral treatment. It is concluded that vaginal application of 500 mg metronidazole daily for 7 days is equally effective as oral administration in the treatment of bacterial vaginosis.

Administration, Oral↗
PubMed1983

Fetal scalp catecholamines during labor.

Samples of scalp blood were collected from 129 fetuses during the first stage of labor for analysis of plasma norepinephrine and epinephrine concentrations by high-performance liquid chromatography. The catecholamine levels were related to scalp blood pH and fetal heart rate patterns during the 20-minute period preceding the collection of scalp blood. The median norepinephrine level was 9.2 nmol/L (range, 1.3 to 99.7), and the median epinephrine level was 0.5 nmol/L (range, less than 0.5 to 19.2) (n = 111) during the first stage of labor when the pH was above 7.25. The norepinephrine level was considerably higher than that in the resting adult. Significantly higher concentrations of catecholamines were found when scalp blood pH was below 7.26 (p less than 0.001). Maternal analgesia did not influence the fetal catecholamine levels in uncomplicated labor. Significantly higher concentrations of norepinephrine were found during the appearance of abnormal fetal heart rate patterns.

Analgesics↗
PubMed1983

Fetal plasma catecholamine concentrations and fetal heart-rate variability during first stage of labour.

Fetal heart-rate (FHR) variability was studied in 50 term fetuses during the first stage of labour. The variability was computed as an arbitrary index during a 20-min period preceding a fetal scalp blood sample which was used for the measurement of pH, adrenaline and noradrenaline. None of the fetuses was found to have a scalp blood pH less than 7.2. The short-term variability index was significantly correlated with the noradrenaline concentration in fetal blood, but the adrenaline levels which were generally very low showed no correlation with the variability values. There was no correlation between variability index and cervical dilatation or blood pH. We have shown previously high plasma catecholamine concentrations in the asphyxiated fetus with a decreased pH. In this study where fetal pH was normal a correlation between FHR variability and fetal scalp plasma noradrenaline levels was found. Thus an increased FHR variability might be an early sign of fetal distress when fetal pH is still normal.

Analgesics↗
PubMed1981

Cyclic 3',5'-adenosine monophosphate in umbilical cord blood of the newborn infant: relation to fetal stress and plasma catecholamines.

Cyclic 3',5'-adenosine monophosphate (cyclic AMP) was analyzed in the venous blood of the mothers and in the umbilical vein and artery of the infant at birth. In general, higher cyclic AMP levels were found in the umbilical vein than in the artery which were similar to the maternal values. Asphyxia and vacuum extraction were associated with significantly higher cyclic AMP levels, while the concentration was lower after elective cesarean sections than after uncomplicated vertex deliveries. The cyclic AMP concentrations were inversely correlated to pH and directly related to the catecholamine concentrations. The origin and possible significance of cyclic AMP in umbilical cord plasma is discussed.

Acidosis↗
PubMed1981

Preterm breech delivery. Early and late complications.

One hundred and ten singleton breech infants with a birth-weight less than 2 500 g have been delivered at Huddinge University Hospital during the years 1972-78. The cesarean section rate was 30.1 per cent. Vaginal and abdominal deliveries were compared with regard to perinatal mortality and asphyxial morbidity at birth. All infants born with reduced Apgar scores or traumatic birth injuries have been followed up. During a 6-year period 3 children born with low Apgar scores were found to have persistent sequelae. Two of these were considered to relate to the delivery. We conclude that cesarean section is of benefit for infants weighing 1 000-1 500 g. However, it is doubtful if abdominal delivery is of benefit for the fetus weighing 1 500-2 500 g. A high congenital anomaly rate (13.6 per cent) was found.

Apgar Score↗
PubMed1981

Term breech delivery. Early and late complications.

Three hundred and sixty-six consecutive singleton breech presentations were analyzed for clinical factors associated with fetal complications related to vaginal delivery, and for the impact of different cesarean section rates on the incidence of fetal complications. The condition at birth of the vaginally delivered (243 cases) infants was found to correlate with maternal pre-pregnancy weight, and size of the fetal head. During the period of study the cesarean section rate changed from approximately 20 per cent of term breech presentations at the beginning to almost 50 per cent at its end. This was accompanied by a decrease in the traumatic morbidity. However, at follow-up only a small minority of those registered were found to be significantly affected. The fetal asphyxia rate was not influenced by the increased cesarean section rate. At follow-up one of 33 infants born asphyxiated showed late psychomotor development.

Asphyxia Neonatorum↗
PubMed1980

Correlation of fetal heart rate patterns with umbilical artery pH and catecholamines during last hour of labor.

Fetal heart rate (FHR) patterns were analysed during last hour of labour and correlated to umbilical artery pH and catecholamine (CA) levels. Fetuses with pathological FHR had significantly higher levels of CA than those with normal FHR. Particulary high levels were found in fetuses with bradycardia and late decelerations. FHR was further analysed by a computer (DPAC, data processor and computer) in 100 women during last hour of labor. No correlation between deceleration areas of variability and umbilical artery pH and CA was found. It is concluded that although there is a good correlation between the general FHR-pattern and umbilical artery CA and pH it is impossible to quantify the degree of fetal distress by calculation of deceleration areas and variability.

Catecholamines↗
PubMed1980

[The coagulation system in Rivanol-induced abortion (author's transl)].

Second-trimester abortion was induced in 20 women by extra-amniotic instillation of rivanol. Studies were conducted into partial thromboplastin time (APIT), prothrombin, platelet count as well as into fibrinogen and fibrin split products. Twenty women with spontaneous abortion in the second trimester were used for control. APTT was elevated at the time of abortion, and both prothrombin as well as fibrin were elevated 24 hours after expulsion in response to rivanol-induced abortion. At the time of abortion, the fibrin split products in all cases or rivanol-induced abortion were higher than those of the control group. Yet, they were back to normal after another 24 hours. The platelet count did not change in the two groups during treatment. - The above results are likely to suggest that in both spontaneous abortion and rivanol-induced abortion the coagulation system is activated at similarly low levels, which seems to underline an unambiguous superiority over the use of hypertonic solutions for induced abortion.

Abortifacient Agents↗
PubMed1977

Catecholamine release in the newborn infant at birth.

Catecholamines were determined by a fluorimetric technique in umbilical blood which was collected from newborn infants immediately after birth. The mean catecholamine concentration was 62.1 nmol/liter in the umbilical artery and 29.3 nmol/liter in the umbilical vein of newborn full term infants delivered uneventfully. This value is considerably higher than in resting adults. Similar levels of catecholamines were seen after elective cesarean sections, whereas considerably higher levels were found after breech deliveries. In the full term asphyxiated infants about a 4-fold increase of the catecholamine concentration was found in both the umbilical arterial and venous blood. The amine concentration level correlated inversely to the pH below 7.25 (10 log catecholamine concentration versus pH, r = -0.71). Preterm infants had, in general, lower amine levels than full term infants both after uneventful deliveries and after intrauterine asphyxia. The catecholamine levels were considerably increased in the newborn infants who showed some kind of abnormal fetal heart rate variation during the last hour before birth; in particular baseline changes were associated with high levels whereas only a moderate increase was seen after loss of beat-to-beat variation.

Apgar Score↗
PubMedDate not supplied

Routine use of endometrial cytology in clinical practice.

The aim of this study was to evaluate the long-term use of endometrial cytology with the Endopap sampler in clinical practice. Emphasis was placed on diagnostic accuracy, reduction of the number of curettages and cost per diagnostic test. Blind comparisons of two diagnostic tests were made during an observation period of five years. Endometrial cytology was compared with endometrial curettage as a standard if both samples had been taken within a six-month period and sufficient material had been obtained with both methods. A total of 468 women were studied. All had undergone endometrial curettage because of vaginal bleeding or impending hysterectomy. Abnormal endometrial cytology was found in 129 of 134 (96%) samples from patients with endometrial cancer, in 23 of 25 (92%) with invasive cervical cancer, in 30 of 31 (97%) with atypical endometrial hyperplasia and in 90 of 100 (90%) with endometrial hyperplasia but no atypia. Specificity was 84%. The annual numbers of fractional curettages decreased from 900 in 1986 to 298 in 1991. The study clearly showed that endometrial cytology is useful in clinical practice.

Clinical Protocols↗