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Biomedical subjects

P Greco

Publications and source records attributed to P Greco.

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

Transvaginal sonography and hysteroscopy in postmenopausal uterine bleeding.

OBJECTIVE: To compare the diagnostic accuracy of transvaginal ultrasound and hysteroscopy in the detection of endometrial pathologies in women with postmenopausal bleeding not using hormonal replacement therapy (HRT). METHODS: Between January 1997 and April 1998, 106 postmenopausal women with uterine bleeding not using HRT underwent a diagnostic work-up including pelvic examination, transvaginal ultrasound, hysteroscopy and endometrial biopsy. Sonographic measurement of endometrial thickness and hysteroscopic findings were compared with histological results. The 'classification tree' method was used to identify cut-off values of sonographic endometrial thickness that could be indicative of a class of uterine pathology. Statistical analysis was performed with the McNemar test. RESULTS: No case of endometrial cancer was found with a cut-off point of 5 mm of endometrial thickness evaluated by ultrasound, whereas all patients with endometrial thickness > or = 15 mm at sonography had an endometrial carcinoma. In the group of patients with endometrial thickness between 6 and 14 mm, we found normal atrophic endometria, benign and malignant pathology. On the other hand, the McNemar test showed a very good correspondence between hysteroscopy and histology (sensitivity 97.5% and specificity 100%), confirming its usefulness in diagnosis of postmenopausal uterine bleeding. CONCLUSIONS: Transvaginal ultrasound has revealed some limitations, mainly in the group of patients with endometrial thickness between 6 and 14 mm. The absence of endometrial malignancy in women with endometrial thickness < or = 5 mm and the high possibility of cancer in those with endometrial thickness > or = 15 mm should be confirmed in larger series. Hysteroscopy proved to be a simple and safe outpatient procedure with a high diagnostic accuracy, and in our opinion it should be considered in all women with postmenopausal uterine bleeding.

Aged↗
PubMed1999

Anti-phospholipid antibodies in patients with multiple sclerosis and MS-like illnesses: MS or APS?

OBJECTIVE: To describe the frequency, clinical, and laboratory features of patients diagnosed with multiple sclerosis (MS) or MS-like illnesses (MSL) among a large, prospectively followed cohort of anti-phospholipid antibody (aPL)-positive patients. METHODS: Between 1990 and 1995 patients referred to a university-affiliated rheumatology clinic were prospectively evaluated for aPL based on questionnaires designed to detect aPL-related symptoms and/or a family history of aPL-related illnesses. Magnetic resonance imaging (MRI) was performed when significant neurological features were present. A subgroup of all patients diagnosed with MS or MSL was identified and their clinical, laboratory, and imaging findings were reviewed. RESULTS: Of 322 patients evaluated for aPL-related symptoms or events, 189 (59%) were positive for at least one class of aPL. Twenty-six of 322 patients (8%) carried a diagnosis of MS or MSL, either at the initial evaluation or during the study period. Twenty-three of the 26 individuals (88%) tested positive for aPL, while the remaining 3 (11%) tested repeatedly negative. Eighteen of the 23 patients (78%) had either more than one class of aPL or had multiple positive titers. IgM aCL was noted in 18 of the 23 patients (78%). Oligoclonal bands were noted in five patients. Antinuclear antibodies (ANA) and low complement levels were frequently observed. Blinded MRI readings showed lesions consistent with MS in the majority of cases. Clinically, 7 patients had transverse myelitis (TM), while optic neuritis (ON) was present in 8 patients. Most patients had either occult symptoms of rheumatic disease or contributory family histories. None had a defined underlying connective-tissue disease. CONCLUSION: A substantial number of aPL-positive patients have a concurrent diagnosis of MS or MSL, frequently presenting with elevated IgM aCL, optic neuritis, and transverse myelitis. The anti-phospholipid syndrome (APS) should be strongly considered as an alternative diagnosis to MS in these patients.

Adolescent↗
PubMed1999

Reproductive choice in individuals HIV-1 infected in south eastern Italy.

OBJECTIVE: To evaluate the impact of counseling on reproductive choices in seropositive women in South-Eastern Italy. SETTING: University Hospital, Apulia region, South-Eastern Italy, tertiary referral center for high risk obstetrics and infectious diseases. METHODS: Between March 1985 and December 1996, two hundred and twenty-five HIV-infected women, receiving treatment at our clinic for infectious diseases were enrolled. They were all regularly given treatment and counseling and their sexual partners, if negative, tested for HIV-1 antibodies. Their reproductive choices and their attitude toward pregnancy were recorded and analyzed. RESULTS: Seventy-six pregnancies were observed during this period in 76 women. Twenty-one of these women (27.7%) decided to terminate the pregnancy. Women that were intravenous drug users or with a longer history of known seropositivity were more likely to have a termination. A decreasing trend in the request of abortion was observed with time. CONCLUSIONS: The data show that the scenario of HIV-infected women is changing in our setting. As a consequence, many seropositive women deliberately choose to have a pregnancy and factors different from those we expect to be modified by the counseling influence their reproductive choice. They should be taken into account in the management of these women before and during pregnancy.

Abortion, Induced↗
PubMed1999

The diagnostic role of "in utero" magnetic resonance imaging.

OBJECTIVE: To assess the diagnostic potential of Magnetic Resonance Imaging (MRI) in the management of ultrasonically diagnosed congenital anomalies. PATIENTS AND METHODS: Ninety-two patients were included into the study after the ultrasonic diagnosis of an abnormality. Sixty-three of these patients were affected by an abnormality of the central nervous system (CNS) and 29 by abnormalities in other apparatuses. The GRE technique was used to obtain T1 and T2 star-weighted images. RESULTS AND DISCUSSION: Satisfactory imaging was obtained in all but one case. In order to define the "reliability" of MRI for a given condition, a diagnostic score was designed and separately given by the obstetrician and the radiologist involved in the case. MRI scored less than ultrasonography for abnormalities of the fetal contour and for large and complex distortion of the CNS as holoprosencephaly. For subtle midbrain anomalies, as well as for neuronal migration disorders, MRI definitely was superior to sonography. For other anomalies, as for example congenital diaphragmatic hernia, MRI was better than conventional techniques in assessing prognosis and outcome, but less reliable in assessing associated anomalies. MRI seems to be a valuable adjunct to us for prenatal diagnosis of only selected fetal anomalies and requires precise guidelines in a multidisciplinary approach to prenatal pathology.

Abdomen↗
PubMed1999

Endometrial stromal sarcoma: a clinicopathologic study.

BACKGROUND: This study is a clinicopathologic evaluation of five patients with endometrial stromal sarcoma. PATIENTS AND METHODS: Over a period of 9 years 5 cases of ESS were observed in our Unit. The patients were retrospectively staged according to the FIGO staging system for endometrial cancer. The neoplasm was divided into two groups based on mitotic activity. Patients underwent endouterine curettage, surgery therapy and, except one of them, chemotherapy. RESULTS: Two patients had low-grade ESS stage Ib and Ic. The other three had high-grade ESS, and were in stage IIIa. Treatment was surgery for all patients, and adjuvant chemotherapy for 4 out of 5. Both patients in stage I are alive, clinically free from the disease, 25 and 36 months after diagnosis. In stage III all patients died 14, 25 and 36 months after diagnosis. CONCLUSION: ESS is a rare uterine neoplasm. Histologic grade is the most important prognostic factor.

Adult↗
PubMed1999

[Intratumor flowmetry in endometrial carcinoma. Correlation with the tumor stage].

BACKGROUND: To assess the value of intra-tumoral (endometrial) flow as detected by color Doppler ultrasound in relationship with negative prognostic factors in patients with endometrial carcinoma. METHODS: Fifty-three patients with a previous histological diagnosis of endometrial carcinoma were included in the study. Transvaginal ultrasound with pulsed color Doppler was performed in order to record resistance indexes and vascular density (defined as "high" if > or = 3 vascular spaces were detectable for any given area). All cases were classified according to FIGO after surgery and histology. Prognostic bad factors were considered: FIGO stage (> I), tumor grade (> 1), myometrial invasion (> 50%) involvement of vascular spaces and lymph node metastasis. RESULTS: Both resistance indexes and vascular density in the endometrium related well to more prognostic signs. No relationship was found for lymph node metastasis, probably justified by the small number of positive nodes (2/27). DISCUSSION: Color Doppler ultrasound seems to be a promising technique in pre-surgical staging of endometrial carcinoma. Detection of vascular spaces rather than low resistance indexes is, in personal experience, more significantly related to advanced disease. It is hypothesized that long term follow-up of these patients can show a predictive value of Doppler ultrasound on the outcome of the disease.

Adenocarcinoma↗
PubMed1999

[Impact of counseling on the sexual habits and reproductive decisions in HIV-1-positive subjects].

BACKGROUND: To assess the results of counselling on sexual behavior and reproductive choices of couples discordant for HIV-1, in South-Eastern Italy. SETTING: University Hospital, Apulia region, South-Eastern Italy. METHODS: In the period March 1985-December 1995, one hundred and forty-four HIV-1 discordant couples were enrolled. They were followed up for a median period of 39 months (range 12-60 months). Behavioural counselling was performed at each visit of the infected case and the sexual partner was periodically tested for HIV-1 antibodies. RESULTS: Sixty percent of couples pursued in unprotected sex intercourse, 30 new infections being diagnosed during the study period (cumulative incidence rate = 21%). In addition, 49 pregnancies in 38 women were recorded. Termination was very seldom the choice of pregnant women. CONCLUSIONS: There is a clear indication for a failure in the counselling process. A change in population characteristics is to be pointed out as the main factor of the results. More appropriate counselling modalities need to be introduced for the different targets of sexual behaviour of our population.

Adult↗
PubMed1999

[Chemotherapy in the treatment of ovarian carcinosarcoma].

Carcinosarcoma of the ovary is a rare neoplasm representing 1% of this organ malignancies. The disease appears almost exclusively in advanced stage having an unfavourable prognosis. Three patients affected by carcinosarcoma (MMMT) of the ovary admitted to our Operative Unit have been treated. All patients underwent surgery and subsequently chemotherapy. Two patients were affected by heterologous MMMT and were stage IV and IIIc respectively, the other one, affected by homologous MMMT, was stage IIIc. Stage IV patient was submitted to 6 cycles of CARBO + IFX + CDDP, second look and further 6 cycles of TAX. After 23 months she was submitted to colostomy for intestine occlusion. At the 35 months she died for cachexia and intestine occlusion. Stage IIIc heterologous patient was submitted to 6 cycles of CDDP + EPI + IFX + MESNA for 3 days; at 6 months from diagnosis she did not present any sign of disease. Stage IIIc homologous patient, affected by chronic renal insufficiency and submitted to dialysis, underwent 5 cycles of TAX and at 11 months from diagnosis presented partial response. Carcinosarcoma of the ovary, because of its rarity, and of the poor record of cases in the literature, is a much debated topic in particularitis complementary therapy. Opinions of the several authors are in contrast regarding the use of CHT + RT at the same time. Only RT after surgery does not seem to improve the survival of these patients. Personal experience, with the reported outlines, compared with survival, seems to confirm the use of CDDP and of IFX and to give new horizons to TAX, waiting for further findings.

Antineoplastic Agents, Alkylating↗
PubMed1998

Expression of tenascin is related to angiogenesis in pre-eclampsia.

METHODS: Ten samples of decidua basalis from pre-eclamptic women and 10 from healthy primigravid women subjected to caesarean section (control tissues) were investigated immunohistochemically for changes in angiogenesis and expression of tenascin, an extracellular matrix protein thought to modulate angiogenesis. In addition, pre-eclamptic and control samples were grafted onto the chick embryo chorioallantoic membrane (CAM) to study their possible angiogenic activity in vivo. RESULTS: Although the microvessel area was low in control samples, it increased significantly in the pre-eclamptic decidua. In parallel, the area covered by tenascin staining underwent a significant expansion that was highly correlated with the microvessel area. Angiogenic activity was assessed both macroscopically and microscopically on histological sections 4 days after grafting. In contrast to control samples, pre-eclamptic decidua induced an intense capillary growth, and numerous capillaries converging towards the implant and forming a spoke-wheel pattern were evident. Histological examination using a planimetric point-count method showed that microvessel counts in the CAM area under and around the pre-eclamptic implants were significantly higher than those of control samples. Again, the extracellular matrix of nearby microvessels was strongly immunoreactive with tenascin. CONCLUSION: It is suggested that, unlike normal decidua, pre-eclamptic decidua displays an intense, autonomous angiogenic activity, probably mediated by tenascin in addition to its own angiogenic factors.

Allantois↗
PubMed1998

Antenatal diagnosis of isolated lissencephaly by ultrasound and magnetic resonance imaging.

Lissencephaly (agyria) is a cortical dysplasia associated with a disturbance in the migration of neocortical neurons. Because of abnormal sonographic findings in the brain of a 24-week fetus, we carried out serial magnetic resonance imaging (MRI) examinations which raised the suspicion of isolated lissencephaly. In the second trimester, an area of damage depicted as low-intensity signals was identified by MRI inside the cortical parenchyma. In the same cortical area, agyria was detected later in pregnancy, and postnatally calcification was observed by computerized tomography (CT) scan. We believe that ultrasound and targeted MRI examination can improve our understanding of some disorders of neuronal migration and that earlier diagnosis is feasible if both methods are employed and interpreted by sound criteria.

Adult↗
PubMed1998

[Angiogenesis and endometrial carcinoma. Correlations with blood flow analysis by transvaginal color Doppler ultrasonography].

Neoangiogenesis is a basic event in the evolution and spread of several solid neoplasms. Angiogenesis is an active phenomenon in physiological endometrium in the reproductive age and seems to disappear in postmenopause. Endometrial hyperplasia and adenocarcinoma are associated with signs of angiogenetic activity. The factors promoting angiogenesis in endometrial carcinoma are still unknown. Similarly it is not possible to recognize which endometrial carcinoma is potentially angiogenetic, but a relationship between angiogenesis and early metastatic spread has been established. Angiogenesis is definitely a late component of invasive tumour, but an early angiogenetic behaviour of some neoplastic clones, that could be a main prognostic factor for endometrial carcinoma is hypothesized.

Adult↗
PubMed1998

Astroglia-microvessel relationship in the developing human telencephalon.

The telencephalon of 12 and 18 week-old human foetuses was examined for evidence of astroglia-microvessel relationship. Immature astroglia cells (radial glia and astroblasts) and astrocytes were immunostained using antibodies to the cytoskeletal proteins vimentin (VIM) and glial fibrillary acidic protein (GFAP). The microvessels were detected using an antibody to the blood-brain barrier (BBB)-specific glucose transporter GLUT1. Two extracellular matrix (ECM) glycoproteins, laminin (LM), an endothelial-derived molecule, and tenascin-C (TN-C), a glia-derived molecule, were also analyzed. In the two stages examined, VIM- and GFAP-positive fibers of the radial glia establish close relationships with the radial and periventricular microvessels, which are GLUT1-positive and lined by an LM-positive basal lamina-like matrix. At the 18th week, also radial glia transitional forms and immature astrocytes exhibit extensive contacts with the microvasculature. A TN-C-rich ECM is revealed around the vascular plexus of ventricular zones at the 12th week, and around the newly growing radial microvessels and the microvessel branching sites at the 18th week. The observations taken as a whole, suggest that during the telencephalon morphogenesis the immature astroglia cells play a role in the early establishment of the distribution pattern of the neural microvessels and in their growth and maturation.

Abortion, Spontaneous↗
PubMed1998

[Maternal viral and gestational risk factors in vertical transmission of HIV-1 infection].

BACKGROUND: Several risk factors are related to vertical transfer of HIV-1 infection, but the influence of each one separately is controversial. Various risk factors have been evaluated altogether and separately, in order to find a single condition, that is, early in pregnancy predictive of fetal infection. METHODS: A prospective, observational study has been carried out during the period January 1992-January 1997, at the Centre for infectious diseases in pregnancy, University Hospital of Bari, a tertiary reference setting. Forty-four HIV-1 infected mothers have been recruited in early pregnancy, to be followed-up until delivery. Neonates have been evaluated in the Pediatric Department of the same hospital until 18 months of age. Maternal risk factors, such as age, infection in the partner, mode of acquisition of HIV-1, drug addition, life-style and risky behaviour as well as stage of disease, immunological status and antiviral treatment were considered. Obstetrical factors, too, (parity, preterm delivery, rupture of membranes, duration of labour and mode of delivery) were taken into account. Data were analyzed according to Fisher exact test and Draper and Smith multivariate analysis. RESULTS: Thirty cases (9 inadequate for follow-up, 4 ongoing pregnancies, 1 perinatal death before ascertainment of infection) were evaluated for final results. The overall transmission rate was 13.3%. Single factors significantly related to transmission were stage of disease (p < 0.01), mode of maternal infection (p < 0.03) and maternal HCV infection (p < 0.04). Multivariate analysis has shown the stage of disease to be the only positively-related risk-factor. CONCLUSIONS: The data identify a sub-group among HIV-1 infected women, where the more sustained rate of vertical transmission is associated with risky behaviour, as determined both by drug addiction and positivity for another sexually transmitted disease. Maternal compromise and immunological status are, however, the highest-risk conditions for delivering a HIV-1 infected baby.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Celiac disease and selective immunoglobulin A deficiency.

Selective IgA deficiency was observed in 12 of 688 (1.7%) patients with celiac disease who were clinically undistinguishable from patients with celiac disease with normal IgA levels. This high prevalence of IgA deficiency in patients with celiac disease makes serum IgA assay advisable when screening for celiac disease is performed by measurement of antigliadin antibodies or anti-IgA endomysium antibodies. Similarly, subjects with IgA deficiency should be considered at risk of celiac disease.

Adolescent↗
PubMed1997

Transvaginal color Doppler sonography in predicting the response to chemotherapy in advanced cervical cancer.

The role of Doppler ultrasonography in the diagnosis of advanced cervical cancer continues to be controversial. This study was designed to assess the clinical value of the technique in terms of predicting the response to chemotherapy in patients with advanced cervical cancer. Twenty-three patients with cancer of the cervix (FIGO stages Ib bulky-IIIb) and 20 healthy women underwent transvaginal color Doppler assessment of the uterine arteries (both ascending and descending branches) and the intracervical vessels. Statistical analysis was performed by Student's t test for paired and unpaired data. The intracervical vessels were the only site to show significant differences both in the resistance and in velocity parameters. A subgroup of 14 patients, scheduled for neoadjuvant chemotherapy, were evaluated before and at the completion of treatment. A significant increase in resistance and pulsatility index values and a decrease in peak systolic velocity were observed in the ten patients who responded to chemotherapy. Preliminary results of our study suggest that Doppler parameters can be clinically useful in the evaluation of the response to neoadjuvant chemotherapy. More patients, sampled in a prospective way in order to increase the number of non-responders, would be necessary to assess the possible role of Doppler ultrasound in predicting which patients will respond to chemotherapy.

Aged↗
PubMed1997

Social validity of support group and behavior therapy interventions for families of adolescents with insulin-dependent diabetes mellitus.

Compared the social validity of behavior therapy vs. support group interventions for reduction of parent-adolescent conflict among families of adolescents with diabetes. Families were randomized to 10 sessions of an Education and Support group (ES) or 10 sessions of Behavioral Family Systems Therapy (BFST). We compared participants' social validity ratings of BFST and ES using the Treatment Evaluation Questionnaire (TEQ). Mean TEQ scores were significantly more positive for BFST than ES and, for 13 of 20 items, BFST was rated significantly more positively by parents and/or adolescents. Adolescents rated ES less positively than did parents. Fathers' responses reflected fewer differences between ES and BFST. Results extend previous research on BFST and confirm its superiority over ES for targeting family conflict.

Adaptation, Psychological↗
PubMed1997

Directive and nondirective social support in diabetes management.

Directive and Nondirective Support were distinguished (interrater agreement = 88.2%) through open-ended interviews completed by 60 adults with Insulin Dependent Diabetes Mellitus. Supporting validity, the sum of both Directive and Nondirective Support was correlated with scores on the Interpersonal Support Evaluation List (ISEL; r = .36). Supporting their distinction, Directive and Nondirective Support were inversely correlated (r = -.26), and Directive but not Nondirective Support decreased with age. Partial/correlations controlled for general support as measured by the ISEL, to examine the unique associations of Directive and Nondirective Support. For those less than 30 years old, Nondirective Support was associated with better metabolic control (p = .004). For those 30 or older, Directive Support appeared counterproductive, being associated with greater negative mood (p = .02). Different types of support may play different roles in different areas of disease management (e.g., metabolic control versus mood) and as a function of individual characteristics such as age.

Journal Article↗