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Biomedical subjects

R Grio

Publications and source records attributed to R Grio.

At least 19 recordsLinked to original sources
PubMed2002

[A new method of neovagina in Rokitansky's syndrome. A review of the literature and description of a series].

BACKGROUND: The absence or hypoplasia of the vagina is a frequent finding in Rokitansky-Mayer-Küster-Hauser syndrome. METHODS: A group of 13 patients with Rokitansky-Mayer-Küster-Hauser syndrome were treated between 1982 and December 2001 at the Plastic Surgery Department of C.T.O. (Turin) and the 2nd Obstetrics-Gynecology Clinic of Turin University. Surgery was the proposed therapy in all patients, using a modified version of the McIndoe technique. RESULTS: In this series, the cytological tests of neovaginal tissue carried out one year after surgery showed a syndrome of slight atrophy in 8 cases, but this was not sufficient to impede the sexual activity of these patients. Two patients were lost in the follow-up; 3 patients declared that they were reasonably satisfied with their sex life, whereas the remaining 8 reported a normal sex life. CONCLUSIONS: The treatment of choice for complete vaginal agenesia is a neovagina using the skin graft method. This technique produces excellent anatomical results, especially in young patients, even without regular dilatation or frequent sexual relationships. The only drawback of this method is that the vagina tends to retract in some patients, a problem that has been largely solved by the most recently proposed surgical variants.

Abnormalities, Multiple↗
PubMed2002

[Cervico-vaginal infections. Study of a population in the Turin area].

BACKGROUND: Aim of this study is to determine the prevalence, in the Turin area, of the pathogens chiefly involved in the genesis of the most common infections of the female genitalia. METHODS: This is a retrospective study. During the period of time beginning from January 1, 1997 and ending December 31, 1999, we examined 10,249 women from 14 years to 54 years of age, who were seen at the out-patient diagnosis service of the Sant'Anna Hospital. The patients' cervical specimens were screened for common germs, Candida spp., Trichomonas vaginalis, Bact. Vaginosis, Chlamydia trachomatis, Microplasms, and Neisseria gonorrhea. The prevalence of each micro-organism was found. The obtained data were cross-referenced with the risk factors in the clinical history of each patient. The chi(2) test with a C.I. of 95% was used for the statistical evaluations. RESULTS: It is shown by a detailed analysis of the data in our possession that an anamnesis oriented mainly for the evaluation of the various risk factors would be more effective than one oriented for the presence of a subjective symptomatology, since many of these infections are either weakly symptomatic or totally asymptomatic (especially in the case of C. trachomatis), as has been many times underlined in the international literature. CONCLUSIONS: Greater attention should be given to the collection of anamnestic information in order to more precisely target for examination those subjects at greater risk of contracting a sexually transmitted infection.

Adolescent↗
PubMed2002

[Therapy for cervical intraepithelial neoplasia and fertility].

BACKGROUND: We reviewed the case records of patients of childbearing age treated with various types of surgical techniques for cervical intraepithelial neoplasia (CIN) to determine the impact of surgical treatment on their fertility. METHODS: Between 1983 and 1997 a total of 486 women with CIN received surgical treatment at out unit. Laser vaporization was used in 196 cases, cold-knife conization in 163 and REP in 127. The outcome of the various treatments was then compared. RESULTS: Independent of the surgical technique used, the percentage of pregnancies achieved after surgery was high: 93.33 and 96.66% of patients treated with laser vaporization and REP, respectively, and 87.69% of those who received cold-knife conization. The differences did not reach statistical significance nor were significant differences observed in the number of abortions or in the method of birth delivery (spontaneous, Cesarean section). However, a higher percentage of premature births was noted among women who received cold-knife conization (31.57%), which was statistically significant in the comparison among the three groups. CONCLUSIONS: The results from our study indicated which techniques for the treatment of CIN may be preferable. Compared with the other two techniques, cold-knife conization bears higher costs (hospitalization, general anesthesia) and has been superceded by laser vaporization and REP as evaluated in this series. When cold-knife conization must be used, cerclage of the cervix uteri should be performed in the event of future pregnancy. In contrast, laser vaporization and REP can be performed in an outpatient setting with local anesthesia. These techniques, because they are conservative, afford the advantages of complete lesion removal and maintenance of reproductive capability. Another important consideration is that REP is less costly and allows histological examination of the surgical specimen.

Adult↗
PubMed2002

[Congenital hepatic fibrosis in pregnancy].

The purpose of this study was to analyse the course of pregnancy of a 20-year-old woman suffering from congenital hepatic fibrosis (CHF), a genetic disease with recessive autosomic transmission, attributed to the group of hepato-nephro-pancreatic fibropolycystic familial diseases. This was the only time such a case had ever been encountered in a pregnancy in the history of Turin University's Obstetrics and Gynaecological Clinic. The case of a 20-year-old woman is considered. She was admitted to our observation at the Obstetrics and Gynaecological Department of Faculty "B" of the University of Turin, suffering from CHF, a primigravid in the eighth week of gestation. Haematochemical tests carried out on the patient showed a platelet deficiency without evident changes in liver and renal function. Objective examination revealed a slight hepatosplenomegaly confirmed by abdominal echotomography. The haematochemical examinations subsequently carried out confirmed thrombocytopenia due to hepatosplenic hyperhaemocataresis. In agreement with the will of the patient and her family, and after having heard the opinion of our hospital's anaesthetists and internists, a conservative approach was decided on and close monitoring of maternal and foetal conditions was planned, with hospitalisations scheduled for every fortnight. Together with the internists and anaesthetists, it was decided to allow the pregnancy to proceed as far as foetal maturity but not to term, to avoid problems relating to the excessive increase in uterine volume which would have led to pressure on the portal tree and so favoured haemorrhaging due to rupture of the oesophageal varices. Caesarean delivery was planned for the 37th week of gestation. The birth went according to plan and the foetus was a live, vital male with Apgar index of 9/9. The placenta presented normal characteristics and a weight of 590 g. No haemorrhagic complications were observed either in the course of surgery or in the postoperative phase, notwithstanding the preoperative finding of a platelet count of 64,000 platelets/ mm3. Although in our case neither the pregnancy nor the delivery constituted a serious danger for the life of the mother, possible obstetric complications are among the most serious encountered in obstetric pathology and can lead both to maternal death and to the intrauterine death of the foetus. For these reasons we believe it essential to provide correct, clear and adequate information about the risks involved for patients suffering from congenital hepatic fibrosis, especially if they are associated with renal polycystic disease, and who are admitted to our wards with the desire to programme a pregnancy.

Adult↗
PubMed2001

[Observations on vaginal delivery in women with previous cesarean section].

BACKGROUND: The significant increase in cesarean sections both before (52.73%) and during labour (89.82%) observed in the 1990s compared to the period 1970-1980 prompted the authors to review the cases of women admitted to Department B of the Gynecology and Obstetrics Clinic at the University of Turin and to study the number of women with previous cesarean sections undergoing labour. The aim of this study was to throw light on this complex question and to reduce the incidence of surgical births wherever possible. METHODS: Two groups of pregnant women with previous cesarean sections were studied in Department B of the Gynecology and Obstetrics Clinic at the University of Turin: one group included women undergoing cesarean sections between 1990-1998, and the other included women undergoing cesarean sections between 1970-1980. The authors analysed the indications for repeat cesarean section and the percentage of vaginal births. RESULTS: The results show that during 1970-1980 the percentage of vaginal births was 24.34% (259 vaginal births out of 1593 patients), whereas between 1990-1998 the percentage of vaginal births fell to 10.18% (51 vaginal births out of 1060 patients). CONCLUSIONS: The high percentage of repeat cesarean sections found in the 1990s is not only due to strictly medical reasons, but also to ethical and political motives, and above all the maternal desire not to undergo natural labour.

Female↗
PubMed2001

[Maternal morbidity in multiple pregnancies].

BACKGROUND: This study aimed to outline the clinical physiognomy of maternal morbidity in multiple pregnancies in order to improve maternal and feto-neonatal. METHODS: We reviewed the admissions to Department B of the Gynecology and Obstetrics Clinic at Turin University during the decade 1989-1998. Out of 17,445 pregnancies, we noted a 205 multiple pregnancies (1.17%), including 199 sets of twins, 5 triplets and 1 quadruplets. The percentages for the incidence of the various forms of maternal morbidity were compared to a control group of 1000 single births. RESULTS: Of 205 multiple pregnancies, 169 (82.43%) presented complications of varying severity and associated with statistically significant increase (always over 50%). These took the form of: premature birth (75.12%), PROM (28.29%), threat of premature birth (14.63%), phlebectasia (9.75%), anemia (8.78%), hyperemesis in the first quarter (8.29%), abortion (4.89%), polyhydramnios (4.39%), urinary tract infection (1.95%), detachment of the placenta (1.95%), liver pathology (1.46%), placenta previa (0.97%). CONCLUSIONS: The pathological picture revealed by this survey may seriously jeopardise the normal evolution of pregnancy, with severe repercussions for mother and fetus-neonate. These high-risk pregnancies should be included in a preventive programme of medical-social-outpatient and home assistance to guarantee early hospitalisation.

Adult↗
PubMed2001

[Embryo-fetal diseases in multiple pregnancies].

BACKGROUND: Embryo-fetal diseases are the consequence of prenatal (progenetic and metagenetic or environmental) and intranatal (of a traumatic, infective, toxic nature) pathological factors. In multiple pregnancies this complex etiopathogenesis also includes an altered didymous embriogenesis. This study aimed to evaluate the pathologies affecting the fetus in multiple pregnancy, a special biological situation leading to the potential onset of severe fetal and neonatal damage. METHODS: The authors studied 205 patients with multiple pregnancies, including 199 bigeminal, 5 trigeminal and 1 quadrigeminal, admitted to the Department B of the Obstetrics and Gynecological Clinic of Turin University between 1989-1999. Possible embyro-fetal damage was examined using a chronological criterion: namely following the development of the multiple fetuses from the zygotic to the neonatal phase. RESULTS: Pregnancies were biamniotic bichorionic in 54% of cases, biamniotic monochorionic in 45% and monochorionic monoamniotic in 1%. There were a total of 154 (79.38%) premature births out of 194 and neonatal birth weight was always SGA (small for gestational age). 66.84% of newborns were LBW (<2500 g) and 7.14% were VLBW (<1500 g). Fetal mortality (2.29%) was higher than early neonatal mortality (1.53%). Perinatal mortality (3.82%) was three times higher than in all neonates from the same period (1.03%). CONCLUSIONS: The severe embryo-fetal and neonatal damage found in multiple pregnancies is a clinical reality that calls for adequate diagnostic and therapeutic measures, and above all specific medical and social prevention to limit maternal pathogenic risks.

Birth Weight↗
PubMed2001

[Ethical problems concerning artificial fecondation].

In view of the seriousness of the facts regarding artificial fecondation as reported in the news and by the mass media, the various experiments carried out are analysed from the anthropological and ethical points of view. The purpose of these experiments is the procreation of a person and all those who are implicated in vital decisions-physicians, nurses, legislators and families-are invited to refrain from carrying out experiments or actions that might be damaging to the dignity of people and the couple in question.

Adult↗
PubMed2001

[HRT: state of the art].

Hormone replacement therapy (HRT) in postmenopause represents the most advanced frontier of preventive medicine in a rapidly evolving society that aims to emphasise, today as in the past, the leading role of women. While modern medicine has extended the average life expectancy of women today, it is now the task to enhance the quality of these extra years. HRT prevents cardiovascular disease, osteoporosis, disorders relating to changes in pelvic connective tissue and genitourinary tissues, and it can also have a positive influence on the psycho-affective sphere and, perhaps, alterations in cognitive capacity. Cultural delays and alternate phases of optimism and alarm are not always backed by solid scientific knowledge. Epidemiological research over the past years has underlined the oncological risk of using estrogens, even if associated with progestin, without the necessary methodological clarity and efficacy. From the data reported in the international literature and on the basis of over ten years experience accumulated at Department B of Gynecology and Obstetrics of Turin University, it appears that the oncogenic risk in women taking HRT is not significantly higher if the indications are strictly respected and, when necessary, progestin is associated with estrogen.

Atrophy↗
PubMed2001

[Delivery in multiple pregnancies].

BACKGROUND: A knowledge of clinical physiognomy in pathologies related to multiple births is indispensable for improving maternal and feto-neonatal prognosis. This study is a contribution to the solution of this problem. METHODS: A meta-analysis of data for multiple births at Department B of the Gynecology and Obstetrics Clinic at the University of Turi during the decade 1989-1998 was carried out, focusing on the arrangement and presentation of fetuses, the various types of birth, the gestational age at which birth occurred, the weight of neonates, neonatal mortality and maternal morbidity. RESULTS: Out of 11,523 births, there were a total of 194 (1.68%) multiple births, including 190 sets of twins and 4 triplets. 154 (79.38%) premature births were reported; 20 occurred <32(nd) week (10.29%). There was a high incidence of podalic presentation (26.30%) and shoulder presentation (5.61%) among twins; 202 were delivered using a cesarian section (51.53%) and 190 by vaginal birth (48.47%), of which 172 (90.52%) spontaneously. Surgical birth was an important means of extracting fetuses rapidly from a pathological environment. two hundred and sixty-two neonates (66.84%) were LBW (<2500 g), including 28 (7.14%) VLBW (>1500 g). The perinatal mortality rate was 3.82%. Maternal complications mainly occurred during the placental state, in the immediate postpartum and in puerperio. CONCLUSIONS: The authors feel that a more careful medical and social assistance, preventive hospitalisation, early recognition of the risk, constant monitoring for the optimal timing of birth, and lastly, qualified medical assistance during labour (expert gynecologist, trained obstetric staff) with other medical personnel (anesthetist, neonatal specialist) represent winning strategies to solve the problems arising during multiple pregnancies.

Adult↗
PubMed2001

[Preventable perinatal mortality].

BACKGROUND: Using a critical systematic analysis of perinatal mortality, this study aims to examine, on the basis of current medical and scientific knowledge, whether there are still situations in which feto-neonatal death could be prevented and to define and evaluate the feasibility of realising this goal. METHODS: The concept of preventable feto-neonatal death refers to the number of individuals who could have survived with better pre-, intra and postnatal care. In other words, it indicates the number of deaths that could have been avoided in an almost perfect health organisation and therefore, by reference, the number of inevitable deaths (not preventable). In this field it is important to distinguish between clinically preventable, where there are preventable factors at the time of hospitalisation and during the clinical phase of the disease, and extra-clinically preventable when these factors, if potentially present during the preclinical phase of disease, disappear owing to the gravity of conditions at the time of hospitalisation. Using data from maternal and neonatal clinical records, death certificates and autopsy findings, the authors examined the perinatal mortality rate in Department B of the Gynecological and Obstetrics Clinic of Turin University during the period 1979-1998. The results of these two decades were compared in terms of clinical practice. RESULTS: The perinatal mortality rate fell significantly (p<0.01) during the period 1989-1998: 1.02 vs 1.77%. It is worth underlining that this was mainly the result of a marked reduction (over 50%) in late fetal mortality: 0.43 vs 0.98% (p<0.01). Early neonatal mortality also diminished, although not significantly (0.59 vs 0.79%). In order to evaluate preventable deaths, perinatal mortality was subject to a detailed critical analysis to analyse its chronological evolution: prenatal, intranatal, early neonatal. During the second period examined, the preventable nature of perinatal mortality, although slightly lower, applied to 36.35% of cases. It is important to underline that although clinically preventable deaths were unfortunately still present (approx. 10%), most cases (approx. 90%) referred to extra-clinically preventable deaths. CONCLUSIONS: On the basis of current medical and scientific knowledge, the authors outline the directives for medical and specialist obstetric and social care required in the specific fight against preventable perinatal deaths. Recent progress in basic scientific research, especially in the genetic field, may make a vital contribution to limit and reduce the coefficient of feto-neonatal pathology that is still beyond control.

Feasibility Studies↗
PubMed1999

[Sexuality in menopause. Importance of adequate replacement therapy].

BACKGROUND AND AIMS: The harmful repercussions of estrogen deficiency in menopause on the female organism are also responsible for reduced libido and uncomfortable trophic disorders of the genitourinary tract leading to reduced vaginal lubrication and severe alterations affecting sexual function, as well as for the more commonplace vasomotor phenomena and psychoemotive changes. METHODS: The authors treated 102 menopausal patients who presented reduced libido and orgasmic difficulties, as well as other menopausal problems, with 17-beta estradiol+noretisterone acetate using a transdermal route. The main advantage offered by the transdermal route is that conjugated estrogens "bypass" the liver and reach the target organs in an unmodified manner. This treatment is well tolerated by almost all patients, even those suffering from slight gastroenteric and hepatic problems. RESULTS AND CONCLUSIONS: This study showed the good tolerability and almost complete innocuousness of the drug used. None of the patients receiving replacement therapy reported any collateral effects worthy of note or the onset of malignant lesions of the breast or pelvic organs. The results obtained show that the use of 17-beta estradiol+noretisterone acetate can effectively modify menopausal symptoms, improving both quality of life and sexual function.

Estrogen Replacement Therapy↗
PubMed1999

[Vaginal delivery following previous cesarean section].

BACKGROUND AND AIM: The increased use of cesarean section (CS) over the past 30 years has raised a problem which has been much debated in obstetric practice: is it always necessary to repeat CS in women who have previously undergone cesarean section? The aim of this study was to establish whether women previously undergoing CS can start trial labour? METHODS: The authors examined 195 pregnant women who had previously undergone 1 or 2 CS. Medical history, clinical examination and maternal and fetal monitoring techniques were used to select the women who could start trial labour.

Cesarean Section↗
PubMed1999

[Abnormal uterine bleeding during climacteric. Correlation between transvaginal ultrasonography, hysteroscopy and histology].

BACKGROUND AND AIMS: The authors evaluated the accuracy of ultrasonographic findings compared to hysteroscopic and histological results in the diagnosis of anomalous uterine bleeding in menopause. METHODS: Forty-eight women suffering from the above pathology and attending the Preventive Gynecology outpatient clinic of Department C of the Gynecology and Obstetrics faculty at Turin University during the period between September 1996 and July 1997, underwent first ultasonography using a transvaginal probe and then outpatient hysteroscopy with endometrial biopsy. RESULTS: A total overlap between the ultrasonographic image, hysteroscopic results and histological diagnosis was only obtained in the group of menopausal patients. CONCLUSIONS: In line with the data reported in the literature, the authors imposed a cut-off endometrial thickness of 4 mm above which further diagnostic tests were performed using hysteroscopy with targeted biopsy.

Aged↗
PubMed1998

[Estrogen and progestin treatment in postmenopause. Effects on the endometrium].

BACKGROUND AND AIMS: It has been well demonstrated that menopausal disorders resulting from the lack of estrogens may be delayed and partly eliminated by appropriate hormone replacement therapy. The aim of this study was to demonstrate the absolute innocuity of the association of estrogen and progestin. METHODS: The authors used an association of conjugated equine estrogens and medroxi-progesterone acetate to treat menopausal syndrome in 80 women aged between 48 and 55 years old. The study lasted 2 years. RESULTS AND CONCLUSIONS: The results obtained showed the good tolerability and marked efficacy of the drugs used, as well as the absolute innocuity in relation to the target organs, namely the breast and endometrium. No cases of endometrial hyperplasia with atypical development or malignant evolution were reported during the study and there was a significant improvement in lipid metabolism, vasomotor or psychomotive disorders, as well as increased trophism of the genitourinary tract and skeleton.

Breast↗
PubMed1998

[Clinical efficacy of tamoxifen in the treatment of premenstrual mastodynia].

BACKGROUND: Premenstrual syndrome (PMS), which was first described by Frank in 1931, is a clinical condition that is not easy to classify in terms of either symptoms or from a diagnostic and therapeutic point of view. AIMS: The aim of this study was to evaluate the efficacy of tamoxifen, an antiestrogen drug, using a double-blind study with placebo in the treatment of mastodynia, one of the most frequent symptoms of PMS, given that an absolute or relative increase in estrogens is one of the most controversial etiopathogenetic hypotheses. METHODS: The study included a group of 88 outpatients aged between 22 and 40 with regular menstrual cycles and intense mastodynia. Before commencing therapy, a detailed medical history was compiled for each subject and all underwent a gynecological and breast examination, hematochemical and instrumental tests (scan and mammography) in order to rule out other PMS-related organic pathologies. The patients were randomly divided into two groups of 44: one group received tamoxifen at a dose of 10 mg by mouth from day 5 to day 24 of the menstrual cycle, whilst a placebo was administered to the other group using the same dosage scheme. All women underwent a thorough control examination at the end of treatment and two months after the end of treatment. RESULTS: At the end of treatment 90% of patients reported a complete resolution of symptoms, whilst 10% only showed a slight improvement. In the control group, 86% showed a transitory reduction in symptoms and 13% did not report any improvement. CONCLUSIONS: On the basis of the results obtained, the authors affirm the validity and efficacy of tamoxifen in the treatment of mastodynia in PMS owing to both its innocuity and its atoxity.

Adult↗
PubMed1998

[Anomalous uterine hemorrhages in the climacteric. Their etiopathogenesis].

Anomalous uterine bleeding accounts for approximately two-thirds of the causes of outpatient gynecological check-ups for women in menopause. The high incidence of this pathology raises considerable problems from a clinical and social point of view. In this paper the authors outline the main causes of both organic and functional bleeding.

Climacteric↗