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Biomedical subjects

R Marana

Publications and source records attributed to R Marana.

At least 37 records · Page 2Linked to original sources
PubMed1996

Endometriosis-Associated Dysmenorrhea Is Not Related to Typical or Atypical Peritoneal Implants

From April 1, 1995, to December 31, 1995, 45 patients undergoing diagnostic or operative laparoscopy for infertility, pelvic pain, or both, were found to have endometriosis. No woman had undergone any preoperative medical or surgical treatment for the disease. Preoperatively they answered a questionnaire, including a visual analog scale (VAS) to evaluate their associated symptoms. All visible signs of endometriosis were evaluated at laparoscopy by a single observer and recorded. Endometriosis was classified as cysts, adhesions, typical implants (black-blue powder burn implants), and atypical implants (clear papules, red polyps, flamelike lesions, red-brown vesicles, white opacification, peritoneal defects). The revised American Fertility Society (AFS) score was also used to stage the disease. The VAS scale for dysmenorrhea correlated significantly with the AFS total score (Pearson's r = 0.510, p <0.001), the cyst subscore (r = 0.490, p <0.001), and the adhesion subscore (r = 0.381, p <0.01). There was no correlation between the VAS scale for dysmenorrhea and the AFS implant subscore (r = 0.019), or with the total number of endometriosis implants (r = 0.160), the number of typical implants (r = 0.025), or the number of atypical implants (r = 0.161). The AFS score for endometriosis, devised primarily to formulate a prognosis in infertile women, seems to be correlated also with endometriosis-associated dysmenorrhea. Although atypical implants produce higher amounts of prostaglandin F2alpha compared with typical implants, the present study does not support the suggested association between them and the severity of dysmenorrhea.

Journal Article↗
PubMed1996

Low-Dose Aspirin to Prevent Postoperative Adhesion Formation in the Rabbit Model

Among the various agents used to prevent postoperative adhesion formation, nonsteroidal antiinflammatory drugs (NSAIDs) have recently gained wide attention because of the relative lack of side effects compared with traditional antiinflammatory agents, namely, corticosteroids. The inconsistency of data published in the literature for the adhesion prophylactic effect of NSAIDs could be related to the different compounds and dosage regimens. We evaluated the efficacy of intramuscular acetylsalycilic acid (ASA) administered perioperatively for 5 days in two regimens: low-dose (L-ASA) 1.7 mg/kg/day, and high-dose (H-ASA) 28.0 mg/kg/day, versus no perioperative treatment (controls) in 24 New Zealand white female rabbits undergoing conservative pelvic surgery in a randomized trial. At second look, the adhesion score was significantly lower in the L-ASA animals than in the H-ASA and control groups. The adhesion score in the H-ASA group was lower, although not significantly, than in the control group. We conclude that the inhibition of postoperative adhesion formation observed with L-ASA could be due to the selective inhibition of thromboxane A2 over prostacyclin.

Journal Article↗
PubMed1996

Production of Prostaglandin F2alpha by the Different Forms of Endometriosis

It has been suggested that atypical, nonpigmented endometriotic lesions have an increased capacity to synthesize prostaglandin (PG)F2alpha compared with typical endometriosis, and could therefore represent the more active forms of the disease. We took biopsy specimens of various endometriotic lesions and of normal endometrium and peritoneum during operative laparoscopy in 12 infertile women. The specimens were transferred in flasks containing Krebs solution and placed in a shaking incubator for 1 hour at 37&deg; C. The incubation solution was changed every 20 minutes and assayed by radioimmunoassay procedures for the concentration of PGF2alpha. Biopsy specimens from normal peritoneum and normal endometrium were also taken from five control patients with no evidence of endometriosis. The PGF2alpha concentration/milligram of tissue was not significantly less different between typical and atypical implants, and among the different atypical forms. Endometriotic cyst wall produced significantly less PGF2alpha than both typical and atypical peritoneal implants, and significantly more than normal peritoneum. There was no difference in production for normal tissue (endometrium or peritoneum) between patients with endometriosis and controls. We did not confirm evidence from the literature of a higher production of PGF2alpha in atypical versus typical endometriotic lesions. Our data do not support selective ablation of atypical forms, since typical endometriotic lesions could be similarly active in prostaglandin production.

Journal Article↗
PubMed1996

Distal fallopian tube occlusion: false diagnosis with hysterosalpingography in cases of tubal diverticula.

PURPOSE: To evaluate the accuracy of hysterosalpingography (HSG) in the diagnosis of distal fallopian tube occlusion in infertile patients who were candidates for laparoscopic surgery. MATERIALS AND METHODS: A retrospective review of charts was performed for 25 patients who were scheduled to undergo laparoscopic surgery. A preoperative diagnosis was made at HSG of bilateral (or unilateral in case of previous contralateral salpingectomy) distal tube occlusion. RESULTS: At laparoscopy, in three patients (12%) who were scheduled for salpingostomy, the diagnosis of distal tube occlusion made at HSG was incorrectly positive; in the three patients, a single tubal diverticulum was present in the distal ampulla in otherwise normal, patent tubes. CONCLUSION: Bilateral tubal diverticula appear to be often misdiagnosed at HSG as distal tube occlusion.

Adult↗
PubMed1996

Laparoscopically assisted vaginal hysterectomy as an alternative to abdominal hysterectomy. A pilot study.

Laparoscopically assisted vaginal hysterectomy (LAVH) allows for conversion of some abdominal hysterectomies to a vaginal route. LAVH may be particularly useful when adnexectomy is indicated. In this study the authors evaluate the results obtained in a series of 21 patients prospectively selected for LAVH. The mean operative time was 96 min (range 58-155), with an estimated blood loss of 218 ml (range 50-510). The mean uterine weight was 320 g (range 105-610). Intraoperative complications were limited to one case of bladder injury which occurred during the vaginal phase of the procedure. No patient required heterologous blood transfusion. No postoperative complications were observed. The average length of hospitalisation was 4.4 days (range 2-9). The authors conclude that LAVH allows for conversion of a significant number of abdominal hysterectomies to a vaginal route and that with respect to the former it is definitely less costly since it allows for earlier hospital discharge and resumal of a normal lifestyle.

Endometriosis↗
PubMed1996

Use of fibrin sealant for reproductive surgery: a randomized study in the rabbit model.

The present study was undertaken to compare adhesion formation and reproductive outcome after reproductive surgery with or without the application of fibrin sealant. At laparotomy, the ovaries and uterine horns of 20 rabbits were longitudinally incised on the antimesenteric side using a monopolar microneedle. At random, one ovary and the ipsilateral uterine horn were covered with fibrin sealant, while those on the contralateral side were left uncovered without application of sutures. The rabbits were then mated, and 2 weeks later a second-look laparotomy was performed by a blinded observer. No statistically significant differences were found in postoperative adhesions, number of corpora lutea in each ovary, number of embryos in the ipsilateral uterine horn, and nidation index for each side. Fibrin sealant for conservative surgery does not appear to significantly affect either postoperative adhesion formation or reproductive outcome.

Animals↗
PubMed1996

Operative laparoscopy for ovarian cysts. Excision vs. aspiration.

OBJECTIVE: To evaluate operative laparoscopy for excision vs. aspiration of ovarian cysts. STUDY DESIGN: From July 1, 1990, to June 30, 1993, 100 women under 40 years of age were subjected by the senior author to laparoscopic cyst excision, and 31 patients with similar characteristics underwent laparoscopic cyst aspiration by their attending physicians. Four-puncture laparoscopy was performed for laparoscopic cyst excision using the stripping technique, whereas two-puncture laparoscopy was employed for laparoscopic cyst aspiration. All patients underwent postoperative serial clinical examinations and ultrasound scans for the detection of recurrence. RESULTS: Four recurrences (4%) were observed in the group that underwent laparoscopic cyst excision, whereas 26 (84%) recurrences occurred in the group that underwent laparoscopic cyst aspiration (P < .0001). CONCLUSION: Provided that patients are carefully selected according to age and sonographic pattern, enucleation of adnexal masses at operative laparoscopy is the treatment of choice.

Adolescent↗
PubMed1995

Prognostic role of laparoscopic salpingoscopy of the only remaining tube after contralateral ectopic pregnancy.

OBJECTIVE: To evaluate the prognostic value of laparoscopic salpingoscopy in detecting patients who are at increased risk for a repeat ectopic pregnancy (EP). DESIGN: Patients with secondary infertility after a previous contralateral salpingectomy for EP were evaluated by laparoscopy with tubal perfusion and salpingoscopy of the only remaining tube. Subsequent reproductive outcome was evaluated and correlated to laparoscopic and salpingoscopic findings. SETTING: Department of Obstetrics and Gynecology of the Catholic University, a tertiary care university center in Rome, Italy. PATIENTS: Eighteen patients submitted to laparoscopy and salpingoscopy after a previous salpingectomy for EP. INTERVENTION: A two- to three-puncture laparoscopy with tubal perfusion and salpingoscopy. MAIN OUTCOME MEASURE: Reproductive outcome after a mean follow-up of 42.6 months. RESULTS: Salpingoscopy revealed a normal tubal mucosa in 13 patients (72%) and intra-ampullary adhesions in 5 patients (28%). Eight of the 13 patients with a normal mucosa conceived an intrauterine pregnancy. In the 5 patients with intra-ampullary adhesions, there were 3 repeat EPs, with one patient having first a term pregnancy and then a repeat EP. The presence of peritubal adhesions at laparoscopy was not of prognostic significance. CONCLUSION: Direct visualization of the ampullary mucosa by salpingoscopy can allow the detection of intraluminal adhesions that put the patient at increased risk for a repeat EP.

Adult↗
PubMed1995

Correlation between the American Fertility Society classifications of adnexal adhesions and distal tubal occlusion, salpingoscopy, and reproductive outcome in tubal surgery.

OBJECTIVE: To compare the prognostic value of salpingoscopy with a current classification system of adnexal adhesions and distal tubal occlusion in patients with tubal infertility undergoing reconstructive tubal surgery. DESIGN: Prospective clinical study. SETTING: Department of Obstetrics and Gynecology of the Catholic University, a tertiary care University Center in Rome, Italy. PATIENTS: Fifty-five infertile patients with either adnexal adhesions (29 patients) or hydrosalpinx (26 patients) undergoing reconstructive tubal surgery. INTERVENTIONS: Salpingoscopy performed concomitantly to salpingo-ovariolysis or salpingoneostomy at the time of either operative laparoscopy or laparotomy using microsurgical techniques. MAIN OUTCOME MEASURES: Salpingoscopic findings were compared with a current classification system of adnexal adhesions and distal tubal occlusion. The patients were followed for a mean follow-up of 49 months; the pregnancy rates achieved were correlated with the salpingoscopic findings and the classification system used. RESULTS: There was a significant correlation between the salpingoscopic grade and the occurrence of a term pregnancy for both the salpingo-ovariolysis and salpingoneostomy groups of patients. There was no significant correlation between the classification system used and the occurrence of a term pregnancy for both groups of patients. CONCLUSION: Salpingoscopy plays an important role in selecting the patients who may benefit the most from reconstructive tubal surgery.

Adnexal Diseases↗
PubMed1995

Laparoscopic findings after transvaginal ultrasound-guided aspiration of ovarian endometriomas.

From 1 July 1990 to 31 January 1994, 55 patients underwent operative laparoscopy for the excision of monolateral endometriomas. None of the patients had previously undergone surgery by laparotomy or laparoscopy. At the time of laparoscopy, the surgeon staged the disease according to the American Fertility Society classification of endometriosis. A second surgeon, blinded to the preoperative management of the patients, re-staged the disease based on a videotape review. Interobserver disagreement was between 0 and 12%. Total, endometriosis (deep and superficial) and adhesion scores were evaluated separately. These scores in patients who had previously undergone transvaginal ultrasound-guided aspiration of the cyst content (n = 13) were compared with those from patients who had not undergone this procedure (n = 42). The total and endometriosis scores were not significantly different between the two groups, whereas the adhesion score in patients who had undergone a transvaginal aspiration procedure was significantly higher than in patients who had not (mean +/- SD, 12.0 +/- 13.7 versus 5.9 +/- 4.6; P = 0.02). Therefore it is possible that transvaginal ultrasound-guided endometrioma aspiration may determine tissue trauma that enhances adhesion formation.

Adolescent↗
PubMed1995

False diagnosis of distal tubal occlusion in case of tubal diverticula.

A 28-year-old infertile patient with a diagnosis of bilateral distal tubal occlusion made at hysterosalpingography and laparoscopy was found at a second laparoscopy to have bilateral single diverticula in patient tubes. The patient conceived an intrauterine pregnancy 5 months after discharge. This report casts doubt on the suggested association between tubal diverticula and infertility.

Adult↗
PubMed1994

Laparoscopy versus laparotomy for ovarian conservative surgery: a randomized trial in the rabbit model.

OBJECTIVE: Our purpose was to compare postoperative adhesion formation and reproductive outcome after the same ovarian surgical procedure performed by laparoscopy or laparotomy by means of microsurgical techniques. STUDY DESIGN: Twenty-eight New Zealand White female rabbits were randomly assigned to laparotomy or laparoscopy for the same standardized surgical procedure: both ovaries were grasped with atraumatic forceps and longitudinally incised on the antimesenteric side from the cortex to the hilum with a microelectrode delivering a tissue power density of 66,666 W/cm. The rabbits were then mated, and 2 weeks later a second-look laparotomy was performed by a blinded observer for the evaluation of postoperative adhesions, number of corpora lutea in each ovary, number of embryos in the ipsilateral uterine horn, and nidation index for each side. RESULTS: At second look no statistically significant differences were found in postoperative adhesion formation, number of corpora lutea, number of embryos, and nidation index between the laparoscopy and the laparotomy groups. CONCLUSION: Laparoscopy or laparotomy for ovarian conservative surgery do not appear significantly different in postoperative adhesion formation and reproductive outcome in the rabbit model.

Animals↗
PubMed1994

Correlation Between AFS Classification Systems of Adnexal Adhesions and Distal Tubal Occlusion, Tubal Mucosa at Salpingoscopy and Reproductive Outcome of the Patient

From November 1988 to December 1991, 45 infertile patients underwent salpingo-ovariolysis and/or salpingoneostomy during laparotomy or laparoscopy. Findings at surgery were scored according to the AFS classification. Salpingoscopy was performed to evaluate the status of the ampullary mucosa. The mean age of the patients was 29.5 years and the mean length of infertility prior to surgery was 4.4 years. All patients were contacted by phone to obtain information on reproductive outcome with a minimum period of 18 months of follow-up. Statistical analysis of data was performed using the Fisher's exact test. AFS scores were not correlated with reproductive outcome, while the status of the tubal mucosa at salpingoscopy was significantly correlated with reproductive outcome.

Journal Article↗
PubMed1994

Laparoscopic Excision of Ovarian Endometriomas: Does Post-Operative Medical Treatment Prevent Recurrence?

Of 103 women undergoing laparoscopic excision of ovarian endometriomas, 41 patients were prescribed to 3 to 6 months therapy with GnRH analogs or danazol postoperatively and 62 received no additional treatment. No significant difference in extent of disease was present between the two groups at the time of surgery. Follow-up longer than 3 months, including a sonogram, was available for 40 patients of the treatment group and for 42 patients of the group receiving no additional treatment. Four recurrences (10%) at 3, 12, 16 and 21 months occurred in the treatment group, and 3 recurrences (7%) at 5, 6 and 6 months occurred in the no-treatment group (p=NS). Postoperative medical treatment does not prevent recurrence of laparoscopically excised ovarian endometriomas.

Journal Article↗
PubMed1994

Operative Laparoscopy for Adnexal Cystic Masses in Patients Under 40 Years of Age

From January 1990 through October 1993, 527 patients under 40 years were submitted to operative laparoscopy for the treatment of 544 adnexal cystic masses by stripping or vaporization/coagulation techniques in nine centers in Rome. The mean age of patients was 27.8 years, ranging from 13 to 39. The mean diameter of the cysts was 45.8 mm. ranging from 20 to 130. The procedure was completed by laparoscopy in 518 cases (95.2%) whereas 26 cases (4.8%) were converted to laparotomy. Conservative treatment was performed in all cases except 6 (1.1%), where ovariectomy or adnexectomy was performed. Histopathology revealed a borderline tumor in two; in all others the cyst was benign. It is concluded that operative laparoscopy is the procedure of choice for the treatment of carefully selected adnexal masses in patients of reproductive age.

Journal Article↗
PubMed1994

Bag Surgery as Part of a Protocol to Treat Ovarian Masses by Laparoscopy

In a protocol to treat all ovarian masses endoscopically the major objection is that there are reports that even if the preoperative examinations are favorable there is still a chance as high as 2 to 6% of encountering a malignant proliferation within the cyst, necessitating a conversion to laparotomy within the same operating session. Using the following selection criteria: Premenopausal patients less than 45 years; uni-locular cysts on ultrasound or slightly septated; size of the cyst between 4 and 10 cm; benign characteristics on ultrasound; normal biochemistry, including CA 125, ESR, liver enzymes; and cysts resistant to therapy at least for 6 weeks, we have used the bags whenever the macroscopic aspect of the cyst appeared suspicious for malignancy to the surgeon. The tumor was first fully inserted in the Endo pouch (Autosuture-US Surgical) and then transected from its pedicle. We used bipolar coagulation and scissors. The bag was then brought to the abdominal wall and a minilaparotomy of 5 cm on average was performed. The bag was brought into the opening, the sac opened with scissors, the plastic spread on the skin and only then the tumor was treated inside the bag. Using this technique we did not experience any spread in the abdomen as the laparoscope remained in place and the bag prevented the pneumoperitoneum from deflating.

Journal Article↗
PubMed1994

Operative Laparoscopy for the Treatment of Ovarian Dermoids

From January 1, 1991, to October 31, 1993, 67 patients with a histologic diagnosis of benign cystic teratoma were treated by operative laparoscopy in nine centers in Rome. The mean age of patients was 29.7. years, ranging from 16 to 45 years. The mean diameter of the cysts was 41.6 mm, ranging from 20 to 120 mm. The procedures were completed by laparoscopy in 62 cases (92.5%) whereas 5 cases were converted to laparotomy. Conservative treatment was performed in all cases except seven cases (10.44%), where ovariectomy was performed. No recurrences occurred in all patients, with a follow-up of at least 3 months. We conclude that operative laparoscopy can be considered a valid alternative to classic laparotomy for dermoid cysts.

Journal Article↗