Biomedical subjects

R Marana

Publications and source records attributed to R Marana.

69 records · Page 4Linked to original sources

PubMed1977

Iatrogenic hyperstimulation of the ovary with ascites. Report of a case and considerations and management.

The authors describe a case of iatrogenic hyperstimulation of the ovary with ascites in a patient with primary amenorrhea and hypogonadotropic hypogonadism. They present the results of total urinary estrogen assays stressing the advisability of a technical check in the presence of an apparently abnormally high estrogen excretion during HMG therapy. The patient's biochemical and hematological data during the stage of clinical hyperstimulation are set out and management is discussed. Finally, the usefulness of timely and adequate albumin administration under CVP control is stressed and the possibility of clinical application of the result of recent experimental research (viz. antihistamines is discussed.

Adult↗

PubMedDate not supplied

Tubal factor infertility.

Various studies demonstrated that there is no close correlation between the intratubal damage and the extent and type of pelvic adhesions. Moreover, the results of prospective studies on the prognostic value of salpingoscopy showed that the tubal mucosal status is the most important prognostic factor in terms of reproductive outcome. Salpingoscopy has modified the management of patients with tubal infertility, since the accurate evaluation of the tubal mucosa permits the selection of patients with a normal mucosa (34-42% of the patients with hydrosalpinx and 76-80% of those with periadnexal adhesions) who can benefit from tubal reconstructive surgery. In these patients the term pregnancy rate is 60% in case of hydrosalpinx and 70% in case of periadnexal adhesions.

Fallopian Tube Diseases↗

PubMedDate not supplied

Endometriosis externa and interna: endoscopic diagnosis.

Endometriosis is defined as the presence of the endometrium outside the endometrial cavity. If the ectopic mucosa is located within the endometrium, the disease is defined as endometriosis interna, or adenomyosis, whereas the localization of the endometrium outside the uterus is defined as endometriosis externa, or pelvic endometriosis. The diagnosis of pelvic endometriosis requires invasive techniques, such as laparoscopy or laparotomy, with histologic confirmation on the surgical specimen. The diagnosis of adenomyosis should be based on histology of hysterectomy specimen, since the endoscopic diagnosis is still too inaccurate. Laparoscopy allows the visualization of the different aspects of pelvic endometriosis, i.e. superficial implants, deep lesions, and associated adhesions. Staging is based on a score attributed to each location in order to establish a prognosis in terms of the patient's reproductive performance.

Endometriosis↗

PubMedDate not supplied

Operative laparoscopy.

Operative laparoscopy has replaced the conventional approach by laparotomy to the treatment of most benign gynecological diseases (benign adnexal cysts, ectopic pregnancy, tubal infertility, polycystic ovarian disease, endometriosis, myomas), with advantages in terms of shorter hospital stay, less discomfort and complications for the patient, minor social costs due to the early resumption of normal working activities, and comparable results in terms of reproductive outcome.

Female↗

PubMedDate not supplied

Incidence of genital tuberculosis in infertile patients submitted to diagnostic laparoscopy: recent experience in an Italian university hospital.

The incidence of genital tuberculosis is decreasing in industrialized countries. The authors report their experience in 254 patients with primary or secondary infertility. Out of 101 patients with a tubal factor of infertility, two patients were diagnosed as having tuberculosis by both endometrial biopsy and endometrial culture. In a third patient, even in the presence of laparoscopic findings suggesting genital tuberculosis Mycobacterium tuberculosis was isolated only from the urine.

Adult↗

PubMedDate not supplied

Evaluation of the correlation between endometriosis extent, age of the patients and associated symptomatology.

Two-hundred-and-six patients newly diagnosed to have endometriosis at laparoscopy were evaluated in order to see if endometriosis-associated symptoms are proportional to the extent of the disease, as assessed using the Revised American Fertility Society Classification, and if the extent worsens with age. At hospital admission 81% of the patients complained of dysmenorrhea, 54% of chronic pelvic pain and 27% of dyspareunia. At laparoscopy, 39% of the patients had stage I endometriosis, 13% stage II, 35% stage III and 13% stage IV. At statistical analysis, no significant differences were found in total endometriosis scores, in active scores or in adhesion scores in different age groups. Although a difference in prevalence rate for dysmenorrhea and dyspareunia stage I versus III was found, a trend of increasing severity of symptoms with more widespread disease was not evident. There was not a significant difference in prevalence rate of symptoms for different aspects of endometriosis (implants, cysts or adhesions). Our data show that the American Fertility Society classification does not reflect the intensity of endometriosis-associated symptoms, probably underestimating the most active forms of this disease, and does not allow to follow a possible natural progression of the disease.

Abdominal Pain↗

PubMedDate not supplied

Perlaparoscopic salpingoscopy in the evaluation of the tubal factor in infertile women.

Endoscopic evaluation of tubal mucosa during tubal reconstructive microsurgery has been shown to be an important prognostic factor in predicting the probability of a subsequent intrauterine pregnancy. Recent reports have described the use of this technique during laparoscopy in order to evaluate the tubal factor in infertility. We report our experience with this new diagnostic procedure. We utilized a flexible fiberscope with an outer diameter of 3.8 mm for endotracheal intubation. The fiberscope was passed through the operating channel of the laparoscope in order to evaluate the tubal mucosa in patients with primary and secondary infertility associated with tubes patent at the distal end. We encountered abnormalities of the infundibulum or of the ampullary mucosa in 24% of the tubes considered normal at HSG and in 27% of the tubes judged normal at laparoscopy. On the contrary, 44% of the tubes with abnormalities at HSG and 58% of the tubes with abnormalities at laparoscopy presented normal mucosa at salpingoscopy. Our results, in addition to those published in the literature, demonstrate that salpingoscopy is an important and valuable diagnostic procedure for an accurate evaluation of infertile patients. With this technique it is also possible to select patients with a favorable prognosis for tubal microsurgery.

Endoscopes↗

PubMedDate not supplied

Salpingoscopy in patients with endometriosis-associated infertility.

Endoscopic evaluation of the tubal mucosa has been shown to be an important prognostic factor in predicting the probability of a subsequent intrauterine pregnancy. A recent classification of the tubal mucosa lesions allows uniformity of evaluation, permitting comparison of results in prospective studies. It has been suggested that endometriosis may be associated with intratubal abnormalities. In this prospective study we evaluated 35 patients with endometriosis-associated infertility. No intraluminal abnormalities were found, and all the patients that subsequently conceived had an intrauterine pregnancy.

Adult↗

PubMedDate not supplied

Absorbable versus non-absorbable sutures in ovarian microsurgery: experimental results in the rabbit model.

Microsurgery has been shown to reduce the risk of adhesion formation when compared to conventional surgery in cases of benign ovarian pathology. However, the microsurgeons have contrasting opinions concerning the use of absorbable versus non-absorbable suture materials. In the present study we compared nylon versus vicryl sutures for ovarian surgery using the rabbit as an experimental model. No differences were found in terms not only of post-operative adhesions but also in terms of post-operative reproductive outcome for the sutures analyzed.

Animals↗

PubMedDate not supplied

Successful term pregnancies after tubal anastomosis utilizing contralateral tubal segments.

In performing reversal of tubal sterilization, the microsurgeon sometimes has to face difficult anatomical situations due to extensive tubal damage, particularly after laparoscopic unipolar cauterization. In a recent case report, a technique of utilization of contralateral fallopian tube segments in tubal reanastomosis has been described. An intrauterine pregnancy followed, which resulted in a spontaneous abortion at 8 weeks' gestation. We report here our experience in ten cases utilizing a similar technique. Three patients achieved a term pregnancy. One patient achieved three intrauterine pregnancies that ended in first-trimester abortions. It is felt by the authors that this technique should be kept in mind by the practicing microsurgeon for selected cases.

Adult↗

PubMedDate not supplied

Distal tubal occlusion: microsurgery versus in vitro fertilization--a review.

The success of in vitro fertilization (IVF) has established it as a viable alternative in the treatment of infertility associated with distal tubal occlusion (DTO). In an attempt to adequately counsel patients with DTO as to whether their primary treatment should be microsurgery or IVF, the authors have performed a comprehensive world-wide literature review. Based on what has been published to date, it would appear that patients with mild to moderate tubal disease should be offered salpingoneostomy as their first treatment modality. For patients with severe disease accompanied by extensive pelvic adhesions, salpingoneostomy should be discouraged.

Fallopian Tube Diseases↗

PubMedDate not supplied

Proximal tubal occlusion: microsurgery versus IVF--a review.

The success of IVF has established it as a viable alternative to microsurgery in the treatment of infertility associated with certain types of tubal occlusion. The authors have recently reported on the success rates of microsurgery versus IVF in cases of distal tubal occlusion. The present study summarizes the results reported in the world literature for microsurgery in cases of proximal tubal occlusion secondary to surgical sterilization, previous infection, or endometriosis, and compares them with the results reported for IVF. Based on what has been published to date, it appears that microsurgical tubocornual anastomosis remains the procedure of choice for proximal tubal occlusion.

Constriction, Pathologic↗

PubMedDate not supplied

GnRH analogs versus expectant management in minimal and mild endometriosis-associated infertility.

The aim of the present study is to compare the outcome of GnRH analog treatment versus expectant management in infertile patients with minimal and mild endometriosis. From January 1987 to December 1990, 14 patients with stage I and II endometriosis underwent a six-month course of the GnRH analog buserelin, whereas 38 patients underwent expectant management. The two groups were comparable as to mean age of the patients, mean length of infertility prior to diagnosis and mean scores of endometriosis. No major tubal or male factor of infertility was present in any patient. Cumulative pregnancy rates at 12 months were comparable in the two groups (48% for GnRH analog treatment and 42% for expectant management). Expectant management should therefore be considered the most cost-effective option in the management of mild endometriosis-associated infertility.

Buserelin↗

PubMedDate not supplied

Reproductive performance in women with bicornuate uterus.

The medical records of 21 patients with bicornuate uterus were analyzed. Thirteen patients did not undergo corrective surgery, whereas eight underwent metroplasty. The pregnancies in patients who did not undergo surgery, and the outcome evaluated. The outcome of pregnancies after corrective surgery was also analyzed. The cumulative pregnancy rates at 12 and 24 months were 67% and 95% in patients without surgical correction and 63% and 88% in patients after surgical correction. The probability of giving birth to a live-born infant with no corrective surgery was 30%, 58% and 79% for the first, second and third pregnancy respectively; the probability of giving birth to a live-born infant after corrective surgery was 71% for the first and 86% for the second pregnancy. Fertility is not impaired in patients with bicornuate uterus, but gestational capacity is. A prognostic estimate of the likelihood of giving birth to a live-born infant can be formulated according to the number of pregnancies and/or surgical correction.

Adult↗

PubMedDate not supplied

[Usefulness of color Doppler in the differential diagnosis of adnexal masses].

BACKGROUND: The aims of this study were to verify the predictive performance of color-Doppler analysis in the differential diagnosis of adnexal masses and to evaluate the prognostic value of a new "vascular score". METHODS: One-hundred-ninety-six patients referred to our Institute for adnexal masses were evaluated with color and pulsed Doppler within 2-3 days from surgery, and the velocimetric results were compared to histopathological data. On the basis of histopathology, patients were classified in 166 with benign and 30 with malignant ovarian tumors. RESULTS: The predictivity obtained with color Doppler analysis ("vascular score") was compared to that of some "morphological scores" commonly used in the literature. The sensitivity was 100% for all the techniques used, but Doppler analysis had a higher specificity with respect to the others (95% vs max 76% for echographic techniques). The introduction of a new "vascular score" based on the introduction of the acceleration of flow in another score system previously presented, was not able to improve the predictive performance of color Doppler analysis. CONCLUSIONS: Color Doppler ultrasonography of ovarian tumors seems to be a reliable method in the differential diagnosis of adnexal masses, and its potential use in the choice of a less-invasive surgical approach in selected cases (those negative to the "vascular score") should be considered.

Adenocarcinoma↗