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Biomedical subjects

R Orvieto

Publications and source records attributed to R Orvieto.

At least 73 records · Page 4Linked to original sources
PubMed1999

Evaluation of the upper uterine cervix by the location of the vesicocervical fold of the urinary bladder to rule out cervical shortening during pregnancy with and without premature contractions.

OBJECTIVES: To measure the length of the upper and lower cervix, as demarcated anatomically by the lowermost edge of the urinary bladder, in second- and third-trimester pregnancies with and without premature contractions. We hypothesized that patients with active premature contractions have a shorter upper cervix, placing them at greater risk of preterm delivery. METHODS: The lengths of the total cervix and of the upper and lower cervix, separately, and funnelling of the internal os, were assessed by endovaginal ultrasonography. In 120 women with normal pregnancy (43 of which with premature contractions), cervical dilatation and effacement were determined by digital examination. The correlation of cervical variables with the course of pregnancy was analyzed by the Wilcoxon test. RESULTS: The mean lengths of the upper and lower cervix were 15.9 +/- 1.7 mm (median 16.0 mm) and 26.4 +/- 3.7 mm (median 27.0 mm), respectively, in patients without premature contractions and 6.9 +/- 3.7 mm (median 6.0 mm) and 24.7 +/- 4.7 mm (median 25.0 mm), respectively, in patients with premature contractions. In the latter subgroup, the upper cervix was significantly shorter (p = 0.0001) but the lower cervix remained almost unchanged. Digital palpation was less accurate than transvaginal sonography for evaluating total cervical length. CONCLUSIONS: Transvaginal sonography is the method of choice for assessing cervical changes during pregnancy. In this prospective study, upper cervical length was the best predictor of preterm labor of all cervical parameters studied. Its length could be accurately determined by the location of the lowermost edge of the urinary bladder (vesicocervical fold of the bladder).

Adult↗
PubMed1999

Diagnosis of ruptured fetal membranes in pregnancy with the use of urograffin.

The objective of our study was to assess the value of intraamniotic injection of urograffin in the diagnosis of premature rupture of membranes (PROM). Intra-amniotic injection of urograffin with the concomitant insertion of a vaginal tampon was performed in 30 consecutive patients who were admitted because of suspected PROM and the presence of a heavy bloody vaginal secretion. The vaginal tampons were X-rayed for the presence of radio-opacity. In 23 patients, traces of urograffin were found in the vaginal tampons by X-ray. No fetal or maternal complications were observed during delivery and puerperium. We suggest the use of intraamniotic injection of urograffin for the diagnosis of PROM in cases where heavy bloody vaginal discharge is present.

Journal Article↗
PubMed1999

Pharmacokinetics of natural progesterone administered in the form of a vaginal tablet.

Our study was conducted to assess the pharmacokinetics of natural progesterone administered in the novel formula of an effervescent vaginal tablet. Fifty post-menopausal women, with a median age of 43.5 years (range 28-55), volunteered to participate in the research. All women discontinued their hormonal replacement therapy 1 month prior to the study. The pharmacokinetics of 50 and 100 mg of progesterone administered as a vaginal tablet were evaluated. After the initial administration of 50 mg or 100 mg, a mean serum Cmax of 20.43 +/- 8.01 nmol/l and 31.61 +/- 12.62 nmol/l (P < 0.0004) was reached at a Tmax of 6.1 +/- 2.63 and 6.4 +/- 3.35 h respectively. The terminal half-life was 13.18 +/- 1.3 and 13.7 +/- 1.05 h respectively. Continuous use of the 100-mg tablet resulted in a mean serum progesterone concentration of 26.08 +/- 13.96 nmol/l and 21.42 +/- 16.32 nmol/l after 14 and 30 days respectively. Women >40 years were found to have a significantly lower Tmax compared to younger women (P = 0.02). The continuous use of vaginal progesterone did not influence the hormonal, liver or lipid profiles evaluated. Only three (6%) women suffered from mild vaginal irritation. Natural progesterone given as a vaginal tablet is well tolerated, safe and an easily administered treatment. Even in a non-oestrogenized vagina the absorption was efficient and the 100 mg dosage resulted in adequate serum progesterone concentrations.

Absorption↗
PubMed1999

Cervical pregnancy--a conservative stepwise approach.

A case of cervical pregnancy resistant to intramuscular methotrexate therapy is presented, which was successfully treated by intra-arterial methotrexate followed by selective prophylactic hypogastric artery embolization to avoid aggravating the vaginal bleeding. It is suggested that, in cervical pregnancies in which fertility preservation is desired, a stepwise conservative approach should be applied before resorting to surgical intervention.

Adult↗
PubMed1999

Pilot study of isolated early human follicles cultured in collagen gels for 24 hours.

The human ovarian cortex contains mainly primordial and primary follicles. The ability to mature these follicles in vitro could be of great importance for infertility treatments. Fresh and frozen-thawed ovarian tissue was incubated with collagenase and DNase. Follicles with one layer or an incomplete second layer of granulosa cells were then dissected. The follicles were embedded in collagen gels and cultured with Earle's balanced salt solution, 10% fetal calf serum and 0.5 IU/ml follicle stimulating hormone. Increases in the number of granulosa cell layers and in oocyte size were observed in 40 and 38.7% of the follicles from fresh and frozen-thawed tissue respectively, during a 24 h culture period. All the growing follicles were surrounded by cellular outgrowths. Attempts to culture the follicles longer resulted in deterioration of the follicles and oocyte release. Since our study was purely morphological, further growth parameters, e.g. DNA synthesis, should be examined in the future.

Adult↗
PubMed1999

Assessment of fetal cardiovascular function: ultrasound study of the fetal circulatory compartments.

Recent advances in high-resolution ultrasonography combined with color-coded Doppler analysis have enabled a new insight to be gained into fetal physiology and allowed the investigation of small, previously inaccessible fetal vessels under normal and abnormal conditions. In addition, the findings in some cases contradict the accepted fetal pathophysiology derived from animal studies. The aim of the present study is to describe new reports assessing the major compartments of the fetal cardiovascular system (heart, lung, splanchnic and fetal venous circulations) and to discuss the developments in these fields.

Cardiovascular Physiological Phenomena↗
PubMed1999

Controlled ovarian hyperstimulation: a state of neutrophil activation.

PROBLEM: To investigate if controlled ovarian hyperstimulation (COH) affects the expression of neutrophil adhesion molecules and if a correlation exists between neutrophil activation and serum sex-steroid levels. METHOD OF STUDY: The pilot study was carried out in the in vitro fertilization (IVF) unit of our department, and required no modification of our routine IVF protocol. Four patients arriving for baseline hormonal profile on day 1 of the menstrual cycle before initiation of COH (control group) and 11 patients admitted for oocyte recovery (study group) were included. Venous blood was obtained from all patients and examined for hormonal profile and neutrophil activation. The latter was performed by staining for the surface adhesion molecules beta2 integrin and L-selectin. Positive cell count and mean fluorescence intensity were determined by flow cytometry. RESULTS: While neutrophil L-selectin was significantly lower in the study group than in the control group, neutrophil beta2 integrin was nonsignificantly higher. Though no significant correlations were found between neutrophil adhesion molecules and patient age, serum estradiol level, and human chorionic gonadotropin level; neutrophil L-selectin was negatively correlated with serum progesterone levels. CONCLUSIONS: COH leads to neutrophil activation, which correlates with the degree of luteinization. Further studies are required to elucidate the relationship between the immune system and COH. These may lead to new strategies for promoting fertility and preventing complications of COH.

Adult↗
PubMed1999

Standard in vitro fertilization or intracytoplasmic sperm injection in advanced female age--what may be expected?

This study was conducted to evaluate the current results of standard in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in the elderly (> or = 40 years of age) female population. Oocyte recovery, fertilization, embryo transfer, pregnancy and cumulative pregnancy rates were assessed. The results were analyzed for: the entire elderly population; the standard IVF group (group 1); all those in the ICSI group (group 2); and ICSI for severe male-factor category (group 3). A total of 330 IVF and 158 ICSI treatment cycles were carried out in 249 women. Forty-five (9.2%) clinical pregnancies were achieved. This rate was not statistically different from those achieved for groups 1, 2 and 3 (9.1%, 9.5% and 6.8%, respectively). The cumulative pregnancy rate for a total of five cycles was 19.2% and 26.4% for groups 1 and 2, respectively. For those who started their treatments at > or = 40 years, the cumulative pregnancy rate for three cycles was 26.5% and 36.5% in groups 1 and 2, respectively. These results clearly demonstrate that female age is a major success determinant, with similar influence on both standard IVF and ICSI therapy modalities.

Adult↗
PubMed1999

Does female age affect embryo morphology?

Deteriorating oocyte quality is commonly believed to be the primary determinant of the decreased implantation potential in older women. We assessed the influence of age on embryo morphology in standard in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) modalities. All 6350 consecutive embryos (2990 IVF, 3360 ICSI) obtained in our Assisted Reproductive Technology Unit from January 1996 through June 1997 were included. High quality embryos were defined as those with equal-sized blastomeres and < 10% fragmentations and a cleavage rate of four cells on day 2 or eight cells on day 3 transfers. The results were analyzed for the standard IVF group, the ICSI group, and the ICSI subgroup with severe male factor infertility (< or = 1 x 10(6) total motile spermatozoa in the ejaculate). For standard IVF, a positive association was observed between female age and increased proportion of good quality embryos. No such association was detected for the ICSI cycles (whole group or subgroup). We conclude that in standard IVF, embryo quality, as reflected by embryo morphology, does not deteriorate with increased maternal age.

Adult↗
PubMed1999

Pelvic abnormalities in hysterectomized patients-role of early postoperative ultrasonographic evaluation.

OBJECTIVE: To assess the incidence of post-hysterectomy pelvic fluid collection in the early postoperative period and to study its natural history. STUDY DESIGN: Cross-sectional, prospective, observational study. PATIENTS AND METHODS: The study sample comprised 36 consecutive patients undergoing hysterectomy for benign conditions in our department. All patients underwent two pelvic ultrasonographic examinations, the first on the third postoperative day and the second one year later. All postoperative complications were thoroughly evaluated. RESULTS: Thirty-two patients completed the study evaluations. Abnormal ultrasonographic findings were detected in 4 of them on the early postoperative scan. Three (9.4% of the sample) had pelvic fluid collections which persisted on the follow-up scan. The fourth patient had a simple ovarian cyst 4 cm in diameter which disappeared on follow-up. None of the patients with pelvic fluid collections had a febrile morbidity during the postoperative course. CONCLUSIONS: Transvaginal ultrasonography can detect asymptomatic early postoperative pelvic fluid collections and enables conservative management, thereby reducing patients stress, medical costs, and the need for unnecessary interventions.

Ascitic Fluid↗
PubMed1999

The role of intravenous albumin in the prevention of severe ovarian hyperstimulation syndrome. A pilot experimental study.

OBJECTIVE: To evaluate the role of intravenous albumin in the prevention of severe ovarian hyperstimulation syndrome (OHSS). DESIGN: A pilot experimental study. MATERIAL AND METHODS: Ovarian hyperstimulation was induced in 5 rabbits using human menopausal gonadotropin/human chorionic gonadotropin, after pretreatment without (control group) or with bovine serum albumin (BSA group). RESULTS: Despite an increase in serum protein levels, the BSA group showed comparable delta increase in body weight and degree of ascites formation. CONCLUSIONS: Intravenous albumin did not prevent severe OHSS in a rabbit model despite the observed increase in serum oncotic pressure.

Animals↗
PubMed1999

Endometrial polyps during menopause: characterization and significance.

BACKGROUND: To characterize postmenopausal women with endometrial polyps and to evaluate their significance. METHODS: The study population included all consecutive postmenopausal patients with a diagnosis of endometrial polyp, treated at our center over a two-year period. Demographic, medical and gynecological data were assessed with regard to the endometrial histologic findings. RESULTS: Of the 146 eligible patients, 15 had endometrial hyperplasia (four with atypia); there were no cases of endometrial carcinoma. The 20 patients (13.7%) using hormone replacement therapy had a significantly higher rate of endometrial hyperplasia than non-hormone users (p<0.006). No differences were observed among the endometrial histological categories for any of the presenting symptoms and signs, ultrasonographic findings, or medical histories. CONCLUSIONS: Postmenopausal endometrial polyp is a common, mostly benign entity. However, the relatively high rate of concomitant endometrial hyperplasia, especially in patients receiving hormone replacement therapy, dictates a thorough histological evaluation in all cases.

Aged↗
PubMed1998

Endometrial carcinoma in a post-menopausal woman with atrophic endometrium and intra-cavitary fluid: a case report.

Measurement of endometrial thickness by vaginal ultrasonography is used to detect post-menopausal women at risk for endometrial pathology. The efficacy of this procedure is doubtful in cases of intrauterine fluid accumulation, which is a common finding in this population. We present a case of endometrial carcinoma in an asymptomatic, post-menopausal woman with ultrasonographic imaging of an atrophic endometrium and intra-cavitary fluid. It may be suggested that, in a case of intrauterine fluid accumulation (IFA), endometrial biopsy should be performed regardless of the sonographic endometrial thickness, since the fluid may increase the intracavity pressure and can mask endometrial pathology.

Aged↗
PubMed1998

Twin gestation: is there a correlation between the location of the gestational sacs at the beginning of pregnancy, and the order of delivery.

OBJECTIVES: To determine whether there is a dynamic in the location of amniotic sacs in a twin gestation, during pregnancy. STUDY DESIGN: The study group comprised 63 twin pairs discordant for sex, who by vaginal sonography performed between 14 and 16 weeks' gestation, were characterized as first twin (opposite the internal os), and second twin. The order of delivery was recorded in the pregnancies that ended with vaginal birth. RESULTS: Thirty seven of 41 (90.2%) twins who were delivered vaginally (between 32 and 41 weeks' gestation), were born in the same order as that predicted by transvaginal sonography early in pregnancy. It was found that in this small series there was a dynamic in the amniotic sac location in twin gestations during pregnancy in only about 10% of the cases. CONCLUSIONS: In roughly 90% of twins, there is no dynamic in the location of the amniotic sacs during pregnancy, and the first twin at the beginning of pregnancy intrinsically remains.

Adult↗
PubMed1998

Pre-operative ultrasonographic evaluation of nongravid, enlarged uteri--correlation with bimanual examination.

OBJECTIVE: To correlate the size of the nongravid uterus measured by ultrasound and bimanual examination before hysterectomy, with the actual size of the specimens. PATIENTS AND METHODS: Uterine size of 49 consecutive patients, who underwent elective hysterectomy, was assessed by bimanual pelvic examination, preoperative ultrasonographic evaluation and actual postoperative size. RESULTS: All preoperative ultrasonographic uterine dimensions significantly correlated with the corresponding actual dimensions of the uterine specimens. Furthermore, ultrasonographic uterine length had the best correlation with uterine size estimation by bimanual examination. A formula was established in an attempt to calculate clinical uterine size by gestational week, using preoperative ultrasonographic dimensions. CONCLUSIONS: By using the aforementioned formula, ultrasonographic uterine dimensions can be extrapolated to uterine size in terms of gestational week, and therefore, be applicable to traditional clinical practice.

Female↗
PubMed1998

Single intrauterine fetal death (fetus papyraceus) due to uterine trauma in a twin pregnancy.

Fetus papyraceus is a rare condition. We describe the intrauterine fetal death with subsequent fetus papyraceus of one twin due to blunt maternal trauma in the second trimester of pregnancy. Blunt maternal trauma should raise the clinical suspicion of fetal death and dictate further observation; in a twin pregnancy, the possibility of a single fetal death should be investigated.

Abdominal Injuries↗