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Biomedical subjects

R Orvieto

Publications and source records attributed to R Orvieto.

At least 91 records · Page 5Linked to original sources
PubMed1998

The role of intravenous immunoglobulin in the prevention of severe ovarian hyperstimulation syndrome.

PURPOSE: The role of intravenous immunoglobulin (IVIG) in the prevention of severe ovarian hyperstimulation syndrome (OHSS) was evaluated. METHODS: Ovarian hyperstimulation was induced in eight rabbits using human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG) after pretreatment with IVIG (IVIG group) or bovine serum albumin (BSA group). Main outcome measures included (1) signs of OHSS, such as the degree of ascites formation and the increase in body weight; and (2) the degree of ovarian stimulation as reflected by serum sex-steroid hormone levels. RESULTS: A significantly lower ascites response and a tendency toward a decreased change in body weight were observed in the IVIG group compared to the BSA group. Serum estradiol, progesterone, total protein, and ovarian weights were not statistically different between the two groups. CONCLUSIONS: IVIG prevented severe OHSS in a rabbit model, whereas BSA did not. Further studies are justified in an attempt to clarify the role of the immune system and IVIG in the pathophysiology and prevention of severe OHSS.

Animals↗
PubMed1998

Simplifying ovulation induction for surrogacy in women with Mayer-Rokitansky-Kuster-Hauser syndrome.

A simple approach for ovulation induction in women with Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKH-S) during in-vitro fertilization (IVF)/freezing/surrogacy cycles was evaluated. Weekly progesterone plasma concentrations were measured in order to accurately establish the luteal phase in MRKH-S women. When a rising titre was detected, a gonadotrophin-releasing hormone analogue (GnRHa) was administered as part of a long protocol. Two weeks later human menopausal gonadotrophin (HMG) therapy was started. Ten treatment cycles in four women with MRKH-S were carried out. In all cases, three or less progesterone estimations were needed. Three of the four women are now, through surrogacy, genetic mothers; one of them has two children. We concluded that weekly determination of progesterone plasma concentration is a convenient, efficient and inexpensive simple approach to identify the luteal phase, and therefore suitable to the start of a GnRHa/HMG protocol in MRKH-S women enrolled in an assisted reproduction technology programme.

Amenorrhea↗
PubMed1998

Ovarian abscess after ovum retrieval for in-vitro fertilization.

An ovarian abscess is an uncommon surgical emergency that could be lethal. The causes of an ovarian abscess vary, and treatment thereof may unfortunately lead to an oophorectomy. In order to draw the attention of physicians to this rare entity, we present a case of ovarian abscess resulting from follicle aspiration for in-vitro fertilization. Furthermore, with correct preoperative diagnosis and prompt surgical intervention at an early stage, the affected ovary may be salvageable.

Abscess↗
PubMed1998

The impact of intrauterine contraceptive devices on cytological findings from routine Pap smear testing.

OBJECTIVE: To evaluate the impact of intrauterine contraceptive device (IUCD) use on the interpretation of routine Pap smears. STUDY DESIGN: A retrospective case-control study. PATIENTS AND METHODS: During a 2-year period, we evaluated the Papanicolaou (Pap) tests of 452 consecutive asymptomatic women of childbearing age who used a copper IUCD (study group), and 452 matched controls who practiced no contraceptive methods (control group). RESULTS: Inflammatory exudate, inflammatory epithelial changes or extensive metaplastic cells were more commonly encountered among the IUCD user as compared with non-users (p < 0.05). No difference was noted in the detection rates of cervical squamous intraepithelial lesions in the two study groups. CONCLUSIONS: It can therefore be concluded that the use of an IUCD does not increase the incidence of squamous intraepithelial lesions. Any abnormal Pap smear in an IUCD user should first be repeated after local vaginal treatment, if only to temporarily palliate the inflammatory cellular reaction which impedes unequivocal interpretation of the routine Pap smear.

Adult↗
PubMed1998

Flexible starting schedule for oral contraception: effect on the incidence of breakthrough bleeding and compliance.

OBJECTIVE: To compare the effect of starting oral contraceptives on the first day of menses with the effect of starting on the day of menses' cessation (but no later than the 5th day following its onset), on the incidence of early breakthrough bleeding. METHOD: Oral contraceptives containing 30 micrograms ethinylestradiol and 75 micrograms gestodene were prescribed to 200 consecutive healthy women in whom oral contraceptives were found to be the most suitable method of contraception. In the first 100 women, treatment was started on the 1st day after the onset of menses (Day 1 group), and in the remainder, treatment was started on the day of menses' cessation, but no later than the 5th day following its onset (Flexible group). RESULTS: The Flexible group had better compliance and a reduced incidence of breakthrough bleeding. No differences were observed between the two groups for age, parity and gravity, or contraceptive failure. CONCLUSIONS: Oral contraceptives may be initiated on the day of menses' cessation, but no later than the 5th day following its onset. This regimen might increase patient compliance and lower the incidence of breakthrough bleeding, probably without adversely affecting contraceptive efficacy.

Adolescent↗
PubMed1998

Asymptomatic postmenopausal intrauterine fluid accumulation: characterization and significance.

OBJECTIVES: The aims of the study were to characterize those postmenopausal women who develop intrauterine fluid accumulation and to evaluate its significance. METHODS: All asymptomatic postmenopausal women who were referred for routine transvaginal ultrasonographic examination between 1 January 1995 and 31 March 1996 were included in the study. Demographic and ultrasonographic parameters were recorded on a prospectively created computerized database. When intrauterine fluid accumulation was identified, the women was referred for endometrial sampling. RESULTS: A total of 1175 consecutive, asymptomatic postmenopausal women were evaluated; intrauterine fluid accumulation was identified sonographically in 166 (14.1%). Women with intrauterine fluid accumulation were older, had experienced more years since the menopause, and had smaller uterine volume indices, thinner endometria and smaller indices of ovarian area, compared to those without intrauterine fluid accumulation (all at a significant level of p < 0.0005). The prevalences of hormone replacement therapy use were 6.6% in the 'accumulating fluid' women and 43% in the 'non-accumulating fluid' group (p < 0.0005). Of the 166 women with intrauterine fluid accumulation, 91 had an endometrial biopsy, of which 70% were insufficient for evaluation and 30% were normal on histology. CONCLUSION: Postmenopausal intrauterine fluid accumulation is a common, mostly benign phenomenon that typically occurs in the late postmenopausal age subgroups. It may be postulated that it represents part of the atrophic mechanism that takes place at this stage of life. Hormone replacement therapy appears to be a 'protection' against this phenomenon.

Aged↗
PubMed1998

Superior mesenteric artery blood flow velocimetry: cross-sectional Doppler sonographic study in normal fetuses.

Our objectives were to describe the flow velocity waveform of the fetal superior mesenteric artery and to establish a nomogram for its pulsatility index. In a cross-sectional study using color Doppler ultrasonography, superior mesenteric artery flow velocimetry was investigated prospectively in 96 healthy fetuses of between 14 and 37 weeks of gestation. In normal fetuses the pulsatility index measurements showed a slight but insignificant increase over the course of gestation (r = 0.26; P > 0.5). The lowest mean +/- standard deviation for pulsatility index in the superior mesenteric artery was 1.86 +/- 0.45 (95% confidence interval 1.67-2.06), recorded between 18 and 21 weeks' gestation. Thereafter the pulsatility index increased to 1.94 +/- 6.4 (95% confidence interval 1.74-2.8) at 22 to 25 weeks, and from weeks 26 to 29 it increased to 2.18 +/- 0.52 (95% confidence interval 1.91-2.46). During the third trimester and at term, the mean pulsatility index of 2.23 +/- 0.32 (95% confidence interval 1.43-3.03) did not change significantly with gestational age. In normal fetuses, except for the early stages, a relatively stable vascular resistance of the intestinal circulation was found. The application of this nomogram in clinical practice may facilitate evaluation of intestinal perfusion in compromised fetuses with blood flow centralization.

Adult↗
PubMed1998

Prolonged vaginal bleeding during central precocious puberty therapy with a long-acting gonadotropin-releasing hormone agonist.

OBJECTIVE: To describe our experiment with the treatment of GnRH-a in premenarchal girls with idiopathic central precocious puberty (CPP). PATIENTS AND METHODS: Twenty-eight girls, aged 6.5-11 years, with idiopathic central precocious puberty were treated every 28 days with an intramuscular depot gonadotropin releasing hormone agonist (GnRH-a) in an attempt to delay sexual maturation. RESULTS: Eight of the 28 (28.5%) developed vaginal bleeding after GnRH-a administration. Of these, prolonged vaginal bleeding of 11-13 days occurred in four girls, three recurrent episodes occurred in one during the second injection, and in one other girl the 4th episode occurred after 6 months of treatment. CONCLUSION: Uterine bleeding following GnRH-a treatment in premenarchal girls with CPP is common, and may be massive and recurrent, since most episodes resolved spontaneously and necessitated no further treatment, careful advice should be given to the girls and their families prior to treatment initiation, in an attempt to avoid unnecessary anxiety and achieve better compliance.

Child↗
PubMed1998

Abnormal sonographic endometrial findings in asymptomatic postmenopausal women: possible role of antihypertensive drugs.

OBJECTIVE: The purpose of this study was to evaluate the possible effect of the antihypertensive agent nifedipine (a calcium channel antagonist) on the endometrium of asymptomatic menopausal women by using transvaginal sonography, hysteroscopy, and endometrial sampling. DESIGN: Eighty-five asymptomatic postmenopausal women with an ultrasonographically detected endometrial thickness of more than 7 mm were examined. The study group comprised 43 women treated with nifedipine (30-60 mg/day) for mild to moderate hypertension for at least 1 year, and the control group comprised 42 normotensive women. All participants underwent transvaginal sonography, hysteroscopy, and, if necessary, endometrial biopsy. RESULTS: Of the 85 patients, 53 were found to have atrophic endometrium, 36 (83.7%) in the study group and 17 (40.5%) in the control group. The difference between the groups was statistically significant (p < 0.05). There were three cases of hyperplasia and three cases of carcinoma of the endometrium, with similar rates in the two groups. CONCLUSIONS: Among asymptomatic postmenopausal patients with sonographically thickened endometrium, atrophic endometrium was found to be significantly more prevalent in those using calcium channel antagonists to control hypertension than in those who were normotensive controls. The presence of endometrial hyperplasia and malignancy in the study group underscores the importance of meticulous endometrial evaluation whenever sonographically thickened endometrium is encountered.

Aged↗
PubMed1998

Ultrasonographic evaluation of hysterectomized patients with and without concomitant adnexectomy?

OBJECTIVE: To present our experience with the use of ultrasonography in the evaluation of hysterectomized patients. METHODS: The study group was comprised of 100 consecutive women referred to our ambulatory unit for pelvic sonographic evaluation between April 1, 1996 and March 31, 1997. Inclusion criteria were previous hysterectomy for a benign condition with or without concomitant bilateral salpingo-oophorectomy and available medical and gynecological histories. RESULTS: No significant difference was observed in the rate of abnormal ultrasonographic findings among the patients who had had bilateral salpingo-oophorectomy 5/50 and those who had not (8/50). There was also no significant difference in pelvic mass rate between the patients who were receiving hormone replacement therapy and those who were not. The sensitivity of sonography in our study was 100% and the positive predictive value, 84.5%. CONCLUSIONS: Sonography is a useful diagnostic tool in the follow-up and management of post-hysterectomy patients.

Aged↗
PubMed1997

Morphology and clinical outcomes of embryos after in vitro fertilization are superior to those after intracytoplasmic sperm injection.

OBJECTIVE: To compare embryos obtained after IVF and intracytoplasmic sperm injection (ICSI) regarding morphology and the likelihood of achieving clinical pregnancy. DESIGN: Case-control study. SETTING: An IVF unit controlling 1,310 cycles in 1996. PATIENT(S): Women having a total of 477 IVF and 475 ICSI consecutive cycles. INTERVENTION(S): Ovarian stimulation, IVF-ET, or ICSI-ET for all couples. MAIN OUTCOME MEASURE(S): Number of grade-A embryos transferred, preclinical pregnancy losses, and clinical pregnancy rates in IVF and ICSI cycles. RESULT(S): In comparison with the ICSI group, the IVF group showed significantly more grade-A embryos available for transfer (mean, 2 +/- 1.6 versus 1.8 +/- 1.5), significantly fewer preclinical pregnancy losses (1.6% versus 4%), and significantly higher clinical pregnancy rates (25% versus 19.1%). CONCLUSION(S): Embryos obtained after IVF are superior to those obtained after ICSI in relation to embryo morphology and the likelihood of achieving clinical pregnancy.

Adult↗
PubMed1997

Torsion of a fallopian tube following Pomeroy tubal ligation: a rare case report and review of the literature.

A case of unilateral fallopian tube torsion following Pomeroy tubal ligation, as well as a review of the literature, is presented. Although uncommon, this entity should be considered in the differential diagnosis of abdominal pain in the female patient. Early surgical intervention by means of laparoscopy is mandatory in order to correctly diagnose and treat this complication.

Abdominal Pain↗