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Biomedical subjects

R Orvieto

Publications and source records attributed to R Orvieto.

At least 109 records · Page 6Linked to original sources
PubMed1997

Gestational diabetes and preterm labour: is glycaemic control a contributing factor?.

OBJECTIVES: (1) to evaluate the incidence of preterm delivery in patients with gestational diabetes mellitus; (2) to determine the association between glycaemic control and preterm delivery in these patients. STUDY DESIGN: (1) The incidence of spontaneous preterm singleton deliveries was determined in 550 intensively-treated patients with gestational diabetes mellitus. A total of 14 552 consecutive patients without gestational diabetes mellitus who delivered during the same interval served as a control population; (2) Glycaemic profiles (i.e., mean blood glucose, percent of hypoglycaemic [ < 60 mg/dl] and hyperglycaemic [ > 120 mg/dl] episodes) were compared in 34 patients with gestational diabetes mellitus who delivered preterm, and 68 matched controls with gestational diabetes mellitus who delivered at term. RESULTS: (1) The incidence of preterm delivery in gestational diabetics was similar to that found in the non-diabetic population (6.2% vs. 6.5%, respectively, P = 0.82; confidence limits: 0.65, 1.36); (2) women with gestational diabetes mellitus who delivered at term, or preterm had similar glycaemic profiles for both the entire treatment period and the week preceding delivery. CONCLUSIONS: (1) There is no increased risk for preterm delivery in intensively-treated gestational diabetes mellitus patients; (2) In a population such as this women with gestational diabetes mellitus who deliver preterm cannot be characterised by their glycaemic profile.

Adult↗
PubMed1997

A new concept of cotreatment with human growth hormone and menotropins in ovulation induction protocols.

Follicular development in the primordial and preantral stages is almost completely independent of gonadotrophins or steroids and is mainly dependent on growth factors and local regulators. Since human growth hormone (hGH) was found to facilitate ovarian response to gonadotrophin stimulation, we hypothesized that the administration of hGH in an hypogonadotrophic state and prior to ovarian stimulation with menotropins, may initiate or facilitate the propagation of the primordial and preantral follicles to the gonadotrophin-dependent stages. We suggest that treatment with hGH prior to menotropin administration may be useful to improve results for poor responders to gonadotrophins.

Clinical Protocols↗
PubMed1997

Non-response to ovarian stimulation in normogonadotrophic, normogonadal women: a clinical sign of impending onset of ovarian failure pre-empting the rise in basal follicle stimulating hormone levels.

The most important aspect of diminished ovarian reserve is the associated decline in reproductive potential. Assessment of ovarian reserve is mainly based on measurement of early follicular phase follicle stimulating hormone (FSH) concentration. The objective of this study was to report the identification of a group of 12 infertile women initially diagnosed as having unexplained or anovulatory infertility, who had a normal baseline hormonal profile and did not respond to repeated ovarian stimulation with gonadotrophins. All developed ovarian failure within a relatively short time span. Non-response to ovarian stimulation was defined by failure to achieve development of follicles >12 mm and failure to raise oestradiol concentration >350 pmol/l in two successive cycles of human menopausal gonadotrophin (HMG) doses of up to five ampoules per day for 5-8 days. Within a mean of 9 months following the failed attempts of ovarian stimulation the mean day 3 FSH concentrations rose from 5.4 +/- 2.7 IU/l to 53.5 +/- 19.7 IU/l. In these patients, day 3 FSH concentration failed to indicate the low ovarian reserve manifested only by lack of clinical response to treatment with gonadotrophins which was the first sign of impending ovarian failure. We conclude that women with normal early follicular phase serum FSH concentrations who do not respond to ovarian stimulation by HMG are at risk of developing ovarian failure within several months.

Adult↗
PubMed1997

Ovarian cysts and cyclic hormone replacement therapy: is there an association?

OBJECTIVES: To evaluate whether there may be an association between postmenopausal ovarian cysts and hormone replacement therapy. METHODS: The study comprised 564 consecutive, asymptomatic, postmenopausal women who were referred for routine, transvaginal ultrasound examinations between January 1 and December 31, 1995. Various demographic and ultrasonographic parameters were recorded on a prospectively-created, computerized data base. RESULTS: There was no difference in the prevalence of ovarian cysts with or without hormone replacement therapy (10.5% vs. 12.5%, respectively). However, in the subgroup of early postmenopausal women (40-55 years), the use of hormone replacement therapy was associated with a significantly reduced prevalence of ovarian cysts (10.4% vs. 28.6%; p < 0.05). CONCLUSIONS: Hormone replacement therapy is associated with a reduced prevalence of ovarian cysts in early postmenopause.

Analysis of Variance↗
PubMed1997

Interleukin-2 production by human pre-implantation embryos.

The study was conducted to determine whether pre-implantation embryos secrete interleukin-2. Conditioned media of 27 embryos derived from women during in vitro fertilization (IVF) cycles were analyzed for interleukin-2 concentration. The results showed that conditioned embryo medium from the two pronuclei stage to 24 hours later contains interleukin-2. Endometrial large granular lymphocytes, which are probably involved in placentation, replicate in response to interleukin-2. It may therefore be speculated that interleukin-2 secreted by human embryos may modulate the function and replication of large granular lymphocytes.

Blastocyst↗
PubMed1997

Caution: prenatal clubfoot can be both a transient and a late-onset phenomenon.

Clubfoot (talipes equinovarus) is a common orthopaedic malformation that can be accurately diagnosed prenatally. The study was conducted to investigate possible in utero visualization of transient and late-onset clubfoot. Early (13-16 weeks' gestation) prenatal transvaginal sonographic diagnosis of clubfoot deformity was made in 36 cases during the study period. Only those cases where follow-up examination revealed different sonographic findings were considered. The results showed that seven cases of transient (as well as relapsing) clubfoot were identified. In 4 of 7 cases, the clubfoot resolved (all after more than 10 min of observation) during the same examination. In the fifth and sixth cases, it initially resolved, later reappearing in follow-up examinations (20 and 22 weeks' gestation). In the seventh case, the clubfoot persisted for two consecutive examinations (2 weeks apart each) and later disappeared. In addition, six late-onset (22-24 weeks' gestation) clubfoot cases were identified during the study period. Although infrequent, in utero clubfoot can be both a transient and a late-onset phenomenon. Over- and under-diagnosis are potential hazards in these situations.

Clubfoot↗
PubMed1996

[Surgical treatment of extrauterine pregnancy: end of the era of laparotomy?].

Ectopic pregnancies can now be recognized very early, and in most cases, before the appearance of dramatic symptoms. This can be attributed mainly to improved diagnostic methods, such as endovaginal sonography and serial determinations of human, chorionic gonadotropin and progesterone. For this reason, extrauterine pregnancies can currently be treated by several methods, and emergency laparotomy is seldom indicated. Advances in treatment modalities, including tubal-conserving operations, laparoscopic approaches, medical treatment with methotrexate, and expectant management have all been proved to be safe and effective. Between January 1994 and June 1995, 166 patients were treated surgically for extrauterine pregnancy. Of these, 94.6% were treated by laparoscopy; laparotomy was required in only 9 (5.4%). Fecundity rates after laparoscopic treatment for ectopic pregnancy are comparable, if not better, than in those treated by laparotomy. Laparoscopic surgery offers advantages, such as reduction in operating time and shorter hospital stay and convalescence, as compared to conventional abdominal surgery. To date, surgical removal of an ectopic pregnancy remains the method of choice and this can be performed safely by laparoscopy.

Female↗
PubMed1996

The residual ovary syndrome: a 20-year experience.

OBJECTIVE: To address the controversy of ovarian preservation during a hysterectomy for benign indications by using our experience with residual ovary syndrome (ROS). STUDY DESIGN: Over a period of 20 years, 2561 hysterectomies (during which one or both ovaries were preserved) were performed at the Golda Medical Center, Israel. A retrospective, quasi, case-control analysis was undertaken. RESULTS: The incidence of ROS was 2.85%. While chronic pelvic pain was the principle indication for subsequent reexploration in 52 patients (71.3%), an asymptomatic pelvic mass noted during routine follow-up examination accounted for 24.6% of operations for ROS. The majority (75.4%) of patients underwent surgery during the first 10 years, while the highest incidence occurred within the first 5 years (46.6%). Furthermore, histological examination revealed functional cysts, benign neoplasm and ovarian carcinoma in 50.7%, 42.6% and 12.3% of the cases, respectively (in nine patients more than one pathology was observed). CONCLUSIONS: Since ROS was found to occur in 1/35 women who had undergone previous hysterectomies mainly due to physiologic ovarian function and benign cyst formation, but not malignancy, we believe that routine oophorectomy is justified in premenopausal women over 45 years of age. However, the final decision to perform elective oophorectomy at the time of hysterectomy for benign disease should be established on an individual basis, taking into consideration age, individual and family risk factors, the patient's preference and ability to ensure long-term compliance to exogenous hormone replacement therapy.

Adult↗
PubMed1996

The impact of woman's age and sperm parameters on fertilization rates in IVF cycles.

OBJECTIVE: To examine the predictive value of different sperm parameters and the age of a couple on fertilization rate. MATERIAL AND METHODS: One-hundred six consecutive sperm samples were analysed before insemination of oocytes in IVF cycles. Sperm count and motility were examined with the Makler Counter Chamber. Morphology was evaluated by the eosin nigrosin and giemsa stains. Membrane integrity was evaluated by the hypoosmotic swelling test (HOST). RESULTS: Using a step-wise logistic regression test the following parameters were all significantly correlated with the fertilization rates: sperm concentration after a 3-h layering (chi 2 = 15.85, P < 0.001), sperm motility index (chi 2 = 6.12, P < 0.0134), woman's age (chi 2 = 6.25, P < 0.012), and the hypoosmotic test (chi 2 = 6.63, P < 0.01). A fertilization capacity formula was established by using these four parameters to predict the fertilization capacity of a couple. Significantly lower fertilization rates were detected in elderly women with the partner sperm concentration of 7 x 10(6)/ml after 3-h layering, < 30% swollen spermatozoa in the HOST and motility index score of < 50. CONCLUSIONS: By the aforementioned formula, sperm fertilization capacity can be predicted by using simple sperm parameters and women's age. Elderly women with partners who have suboptimal sperm parameters reflected by low fertilization capacity scores may benefit from micro-manipulation procedures.

Adult↗
PubMed1996

Uterine activity after betamethasone administration for the enhancement of fetal lung maturation.

OBJECTIVE: To assess the effect of steroids administered for the enhancement of fetal lung maturation on uterine activity. DESIGN: A retrospective analysis. SETTING: High-risk Pregnancy Unit, Golda Medical Center, Petah Tikvah, Israel. PATIENTS: Fifty-nine courses of betamethasone therapy prescribed for various indications other than premature contractions were studied in 29 pregnant women at 26-34 weeks' gestation. MEASUREMENTS: Uterine activity was monitored on the day of the first (but prior to) beta-methasone injection, then daily for the next 3 consecutive days. The number of uterine contractions during the first 30 min of each tocodynamometric tracing was assessed. RESULTS: The frequency of uterine activity after steroid administration is significantly higher in multiple pregnancies as compared to singletons, and significantly increases as the duration of pregnancy increases. However, labor was not induced and all women delivered at least 1 week after the last betamethasone injection. CONCLUSIONS: Since the increased uterine activity after administration of steroids for the enhancement of fetal lung maturation does not provoke labor, it is suggested that this increase in uterine activity seems to act as a temporary phenomenon. Therefore conservative management, rather than tocolysis, would seem appropriate.

Adult↗
PubMed1996

Serum levels of insulin-like growth factor-1, IGF binding protein-1 and insulin and the response to human menopausal gonadotrophins in women with polycystic ovary syndrome.

In order to determine which factors influence the large variations in sensitivity to gonadotrophins witnessed in women with polycystic ovary syndrome (PCOS), a prospective study was conducted of the correlation between basal clinical and endocrinological features and gonadotrophin requirements of 20 women with clomiphene-resistant PCOS undergoing ovulation induction. Baseline evaluation of serum concentrations of luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone, fasting insulin, insulin-like growth factor-1 (IGF-1), IGF binding protein-1 (IGFBP-1) and sex hormone-binding globulin (SHBG) were performed before administering gonadotrophin-releasing hormone agonist (GnRHa). Two weeks later, human menopausal gonadotrophin (HMG) was given in a standard individualized protocol according to ovarian response, until human chorionic gonadotrophin (HCG) was given. Serum concentrations of insulin, IGF-1, and IGFBP-1 were unaffected by GnRHa. The BMI correlated positively with insulin and inversely with IGFBP-1 serum concentrations and insulin and IGFBP-1 were inversely correlated. The amount of HMG required correlated positively with BMI and insulin concentrations and inversely with IGFBP-1 in the whole group and these correlations were maintained in the sub-group of lean women. No correlation was observed between HMG requirements and IGF-1 or other hormones. Women with hyperinsulinaemia and low IGFBP-1 concentrations required significantly more HMG. Multiple regression analysis revealed that insulin concentration is the most significant determinant of HMG requirement even when dissociated from BMI. We concluded that requirements of HMG in PCOS is not merely determined by obesity but by a cardinal role of insulin concentrations which, when high, induce, hypothetically, a hyperandrogenic intrafollicular milieu.

Adult↗
PubMed1996

The value of hysteroscopic evaluation in patients with preclinical in-vitro fertilization abortions.

The study was conducted on 144 women who experienced preclinical abortions, i.e. a transitory rise in beta-human chorionic gonadotrophin (HCG) without any clinical or sonographic evidence of pregnancy, to identify the relationship between preclinical abortions and intrauterine pathology. Hysteroscopy was performed 1-2 weeks after the decline of beta-HCG concentrations to negative values. Intrauterine adhesions were detected in three patients (2.1%), most of these being of the mild type. Concomitant intrauterine abnormalities, mainly uterine septa, were found in 14 (9.7%) cases. We believe that preclinical abortions do not predispose intrauterine adhesions and curettage is superfluous. An incomplete uterine septum seems to be the major factor predisposing this early pregnancy wastage. Hysteroscopy following this condition is an easy and efficient means for both identifying intrauterine pathology and excluding adhesions.

Abortion, Spontaneous↗
PubMed1996

Severe ovarian hyperstimulation syndrome despite low plasma oestrogen concentrations in a hypogonadotrophic, hypogonadal patient.

Ovarian hyperstimulation syndrome (OHSS) is the most serious, life-threatening, iatrogenic complication of ovulation induction. The importance of excessive oestradiol concentrations on the day of human chorionic gonadotrophin (HCG) administration as a predictor and factor in the pathophysiology of OHSS has been extensively studied and discussed. We present the case report of a woman with hypogonadotrophic hypogonadism who developed severe OHSS during ovulation induction with urinary human follicle stimulating hormone (FSH) and HCG in the presence of low circulating oestradiol concentrations. The implication of FSH treatment and complications in hypogonadotrophic hypogonadal patients, and the role of preovulatory oestradiol concentrations in the prediction of OHSS, are discussed.

Adult↗
PubMed1996

A delayed starting schedule of oral contraception: the effect on the incidence of breakthrough bleeding and compliance in women.

OBJECTIVES: To assess the effect of oral contraception started on the first day of menses and the fifth day following its onset, on women's compliance and the incidence of early breakthrough bleeding. METHODS: Oral contraceptives (OCs) containing 30 micrograms ethinylestradiol and 75 micrograms gestodene were prescribed to 100 consecutive, healthy women for whom OCs were found to be the most suitable method of contraception. In the first 50 women, OCs were started on the first day of menses (day 1 group), while in the remaining 50 women, OCs were started on the fifth day after the onset of menses (day 5 group). RESULTS: The day 5 group had better compliance and a reduced incidence of breakthrough bleeding. No differences were observed between the two groups regarding age, parity and gravity. CONCLUSION: Starting an OC regimen should include initiation on the fifth day following the onset of menses. This regimen might increase patient compliance and lower the incidence of breakthrough bleeding.

Adolescent↗
PubMed1996

The immune system in severe ovarian hyperstimulation syndrome.

Recently, evidence has accumulated concerning the interaction between the immune and reproductive systems that results from sharing certain lymphohematopoietic cytokines and their receptors. Furthermore, several cytokines have been implicated as having a role in the prediction and pathophysiology of ovarian hyperstimulation syndrome (OHSS). The hitherto known studies concerning the role of the immune system in OHSS, together with a hypothesis regarding the role of interleukin-2 as a possible culprit of this complication, are presented.

Cytokines↗