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S Costantini

Publications and source records attributed to S Costantini.

At least 19 recordsLinked to original sources
PubMed2006

Ultrasound imaging of the female perineum: the effect of vaginal delivery on pelvic floor dynamics.

OBJECTIVE: To assess the use of perineal ultrasound in the evaluation of the influence of vaginal delivery on urethral mobility and on the contraction strength of the levator ani muscles. METHODS: This was a prospective observational study of 70 nulliparous women. Each woman underwent perineal ultrasound assessment at 36-38 weeks' gestation and at 1 week and 3 months following delivery. During each examination we assessed: the posterior urethrovesical angle at rest, urethral mobility during Valsalva maneuver and movement of the anorectal angle and levator sling angle during contraction of the levator ani. RESULTS: The urethrovesical angle and the urethral mobility increased significantly after delivery (P < 0.0001). The levator sling excursion decreased proportionally. The anorectal excursion had decreased significantly by the examination 3 months after birth. CONCLUSIONS: Perineal sonography provides objective assessment criteria for urethral mobility and for contraction strength of the levator ani muscles and detects changes in the anatomy and function of the pelvic floor after vaginal delivery.

Adolescent↗
PubMed2006

The management of severe vaginal obstruction from genital chronic graft-versus-host disease: diagnosis, surgical technique and follow-up.

AIM: Chronic graft-versus-host disease (GVHD) is one of the most important systemic late-onset complications of haematopoietic stem cell transplantation. Gynaecological manifestations are considered relatively rare, and involve lower genital tract skin and mucosa, causing vulvar scarring, vaginal stenosis, affecting the patients' sexual life, and leading to more serious complications as haematocolpos, haematometra and abscesses. Genital GVHD can be treated with topical therapy when mild to moderate disease is present. Surgery is indicated in advanced and complicated cases to restore normal anatomy. The aim of this study is to propose a standard approach for the management of such condition when medical therapy is not effective. METHODS: From May 2000 to January 2002, 8 patients suffering from genital chronic GVHD were operated in our institution. We describe clinical and sonographic presurgical assessment, simple or ultrasonographic guided surgical technique, postsurgical treatment and follow-up. RESULTS: Surgery was completely successful in restoring genital anatomy in all the cases. Mean follow-up was of 17 months (6 to 38 months). Two patients early discontinued the postsurgical treatment. At 1 month complete vaginal patency was found in 6 cases, weak partial adhesions in 1 case, while 1 patient refused follow-up. Eventually, complete vaginal patency was maintained in 2 cases, and partial adhesions were found in 5 cases. CONCLUSIONS: The combined use of clinical examination and endosonography provides a precise assessment of the level of the obstruction. The surgical technique here described is feasible and successful in restoring normal anatomy, while long term results seem related to the compliance towards the postsurgical treatment.

Adult↗
PubMed2006

A false visualization of ureteral jet with Doppler sonography during transvaginal evaluation of ureterocele.

A case of ureterocele diagnosed by an experimental trial using transvaginal ultrasound is reported. Color Doppler sonography revealed a jet flowing from the ureterocele into bladder. The radionuclide renal scan revealed a right duplex system, a ureterocele of the upper moiety and its functional obstruction. If the upper moiety was obstructed, where was the ureteral jet from? We can suppose that the jet visualized was flowing from the ureteral meatus of the lower moiety, positioned behind the ureterocele, and not from the ureterocele itself. In the light of this case, a urinary obstruction could not be excluded only on the basis of Doppler sonographic findings. In conclusion, a diagnostic work-up using only transvaginal ultrasound is insufficient to adeguately analyse the anatomy and function of the urinary system, especially when there are anatomy malformations.

Adult↗
PubMed2005

Online convective therapies: results from a hemofiltration trial.

With the introduction of the on-line preparation of dialysis fluids, the hemofiltration technique, which has never had a widespread diffusion in its old version with the infusion bags, has gained a new interest. We planned a prospective, randomized, 3-year-long study comparing survival and morbidity in ultrapure bicarbonate dialysis (BD) with on-line predilution hemofiltration (HF). Since comorbidity is one of the main factors limiting survival, the study was addressed to patients with a severe degree of comorbidity. The paper presents the preliminary results of the trial. Sixty-four patients were enrolled and randomized to either BD (N = 32) or HF (N = 32). Mean age and dialysis vintage were comparable. Twenty patients died during the study, 12 in BD and 8 in HF. The relative risk of death was 11% higher in patients treated with BD compared to those in the HF group (p < 0.005). The number of hospitalisation events per single patient was lower, even though not significantly, in HF compared to BD (1.94 + 1.26 in HF vs 2.48 + 1.98 in BD, p = NS). As concerns biochemistry, apart from beta-2-microglobulin, any other substantial difference was not found during the study, though the small solute concentration was generally a little more elevated in HF than in BD. Dialysis hypotension showed a trend to decrease in both the dialysis modalities up to near half of the trial, then, during the last year, it remained quite stable in HF, while, on the contrary, it increased in the BD group. By the end of the protocol, patients in HF showed a 2.5% incidence of acute dialysis hypotension, while patients in BD had 23%.

Aged↗
PubMed2005

Combined simple and complex cord knots associated with an encirclement.

A case of combined simple and a complex knots, and an encirclement of the umbilical cord, which did not cause any detectable harm, is presented. The combination of a simple and a complex true knots, as described in this paper, is a highly unusual phenomenon with only two previous reports in the world literature. No report exist showing a combined simple and complex knots and an encirclement.

Adult↗
PubMed2004

High incidence of complications after 2-chloro-2'-deoxyadenosine combined with cyclophosphamide in patients with advanced lymphoproliferative malignancies.

The combination of purine analogs with alkylating agents is able to produce a synergistic antitumoral effect. However, the addition of immunosuppressive and DNA-targeting agents might increase purine analog-related complications. The risk for serious complications was evaluated in 38 patients treated with 2-chloro-2'-deoxyadenosine (CDA) and cyclophosphamide (CP). The diagnoses were chronic lymphocytic leukemia (CLL) in 15, Waldenström's macroglobulinemia in 4, mantle cell lymphoma in 6, follicular non-Hodgkin's lymphoma (NHL) in 10, and other low-grade NHL in 3 patients. All patients were pretreated (median: 2 lines, range: 1-5) and 23 (61%) were refractory. The patients received a median of two courses (range: 1-5) of 5.6 mg/m(2) CDA, followed by a median of 200 mg/m(2) CP, for 3 days. The response rate was 51% [complete remission (CR): 14%, partial remission (PR): 38%]. Grade 3/4 infections occurred in 16 (42%) patients. Dose-limiting cytopenias were seen in 22 (58%) patients. In 12 (32%) patients, autoimmune manifestations developed requiring treatment in most of them. Second cancers arose in five (13%) patients (myelodysplastic syndrome/acute myelocytic leukemia in three, lung cancer in two). Multivariate analysis showed that cytopenias, gender (F), prior radiotherapy, and age (>65 years) predicted for the complications seen after CDA-CP. To conclude, because of the high incidence of complications, caution is warranted in selecting patients with advanced lymphoid malignancies for the CDA-CP protocol.

Adult↗
PubMed2004

Modification of ultrasonographically measured endometrial thickness after discontinuation of adjuvant therapy with tamoxifen in postmenopausal breast cancer patients.

INTRODUCTION: The aim of this study was to evaluate endometrial changes after five years of tamoxifen treatment by measuring endometrial thickness with transvaginal ultrasonography. MATERIALS AND METHODS: Fifty-five asymptomatic postmenopausal women who had assumed tamoxifen, 20 mg daily, for five years were controlled six months after discontinuation of the therapy. Of these 42 were followed-up at 12 months. Statistical analysis was performed using the analysis of variance for repeated measures and the Anova test; p < 0.05 was considered statistically significant. RESULTS: We found a significant reduction in endometrial thickness at six months (p = 0.0046) and at 12 months (p = 0.0003) but not between six and 12 months (p = 0.06). CONCLUSION: A statistically significant reduction in endometrial thickness after discontinuation of tamoxifen therapy was found. This can probably be attributed to the cessation of the estrogenic side-effects of tamoxifen therapy.

Breast Neoplasms↗
PubMed2003

Determination of cadmium, chromium, lead and vanadium in six fish species from the Adriatic Sea.

Concentrations of cadmium, chromium, lead and vanadium were determined in samples of six fish species collected along the coast of the Adriatic Sea. The concentrations of the elements studied were generally low, often below the detection limits of the analytical methods. The highest values (microg x kg(-1) fresh weight) were observed, mainly in the central area of the Adriatic Sea, for anchovy (Cd 20.2, Cr 82.9, Pb 45.9, V 89.9), red mullet (Cd 3.1, Cr 31.0, Pb 36.0, V 79.1) and mackerel (Cd 7.7, Cr 28.0, Pb 11.4, V 43.5). The concentrations of cadmium and lead in all the species examined were below the maximum levels indicated by the European Community for these two elements in seafood, and also would lead to exposure levels lower than the provisional tolerable daily intakes suggested by the FAO/WHO for Cd (420 microg x week(-1) for a 60-kg person) and Pb (1500 microg x week(-1) for a 60-kg person). The concentration of chromium was lower than the recommended daily amount (50-200 microg x day(-1) for a 60-kg person) indicated by the US National Research Council. An 11-34% contribution to the daily vanadium ingestion with fish was calculated for the population of the Adriatic coast.

Animals↗
PubMed2002

Pilot study on lipocalin expression into extracellular fluids of women in fertile age.

BACKGROUND: To verify the expression of neutrophil gelatinase associated lipocalin (NGAL), molecule now arising great interest because of its proposed involvement in cell-cycle regulation, acute phase response and immunomodulation, into extracellular fluids of female reproductive tract, in order to provide useful data to understand its biological functions. The data collected are purely qualitative, just meant to reveal the presence of lipocalin into the assayed fluids, and they have to be considered as preliminary for a quantitative study (in progress at the moment) based on a double antibody radioimmunoassay. METHODS: Three kinds of extracellular fluid were randomly sampled: amniotic fluid (13 samples), cervical mucus (10 samples), coloster (20 samples). The inclusion criteria concerning the selection of the donor women were: age (fertile period), healthy state and pregnancy state. All the samples underwent protein assay, electrophoresis and western blot. RESULTS: All the samples examined revealed NGAL's presence. CONCLUSIONS: The positive results of this study seem to strengthen the hypothesis related to NGAL biological functions, specifically the ones that suggest its role into cell differentiation, embryonic development and inflammation. Therefore the female reproductive tract is suggested as a new promising study object in this research field.

Acute-Phase Proteins↗
PubMed2001

Phalloidin synthetic analogues: structural requirements in the interaction with F-actin.

Synthetic derivatives of phalloidin have been investigated in solution by circular dichroism (CD) and NMR spectroscopy. They differ from natural phalloidin (PHD). bicyclo(Ala1-D-Thr2-Cys3-cis-4-hydroxy-Pro4-Ala5-2-mercapto-Trp6-(OH)2Leu7)(S-3 --> 6), in that they are modified at positions 2, 3, and 7. Among these synthetic analogues, structural differences and varying degrees of atropisomerism are found. By comparing the respective molecular models obtained by restrained molecular dynamics (RMD) simulations based on experimental NMR data, structural features that may be responsible for the different biological behavior become apparent. Our results indicate that the structural changes that result from an inversion of chirality of residue 3 lead to a complete loss of toxicity. Conversely, toxicity is less affected by the structural changes that stem from an inversion of chirality of residue 2. Moreover, unlike the other phallotoxins, when the thioether unit bridges to the opposite face of the main peptide ring, in contrast to the situation in other phallotoxins, large structural changes are observed as well as a total loss of activity. Molecular models of the synthetic phalloidin analogues have been used to investigate the necessary structural requirements for the interaction with F-actin. To this end, the F-actin/PHD model of M. Lorenz et al. was employed; docking experiments of our molecular models in the PHD binding site are presented.

Actins↗
PubMed2001

Element concentrations and cataract: an experimental animal model.

The determination of inorganic ions in cataractous human lenses has been the subject of several investigations; nevertheless, few studies have been concerned with trace element contents in lenses, and data are sometimes contradictory. An animal experimental model of induced cataract is here proposed with the aim of evaluating the changes of Ca, Na, K, Cu and Zn concentrations. The cataract was produced by an Nd:YAG Laser treatment of the right eye of sexteen male rabbits. The determination of the elements was performed by atomic absorption spectrometry (both flame and flameless methods) after an acid digestion of samples. Compared with the results obtained in left lenses used as a control (Ca 14.4+/-5.7 mg/kg d.w.; Na 1.3+/-0.5 g/kg d.w.; K 9.9+/-1.1 g/kg d.w.; Cu 0.24+/-0.09 mg/kg d.w.; Zn 24.8+/-2.3 mg/kg d.w.), the mean concentration values of opaque lenses showed some significant changes for Ca, Na, and Cu (Ca 123.7+/-106.6 mg/kg d.w.; Na 4.5+/-4.3 g/kg d.w; Cu 0.43+/-0.21 mg/kg d.w.). Potassium showed a tendency to decrease, and zinc to increase. Positive correlations were found between calcium and sodium both in controls (r=0.73, p<0.001) and in treated lenses (r= 0.87, p<0.0001). An inverse correlation between Ca and K confirmed the tendency of potassium to decrease.

Animals↗
PubMed2001

Evaluation of aluminium concentrations in samples of chocolate and beverages by electrothermal atomic absorption spectrometry.

Samples of chocolate, cocoa, tea infusions, soft drinks and fruit juice have been examined by, electrothermal atomic absorption spectrometry (ETA-AAS) for the presence of aluminium (Al). Fruit juices and chocolate were analysed after an adequate sample preparation; the other products were evaluated directly. Sampling was performed in duplicate for 248 independent samples. The mean Al concentration in chocolate was 9.2 +/- 7.5 mg kg(-1), and individual values were correlated with the per cent of cocoa in samples (Y = 0.63 + 0.27X, r = 0.78, p < 0.0001). Al concentration in commercial tea infusions ranged from 0.9 to 3.3 mg l(-1) (mean = 1.80 +/- 65 mg l(-1), whereas in laboratory-prepared samples it was 2.7 +/- 0.93 mg l(-1). In soft drinks, the concentrations of Al were lower, ranging from 9.1 to 179 microg l(-1); the highest values were observed in samples of orange squash (mean = 114 +/- 56 microg l(-1)). Apricot juice showed the highest Al level (mean = 602 +/- 190 microg l(-1)), being statistically, different from that of pear (mean = 259 +/- 102 microg l(-1)), but not different from that of peach juice (mean = 486 +/- 269 microg kg(-1)). Toxicologically, the amount of Al deriving from the consumption of these products is far below the acceptable daily intake of 1 mg kg(-1) body weight indicated by the FAO/WHO, and it is a verv low percentage of the normal Al dietary intake.

Aluminum↗
PubMed2001

[The role of transvaginal ultrasound and sonohysterography in the diagnosis and staging of endometrial adenocarcinoma].

PURPOSE: The aim of this study is to evaluate the accuracy of sonohysterography in early diagnosis of endometrial tumor lesions and in the detection of myometrial infiltration for staging. MATERIAL AND METHODS: We performed sonohysterography as a preoperative test in 24 patients with an hystologic diagnosis of endometrial adenocarcinoma obtained by hysteroscopy and biopsy. The mean age of the patient was between 50 and 82 years. The sonohysterographic examination was performed by using 5.0 and 6.0 MHz transvaginal probes and a 5 or 7 French hysteroinjectors with inflating balloon. 19 of the 24 patients were enrolled in the study: in 2 cases the examination was not technically performable, 2 patients refused surgical treatment and 1 patient had a cervical adenocarcinoma with extension to the myometrium. In each patient we evaluated the number and the size of the lesions and the degree and the depth of myometrial infiltration. Each parameter was compared with the final histopathologic examination. RESULTS: Sonohysterography showed a single lesion in 15 patients, whereas in 4 patients it showed multiple lesions; in 1 of these patients it showed 3 lesions which were, in reality, a single lesion that infiltrated the first half of the myometrium. Myometrial infiltration was correctly evaluated by the examination in 17 of the 19 women (89.4%): 16 positive and 1 negative case. The sensitivity was 88%, the specificity 100%, the positive predictive value 100% and the negative predictive value 33%. The sonohysterography allowed to evaluate exactly the depth of myometrial invasion in 15 of the 16 cases (93.7%), in which a myometrial infiltration was suspected. With regard to this parameter the sensitivity was 85.7%, the specificity was 100%, the positive predictive value 100% and the negative predictive value 90.9%. CONCLUSIONS: Although the introduction of transvaginal ultrasonography in clinical practice allows to obtain an early diagnosis of endometrial adenocarcinoma, about half patients seems to present already at the diagnosis myometrial invasion. Moreover 50% of these patients seems to have pelvic lymphonodes and about 29% positive paraaortic lymphonodes. Currently myometrial invasion is evaluated by the extemporary frozen test and confirmed by the definitive hystologic examination. It would be helpful to have a technique able to detect and evaluate infiltration before surgery. The results of this study suggest that sonohysterography could have a role in preoperative staging. However these data need to be confirmed by further studies.

Adenocarcinoma↗
PubMed2001

Transvaginal ultrasonography and hysterosonography to monitor endometrial effects in tamoxifen-treated patients.

PURPOSE OF INVESTIGATION: Our purpose was to evaluate if, during tamoxifen treatment, hysterosonography may increase diagnostic accuracy when compared with transvaginal ultrasonography and to identify, when and in how many cases, further biopsies may be avoided. METHODS: We performed transvaginal utrasound in 310 asymptomatic women under tamoxifen treatment, using 8 mm endometrial thickness as the cut-off. One hundred and seven patients with an endometrium thicker than 8 mm were enrolled for hysterosonography. Parameters to be evaluated by transvaginal ultrasound and hysterosonography were thickness and structural features of the endometrium. It was possible to compare ultrasound examinations with histopathological findings obtained by biopsy in 83 patients. RESULTS: Globally only ten patients from the study cohort had true endometrial pathology. Based on structural features of the endometrium, we found a global accuracy of 95.6%, with 2.8% false negatives and 4.1% false positives. CONCLUSION: Hysterosonography can increase diagnostic accuracy during tamoxifen treatment and may allow further invasive investigations to be avoided in patients with suggestive hysterosonographic features.

Endometrium↗
PubMed2000

Increased CA 125 serum levels in patients with advanced acute leukemia with serosal involvement.

BACKGROUND: CA 125 is a tumor marker used for the diagnosis and monitoring of ovarian carcinoma. This marker also has been found to be increased in patients with serosal effusion derived from nonneoplastic inflammatory disease and in a few instances of advanced non-Hodgkin lymphoma with serosal involvement. METHODS: CA 125 levels were tested in the serum of 15 patients with acute myeloblastic leukemia (AML) at the time of diagnosis and in 3 patients with advanced leukemia with serosal involvement. In two patients with elevated serum CA 125 levels, a CA 125 assay was performed on leukemic cells and on the supernatant fluid of short term liquid culture. RESULTS: Increased serum CA 125 was found in the three patients with acute leukemia with extramedullary localization and serosal effusion, whereas it was normal in 15 AML patients tested at the time of diagnosis. CA 125 was not detectable in leukemic cell extracts nor in the supernatant fluid of primary cultures. CONCLUSIONS: These results indicate that leukemic cells were unable to produce CA 125 and suggest that its elevation in the serum is likely due to a serosal inflammatory reaction caused by the leukemic infiltration.

Adult↗
PubMed2000

Limited value of sonohysterography for endometrial screening in asymptomatic, postmenopausal patients treated with tamoxifen.

OBJECTIVES: Sonohysterography (SHG) has been proposed as a useful tool for the surveillance of the endometrium in patients receiving tamoxifen. This study aimed to assess the value of SHG in asymptomatic patients who would have been biopsy candidates because of abnormal transvaginal ultrasound (TVUS) results. METHODS: The study population included postmenopausal breast cancer patients receiving adjuvant tamoxifen who had asymptomatic abnormalities at TVUS (endometrial thickness >/=8 mm or endometrial echo not adequately visualized). SHG was performed with an Aloka SSD 680 system using a 5-MHz vaginal probe, with sterile saline solution as contrast medium. RESULTS: Forty-one patients entered the study. A regular endometrial echo was identified by SHG in 9 patients (21.9%). Histology was obtained in the remaining 32 patients with positive (n = 27, 65.8%) or unsuccessful (n = 5, 12.2%) SHG. Benign polyps (n = 15, 36.6%) and endometrial atrophy (n = 14, 34.1%) were the most common findings; 3 patients (7.3%) had simple hyperplasia. CONCLUSIONS: Breast cancer patients with asymptomatic, tamoxifen-associated TVUS abnormalities have little additional benefit from SHG. More than 23 remain candidates for biopsy, which usually yields benign or insignificant findings.

Aged↗