1,720,968 research outputs found
Application of guidelines for occupational HIV infection control during delivery in Italy
No full textObjective: We surveyed the attitudes of Italian obstetricians toward the application of HIV infection control guidelines during labour and delivery proposed by the Italian National Committee for HIV Infection. Study design: We identified 66 obstetric centres affiliated to the AOGOI (Association of Italian Gynecologists and Obstetricians). A postal questionnaire was sent to 752 physicians in charge in the centres. Results: A total of 419 clinicians (55.7%) completed and returned the form to the coordinating centre. Obstetricians were directly asked about the need for routine adoption of the Italian guidelines for delivery of women with positive or unknown HIV status (indicating the routine use during delivery of protective glasses, impermeable garments, mask and sterile latex gloves, the washing of hands with detergent solution after using gloves and collection of needles and sharp instruments in suitable containers). A total of 319 (76.1%) clinicians agreed that all these procedures should be adopted. In clinical practice, however, obstetricians declared that the use of latex gloves and collecting needles in suitable containers were always adopted, 'washing hands after using gloves' less frequently, and other procedures such as protective impermeable garments, glasses and mask were infrequently applied
Risk factors for unexplained dyspermia in infertile men : a case-control study
No full textThis study was conducted to analyze risk factors for dyspermia in infertile subjects in a population of men attending outpatient services for infertility in Milan, Northern Italy. Between September 1989 and November 1990 we conducted a case-control study on risk factors for dyspermia. Cases included infertile men with a diagnosis of unexplained dyspermia consecutively observed for the first time during the study period at the Outpatient Service for Infertility of the First Obstetric and Gynecologic Clinic of the University of Milan. Specific work-up was done to exclude the major known or potential causes of dyspermia and infertility in patients and their partners. Two control groups were selected. The first included normospermic men of infertile couples with negative work-up for any disease that might affect fertility, observed in the same outpatient service where cases had been identified. The second control group included fertile men of unknown semen quality who were the partners of women who gave birth at term (> 37 w gestation) to health infants in randomly selected days at the same clinic. In comparison with those who have never smoked, current smokers were at increased risk of dyspermia versus both normospermic men of infertile couples and fertile men of unknown semen quality, and the risk increased with number of cigarettes smoked per day and duration of smoking. The risk of dyspermia increased with the number of cups of coffee drunk per day compared with men drinking no or one cup per day. Likewise, alcohol drinkers were at increased risk and the risk increased with number of drinks/d. When the comparison group included normospermic men of infertile couples, the relationship was less consistent and not statistically significant. No relationship was observed between body mass index, education, family history of infertility in brothers or sisters, age of first ejaculation or first intercourse, or number of sexual partners and the risk of dyspermia
Dietary habits, reproductive and menstrual factors and risk of dysmenorrhoea
No full textIn order to analyze risk factors for dysmenorrhoea, we conducted a case-control study. Cases were 106 women (median age 27 years) with moderate or severe dysmenorrhoea lasting 12 months or more. Controls were 145 women (median age 26 years) without dysmenorrhoea, admitted for routine gynecological examination at the outpatient gynecological services of the same clinic where cases had been identified. In comparison with women reporting short menstrual cycles (every 25 days or less) the relative risk (RR) of dysmenorrhoea was 2.0 and 2.6, respectively, in those reporting their menstrual cycles of 26-30 days and of 31 days or more, and the RR was 3.6 (95% confidence interval (CI): 1.0-13.4) for women reporting totally irregular menstrual cycles. The estimated RRs were, in comparison with women reporting menstrual flows lasting 4 days or less, respectively 2.2 and 1.9 in those reporting menstrual flows lasting 5 and 6 days or more. Fourty-four (58%) cases but only seven (5%) controls reported heavy menstrual flows (RR in comparison with women reporting slight or normal menstrual flow 12.6, 95% CI: 5.0-32.1). As regards dietary factors, no associations emerged between the various food items, with the exception of cheese and eggs, which tended to be more frequently consumed by cases than controls. The results of this study suggest that the risk of dysmenorrhoea is higher in women with irregular, long and heavy menstrual flows. No association emerged between reproductive history and dysmenorrhoea. Likewise, no clear relationship emerged between intake of several dietary factors and risk dysmenorrhoea
Cigarette smoking, alcohol consumption, and risk of primary dysmenorrhea
No full textWe analyzed the relation between cigarette smoking, alcohol consumption, and risk of dysmenorrhea using data from a case-control study in Milan, Italy. With never-smokers as the reference category, the relative risk (RR) of dysmenorrhea was 1.9 [95% confidence interval (CI) = 0.9-4.4] for women smoking 10-30 cigarettes per day. The risk of dysmenorrhea increased with duration of smoking in women who smoked for less than 10 years (RR = 1.3, 95% CI = 0.6-2.6) and in those who smoked for 10-20 years (RR = 2.8, 95% CI = 1.3-6.2). In comparison with teetotalers, the age-adjusted RR of dysmenorrhea was 0.8 (95% CI = 0.4-1.5) for alcohol drinkers
Induced abortions and risk of ectopic pregnancy
No full textThe relationship between induced abortions and subsequent risk of ectopic pregnancy has been analysed using data from a case-control study conducted in Milan, Italy. The cases were 158 women with a diagnosis of ectopic pregnancy confirmed by laparoscopy or laparotomy, admitted to a network of university and general hospitals. Two control groups were selected. The first one (obstetric controls) included 243 women who gave birth at term (more than 37 weeks gestation) to healthy infants at the same hospitals where the cases had been identified. The second control group (non-obstetric controls) was a random sample of 158 women of comparable age interviewed in the same calendar period, admitted to hospital for a broad spectrum of acute, non-gynaecological or obstetric conditions. A total of 35 out of 158 cases (22%) reported one or more previous induced abortions; the corresponding figures were 29 out of 243 (12%) obstetric controls and 29 out of 158 (18%) non-obstetric ones. The risk of ectopic pregnancy was higher in women reporting induced abortions: the estimated multivariate relative risks (relative risk) for any induced abortions were 2.9 [95%, confidence interval (CI) 1.6-5.3] in comparison with obstetric controls and 2.5 (95% CI 1.2-5.0) in comparison with women admitted to hospital for other conditions. The risk increased with number of induced abortions, being, compared to women with no induced abortion, 13.1 (95% CI 3.2-54.5) and 3.8 (95% CI 1.1-12.7) in women reporting two or more induced abortions when the comparison groups were respectively obstetric and non-obstetric controls. This study shows an increased risk of ectopic pregnancy after induced abortion.(ABSTRACT TRUNCATED AT 250 WORDS
Uterine doppler velocimetry and placental hypoxic-ischemic lesion in pregnancies with fetal intrauterine growth restriction
No full textWe tested the hypothesis that Doppler velocimetry of the ascending uterine arteries (Ut.DV) in cases of fetal intrauterine growth restriction (IUGR) can reflect the presence of hypoxic-ischaemic lesions of the placenta, and whether this prediction is affected by the maternal blood pressure status. Ut.DV was obtained within 7 days of delivery in 90 consecutive pregnancies with IUGR and in 37 uneventful control pregnancies. Abnormal Ut.DV was defined as an average of a (left and right systolic)/diastolic ratio > 2.6 and diastolic notching. After delivery, pathological studies were performed with attention paid to macroscopic and microscopic evidence of hypoxic or ischaemic placental lesions related to uteroplacental vascular pathological features. In patients with IUGR, the total rate of placental lesions was significantly higher in the presence of abnormal Ut.DV compared to the presence of normal Ut.DV (relative risk, 6.35; 95 per cent confidence interval = 5.2-7.3). The rate and the severity of these lesions was not significantly different between normotensive and hypertensive pregnancies (87 versus 93 per cent; P = 0.2). When Ut.DV was normal, the rate of placental lesions was similar between IUGR cases and control pregnancies (14 versus 8 per cent; P = 0.69). The perinatal outcome was not significantly different in any of the normotensive and the hypertensive pregnancies with growth-restricted fetuses and abnormal Ut.DV. The presence of abnormal Doppler velocimetry of the uterine arteries in pregnancies with fetal intrauterine growth restriction is may be in fact an important indicator of hypoxic or ischaemic placental lesions. This abnormal Doppler velocimetry is independent of the maternal blood pressure status
Impact of a multiparameter, ultrasound-based triage on surgical management of adnexal masses
No full textObjective: To prospectively evaluate the accuracy of a multiparameter, ultrasound-based triage and its impact on surgical management of adnexal masses. Methods: Masses evaluated as normal according to Ferrazzi's sonographic morphological score were considered as being at low risk of malignancy and eligible for laparoscopic treatment without further evaluation. Masses evaluated as abnormal, but without additional risk factors such as ascites, diameter ≤ 10 cm, bilaterality, immobility, resistance index ≥ 0.6 and serum CA 125 < 35 IU/mL were considered at moderate risk and eligible for laparoscopic evaluation and treatment. Masses with abnormal morphological score and any of these additional risk factors were considered at high risk and treated by laparotomy. The results of pathological examination were obtained for each mass. Results: Two hundred and four (87%) masses were benign and 30 (13%) were malignant. Among 182 low-risk, 19 moderate-risk and 33 high-risk masses, the odds of malignancy were 1:90, 1:18 and 4.5:1, respectively. To calculate the diagnostic accuracy of this algorithm, low- and moderate-risk groups were considered together: the sensitivity was 90%, specificity 97%, positive predictive value 82% and negative predictive value 99%. The new algorithm was significantly more accurate than was morphological score alone (P = 0.0002). Ninety-six percent of benign masses were treated by laparoscopy. All three patients with malignant masses that were incorrectly assigned to laparoscopy underwent laparoscopic adnexectomy and frozen section. Conclusions: The accuracy of this new algorithm was higher than that of the sonographic morphological scoring system alone. In the present series, it allowed the treatment by laparoscopy of 96% of benign adnexal masses without mismanagement of any cases of ovarian cancer
Transvaginal ultrasonographic characterization of ovarian masses : comparison of five scoring systems in a multicenter study
No full textThe aim of this work was to test and compare the accuracy of five different morphological scoring systems to identify malignant ovarian masses in a prospective multicenter study. Four of the systems had previously been reported by Granberg, Sassone, De Priest and Lerner and the fifth is newly developed. A total of 330 ovarian neoplasms were collected in three different centers, which adopted the same diagnostic procedures. Of these, 261 masses were benign (mean diameter 50 ± 26 mm) and 69 were malignant (mean diameter 69 ± 33 mm) (prevalence 21%). The area under the receiver operating characteristic (ROC) curve for the multicenter score was 0.84. This was significantly better than the areas of the other four scores which ranged from 0.72 to 0.75. The cut-off levels derived from the five ROC curves achieved a sensitivity that ranged from 74% (Sassone score) to 88% (De Priest score ≤ 5), and a specificity from 40% (De Priest) to 67% (multicenter); the highest positive predictive value was 41% (multicenter). With a cut-off level of 9, the accuracy of the multicenter score was significantly better than the scores of Granberg and De Priest (McNemar's test p < 0.0001). Similar results were obtained in 207 ovarian masses of ≤ 5 cm in mean diameter, and when 19 borderline and 11 stage I cancers only were considered. For the clinical purposes of a screening test we also checked a possible cut-off level of ≤ 8, which increased the sensitivity to 93% with a drop of specificity to 56%. With the use of the same criteria for the scores of the different authors, the following values were obtained for sensitivity: 96%, 81%, 93% and 90%; and for specificity: 23%, 56%, 28% and 49%. The multicenter score performed well at distinguishing malignant from benign lesions, and was better than the other four traditional scores, for both large and small masses. This was mainly due to the introduction of two criteria that allowed correction for typical dermoids and endohemorrhagic corpora lutea. A completely reliable differentiation of benign from malignant masses cannot be obtained by sonographic imaging alone
Hysterectomy, oophorectomy, and subsequent ovarian cancer risk
No full textObjective: To analyze the relation between hysterectomy with or without oophorectomy and the risk of subsequent ovarian cancer.
Methods: We have conducted a case-control study since 1983 in a network of general and university hospitals in the greater Milan area. The cases were 953 women aged less than 75 years with histologically confirmed epithelial ovarian cancer. Women younger than 75 years residing in the same geographic area and admitted for acute conditions to the same network of hospitals where the cases had been identified were eligible as controls. Potential controls were excluded if they had been admitted for gynecologic, hormonal, or neoplastic diseases or had previously undergone bilateral oophorectomy. A total of 2758 controls were interviewed.
Results: Fifty-two cases (5.5%) and 215 controls (7.8%) reported a history of hysterectomy, including eight cases and 38 controls who also reported unilateral oophorectomy. In comparison with women with intact uterus and ovaries, the age-adjusted relative risk (RR) was 0.7 in both women who reported hysterectomy alone (95% confidence interval [CI] 0.5-0.9) and in those reporting hysterectomy plus unilateral oophorectomy, though the latter finding was not statistically significant (95% CI 0.3-1.4). The risk of ovarian cancer was inversely related with time from hysterectomy. Compared with women reporting no pelvic surgery, the RR was 0.9 (95% CI 0.4-1.7), 0.7 (0.3-1.6), 0.7 (0.3-1.4), and 0.5 (0.3-0.8), respectively, in women reporting hysterectomy within 4 years or less and 5-9, 10-14, and 15 years or more before interview.
Conclusion: Hysterectomy approximately halves the risk of ovarian cancer, possibly because of altered ovarian blood flow or the opportunity that hysterectomy provides for examining the ovaries
Uterine doppler velocimetry predicts normotensive preeclampsia in pregnancies with fetal growth retrdation : evidencs from placental pathology and perinatal outcome
No full textThe hypothesis is that the typical presclamptic ischemic-haemerragic lesions of the placenta can be predicted by uterine Doppler veiocimatry in normotensive pregnancies with growth retarded fetuses.
Study design: Detailed macroscopic and microscopic placental pathology was studied in 80 pregnancies with fetal growth retardation (FGR) and in 20 normal pregnancies. In 25 patients FGR was associated with pregnancy induced hypertension (PIH). Pregnancies with FGR were classified into four groups according to the presence of PIH and of abnormal Doppler velocimetry of the ascending uterine artery (Uter-DV) measured within 5 days from delivery, The frequency and the severity of lachemic-heamorragic lesions, fetal growth pattern, DV of the umbilical arteries and perinatal outcome were compared in these four groups and in the control group.
Results: The frequency of infarctions and extensive histological ischemic damage of placental tissue was not significantly different between cases with FGR, PIH and abnormal Uter-DV (group 1) (100%) and cases with FGR and abnormal Uter-OV without PIH (group 2) (88%) (p<O.2). The frequency of these same lesions was significantly lower in cases with FGR but with normal Uter-DV (p<O,OOO7) and in cases with FGR, hypertension but normal Uter-DV (p<O.O(X)). Identical results were obse~ed for large
infarctions, abruptio and the most severe ischemic damages.Umbilical S/D ratio (5.8 _+2.9 vs. 6.1 _+2.6), the prevalence of esymmatdcel growth (42 vs. 56%), gestational age (33 +4 vs. 31 +_3) and weight at birth (1297 t-644 vs. 1264 -+525) were not significantly different between group 1 and 2. These perinatal parameters were significantly better in pregnancies with FGR, with or without hypertension, but normal Uter-DV, than in groups 1 and 2.
Conclusions: The frequency, severity and extension of typical presciamptic
ischemic-haemorragio lesions of the placenta is not significantly different in
hypertensive and normotensive patients with FGR and abnormal Doppler velocimetry of the ascending uterine arteries
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