Abano Terme, Italy
Abano Terme, Italy

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Greco E.,European Hospital | Scarselli F.,European Hospital | Minasi M.G.,European Hospital | Casciani V.,European Hospital | And 4 more authors.
Human Reproduction | Year: 2013

Study Questio: NDoes the health status of infants fathered by nonmosaic Klinefelter syndrome (KS) patients whose partners underwent ICSI with sperm obtained from testicular dissection reveal any genetic risk for the offspring?. Summary Answer: KS patients undergoing testicular sperm extraction (TESE) are capable of conceiving healthy children. What Is Known Already: Paternity has been successfully achieved in nonmosaic KS patients (47,XXY karyotype) by ICSI using either ejaculated or testicular spermatozoa. A crucial concern is the potential transmission of genetic abnormalities to the offspring. Some studies reported that 47,XXY spermatogonia are capable of completing spermatogenesis leading to the production of mature spermatozoa with increased aneuploidies. Other authors showed that where focal spermatogenesis is present in nonmosaic KS males, it originates from euploid germ cells and, therefore, produces normal mature gametes. In support of this finding, at present, the great majority of children born from nonmosaic KS patients are chromosomally normal.STUDY Design: , SIZE, DURATIONFrom April 2004 to June 2010, 38 azoospermic patients with nonmosaic KS were examined for the presence of testicular spermatozoa. Spermatozoa were retrieved from 15 patients and 26 ICSI cycles were done (16 with cryopreserved sperm). There were 15 pregnancies leading to the birth of 16 babies who were karyotyped at amniocentesis and after birth. Participants/Materials, Setting, Methods: Participants were recruited from couples attending the European Hospital, Rome, and Clinica MAR&Gen, Granada, for infertility treatment. Both the European Hospital and Clinica MAR&Gen are private clinics. Testicular tissue was extracted with TESE or micro-TESE. After retrieval, fresh sperm was used for ICSI or it was cryopreserved for future use. Main Results and the Role of Chance: Spermatozoa were retrieved from 15 patients (14 TESE and 1 micro-TESE) out of 38 (39.5%). A total of 26 ICSI cycles were performed: 10 with fresh and 16 with cryopreserved-thawed sperm. Mean ages (y) of patients with positive and negative sperm retrieval were, respectively, 34.8 ± 1.72 and 35.6 ± 4.08 (NS, nonsignificant). Comparing ICSI cycles performed with fresh sperm (n = 10) to those performed with frozen-thawed sperm (n = 16): Fertilization rates per injected oocyte were 53.0% (44 of 83) and 47.8% (32 of 67), respectively (NS). The cleavage rate per injected oocyte was 90.6% (29 of 32) versus 68.2% (30 of 44); P = 0.026. Clinical outcomes were not significantly different between the fresh and the frozen-thawed sperm group: clinical pregnancy rates were 7 of 10 (70.0%) and 8 of 16 (50.0%); implanted embryos (per transferred embryo) were 8 of 23 (34.8%) and 8 of 29 (27.6%); delivery rates were 6 of 10 (60.0%) and 5 of 16 (31.3%). Sixteen babies were born, all of them are healthy with a normal karyotype, eight from the fresh sperm group and eight from the frozen-thawed sperm group.LIMITATIONS, REASONS FOR CAUTIONSThe small numbers available for study mean that only common problems can be excluded. Wider Implications of the Findings: This study provides further reassurance that KS men can father healthy children and that pre-implantation genetic diagnosis on embryos conceived with their sperm is not strongly indicated. However, until conclusive information is available, such couples should be offered extensive genetic counseling. Study Funding/Competing Interest: (S)No external funding was obtained for the present study. None of the authors has any conflict of interest to declare. Trial Registration Number: Not applicable. © 2013 The Author.


Zanardo V.,Policlinico Abano Terme | De Luca F.,University of Southampton | Trevisanuto D.,University of Padua | Simbi A.,Policlinico Abano Terme | And 2 more authors.
Acta Paediatrica, International Journal of Paediatrics | Year: 2013

Aim The 'two-step' head-to-body delivery method, which involves waiting for the next contraction to deliver the shoulders, causes a decrease in umbilical artery pH. The aim of this study was to assess whether foetal acidemia activates gluconeogenesis. Methods We tested umbilical artery cord blood glucose concentration and pH after 341 spontaneous and 25 vacuum extractor 'two-step' vaginal deliveries (VD) and after 85 elective and 49 emergency caesarean sections (CS). Results Cord blood glucose concentration was significantly higher (95.5 ± 21.4 mg/dL vs 75.6 ± 16.4, p < 0.001), and pH values significantly lower (7.31 ± 0.09 vs 7.33 ± 0.06, p = 0.003) in 'two-step' VD neonates than in CS delivered neonates. In addition, cord blood glucose concentration was significantly higher (101.4 ± 30.6 mg/dL, p = 0.004), and pH values were significantly lower (7.26 ± 0.10, p < 0.001) in VD by vacuum extractor than in all other groups. The cord blood glucose concentration is significantly and negatively correlated with pH in the study population (r = -0.094, p = 0.036) and strongly significantly and negatively correlated in VD by vacuum extractor (r = -0.594, p = 0.007). Conclusion Cord blood glucose concentrations are significantly higher and pH values significantly lower in 'two-step' VD neonates, indicating activated foetal gluconeogenesis. ©2013 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd.


Soldati G.,Valle del Serchio General Hospital | Sher S.,CaGranda Hospital | Testa A.,Policlinico Abano Terme
European Review for Medical and Pharmacological Sciences | Year: 2011

Background: Literature concerning lung ultrasonography is largely growing and opening new diagnostic opportunities. The clinical value of the ultrasonographic interstitioalveolar syndrome, based on artifactual (lung comets or B-lines) rather than real images, in the detection of lung contusion, pneumonia and pulmonary edema, is clearly demonstrated. As clinical echographists, though, we are living the paradox of relying our experience in lung pathology on images whose biophysical and genetic nature is not fully understood. Objective and Perspectives: A detailed review of the ultimate findings with an analysis of recent and past literature regarding the formation of ultrasonographic artifacts was undertaken with the aim of clarifying what we know and where we are heading in this field. It is important for us to underline how lung ultrasonography is not morphological, as this, along with the study of artifact formation, will be the base for the development of a novel 'view' able to take us from artifact to reality in terms of 'quantification' of lung disease and damage. Conclusions: Lung ultrasonographic artifacts need to be read in a new light which will privilege biophysical knowledge and research. In this field a gap of basic knowledge clearly exists. A greater understanding of the formation of acoustic artifacts from ultrasound interference on discretely aerated tissues of variable density, would place the practice of lung "ultrasonography" in the correct technological and clinical position.


Manzi M.,Interventional Radiology Unit | Palena L.M.,Interventional Radiology Unit | Brocco E.,Policlinico Abano Terme
Journal of Cardiovascular Surgery | Year: 2012

Aim. The authors aimed to assess clinical results following percutaneous transluminal angioplasty (PTA) of pedal arteries and digital branches in order to avoid minor amputations or support surgical skin incisions, in patients with CLI and distal wounds on the toes. Methods. Baseline, procedural and mid-term outcome data of all consecutive patients with CLI and ulcerative lesion on the toes, in which endovascular treatment of the foot arteries and digital branches was attempted, were prospectively collected between January 2010 and January 2011. The primary end-point was acute success (i.e. technical, angiographic and procedural success). Secondary end-points included limb, foot and toes salvage rates, minor amputations, reocclusion/restenosis and repeat treatment. Results. 1057 consecutive patients with CLI were treated and in 24 cases (2.3%), after tibial and foot arteries PTA, related to the presence of arterial lesion (stenosis/occlusion) in the digital branches, the recanalization of the target vessel was performed. Acute technical success was achieved in 100% of cases, with adequate angiographic results without peri-procedural complications. Clinical improvement was obtained and maintained after an average of 9 months. Amputation was avoided in 9 patients (37.5%), in 8 patients (29.6%) amputation involved only a distal phalange, in 5 patients (20.8%) toe amputations was necessary, in 2 patients (8.4%) trans-metatarsal amputation was performed. No below the ankle (BTA) or major amputations were performed. Conclusions. Endovascular recanalization of digital branches in patients with CLI and distal wounds on the toes is feasible and safe; represent a support to avoid minor amputations or surgical skin lesion healing.


Ercoli A.,Policlinico Abano Terme | Dasta M.,Policlinico Abano Terme | Fagotti A.,Catholic University | Fanfani F.,Catholic University | And 4 more authors.
Human Reproduction | Year: 2012

Background Deep infiltrating endometriosis (DIE) is a complex disease that impairs the quality of life and the fertility of women. Since a medical approach is often insufficient, a minimally invasive approach is considered the gold standard for complete disease excision. Robotic-assisted surgery is a revolutionary approach, with several advantages compared with traditional laparoscopic surgery.Methods From March 2010 to May 2011, we performed 22 consecutive robotic-assisted complete laparoscopic excisions of DIE endometriosis with colorectal involvement. All clinical data were collected by our team and all patients were interviewed preoperatively and 3 and 6 months post-operatively and yearly thereafter regarding endometriosis-related symptoms. Dysmenorrhoea, dyschezia, dyspareunia and dysuria were evaluated with a 10-point analog rating scale. Results There were 12 patients, with a median larger endometriotic nodule of 35 mm, who underwent segmental resection, and 10 patients, with a median larger endometriotic nodule of 30 mm, who underwent complete nodule debulking by colorectal wall-shaving technique. No laparotomic conversions were performed, nor was any blood transfusion necessary. No intra-operative complications were observed and, in particular, there were no inadvertent rectal perforations in any of the cases treated by the shaving technique. None of the patients had ileostomy or colostomy. No major post-operative complications were observed, except one small bowel occlusion 14 days post-surgery that was resolved in 3 days with medical treatment. Post-operatively, a statistically significant improvement of patient symptoms was shown for all the investigated parameters. Conclusions To our knowledge, this is the first study reporting the feasibility and short-term results and complications of laparoscopic robotic-assisted treatment of DIE with colorectal involvement. We demonstrate that this approach is feasible and safe, without conversion to laparotomy. © 2012 The Author.


De Santis M.,Catholic University of the Sacred Heart | De Luca C.,Catholic University of the Sacred Heart | Mappa I.,Catholic University of the Sacred Heart | Spagnuolo T.,Catholic University of the Sacred Heart | And 3 more authors.
Infectious Diseases in Obstetrics and Gynecology | Year: 2012

Congenital syphilis is still a cause of perinatal morbidity and mortality. Untreated maternal infection leads to adverse pregnancy outcomes, including early fetal loss, stillbirth, prematurity, low birth weight, neonatal and infant death, and congenital disease among newborns. Clinical manifestations of congenital syphilis are influenced by gestational age, stage of maternal syphilis, maternal treatment, and immunological response of the fetus. It has been traditionally classified in early congenital syphilis and late congenital syphilis. Diagnosis of maternal infection is based on clinical findings, serological tests, and direct identification of treponemes in clinical specimens. Adequate treatment of maternal infection is effective for preventing maternal transmission to the fetus and for treating fetal infection. Prenatal diagnosis of congenital syphilis includes noninvasive and invasive diagnosis. Serological screening during pregnancy and during preconception period should be performed to reduce the incidence of congenital syphilis. Copyright © 2012 Marco De Santis et al.


Straface G.,Policlinico Abano Terme | Selmin A.,Policlinico Abano Terme | Zanardo V.,Policlinico Abano Terme | De Santis M.,Catholic University of the Sacred Heart | And 2 more authors.
Infectious Diseases in Obstetrics and Gynecology | Year: 2012

Infection with herpes simplex is one of the most common sexually transmitted infections. Because the infection is common in women of reproductive age it can be contracted and transmitted to the fetus during pregnancy and the newborn. Herpes simplex virus is an important cause of neonatal infection, which can lead to death or long-term disabilities. Rarely in the uterus, it occurs frequently during the transmission delivery. The greatest risk of transmission to the fetus and the newborn occurs in case of an initial maternal infection contracted in the second half of pregnancy. The risk of transmission of maternal-fetal-neonatal herpes simplex can be decreased by performing a treatment with antiviral drugs or resorting to a caesarean section in some specific cases. The purpose of this paper is to provide recommendations on management of herpes simplex infections in pregnancy and strategies to prevent transmission from mother to fetus. Copyright © 2012 Gianluca Straface et al.


Straface G.,Policlinico Abano Terme | Scambia G.,Catholic University of the Sacred Heart | Zanardo V.,Policlinico Abano Terme
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2016

Objective: Each pregravidic, gestational or intrapartum complication may, per se, have a different impact on the operative delivery rate, regardless of which fetal monitoring system was adopted. We wanted to verify if CTG plus ST interval analysis (STAN) of fetal ECG might be able to reduce the number of operative delivery for fetal distress in high-risk pregnancies compared to low-risk women monitored with CTG alone. Materials and methods: In this cohort study, we evaluated 100 high-risk pregnancies consecutively with STAN® S31 (Neoventa Medical, Gotenburg, Sweden) and 160 low-risk pregnancies consecutively with continuous CTG (Hewlett Packard, 50 IP, Palo Alto, CA). Results: We found that STAN monitoring, although associated with a higher total operativity rate, both vaginal (11% versus 3.12%, p = 0.015) and cesarean (17% versus 4.37%, p = 0.001), reduced the cesarean section rate performed for fetal distress (29.41% versus 85.71%, p = 0.023) compared with low-risk CTG monitoring group. Conclusion: CTG plus ST interval analysis of fetal ECG reduced the risk of operative cesarean delivery for fetal distress in high-risk gestations. © 2016 Informa UK Limited, trading as Taylor & Francis Group.


Zanardo V.,Policlinico Abano Terme | Straface G.,Policlinico Abano Terme
PLoS ONE | Year: 2015

Numerous functional features that promote the natural progression of the birth to breastfeeding continuum are concentrated in the human female's areolar region. The aim of this study was to look more closely into the thermal characteristics of areola, which are said to regulate the local evaporation rate of odors and chemical signals that are uniquely important for the neonate's 'breast crawl'. A dermatological study of the areolae and corresponding intern breast quadrants was undertaken on the mothers of 70 consecutive, healthy, full-term breastfed infants. The study took place just after the births at the Policlinico Abano Terme, in Italy from January to February 2014. Temperature, pH and elasticity were assessed one day postpartum using the Soft Plus 5.5 (Callegari S.P.A., Parma, Italy). The mean areolar temperature was found to be significantly higher than the corresponding breast quadrant (34.60 ±1.40°C vs. 34.04 ±2.00°C, p<0.001) and the pH was also significantly higher (4.60 ±0.59 vs. 4.17±0.59, p<0.001). In contrast, the elasticity of the areolar was significantly lower (23.52±7.83 vs. 29.02±8.44%, p<0.003). Our findings show, for the first time, that the areolar region has a higher temperature than the surrounding breast skin, together with higher pH values and lower elasticity. We believe that the higher temperature of the areolar region may act as a thermal signal to guide the infant directly to the nipple and to the natural progression of the birth to breastfeeding continuum. © 2015 Zanardo, Straface.


Savio F.,Policlinico Abano Terme | Zanardo V.,Policlinico Abano Terme
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2015

Objective: To investigate unconscious dynamics in women pregnant with twins, using Lüscher's color test to objectively measure subjective color preferences, and compare them with women with singleton pregnancies. Methods: The color test was administered to 50 Italian women with twin pregnancies and 100 women with singleton pregnancies. Results: Both the twin and singleton pregnancy groups said that violet was their favorite color (50 versus 49%) and brown was their least favorite color (52 versus 44%), indicating that they idealized being pregnant, but also found it physically stressful. The twin pregnancy group chose yellow as their second favorite (28 versus 17%) and were most likely to combine it with their first choice of violet (44 versus 19%, p=0.0006), indicating that they were worried about their relationships with their new babies and wanted to give birth soon. In addition, both groups preferred form 6, the sine curve on a dark background, but rejected the associated brown color 6, revealing that the women felt the need to look after themselves. Conclusions: Both groups idealized being pregnant, but also found it physically stressful. However, the twin pregnancy group was afraid of building relationships with their babies and wanted to give birth soon. © 2014 Informa UK Ltd. All rights reserved.

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