Gianluca Di Luigi | University of L'Aquila (original) (raw)
Papers by Gianluca Di Luigi
Cite this article: Di Luigi G, D’Alfonso A, Patacchiola F, Sollima L, Leocata P, et al. (2016) Se... more Cite this article: Di Luigi G, D’Alfonso A, Patacchiola F, Sollima L, Leocata P, et al. (2016) Selective Fetal Reduction in a Monochorionic Diamniotic Twin Pregnancy with a Discordance in Pena-Shokeir Type I Phenotype. Med J Obstet Gynecol 4(2): 1079. *Corresponding authors Gianluca Di Luigi, Division of Obstetrics and Gynecology, Department of Life, health & Environmental Sciences, University of L’Aquila, U.O.C. Ginecologia ed Ostetricia a DU, Ospedale Civile “SS Annunziata”, 67039 Sulmona (AQ), Italy, Tel: 00393286169568. Email:
Medicina nei secoli, 2015
Ex voto are devotional objects, widely used in Italy as a form of prayer or wish, or as thanksgiv... more Ex voto are devotional objects, widely used in Italy as a form of prayer or wish, or as thanksgiving for a grace received. In a broader historical perspective, votive offerings are hung in Greek, Etruscan, Roman shrines and later in churches or to show gratitude for miracles obtained, healing from illness or infirmity, or as a simple supplication and prayer. The ex voto here presented seem to be unique in the world: made of majolica, they come from the church of St. Roch in Castelli (Abruzzo). They depict breast benign and malignant lesions (mastitis, abscess, fat necrosis, inflammatory cancer, infiltrating carcinoma) in three dimensions, performing an accurate and personalized portrait of breast diseases (in some cases with the depicted name of the sick woman), showing fine details of each disease, and demonstrating accurate knowledge of the female anatomy and pathology.
Clinical and experimental obstetrics & gynecology, 2012
A case report of a primary interstitial ovarian pregnancy is presented. A 37-year-old married wom... more A case report of a primary interstitial ovarian pregnancy is presented. A 37-year-old married woman with two children after two Cesarean sections and a spontaneous abortion, with a contraceptive intrauterine device (IUD) inserted three years before, presented at five weeks plus five days amenorrhea with a positive pregnancy test and lower abdominal pain but with no vaginal bleeding. Her previous menstrual cycles had been regular. She was hemodynamically stable. On bimanual examination, the uterus was of normal size, and there was an approximate four-cm tender right adnexal mass. Serum beta-human chorionic gonadotropin (b-hCG) was confirmed positive. Ultrasound revealed a well-positioned IUD in the uterus and a right adnexal mass with normal vascular flow on Doppler, that contained a well-defined gestational sac, well-distinct from the quiescent hemorrhagic corpus luteum. There was no fetal node or cardiac activity or free fluid. The patient received four injections of methotrexate i...
Clinical and experimental obstetrics & gynecology, 2011
Syndactyly is an unusual condition in humans where two or more digits are fused together. In our ... more Syndactyly is an unusual condition in humans where two or more digits are fused together. In our report we present a case of prenatal diagnosis of simple, complete, bilateral syndactyly as the only ultrasonographic anomaly in a fetus with Down's syndrome. The mother, a 30-year-old, gravida 2, was referred to our hospital with an abnormal triple-test at 17 weeks of gestation, with a final biochemical risk for Down's syndrome more than 1:50. In this pregnancy neither the NT test nor early morphological exam showed typical findings of any chromosomal disorder. The patient underwent amniocentesis. We performed an accurate second level scan at 21 weeks while waiting for genetic results, and we suspected simple, complete, bilateral syndactyly between the third and fourth finger of the hands (rapper sign). The result of the invasive test was 47,XY,+21 and the mother opted for termination of pregnancy; the baby showed simple, complete, bilateral syndactyly of the two digits as suspe...
Reproductive Biology, 2019
Endometriosis can impair fertility by reducing ovarian reserve and the production of good-quality... more Endometriosis can impair fertility by reducing ovarian reserve and the production of good-quality oocytes. The surgical removal of endometriotic lesions is generally recommended for women who wish to conceive. In this paper we studied whether ovarian cortex adjacent to excised small (diameter ≤ 4 cm) endometriotic cyst (here referred as Cortex Surrounding Endometriotic Cyst, CSEC) showed signs of tissue damages by evaluating the expression of proteins involved in DNA repair and apoptosis. To this end, phosphorylated H2A.X, Chk1 and 2, ATM and ATR, Bcl-2, Bid, phosphorylated and total p53, caspases (9, 8 and 3), XIAP, phosphorylated and total NFκB were analyzed by western blot. Results showed that caspase 8, XIAP, p53/p-p53 and NFκB were more abundantly expressed in all samples of CSEC group in comparison with ovarian cortex of controls. Conversely, the levels of the other proteins were comparable between the two groups. In conclusion, these results suggest that NFκB, caspase 8 and p53/p-p53 elevated expressions in samples of CSEC can be considered as an early sign of tissue injury, indicating that ovarian cortex is already sensitized to apoptosis and inflammation. Therefore, excision of EC should occur very early, to avoid further ovarian damages.
Journal of Breastfeeding Biology, 2015
Background: Scientific research is constantly expanding our knowledge of nutritional needs in pre... more Background: Scientific research is constantly expanding our knowledge of nutritional needs in pregnancy and lactation. In June 2014 the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) issued draft-revised advice encouraging pregnant women, those who might become pregnant, breastfeeding mothers and young children to eat more fish, a total of least 8 ounces per week and to eat a variety of fish lower in mercury in particular anchovies, butterfish, catfish, clam, haddock (Atlantic), herring, mullet, oyster, perch (ocean), sardine, shad, trout (freshwater). However, the presence of radionuclides released from the damaged Fukushima Daiichi nuclear power plant in Pacific biota has aroused worldwide attention and concern. Objective and Methods: Evaluating all the scientific literature available after the Fukushima nuclear disaster, the aim of this review is to demonstrate the safety of seafood products and the use of omega-3 supplements potentially derived ...
We here report the first case of discordant Pena-Shokeir phenotype observed in monochorionic diam... more We here report the first case of discordant Pena-Shokeir phenotype observed in monochorionic diamniotic twins. A 41-year-old woman, pregnant with twins, was referrend at 12 weeks’ gestation because the combined test was altered. Serial ultrasonographic examination suggested that twin A may have had arthrogryposis, micrognathia, kyphoscoliosis, fixed flexion of the limbs, polyhydramnios, myocardial
ventricular hypertrophy, lack of visualization of the stomach, pulmonary hypoplasia, decreased movements, low-set ear, hypertelorism and rocker-bottom feet with a 10% restriction of growth. Twin B showed normal growth, no structural abnormalities, but a severe oligohydramnios. At 31 weeks of gestation a selective reduction of twin A was performed. At 32 weeks of gestation, the twins were delivered by cesarean section. Autopsy findings of twin A were consistent with the diagnosis of Pena-Shokeir phenotype. We suggest that cerebral injury during early gestation is a possible cause for the occurrence of Pena-Shokeir phenotype through an anoxic-ischemic mechanism.
Clinical and experimental obstetrics & gynecology, 2013
Placenta accreta refers to any abnormally invasive placental implantation. Diagnosis is suspected... more Placenta accreta refers to any abnormally invasive placental implantation. Diagnosis is suspected postpartum with failed delivery of a retained placenta. Massive obstetrical hemorrhage is a known complication, often requiring peripartum hysterectomy. The authors report a case of placenta accreta in a primiparous patient with multinodular leiofibromyomatosis of the uterus following failed manual removals of a retained placenta. They describe a conservative management in a stable patient desiring future fertility with a unilateral prophylactic uterine artery embolization, a multidose regimen of methotrexate, and a subsequent abdominal myomectomy.
A case report of a primary interstitial ovarian pregnancy is presented. A 37-year-old married wom... more A case report of a primary interstitial ovarian pregnancy is presented. A 37-year-old married woman with two children after two Cesarean sections and a spontaneous abortion, with a contraceptive intrauterine device (IUD) inserted three years before, presented at five weeks plus five days amenorrhea with a positive pregnancy test and lower abdominal pain but with no vaginal bleeding. Her previous menstrual cycles had been regular. She was hemodynamically stable. On bimanual examination, the uterus was of normal size, and there was an approximate four-cm tender right adnexal mass. Serum beta-human chorionic gonadotropin (b-hCG) was confirmed positive. Ultrasound revealed a well-positioned IUD in the uterus and a right adnexal mass with normal vascular flow on Doppler, that contained a well-defined gestational sac, well-distinct from the quiescent hemorrhagic corpus luteum. There was no fetal node or cardiac activity or free fluid. The patient received four injections of methotrexate intramuscularly using the multidose regimen that involves the administration of methotrexate calculated according to body weight, alternated with 0.1 mg/kg of leucovorin calcium per os after 30 hours until the values of 3-hCG had decreased by 15%. The patient's post-treatment period was uneventful with a full restoration of ovarian morphology and the complete absorption of the gestational sac. This case is the first where diagnosis was made by endovaginal sonography and treatment was made by multidose methotrexate. Spiegelberg criteria for the diagnosis of ovarian pregnancy are obsolete; new ultrasound and laboratory criteria are needed for a diagnosis as early as possible without the need of surgery.
Syndactyly is an unusual condition in humans where two or more digits are fused together. In our ... more Syndactyly is an unusual condition in humans where two or more digits are fused together. In our report we present a case of prenatal diagnosis of simple, complete, bilateral syndactyly as the only ultrasonographic anomaly in a fetus with Down's syndrome. The mother, a 30-year-old, gravida 2, was referred to our hospital with an abnormal triple-test at 17 weeks of gestation, with a final biochemical risk for Down's syndrome more than 1:50. In this pregnancy neither the NT test nor early morphological exam showed typical findings of any chromosomal disorder. The patient underwent amniocentesis. We performed an accurate second level scan at 21 weeks while waiting for genetic results, and we suspected simple, complete, bilateral syndactyly between the third and fourth finger of the hands (rapper sign). The result of the invasive test was 47,XY,+21 and the mother opted for termination of pregnancy; the baby showed simple, complete, bilateral syndactyly of the two digits as suspected during sonography. In presenting our case report, we want to stress the importance of the accuracy of observation of fetal hand morphology, attitude, movements and reactivity. When the observation of fetal hands is not satisfactory (e.g., when the fetus does not open the fist), we recommend external stimulation of fetal reactivity through probe movements on the maternal abdomen (dynamic scan). This approach can make the identification of subtle hand anomalies easier and improve the detection rate of both structural and genetic fetal disorders.
Background: Scientific research is constantly expanding our knowledge of nutritional needs in pre... more Background: Scientific research is constantly expanding our knowledge of nutritional needs in pregnancy and lactation. In June 2014 the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) issued draft-revised advice encouraging pregnant women, those who might become pregnant, breastfeeding mothers and young children to eat more fish, a total of least 8 ounces per week and to eat a variety of fish lower in mercury in particular anchovies, butterfish, catfish, clam, haddock (Atlantic), herring, mullet, oyster, perch (ocean), sardine, shad, trout (freshwater). However, the presence of radionuclides released from the damaged Fukushima Daiichi nuclear power plant in Pacific biota has aroused worldwide attention and concern.
Objective and Methods: Evaluating all the scientific literature available after the Fukushima nuclear disaster, the aim of this review is to demonstrate the safety of seafood products and the use of omega-3 supplements potentially derived from contaminated radioactive fish.
Results and Conclusions: There are no reasons to fear the amount of radiation in Japanese fish. The dose received from seafood consumption can be estimated to result in two additional fatal cancer cases per 10,000,000 similarly exposed people. The safest way to get omega-3 fatty acids during pregnancy is by taking a high-quality fish oil supplement, approved by a governing body that provides proof of quality such as the Council for Responsible Nutrition, the European Pharmocopeia Standard or the Norwegian Medicinal Standard and by the Food and Drug Administration or the Environmental Protection Agency [1, 2].
Pregnant and breastfeeding women do not need to cut fish out of their diet completely, and it may be safely eaten up to three times per week safely [3].
In vaste aree del mondo, nel sud-est asiatico, in Birmania, in India, in zone del Centro America,... more In vaste aree del mondo, nel sud-est asiatico, in Birmania, in India, in zone del Centro America, del Sud America ed Africa, 50 milioni di donne quest' anno daranno alla luce i loro figli nel dolore, come negli antichi tempi biblici, esposte a gravi pericoli. In conseguenza di ciò oggi, come sempre nel passato, centinaia di migliaia di giovani madri, ogni anno, subiscono lesioni da parto; lesioni che le riducono allo stato del più miserabile tra gli ultimi esseri umani… Costantemente nel dolore, incontinenti alle urine ed alle feci… abbandonate dai propri mariti, escluse dalla società, senza possibilità di trovare un lavoro se non nei campi, esse vivono, esistono, senza amici e senza speranza. Dato che le loro lesioni sono pudende, interessano parti del corpo che devono essere nascoste alla vista e delle quali una donna non può parlare apertamente, esse sopportano le proprie menomazioni in silenziosa vergogna. Nessuna organizzazione umanitaria si occupa di loro. La loro miseria è assoluta, solitaria, completa. " RHY Hamilin and E Catherine Nicholson, 1966.
Ex voto are devotional objects, widely used in Italy as a form of prayer or wish, or as thanksgiv... more Ex voto are devotional objects, widely used in Italy as a form of prayer or wish, or as thanksgiving for a grace received. In a broader historical perspective, votive offerings are hung in Greek, Etruscan, Roman shrines and later in churches or to show gratitude for miracles obtained, healing from illness or infirmity, or as a simple supplication and prayer. The ex voto here presented seem to be unique in the world: made of majolica, they come from the church of St. Roch in Castelli (Abruzzo). They depict breast benign and malignant lesions (mastitis, abscess, fat necrosis, inflammatory cancer, infiltrating carcinoma) in three dimensions, performing an accurate and personalized portrait of breast diseases (in some cases with the depicted name of the sick woman), showing fine details of each disease, and demonstrating accurate knowledge of the female anatomy and pathology.
European journal of gynaecological oncology
The malignant transformation of a uterine leiomyoma is still debated and, if it occurs, it is ver... more The malignant transformation of a uterine leiomyoma is still debated and, if it occurs, it is very rare. The case of a patient affected by one small leiomyoma is described. Diagnosis was made postoperatively on histopathological examination. The case reported here is meant to underline the need to keep all uterine myomas in check since the transition into leiomyosarcomas (LMSs) may occur with an evolution over a time period which has not been established so far. Specific receptors for luteinizing hormone/human chorionic gonadotropin (LH/hCG) have also been identified in the myometrium of several animal species, including humans. Conventional LMSs express estrogen receptors (ER), progesterone receptors (PR), and androgen receptors (AR) in 30-40% of cases. In comparison with other more common uterine malignancies, uterine LMSs bear some resemblance to type 2 endometrial carcinomas and high-grade serous carcinomas of ovary/fallopian tube origin, based on their genetic instability, frequent p53 abnormalities, aggressive behavior, and resistance to chemotherapy. It could be useful to understand with further researches if hormonal stimulation could be a contributing factor of uterine leiomyoma transformation into LMS. Until today the oncogenic mechanisms underlying the development of uterine LMSs remain elusive.
Clinical and experimental obstetrics & gynecology, 2013
Placenta accreta refers to any abnormally invasive placental implantation. Diagnosis is suspected... more Placenta accreta refers to any abnormally invasive placental implantation. Diagnosis is suspected postpartum with failed delivery of a retained placenta. Massive obstetrical hemorrhage is a known complication, often requiring peripartum hysterectomy. The authors report a case of placenta accreta in a primiparous patient with multinodular leiofibromyomatosis of the uterus following failed manual removals of a retained placenta. They describe a conservative management in a stable patient desiring future fertility with a unilateral prophylactic uterine artery embolization, a multidose regimen of methotrexate, and a subsequent abdominal myomectomy.
Journal of Assisted Reproduction and Genetics, 2014
To understand if repeated cycles (2-4 rounds) of gonadotropin stimulation could affect intracellu... more To understand if repeated cycles (2-4 rounds) of gonadotropin stimulation could affect intracellular localization/content of proteins controlling cell cycle progression in mouse fallopian tubes (FT) and ovaries. FT and ovaries of estrous mice (control) and of stimulated mice were analyzed to detect Oct-3/4, Sox-2, p53, β-catenin, pAKT and cyclin D1 localization/content. Spindles and chromosome alignment were analyzed in ovulated oocytes. After round 4, FT and ovaries of control and stimulated groups showed no differences in Oct-3/4, Sox-2 and β-catenin localization nor in Oct-3/4, Sox-2, p53, β-catenin and pAKT contents. Cyclin D1 level increased significantly in FT of treated mice. Oocytes number decreased meanwhile frequency of abnormal meiotic spindles increased with treatments. Repetitive stimulations affected oocyte spindle morphology but did not induce changes in a set of proteins involved in cell cycle progression, usually altered in ovarian cancer. The significant increase of cyclin D1 in the FT requires further investigation.
Environmental Toxicology, 2013
Trifluralin, a herbicide used to protect many arable and horticultural crops, was evaluated for i... more Trifluralin, a herbicide used to protect many arable and horticultural crops, was evaluated for its potential toxicity on the mammalian ovary. To this end, adult female mice were fed or not (control) with a trifluralin-enriched diet (150 mg/kg body weight/day) during gestation and lactation. After weaning, 3-week-old female mice from either trifluralin-treated or control groups were used to evaluate whether the exposure to this herbicide in utero and during lactation could induce stress responses in the ovary. It was found that trifluralin exposure caused a significantly higher level of p53, but not of pRb, in the whole ovary, and in particular in granulosa cells. TUNEL staining showed that herbicide treatment did not increase the apoptotic index of the somatic compartment. Also oocyte fertilizability was unaffected, as metaphase II oocytes retrieved from treated mice were capable of forming male and female pronuclei after in vitro fertilization as control mice. However, trifluralin determined a slightly higher number of oocytes with cytoplasmic degeneration compared with control animals. In conclusion, our results suggest that exposure to a low trifluralin dose during pregnancy and lactation does not impair oocyte quality, but can induce a stress response in ovarian somatic cells.
Ex-votos are a particular category of devotional objects widely used in Italy as a form of prayer... more Ex-votos are a particular category of devotional objects widely used in Italy as a form of prayer or wish,
or as a symbol of thanksgiving for a grace received. Historically, ex-votos are hung in churches or shrines
to show gratitude for a miracle, a healing of a disease or infirmity, or as a supplication.
The votive offerings here presented, all dating from the Eighteenth and Nineteenth centuries, are
unique in the world: they are made of majolica (a special type of ceramic produced in various Italian
towns), and come from the rural church of St. Roch in the municipality of Castelli (Abruzzo, Italy).
They depict breast benign and malignant lesions (mastitis, abscess, fat necrosis, inflammatory cancer,
infiltrating carcinoma) in three dimensions, performing an accurate and personalized portrait of breast
diseases (in some cases with the depicted name of the sick woman), showing fine details of each
disease, and demonstrating an accurate knowledge of the female anatomy and pathologies in question.
The expression of our relationship with illness is wonderfully illustrated in these unique votive
offerings, devotional hand-painted ceramics, symbols of a supplications to St. Roch for a miraculous
healing. These devotional majolicas are an individual’s expression of request for the intercession of the
divine in time of illness. They offer a rare opportunity to view health, healing, and illness through the
hearts and minds of the ordinary person.
The female breast is a symbol of fertility and in the same time related to diseases caused by infertility.
The presence of so many breasts made of ceramic in the church of St. Roch in Castelli, confirms the
importance of breast-feeding as the main source of life for the offspring and suggests a high incidence
of breast disease among the local population, perhaps a genetic mutation in a woman ancestor.
Conference Presentations by Gianluca Di Luigi
Objective: Nulliparity and menopause are considered risk factors for ovarian cancer. Nulliparity ... more Objective: Nulliparity and menopause are considered risk factors for ovarian cancer. Nulliparity represents a condition capable of affecting the expression levels of the pro-angiogenic factors and modulating the degree of phosphorylation of signals involved in endothelial cell proliferation. This experimental animal study involved a total of 40 CD1 female mice, young (4-months-old) and old (15-months-old), both parous and nulliparous, where the expression levels of VEGF, VEGFR2, ERK2, Akt and PTEN proteins were determined. Methods: Mice, called Mothers (M), were mated and sacrificed after the first pregnancy and lactation (Young, Y, n = 10) or at 15 month (Old, O, n = 10) of age, when they're in menopause. The same protocol was adopted for the group of nulliparous mice, called Virgins (V), sacrificed without mating either young (YV, n = 10) or old (OV, n=10). Ovaries were collected and stored for Western blot analysis. The expression levels of VEGF, VEGFR2, ERK2, Akt and PTEN proteins were determined into the 4 groups. Results: VEGF content was always higher in V than in M, but no age-dependent increase of VEGF was recorded in V because of the high levels already present in the YV. VEGFR2 content was higher in V than in M, and was accumulated in OV. Akt and ERK2 were phosphorylated more efficiently in V than in M. PTEN was under phosphorylated in OV. Conclusion: The finding that in the ovaries of nulliparous (V) mice the expression levels of pro-angiogenic proteins are enhanced in comparison to parous (M) mice, contributes to explain epidemiological data by providing the first molecular explanation of the protective role of pregnancy on female health; the over-expression of specific pro-angiogenic proteins and their over-activity can contribute to explain the reason why the incidence of ovarian cancer in nulliparous women is higher than in parous ones.
Cite this article: Di Luigi G, D’Alfonso A, Patacchiola F, Sollima L, Leocata P, et al. (2016) Se... more Cite this article: Di Luigi G, D’Alfonso A, Patacchiola F, Sollima L, Leocata P, et al. (2016) Selective Fetal Reduction in a Monochorionic Diamniotic Twin Pregnancy with a Discordance in Pena-Shokeir Type I Phenotype. Med J Obstet Gynecol 4(2): 1079. *Corresponding authors Gianluca Di Luigi, Division of Obstetrics and Gynecology, Department of Life, health & Environmental Sciences, University of L’Aquila, U.O.C. Ginecologia ed Ostetricia a DU, Ospedale Civile “SS Annunziata”, 67039 Sulmona (AQ), Italy, Tel: 00393286169568. Email:
Medicina nei secoli, 2015
Ex voto are devotional objects, widely used in Italy as a form of prayer or wish, or as thanksgiv... more Ex voto are devotional objects, widely used in Italy as a form of prayer or wish, or as thanksgiving for a grace received. In a broader historical perspective, votive offerings are hung in Greek, Etruscan, Roman shrines and later in churches or to show gratitude for miracles obtained, healing from illness or infirmity, or as a simple supplication and prayer. The ex voto here presented seem to be unique in the world: made of majolica, they come from the church of St. Roch in Castelli (Abruzzo). They depict breast benign and malignant lesions (mastitis, abscess, fat necrosis, inflammatory cancer, infiltrating carcinoma) in three dimensions, performing an accurate and personalized portrait of breast diseases (in some cases with the depicted name of the sick woman), showing fine details of each disease, and demonstrating accurate knowledge of the female anatomy and pathology.
Clinical and experimental obstetrics & gynecology, 2012
A case report of a primary interstitial ovarian pregnancy is presented. A 37-year-old married wom... more A case report of a primary interstitial ovarian pregnancy is presented. A 37-year-old married woman with two children after two Cesarean sections and a spontaneous abortion, with a contraceptive intrauterine device (IUD) inserted three years before, presented at five weeks plus five days amenorrhea with a positive pregnancy test and lower abdominal pain but with no vaginal bleeding. Her previous menstrual cycles had been regular. She was hemodynamically stable. On bimanual examination, the uterus was of normal size, and there was an approximate four-cm tender right adnexal mass. Serum beta-human chorionic gonadotropin (b-hCG) was confirmed positive. Ultrasound revealed a well-positioned IUD in the uterus and a right adnexal mass with normal vascular flow on Doppler, that contained a well-defined gestational sac, well-distinct from the quiescent hemorrhagic corpus luteum. There was no fetal node or cardiac activity or free fluid. The patient received four injections of methotrexate i...
Clinical and experimental obstetrics & gynecology, 2011
Syndactyly is an unusual condition in humans where two or more digits are fused together. In our ... more Syndactyly is an unusual condition in humans where two or more digits are fused together. In our report we present a case of prenatal diagnosis of simple, complete, bilateral syndactyly as the only ultrasonographic anomaly in a fetus with Down's syndrome. The mother, a 30-year-old, gravida 2, was referred to our hospital with an abnormal triple-test at 17 weeks of gestation, with a final biochemical risk for Down's syndrome more than 1:50. In this pregnancy neither the NT test nor early morphological exam showed typical findings of any chromosomal disorder. The patient underwent amniocentesis. We performed an accurate second level scan at 21 weeks while waiting for genetic results, and we suspected simple, complete, bilateral syndactyly between the third and fourth finger of the hands (rapper sign). The result of the invasive test was 47,XY,+21 and the mother opted for termination of pregnancy; the baby showed simple, complete, bilateral syndactyly of the two digits as suspe...
Reproductive Biology, 2019
Endometriosis can impair fertility by reducing ovarian reserve and the production of good-quality... more Endometriosis can impair fertility by reducing ovarian reserve and the production of good-quality oocytes. The surgical removal of endometriotic lesions is generally recommended for women who wish to conceive. In this paper we studied whether ovarian cortex adjacent to excised small (diameter ≤ 4 cm) endometriotic cyst (here referred as Cortex Surrounding Endometriotic Cyst, CSEC) showed signs of tissue damages by evaluating the expression of proteins involved in DNA repair and apoptosis. To this end, phosphorylated H2A.X, Chk1 and 2, ATM and ATR, Bcl-2, Bid, phosphorylated and total p53, caspases (9, 8 and 3), XIAP, phosphorylated and total NFκB were analyzed by western blot. Results showed that caspase 8, XIAP, p53/p-p53 and NFκB were more abundantly expressed in all samples of CSEC group in comparison with ovarian cortex of controls. Conversely, the levels of the other proteins were comparable between the two groups. In conclusion, these results suggest that NFκB, caspase 8 and p53/p-p53 elevated expressions in samples of CSEC can be considered as an early sign of tissue injury, indicating that ovarian cortex is already sensitized to apoptosis and inflammation. Therefore, excision of EC should occur very early, to avoid further ovarian damages.
Journal of Breastfeeding Biology, 2015
Background: Scientific research is constantly expanding our knowledge of nutritional needs in pre... more Background: Scientific research is constantly expanding our knowledge of nutritional needs in pregnancy and lactation. In June 2014 the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) issued draft-revised advice encouraging pregnant women, those who might become pregnant, breastfeeding mothers and young children to eat more fish, a total of least 8 ounces per week and to eat a variety of fish lower in mercury in particular anchovies, butterfish, catfish, clam, haddock (Atlantic), herring, mullet, oyster, perch (ocean), sardine, shad, trout (freshwater). However, the presence of radionuclides released from the damaged Fukushima Daiichi nuclear power plant in Pacific biota has aroused worldwide attention and concern. Objective and Methods: Evaluating all the scientific literature available after the Fukushima nuclear disaster, the aim of this review is to demonstrate the safety of seafood products and the use of omega-3 supplements potentially derived ...
We here report the first case of discordant Pena-Shokeir phenotype observed in monochorionic diam... more We here report the first case of discordant Pena-Shokeir phenotype observed in monochorionic diamniotic twins. A 41-year-old woman, pregnant with twins, was referrend at 12 weeks’ gestation because the combined test was altered. Serial ultrasonographic examination suggested that twin A may have had arthrogryposis, micrognathia, kyphoscoliosis, fixed flexion of the limbs, polyhydramnios, myocardial
ventricular hypertrophy, lack of visualization of the stomach, pulmonary hypoplasia, decreased movements, low-set ear, hypertelorism and rocker-bottom feet with a 10% restriction of growth. Twin B showed normal growth, no structural abnormalities, but a severe oligohydramnios. At 31 weeks of gestation a selective reduction of twin A was performed. At 32 weeks of gestation, the twins were delivered by cesarean section. Autopsy findings of twin A were consistent with the diagnosis of Pena-Shokeir phenotype. We suggest that cerebral injury during early gestation is a possible cause for the occurrence of Pena-Shokeir phenotype through an anoxic-ischemic mechanism.
Clinical and experimental obstetrics & gynecology, 2013
Placenta accreta refers to any abnormally invasive placental implantation. Diagnosis is suspected... more Placenta accreta refers to any abnormally invasive placental implantation. Diagnosis is suspected postpartum with failed delivery of a retained placenta. Massive obstetrical hemorrhage is a known complication, often requiring peripartum hysterectomy. The authors report a case of placenta accreta in a primiparous patient with multinodular leiofibromyomatosis of the uterus following failed manual removals of a retained placenta. They describe a conservative management in a stable patient desiring future fertility with a unilateral prophylactic uterine artery embolization, a multidose regimen of methotrexate, and a subsequent abdominal myomectomy.
A case report of a primary interstitial ovarian pregnancy is presented. A 37-year-old married wom... more A case report of a primary interstitial ovarian pregnancy is presented. A 37-year-old married woman with two children after two Cesarean sections and a spontaneous abortion, with a contraceptive intrauterine device (IUD) inserted three years before, presented at five weeks plus five days amenorrhea with a positive pregnancy test and lower abdominal pain but with no vaginal bleeding. Her previous menstrual cycles had been regular. She was hemodynamically stable. On bimanual examination, the uterus was of normal size, and there was an approximate four-cm tender right adnexal mass. Serum beta-human chorionic gonadotropin (b-hCG) was confirmed positive. Ultrasound revealed a well-positioned IUD in the uterus and a right adnexal mass with normal vascular flow on Doppler, that contained a well-defined gestational sac, well-distinct from the quiescent hemorrhagic corpus luteum. There was no fetal node or cardiac activity or free fluid. The patient received four injections of methotrexate intramuscularly using the multidose regimen that involves the administration of methotrexate calculated according to body weight, alternated with 0.1 mg/kg of leucovorin calcium per os after 30 hours until the values of 3-hCG had decreased by 15%. The patient's post-treatment period was uneventful with a full restoration of ovarian morphology and the complete absorption of the gestational sac. This case is the first where diagnosis was made by endovaginal sonography and treatment was made by multidose methotrexate. Spiegelberg criteria for the diagnosis of ovarian pregnancy are obsolete; new ultrasound and laboratory criteria are needed for a diagnosis as early as possible without the need of surgery.
Syndactyly is an unusual condition in humans where two or more digits are fused together. In our ... more Syndactyly is an unusual condition in humans where two or more digits are fused together. In our report we present a case of prenatal diagnosis of simple, complete, bilateral syndactyly as the only ultrasonographic anomaly in a fetus with Down's syndrome. The mother, a 30-year-old, gravida 2, was referred to our hospital with an abnormal triple-test at 17 weeks of gestation, with a final biochemical risk for Down's syndrome more than 1:50. In this pregnancy neither the NT test nor early morphological exam showed typical findings of any chromosomal disorder. The patient underwent amniocentesis. We performed an accurate second level scan at 21 weeks while waiting for genetic results, and we suspected simple, complete, bilateral syndactyly between the third and fourth finger of the hands (rapper sign). The result of the invasive test was 47,XY,+21 and the mother opted for termination of pregnancy; the baby showed simple, complete, bilateral syndactyly of the two digits as suspected during sonography. In presenting our case report, we want to stress the importance of the accuracy of observation of fetal hand morphology, attitude, movements and reactivity. When the observation of fetal hands is not satisfactory (e.g., when the fetus does not open the fist), we recommend external stimulation of fetal reactivity through probe movements on the maternal abdomen (dynamic scan). This approach can make the identification of subtle hand anomalies easier and improve the detection rate of both structural and genetic fetal disorders.
Background: Scientific research is constantly expanding our knowledge of nutritional needs in pre... more Background: Scientific research is constantly expanding our knowledge of nutritional needs in pregnancy and lactation. In June 2014 the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) issued draft-revised advice encouraging pregnant women, those who might become pregnant, breastfeeding mothers and young children to eat more fish, a total of least 8 ounces per week and to eat a variety of fish lower in mercury in particular anchovies, butterfish, catfish, clam, haddock (Atlantic), herring, mullet, oyster, perch (ocean), sardine, shad, trout (freshwater). However, the presence of radionuclides released from the damaged Fukushima Daiichi nuclear power plant in Pacific biota has aroused worldwide attention and concern.
Objective and Methods: Evaluating all the scientific literature available after the Fukushima nuclear disaster, the aim of this review is to demonstrate the safety of seafood products and the use of omega-3 supplements potentially derived from contaminated radioactive fish.
Results and Conclusions: There are no reasons to fear the amount of radiation in Japanese fish. The dose received from seafood consumption can be estimated to result in two additional fatal cancer cases per 10,000,000 similarly exposed people. The safest way to get omega-3 fatty acids during pregnancy is by taking a high-quality fish oil supplement, approved by a governing body that provides proof of quality such as the Council for Responsible Nutrition, the European Pharmocopeia Standard or the Norwegian Medicinal Standard and by the Food and Drug Administration or the Environmental Protection Agency [1, 2].
Pregnant and breastfeeding women do not need to cut fish out of their diet completely, and it may be safely eaten up to three times per week safely [3].
In vaste aree del mondo, nel sud-est asiatico, in Birmania, in India, in zone del Centro America,... more In vaste aree del mondo, nel sud-est asiatico, in Birmania, in India, in zone del Centro America, del Sud America ed Africa, 50 milioni di donne quest' anno daranno alla luce i loro figli nel dolore, come negli antichi tempi biblici, esposte a gravi pericoli. In conseguenza di ciò oggi, come sempre nel passato, centinaia di migliaia di giovani madri, ogni anno, subiscono lesioni da parto; lesioni che le riducono allo stato del più miserabile tra gli ultimi esseri umani… Costantemente nel dolore, incontinenti alle urine ed alle feci… abbandonate dai propri mariti, escluse dalla società, senza possibilità di trovare un lavoro se non nei campi, esse vivono, esistono, senza amici e senza speranza. Dato che le loro lesioni sono pudende, interessano parti del corpo che devono essere nascoste alla vista e delle quali una donna non può parlare apertamente, esse sopportano le proprie menomazioni in silenziosa vergogna. Nessuna organizzazione umanitaria si occupa di loro. La loro miseria è assoluta, solitaria, completa. " RHY Hamilin and E Catherine Nicholson, 1966.
Ex voto are devotional objects, widely used in Italy as a form of prayer or wish, or as thanksgiv... more Ex voto are devotional objects, widely used in Italy as a form of prayer or wish, or as thanksgiving for a grace received. In a broader historical perspective, votive offerings are hung in Greek, Etruscan, Roman shrines and later in churches or to show gratitude for miracles obtained, healing from illness or infirmity, or as a simple supplication and prayer. The ex voto here presented seem to be unique in the world: made of majolica, they come from the church of St. Roch in Castelli (Abruzzo). They depict breast benign and malignant lesions (mastitis, abscess, fat necrosis, inflammatory cancer, infiltrating carcinoma) in three dimensions, performing an accurate and personalized portrait of breast diseases (in some cases with the depicted name of the sick woman), showing fine details of each disease, and demonstrating accurate knowledge of the female anatomy and pathology.
European journal of gynaecological oncology
The malignant transformation of a uterine leiomyoma is still debated and, if it occurs, it is ver... more The malignant transformation of a uterine leiomyoma is still debated and, if it occurs, it is very rare. The case of a patient affected by one small leiomyoma is described. Diagnosis was made postoperatively on histopathological examination. The case reported here is meant to underline the need to keep all uterine myomas in check since the transition into leiomyosarcomas (LMSs) may occur with an evolution over a time period which has not been established so far. Specific receptors for luteinizing hormone/human chorionic gonadotropin (LH/hCG) have also been identified in the myometrium of several animal species, including humans. Conventional LMSs express estrogen receptors (ER), progesterone receptors (PR), and androgen receptors (AR) in 30-40% of cases. In comparison with other more common uterine malignancies, uterine LMSs bear some resemblance to type 2 endometrial carcinomas and high-grade serous carcinomas of ovary/fallopian tube origin, based on their genetic instability, frequent p53 abnormalities, aggressive behavior, and resistance to chemotherapy. It could be useful to understand with further researches if hormonal stimulation could be a contributing factor of uterine leiomyoma transformation into LMS. Until today the oncogenic mechanisms underlying the development of uterine LMSs remain elusive.
Clinical and experimental obstetrics & gynecology, 2013
Placenta accreta refers to any abnormally invasive placental implantation. Diagnosis is suspected... more Placenta accreta refers to any abnormally invasive placental implantation. Diagnosis is suspected postpartum with failed delivery of a retained placenta. Massive obstetrical hemorrhage is a known complication, often requiring peripartum hysterectomy. The authors report a case of placenta accreta in a primiparous patient with multinodular leiofibromyomatosis of the uterus following failed manual removals of a retained placenta. They describe a conservative management in a stable patient desiring future fertility with a unilateral prophylactic uterine artery embolization, a multidose regimen of methotrexate, and a subsequent abdominal myomectomy.
Journal of Assisted Reproduction and Genetics, 2014
To understand if repeated cycles (2-4 rounds) of gonadotropin stimulation could affect intracellu... more To understand if repeated cycles (2-4 rounds) of gonadotropin stimulation could affect intracellular localization/content of proteins controlling cell cycle progression in mouse fallopian tubes (FT) and ovaries. FT and ovaries of estrous mice (control) and of stimulated mice were analyzed to detect Oct-3/4, Sox-2, p53, β-catenin, pAKT and cyclin D1 localization/content. Spindles and chromosome alignment were analyzed in ovulated oocytes. After round 4, FT and ovaries of control and stimulated groups showed no differences in Oct-3/4, Sox-2 and β-catenin localization nor in Oct-3/4, Sox-2, p53, β-catenin and pAKT contents. Cyclin D1 level increased significantly in FT of treated mice. Oocytes number decreased meanwhile frequency of abnormal meiotic spindles increased with treatments. Repetitive stimulations affected oocyte spindle morphology but did not induce changes in a set of proteins involved in cell cycle progression, usually altered in ovarian cancer. The significant increase of cyclin D1 in the FT requires further investigation.
Environmental Toxicology, 2013
Trifluralin, a herbicide used to protect many arable and horticultural crops, was evaluated for i... more Trifluralin, a herbicide used to protect many arable and horticultural crops, was evaluated for its potential toxicity on the mammalian ovary. To this end, adult female mice were fed or not (control) with a trifluralin-enriched diet (150 mg/kg body weight/day) during gestation and lactation. After weaning, 3-week-old female mice from either trifluralin-treated or control groups were used to evaluate whether the exposure to this herbicide in utero and during lactation could induce stress responses in the ovary. It was found that trifluralin exposure caused a significantly higher level of p53, but not of pRb, in the whole ovary, and in particular in granulosa cells. TUNEL staining showed that herbicide treatment did not increase the apoptotic index of the somatic compartment. Also oocyte fertilizability was unaffected, as metaphase II oocytes retrieved from treated mice were capable of forming male and female pronuclei after in vitro fertilization as control mice. However, trifluralin determined a slightly higher number of oocytes with cytoplasmic degeneration compared with control animals. In conclusion, our results suggest that exposure to a low trifluralin dose during pregnancy and lactation does not impair oocyte quality, but can induce a stress response in ovarian somatic cells.
Ex-votos are a particular category of devotional objects widely used in Italy as a form of prayer... more Ex-votos are a particular category of devotional objects widely used in Italy as a form of prayer or wish,
or as a symbol of thanksgiving for a grace received. Historically, ex-votos are hung in churches or shrines
to show gratitude for a miracle, a healing of a disease or infirmity, or as a supplication.
The votive offerings here presented, all dating from the Eighteenth and Nineteenth centuries, are
unique in the world: they are made of majolica (a special type of ceramic produced in various Italian
towns), and come from the rural church of St. Roch in the municipality of Castelli (Abruzzo, Italy).
They depict breast benign and malignant lesions (mastitis, abscess, fat necrosis, inflammatory cancer,
infiltrating carcinoma) in three dimensions, performing an accurate and personalized portrait of breast
diseases (in some cases with the depicted name of the sick woman), showing fine details of each
disease, and demonstrating an accurate knowledge of the female anatomy and pathologies in question.
The expression of our relationship with illness is wonderfully illustrated in these unique votive
offerings, devotional hand-painted ceramics, symbols of a supplications to St. Roch for a miraculous
healing. These devotional majolicas are an individual’s expression of request for the intercession of the
divine in time of illness. They offer a rare opportunity to view health, healing, and illness through the
hearts and minds of the ordinary person.
The female breast is a symbol of fertility and in the same time related to diseases caused by infertility.
The presence of so many breasts made of ceramic in the church of St. Roch in Castelli, confirms the
importance of breast-feeding as the main source of life for the offspring and suggests a high incidence
of breast disease among the local population, perhaps a genetic mutation in a woman ancestor.
Objective: Nulliparity and menopause are considered risk factors for ovarian cancer. Nulliparity ... more Objective: Nulliparity and menopause are considered risk factors for ovarian cancer. Nulliparity represents a condition capable of affecting the expression levels of the pro-angiogenic factors and modulating the degree of phosphorylation of signals involved in endothelial cell proliferation. This experimental animal study involved a total of 40 CD1 female mice, young (4-months-old) and old (15-months-old), both parous and nulliparous, where the expression levels of VEGF, VEGFR2, ERK2, Akt and PTEN proteins were determined. Methods: Mice, called Mothers (M), were mated and sacrificed after the first pregnancy and lactation (Young, Y, n = 10) or at 15 month (Old, O, n = 10) of age, when they're in menopause. The same protocol was adopted for the group of nulliparous mice, called Virgins (V), sacrificed without mating either young (YV, n = 10) or old (OV, n=10). Ovaries were collected and stored for Western blot analysis. The expression levels of VEGF, VEGFR2, ERK2, Akt and PTEN proteins were determined into the 4 groups. Results: VEGF content was always higher in V than in M, but no age-dependent increase of VEGF was recorded in V because of the high levels already present in the YV. VEGFR2 content was higher in V than in M, and was accumulated in OV. Akt and ERK2 were phosphorylated more efficiently in V than in M. PTEN was under phosphorylated in OV. Conclusion: The finding that in the ovaries of nulliparous (V) mice the expression levels of pro-angiogenic proteins are enhanced in comparison to parous (M) mice, contributes to explain epidemiological data by providing the first molecular explanation of the protective role of pregnancy on female health; the over-expression of specific pro-angiogenic proteins and their over-activity can contribute to explain the reason why the incidence of ovarian cancer in nulliparous women is higher than in parous ones.
Opera coperta dal diritto d'autore -Tutti i diritti sono riservati Questo testo contiene material... more Opera coperta dal diritto d'autore -Tutti i diritti sono riservati Questo testo contiene materiale, testi ed immagini, coperto da copyright e non può essere copiato, riprodotto, distribuito, trasferito, noleggiato, licenziato o trasmesso in pubblico, venduto, prestato a terzi, in tutto o in parte, o utilizzato in alcun altro modo o altrimenti diffuso, se non previa espressa autorizzazione dell'editore. Qualsiasi distribuzione o fruizione non autorizzata del presente testo, così come l'alterazione delle informazioni elettroniche, costituisce una violazione dei diritti dell'editore e dell'autore e sarà sanzionata civilmente e penalmente secondo quanto previsto dalla L. 633/1941 e ss.mm.