Lazaros G Lavasidis

University of Ioannina, Yannina, Epirus, Greece

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Publications (11)35.9 Total impact

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    ABSTRACT: To determine the accuracy of hysteroscopy in diagnosing endometrial cancer, hyperplasia, polyps and submucous myomas. Relevant articles were retrieved from the MEDLINE and the Cochrane Library (1986-2011). Studies were selected blindly. Results for diagnostic accuracy were extracted to form separate 2 × 2 tables (for endometrial cancer, hyperplasia, polyps and submucous myomas). A summary sensitivity and specificity point reflected the average accuracy observed. Summary ROCs (SROCs) were also calculated according to the HSROC model. For endometrial cancer, the estimated sensitivity was 82.6 % (95 % CR 66.9-91.8 %) and the specificity was 99.7 % (95 % CR 98.1-99.9 %). For endometrial hyperplasia, sensitivity was 75.2 % (95 % CR 55.4-88.1 %), while specificity was 91.5 % (95 % CR 85.7-95.0 %). For endometrial polyps, sensitivity was 95.4 % (95 % CR 87.4-98.4 %) and specificity was 96.4 % (95 % CR 93.7-98.0 %). Finally, for submucous myomas, sensitivity was estimated to 97.0 % (95 % CR 89.8-99.2 %) and specificity to 98.9 % (95 % CR 93.3-99.8 %). Diagnostic accuracy for hysteroscopy is high for endometrial cancer, polyps and submucous myomas, but only moderate for endometrial hyperplasia.
    Archives of Gynecology and Obstetrics 12/2014; 291(6). DOI:10.1007/s00404-014-3585-x · 1.36 Impact Factor
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    ABSTRACT: In recent years, hysteroscopy, used as an outpatient office procedure, in combination with endometrial biopsy, has demonstrated its great potential as the method of first choice in the diagnosis of various gynecological abnormalities including abnormal uterine bleeding (AUB) and endometrial cancer (CA). In patients suffering with AUB, the blood vessels of the endometrium are hypertrophic, whereas in the case of CA vascularization is irregular or anarchic. In this paper, a methodology for the classification of hysteroscopical images of endometrium using vessel and texture features is presented. A total of 28 patients with abnormal uterine bleeding, 10 patients with endometrial cancer and 39 subjects with no pathological condition were imaged. 16 of the patients with AUB were premenopausal and 12 postmenopausal, all with CA were postmenopausal, and all with no pathological condition were premenopausal. All images were examined for the appearance of endometrial vessels and non-vascular structures. For each image, 167 texture and vessel's features were initially extracted, which were reduced after feature selection in only 4 features. The images were classified into three categories using artificial neural networks and the reported classification accuracy was 91.2 %, while the specificity and sensitivity were 83.8 and 93.6 % respectively.
    Medical & Biological Engineering 03/2013; 51(8). DOI:10.1007/s11517-013-1058-1 · 1.73 Impact Factor

  • European journal of obstetrics, gynecology, and reproductive biology 10/2011; 159(1). DOI:10.1016/j.ejogrb.2011.09.016 · 1.70 Impact Factor
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    ABSTRACT: Hysteroscopy is an effective method for examining the uterine cavity but has some limitations, including the occasional need for cervical dilatation. Misoprostol is routinely used for cervical dilatation in various procedures but has not gained wide acceptance for use before hysteroscopy. This review includes randomized controlled trials which compare the use of misoprostol versus placebo by different routes and doses before diagnostic or operative hysteroscopy. The MEDLINE database and the Cochrane Central Register of Controlled Trials were searched for articles published from January 1970 to April 2010. The outcome measures studied were related either to the facilitation of the hysteroscopic procedure (need for cervical dilatation, cervical width at the beginning of hysteroscopy, duration of the procedure and complications such as cervical tear and uterine perforation) or to the medication side-effects. With regard to side-effects, we studied the incidence of nausea, diarrhea, abdominal pain, bleeding, and fever. Vaginal misoprostol reduced the need for cervical dilatation in the total population of pre- and post-menopausal women to a statistically significant degree. In the subgroup of operative hysteroscopy the need for dilatation and the duration of the procedure were also significantly reduced. Most other outcomes relating to the facilitation of the procedure did not reach statistical significance. The side effects in the misoprostol group were significantly more frequent than in the placebo group. There is insufficient evidence to recommend the routine use of misoprostol before every hysteroscopy. As the lack of serious benefit from misoprostol is unlikely to be due to type II error, its use should be reserved for selected cases.
    European journal of obstetrics, gynecology, and reproductive biology 05/2011; 158(1):17-23. DOI:10.1016/j.ejogrb.2011.04.022 · 1.70 Impact Factor
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    ABSTRACT: Life exists by establishing a balanced equilibrium, called homeostasis, constantly challenged by adverse stimuli, called stressors. In response to these stimuli, a complex neurohormonal reaction exerted by the activation of the so-called stress system is initiated. The latter is activated in a coordinated fashion, leading to behavioral and peripheral changes that improve the ability of the organism to adjust homeostasis and increase its chance for survival. The stress system suppressive effects on female reproduction involve suppression of the hypothalamic-pituitary-ovarian axis at the hypothalamic, pituitary, ovarian, and uterine levels. Experimental and human data suggest that adverse prenatal stimuli, of either maternal or fetal origin, acting in the developing embryo in utero, can lead to the development of short- and long-term health disorders. These include preterm birth of the offspring, low birth weight, and the development of adult diseases ranging from the metabolic syndrome to several neurodevelopmental disorders.
    Annals of the New York Academy of Sciences 09/2010; 1205(1):69-75. DOI:10.1111/j.1749-6632.2010.05686.x · 4.38 Impact Factor
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    ABSTRACT: The stress system has suppressive effects on female and male reproductive function. Corticotrophin-releasing hormone (CRH), the principal regulator of stress, has been identified in the female and male reproductive system. Reproductive CRH participates in various reproductive functions that have an inflammatory component, where it serves as an autocrine and paracrine modulator. These include ovarian and endometrial CRH, which may participate in the regulation of steroidogenesis and the inflammatory processes of the ovary (ovulation and luteolysis) and the endometrium (decidualization and blastocyst implantation) and placental CRH, which is secreted mostly during the latter half of pregnancy and is responsible for the onset of labor. It has been suggested that there is a "CRH placental clock" which determines the length of gestation and the timing of parturition and delivery. The potential use of CRH-antagonists is presently under intense investigation. CRH-R1 antagonists have been used in animal studies to elucidate the role of CRH in blastocyst implantation and invasion, early fetal immunotolerance and premature labor. The present review article focuses on the potential roles of CRH on the physiology and pathophysiology of reproduction and highlights its participation in crucial steps of pregnancy, such as implantation, fetal immune tolerance, parturition and fetal programming of the hypothalamic-pituitary-adrenal (HPA) axis.
    Journal of Reproductive Immunology 05/2010; 85(1):33-9. DOI:10.1016/j.jri.2010.02.005 · 2.82 Impact Factor
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    ABSTRACT: Alopecia after birth-related caput succedaneum is an extremely rare complication. The case of a child with permanent alopecia due to birth-related caput succedaneum is presented. After delivery with vacuum extraction, caput succedaneum at the left occipitoparietal region of the neonate's head was noted, which subsided within a week, leaving a circular necrotic crust and finally a circular bald area. At age 4, the child was referred at a tertiary center for the management of alopecia. Treatment initially consisted of the expansion of the hair-bearing skin adjacent to the bald area, which was excised at a second stage and covered with the expanded skin. A pleasing esthetic result was achieved. Neonatal alopecia is a rare birth-associated complication. Premature rupture of the membranes, prolonged second stage of the labor, and prolonged vacuum extraction time may be important features in the pathogenesis of this complication. In case of permanent alopecia, excellent esthetic results can be achieved with the use of reconstructive plastic surgery techniques.
    Obstetrics and Gynecology 09/2007; 110(2 Pt 2):487-90. DOI:10.1097/ · 5.18 Impact Factor

  • Fertility and Sterility 09/2007; 88. DOI:10.1016/j.fertnstert.2007.07.827 · 4.59 Impact Factor
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    ABSTRACT: The fundamental process of implantation involves a series of steps leading to effective cross-talk between invasive trophoblast cells and the maternal endometrium. The molecular interactions at the embryo-maternal interface during the time of blastocyst adhesion and subsequent invasion are not fully understood. Embryonic trophoblast and maternal decidual cells produce corticotropin-releasing hormone (CRH) and express Fas ligand (FasL), a proapoptotic cytokine. Fas and its ligand are pivotal in the regulation of immune tolerance. Trophoblast and decidual CRH play crucial roles in implantation, as well as in the anti-rejection process that protects the fetus from the maternal immune system, primarily by killing activated T cells through Fas-FasL interaction. The potential use of CRH antagonists is presently under intense investigation. CRH antagonists have been used experimentally to elucidate the role of CRH in blastocyst implantation and invasion, early fetal immunotolerance, and premature labor.
    Critical Reviews in Clinical Laboratory Sciences 02/2007; 44(5-6):461-81. DOI:10.1080/10408360701548468 · 3.69 Impact Factor
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    ABSTRACT: Heavy menstrual bleeding (HMB) occurs in a considerable percentage of the general population and is one of the main causes due to which a patient is referred to health services. Despite the efforts for pharmaceutical interventions, the symptom usually persists, therefore operative techniques are needed to control the bleeding. Today, apart from the choice of hysterectomy, other less aggressive techniques have been invented. The first results of the Greek Study Group on Gynecological Endoscopy regarding the use of the Thermachoice device are hereby presented. One hundred patients suffering HMB were treated with the Thermachoice device following a standard protocol designed by the Study Group. The follow-up meetings with the patients were held at 3, 6, 12, 24, and 36 months. It seems that the overall effectiveness rate (96%) is satisfactory and it is similar to the overall effectiveness rate reported in other relevant studies upon the Thermachoice device.
    Annals of the New York Academy of Sciences 01/2007; 1092(1):460-5. DOI:10.1196/annals.1365.045 · 4.38 Impact Factor
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    ABSTRACT: The term hysteroscopy is used to determine the procedure during which an endoscopic view of the endometrial cavity is achieved with the help of a type of endoscopic device called "the hysteroscope." Hysteroscopy is used to assist the diagnosis for a series of female pathology. Apart from its diagnostic value, hysteroscopy can also be used for operative procedures including ablation and resection. Both diagnostic and operative hysteroscopy have been used for a number of years and various studies have been published to describe their success and complication rates throughout this period. Diagnostic hysteroscopy is relatively safe, whereas complications occur more frequently when operative hysteroscopy is used. These complications include uterine perforation, hemorrhage, fluid overload, gas embolization, and hyponatremia. The rate in the appearance of these complications is dependent on the type of the hysteroscopic procedure, the distending medium, and the experience of the hysteroscopist. To avoid any problems concerning the application of hysteroscopic procedures, it is important to take the necessary precautions both preoperatively and intraoperatively. For example, the preoperative use of thinning agents of the endometrium and the reduction of the operating time, or the avoidance of cutting too deeply into the myometrium, are some of the parameters to be considered when hysteroscopy is in argument.
    Annals of the New York Academy of Sciences 01/2007; 1092(1):229-34. DOI:10.1196/annals.1365.019 · 4.38 Impact Factor