M Varras

Elena Venizelou Hospital, Athínai, Attica, Greece

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Publications (49)34.58 Total impact

  • Varras M · Anastasiadis A · Akrivis C · Gialelis J ·
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    ABSTRACT: Introduction Pentalogy of Cantrell consists of the following five congenital major malformations: (a) a defect in the anterior diaphragm, (b) a midline supraumbilical anterior abdominal wall defect, (c) a defect in the diaphragmatic pericardium, (d) various congenital cardiovascular malformations and (e) a defect in the lower part of the sternum typically with ectopia cordis. Moreover, additional features may exist to a various extent. The pathogenesis of pentalogy of Cantrell remains uncertain and most of the cases are thought to be sporadic. Genetic and environmental factors or disrupted defects of the vessels have also been implicated. Prenatal diagnosis of pentalogy of Cantrell is easily obtained when malformations such as ectopia cordis with omphalocele or other midline abdominal wall defects are visible during the foetal ultrasound scans. The diagnosis of pentalogy of Cantrell with ultrasonography is made after the 12th week of gestation, because of the normal bowel herniation outside the abdomen before that time and offers the option of termination of the pregnancy in cases with complexity of the cardiac defects and serious associated malformations. With the Color and Power Doppler ultrasound scans the heart is easily recognized protruding outside the thorax. Also, MRI enhances the visualization of the defects, confirms the diagnosis and guides the surgical decisions. In patients choosing to continue the pregnancy the best treatment approach includes a multispecialty medical team and the surgical corrections should be attempted at the same time soon after delivery. The aim of this review is to remind in Obstetricians Gynaecologist the rare entity of pentalogy of Cantrell. Conclusion The pentalogy of Cantrell is an extremely rare entity with a generally poor prognosis. The treatment of all the congenital heart defects found in this entity is very important for the long-term prognosis of children.
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    ABSTRACT: Decreased expression of E-cadherin has been associated with poorly differentiated endometrial carcinomas and poorer outcomes. The purpose of this study was to examine the distribution of E-cadherin immunohistochemical expression in specimens from primary endometrial carcinomas and its relation to classical clinicopathological prognostic factors. Surgically-resected tissues of 30 patients with primary endometrial carcinomas were studied. Histological type and grade, depth of myometrial invasion, lymph-vascular space invasion, fallopian tube or ovarian invasion, and the presence of tumoral necrosis were evaluated. Immunohistochemical examination was performed on deparaffinized four-microm-thick sections. The mean age of patients was 65 years (+/- 11.41). The 63.54% of carcinomas were moderately/poorly differentiated. No statistical correlation was found between the score or intensity of E-cadherin immunohistochemical staining (strong or moderate positive expression) and the clinicopathological factors tested. The association of E-cadherin immunoreactivity with the standard clinicopathological factors seemed to be contradictory. The classical clinicopathological factors remain the most important prognostic parameters.
    European journal of gynaecological oncology 04/2013; 34(1):31-5. DOI:10.1016/S0020-7292(12)61567-7 · 0.61 Impact Factor
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    ABSTRACT: It is well known that the innate immunity system, involving the contribution of monocytes and macrophages, may dysfunction in fetuses and preterm neonates. Monocytes are capable of differentiating into dendritic cells (DCs) or into mucosal macrophages during certain infections and of producing inflammatory mediators such as TNF- α (tumor necrosis factor-alpha), nitric oxide, and reactive oxygen species. Fetuses as well as neonates are prone to infections as a result of a defective mechanism within the above mononuclear system. Monocyte function in fetuses and preterm neonates depends on the phagocytic and oxidative capacity of macrophages and their antigen-adhesion ability. Functional rather than anatomical impairment is probably the underlying cause, while a defective production of cytokines, such as TNF- α , IL-6 (Interleukin 6), IL-1 β (Interleukin 1 beta), and G-CSF (Granulocyte Colony-Stimulating Factor), has also been involved. The insufficient production of the above inflammatory mediators and the phenomenon of endotoxin intolerance, which latter occurs during entry of any antigen into the premature neonate, place preterm neonates at higher risk for infections. Existing research data are herein presented which, however, are deficient and fragmental, this accounting for the fact that the precise pathophysiology of these disturbances is not yet fully clarified.
    Mediators of Inflammation 04/2013; 2013(3):753752. DOI:10.1155/2013/753752 · 3.24 Impact Factor
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    ABSTRACT: Sexually transmitted diseases threaten every sexually active individual, whereas especially our younger adults, as more IT literate, should be better familiarized with the various methods of STDs protection as well as of the traditional and modern contraception. Our purpose was to investigate and compare the awareness of 18-45 years old adults from urban and rural areas on sexual and reproductive health issues and to establish any potential new strategies for its best promotion. Two hundred individuals coming from either our capital, which represents the purest urban dimension of our Greek lifestyle spectrum, or one specific carefully selected, as a characteristic opposite non-urban dimension in our lifestyle scale, rural town, were stratified randomly and answered a three-part closed ended questionnaire. Useful results were extracted, like, for example, although 29.5% reported that they were in a committed relationship, trusted traditional methods of contraception and protection from STDs, like condom, 18% out of them has not been regularly using it. Moreover the percentage of hormonal contraception was low (9%). The younger the people and the more the urban lifestyle they have adopted, the lesser cautious on their choice of sexual partners are. Men still seem to be alternating between sexual partners and perform “one night stands” more frequently than women. Finally we came to the conclusion that the awareness on sex and reproduction is not so developed as we would expect from our adequate standard of living before the years of the economic crisis (<2010). We noticed many cases of fragmentary information, false view and high-risk sexual behavior. Moreover, mainland residents seem to be less informed about the current data of STDs and contraception, even though their behavior is less risky.
    04/2013; 1(1):2.. DOI:10.13172/2053-0501-1-1-435
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    ABSTRACT: Atherosclerosis is the principal cause of cardiovascular disease (CVD) and has many risk factors, among which is diabetes. Osteoprotegerin (OPG) is a soluble glycoprotein, involved in bone metabolism. OPG is also found in other tissues, and studies have shown that it is expressed in vascular smooth muscle cells. OPG has been implicated in various inflammations and also has been linked to diabetes mellitus. Increased serum OPG levels were found in patients with diabetes and poor glycemic control. Furthermore, prepubertal children with type 1 diabetes have significantly increased OPG levels. Receptor activator of nuclear factor kappa-B ligand (RANKL) is not found in the vasculature in normal conditions, but may appear in calcifying areas. OPG and RANKL are important regulators of mineral metabolism in both bone and vascular tissues. Few data are available on the relationship between plasma OPG/RANKL levels and endothelial dysfunction as assessed using noninvasive methods like ultrasound indexes, neither in the general population nor, more specifically, in diabetic patients. The aim of our review study was to investigate, based on the existing data, these interrelationships in order to identify a means of predicting, via noninvasive methods, later development of endothelial dysfunction and vascular complications in diabetic patients.
    International Journal of Endocrinology 01/2013; 2013:182060. DOI:10.1155/2013/182060 · 1.95 Impact Factor

  • 01/2013; 2(1). DOI:10.13172/2052-0077-2-1-364

  • 01/2013; 1(1). DOI:10.13172/2053-0501-1-1-625
  • A Koumousidis · M Varras · C Sofoudis · N Salakos ·

    01/2013; 1(1). DOI:10.13172/2053-0501-1-1-661
  • M Varras · G Diakakis · I Monselas · CH Akrivis ·

    01/2013; 2(1). DOI:10.13172/2052-0077-2-1-406
  • Varras M · Anastasiadis A · Panelos J · Balassi E · Demou A · Akrivis CH ·
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    ABSTRACT: Introduction Autoimmune oophoritis is a rare condition, which provokes ovarian failure with either primary amenorrhea or secondary amenorrhea and a subsequent loss of fertility and ovarian hormonal function. The purpose of this report is to document the clinical findings from two patients with autoimmune oophoritis. Case report Two cases of autoimmune oophoritis are presented whose histopathological findings were consistent with international literature. Both cases were histopathologically characterised by lymphocytic and plasmacytic inflammatory infiltrations around the cystic follicles. The inflammation was located both in the theca and granular layers. Conclusion Patients with autoimmune oophoritis should be recognised by the histopathology of the ovarian biopsies as they are at an increased risk of developing other autoimmune disorders.
    01/2013; DOI:10.13172/2052-0077-2-1-369

  • 01/2013; 2(7). DOI:10.13172/2052-0077-2-7-724
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    ABSTRACT: Background The purpose of the study was to determine the incidence of gene expression of Oct-4 and DAZL, which are typical markers for stem cells, in human granulosa cells during ovarian stimulation in women with normal FSH levels undergoing IVF or ICSI and to discover any clinical significance of such expression in ART. Methods Twenty one women underwent ovulation induction for IVF or ICSI and ET with standard GnRH analogue-recombinant FSH protocol. Infertility causes were male and tubal factor. Cumulus–mature oocyte complexes were denuded separately and granulosa cells were analyzed for each patient separately using quantitative reverse-transcription–polymerase chain reaction analysis for Oct-4 and DAZL gene expression with G6PD gene as internal standard. Results G6PD and Oct-4 mRNA was detected in the granulosa cells in 47.6% (10/21). The median of Oct-4 mRNA/G6PD mRNA was 1.75 with intra-quarteral range from 0.10 to 98.21. The OCT-4 mRNA expression was statistically significantly correlated with the number of oocytes retrieved; when the Oct-4 mRNA expression was higher, then more than six oocytes were retrieved (p=0.037, Wilcoxon rank-sum). No detection of DAZL mRNA was found in granulosa cells. There was no additional statistically significant correlation between the levels of Oct-4 expression and FSH basal levels or estradiol peak levels or dosage of FSH for ovulation induction. No association was found between the presence or absence of Oct-4 mRNA expression in granulosa cells and ovarian response to gonadotropin stimulation. Also, no influence on pregnancy was observed between the presence or absence of Oct-4 mRNA expression in granulosa cells or to its expression levels accordingly. Conclusions Expression of OCT-4 mRNA, which is a typical stem cell marker and absence of expression of DAZL mRNA, which is a typical germ cell marker, suggest that a subpopulation of luteinized granulosa cells in healthy ovarian follicles (47.6%) consists of stem cells, which are not originated from primordial germ cells. Absence of Oct-4 gene expression in more than half of the cases means probably the end of the productive journey of these cells, towards the oocyte.
    Journal of Ovarian Research 11/2012; 5(1):36. DOI:10.1186/1757-2215-5-36 · 2.43 Impact Factor

  • International Journal of Gynecology & Obstetrics 10/2012; 119:S534. DOI:10.1016/S0020-7292(12)61204-1 · 1.54 Impact Factor
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    ABSTRACT: Background The purpose of the study was to determine the incidence of survivin gene expression in human granulosa cells during ovarian stimulation in Greek women with normal FSH levels, undergoing IVF or ICSI and to discover any correlation between levels of gene expression and clinical parameters, efficacy of ovulation or outcomes of assisted reproduction. Methods Twenty nine women underwent ovulation induction for IVF or ICSI and ET with standard GnRH analogue-recombinant FSH protocol. Infertility causes were male and tubal factor. Cumulus–mature oocyte complexes were denuded and the granulosa cells were analyzed for each patient separately using quantitative reverse transcription polymerase chain reaction analysis for survivin gene expression with internal standard the ABL gene. Results The ABL and survivin mRNA were detected in granulosa cells in 93.1%. The expression levels of survivin were significantly lower in normal women (male infertility factor) compared to women with tubal infertility factor (p = 0.007). There was no additional statistically significant correlation between levels of survivin expression and estradiol levels or dosage of FSH for ovulation induction or number of dominant follicles aspirated or number of retrieved oocytes or embryo grade or clinical pregnancy rates respectively. Conclusions High levels of survivin mRNA expression in luteinized granulosa cells in cases with tubal infertility seem to protect ovaries from follicular apoptosis. A subpopulation of patients with low levels of survivin mRNA in granulosa cells might benefit with ICSI treatment to bypass possible natural barriers of sperm-oocyte interactions.
    Reproductive Biology and Endocrinology 09/2012; 10(1):74. DOI:10.1186/1477-7827-10-74 · 2.23 Impact Factor
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    Michail Varras ·

    01/2012; 01(04). DOI:10.4172/2161-038X.1000e106
  • M Varras · C Akrivis · A Anastasiadis · G Lekkas · G Diakakis ·
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    ABSTRACT: A case of peritonitis as an unusual complication of LLETZ (large loop excision of the transformation zone) for the treatment of CIN III associated with unrecognized iatrogenic posterior colpotomy is presented. After the procedure, the patient developed fever 38.3 degrees C and diffused severe pelvic pain. The contributing factors, prevention and management of this complication are discussed. Also, the complications of cold knife cervical conization and LLETZ procedure are reviewed.
    European journal of gynaecological oncology 01/2012; 33(2):214-6. · 0.61 Impact Factor
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    ABSTRACT: Ovarian steroid cell tumours, not otherwise specified (NOS) are rare sex cord-stromal tumours of the ovary. These tumours should be considered a cause of isosexual precocious puberty in children and virilisation in adults. We report a case of 40-year-old woman with mental handicap who presented with 3 years of amenorrhea and progressive virilisation. Pelvic ultrasonography identified a 6.19 × 6.15 cm well-defined echogenic-multilobular mass arising from the left ovary. Fluid in the cul-de-sac was noted. Colour Doppler examination with endovaginal ultrasonography showed high vascularity of the tumour with low resistance to flow. A computed tomography (CT) scan of the upper and lower abdomen showed a lobular mass with diaphragms in the left adnexal structure and fluid in the cul-de-sac; no adrenal gland enlargement or additional tumour was detected. Laboratory analysis revealed increased levels of serum total testosterone. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histological examination showed a benign steroid cell tumour, NOS without evidence of necrosis, haemorrhage or invasion. The immunohistochemical study showed that the tumour cells were positive for inhibin, CD 99, Melan A and vimentin and negative to CK AE1, CK AE3, progesterone and estrogen receptors. Careful medical history, physical examination, laboratory serum values and imaging studies are helpful in making the pre-operative diagnosis. Steroid cell tumours, NOS are usually benign, unilateral and characterised by the composition of two similar-appearing polygonal cell types. They differ from Leydig cell tumours in the lack of crystals of Reinke in their cytoplasm.
    Gynecological Endocrinology 06/2011; 27(6):412-8. DOI:10.3109/09513590.2010.495432 · 1.33 Impact Factor
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    ABSTRACT: Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors that develop in the wall of the gastrointestinal tract and their diagnosis during pregnancy or puerperium is extremely rare. A 28-year old patient presented with acute abdomen due to hemoperitoneum from a large mass arising of the small intestine with distended vessels on its top and a ruptured superficial vessel bleeding into the peritoneal cavity. The patient was at the tenth postpartum day of her first pregnancy. The preoperative diagnosis was a possible ovarian or uterine mass. After an emergency exploratory laparotomy a segmental bowel resection was performed, removing the tumor with a part of 3-cm of the small intestine. Histology revealed GIST with maximum diameter of 13 cm and mitotic rates more than 5 mitoses per 50 high power fields with some atypical forms, indicating a high risk malignancy. Immunohistochemical staining of the tumor tissue demonstrated strongly positive reactivity to CD 117 (c-kit) and CD34 in almost all the tumor cells. The patient was treated with oral imatinib mesylate (Gleevec) 400 mg daily for one year. Three years after surgery, the patient was alive without evidence of metastases or local recurrence. Considering that only few patients with gastrointestinal stromal tumors have been reported in the obstetrical and gynecological literature, the awareness of such an entity by the obstetricians-gynecologists is necessary in order to facilitate coordinated approach with the general surgeons and oncologists for the optimal care of the patients.
    World Journal of Surgical Oncology 11/2010; 8(1):95. DOI:10.1186/1477-7819-8-95 · 1.41 Impact Factor
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    Michail Varras · Christodoulos Akrivis ·
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    ABSTRACT: Hemivertebra is a rare congenital spinal malformation, where only one side of the vertebral body develops, resulting in deformation of the spine, such as scoliosis, lordosis, or kyphosis. We present the ultrasonographic features of a fetus with hemivertebra at 20 weeks' gestation confirmed by post mortem radiography and pathological examination. The prenatal literature on this disorder is also reviewed. Useful background information is provided for both clinicians and other health professionals who are not familiar with this condition.
    International Journal of General Medicine 07/2010; 3(4):197-201. DOI:10.2147/IJGM.S11532
  • M Varras · Ch Krivis · Ch Plis · G Tsoukalos ·
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    ABSTRACT: This was a retrospective clinical study of emergency hysterectomy performed between 1997 and 2007 at two tertiary hospitals to study incidence, indications and maternal mortality. We included all women who required emergency hysterectomy to control major postpartum hemorrhage after delivery, following a pregnancy of at least 24 weeks' gestation, regardless of the mode of delivery. There were 12 emergency hysterectomies, with a frequency of 0.0726% among 16,521 deliveries. Indications included uterine atony (4 cases), uterine rupture (3 cases), uterine retroversion (2 cases), abnormal placentation (2 cases) and amniotic fluid embolization (1 case). The result was two maternal deaths. Although emergency obstetric hysterectomy is a life saving operation, it is associated with high maternal mortality.
    Clinical and experimental obstetrics & gynecology 01/2010; 37(2):117-9. · 0.42 Impact Factor

Publication Stats

296 Citations
34.58 Total Impact Points


  • 2010-2013
    • Elena Venizelou Hospital
      Athínai, Attica, Greece
  • 2012
    • Alexandra Regional General Hospital
      Athínai, Attica, Greece
  • 2009-2011
    • Tzaneio General Hospital of Piraeus
      Le Pirée, Attica, Greece
  • 2005-2006
    • Άγιος Σάββας Αντικαρκινικό Νοσοκομείο
      Athínai, Attica, Greece
  • 2004-2005
    • Attikon University Hospital
      • Department of Obstetrics - Gynecology
      Athínai, Attica, Greece