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ABSTRACT: Summary Forty-one pregnancies complicated by rhesus (D) iso-immunisation were managed by serial fetal blood sampling and in utero intravascular transfusion. Eighteen patients were only monitored with fetal blood sampling during pregnancy. Fetal blood group and rhesus factor, haematocrit, bilirubin levels, albumin concentrations and acid-base balance were determined. In this group all patients delivered at term without complications. Twenty-three patients had 42 intravascular transfusions. The ‘procedure related’ fetal loss rate was 2.3 per cent. Obstetric management was individualised according to serial fetal haematocrit estimations, acid base balance and cardiotocographic monitoring of each patient. The overall perinatal survival rate was 87 per cent.
07/2009; 11(3):171-174.
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ABSTRACT: The aim of this prospective study was to compare triple test screening (alpha-fetoprotein, beta-chorionic gonadotrophin and unconjugated oestriol) with amniocentesis in the detection of fetuses with Down's syndrome in women of 35 years of age or more. Between 1992 and 1996, maternal serum markers were evaluated in 1406 women who had amniocentesis for prenatal diagnosis of chromosomal abnormalities related to a maternal age of 35 or more years. Sixteen fetuses with Down's syndrome were identified in the whole group by amniocentesis and karyotyping. The group with negative triple test screening consisted of 919 pregnancies and included two fetuses with trisomy-21 (false negatives). With triple test screening in the age group over 35, there was a detection rate of 87.5% for cut-off points ranging from 1:200 up to 1:350, with corresponding false positive rates ranging between 23% and 34%. In our population, if we had practiced the policy of offering amniocentesis only to women screening positive for the ages of 35 and 36 and to all pregnant women of 37 or more, we would have carried out 30% less amniocenteses. In this group of 1406 women, 33 abnormal karyotypes were detected with amniocentesis (16 Down's syndrome included) and equal number of elective abortions were carried out. Nevertheless, 19 healthy fetuses and neonates were lost after amniocentesis. Considering the high detection rates that can be achieved with triple test screening, the existing procedure related risk of amniocentesis (0.5-1.0%), and the facts that conception in women over 35 years of age is usually more difficult and the background loss usually higher than in younger women, we believe that in the future women over 35 should be offered a choice between non-invasive and invasive procedures after being thoroughly informed.
Journal of Obstetrics and Gynaecology 05/1999; 19(3):253-6. · 0.54 Impact Factor
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Contraception, fertilité, sexualité (1992) 12/1997; 25(11):811-5.
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Journal of Obstetrics and Gynaecology 05/1997; 17(3):270-2. · 0.54 Impact Factor
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ABSTRACT: Eighteen patients with 26 pelvic lymphocoeles following radical hysterectomy underwent percutaneous therapeutic intervention with either needle aspiration, or catheter drainage. In eight patients a percutaneous needle aspiration under sonographic control was performed. Five out of eight patients were successfully managed with needle aspiration, three of them requiring repetitive aspirations. Thirteen patients, with a total of 21 lymphocoeles underwent catheter drainage. Seventeen of the 21 lymphocoeles completely resolved. Redrainage was performed in four cases and it was successful in two of them. The duration of the catheter drainage was 8 to 34 days. Nine of the lymphocoeles were infected at initial drainage. Two patients underwent surgery because of increased volume of output. Percutaneous drainage is a safe and effective method and should be considered as the initial treatment for all patients with postoperative lymphocoeles.
Journal of Obstetrics and Gynaecology 03/1997; 17(2):192-4. · 0.54 Impact Factor
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ABSTRACT: One hundred primary ovarian cancers were studied for the expression of cathepsin-D, CA125 and epidermal growth factor receptor (EGF-R) by staining of imprint smears from freshly obtained surgical specimens. Estrogen and progesterone receptors of the primary tumor, lymph node invasion, menopausal status of the patients and primary tumor size were also noted. The polymorphism of the antigenic characteristics of ovarian carcinomas was noted and significant associations of EGF-R positivity and lymph node negativity, EGF-R positivity and serous carcinomas, EGF-R positivity and cathepsin-D positivity, cathepsin-D positivity and CA125 positivity, and CA125 positivity and serous carcinomas were observed. The high incidence of cathepsin-D positivity makes it a possible complementary method to CA125 for following up patients. It is suggested that complete antigenic profiles of individual tumors are more likely to provide accurate prognostic information in individual cases.
Gynecologic and Obstetric Investigation 02/1997; 43(2):125-30. · 1.28 Impact Factor
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ABSTRACT: To study the expression of Cathepsin D (Cath D) and CA 125 antigens and ER and PR receptors on freshly obtained surgical specimens of ovarian carcinomas and their relationship with menopausal status, tumor histology, primary tumor size and lymph node invasion.
The tumors obtained from 100 women were measured and cut in half. The cut surface of one half was pressed against glass slides which were air dried and stained using the Avidin-Biotin peroxidase method for Cath D and CA 125 antigens. The slides were viewed under the light microscope for the characteristic brown granules in the cytoplasm or membrane of the malignant cells. The other half of the tumor was subjected to routine histological examination and part used for the demonstration of ER and PR receptors. The results were analyzed using chi 2 analysis.
Cath D positivity was as common as CA 125 positivity. Cath D positivity is more frequently associated with serous carcinomas than with others. No relationship was observed between ER/PR positivity and Cath D or CA 125 positivity.
The high incidence of Cath D positivity makes it a possible complementary method for following up ovarian carcinoma patients especially those who are CA 125 negative.
International Journal of Gynecology & Obstetrics 02/1997; 56(1):31-7. · 2.05 Impact Factor
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ABSTRACT: Estrogen (ER) and progesterone (PR) receptor status, factors known to influence the prognosis and therapeutic possibilities in patients with breast cancer; alpha-fetoprotein (AFP), which is an estrogen binder; and vimentin (V) were determined in cytological imprint smears of 75 mastectomy specimens. The results were classified according to tumor type and menopausal state and analyzed to determine possible relationships among these four markers under the different circumstances. There was a positive association of ER positivity with PR positivity, AFP positivity, and V negativity using chi 2 analysis. The lobular carcinomas studied were predominantly ER+, AFP+, V-, while in the ductal carcinomas V positivity was marginally predominant and also frequently associated with ER+ or PR+ status. The small number of medullary carcinomas made statistical analysis of this group difficult. It seemed probable that the marker status of the tumors was dependent more on the tumor type than on the menopausal state of the patients, thorough follow-up, especially of V+ medullary carcinomas, may provide insight into the value of vimentin as a primary rather than a secondary prognostic factor.
Cancer Detection and Prevention 02/1997; 21(3):207-12. · 2.52 Impact Factor
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ABSTRACT: The purpose of this study was to investigate the effect of male and female serum supplementation on the in vitro development of mouse embryos beyond the blastocyst stage until the outgrowth stage since the latter may be related to the nidation of the embryo. We also studied the effect of EGF addition on embryo culture and blastocyst outgrowth.
The blastocyst and hatching rates of two-cell mouse embryos cultured in Ham's F-10 + BSA, Ham's F-10 + male serum, or Ham's F-10 + female serum were found to be comparable (P > 0.05). The outgrowth rate of hatched blastocysts was significantly increased, though, when they were transferred to 50% male serum compared to either 50% BSA or 50% female serum (P < 0.01 and P < 0.05, respectively). In the last experiment, either 100 or 150 ng/ml EGF was added to the culture medium from the two-cell stage till blastocyst development and the latter were cultured till outgrowth in 50% BSA, male serum, or female serum. For both concentrations of EGF, the outgrowth rate was significantly higher in male serum compared to the other conditions (P < 0.01 and P < 0.05, respectively). The outgrowth rate was also higher when EGF was used compared to plain medium before transferring the blastocysts to either male or female serum (P < 0.01 for both).
We conclude that the development of embryos to the outgrowth stage is significantly enhanced by male serum. The addition of EGF from the two-cell stage also significantly improves the outgrowth success rate for both male and female serum conditions.
Journal of Assisted Reproduction and Genetics 11/1996; 13(10):786-92. · 1.84 Impact Factor
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ABSTRACT: Synchronization of the availability of good quality oocytes from donors and adequate endometrial maturation of recipients are very important for the success of an oocyte donation programme. A flexible protocol for the endometrial preparation of recipients is important in timing embryo transfer between days 17 and 19 of the cycle ('window of receptivity'). The purpose of this study was to evaluate the effect of the length of oestradiol administration to recipients on pregnancy outcome. Oestrogen administration was 8 mg/day, but its length varied prospectively from 6 to 27 days, followed by the addition of progesterone (100 mg daily i.m.) for 2-4 days according to the availability of good quality oocytes. Pregnancy outcome was evaluated regardless of age, indication for oocyte donation or number of embryos transferred per patient. The pregnancy rate per cycle was comparable when oestradiol was administered from 6 to 11 days before progesterone addition, while it dropped significantly thereafter. The variation in progesterone administration did not affect pregnancy outcome. These findings provide us with a greater flexibility by allowing us to vary oestradiol administration to recipients from 6 to 11 days prior to progesterone, reducing considerably, therefore, the need to cancel embryo transfer because of oocyte unavailability. Thus we can arrange to transfer embryos between days 17 and 19 of the recipient's cycle so as to obtain the best possible clinical outcome.
Human Reproduction 06/1996; 11(5):1063-6. · 4.47 Impact Factor
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ABSTRACT: Undetectable or extremely low levels of circulating immunoreactive parathyroid hormone (PTH) have been reported in human newborns while PTH bioactivity was high. This prompted the hypothesis that the fetal calcemic hormone might be PTH-related protein. The purpose of this study was to measure circulating immunoreactive PTH-related protein in human fetuses and newborns in order to investigate this hypothesis. Parathyroid hormone-related protein (PTHrP(1-86) and intact PTH were measured using two-site immunoradiometric assays in plasma obtained by cordocentesis from 23 fetuses (19-33 weeks of gestation), from 17 newborns at term (38-41 weeks), from their mothers and from 22 normal women of reproductive age. Plasma PTHrP was detectable in all but one of the fetuses and newborns and in all the mothers and the controls. The mean level was similar among fetuses (19-33 weeks) (0.43 +/- 0.18 pmol/l), newborns (0.48 +/- 0.12), mothers (0.48 +/- 0.14) and normal controls (0.46 +/- 0.09). Plasma PTH was found to be significantly higher in fetuses at midgestation (1.0 +/- 0.99 pmol/l) than in the newborns (0.22 +/- 0.21) (p < 0.0025); maternal PTH was significantly higher compared to fetal level at mid-gestation (2.1 +/- 1.0, p < 0.01) as well as at term (2.69 +/- 1.40, p < 0.001). In the control women PTH was 3.07 +/- 1.25 pmol/l. These results showed that plasma amino-terminal PTHrP-(1-86) is detectable during the second half of human fetal life and its level remains unchanged during this period of time, in contrast to changing levels of fetal plasma PTH. The relatively low PTHrP-(1-86) level that we found in the newborns is not responsible for the high PTH-like bioactivity found by some investigators in cord blood at term.
European Journal of Endocrinology 05/1996; 134(4):437-42. · 3.42 Impact Factor
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ABSTRACT: Recently, oocyte donation to women of advanced age has led to a considerable number of conceptions, thus increasing the age limit for becoming pregnant. A main consideration encountered by physicians, though, is the potential medical and obstetric complications of a pregnancy at an advanced age. In this study, the obstetric complications, as well as the perinatal outcome, of pregnancies of aged recipients (above 40) are presented and compared to those of younger recipients. A significantly higher incidence of gestational diabetes (P < 0.001), an increased incidence of pre-eclampsia (at the 10% level of significance) and an increased risk for thrombophlebitis (again at the 10% level) was observed in the older patients, but a careful follow-up during their pregnancy led to a highly satisfactory obstetric and perinatal outcome. A rigorous precycle medical screening (especially for cardiovascular diseases and diabetes) and a careful follow-up during pregnancy is, therefore, imperative so that oocyte donation to older women is not withheld and continues to provide fertility possibilities to otherwise sterile patients.
European Journal of Obstetrics & Gynecology and Reproductive Biology 03/1996; 64(2):175-8. · 1.97 Impact Factor
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ABSTRACT: In order to improve the selection of couples for intrauterine insemination (IUI) because of longstanding primary infertility of alleged male origin, we have performed a prospective study measuring conventional and advanced analysis of sperm characteristics, the hypoosmotic swelling test, the Shorr stain, the acidified aniline blue stain and alpha-glucosidase activity in seminal plasma, of 89 couples with no demonstrable abnormality of the female partner. Twenty-four couples attained spontaneous conception, 23 were successful within six cycles of IUI, and 42 remained without conception in spite of IUI during six unstimulated cycles. The proportion and concentration of spermatozoa with progressive motility was significantly lower (P < 0.01) in the successful IUI cases than in the couples attaining spontaneous conception, and the lower quartile value was lower in the former than in the latter. There were less pregnancies among IUI treated couples when sperm concentration and motility were within the range of normal fertile men, or when the concentration of white blood cells was elevated. More pregnancies occurred when markers of epididymal function, namely the result of the Shorr stain and alpha-glucosidase measurement, were normal. Total progressive motility and the result of the Shorr stain were the only independent variables selected by logistic regression to discriminate between successful and failed IUI cases. It is concluded that only a limited group of couples may benefit from IUI.
European Journal of Obstetrics & Gynecology and Reproductive Biology 02/1996; 64(1):115-8. · 1.97 Impact Factor
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ABSTRACT: Carbon Dioxide Laser ablation therapy was originally offered to 25 women with Vaginal Intraepithelial Neoplasia (VAIN). The disease was primary in 12 and secondary after a previous hysterectomy in 13 cases. Treatment was accomplished under local anesthesia in 22 cases and was well-tolerated by all patients. The age of the patients ranged from 19 to 68 with a mean age of 44 years. All women were followed-up by cytology and colposcopy within a time period of 35 to 82 months (mean 49 months). Eight patients relapsed resulting in a failure rate of 32%. A second Laser CO2 treatment was offered to these patients with a final cure rate of 84% (21/25). The four cases in which the disease reappeared, after the 2nd treatment, were managed by upper colpectomy (3 cases) and follow-up (1 case). Laser CO2 ablation is an acceptable treatment modality for VAIN considering the promising cure rates and the preservation of the anatomic integrity of the vagina. Close colposcopic follow-up of these patients is necessary for early detection of disease relapses.
European journal of gynaecological oncology 02/1996; 17(5):389-92. · 0.47 Impact Factor
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ABSTRACT: The role of growth hormone (GH) in follicular development, ovulation and embryo development is currently under reconsideration. In this study, we have tried to investigate the effect of GH on preimplantation development of mouse embryos in vitro. Zygotes and two-cell mouse embryos were cultured without (control) or with GH. For zygotes, the addition of 0.2 micrograms/ml of GH resulted in 77 +/- 1% of blastocysts formed and 66 +/- 3% rate of hatching (control 64 +/- 4 and 31 +/- 3%, p < 0.05 and p < 0.01, respectively). For two-cell embryos, the addition of 0.2 micrograms/ml of GH resulted in 87 +/- 2% of blastocysts formed and 60 +/- 4% hatching rate (control 76 +/- 4 and 47 +/- 5%, p < 0.05 for both). This positive effect of GH addition implies that the latter can support mouse preimplantation development in vitro and it suggests, along with its local action on the ovary and its possible effects, via the insulin-like growth factor system, on the tubal and uterine epithelium, a continuous role of this hormone in reproductive physiology from follicular maturation to embryonic development and, possibly, implantation.
Gynecologic and Obstetric Investigation 02/1995; 40(4):222-6. · 1.28 Impact Factor
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ABSTRACT: This study aimed to establish normal endothelin (ET) ranges in non malformed appropriate for gestational age fetuses of 18-24 weeks gestation and to investigate a possible correlation between maternal and fetal ET plasma levels. Twenty "mother-fetus" pairs were included in the study. The determination of ET 1-21 was performed by radioimmunoassay using 1 ml of fetal blood obtained by cordocentesis--indicated for various reasons--and in 2 ml of maternal venous blood. The statistical analysis involved the Wilcoxon test for pair differences and the Spearman rank correlation coefficient. Fetal and maternal ET 1-21 levels were respectively 11.39 +/- 2.22 pmol/L and 6.44 +/- 1.00 pmol/L. Fetal levels were significantly higher (p < 0.01) thus excluding passive ET transfer through the placenta, while no correlation between maternal and fetal levels was found. It is speculated that high fetal ET 1-21 levels result from increased ET production, which possess cell proliferative properties and/or decreased ET removal from the fetal circulation because of hypofunctioning lungs and kidneys. It can be assumed that the increased amounts of fetal ETs contribute to normal growth and development directly as well as by regulating vascular tonus and local blood flow.
Journal of Perinatal Medicine 01/1995; 23(4):321-5. · 1.70 Impact Factor
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ABSTRACT: A total of 323 women of reproductive age (19-40 years) were submitted to a complete investigation of infertility routinely including hysterosalpingography and hysteroscopy. In 177 cases (54.7%) no pathological conditions were found by either of the applied methods, while in 65 cases (20.1%) similar abnormalities were observed by hysterosalpingography and hysteroscopy with a global correlation of 74.8%. Hysterosalpingography also presented false positive results in 11.7% and false negative ones in 13.3% of all the studied cases. In conclusion, the combined use of these techniques in infertility investigation gives complete and accurate information about the uterine cavity, despite the disadvantages of hysterosalpingography due to false positive and false negative results.
Human Reproduction 01/1995; 9(12):2353-5. · 4.47 Impact Factor
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ABSTRACT: Recently Greece received a large number of refugees mainly from Eastern European countries, Middle East, Africa and the Pontus region. Refugee status, implying psychosocial adversities and financial problems, has traditionally been associated with unfavourable pregnancy outcome. This study aimed to compare the incidence of preterm delivery and low birthweight among 638 refugees and 1231 indigenous women giving birth at the same hospital in Athens. Conditional logistic regression was used in the analysis to account for parity and delivery date (matching variables) as well as controlling explicitly for maternal age and gender of the neonate. It was demonstrated that refugee status did not overall influence the occurrence of preterm delivery or low birthweight, thus implying that these two variables are not sensitive or early indicators of the adverse effects of psychosocial stress suffered by refugees.
Paediatric and Perinatal Epidemiology 11/1994; 8(4):384-90. · 2.31 Impact Factor
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ABSTRACT: Twelve primary amenorrheic adolescents were treated with transdermal estradiol 100 micrograms (Estraderm TTS-100 (R)) twice weekly for 3 weeks, plus MPA 10 mg per os daily (Provera) for the last 11 days, following an interval of 1 week. A basic examination and a re-examination at 6- and 12-month intervals were carried out for clinical evaluation, hormonal assays, lipid, carbohydrate and bone metabolism. No significant changes were recorded on the FSH, LH, 17 beta-estradiol and PRL serum levels. A significant decrease of TC values and atheromatic indices 1 (TC/HDL) and 2 (LDL/HDL) was seen (P < 0.05) at the end of treatment. On the other hand a significant increase in apolipoproteins A1 was found. A beneficial effect was also recorded on the bone mass. Finally, no significant side-effects were reported. It is concluded that this kind of hormone replacement therapy is efficient and safe for the treatment of amenorrheic adolescents due to gonadal dysgenesis.
Maturitas 03/1994; 18(2):105-14. · 2.77 Impact Factor
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ABSTRACT: An attempt was made to predict the probability of malignancy of a given ovarian tumor in a certain patient by using the age and simple morphologic features of the tumor. A cohort of 959 patients with ovarian tumors was analysed retrospectively according to the patient's age and tumor characteristics such as greatest diameter, consistency, bilaterality and diagnosis as malignant (271 patients) or benign (688 patients). All variables were entered unconditionally in a logistic regression. The presence of solid/multilocular elements has a 9.6-fold increased risk of malignancy, where a bilateral tumor has a 2.8-fold increase. Significant increase in risk of malignancy was observed in ages under 20 and over 40 years, as well as in tumors with a diameter larger than 9 cm. All variables were highly significant associated with the discrimination between benign and malignant. A formula including all variables has been developed so that the probability of malignancy can be estimated by a scientific calculator. In conclusion, simple, easily determined by ultrasound and reproducible criteria such as patient's age, tumor size, consistency and bilaterality were assembled in a logistic model in order to predict the probability of malignancy for a given ovarian tumor, in an individual patient.
Gynecologic and Obstetric Investigation 02/1994; 38(2):140-4. · 1.28 Impact Factor
