Correlation of age at natural menopause with occupational status and other epidemiologic factors in women from Prefecture of Kavala, Greece

AIM

Aim of this study was to explore possible associations between the timing of natural menopause and occupational status and other determinant epidemiologic factors among women living in the Prefecture of Kavala, a region of North-East Greece.

METHODS

The sample of the study comprised of 827 naturally menopausal women, who consented to participate in this questionnaire-based interview study between 2011 and 2016. The study population was recruited from women who were hospitalized or visited the outpatient clinics of the General Hospital of Kavala and women working in the public sector services and private companies in the Prefecture of Kavala.

RESULTS

The mean age of the sample at natural menopause was 49.1 years; 12.2 % had early menopause, and 4.5 % were diagnosed with premature ovarian failure. For the majority of enrolled women (80.5 %) menopause occurred between 45-54 years, and for the rest (2.8 %) after 54 years of age. In univariate analysis, a statistically significant correlation was found between age at menopause and occupational status, year of birth, mother's age at menopause, age at menarche, and high levels of chronic stress. Multiple regression analysis revealed that occupational status, year of birth and mother's natural menopausal age could predict age at menopause.

CONCLUSION

Socioeconomic, demographic and familial variables appear to be associated with age at natural menopause in a representative sample of women in the Prefecture of Kavala, Greece. HIPPOKRATIA 2017, 21(1): 32-37.

ANTIMÜLLERIAN HORMONE AS INDICATOR OF OVARIAN DYSFUNCTION

Aim

The purpose of this study was to examine various hormonal, biochemical and environmental factors (i.e., smoking and alcohol intake) and to investigate their possible correlation to the development of polycystic ovary syndrome (PCOS). The main objective was to evaluate the associations between hormonal profile and the antimüllerian hormone (AMH) levels in PCOS patients and their relation to environmental factors.

Patients and Methods

In two gynecological clinics, 38 women with PCOS (defined according to the Rotterdam criteria) were enrolled and observed in relation to AMH, follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), Δ4-androstendione (Δ4-A), dehydroepiandrosterone sulfate (DHEA-S) and glucose plasma concentrations. Obesity, smoking and alcohol exposure were also studied.

Results

AMH, T, Δ4-Α, DHEA-S, LH and FSH were increased in 76.3%, 50%, 31.8%, 23.7%, 21% and 18.4% of the patients, respectively. The LH/FSH ratio and glucose concentrations increased abnormally in 18.4% and 15.8% of the patients, respectively. AMH and T levels were both increased in 47.4% of the patients whereas both AMH and LH levels increased in 21% of the patients. Smoking, alcohol intake, obesity and glucose concentrations were not associated with AMH concentrations. On the contrary, high levels of T and LH were linked to higher levels of AMH. FSH concentrations were not increased in these patients.

Conclusion

AMH is an important hormonal parameter for the diagnosis of PCOS. Larger clinical controlled studies are necessary in an effort to further investigate the inclusion of AMH measurement in the diagnostic criteria of PCOS.

Attenuation of the oestrogen positive feedback mechanism with the age in postmenopausal women

OBJECTIVE

It has been reported that the positive feedback mechanism of oestrogens and progesterone is preserved, although attenuated, in late postmenopausal years. Whether this is also true for the positive feedback effect of oestrogens alone has not been investigated.

DESIGN

Prospective intervention study.

PATIENTS

Thirty healthy postmenopausal women.

MEASUREMENTS

The women were divided into three groups according to the years since menopause (group I: 2-8 years, group II: 9-17 years, group III: 18-25 years). They were studied during a period of 41 days. Two acute experiments (EP) of exogenous oestradiol, given via skin patches, were performed from days 1 to 7 (EP1) and from days 35 to 41 (EP2) to induce an LH surge. Between the two experiments (days 7-34), oestradiol was given at the dose of 100 μg every 3 days, while oral progesterone was added from day 21 to day 34 in order to simulate a luteal phase. Blood samples were taken every 6 h during EP1 and EP2 as well as on days 8, 13, 20, 21, 27 and 34. FSH, LH, oestradiol and progesterone were measured in all blood samples.

RESULTS

An LH surge occurred as a result of the oestradiol positive feedback mechanism in group I and in group II, in both EP1 and EP2. Peak LH values during the surge were significantly lower in group II than in group I in both experiments. None of the patients in group III displayed an LH surge.

CONCLUSIONS

These results demonstrate for the first time a gradual attenuation of the pituitary response to oestrogenic provocation over a certain period following the menopause, with complete abolition after 20 years. It is suggested that the reserves of pituitary gonadotrophs diminish with age.

Attenuating activity of the ovary on LH response to GnRH during the follicular phase of the cycle

OBJECTIVE

Oestradiol sensitizes the pituitary to GnRH, while gonadotrophin surge attenuating factor (GnSAF) may oppose this action. Using the LH response to GnRH during treatment with FSH as an in vivo bioassay for GnSAF, we tested the hypothesis that the augmented LH response to GnRH in the late follicular phase is related to reduced production of GnSAF from the ovulatory follicle.

DESIGN

Prospective intervention study.

PATIENTS

Ten healthy, normally cycling women.

MEASUREMENTS

The LH response to 10 μg GnRH i.v. (ΔLH) was investigated on days 2 and 3 and on days v (follicle size 16-17 mm) and v + 1 of cycle 1 (control) and cycle 2. On days 2 and v, a single s.c. injection of either normal saline (cycle 1) or 450 IU recombinant FSH (cycle 2) was given after the end of the GnRH experiment.

RESULTS

FSH injection increased both serum oestradiol and inhibin B. In cycle 1, ΔLH remained unchanged from days 2 to 3 but increased significantly from days v to v + 1. In contrast, in cycle 2, ΔLH decreased significantly from days 2 to 3 (P < 0·05) and showed a nonsignificant increase from day v to day v + 1. The percentage difference in ΔLH between cycle 1 and cycle 2 was similar on days 3 (-66·9 ± 17·5%) and v + 1 (-65·2 ± 3·6%).

CONCLUSIONS

These results suggest that during the follicular phase of the menstrual cycle, GnSAF is produced by small antral follicles, while the contribution of the ovulatory follicle is minimal.

The riddle of Ballantyne's syndrome in the aspect of hydrops fetalis

Ballantyne's syndrome, the combination of maternal generalized edema and fetal ascites, is rare and alarming in gestation. Early diagnosis might be useful in providing proper management of the fetus and aiming at an improved clinical result. The syndrome is an indication that HF is there, it has already started expanding the fetal torso and endangering the child-bearer's life. Despite the detailed investigation, no apparent cause for the emergence of the hydrops was identified.

The relationship between Anti-Müllerian hormone and other reproductive parameters in normal women and in women with polycystic ovary syndrome

OBJECTIVE

To correlate Anti-Müllerian hormone (AMH) levels with years since menarche as well as to investigate the AMH relationship with ovarian morphology and levels of androgens in healthy normo- ovulatory women and in women with polycystic ovary syndrome (PCOS).

DESIGN

Prospective clinical study.

SETTING

University Hospital of Alexandroupolis, Lito Maternity Hospital.

PATIENTS

Forty two healthy normo-ovulatory women and sixty one women with PCOS, recruited on the basis of the classic PCOS criteria (Rotterdam consensus meeting definition of PCOS (ESHRE/ASRM, 2004).

INTERVENTIONS

Fasting blood was obtained from all subjects in the early follicular phase (days 5-6) after spontaneous or induced menses (in PCOS), and transvaginal ultrasound examination was performed.

MAIN OUTCOME MEASURES

Assessment of values for follicular stimulating hormone (FSH), testosterone (T), AMH, as well as assessments of years since menarche and ovarian volume.

RESULTS

AMH had a statistically significant positive correlation with the ovarian volume (r =0,623, r =0,579 P<0.01) and negative correlation with years since menarche (r =-0,766, r =-0,796 (P<0.01). In women with PCOS, AMH and years since menarche had a significant correlation with testosterone (r =0,477, r = -0,527, P<0.01) CONCLUSIONS: This study underlines the relation between AMH and years since menarche as well as the AMH differences in relation with certain clinical or endocrine characteristics between normal and PCOS women.

Conservative surgery for borderline ovarian tumors--emphasis on fertility preservation. A review

BACKGROUND

Borderline ovarian tumors account for 15-20% of all ovarian epithelial tumors. Since their original description in 1929, our knowledge of their natural history and molecular pathology has advanced most dramatically over the last two decades. This improved knowledge of BOT has permitted to drastically decrease the therapeutics of these tumors, which remains mostly surgical.

METHOD

We studied the available literature on surgical management of BOT accentuating the most important aspects on this topic: radical vs. conservative treatment, fertility preservation.

RESULTS

Although there are conflicting reports about some of the aspects of surgical management of these tumors, since BOTs commonly affect women of reproductive age, who have not completed childbearing, have an excellent overall prognosis and the majority of them (approximately 50% to 85%) are stage I at diagnosis, conservative surgery (unilateral salpingo-oophorectomy or cystectomy) can be safely performed after comprehensive surgical staging, in order to preserve fertility.

CONCLUSION

Conservative surgery could be safely performed in young patients treated for BOT, provided that they are carefully followed-up.

Differential expression of tenascin-C in the developing human lung: an immunohistochemical study

Much of the specification for the basic embryonic body plan is the result of a hierarchy of developmental decisions at different developmental times. The extracellular matrix (ECM) appears to be a very dynamic structure during embryogenesis. One of the mesenchymal ECM proteins, tenascin, is reported to be transiently expressed during embryonic tissue development, and is absent or much reduced in most fully developed organs. The respiratory system is an outgrowth of the ventral wall of the foregut, and the epithelium of the larynx, trachea, bronchi and alveoli is of endodermal origin. The cartilaginous and muscular components are of mesodermal origin. The aim of this study was to investigate the role of tenascin-C (TNC) in the developing human lung, during the pseudoglandular, canalicular and saccular stage of lung maturation. Formalin-fixed, paraffin-embedded tissue from the lungs of 30 embryos (10 corresponding to the 10th to the 16th gestational week (pseudoglandular stage), 10 to the 17th to the 23rd gestational week (canalicular stage), and 10 to the 24th to the 27th gestational week (saccular stage), were investigated by conventional histology and immunohistology for the expression levels of TNC. The changes observed in the distribution patterns suggest that during embryogenesis, the rate of tenascin synthesis changes significantly. During the pseudoglandular stage, the density of cells expressing TNC was higher in the condensing mesenchyme surrounding the epithelial glands than in the epithelial cells, whereas the inverse result was observed during the canalicular stage. During the saccular stage the pattern of immunoreactivity with TNC was lower than those of the pseudoglandular and canalicular stage, either in epithelial or mesenchymal cells, but it was highly expressed in the basement membranes. This restricted spatiotemporal distribution suggests that tenascin has a key role (1) in mesenchymal tissue remodeling during the pseudoglandular stage, a period that describes the development of the complete bronchial tree and (2) on the epithelial cell shape and function during the canalicular stage, a period that describes the formation of pneumocytes type I and pneumocytes type II. The later, will produce the surfactant, a phospholipid-rich fluid capable of lowering surface tension at the air-alveolar interface. During the saccular stage, tenascin was present mainly in the basement membranes surrounding the acinar and vascular structures, indicating a supporting and mechanical role.

Irregular dental structures in a benign ovarian cystic teratoma (dermoid cyst): case report

Mature cystic teratomas, often referred to as dermoid cysts, are the most common germ cell tumors of the ovary in women of reproductive age. The gross pathologic appearance of a dermoid cysts is characteristic. Hair follicles, skin glands, muscle, and other tissues lie within the cyst wall. We present a case of a dermoid cyst ovarian tumor in a 24-your-old patient with a tooth lying on each wall. The mass was laparoscopically removed by ovarian cystectomy.

Attitudes towards contraception in three different populations

OBJECTIVE

To investigate contraceptive behavior of women belonging to three different ethnic and/or socioeconomic populations as well as to evaluate the main sources of information concerning contraception in each population.

METHODS

150 Muslim women living in Germany (group A), 120 Muslim women living in Thrace, Greece (group B) and 140 Christian Orthodox women living in Thrace, Greece were enrolled in the study. Attitudes concerning contraceptive practices were assessed by means of a questionnaire. Demographic and socioeconomic characteristics of each group were compared with the method of contraception used. Statistical analysis was performed using one-way analysis of variance (ANOVA), followed by Turkey's test, chi-square test and multiple logistic regression analysis.

RESULTS

The contraceptive pill (41.7%), the condom (35.1%), periodic abstinence (24.4%) and interrupted coitus were the most common methods of contraception. The gynecologist (23.4%), the family consultant (12.0%) and the sexual partner (10.2%) were the most usual sources of information. The use of contraceptive pills was more frequent among Muslims from Germany and Christians from Greece (p < 0.001), while the use of condoms was more frequent among Christians from Greece (p = 0.019). The use of IUDs was more frequent among Muslims from Germany and Greece (p = 0.039).

CONCLUSIONS

Our study results reveal that there are behavioral differences between race/ethnic groups and minorities regarding contraceptive practices, probably due to different cultural, socioeconomic and educational factors.

DNA damage of human spermatozoa in assisted reproduction: origins, diagnosis, impacts and safety

Sperm DNA contributes half the offspring's genomic material and abnormal DNA can lead to derangements in the reproductive process. Normal sperm genetic material is required for successful fertilization, as well as for further embryo and fetal development that will result in a healthy child. Thus, the damage to sperm DNA is critical in assisted reproductive techniques which are increasingly used to treat infertile couples. There has been improving data about the effects of human sperm DNA damage or fragmentation. As well, increasing knowledge concerning the effects of DNA damage on embryo and fetal development has been attained. This review aims to summarize the present knowledge on the impact of human sperm cell DNA damage on male infertility and outcome in the context of safety.

Preimplantation genetic diagnosis

Preimplantion genetic diagnosis (PGD) is now used for identification of gene and chromosomal defects in embryos. In this article we describe its use primarily for identification of chromosomal defects in women with recurrent abortions, repeated in vitro fertilization (IVF) failure, and advanced maternal age. In all these situations there is increase in chromosomal defects. The identification of normal embryos and the elimination of abnormal embryos are argued to be helpful in increasing implantation and pregnancy rates in these women.

Hypertensive disorders in pregnancy: risk factors and epidemiologic analysis

OBJECTIVE

To measure the incidence of preeclampsia-eclampsia and its perinatal mortality as they appear in the two major ethnic groups in Thrace: Christian Orthodox and Muslims.

STUDY DESIGN

Incidence and perinatal mortality of preeclampsia-eclampsia were studied retrospectively on all women managed in our clinic for hypertensive disorders in pregnancy who were delivered of a stillborn or healthy neonate between 1986 and 1999. We also compared the prevalence of certain risk factors of the disease as they appear in the above-mentioned distinct ethnic groups.

RESULTS

The total incidence of preeclampsia-eclampsia in Thrace was 2.3% and the total perinatal mortality 6.4%. Both variables presented higher values and severe preeclampsia-eclampsia had greater prevalence in the Muslim population. Most risk factors presented statistically significant differences between Christians and Muslims (chi2 test, p < 0.05).

CONCLUSIONS

There was an ethnic variation in most epidemiologic variables of hypertensive disorders in Thrace between Christians and Muslims.

Biomagnetism in perinatal medicine. Our experience in Greece

This is a report on our experience in the application of biomagnetism in perinatal medicine. We provide a brief description of our research work in fetal magnetoencephalography and fetal magnetocardiography in normal, preeclamptic and IUGR pregnancies, together with hemodynamics of the umbilical cord and uterine arteries, providing a new approach to biomagnetism as a non invasive imaging modality in the investigation of perinatal complications.

Magnetic field profiles in normal human breast during the menstrual cycle

OBJECTIVE

To investigate the subtle magnetic fields produced by living normal breast tissue during the menstrual cycle.

METHODS

The magnetic activity of the breast was recorded in four young women, 26-28 years old; two had regular and two irregular menstrual cycles. The recordings were accomplished with a biomagnetometer and covered two complete menstrual cycles. The results were correlated with estrogen and progesterone levels on days 7, 14 and 21 of the menstrual cycle.

RESULTS

The magnetic breast recordings in the two young women with the regular cycling endometrium showed a biphasic magnetic curve, apparently corresponding to the proliferative and secretory phase of the menstrual cycle. By contrast, the two young women with irregular menstrual cycles showed a monophasic magnetic curve.

CONCLUSION

It is suggested that a biphasic, but not a monophasic, pattern of magnetic activity in the breast is indicative of an ovulatory endometrial cycle.

Biomagnetism in gynaecologic oncology. Our experience in Greece

Our experience in the application of biomagnetism in gynaecologic oncology is presented. We provide a brief description of our research work in the investigation of biomagnetic activity in benign and malignant ovarian and breast diseases, and an evaluation of uterine myomas, providing a new approach of biomagnetism as a non invasive imaging modality for assessing gynaecologic tumours.

Magnetoencephalography and magnetocardiography in neonates. Our experience in Greece

This study reports our experience in the application of magnetoencephalography (MEG) and magnetocardiography (MCG) in neonates. Results gained from our studies, lead us to believe that MEG and MCG could provide clinical practice with non-invasive, rapid and easy to perform methods, which could be adjuncts to conventional methods for the evaluation of neonatal brain and heart function.

Human oocyte cryopreservation: past, present and future

Despite inferior results in the past compared with embryo freezing, oocyte cryopreservation has made great strides in recent years. In fact, it has become a necessity in assisted reproduction technology, providing alternatives to legal, moral and religious problems originating from embryo freezing. Recent advances in freezing technology, modifications of conventional protocols used and continuing optimization of vitrification have efficiently improved the method. A historical description of the method's progression over time, and a comparison of principles, procedures and results as reported in the literature are presented in this review.

Correlation between biomagnetic and Doppler findings of the uterine artery in normal and preeclamptic pregnancies

OBJECTIVES

To elucidate the hemodynamics of the uterine artery in normal and abnormal pregnancies by use of Doppler ultrasound and SQUID biomagnetometry.

METHOD

Two hundred and three women (gestational age 28-42 weeks) were included in the study. Forty-three of them had preeclampsia and/or intrauterine growth restriction and 160 were normal. Uterine artery waveform measurements were evaluated by use of pulsatility index (PI) (normal value PI<1.45). Biomagnetic signals of uterine arteries were recorded and analyzed with Fourier analysis. The biomagnetic signals were distributed according to spectral amplitudes as high (140-300 fT/ radicalHz), low (50-110 fT/ radicalHz) and borderline (111-139 fT/ radicalHz).

RESULTS

There was a statistically significant difference between normal and abnormal pregnancies concerning the waveform amplitudes (p < 0.001) and the PI index (p < 0.001). Specifically, we noticed high biomagnetic amplitudes in most normal pregnancies (92.5%) and low biomagnetic amplitudes in most preeclamptic cases (90.7%).

CONCLUSIONS

Our study results indicated that biomagnetic measurements of uterine artery might prove to be useful in the evaluation of the fetal well being, especially in cases of preeclampsia and intrauterine growth restriction.

Epidemiology of congenital anomalies in different ethnicities

PURPOSE OF INVESTIGATION

To study the prevalence and the epidemiologic characteristics of major congenital anomalies (MCAs) in two different populations in Thrace-Greece.

METHODS

The ethnic origin of all mothers who delivered in our department and the types of MCAs were determined. We compared the frequencies of MCAs between Christians and Muslims. The chi-square test, t-test, binary and multinomial logistic regression analysis were performed.

RESULTS

The prevalence of MCAs was significantly higher in Muslims as compared to Christians (51/4,028 (12.78%) vs 49/5,994 (8.17%), p = 0.035). However, the frequencies of each type of MCA in the total number of deliveries between the two groups did not differ significantly. The central nervous system malformations were most frequently associated with perinatal mortality.

CONCLUSION

This is the first study in Greece showing that there is probably a higher prevalence of MCAs in Muslims as compared to Christians, although it can not be elucidated whether this increased risk is related to specific differences between them.

Attitudes towards male condom use in two different populations in Thrace, Greece

OBJECTIVE

To outline Thracian women's disposition and attitude towards the male condom.

METHODS

Representatives of the two major religious subgroups in Thrace (127 Christian Orthodox and 120 Muslim women) were studied. All respondents were of reproductive age (from 17 to 39 years) and were encouraged to answer a specific questionnaire. Women expressed their opinions about their mood while using it, its safety and similarity to natural contraception, and its contribution to the prevention of carcinogenesis and sexually transmitted diseases (STDs). They were also questioned about the ease of accessibility to supplies, the convenience experienced in buying it, its cost, and whether they thought it was necessary to use one in every act of intercourse as a contraceptive method. The statistical software package used was the Sigma Stat 2.0.

RESULTS

The majority of the respondents in both subgroups had a positive opinion about the condom's contribution to the prevention of acquired immune deficiency syndrome (AIDS) and STDs. Christians were better informed about the condom's contribution to the prevention of carcinogenesis, while the majority of Muslims did not feel convinced about the condom's contraceptive efficacy.

CONCLUSIONS

The study results reveal a significant difference in the way that Christian and Muslim women in Thrace consider the impact of condom use on sexual behavior and reproductive health care.

Umbilical cord serum vascular endothelial growth factor (VEGF) levels in normal pregnancies and in pregnancies complicated by preterm delivery or pre-eclampsia

OBJECTIVES

The aim of this study was to determine whether increased levels of vascular endothelial growth factor (VEGF) are implicated in the pathogenesis of pre-eclampsia and in preterm delivery.

METHODS

Umbilical cord serum VEGF levels from women with uncomplicated term pregnancies (control group, n=24), with pregnancies complicated by pre-eclampsia (n=21), or with preterm delivery (n=29) were compared. Statistical analysis was performed using the Mann-Whitney U-test, the t-test, and Smirnoff-Kolmogorov test.

RESULTS

The mean VEGF concentration was significantly higher in the women with pre-eclampsia than in women from the control group (P<0.01). There were also increased but not significantly higher VEGF concentrations in the preterm delivery group compared with the control group (P=0.16).

CONCLUSIONS

Our study results support previous findings that raised umbilical cord serum VEGF levels might be correlated with the clinical development of pre-eclampsia and, in some circumstances, of preterm delivery.

Laparoscopic evaluation of congenital absence of the uterus. a case report

Anatomic gynecologic anomalies, including congenital absence of the uterus, occur with surprising frequency in referral practice of reproductive endocrinology and reproductive surgery. Female individuals with uterus agenesis have normal external genitalia and, therefore, the diagnosis is rarely made in infancy. We report a case of congenital absence of the uterus in a young woman 25 years old, presenting with primary amenorrhea. The patient had a normal karyotype and normal secondary sex characteristics. Sex hormones were within normal limits, indicating normal function of the hypothalamic-pituitary-ovarian axis. The diagnosis was set by bimanual gynecologic examination, which was followed by vaginal ultrasound examination. The patient underwent a laparoscopic investigation, which revealed the absence of the uterus and the presence of small rudimentary uterine horns, connected to normal fallopian tubes. Ovarian morphology was bilaterally normal. In conclusion we believe that every patient with genital tract abnormalities has to be dealt with individually, depending on the patient's anatomy, desires and age.

Chaotic Analysis Approach in Neonatal Magneto-Encephalography

The aim of this study was to investigate the presence of any non-linearity in the magneto-encephalographic recordings (MEG) in neonates born to pre-eclamptic mothers in comparison with the ones born to mothers having uncomplicated pregnancies, in order to find out differences in the mechanisms underlying their brain waves. Our study population consisted of 40 term neonates who were delivered normally, without any clinical signs of brain damage. Thirty of them had a normal pregnancy and labour with normal Apgar scores, umbilical cord pH, and birth weight, while 10 neonates had suffered a pre-eclamptic pregnancy. The above analysis of the MEG in the neonatal pre-eclamptic brain showed a lower dimension complexity as compared with the normal neonatal brain and a lower first Lyapunov exponent which means lower information processing. The non-linear analysis of the MEG activities in neonates may offer important perspectives to understand significant features of their brain function.

Removal of endometrial polyps by use of grasping forceps and curettage after diagnostic hysteroscopy

PURPOSE OF INVESTIGATION

To determine the therapeutic efficacy of the use of gall stone forceps and curettage in endometrial polyps removal, after their detection with diagnostic hysteroscopy.

METHODS

From 1997 to 2001, we conducted a prospective study in 53 patients who presented at our department for menstrual disorders, infertility problems or postmenopausal bleeding and in whom endometrial polyps were detected by hysteroscopy. All patients received general anesthesia and after hysteroscopic detection of the polyps' location, their removal was attempted by use of Desjardins gall stone forceps and curettage. Immediately after the procedure, a second hysteroscopy was performed in order to detect remnants of the polyps.

RESULTS

Fifty patients presented with only one polyp, two with two polyps and one with three polyps. The mean diameter of the polyps ranged from 0.5 to 3 cm. The hysteroscopic appearance of all polyps was not suggestive of malignancy. During the second hysteroscopy we found parts or whole polyps in five and two cases, respectively, accounting for a therapeutic success of 86.8%. The hospitalization time for all patients was 24 hours and occurred no intraoperative or postoperative complications.

CONCLUSION

Our method seems to be safe, with low cost and sufficient therapeutic outcome and could be used in hospitals with availability of diagnostic hysteroscopy only.

Chaotic and periodic analysis of fetal magnetocardiogram recordings in growth restriction

OBJECTIVE

We studied how chaotic and periodic heart rate dynamics differ between normal fetuses (n = 19) and intrauterine growth restricted fetuses (n = 11) at 34 to 37 weeks of gestation. We quantified the chaotic dynamics of each heart rate time series obtained by fetal magnetocardiography (FMCG) using correlation dimension.

METHODS

The FMCG was recorded digitally by a single-channel biomagnetometer in an electrically shielded room of low magnetic noise. The position of the fetal heart was determined using ultrasonography.

RESULTS

The correlation dimension was significantly lower in IUGR than in normal fetuses (p < 0.001, t-test). The periodic dynamics were also obtained by FMCG and measured by power spectrum. The low-frequency components and therefore the periodicity of the low-frequency range were significantly higher in IUGR than in normal fetuses (p < 0.001, t-test).

CONCLUSIONS

The analysis of FMCG recordings may offer important perspectives to understand significant features of the heart function of the fetuses. This technique improves the recognition of IUGR fetuses over healthy ones and may help improve perinatal morbidity and mortality.

Correlation between biomagnetic and Doppler findings of umbilical artery in fetal growth restriction

OBJECTIVE

To assess the value of biomagnetic recordings of the umbilical artery over Doppler ultrasound screening in order to predict complications of impaired uteroplacental blood flow in fetuses with intrauterine growth restriction (IUGR).

METHODS

Our study population included 11 IUGR preeclamptic (34-37-weeks gestation; birth weight 1969 +/- 129 g) and 19 normal pregnancies (34-37-weeks gestation; birth weight 3195 +/- 229 g). Umbilical artery Doppler ultrasound waveform measurements were expressed in terms of pulsatility index (PI). Biomagnetic signals (waveforms) recorded from the IUGR umbilical artery were expressed in terms of magnetic power spectral amplitudes.

RESULTS

In all cases, the frequency band considered was 2 to 7 Hz. The spectral amplitudes were low (mean: 117+/-24 fT/ radical Hz) in most (90.9%) IUGR pregnancies and high (mean: 224+/-37 fT/ radical Hz) in most normal pregnancies (89.5%). There was a statistically significant difference between normal and IUGR pregnancies with respect to spectral amplitudes (p < 0.0001), Doppler PI (p < 0.0005), pH (p < 0.0005) and Apgar score (p < 0.0005). Multiple linear regression analysis revealed an influence of PI, pH and Apgar scores on the biomagnetic values (ANOVA: p < 0.0005).

CONCLUSION

Our data imply that biomagnetic values of the umbilical artery flow could prove to be a helpful method for the evaluation of fetal well being especially in pregnancies complicated with preeclampsia and growth restriction.

Proliferative breast disease: epidemiologic aspects, and cytologic diagnosis

PURPOSE

The aim of the present study is to describe the prevalence of proliferative breast lesions in cases of benign and malignant tumors of the breast as well as to assess the contribution of rapid intraoperative imprint cytology in the diagnosis of proliferative breast disease.

METHODS

Frozen section and intraoperative imprint cytology were performed on breast tissue biopsies from 486 breast cancer patients who underwent primary surgical treatment. Imprints were stained either by the Papanicolaou (Pap) or the May Grünwald-Giemsa (MGG) or the Hematoxylin eosin (HE) technique. Cytologic diagnoses were compared to the histopathologic ones from paraffin sections.

RESULTS

Sclerosing adenosis was the most common finding in benign breast biopsies while in breast cancer the prevalence of the lesion was reduced by half. On the other hand, atypical hyperplasias in malignant biopsies were almost twice as many as in benign ones. Imprint cytology presented high sensitivity and specificity (99% and 96% respectively) in distinguishing benign proliferative from malignant lesions as a whole, but regarding atypical hyperplasias the specificity was significantly reduced (76% vs 96%).

CONCLUSION

Clarification of cytologic diagnostic criteria and expertise in cytologic interpretation could show off intraoperative imprint cytology as a useful and inexpensive diagnostic tool providing the surgeon with prompt and accurate information regarding the nature of breast lesions.

Attitudes towards contraceptive pill use in two different populations in Thrace, Greece

OBJECTIVE

To investigate the differentiation in attitudes towards contraceptive pill use in two different populations in Thrace, Greece. A retrospective study on representatives of the two major religious subgroups in Thrace: 127 Orthodox Christians and 120 Muslims. The questionnaire was designed to investigate women's opinions concerning the possible beneficial and adverse effects of the contraceptive pill.

RESULTS

In comparison with Christians, a higher percentage of Muslims responded 'don't know' in questions about the pill's efficacy in regulating menses (p = 0.019), 'yes' concerning the inconvenience of daily uptake (p = 0.032) and the pill's contribution to nausea (p = 0.003), and 'maybe' in the question concerning the pill's contribution to depression and headaches (p < 0.001). A higher percentage of Christians responded 'yes' concerning the pill's contribution to depression and headaches, and 'don't know' concerning the pill's contribution to nausea. There were no significant differences in the responses to the remaining questions, and it was clear that most women believed that use of the pill is correlated with increased risk of cardiovascular disease and cancer.

CONCLUSIONS

Muslims appeared more reluctant than Christians to use the pill as a contraceptive method. Christians seemed to be better informed about the pill's phamacological actions and beneficial effects, but both populations were unaware of current information regarding the pill's safety. There is a need to promote information about these topics in Thrace.

Neonatal magnetocardiography and Fourier spectral analysis

OBJECTIVE

In this study we investigated the relationship between heart rate variability (HRV) and respiration in healthy and probably asphyxiated infants using magnetocardiographic (MCG) recordings.

METHODS

Ten healthy and eight infants from pregnancies complicated by preeclampsia with indications of mild perinatal asphyxia were included in the study. All were near term. Maternal age ranged from 16 to 39 years (mean = 29.05, SD = 6.13). Spectral analysis was used to find out any association between respiration and HRV.

RESULTS

Respiratory sinus arrhythmia (RSA) was reduced in preeclamptic infants with indications of mild perinatal asphyxia. This difference was statistically significant (p < 0.0002, t-test), whereas the heart rate of the two groups was not statistically significant (p = 0.1, t-test).

CONCLUSION

The results suggest that infants with indications of mild preeclampsia differ from controls in respiratory activity and this difference is independent of basal heart rate. Thus, spectral analysis could be useful for the estimation of influence of mild perinatal asphyxia in the RSA rhythm of newborns.

Neonatal magnetocardiography

PURPOSE

The aim of the present study was to test the validity of magnetocardiography (MCG) in the estimation of neonatal cardiac rhythm using a single channel superconductive quantum interference device (SQUID).

MATERIALS AND METHODS

Our study population consisted of 50 neonates who were delivered normally between 37-41 weeks of gestation from clinically uncomplicated pregnancies. There was also a neonate included in the study in which the diagnosis of "hypoplastic left heart syndrome" was demonstrated by U/S Doppler examination. Maternal age ranged from 18 to 39 years (mean=29.15, SD=6.13).

RESULTS

Our study results revealed 44 neonates with normal cardiac rhythm, four with ventricular tachycardia (VT), one with ventricular tachycardia (VT) and extrasystolic beats and one with bradycardia. The neonate with the hypoplastic left heart syndrome presented frequent episodes of ventricular bigeminy in the magnetocardiographic trace. M-mode echocardiography confirmed the diagnosis of the seven cases of arrhythmia in our study group.

CONCLUSION

Results gained from the study lead us to believe that MCG could provide clinical practice with a non-invasive, rapid and easy to perform method, which could be used as an adjunct to conventional methods for the evaluation of neonatal cardiac rhythm.

Neonatal magnetoencephalography and spectral analysis

PURPOSE

We performed a prospective study of neonatal brain function on 44 respective term neonates who were delivered normally, without any clinical signs of brain damage. Thirty were associated with a normal pregnancy and labor with normal values of Apgar scores, umbilical cord pH and birth weight, while 14 neonates were the result of pre-eclamptic pregnancy.

METHODS-RESULTS

Biomagnetic measurements were performed by means of a Superconducting Quantum Interference Device (SQUID) in an electrically shielded room of low magnetic noise. Biomagnetic signals (waveforms) recorded from neonatal brains in the frequency range of 2-7 Hz were expressed in terms of magnetic power spectral amplitudes. These were low (mean value 163.2, SD 22.57) in almost all neonates from the "normal pregnancy" group, while they were high (mean value 211.6, SD 37.74) in most neonates from the "pre-eclamptic" group. The difference between the two groups was statistically significant (Student's t-test, p < 0.005).

CONCLUSION

A statistically significant difference in spectral amplitudes of neonatal brain activity was observed between normal term neonates and the pre-eclamptic neonates. Biomagnetic measurements of neonatal brain activity could provide clinical practice with a promising procedure for assessing brain function.

Imprint cytology of non-specific granulomatous mastitis

Non-specific granulomatous mastitis (NSGM) is a tumor-like inflammatory condition involving breast lobules. Its recognition is of great significance because of clinical masquerade to invasive carcinoma. A 25-year-old woman developed a palpable breast lump with clinical and mammographic findings suggestive of malignancy. Touch imprint cytology of the excised lump was consistent with a granulomatous inflammation while histopathological examination documented a NSGM with central necrosis. Clinical, radiologic and laboratory testing failed to identify any specific causative agent.

The significance of rapid intraoperative cytology in the evaluation of intraperitoneal and retroperitoneal spread of cervical cancer

OBJECTIVE

To evaluate the contribution of the rapid intraoperative cytology (peritoneal washing [PW] cytology together with imprint cytology performed on lymph node samples) in the assessment of peritoneal and retroperitoneal dissemination of cervical cancer.

METHODS

Seventy-nine patients with clinical Stage IA2-IIA cervical cancer underwent PW cytology and imprint cytology performed on retroperitoneal lymph node samples during primary surgical treatment. Cytologic specimens were stained with the May-Grünwald-Giemsa (MGG) and hematoxylin-eosin (HE) techniques. Pertinent histologic sections of the cervical lesions, of the cell blocks prepared from PW sediments, and of the lymph node sampling were studied and compared with the cytologic findings.

RESULTS

PW cytology was positive in 2.5% of the patients, and lymph node imprints revealed metastases in 19% of the patients. Cervical adenocarcinomas presented increased rates of metastatic disease in both the peritoneal cavity and retroperitoneum. HE presented higher sensitivity in detecting malignant cells in the peritoneal fluids, while MGG gave more accurate results in the diagnosis of lymph node metastases.

CONCLUSIONS

Cytologic evaluation of intraperitoneal and retroperitoneal spread of cervical cancer by use of PW cytology and imprint cytology performed on lymph node samples contributes to the assessment of the extent of disease and therefore could be useful in further treatment of the patient.

Fetal heart rate patterns in normal and ritodrine-treated pregnancies, detected by magnetocardiography

OBJECTIVE

The aim of the present study was to test the validity of magnetocardiography in the diagnosis of fetal heart rate arrhythmias in normal pregnancies, as compared to the number of arrhythmias reported in other series, which were detected by use of other diagnostic techniques. We also evaluated the influence of ritodrine on the fetal heart rhythm in pregnancies treated for the risk of preterm labor by means of magnetocardiography, in order to provide preliminary results that could be utilized in the future establishment of magnetocardiography as a screening procedure in the diagnosis and management of fetal arrhythmias.

METHODS

We performed a prospective study on two subgroups of pregnant women: one of 84 women with normal healthy singleton pregnancies and one of 68 pregnant women treated with ritodrine for the risk of preterm labor.

RESULTS

The prevalence of fetal arrhythmias in the first subgroup was 3.5% (3/84), while in the second subgroup the prevalence was 16% (11/68).

CONCLUSIONS

The incidence of fetal arrhythmias detected in our population of normal pregnancies was comparable to that reported in previous studies by use of other techniques. Results gained from the second subgroup, although not comparable to others, owing to lack of similar reports, led us to believe that magnetocardiography's advantages over conventional methods of fetal cardiac surveillance could highlight the technique as a useful screening procedure for the detection of preterm fetuses, which should be submitted to closer investigation, because of the arrhythmias caused by ritodrine infusion.

Fetal magnetocardiogram recordings and power spectra analysis in biomagnetic arrhythmic signals

In this study we investigated fetal arrhythmias using a Superconductive Quantum Interference Device (SQUID) in a shielded environment of low magnetic noise. The subjects involved were 84 pregnant women, 1941 years old (mean=30.55, SD=7.18) with single normal uncomplicated pregnancies and gestational ages 2532 weeks and 68 pregnant women 2342 years old (mean=32.89, SD=5.28), treated with ritodrine for the risk of preterm labour; with gestational ages 2635 weeks. Fourteen fetuses were found with cardiac arrhythmia six cases with tachycardia, one with bradycardia and seven with supraventricular/ ventricular (S/V) extrasystoles. Power spectra analysis of fetal magnetocardiographic arrhythmic signals assesses the functional state of their autonomic nervous system. Thus, magnetocardiography and power spectral analysis of the arrhythmic signals inform us that there is no deviation in the physiological process of the fetal heart in cases of fetal arrhythmia.

Differentiation in contraceptive behavior of the female population in Thrace, Greece

OBJECTIVE

To investigate the factors influencing the contraceptive practice of the female population in the rural area of Thrace, Greece.

METHODS

We conducted a retrospective sociopsychological study on representatives of the two major religious subgroups in Thrace: 127 Orthodox Christians and 120 Muslims. The women were reasonably representative in terms of age, education, marital status and professional life. Interviews covered sexual history and contraceptive use in detail.

RESULTS

We observed a significant preference of Christians for condoms, and of Muslims for coitus interruptus. The use of the male condom was significantly higher in younger, compared to older, Christians (p < 0.001). Muslim women aged 30-39 years showed a significant preference for coitus interruptus and intrauterine devices, as compared with Christians. Highly educated women of both subgroups did not present statistically significant differences concerning contraception. It was found that, the more intense the sexual activity, the more common the use of the condom for Christians and the more popular the choice of interrupted intercourse for Muslims. Muslims with a permanent sexual relationship preferred interrupted intercourse, while all Muslims with multiple sexual partners used the male condom.

CONCLUSIONS

There is an urgent need to promote information concerning the variety of modern contraceptive options in order to improve the prevalence of contraceptive use and reproductive health in the region of Thrace.

Differential diagnosis of breast lesions by use of biomagnetic activity and non-linear analysis

PURPOSE

Breast cancer mortality rates have not changed during the past 60 years despite significant advances in screening methods. It is tempting therefore to use novel technology in order to better understand breast oncology. In this study we investigated the biomagnetic activity obtained in benign and malignant breast lesions using a single channel biomagnetometer SQUID (Superconducting Quantum Interference Device) in order to assess the method's efficacy in the differential diagnosis of these two types of lesions and its establishment as a screening technique.

METHOD

Magnetic recordings were obtained from 21 patients with palpable breast lumps. Of these 11 were invasive carcinomas and 10 were benign breast lesions. We used non-linear analysis to investigate whether there is any biological differentiation in the dynamics in these two types of lesions.

RESULTS

High amplitudes characterized the waveform of a malignant breast lesion whereas in benign breast lesions the corresponding amplitudes were low. Using the application of non-linear analysis we observed a clear saturation value for the dimension of malignant breast lesions and no saturation for benign ones.

DISCUSSION

Biomagnetic measurements with the SQUID and the application of non-linear analysis are promising procedures in assessing and differentiating breast tumors.

Ovarian cancer epidemiology in Thrace, Greece

PURPOSE OF INVESTIGATION

To report the differences in ovarian cancer prevalence between the two major ethnic groups (Christian Orthodox and Muslims) in Thrace, Greece.

METHOD

We carried out a retrospective study on 57 patients, aged 16-79 years, who were treated in our clinic for ovarian cancer.

RESULTS

The cumulative ovarian cancer prevalence in Thrace was 6.8/100,000 (5.5/100,000 for Christian Orthodox and 1.3/100,000 for Muslims). There were no statistically significant differences in most variables affecting the tumour itself. The statistical analysis of demographic risk factors revealed that the Christian population was more of a middle class profile, while the Muslim lifestyle sustained its cultural characteristics, a difference that could be related to the discrepancy observed in ovarian cancer prevalence among them.

CONCLUSIONS

The overall ovarian cancer prevalence in Thrace is lower than that reported for most developed countries and higher than that for most Asian countries. The variance in prevalence between Christian Orthodox and Muslims could possibly be attributed to the different major parameters in lifestyles.

Invasive adenocarcinoma of mixed endocervical and clear cell type, associated with invasive squamous cell carcinoma of the cervix uteri. A case report

A case of invasive adenocarcinoma (predominantly of endocervical type but also with clear cell elements blended in part of the growth) associated with squamous cell carcinoma of the uterine cervix is reported in a young woman aged 18 years. Malignant squamous and atypical glandular cells were detected in Papanicolaou (Pap) smears, which raised the question of a mixed tumor. A diagnosis of cervical cancer was justified by means of a punch biopsy and the patient was treated by modified radical hysterectomy. Histologic and immunohistochemical examination of the hysterectomy specimen revealed two distinct types of an invasive malignant tumor, i.e., of glandular and squamous cell origin, closely related but not integrated. Interestingly, the glandular component comprised both endocervical and clear cell elements. Careful consideration of squamous or glandular atypia in cytological smears may lead to a more precise diagnosis, especially in young women.