Athanasios Mousiolis

Preterm birth trends in Greece, 1980–2008: a rising concern

To identify preterm birth trends in Greece.

Gitelman syndrome-associated severe hypokalemia and hypomagnesemia: case report and review of the literature

We report a case of a woman with Gitelman syndrome who presented to our hospital mainly due to hyperemesis. Following her admission, intravenous potassium and magnesium supplementation was commenced to counter the observed hypokalemia and hypomagnesemia. Hyperemesis receded and although serum potassium remained low, she became asymptomatic. Oral potassium and magnesium supplementation was administered throughout pregnancy and biweekly ion level measurements were scheduled. Despite the intensive replacement, ion levels remained constantly low. She delivered at 38 weeks with an elective caesarean section because of a breech presentation, a healthy female baby weighing 3350 g. Neonatal electrolyte profile was normal.

Polycystic ovary syndrome: double click and right check. What do patients learn from the Internet about PCOS?

OBJECTIVE To identify the websites most visited by patients regarding polycystic ovary syndrome (PCOS), and to evaluate the quality of information provided by these websites. STUDY DESIGN We sought data regarding the popularity of sites providing information about PCOS regardless of the way the visitors reached the site. We then scrutinized the top sites for predefined quality check points to evaluate the quality of information provided, including Health on Net Foundation (HON) accreditation. Finally, we searched for the expansion of these sites in social networks (Facebook and Twitter). RESULTS Of the top 15 sites, 8 were HONcode certified. The mean performance of content presence for all sites was 7.33 (min=4, max=10, SD=1.633). There was a moderate correlation of higher performance score with HON accreditation (R: 0.535, p<0.05). Several sites have expanded in social media. None of the high-score sites has a page dedicated to PCOS. CONCLUSIONS There exists a lack of HON accreditation in many sites and a wide variability in the quality of the information provided. In some cases, key elements of content, necessary for complete appreciation of PCOS, are missing. Official and high authority healthcare organisms should introduce themselves in the social media world.

Optimum mode of delivery in gestations complicated by preterm premature rupture of the membranes

Objectives: To provide evidence about the preferable mode of delivery, vaginal (VD) or caesarean section (CS), in PPROM. Methods: A retrospective study of 190 cases. Survival analysis was used to identify statistically significant differences in mortality rates. Results: A total of 126 pregnancies were included in our study. Mean gestational age of rupture was 28+0 weeks (min = 15, max = 36+4, sd = 5.796). Mean birth age was 30+0 weeks (min = 15, max = 37+2, sd = 5.353). CS was performed in 55 cases (43.7%), VD in 71 cases (56.3%). Data analysis showed that, regardless of presentation, there was a statistically significant benefit on survival in favor of the CS in births below 30 gestational weeks (n = 39, nCS = 18, nND = 21, χ2 = 7.946, p = 0.005). Hazard ratio estimation set the critical gestational age at 28 weeks. For vaginal deliveries, breech presentation was associated with inferior survival outcome compared to vertex (nTotal = 71; nVertex = 63, nBreech = 8, χ2 = 13.012, p < 0.001.Also in breech presentation, VD survival outcome was inferior to CS (nTotal = 9; nVD = 6, nCS = 3, χ2 = 5.145, p < 0.05). Conclusions: According to our results, in cases of PPROM, CS was beneficial below 28 weeks and in breech presentation below 30 weeks.

Maternal age as a predictive factor of pre-term birth. An epidemiological study from 1999 to 2008 in Greece

The aim of the study was to estimate the risk of pre-term birth in women giving birth in Greece in different age groups. Data about women giving birth in Greece were retrieved from the Hellenic Vital Statistics covering the years from 1999 to 2008. Relative risk using χ2 contingency tables was estimated among maternal age groups formed. These groups included mothers < 15 years of age, 15–19, 20–34 (used as a control group) and women > 34 (35–39, 40–44, 45–49 and ≥ 50) years of age. Relative risk of each age group was compared with mothers 20–34 years of age. A total of 1,069,413 valid births were included in the study and 72,156 of them were pre-term (6.75% of total count). Results exhibit a ‘U’-shaped distribution of risk. Higher risk of pre-term birth is noted in the groups of < 15 years (Pearson χ2 = 14.964, p < 0.001, risk = 1.569, CI = 1.249–1.970) and above 34 years of age (Pearson χ2 = 2991.26, p < 0.001, risk = 1.572, CI = 1.546–1.597). For older women, a steep rise in the relative risk for pre-term birth was noted beyond the 40–44 years of age group. Finally, of interest is the fact that ‘late’ pre-terms (34–36 gestational weeks) account for most of the pre-term birth in mothers beyond 34 years of age.

Can isosorbide mononitrate be useful in second trimester termination of pregnancies

BACKGROUND Isosorbide mononitrate (IMN) administration is thought to enhance in the cervical ripening process. We sought to identify the clinical usefulness and safety of IMN administration for shortening the time to termination of the second trimester pregnancy procedures when used in addition to misoprostol. STUDY DESIGN Women were randomly selected to receive either the standard misoprostol treatment (control group) or, additionally, receive vaginally IMN as well as the misoprostol treatment. RESULTS The mean induction to complete abortion interval was 20.4 h [95% confidence interval (CI)=16.63-24.17] in the misoprostol group compared with 12.4 h (95% CI=10.33-14.47) in the misoprostol plus IMN group. This difference was statistically significant (p<.05). In the subgroups of nulliparas and multiparas, the shortening effect of the IMN was also statistically significant. CONCLUSIONS A net benefit after the combined use of IMN and misoprostol was noted. Therefore, we believe that IMN has a clinical role in the ripening process.

Vaginal trauma after a personal watercraft accident

6 weeks aft er application (Pandit 2005) and as late as 21 years (Kolias et al. 2010). Th e mechanism of migration is thought to be as follows: the clip, when correctly placed on the fallopian tube, induces avascular necrosis of the occluded part, thus leaving two blind stumps. Normally, the clips remain attached to one of the blind ends of the tube, and are then gradually covered by peritoneal growth. If this growth fails to occur, the clips may fall off . Th ey usually reside symptomless in the pouch of Douglas or in the paracolic gutters. Only a few case reports exist of migrating Filshie ® clips causing discomfort. Th e process of migration and expulsion is believed to be driven by low-grade infl ammation, as histology reports of excised tissue containing migrating clips have confi rmed (Connolly et al. 2005), although this mechanism is questioned by YellamareddyGari et al. (2005) as a response to Pandit ’ s case study (Pandit 2005), where an abdominal X-ray confi rmed the intra-abdominal location of a clip, 1 week before its expulsion through the anus. Could an infl ammatory process induce migration so quickly? If not, what other possible mechanism could explain such a fast process? Would it be more plausible to assume that at the time of the abdominal X-ray, the clip was already penetrating the sigmoid wall? Our two patients experienced discomfort due to a dislocated clip, both 8 years aft er the correct clip placement, which could fi t in a theory of long-term, low-grade infl ammation causing migration.

Preterm birth seasonality in Greece: an epidemiological study

Objective: Seasonality of preterm birth has been noted, although not conclusively studied. Weather is also thought to play a role. We sought preterm birth seasonality and additionally studied the effect of weather parameters in the preterm birth pattern. Methods: Vital statistics from the Hellenic Statistical Authority were retrieved, covering the years from 1980 to 2008. Additionally, weather data were retrieved for the years of the study. Time series analysis was used to create various statistical models that would be compared to each other for their accuracy to predict preterm birth. Factors used in the modeling included month of birth, gender and weather factors. Results: Preterm birth seasonality was exhibited. Two peaks of higher risk of preterm birth were noted: One during summer and one during winter. Males were more influenced by seasonality and exhibited slightly different seasonal patterns than females, although no higher risk for preterm birth was noted. The best model that described seasonal pattern of preterm birth was the one that included meteorological factors. Notably, extreme (hotter or colder) weather was accompanied by an increase in preterm birth. Conclusions: Evidence for seasonality of preterm birth was shown and extreme weather was associated with a higher incidence of it.

Laparoscopic Cystectomy In-a-Bag of an Intact Cyst: Is It Feasible and Spillage-Free After All?

This prospective study was conducted to assess the feasibility of laparoscopic cystectomy of an intact adnexal cyst performed inside a water proof endoscopic bag, aiming to avoid intraperitoneal spillage in case of cyst rupture. 102 patients were recruited. Two of them were pregnant. In 8 of the patients the lesions were bilateral, adding up to a total of 110 cysts involved in our study. The endoscopic sac did not rupture in any case. Mean diameter of the cysts was 5.7 cm (range: 2.3–10.5 cm). In 75/110 (68.2%) cases, cystectomy was completed without rupture, whereas in the remaining 35/110 (31.8%) cases the cyst ruptured. Minimal small spillage occurred despite every effort only in 8/110 (7.2%) cases with large (>8 cm) cystic teratomas. There were no intraoperative or postoperative complications. We concluded that laparoscopic cystectomy in-a-bag of an intact cyst is feasible and oncologically safe for cystic tumors with a diameter < 8 cm. Manipulation of larger tumors with the adnexa into the sac may be more difficult, and in such cases previous puncture and evacuation of the cyst contents should be considered.

Authors' Reply: Preterm birth rise in Greece: time for action

Sir It was with great interest that we read the letter sent to AOGS by Vlachadis et al. (1), where updated results of our work (2) were presented. We are grateful for their kind words and their valuable contribution in highlighting preterm birth as a major public health issue and, indeed, an epidemic. Their results are also interesting because they represent the first data on preterm birth in the financial crisis era. It seems that the trend for an increase in preterm birth persists regardless of the financial turmoil. The projected rate of preterm birth by the end of the current decade is extremely high and if proven accurate then the consequences will be severe. Could an increase in preterm birth rate be justified by a favorable impact on stillbirths and neonatal death counts? Recently published results show that the increase in preterm birth rate is associated with a lower stillbirth and neonatal death rate (3), but this finding is not supported by the results in our population. We concluded that, in our dataset, the factors contributing to the preterm birth rate rise are a combination of increased maternal age, increased use of assisted reproductive technology techniques and obstetric intervention. The impact of the financial crisis will most probably lead to a further increase in the maternal age (4) and further affect the rate. The aim of our study was to record the preterm birth rate in Greece so that action against its rise could be initiated. We believe that our esteemed colleagues think the same and we would like to invite them to join forces with us. In this context, we would like to announce from the platform of AOGS our next moves: We will forward the results of our study to the Greek authorities as well as to the relevant scientific societies, to officially inform them about our findings. We will urge for efforts to be put into identifying the exact causes of preterm birth in Greece and for guidelines to be implemented. The hypothesis that the altered obstetrical practice (and the concomitant increase in cesarean sections rate) plays a significant role needs to be investigated. Additionally, we will issue a press announcement explaining the main results of our study in lay language so that the Greek public may be aware of the sequelae of preterm birth (even after 34 weeks of gestation). We endeavor to raise the issue among the health practitioners and the people. We believe that in this way, academic results will disseminate in the community and may have an impact on the incidence of preterm birth. We believe that it is time to change course and re-evaluate our approach to preterm birth. The consequences of preterm birth have to be thoroughly understood. Increased use of assisted reproductive technology techniques and the everincreasing maternal age are contributing factors that are not easy to intercept in a modern European society. Obstetric practice complying with already established international guidelines is the key to reduce the epidemic of preterm birth.