Dimitrios Athanatos

Laparoscopic management of mesenteric cyst: a case report

Mesenteric cysts are rare intra-abdominal lesions with variable clinical symptoms and signs that make pre-operative diagnosis difficult. Optimal treatment is surgical excision of the cyst with laparotomy or laparoscopy. We present a case of mesenteric cyst that was misdiagnosed as para-ovarian cyst and managed laparoscopically by gynaecologists.

Ultrasound and MR-imaging in preoperative evaluation of two rare cases of scar endometriosis

Scar or incisional endometriosis is a rare, often misdiagnosed, pathologic condition of the abdominal wall. Two cases of incisional endometriosis are presented. Both patients presented with atypical cyclic pain and palpable nodules on scars of previous cesarean sections. In both cases, the mass was totally excised, after accurate preoperative evaluation with 2-D ultrasound, power Doppler and MRI. Microscopic examination confirmed the preoperatively presumed diagnosis of cutaneous endometriosis. In cases of suspected scar endometriosis, preoperative diagnostic imaging is valuable in determining the extent of disease, thus enhancing accurate and total excision.

Reproductive and obstetric outcome after laparoscopic excision of functional, non-communicating broadly attached rudimentary horn: a case series.

OBJECTIVE To present the reproductive and obstetric outcome after laparoscopic excision of functional, non-communicating broadly attached rudimentary horn. STUDY DESIGN As a part of a retrospective study performed over the past 21 years to determine the reproductive and obstetric outcome after laparoscopic treatment for symptomatic non-communicating rudimentary horn, we identified seven women who became pregnant after laparoscopic removal of the broadly attached rudimentary horn. The main outcome measures were reproductive outcome, preterm birth, mode of delivery, birth weight, pregnancy-induced hypertension, antenatal bleeding and presence of other congenital anomalies. RESULTS Infertility was present in 3 out of 8 cases (37.5%), although in 2 of them other confounding infertility factors existed. Seven out of 8 patients conceived, 2 of them by assisted reproduction techniques. All patients had a preterm delivery at 33 weeks of gestation (32.5±2.4) by cesarean section due to pregnancy-induced hypertension (3 cases), IUGR (one case), contractions and hemorrhage (one case), while two were elective. The mean weight of infants was 1897±607.8 g. Pregnancy-induced hypertension was observed in 3 and antenatal vaginal bleeding occurred in 5 patients. All infants are alive with no apparent congenital anomaly. CONCLUSIONS This case series confirms that pregnancies in women after laparoscopic excision of broadly attached rudimentary horns should be considered as high-risk ones and should be managed accordingly to ensure a satisfactory obstetric outcome.

Placenta abruption in a woman with Wilson's disease: a case report

Wilsons disease is a rare genetic disorder of copper metabolism that causes primary hepatic cirrhosis, secondary menstrual abnormalities and infertility. Following the appropriate therapy patients are asymptomatic and pregnancy may be achieved. We present a case of placental abruption in a pregnant woman with Wilsons disease and we review the management dilemmas and treatment options of pregnant women with Wilsons disease.

Complete uterine inversion during caesarean section: A case report

Inversion of the uterus through the uterine lower segment incision during a caesarean section is an extremely rare obstetric incident. It consists, though, an emergency complication that is potentially life-threatening, especially in cases of prolonged inversion, because haemodynamic instability and shock may occur. Prompt diagnosis and immediate uterine reversion are the key actions in the management of this serious complication.

Galanin in the amniotic fluid and neonatal birth weight: a prospective observational study

Abstract Objective: The aim of the present study was to examine whether an association is present between amniotic fluid (AF) galanin and neonatal birth weight (NBW). Design: Prospective observational study. Setting: Fetal maternal unit in a tertiary teaching hospital. Population: Fifty women of singleton pregnancy who underwent amniocentesis during the second trimester and delivered after the 37th week of gestation. Methods: Amniocentesis 18th–19th gestational week for genetic indication with the use of a 22G needle under real-time sonographic guidance and measurement of galanin concentration in the AF. Main outcome measures: Association between concentration of AF galanin and NBW at term. Results: Galanin was isolated in all samples of AF (median concentration 19.95 pg/mL; range: 19.0–21.7). A strong linear correlation between AF galanin and NBW was detected (τ = 0.928; p < 0.001). Non-parametric linear regression analysis revealed that galanin concentration could explain 72.1% of the variance in the NBW, when controlling for gestational week at birth and mother’s body mass index at delivery. Conclusions: AF galanin during the second trimester seems to have a strong linear correlation with NBW of term deliveries in singleton pregnancies, even when controlling for important confounders.

Treatment options for dysfunctional uterine bleeding: evaluation of clinical results

Abnormal uterine bleeding is one of the most common problems in women of reproductive age, and dysfunctional uterine bleeding (DUB) accounts for about half the cases. The aim of this review is to present all treatment options for women suffering from DUB and to evaluate their effectiveness. A detailed search strategy on electronic databases was carried out to identify trials and reviews on management of abnormal uterine bleeding. Tranexamic acid is the most effective medical treatment. A levonorgestrel-releasing intrauterine device is a low-cost, simple, and effective medical method, comparable to hysterectomy in terms of quality of life. In cases of DUB resistant to medical treatment, surgical treatment should be offered. First-generation ablation techniques are effective, but have a long learning curve. Second-generation ablation devices are highly effective and safe alternatives, thoroughly compared to first-generation techniques. Hysterectomy is the only method that guarantees treatment of dysfunctional uterine bleeding, but is a major operation associated with higher morbidity and mortality rates. Proper counseling of each woman with DUB regarding all treatment modalities can provide the best choice for each patient. More prospective randomized trials are needed to establish the effectiveness of these methods

Embryo with XYY syndrome presenting with clubfoot: a case report

Talipes equinovarus (clubfoot) is a skeletal anomaly of the embryos legs, with a frequency of 1-3:1000 living born babies. It may occur as an independent anomaly, or as part of a syndrome with concomitant chromosomal abnormalities.XYY syndrome is a quite rare sex chromosomal abnormality with 47, XYY karyotype. Prenatal diagnosis is usually accidental because the syndrome is not associated with increased prevalence of sonographically detectable defects. The possibility of co-existence of skeletal anomalies in embryos with 47, XYY karyotype is scant, with only a few cases reported in the literature.An amniocentesis was performed in an embryo at the 21st week of gestation because clubfoot was detected in the 2nd trimester scan, and the embryo was found to have abnormal karyotype of 47, XYY. Current opinions and management dilemmas are discussed.

Attitudes of Greek gynecologists to prescription of hormone replacement therapy for survivors of cervical cancer

unbiased status quo technique is 1–3 years lower than that reported in industrialized nations. It is possible that exposures related to rural poverty in El Salvador may be leading to the acceleration of ovarian ageing. Living in a countrywith a lowGNP has been associatedwith an earlier onset of menopause in Latin America [3]. After adjustment for age, none of the sociodemographic or reproductive risk factors we considered were associated with menopausal status, which underscores the importance of controlling for this potential confounder. Further research on the determinants of age at menopause using status quo techniques and controlling for age and other confounders, is needed in this population. Because earlier menopause increases the risk of some adverse health outcomes such as cardiovascular disease [4], access to preventative health care for postmenopausal women in rural El Salvador must be improved.