Dimitrios Kassanos

Performance of third-trimester ultrasound for prediction of small-for-gestational-age neonates and evaluation of contingency screening policies

To assess the performance of third‐trimester fetal biometry and fetal Doppler studies for the prediction of small‐for‐gestational‐age (SGA) neonates, and to explore contingency strategies using a first‐trimester prediction model based on maternal and fetal parameters and third‐trimester ultrasound.

Adenomyoma and leiomyoma: Differential diagnosis with transvaginal sonography

The purpose of this study was to evaluate the capability of transvaginal sonography to differentiate adenomyomas from leiomyomas.

Maternal Plasma Leptin Levels and Their Relationship to Insulin and Glucose in Gestational-Onset Diabetes

To investigate the changes in leptin levels and the relationship between this substance and insulin and glucose in pregnant women with gestational-onset diabetes, we measured plasma leptin levels in the maternal peripheral vein of 17 healthy and 17 diabetic women at 29 and 33 weeks of gestation. We also correlated maternal plasma leptin levels in diabetic women with fasting plasma insulin levels and plasma glucose levels obtained 1 h after oral administration of 50 g of glucose. Maternal serum leptin levels in women with gestational diabetes (mean ± SD 16.52 ± 5.07 ng/ml, range 10.84–27.4 ng/ml) were significantly higher (p < 0.001) than those found in uncomplicated pregnancies (10.61 ± 1.47 ng/ml, range 7.28–13.4 ng/ml). A positive correlation was found between maternal serum leptin levels and glycosylated haemoglobin values in diabetic pregnant women (r = 0.94, p < 0.001). A positive correlation was also found between maternal leptin concentrations and fasting serum insulin levels, as well as between leptin concentrations and plasma glucose levels obtained 1 h after the administration of 50 g of glucose in women with gestational diabetes (r = 0.84, p < 0.001, and r = 0.92, p < 0.001, respectively). We conclude that leptin levels are elevated in pregnant women with gestational diabetes, and its metabolism depends on insulin levels and the severity of diabetes.

Augmentation of cortical bone mineral density in women with polycystic ovary syndrome: a peripheral quantitative computed tomography (pQCT) study

BACKGROUND Women with polycystic ovary syndrome (PCOS) may have increased cortical bone mineral density (BMD) and probably higher bone material quality as well as better resistance in the compression strength of the tibia, measured by peripheral quantitative computed tomography (pQCT), in comparison with that of age-matched healthy subjects. METHODS Thirty women with PCOS, (15 lean and 15 obese) and 15 age-matched healthy controls were enrolled in this study. The clinical, biochemical and ultrasound characteristics of the two groups were evaluated. Using pQCT, the following parameters were measured: volumetric cortical density (CBD) and volumetric trabecular density (TBD) BMD, total bone cross-sectional area (ToA), cortical area (CoA), cortical thickness (CRT-THK-C) and finally the strength-strain index (SSI). RESULTS The geometrical parameters (CoA, ToA, CRT-THK-C), the SSI as well as the TBD were increased in the PCOS women; however, these differences did not achieve statistical significance between lean PCOS women, obese PCOS women, and controls. Conversely, CBD was significantly higher in PCOS women compared with controls (P < 0.000) and furthermore in lean PCOS women compared with obese ones (P < 0.01040). CONCLUSIONS The PCOS women of our study seem to have a higher quality of bone material in the distal tibia and probably a better resistance of bone in the compression strength without alterations in bone mass and geometry (especially the lean PCOS women), indicating that our oligomenorrheic and hyperandrogonemic PCOS women may be protected from the development of osteoporosis and fracture risk later in life.

Defective antioxidant mechanisms via changes in serum ceruloplasmin and total iron binding capacity of serum in women with pre-eclampsia.

OBJECTIVES The aim of this study was to investigate the role of serum ceruloplasmin, its ferroxidase activity and total iron binding capacity in women with pre-eclampsia. METHODS Thirty primigravidas between 32 and 36 weeks of gestation were studied. The subjects were divided into two groups: group A consisted of 15 normal pregnancies with a mean gestational age of 33.9 weeks, and group B consisted of 15 pre-eclamptics with a mean gestational age of 32.8 weeks. RESULTS The pre-eclamptics presented significantly higher serum ceruloplasmin levels compared to those with normal pregnancies (P<0.01), while the mean ferroxidase activity levels of ceruloplasmin did not differ significantly between the two groups (450.13+/-110.88 and 467.26+/-135.35 micromol/l/min in groups A and B, respectively). The mean+/-S.D. serum iron level (104.48+/-39.81 microg/dl) was greater whereas the total iron binding capacity (55.59+/-8.47 micromol/l) was lower in women with preeclampsia when compared to normal pregnancies (P<0.01 and P<0.0001 respectively). CONCLUSIONS Our results indicate that the plasma of pre-eclamptic women shows a loss of ferroxidase activity of ceruloplasmin as well as a reduction of total iron binding capacity. Thus, it seems that the plasma of pre-eclamptic women lacks the protective anti-oxidative action of these substances.

Performance of the ultrasound examination in the early and late third trimester for the prediction of birth weight deviations

This study aimed to define the optimal gestational age in the third trimester, early (30–33 weeks + 6 days) versus late (34–37 weeks), for performing an ultrasound examination for fetal biometry to predict birth weight deviations: small for gestational age (SGA ≤ 5th centile) and large for gestational age (LGA ≥ 95th centile) neonates.

Fetal intracranial translucency and cisterna magna at 11 to 14 weeks: reference ranges and correlation with chromosomal abnormalities

To measure the intracranial translucency (IT) and the cisterna magna (CM), to produce reference ranges and to examine the interobserver and intraobserver variability of those measurements. To examine the possible association of IT with chromosomal abnormalities.

The clinical significance of Doppler findings in fetal middle cerebral artery during labor

OBJECTIVES (1) To investigate fetal intracranial circulation, relative to peripheral blood flow, during labor with abnormal cardiotocographic (CTG) patterns, using three non-invasive methods. (2) To determine the utility of monitoring middle cerebral artery (MCA) Doppler during labor. INTERVENTIONS Fetuses were assessed using simultaneous CTG, pulse oximetry, and Doppler ultrasonography of both the MCA and umbilical artery (UA) to measure the pulsatility index (PI), resistance index (RI), and flow velocity integral (FVI). STUDY DESIGN During labor 20 term fetuses with abnormal CTG patterns and oxygen saturation values >30%, and 24 term fetuses with abnormal CTG patterns and oxygen saturation values <30% were studied, and peripartum outcomes were compared. The groups were comparable with regard to maternal age and parity. Results were evaluated using the Students t-test and Fisher exact test. RESULTS MCA Doppler showed significantly lower PI and RI, and higher FVI in the presence of reduced oxygen saturation. Differences in fetal outcomes between the two groups correlated with MCA Doppler findings. CONCLUSIONS In experienced hands, Doppler screening of fetal middle cerebral artery waveforms during labor can be useful in the evaluation of intrapartum hypoxia in complicated pregnancies.

Attitudes of pregnant women regarding termination of pregnancy for fetal abnormality

To study the attitudes of pregnant women towards termination of pregnancy for fetal abnormality.

The diagnostic accuracy of two methods for E6&7 mRNA detection in women with minor cytological abnormalities

Objective. To examine the diagnostic accuracy of nucleic acid sequence based amplification (NASBA) and flow cytometry for E6&7 human papillomavirus (HPV) mRNA detection in the triage of minor cytological abnormalities. Design. Prospective diagnostic accuracy study. Setting. Gynecology outpatient clinics of a university hospital. Population. 472 women with low‐grade squamous intraepithelial lesion (LSIL) or atypical squamous cells of undetermined significance (ASCUS). Methods. Residual material of the liquid‐based smears was tested by NASBA and by flow cytometry for E6&E7 mRNA expression. Histological diagnosis was used as reference standard. Main outcome measures. Accuracy indices of the two techniques and of type 16‐specific NASBA for the detection of cervical intraepithelial neoplasia (CIN) 2+ and CIN3+, accuracy indices at age >35 years, correlation between NASBA and flow, comparison between integrated and episomal high‐risk HPV infection for risk of CIN2+. Results. Both tests showed increased positivity rates with increasing severity of the lesion (p < 0.05, chi‐squared test for trend). There was a positive correlation between NASBA and flow results (phi coefficient = 0.325). NASBA‐positive cases were more likely to have CIN2+ than were NASBA‐negative/DNA‐positive for types 16, 18, 31, 33, 45 (25/73 vs. 4/52, p= 0.0004; Fisher‘s exact test). In the LSIL group the NASBA accuracy indices for CIN3+ were: sensitivity 75%, specificity 78.7% and positivity rate 20.8%, and for flow 77.8%, 64.5% and 35.9%, respectively. Conclusions. NASBA has favorable specificity and positivity rates for triaging LSIL prior to colposcopy. A relatively low sensitivity warrants cytological surveillance of the NASBA‐negative LSILs. Flow cytometry does not perform as well overall.