Dimitrios Tsolakidis

A prospective comparison of transvaginal ultrasound, saline infusion sonohysterography, and diagnostic hysteroscopy in the evaluation of endometrial pathology

OBJECTIVE To compare the diagnostic performance of saline infusion sonohysterography (SIS), transvaginal ultrasound (TVS), and diagnostic hysteroscopy (DH) in the detection of endometrial lesions in symptomatic women. DESIGN Prospective, comparative study. SETTING Obstetrics and Gynecology Department of a tertiary academic hospital. PATIENT(S) A total of 105 consecutive women presenting in an outpatient clinic with symptoms of menorrhagia, postmenopausal bleeding, and infertility. INTERVENTION(S) Each patient had TVS, SIS, and DH. MAIN OUTCOME MEASURE(S) The sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR-) for TVS, SIS, and DH were determined for the diagnosis of endometrial pathology. More specifically, the diagnostic performance of each of these three methods was compared after receiver operating characteristic analysis. RESULT(S) By comparative analysis of the area under the curve, DH was found to have a significantly better diagnostic performance compared to SIS and TVS. In addition, after comparing the receiver operating characteristic curves, DH was found to be significantly more precise in the diagnosis of intracavitary masses than TVS and SIS. However, SIS was more accurate compared to TVS. CONCLUSION(S) Saline infusion sonohysterography appears to be more valuable than TVS in the diagnosis of intracavitary masses (both polyps and myomas).

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.

The combination of ovarian volume and outline has better diagnostic accuracy than prostate-specific antigen (PSA) concentrations in women with polycystic ovarian syndrome (PCOs).

OBJECTIVES The aim of this study was to determine the performance of prostate specific antigen (PSA) and ultrasound parameters, such as ovarian volume and outline, in the diagnosis of polycystic ovary syndrome (PCOS). STUDY DESIGN This prospective, observational, case-controlled study included 43 women with PCOS, and 40 controls. Between day 3 and 5 of the menstrual cycle, fasting serum samples were collected and transvaginal ultrasound was performed. The diagnostic performance of each parameter [total PSA (tPSA), total-to-free PSA ratio (tPSA:fPSA), ovarian volume, ovarian outline] was estimated by means of receiver operating characteristic (ROC) analysis, along with area under the curve (AUC), threshold, sensitivity, specificity as well as positive (+) and negative (-) likelihood ratios (LRs). Multivariate logistical regression models, using ovarian volume and ovarian outline, were constructed. RESULTS The tPSA and tPSA:fPSA ratio resulted in AUC of 0.74 and 0.70, respectively, with moderate specificity/sensitivity and insufficient LR+/- values. In the multivariate logistic regression model, the combination of ovarian volume and outline had a sensitivity of 97.7% and a specificity of 97.5% in the diagnosis of PCOS, with +LR and -LR values of 39.1 and 0.02, respectively. CONCLUSIONS In women with PCOS, tPSA and tPSA:fPSA ratio have similar diagnostic performance. The use of a multivariate logistic regression model, incorporating ovarian volume and outline, offers very good diagnostic accuracy in distinguishing women with PCOS patients from controls.

Serous ovarian cancer signaling pathways.

Abstract Ovarian cancer is the most lethal malignancy of the female genital tract, mainly due to the failure of early diagnosis and the limitations posed by the conventional chemotherapies. Current research has focused in the study of cascades of various cellular molecular reactions, known as signaling pathways. In this review article, authors try to describe the current knowledge regarding the signaling pathways that influence multiple cellular processes in serous ovarian cancer and especially the pathogenesis. Thorough understanding of the precise role of these pathways can lead to the development of new and more effective targeted therapies as well as novel biomarkers in ovarian cancer.

Regulatory Τ-cell differentiation between maternal and cord blood samples in pregnancies with spontaneous vaginal delivery and with elective cesarian section.

Citation Bili H, Fleva A, Pados G, Argyriou T, Tsolakidis D, Pavlitou A, Tarlatzis BC. Regulatory T‐cell differentiation between maternal and cord blood samples in pregnancies with spontaneous vaginal delivery and with elective cesarian section. Am J Reprod Immunol 2011; 65: 173–179

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

Management of atypical polypoid adenomyomas. A case series

OBJECTIVE Atypical polypoid adenomyomas (APAs) are endometrial, non-malignant, focal, and non-invasive lesions that are intriguing for their histological resemblence to invasive endometrioid adenocarcinoma or malignant mixed Müllerian tumor. The aim of this study was to present our clinical experience, regarding the reproductive outcome, the recurrence rate, and the association with hyperplasia and cancer, in a small series of patients with APA. STUDY DESIGN Retrospective case series of patients treated for APA in a single private hospital setting from 1998 to 2016. All patients underwent diagnostic hysteroscopy and hysteroscopic removal of the lesion. Follow-up was performed annually with endovaginal ultrasonography and hysteroscopy when necessary. RESULTS Nine patients (mean age: 37.9 years-old ±8.3years) were treated because of menorrhagia, infertility, and incidental asymptomatic endometrial lesions with operative hysteroscopy. Mean follow-up was 10.0 years (±5.8years). Three patients intended for pregnancy and 2 of them had achieved a full term delivery. There were 2 recurrences (22.2%), two cases of atypical endometrial hyperplasia (22.2%), and 2 patients with endometrioid adenocarcinoma (22.2%), all within the first 5 years. CONCLUSIONS It appears that APAs exhibit a significant recurrence rate and they may be related both to atypical endometrial hyperplasia and endometrial adenocarcinoma; therefore, clinicians should be aware of these lesions in order to individualize treatment according to the patents age and fertility history.

Uterine manifestations of tuberous sclerosis complex as a random finding at laparoscopy.

Tuberous sclerosis complex is a genetic disease inherited by the autosomal dominant pattern that causes nonmalignant tumors to multiple organs, such as the brain, kidneys, heart, eyes, and skin [1]. Symptoms are relevant to the target organs. The existing literature is limited regarding uterine manifestations; and the behavior of uterine lesions is generally benign, although a few cases have been reported in the literature with local aggressive behavior and distant metastases [2]. A 33-year-old woman presented to the Gynecology Outpatient Clinic in May 2012 with primary infertility of 18 months’ duration. The patient had been diagnosed with tuberous sclerosis complex involving the brain and both kidneys, but had no pertinent gynecological history other than dysmenorrhea. During transvaginal ultrasound, a 4-cm left ovarian cyst was detected thatwas consistentwith endometrioma. Routine diagnostic hysteroscopy was performed and there were no abnormal findings. During laparoscopy, the uterus was observed to have multiple hemorrhagic subserous cysts (Fig. 1), a left ovarian endometrioma, and scattered endometriosis on the right ovary and both lateral pelvic walls. The ovarian endometriomawas removed and the scattered endometriosis was vaporized with a carbon dioxide laser. Biopsies were taken from the uterine hemorrhagic cysts and sent for immediate histopathologic examination, where endometriosis and malignancy were excluded. Owing to excessive bleeding during biopsy sampling it was decided that the uterine lesions should not be removed without assessment of the depth of involvement into the myometrium. The final pathology report was lymphangiomyomatosis with contributions of lymphatic, muscle, and vascular tissue. Lymphangiomyomatosis is a common finding of tuberous sclerosis complex in the lungs, where the lung parenchyma can be replaced by multiple cysts. Subsequent CT scan of the lung revealed no abnormal findings. The management decision was not to remove the uterine lesions owing to the excessive bleeding during biopsy and because they had been asymptomatic. In addition, the patient had not provided written consent for a further procedure, other than for surgical management of endometriosis.