Dionysios Aravantinos

Arm morbidity following treatment of breast cancer with total axillary dissection : a multivariated approach

In order to clarify the factors that mainly influence arm morbidity following treatment of breast cancer with the full axillary dissection protocol, we evaluated, in a model of multiple regression analysis, parameters such as the type of breast surgery, adjuvant radiotherapy, time of irradiation, age, number of dissected nodes and axillary nodal status. A total of 104 women were studied. Late arm edema was observed in 17% of the patients and was more frequent when (1) irradiation was given immediately after the operation than if it was given 6 months later (p = 0.009) and (2) the number of removed nodes exceeded 40 (p = 0.037). Upper limb pain was reported by 16% of the patients and was reported more frequently from patients over 60 years of age (p = 0.036), as well as from patients who underwent modified radical mastectomy (p = 0.044) and those in whom 30-40 nodes were dissected (p = 0.025). Shoulder joint mobility was impaired in 17% of the patients, and it was not affected by any of the examined factors. It seems that conservative breast surgery or adjuvant breast radiotherapy 6 months after the operation might reduce independently the likelihood of arm morbidity by 25%.

Prostaglandins: PGF2α, PGE2, 6-keto-PGF1α and TXB2 serum levels in dysmenorrheic adolescents before, during and after treatment with oral contraceptives

Ten adolescents with primary dysmenorrhea (PD) were treated with the oral contraceptive (OC) Lyndiol 2.5 mg (R) for one cycle. The levels of PGF2 alpha, PGE2 and the metabolites of PGI2 and TXA2: 6-keto-PGF1 alpha and TXB2 were tested by a radioimmunoassay method during the 1st and 23rd day of the pre-treatment cycle (PrTC), the 23rd day of treatment (TC) and the 1st day of the post-treatment cycle (PoTC). The ratios PGF2 alpha/PGE2 and TXB2/6-keto-PGF1 alpha were also tested and compared during the above-mentioned days. Analytical comparison was made, for each Prostaglandin (PG) separately, between the 1st day of the PrTC and PoTC as well as the 23rd day of the PrTC and TC, respectively. All PG levels during TC and PoTC were found significantly lower, compared to those of the PrTC respectively. With regard to the ratios mentioned above, no statistically significant differences were found on the same days and cycles as previously stated. The reduction of the PG levels in PD patients after treatment with oral contraceptives, together with an improvement of the clinical findings of the disease, support the theory that oral contraceptives can be used for the treatment of PD cases, especially for those adolescents who also desire a contraceptive method.

Bacterial contamination of the cervix and premature rupture of membranes

The endocervical flora was examined in 32 women with premature rupture of membranes (PROM). Sixty-six pregnant women served as controls. Ten patients with PROM who later developed chorioamnionitis were also included in the study. Samples for culturing were obtained from the endocervix on admission and at delivery and later from the fetal surface of the placenta. Blood for culturing was also taken in cases of chorioamnionitis. The total number of bacteria in the endocervix and placenta was higher in patients with PROM. Anaerobes were the most common, except for the fetal surface of the placenta, where aerobes were found in greater numbers. Cultures of blood from women with chorioamnionitis were positive in seven cases. These findings suggest that the high incidence of pathogenic or potentially pathogenic cervical bacteria in pregnancy is related to chorioamnionitis and PROM.

Treatment of polycystic ovarian disease during adolescence with ethinylestradiol/cyproterone acetate versus a d-tr-6-lhrh analog

OBJECTIVE: This study was undertaken to compare the clinical and endocrinological results of two kinds of treatment on adolescents with polycystic ovarian disease (PCOD). METHOD: Forty‐five adolescents with PCOD were randomly allocated into two groups, treated either with ethinylestradiol (EE)/ cyproterone acetate (group A) or the GnRH analog D‐Tr‐6‐LHRH (group B). RESULT: No significant changes were detected on the body mass index and waist‐hip circumference. A significant improvement of hirsutism was noticed in both groups of patients. A normal menstrual period was recorded in group A adolescents while all group B patients became amenorrheic. A favorable decrease of ovarian volume was detected in both groups. LH/FSH ratio and Δ4‐androstenedione serum levels were found significantly reduced in both groups in comparison to pre‐treatment levels. The comparison between the two groups, after 6 months, showed significantly lower values of LH/FSH ratio in group B cases. CONCLUSION: Both forms of treatment are safe and effective to a various degree for the management of PCOD adolescents.

Ovarian Tumors: Prediction of the Probability of Malignancy by Using Patient's Age and Tumor Morphologic Features with a Logistic Model

An attempt was made to predict the probability of malignancy of a given ovarian tumor in a certain patient by using the age and simple morphologic features of the tumor. A cohort of 959 patients with

Pelvic surgery, reproductive factors and risk of ectopic pregnancy: a case controlled study

A case controlled study among 361 women with surgically treated ectopic pregnancy and 420 women delivered at term was designed, aiming at characterization of the association among previous pelvic operations, selected reproductive factors and ectopic pregnancy. All types of previous pelvic operations increase the risk of ectopic pregnancy from a 2‐fold increase for appendectomy to a 9‐fold increase for ectopic pregnancy, if maternal age, parity, history of spontaneous and induced abortions and history of infertility is controlled. This study suggests that a previous pelvic operation may increase the risk of ectopic pregnancy.

Untreated cervical infections, chorioamnionitis and prematurity

Objective: To examine the relationship of endocervical pathogens and cervicitis with the development of chorioamnionitis, premature rupture of membranes (PROM) and prematurity. Methods: Three groups of pregnant women were included in the study: group A, controls with no evidence of cervicitis; group B, women with cervicitis due to pathogenic bacteria, who had been treated; and group C, women with untreated cervicitis who had not followed the prescribed therapy. Endocervical samples were cultured and aerobic and anaerobic bacteria isolated to examine the correlation of cervicitis with chorioamnionitis, PROM and prematurity. Results: There was a significantly higher incidence of prematurity in women with untreated cervicitis (group C). Mixed endocervical pathogens were most often involved (36.3%). A significantly higher number of endocervical pathogens were isolated in cases of chorioamnionitis (P < 0.001). Prematurity was seen in 39.6% of cases of chorioamnionitis. Prematurity was also more common in women with PROM (42.1%) than in those with intact membranes (11.8%). Conclusion: It is concluded that untreated endocervical infections are an etiological factor of chorioamnionitis, PROM and prematurity.

Intracervical Prostaglandin E2 Gel for Cervical Ripening and Labor Induction: What Is the Appropriate Dose?

In order to evaluate a dose-related response of cervical ripening and labor induction to a prostaglandin E2 (PGE2) gel, 110 women with uncomplicated postdate pregnancies and unripe cervices received intracervically 0.5 mg PGE2 (n = 40), 1.5 mg PGE2 (n = 35) or 2.5 mg PGE2 (n = 35). The failure rate in terms of cervical ripening was similar in all groups. Labor characteristics such as the duration of the latent phase as well as the total length of labor, the cesarean-section rate, instrumental deliveries and neonatal outcome were similar in all groups. The number of women who required oxytocin for labor augmentation was negatively correlated to the dose of PGE2 (p < 0.05). In addition, 3 out of 35 women in the 2.5-mg group presented hypertonic uterine activity. The increase in the dose of PGE2 gel did not increase the possibility for a vaginal delivery, but reduced the requirement for oxytocin while increasing hypertonic uterine action.

Endocrinological profile of oligomenorrheic strenuously exercising adolescents

The endocrinological profile of 20 strenuously exercising oligomenorrheic adolescents divided into 2 groups (groups A and B), was correlated with that of 10 athletes (group C) with normal menstrual cycles and without strenuous exercise. Group A LH serum baseline values were found to be statistically significantly lower than those of group C (P < 0.001). FSH/LH basic values were 1.9‐ and 2.9‐times higher in group A athletes than those of group B or C (P < 0.05 and P < 0.001, respectively). 17β‐estradiol (E2) and prolactin serum levels were found lower in group A and B athletes than those of group C (P < 0.01–0.05). Dehydroepiandrosterone sulfate and Δ4 androstenedione serum levels were found lower in group A athletes than those of group C (P < 0.001). The low LH and E2 values indicate the anovulatory status of group A and B cases which were also confirmed by ultrasound. It is concluded that no severe endocrinological changes exist in strenuously exercising oligomenorrheic athletes in relation to menarche.

Outcome of Ovarian Response after Suppression with a Gonadotropin Releasing Hormone Agonist in Different Chronological Periods prior to Gonadotropin Stimulation for in vitro Fertilization

Gonadotropin-releasing hormone analogues (GnRH-a) are currently used in combination with gonadotropins in ovarian stimulation for in vitro fertilization programs (IVF). The present study aims at evaluating the treatment cycles for IVF for which human menopausal gonadotropin (HMG) was initiated only when pituitary desensitization was confirmed regardless of the time of GnRH-a administration. Two groups of patients were examined. Patients in group A (n = 46) were commenced with HMG treatment on day 15 when E2 level was less than 40 pg/ml. Group B patients (n = 27) comprised the cycle treatments in which E2 levels were greater than 40 pg/ml on day 15. In these cases HMG was first given when E2 levels declined to less than 40 pg/ml. The fertilization rate was similar in both A and B groups, 71.6 and 67.7% respectively. The pregnancy rate per transfer was 27.5 and 34.6% in group A and B respectively. Multiple pregnancies were found at 18.1% in group A versus 44.4% in group B. It is concluded that postponement of HMG administration in patients with high levels of E2 on day 15 after GnRH-a administration seems to offer an improvement in embryo cleavage speed, pregnancy rate and multiple pregnancies.