George Mavromatidis

Prevalence of metabolic syndrome in women with polycystic ovary syndrome.

The polycystic ovary syndrome (PCOS) and the metabolic syndrome (MetS) are common disorders that share many characteristics, particularly abdominal obesity and insulin resistance. Our objective was to compare the prevalence of MetS between a large cohort of patients with PCOS and body mass index ‐matched controls.

Factors that may predispose to rupture of tubal ectopic pregnancy

OBJECTIVE The purpose of our study was to evaluate factors that may predispose to rupture of tubal ectopic pregnancy. The study included 99 cases of ectopic pregnancies that were treated during the 5-year period 1992-1996. RESULTS It was found that: (1) tubal rupture is encountered more often in women with no history of ectopic pregnancy and in those who have full-term pregnancy, suggesting that ectopic pregnancy is less suspected in these women; (2) tubal rupture is encountered less often in lower age ectopic pregnancy; and (3) serum beta-hCG level does not predict tubal rupture. CONCLUSIONS Rupture of the tube is more often observed in women with a history of ectopic pregnancy and in women with full-term pregnancy. Such observations suggest that ectopic pregnancy is less suspect in these cases.

The influence of tibolone upon serum leptin levels in post-menopausal women

OBJECTIVE To estimate serum leptin levels in post-menopausal women, to relate these to the duration of the post-menopausal period, and to body mass index (BMI), and to assess the influence of tibolone on them. METHODS Fifteen women (age 49-64 years) were included. Three groups were studied; I, those with normal BMI taking tibolone; II, those with a raised BMI taking tibolone, and III, a group with raised BMI not taking tibolone. Blood samples were drawn before and 1, 2, 6, 9 and 12 months after the initiation of tibolone or, in group III, after the start of the study. RESULTS Serum leptin concentrations were high in all women with abnormal BMI. Long-term tibolone administration did not have any significant effect on serum leptin concentrations. There was no correlation between serum leptin levels and the age and the duration of post-menopausal period. There was a high positive correlation between serum leptin levels and BMI values. CONCLUSIONS BMI values affect serum leptin concentrations but long-term tibolone administration does not seem to have any effect on serum leptin levels.

Pyriform head: a frequent but little-studied morphological abnormality of sperm.

This study was conducted to investigate the frequency of sperm with a pyriform head in semen samples, to determine the percentage of the occurrence of this abnormal sperm form, and to assess its possible correlation with other semen parameters. The study was designed as a retrospective data analysis in the setting of an andrology laboratory at a tertiary-care academic hospital. Semen quality data were analyzed from 114 subfertile men and 60 fertile men. The Students t test, the Mann-Whitney nonparametric test, and the Pearson correlation coefficient were used for statistical analysis. Sperm with a pyriform head were present in the semen samples of 98% of the subfertile men and 100% of the fertile men; the percentage of this abnormal sperm form was 22 - 14.9% in subfertile and 13% - 7.8 in fertile men ( p <.001); 16% of the subfertile men presented a higher percentage of these abnormal sperm than the normal upper limit. In some subfertile men with a high percentage of sperm with a pyriform head, their subfertility could be attributed to the cause that produces this morphological abnormality. Moreover, morphological abnormalities in the neck and the tail, as also a cytoplasmic droplet, are significantly more frequent in sperm with a pyriform head than in sperm with a normal head.

Parameters affecting latency period in PPROM cases: a 10-year experience of a single institution

Abstract Objective: To investigate the association of epidemiological and pregnancy-related parameters with the latency period achieved in cases of preterm premature rupture of membranes (PPROM). Method: A retrospective study was performed enrolling cases admitted in high-risk pregnancy unit (HRPU) with PPROM between 24 + 0 and 36 + 6 gestational week during 2002–2011. Cases with vaginal bleeding at admission, co-existing maternal or fetal pathology, placenta praevia, previous interventions in cervix or uterus, triplets or higher order pregnancies were excluded. Epidemiological parameters and latency period between admission due to PPROM and delivery were recorded. Obstetrical complications, mode of delivery, and neonatal morbidity parameters were also studied. A multivariate regression model was used to correlate latency period with epidemiological and pregnancy-related risk factors. Results: Overall, there were 319 cases of PPROM admitted, of which 303 (94.9%) met inclusion criteria. Median latency period was 5.2 d. The latency interval exceeded 48 h in 65.0% of cases (197/303). Emergency cesarean was demanded in 20.2% of cases, chorioamnionitis was diagnosed in 7.5% while 76.1% of neonates were admitted in neonatal intensive care unit. Higher gestational week at admission was associated with shorter latency interval (p < 0.001), twin pregnancy with shorter latency interval (p = 0.02), while latency interval was significantly lower in cases complicated with chorioamnionitis (p = 0.048). Conclusion: Gestational week at PPROM, twin gestation and chorioamnionitis are factors significantly affecting latency interval.

Operator experience reduces the risk of second trimester amniocentesis-related adverse outcomes

OBJECTIVE To investigate the impact of operator experience on amniocentesis-related adverse outcomes. STUDY DESIGN Retrospective study of mid-trimester amniocenteses performed by the same operator on singleton pregnancies in a single private institution during 1994-2007. Outcomes were hemorrhagic or dark amniotic fluid aspiration, insufficient volume aspiration, repeated puncture and fetal loss. Rates were estimated annually, as well as for every 10% of procedures up to the total number. The association of each outcome with epidemiological aspects was also examined. RESULTS In total, 5913 amniocenteses were performed. The overall rate of adverse outcomes was 5.4%. The total adverse outcome rate reduced from 10.2% in the first 10% of cases to 3.0% in the last 10% (P=.001). The rate of hemorrhagic fluid gradually decreased from 4.4% to 1.5% (P=.05) over the same intervals. The fetal loss rate was also reduced from 0.5% during the first half to 0.3% in the second half of the study period (P=NS). Logistic regression analysis indicated no significant correlations between adverse outcomes with any of epidemiological parameters of women undergoing amniocentesis. CONCLUSION Operator experience has a beneficial impact on preventing procedure-related adverse outcomes.

Spontaneous Postpartum Rupture of an Intact Uterus: A Case Report

Rupture of uterus is an obstetrical complication characterized by a breach in the uterine wall and the overlying serosa. We report an unusual case of spontaneous rupture of an unscarred uterus in a 33-year-old woman, a day after her third successful vaginal delivery. A 33-year-old pregnant woman, gravid 3, para 3, was referred to our department at 39 gestational week because of rupture of membranes. Despite tocolysis administration, her pregnancy was delivered vaginally after 2 days, giving birth to a male neonate of 3,020 g with normal Apgar scores at first and fifth minute. Her uterus was intact and gynecological examination after delivery was normal without any potential signs or symptoms of pathology. However, the day following her labor, patient complained of left iliac fossa pain. Her blood tests revealed a CRP value at 27.6 mg/L, whereas the X-rays revealed an extensive impacted fecal mass in the colon. MRI revealed that the left lower myometrial part of the uterus was depicted abrupt, with simultaneous presence of hemorrhagic stuff. The decision of laparotomy was therefore made in order to further evaluate rupture of uterus and properly treat patient. And subtotal hysterectomy was performed. Postoperative follow-up period was not characterized by any complications and patient was finally discharged 4 days after hysterectomy.

PROGNOSTIC VALUE OF EVALUATION OF TOTAL NUMBER OF MORPHOLOGICAL ANOMALIES IN 100 SPERM IN SEMEN OF INFERTILE MEN

In this study, the evaluation of the total number of morphological anomalies per 100 sperm was more reliable, as far as potential fertility is concerned than the concentration of sperm per milliliter, the percentage of motile sperm, and the percentage of sperm with normal or abnormal morphology. This parameter allows for discrimination between subfertile and fertile semen and therefore can help in the selection of men who require assisted reproduction techniques.

Level of knowledge about genital chlamydial infection among Greek midwives and midwifery students

Abstract We aimed to evaluate the knowledge about chlamydial infection of Greek midwives and midwifery students. An appropriately designed, self-administered, anonymous questionnaire was distributed to 107 midwives and 29 graduating midwifery students. Perceived awareness of chlamydial infection was similar in midwives and students (p=0.083). However, midwives were more aware than students that Chlamydia are acquired through sexual contact (84.1% vs 58.7%; p=0.004) and that chlamydial infection is frequently asymptomatic (72.9% vs 37.9%; p=0.001). Knowledge of the consequences was poor in both groups, but it was relatively better in midwives; only 7.5% of the midwives did not know any of the potential sequelae of chlamydial infection compared with 24.1% of the students (p=0.006). In contrast, the majority of both midwives and students were aware that when chlamydial infection is diagnosed in a woman, both she and her partner should receive treatment (90.7% vs 93.2%; p = 0.901). In conclusion, an important proportion of midwifery students ignore important aspects of chlamydial infection. Therefore, it is important to improve the educational curriculum in midwifery schools in order to maximize the contribution of midwives to decrease the prevalence of chlamydial infection and of its complications.

Suppression of Serum Prolactin Levels after an Oral Glucose Tolerance Test in Patients with Polycystic Ovarian Syndrome

In order to assess if an oral glucose load has any effect on serum prolactin levels in patients with polycystic ovary syndrome (PCOS), an oral glucose tolerance test (OGTT) was performed in 30 patients with PCOS and 20 controls, with normal or abnormal body mass index (BMI). OGTT resulted in decreased prolactin levels, being significant only in patients with PCOS and in controls with normal BMI. Our results show that obesity is an important inhibiting factor of serum prolactin level suppression which occurs with a mild suppressive test, as the OGTT; however, hyperandrogenemia may also play an inhibiting role in serum prolactin level suppression.