Georgios Galazios

Association of −634G/C and 936C/T polymorphisms of the vascular endothelial growth factor with spontaneous preterm delivery

Background.  There is convincing evidence for a central role of vascular endothelial growth factor (VEGF) in fetal and placental angiogenesis. Our present study was undertaken to examine the possible relationship between two common functional VEGF gene polymorphisms (− 634G/C and 936C/T), linked with altered VEGF gene responsiveness, and spontaneous preterm delivery.

Umbilical cord serum vascular endothelial growth factor (VEGF) levels in normal pregnancies and in pregnancies complicated by preterm delivery or pre-eclampsia

Objectives: The aim of this study was to determine whether increased levels of vascular endothelial growth factor (VEGF) are implicated in the pathogenesis of pre‐eclampsia and in preterm delivery. Methods: Umbilical cord serum VEGF levels from women with uncomplicated term pregnancies (control group, n=24), with pregnancies complicated by pre‐eclampsia (n=21), or with preterm delivery (n=29) were compared. Statistical analysis was performed using the Mann–Whitney U‐test, the t‐test, and Smirnoff–Kolmogorov test. Results: The mean VEGF concentration was significantly higher in the women with pre‐eclampsia than in women from the control group (P<0.01). There were also increased but not significantly higher VEGF concentrations in the preterm delivery group compared with the control group (P=0.16). Conclusions: Our study results support previous findings that raised umbilical cord serum VEGF levels might be correlated with the clinical development of pre‐eclampsia and, in some circumstances, of preterm delivery.

Two Episodes of Hemoperitoneum from Luteal Cysts Rupture in a Patient with Congenital Factor X Deficiency

The clinical manifestation of two episodes of hemoperitoneum from ruptured corpus luteum cysts, during the luteal phase of the cycle in a young patient with the rare congenital factor X deficiency, is reported for the first time in literature. The correct diagnosis of the underlying disorder, the gynecological management and the regular follow-up can minimize the risks of this potentially life-threatening hematological disorder.

The role of cytokines IL-6 and IL-8 in the pathogenesis of spontaneous abortions

Objective. The aim of this study was to investigate the role of interleukin-6 and interleukin-8 in the spontaneous abortion of the first and second trimester of pregnancy and the possibility of IL-6 and IL-8 being used as markers for the pregnancy outcome. Method. The patients were divided into three groups: group 1, women at the time of first trimester miscarriage (n = 35); group 2, women at the time of second trimester miscarriage (n = 35); group 3 included the women without previous history of abortions submitted to hysterectomy (n = 10). Plasma levels of interleukin-6 and interleukin-8 were measured by bioassays method (ELISA). Mann–Whitney U test and Kruskal–Wallis test were used to assess differences between two or more groups of patients, respectively. Post hoc analysis was performed using Mann–Whitney U test with Bonferroni’s correction. Results. Interleukin 6 levels in women who had a second trimester abortion were statistically higher compared to those who had a first trimester abortion. Interleukin-8 levels in patients with second trimester abortion were also statistically higher compared to the control group. No significant differences between women with first trimester abortions and those without previous history of abortions were found. Conclusions. Our data suggest that IL-6 and IL-8 might be crucial factors which take part in the defensive reaction of maternal organization during the 2nd trimester of pregnancy.

Endometrial cancer: molecular and therapeutic aspects

Endometrial cancer (EC) is the most commonly diagnosed gynecologic malignancy. Although early-stage EC is effectively treated surgically, commonly without adjuvant therapy, the treatment of high-risk and advanced disease is more complex. Chemotherapy has evolved into an important modality in high-risk early-stage and advanced-stage disease, and in recurrent EC. Multi-institutional trials are in progress to better define optimal adjuvant treatment for subsets of patients, as well as the role of surgical staging in reducing both overuse and underuse of radiation therapy. Understanding and identifying the molecular biology and genetics of EC are central to the development of novel therapies. A number of molecular and genetic events have been observed in ECs, which have enabled us to have a better understanding of the biology and development of the disease. For example, the PTEN/AKT pathway and its downstream targets and the mTOR pathway have been shown to play an important role in EC pathogenesis. This review summarizes the background of the known molecular alterations, and the management of patients with EC.

Fetal ovarian cysts. Our clinical experience over 16 cases and review of the literature.

Objective. Fetal ovarian cysts are intra-abdominal structures frequently diagnosed prenatally, tending to present as isolated unilateral lesions in normal fetuses in the third trimester. These cysts may present with complications and their diameter and echogenicity are the main criteria for establishing their prognosis. Spontaneous regression of fetal ovarian cysts is very usual. In the present study, we present our clinical experience on fetal ovarian cyst surveillance and treatment, as well as a review of the literature in the same field. Material and method. In this study, we reviewed pre- and postnatal medical records and ultrasonography of 16 fetuses that were diagnosed with ovarian cysts, in Obstetrics Department of University Hospital of Alexandroupolis, between January 2000 and April 2010. We have also reviewed the available literature about fetal ovarian cysts. Results. In a total of 16 cases, postnatal surgery was performed in one infant due to ovarian cyst torsion. In the remaining 15 cases, cysts regressed completely in two fetuses during pregnancy and all the rest of the cysts, including four complex ones, resolved spontaneously after birth. Conclusions. When fetal ovarian cysts are detected, they should be followed up by serial ultrasonographic examinations. The majority of them will regress spontaneously in a period of 12 months after birth, independent of their sonographic findings. Only symptomatic cysts or cysts with a diameter >5 cm, which do not regress or enlarge, should be treated.

Interpregnancy interval and the risk of preterm birth in Thrace, Greece

OBJECTIVE To examine the influence of short interpregnancy interval on the prevalence of preterm birth in two, ethically different, Greek populations. STUDY DESIGN We studied 652 urban Christian women and 578 rural, Romany, Muslim women who had had two consecutive, singleton pregnancies. We related the prevalence of preterm birth to the interpregnancy intervals (cut-off point, 6 months). Students t-test, x(2)-test and relative risk estimation were used. RESULTS Preterm birth and interpregnancy intervals less than 6 months occurred more often among Muslims than Christians. Among Muslims, an interval of <6 months was associated with greater prevalence of preterm birth (16% versus 7.3%, P=0.013, RR=2.4 and 95% C.I. 1.3-4.7). Christians did not demonstrate a similar relationship. CONCLUSIONS A short interpregnancy interval seems to be a risk factor for preterm birth in the population of rural, Romany, Muslim women.

Significance of Serum Tumor Necrosis Factor-Alpha and its Combination with Her-2 Codon 655 Polymorphism in the Diagnosis and Prognosis of Breast Cancer:

Purpose The present study was conducted to clarify the diagnostic and prognostic significance of TNF-alpha and its combination with HER-2 Ile655Val SNP in breast cancer. Methods In this case-control study, 56 consecutive patients with primary breast cancer were prospectively evaluated. The control group consisted of 45 healthy women. Serum concentrations of TNF-alpha were measured by quantitative sandwich enzyme immunoassay (ELISA). HER-2 SNP was genotyped using the PCR-RFLP method. Results Serum TNF-alpha was significantly increased in patients compared to controls. ROC analysis indicated a cutoff point of 11.00 pg/mL to classify breast cancer patients (sensitivity, 86%; specificity, 71%). Elevated TNF-alpha levels were associated with larger, poorly differentiated, invasive and advanced-stage tumors, and >3 positive lymph nodes. Regarding HER-2 SNP, patients with Ile-Val and Val-Val genotypes had significant TNF-α elevation compared with homozygous Ile-Ile patients. In multivariate analysis, high serum TNF-alpha remained an independent prognostic factor of worse overall survival; its combination with Val-Val genotype predicted a worse prognosis than high TNF-alpha alone. Conclusions Serum TNF-a could be used clinically as a useful tumor marker for diagnosis, disease extent and outcome of breast cancer. The negative impact on survival seems to be enhanced through the interaction with HER-2 Ile655Val SNP.

Interleukin-6 levels in umbilical artery serum in normal and abnormal pregnancies

Objective: The aim of our study was to determine the correlation of abnormal umbilical artery interleukin‐6 levels with pregnancies complicated by preterm delivery and pre‐eclampsia. Method: Cord serum (umbilical artery) was collected at delivery by cesarean section or spontaneous delivery. Samples were retrieved from patients with normal and abnormal pregnancies. Patients were divided into three groups: group 1, a control group of samples from uncomplicated pregnancies (n=24); group 2, patients with pre‐eclampsia (n=21); and group 3, patients having had preterm delivery (n=29). Interleukin‐6 was measured by bioassays. Statistics were performed with the Mann–Whitney U‐, Students t‐ and the Kruskal–Wallis tests. Results: Interleukin‐6 levels in women with preterm delivery were statistically higher compared to those of normal pregnancies (P<0.05) and lower in the cord serum of pre‐eclamptic when compared to those of normal pregnancies (P<0.05). Conclusion: In conclusion, we believe that further investigations could elucidate the role of this pleiotropic cytokine in both, normal and pathologic reproductive biology, and determine the clinical utility of IL‐6 measurements in obstetric practice.

Pregnancies and their obstetric outcome in two selected age groups of teenage women in Greece

Aim: The aim of this study was to evaluate the outcome of pregnancies in adolescents in the Department of Obstetrics and Gynaecology of Democritus University of Thrace, North-Eastern Greece. Material and methods: We retrospectively reviewed 194 cases of adolescent pregnancies, with an average maternal age of 16.5 years, from 1st January 2006 to December 30th 2008. Socioeconomic characteristics, type of delivery and complications, such as preterm labor, preeclampsia, intra- and post-partum complications, were evaluated. Results: The median age at first intercourse was 14.2 years and the average period between first intercourse and pregnancy was 1.2 years. Most teen mothers (86.6%) did not use any contraceptive method. Among the teen mothers recruited for the study, 89.7% were married. Adolescent pregnancies accounted for 9.02% of all deliveries (2150) in our Department. In 49 (25.3%) of the pregnant adolescents, no previous pregnancy was reported. The rates of preterm birth of teen mothers were 11.3%, 41.3% and 47.4% in correlation to <32 weeks, 32–34 weeks and >34 weeks, respectively. In 95.4% of the cases, deliveries were not complicated. According to our results, the main complications, especially in very young girls, are preterm labor, anaemia, hypertensive disease, obstructed labor after premature rupture of the membranes and increased neonatal mortality and morbidity. Antenatal care is often inadequate. Conclusion: Early teenage pregnancies have always been considered of increased risk for obstetric complications. Prevention of adolescent pregnancy, by wide use of effective contraception programs, would decrease its frequency and intensive care of pregnant adolescents may reduce the pregnancy complications.