Georgios Michail

Successful pregnancy outcome in a patient with primary Addison's disease

A 32-year-old primigravida with primary Addisons disease was followed up from the early stages of pregnancy to delivery and puerperium by a multidisciplinary medical board. Besides fetal surveillance, great attention was given to steroid replacement therapy in order to avoid complications. Vaginal labor resulted in the birth of a healthy neonate that performed well.

Female students receiving post-secondary education in Greece: the results of a collaborative human papillomavirus knowledge survey

OBJECTIVES Contrary to the optimistic forecasts, existing until 2008 and despite the incorporation of the vaccine into the Greek National Immunization Program, six years later, the percentage of HPV vaccination coverage in Greece remains disappointingly low. The aim of this extended study was to investigate the knowledge, behaviour and attitude of a representative sample of the initial target group; young female students of Greek higher education institutions to Pap cervical screening, biology of HPV infection and principles of HPV vaccination. STUDY DESIGN Cross-sectional study. METHODS One thousand two hundred ten (1210) questionnaires were completed by young female students aged 17-24 years. The survey questionnaire sought data relating to sociodemographic characteristics, health behaviour and knowledge about HPV, as well as vaccination status. RESULTS 79.6% of the sample reported at least one annual gynaecologic examination and 92.6% were familiar with the rationale of cervical screening; however only 52.9% had undergone a Pap smear. 69.7% reported adequate knowledge about HPV and 89.3% were aware of the possible course of HPV infection. Despite most (95.9%) were aware of vaccine availability, vaccinated students represented only 33.1%. According to the multivariate analysis, vaccination status was associated with university studies (OR 1.96; 95% CI: 1.19-3.20), parental area of expertise (OR 2.77; 95% CI: 1.18-6.53, OR 2.03; 95% CI: 1.05-3.94), and adequate knowledge of the reasons for which women should undergo regular cervical screening (OR 4.23; 85% CI: 1.55-11.55). Fear of side-effects and equivocal information were the main reasons of non-vaccination (52.2% and 33.1% respectively). Finally, the majority of unvaccinated individuals showed a positive attitude towards prospective HPV vaccination, providing they received well-documented advising. CONCLUSIONS Young women attending Greek higher education exhibit a good level of knowledge about HPV and its correlation with cervical cancer. These data highlight the need for further sensitization of the general population.

A clinicopathologic study on patients with endometrial cancer after adjuvant tamoxifen treatment for breast cancer: a single center experience.

To the Editor: Tamoxifen (TAM) is a nonsteroidal, selective estrogen receptor (ER) modulator that has potent anti-estrogenic activity in the breast while displaying weak estrogen activity in the endometrium. It is the hormonal treatment of choice for postmenopausal breast cancer patients with positive ER over the past two decades and its use has been convincingly shown to improve the disease-free survival as well as overall survival (1). One of the most significant and deleterious side effects of TAM treatment in postmenopausal women with breast cancer appears to be its proliferative effect on the endometrium. Overall endometrial pathologies, including hyperplasia, polyps, carcinoma and sarcoma have been identified in up to 36% of postmenopausal breast cancer TAM-treated patients. The frequency of these endometrial pathologies was found to be significantly higher among postmenopausal breast cancer TAM-treated patients, compared with postmenopausal breast cancer non-TAM-treated patients (2–4). It was also found to be more common among healthy women who receive preventive TAM treatment, compared with healthy non-TAM-treated women (5). The pathogenic mechanism for the development of TAMassociated malignant endometrial tumors has not yet been clearly defined. The Stockholm Trial showed a continued divergence of the cumulative incidence curves of endometrial cancer for the TAM-treated and control groups even several years after cessation of TAM treatment (6). Many other reports published in recent years have demonstrated a significant positive association between longer duration of TAM treatment and the appearance of endometrial cancer. The relative risk (RR) for endometrial cancer, when compared with non-TAMtreated patients, with gradual increase in duration of TAM treatment, is increasing up to 60 consecutive months (7). It has been synonymously reported that endometrial pathologies are associated with high cumulative doses of TAM administered to postmenopausal breast cancer patients. Women who received 20 mg of TAM daily developed endometrial pathologies after longer periods of treatment compared to those who were treated with 40 mg of TAM daily (8). During the last decade efforts have focused on attempting to identify cytokinetic or molecular events that correlate with the malignant potential of endometrial cancers. Several investigators have evaluated the expression of oncogenes and tumor suppressor genes. Furthermore indicators of cell proliferation have been evaluated. Estrogen stimulates cellular proliferation regulated by the ER, whereas progesterone inhibits cellular growth and induces differentiation regulated by the progesterone receptor (PR). It is well recognized that ER and PR are important prognostic factors for zendometrial carcinoma. High levels of ER and PR are directly correlated with a lower tumor grade, less myometrial invasion and a lower incidence of lymph node metastases (9). Members of the human epidermal growth factor receptor family (HER) of receptor tyrosine kinases play a critical role in both development and oncogenesis. The latter is suggested by the frequent overexpression of HER-2, EGFR, HER-3 and HER-4 in a wide variety of tumors including breast, colorectal, ovarian, and non-small cell lung cancers. The biological activities of the HER family are exerted through various ligandreceptor and receptor-receptor interactions. One receptor that plays a central role in this signaling network is HER-2/Neu (cerb2), which is considered the preferred heterodimerization partner for other members of the HER family and responsible for regulating cell growth and differentiation (10). Ki-67 is a marker of cell proliferation. It is expressed in the nucleus of cells that are actively undergoing cell proliferation (i.e., not in G0 or early G1) (11). The balance between cell proliferation Address correspondence and reprint requests to: Dimitrios M. Kardamakis, Department of Radiotherapy, University of Patras Medical School, 26500 Rion, Patras, Greece, or e-mail: kardim@med.upatras.gr

Recent Advances in the Treatment of Vaginal Primary Malignant Melanomas

In patients with confined local disease in which wide local excision with clear margins is feasible, radical operations should be avoided because of the technical difficulties and related surgical morbidity with more side-effects and lower quality of life [1,37,11,12,15]. In sharp contrast, in patients with extended disease where wide local excision with clear margins is impossible, more radical surgical approaches should preferred in carefully selected patients [1,3-7,16].

Cervical Cancer Surveillance - Considerations in the Vaccination Era

Cancer of the uterine cervix is still a major cause of young women’s mortality, despite more than a half a century of sustained cytological effort and the launch of the VLP HPV vaccine almost one decade ago, which was the first vaccine to target an STI. While the treatment of severe cervical dysplasias averts the development of cancer, it also represents the source of significant (mainly obstetric) morbidity.

Uterine Artery Embolization as an Alternative to Hysterectomy, in Patients with Uterine Myomas

Uterine artery embolization (UAE) is a minimal invasive technique that uses transcutaneous common femoral artery approach to block uterine blood supply. The aim of the procedure is to occlude or markedly reduce blood flow in both uterine arteries at the arteriolar level. This causes irreversible ischemia and leads to necrosis and subsequent shrinkage of uterine myomas. In current clinical practice, uterine artery embolization represents an acceptable alternative to hysterectomy and myomectomy.

Molecular Mechanisms, Expression and Clinical Role of ErbB Receptors in Endometrial Cancer

The epidermal growth factor system (EGF System) is present in various human organs. It has 4 receptors (EGFR, ErbB-2, ErbB-3 and ErbB-4) and numerous ligands. Especially in cancer, the epidermal growth factor system signaling network becomes hyperactivated with a variety of mechanisms (ligand overproduction, receptor overproduction, constitutive receptor activation). ErbB receptors are trans-membrane glycoproteins. Dimerization of ErbB receptors leads to intracellular kinase activation and initiates intracellular signaling via several pathways. Due to the inactive status of postmenopausal endometrium, we expect to find significantly higher expression of the 4 ErbB receptors in endometrial cancer tissue. In unselected endometrial cancer patients, there is EGFR expression in 43-67% of cases. EGFR overexpression in patients with Type I endometrial cancer, did not affect disease progression. However EGFR overexpression in patients with Type II endometrial cancer, associated with high grade disease and adverse clinical outcome. In unselected endometrial cancer patients, ErbB-2 amplification/overexpression represents a rare event. ΕrbB-2 overexpression especially in patients with Type II endometrial cancer, is an indicator of a highly aggressive disease with poor overall survival. Recent years ErbB receptors (especially EGFR and ΕrbB-2) have a particular importance, as they are potential targets in endometrial cancer treatment.