Konstantinos Dinas

Pregnancy and oral health: utilisation of dental services during pregnancy in northern Greece.

Background. Recent studies have shown that gingivitis and periodontal infection during pregnancy represent an independent risk factor for pre‐term birth. However, little is known about the prevalence and correlates of dental attendance during pregnancy. Methods. During the first 3 days postpartum, an anonymous questionnaire was administered to 425 women in order to explore their dental condition and utilisation of dental health services during pregnancy, as well as their perceptions on the potential associations between dental care during pregnancy and pregnancy outcomes. Results. Almost half of the respondents (46.8%) reported symptoms of gingivitis during their pregnancy. Pregnancy gingivitis was independently associated with non‐Greek ethnicity (p = 0.008), multiparity versus primiparity (p<0.005), lower economic class versus middle and upper classes (p = 0.001), and the lack of routine primary dental care (p = 0.005). Some 27.3% reported a visit to the dentist during their pregnancy. The majority (72.2%) believed that dental treatment during pregnancy might have a negative affect on pregnancy outcome. The presence of pregnancy gingivitis and the belief that dental treatment during pregnancy is safe were both independently associated with visiting a dentist during pregnancy (p<0.0005 for both). Conclusions. Despite the increased prevalence of dental problems among pregnant women, few women seek dental services in this population, which can be primarily attributed to womens erroneous beliefs regarding the safety of dental examination. Therefore, there is an imperative need to offer oral health education and develop preventive programs for women of reproductive age.

Current caesarean delivery rates and indications in a major public hospital in northern Greece

Background:  Over the past 25 years, there has been a sustained increase in caesarean section (CS) rates around the world. However, there is a paucity of data regarding the current CS rates and particularly the trends of CS indications in Greece.

Awareness of human papillomavirus infection, testing and vaccination in midwives and midwifery students in Greece

Summary Midwives play an important role in the implementation of cervical cancer screening. We assessed the knowledge of human papillomavirus (HPV) infection and of its relationship with cervical cancer in 107 midwives and 29 graduating midwifery students. The majority of midwives (78.5%) were aware that a viral infection causes cervical cancer, whereas only 48.3% of the students knew this (p = 0.003). Only one midwife (0.9%) was not aware of HPV infection compared with 10.3% of the students (p = 0.029). Midwives were also more knowledgeable of the relationship between HPV infection and cervical cancer and of the availability of a vaccine against HPV infection (p = 0.005 and p < 0.0001, respectively). In conclusion, Greek midwives have a satisfactory level of knowledge about cervical cancer and HPV infection, in contrast to midwifery students. It is important to better educate midwifery students in order to facilitate the incorporation of HPV testing and vaccination in clinical practice.

Knowledge and practice of contraception among Greek female medical students

Objective In Greece, modern contraceptive methods are used on a limited scale. This study aimed to investigate the knowledge as well as the practice of contraception among female medical students in Greece. Study design Knowledge and practice of contraception of 102 female graduating medical students were assessed with a self-administered, anonymous questionnaire. Results Most students were using condoms as the only contraceptive method (45.1%) and 16.7% were not applying any contraceptive method at all. Oral contraceptives were used as only contraceptive means by 4.9% of the students and in combination with condoms by another 4.9%. Condoms were thought to be the most effective contraceptive method available by 28.4% of the students, whereas 4.9% responded that they did not consider any contraceptive method to be effective. Only 55.9% of the students had ever asked their gynaecologist about contraception. Conclusion Much more time should be spent in teaching contraception in the Greek medical schools to ensure the delivery of adequate family planning guidance by future practitioners.

Breast cancer and bone mineral density: the Marburg Breast Cancer and Osteoporosis Trial (MABOT II).

Objectives The current case–control study is the first to examine the relationship between bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) and quantitative ultrasonometry (QUS) in pre- as well as postmenopausal women with breast cancer compared to healthy matched controls. Methods Among 1422 women (premenopausal, n = 238, postmenopausal, n = 1184), BMD and QUS were measured. In total, 541 of the women had an incident diagnosis of breast cancer (122 premenopausal, 419 postmenopausal) without prior breast cancer treatment. Because of significant intergroup differences in multiple risk factors, a matched-pair analysis (88 premenopausal and 402 postmenopausal women with and without breast cancer) was performed. Additionally, a multiple linear regression analysis was undertaken, odds ratios were determined and subjects grouped according to quartiles of DXA and QUS results. Results DXA results (except the L1–L4 Z-score) were significantly higher in postmenopausal women with breast cancer even after a matched-pair analysis was performed (p < 0.05). In premenopausal women, we observed no significant differences in DXA results between the groups. QUS results in pre- and postmenopausal women with breast cancer were significantly higher compared with their matched controls (p < 0.001 for all, except for speed of sound in premenopausal patients, p < 0.05). Odds ratios for breast cancer risk in the second, third and fourth quartiles compared with the lowest quartile were significantly different for a number of variables. Conclusions Our results showed significantly higher BMD irrespective of the method and site of measurement in postmenopausal women with breast cancer compared to controls, even after matching for possible confounders for the first time.

Cystic degenerated angioleiomyoma mimicking ovarian pathology

Leiomyomas are not only the commonest tumors found in the uterus, or even in the genital tract, but in the human body (1). They are found in up to three-quarters of hysterectomy specimens, and it is estimated that about 20% of all women have one or more present in the uterus at death (1, 2). However, there are specific types of leiomyomas (mitotically active, atypical, cellular, epithelioid, myxoid, vascular, lipoleiomyoma), which are uncommon or extremely rare (2–4). While typical leiomyomas are most often straightforward in their presentation and management, they can undergo various kinds of mostly asymptomatic degeneration that drastically alters their appearance and muddies the diagnostic and therapeutic procedure. Angioleiomyoma (vascular leiomyoma) is one of the relatively rare forms of uterine smooth muscle tumors with muscular and vascular components, which can also undergo degenerative changes with large cavernous deformation of the vascular spaces (5). We report a case of myomatous uterus with a large cystic degenerated angioleiomyoma mimicking cystic ovarian pathology.

Placenta abruption in a woman with Wilson's disease: a case report

Wilsons disease is a rare genetic disorder of copper metabolism that causes primary hepatic cirrhosis, secondary menstrual abnormalities and infertility. Following the appropriate therapy patients are asymptomatic and pregnancy may be achieved. We present a case of placental abruption in a pregnant woman with Wilsons disease and we review the management dilemmas and treatment options of pregnant women with Wilsons disease.

Successful pregnancy and caesarean section delivery in a patient with single ventricle and transposition of the great arteries

(2005). Successful pregnancy and caesarean section delivery in a patient with single ventricle and transposition of the great arteries. Journal of Obstetrics and Gynaecology: Vol. 25, No. 1, pp. 69-70.

Discontinuation of treatment using anticholinergic medications in patients with urinary incontinence.

OBJECTIVE: To evaluate the discontinuation rates of anticholinergics prescribed in patients with urinary incontinence (UI). METHODS: Data from a Disease Analyzer database including 988 general, 95 urologist, and 203 gynecologic practices were examined. Twenty six thousand eight hundred thirty-four patients were identified as having received a first-time anticholinergic prescription for UI, namely darifenacin, fesoterodine, oxybutynin, propiverine, solifenacin, tolterodine, or trospium, between 2005 and 2012. Covariates studied included demographic data, concomitant diagnoses, and potential drug-induced side effects. The cumulative discontinuation rate of initial treatment was estimated using a Kaplan–Meier analysis. A Cox proportional hazard regression model was used to estimate the relationship between discontinuation and the demographic and clinical variables for up to 36 months. RESULTS: An increasing discontinuation rate was observed in years 1, 2, and 3 (74.8%, 77.6%, 87%). Within 3 years, discontinuation rates were higher for men than for women (87.9%, 86.5%; P=.056; hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.11–1.18; P<.001), for patients treated in gynecologic practices and general practices than those treated in urologist practices (HR 1.60; 95% CI 1.52–1.67, P<.001 and HR 1.24, 95% CI 1.20–1.29, P<.001, respectively) and for younger patients than those older than 80 year old (60 years or younger, HR 1.27, 95% CI 1.22–1.33; 61–70 years, HR 1.16, 95% CI 1.11–1.21; 71–80 years, HR 1.14, 95% CI 1.09–1.18, P<.001). Those using propiverine or solifenacin were less likely to discontinue treatment than those using oxybutynin (HR 0.94, 95% CI 0.88–0.99, P=.024 and HR 0.93, 95% CI 0.87–0.98, P=.004, respectively). CONCLUSION: Patients with UI demonstrate high discontinuation rates for anticholinergics with only slight variations between the various drugs in this category. LEVEL OF EVIDENCE: III

Indications of diagnostic hysteroscopy, a brief review of the literature

Plenty of authors propose outpatient hysteroscopy as the gold standard diagnostic method for the evaluation of endometrial pathology. This statement has been strengthened in the recent years due to the wide use of smaller diameter hysteroscopic devices, which have made the dilation of the cervix and the use of anesthesia unnecessary. The main purpose of this paper is to summarize the indications of diagnostic hysteroscopy. In this review, we used the most recent publications in MEDLINE and Cochrane Library in order to specify the indications of diagnostic hysteroscopy and the experience that have been obtained till today in the management of certain pathological uterine conditions. The key words we used were diagnostic hysteroscopy, abnormal uterine bleeding, infertility, endometrial cancer. Hysteroscopy provides an accurate method of evaluation and direct visualization of the endometrial cavity and moreover directed biopsy and sampling of suspected lesions. Last years with the continuous development in the hysteroscopy devices, plenty of women benefit surgical hysteroscopy techniques for uterine abnormalities. Hysteroscopy is useful for the diagnosis in patients with abnormal uterine bleeding, with endometrial cancer and in infertile women. Hysteroscopy has the unique advantage of combining a thorough procedure with great diagnostic accuracy. The only disadvantage is that hysteroscopy requires specific teaching and training and has a long learning curve.