Nikolaos Salakos

Clinical parameters linked with malignancy in endometrial polyps

Aim To investigate the association of different clinical parameters with the histological diagnosis and the prevalence of premalignant and malignant endometrial polyps. Method The study included 516 cases from January 2002 to December 2006. Possible risk factors such as age, menopause status, abnormal bleeding, obesity, hypertension, diabetes mellitus, hormone therapy, use of tamoxifen and size of polyp were investigated in relation to their association with the malignant potential of endometrial polyps. Results All cases of endometrial polyps underwent hysteroscopic resection; 96.9% of the cases were benign, 1.2% premalignant and 1.9% malignant. Premalignant and malignant endometrial polyps were significantly associated with advanced age (>60 years), menopause, obesity and diabetes. The malignant polyps were analyzed to eight endometrioid, one serous and one clear cell carcinoma. Conclusion The prevalence of premalignant and malignant endometrial polyps is very low. Advanced age, menopause, obesity and diabetes increase the risk of endometrial polyp malignancy.

Acute lung injury in preterm fetuses and neonates: mechanisms and molecular pathways.

Abstract Acute lung injury (ALI) results in high morbidity and mortality among preterm neonates and efforts have therefore been devoted to both antenatal and postnatal prevention of the disease. ALI is the result of an inflammatory response which is triggered by a variety of different mechanisms. It mostly affects the fetal lung and, in particular, causes damage to the integrity of the lung’s alveolar-capillary unit while weakening its cellular linings. Chemotactic activity and inflammatory products, such as proinflammatory cytokines TNF-α, IL-1, IL-6, IL-11, VEGF,TGF-α and TGF-β, provoke serious damage to the capillary endothelium and the alveolar epithelium, resulting in hyaline membrane formation and leakage of protein-rich edema fluid into the alveoli. Chorioamnionitis plays a major part in triggering fetal lung inflammation, while mechanical ventilation, the application of which is frequently necessary in preterm neonates, also causes ALI by inducing proinflammatory cytokines. Many different ventilation-strategies have been developed in order to reduce potential lung injury. Furthermore, tissue injury may occur as a result of injurious oxygen by-products (Reactive Oxygen Species, ROS), secondary to hyperoxia. Knowledge of the inflammatory pathways that connect intra-amniotic inflammation and ALI can lead to the formulation of novel interventional procedures. Future research should concentrate on the pathophysiology of ALI in preterm neonates and οn possible pharmaceutical interventions targeting prevention and/or resolution of ALI.

Treatment of hirsutism with combined pill containing drospirenone

The aim of the present study was to evaluate the biochemical and clinical effects of the combined pill consisting of ethinyl estradiol (EE) and drospirenone (DRSP) in hirsute patients. Fifty-two adolescents or young women from Greece were treated with 30 μg EE and 3 mg DRSP for 1 year. Hirsutism was evaluated by the Ferriman–Gallway (FG) score in the initial visit and at 3, 6 and 12 months. Follicle-stimulating hormone, luteinizing hormone, etradiol, free and total testosterone (T), sex hormone-binding globulin (SHBG), androstenedione and dehydroepiandrosterone sulfate were determined at the same intervals. Hirsutism improved and FG scores reduced to 77.4%, 67.2% and 51.8% at 3, 6 and 12 months, respectively. Plasma SHBG levels rose, while free and total T levels reduced from the third month onwards. In conclusion, the EE/DRSP pill improves hirsutism in women via antiandrogenic and antimineralocorticoid action. The biochemical manifestations of hyperandrogenism are also improved.

Thermal balloon endometrial ablation: a systematic review

ObjectiveThe aim of our study is to review the role of thermal balloon endometrial ablation (TBEA) as an alternative in treating abnormal uterine bleeding.MethodsArticles relevant to our review and relevant references from the initially identified articles on the field that were archived by May 2007, were retrieved from Pubmed.ResultsSuccess rates ranged from 83 up to 94%, with patient’s satisfaction ranging from 57 up to 94%. Persisted menorrhagia could reach 17% in some studies.ConclusionTBEA is an effective alternative method used in the treatment of menorrhagea which results in a significant reduction in menstrual bleeding and high satisfaction rates. However, a longer follow-up is required to determine the role of such a treatment.

Bakri balloon tamponade for the management of postpartum hemorrhage.

Maternal mortality –0.46 (0.004) –0.36 (0.063) West: –0.63 (0.008) West: –0.69 (0.013) East: –0.24 (0.478) East: 0.04 (0.919) Central: 0.75 (0.246) Central: 0.99 (0.037) Southern: –0.80 (0.101) Southern: –0.67 (0.327) Neonatal mortality –0.39 (0.019) –0.30 (0.119) West: –0.55 (0.027) West: –0.53 (0.079) East: –0.04 (0.912) East: –0.24 (0.539) Central: –0.92 (0.080) Central: –0.98 (0.116) Southern: –0.52 (0.369) Southern: –0.23 (0.773) Early neonatal mortality –0.31 (0.062) –0.22 (0.254) West: –0.47 (0.064) West: –0.44 (0.156) East: –0.08 (0.803) East: –0.26 (0.496) Central: –0.96 (0.034) Central: –0.97 (0.154) Southern: –0.49 (0.401) Southern: –0.18 (0.820) Late neonatal mortality b –0.47 (0.004) –0.39 (0.043) West: –0.59 (0.014) West: –0.55 (0.063) East: 0.05 (0.877) East: –0.11 (0.787) Central: –0.84 (0.156) Central: –0.99 (0.056) Southern: –0.59 (0.295) Southern: –0.37 (0.627)

Association of endometriosis and breast cancer: mini review of the literature

BackgroundEndometriosis is a common, estrogen-dependent, gynecological disease, which is defined as the presence of endometrial tissue outside the uterine cavity. Current data have associated endometriosis with specific malignancies, including ovarian and breast cancer.PurposeThe purpose of our study is to summarize and present published literature providing evidence regarding the possible relationship between endometriosis and breast cancer.MethodsPubmed and Scopus databases were searched systematically for studies that sought to identify a potential association of endometriosis and breast cancer. 15 relevant articles were retrieved and included in the present review.ResultsA small number of observational studies have shown a correlation of endometriosis and breast cancer. Other studies found that the risk of breast cancer increases with age. The scenario of an early interruption of the inflammatory process, derived from endometriosis, by oophorectomy and a possible consequent decrease in the risk of breast cancer has also been proposed. The hypothesis that both conditions could be related through common mutations on BRAC1 and BRAC2 genes has also been investigated.ConclusionThe available published evidence is inconclusive. Further studies are needed to evaluate the association of endometriosis and breast cancer and the possible pathogenetic pathways that relate the two disorders.

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.

Cancer mortality in Greece during the financial crisis

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Translation and validation of the Perinatal Grief Scale in a sample of Greek women with perinatal loss during the 1st and 2nd trimester of pregnancy

Abstract Objective: To translate and validate the Perinatal Grief Scale (PGS) (short version) in a sample of Greek women with perinatal loss during the first and second trimester of pregnancy. Methods: One hundred seventy-six women were approached a few hours after the loss. Along with the PGS, three more questionnaires were completed: the Edinburgh Postnatal Depression Scale (EPDS), the Hospital Anxiety and Depression Scale (HADS) and the State-Trait Anxiety Inventory (STAI), in order to assess the convergent validity of the PGS. Results: Total sample mean age was 34.1 years (SD = 5.2). Mean values and Cronbach’s alpha coefficients for PGS subscales exceeded the minimum reliability standard of 0.70. Mean score for “Active grief” was 31.47 (SD = 9.31), for “Difficulty Coping” was 23.13 (SD = 7.54) and for “Despair” was 21.07 (SD = 7.07). By applying Pearson’s correlation coefficients, PGS subscales positively correlated with scores on EPDS, STAI and HADS. Conclusions: The PGS Greek version is a reliable instrument in terms of internal consistency and the Cronbach’s alpha coefficients are high. The Greek version of PGS can be a useful instrument for the detection of the psychological impact after a perinatal loss and it has implications for both scientific research and clinical routine.