Tzafettas J

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.

Levels and profiles of brominated and chlorinated contaminants in human breast milk from Thessaloniki, Greece.

Human breast milk samples (n=87) collected between July 2004 and July 2005 from primipara and multipara mothers from Thessaloniki, Greece were analysed for six groups of persistent organic pollutants (POPs): polybrominated diphenyl ethers (PBDEs), polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane and its metabolites (DDTs), chlordane compounds (CHLs), hexachlorocyclohexane isomers (HCHs) and hexachlorobenzene (HCB). DDTs [median: 410ng/g lipid weight (lw)], PCBs (median: 90ng/g lw) and HCHs (median: 40ng/g lw) were the predominantly identified compounds in all the breast milk samples. Levels of PBDEs (median: 1.5ng/g lw) in human breast milk samples from Thessaloniki, Greece were lower compared to other countries. Maternal age had a positive correlation with most compounds, but not with PBDEs. Women with a higher occupational exposure to PBDEs (i.e., working in office environments) had higher PBDE concentrations than all others and showed strong correlations, especially for BDE 47 and BDE 153. None of the analysed compounds showed any correlation with parity. Based on these levels, the daily intake of each group of POPs via human milk was calculated and compared with the tolerable daily intakes (TDI) or the reference doses (RfD). For the majority of samples (85 out of 87) a higher daily intake of PCBs than the TDI was calculated, while 11 out of 87 samples had a higher HCB intake than the TDI. The TDI and the RfD were not exceeded for DDTs and PBDEs, respectively. This is the first report of brominated flame retardants in human breast milk from Greece.

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.

Adenosine Deaminase Activity and Its Isoenzyme Pattern in Women with Recurrent Spontaneous Abortions

Normal pregnancy is characterized by suppressed cell-mediated immunity. Adenosine deaminase (ADA) is a purine metabolic enzyme enriched in trophoblast cells of the placenta. It is an early marker of trophoblast cell differentiation. Also, the activation of ADA gene expression in the placenta is crucial and essential for proper fetal development. The activity of ADA shows changes in diseases characterized by the alteration of cell-mediated immunity. The purpose of this study was to assess the possible role of the alteration of cell-mediated immunity in women with recurrent spontaneous abortions (RSA) as a cause of changes in tADA activity, and also to evaluate the extent of the contribution of ADA1 and ADA2 to changes of tADA activity in serum and peripheral blood lymphocytes (PBLs). We measured in serum and in PBLs activities of tADA, ADA1 and ADA2 of 25 married women with RSA (group A) and of 28 healthy non-pregnant women (group B). According to our results in women with RSA, mean serum tADA, ADA1 and ADA2 activities were significantly higher than those of non-pregnant women (p < 0.001, p < 0.05 and p < 0.05 respectively). In women with RSA, mean PBLs tADA, ADA1 and ADA2 activities were significantly higher than those of non-pregnant women (p < 0.001, p < 0.05 and p < 0.05 respectively). The findings of this study show a marked increase of serum and PBLs ADA activities, which is derived from an increase of ADA2 and ADA1 activity in women with RSA. These changes reflect cell-mediated immunological changes.

Anterior vaginal wall reconstruction: anterior colporrhaphy reinforced with tension free vaginal tape underneath bladder base

Objective. To assess the effectiveness of the polypropylene tape in preventing cystocele recurrence. Methods. Fifty Caucasian women aged 50‐77 years (mean age 66.6 years), with stage II–IV pelvic organ prolapse, enrolled into the study. Vaginal reconstructive surgery included an anterior colporrhaphy on all patients, posterior colpoperineorrhaphy on 28 patients and hysterectomy on 36 patients. Patients were divided into a study group of 28 women and a control group of 22 women. As reinforcement to the anterior colporrhaphy procedure, in the study group a polypropylene tape (TVT‐O) was placed underneath the bladder base and fixed with polyglactin sutures. Postoperative follow‐up was carried out every 4 months (total 48 months). The assessment of the anatomic result included both clinical evaluation of the operated sites and perineal sonography. Results. The mean postoperative distance of the bladder base to the inferior edge of the symphysis pubis was 1.5 cm (range: 1.0–2.2 cm) in the study group and 2.8 cm (range: 2.0–3.8) in the control group. Postoperatively, there were two cases of stress incontinence and two cases of urge incontinence, one in each group. No case of tape erosion was noted, no dyspareunia and no recurrent cystocele in the study group. Four cases of recurrent cystocele (20%) were reported in the control group. Conclusion. While the preliminary results of our study are encouraging, larger series of patients and longer follow‐up are required to verify the effectiveness of the aforementioned modification.

Re: Current caesarean delivery rates and indications in a major public hospital in Northern Greece Aust N Z J Obstet Gynaecol 2008 April; 48(2): 142–6

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