Vasilios Liberis

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.

Cytologic diagnosis of axillary lymph node metastasis in breast cancer.

OBJECTIVE To compare imprint cytology with histology as a method for rapid intraoperative diagnosis of axillary lymph node metastasis in breast cancer. STUDY DESIGN We evaluated imprint cytology, comparing it with histopathology. A sample of 635 axillary lymph nodes was studied by imprint cytology using both Giemsa stain and hematoxylin-eosin. The results were compared with each other and with those of histopathologic examination. RESULTS The Giemsa stain method, as compared to histopathology, had 94% accuracy, 97% sensitivity, 90% specificity and 94% positive prognostic value. The hematoxylin-eosin stain method was less accurate than the Giemsa stain method as compared to histopathology (accuracy 91%, sensitivity 96%, specificity 83% and positive prognostic value 92%). CONCLUSION These data confirm the value of imprint cytology as a rapid, reliable method of intraoperative assessment of axillary lymph node metastasis in breast cancer. It results in better staging of the disease. It can be used intraoperatively, as an alternative to frozen section, if a pathology laboratory is not available, to exclude stage I patients from further treatment.

Transvaginal aspiration of ovarian cysts: Our experience over 121 cases

Abstract We performed an evaluation of ultrasound-guided transvaginal aspiration of ovarian cysts as a viable alternative to surgery in 104 reproductive and 17 postmenopausal women. One-hundred and twenty-one patients with a simple >4 cm diameter ovarian cyst, with a benign appearance on ultrasound as well as on clinical and blood examination, underwent transvaginal fine needle aspiration of the cyst under ultrasonographic control. One-hundred and four patients were of reproductive age and 12 were postmenopausal. Sixty women who were of reproductive age and in which OCP treatment was not contraindicated followed a six-month therapy with oral contraceptives after the intervention. In the group of patients of reproductive age under OCP treatment the cyst persisted in nine of the 60 women (recurrence rate 15%). In the other group of patients of reproductive age,under no OCP treatment, the recurrence rate was 47% (21 of the 44 women). In the group of postmenopausal patients, the cyst persisted in ten out of 17 cases (recurrence rate 58,9%). Transvaginal aspiration of ovarian cysts is a reliable alternative to surgery with many advantages such as excellent tolerance, low risk and cost of complications and recurrence. The OCP treatment after aspiration seems to increase the success rate of expectant management.

Incidence and Detection of Contralateral Breast Cancer

Abstract: In this study we estimated the efficacy of contralateral breast biopsy as a subsidiary method of early detection of bilateral breast cancer. We performed blind biopsies in the upper outer quadrant of the opposite breast in 195 patients undergoing surgical treatment for primary breast cancer. The histologic examination of the biopsy specimens showed 12 malignant lesions, which accounts for an incidence of 6.1%. In detail, we had two infiltrating ductal cancers, two infiltrating lobular cancers, three ductal in situ cancers, and five lobular in situ cancers. The overall incidence of invasive disease was 2.05%. We concluded that contralateral breast biopsy should be reconsidered as a method for enhancing early detection of contralateral breast cancer in high‐risk groups, especially when it meets the emotional needs of patients. Permission given, it is included in the main surgical treatment of patients, avoiding the cost and complications of anesthesia, and it is cosmetically acceptable, without being an emotional burden for the woman.

Alpha2B-adrenergic receptor insertion/deletion polymorphism in women with spontaneous recurrent abortions

Aim:  The aim of our study was to investigate the relationship between the alpha2B‐adrenoreceptor insertion/deletion (I/D) polymorphism and recurrent spontaneous abortions (RSA).

Chaotic Analysis Approach in Neonatal Magneto-Encephalography

The aim of this study was to investigate the presence of any non-linearity in the magneto-encephalographic recordings (MEG) in neonates born to pre-eclamptic mothers in comparison with the ones born to mothers having uncomplicated pregnancies, in order to find out differences in the mechanisms underlying their brain waves. Our study population consisted of 40 term neonates who were delivered normally, without any clinical signs of brain damage. Thirty of them had a normal pregnancy and labour with normal Apgar scores, umbilical cord pH, and birth weight, while 10 neonates had suffered a pre-eclamptic pregnancy. The above analysis of the MEG in the neonatal pre-eclamptic brain showed a lower dimension complexity as compared with the normal neonatal brain and a lower first Lyapunov exponent which means lower information processing. The non-linear analysis of the MEG activities in neonates may offer important perspectives to understand significant features of their brain function.

Hysteroscopy and endometrial cancer. Diagnosis and influence on prognosis

Diagnostic hysteroscopy is a simple procedure that can provide a good visualization of the whole uterine cavity without cervical dilation and usually without anesthesia. It has been proposed as an office method for diagnosis of endometrial disorders, including cancer. Hysteroscopy, especially combined with endometrial biopsy, has high diagnostic accuracy. However, concerns have been raised about the potential for hysteroscopy to flush malignant endometrial cells into the peritoneal cavity through the fallopian tubes and to cause dissemination of malignant cells into the abdominal cavity through the fallopian tubes from uteri containing endometrial carcinoma. Moreover, some controversy also remains about the functional viability of these cells and their potential to cause metastases.

SQUID biomagnetometry of the uterine arteries in normal and pre-eclamptic pregnancies

Abstract Aim: This study was designed to investigate the hemodynamics of the uteroplacental circulation in normal and pre-eclamptic pregnancies using the biomagnetometer SQUID. Method: Twenty-two pregnancies complicated by preeclampsia and 49 normal pregnancies were included in this study. All were near term. Biomagnetic signals were recorded from the uterine arteries. After statistical Fourier analysis, the findings were designated in terms of spectral amplitudes as high (140–300 fT/√Hz), low (50–110 fT/√Hz) and borderline (111–139 fT/√Hz). Results: The uterine artery waveforms and the corresponding spectral densities were of high amplitudes in most (89.7 %) normal pregnancies and of low amplitudes in most (81.8 %) pregnancies complicated by preeclampsia (p < 0.005). These findings were of statistical significance and were correlated with fetal heart rate (FHR) monitoring, pH, Apgar score at 1 and 5 minutes and birth weight percentiles: high amplitude cases were related with normal FHR patterns, pH > 7.25, Apgar score >7 and birth weight > 75th percentile, while low amplitude recordings were connected with abnormal FHR patterns, pH < 7.25, Apgar score < 7, and birth weight < 10th percentile (8 cases) and < 50th percentile (10 cases). Conclusion: Biomagnetic measurement of the uterine artery flow, is a promising procedure in assessing fetal health, especially in high-risk pregnancies.