Vassilios Tzingounis

Investigation of kinetic of lead during pregnancy and lactation.

Lead concentration was estimated in peripheral blood, milk as well as in cord blood in 47 women and their infants, using atomic absorption spectrophotometry. Mean maternal blood lead concentration was 14.9 ± 4.1 μg/dl, while in milk a mean level of 2.0 ± 0.5 μg/dl was estimated. Mean lead concentration in cord blood was 13.1 ± 3.7 μg/dl. Analysis of these data showed a statistically significant correlation between lead maternal and cord blood concentration (r = 0.413, p = 0.01) or maternal blood and milk (r = 0.543, p < 0.01). The difference between maternal and cord blood might be indicative of a small filtering effect of placental tissue on lead transfer to the fetus. Placenta can determine 57.4% of the level of lead transferred to the fetus in a dynamic modus, while 42.6% depends on the pollution’s level of mothers.

Short-term versus long-term prophylactic tocolysis in patients with preterm premature rupture of membranes

A randomised prospective clinical trial was conducted over a 7-year period (1987–1993) in the Department of Obstetrics and Gynaecology, University of Patras. The purspose of this study was to compare two management protocols of Preterm Premature Rupture of Membranes (PPROM). Two-hundred forty-one women entered the study and were assigned randomly to one of two groups. Group A consisted of 105 subjects who were managed expectantly (tocolysis used for 48 h only, if necessary, to permit full course of steroid therapy), while Group B consisted of 136 subjects, in whom aggressive tocolysis was utilised. The differences in the latency period (time from rupture of membranes to the onset of labour) were not statistically significant between the two groups. On the contrary, statistically significant differences in the incidence of chorioamnionitis and postpartum endomyometritis were found between the two groups (higher in Group B). Twelve subjects in Group A (12105, 11.4%) and 40 in Group B (40136, 29.4%) had choriamnionitis. The relative risk (RR) was 2.47 (95% C.I. 1.42-4.66, P < 0.001). Endomyometritis was diagnosed in 20 subjects in Group A (20105, 19%) and in 45 in Group B (45136, 33.3%). The RR was 1.74 (95% C.I. 1.10-2.75, P < 0.05). These data suggest that long term prophylactic tocolytic therapy in patients with PPROM, while without demonstrated benefit, may result in an increased risk of maternal infectious morbidity, and raise the cost of treatment.

Anticardiolipin antibodies levels in healthy pregnant and non-pregnant woman

Abstract To determine the prevalence of anticardiolipin antibodies in healthy non pregnant women and during normal pregnancy, 110 healthy women of mean age 25 years old and 53 healthy pregnant females of mean age 24.5 years old, who no one suffered from any autoimmune disease, were studied. In all women the anticardiolipin antibodies were measured in duplicate by the Enzyme Linked Immunosorbent Assay (ELISA). There was no difference in the percentage of the positive anticardiolipin antibodies between non pregnant and pregnant healthy women (9.1% and 5.6% respectively). Also, there was no difference in the antibodies levels during normal pregnancy, as well as, during an equal time of observation in non pregnant women. The positive anticardiolipin antibodies levels were low.

Clinical experience with Norplant subdermal implant system as long-term contraception during adolescence.

Objective: This study was undertaken to assess the efficacy, acceptability and side-effects of the Norplant® (Leiras) contraceptive system during adolescence. Methods: A total of 13 adolescents were implanted with Norplant immediately after menstruation. Adolescents were advised to present for follow-up visits at 3 days after implantation, at 3, 6 and 12 months and every 1 year thereafter. Blood pressure, menstrual disorders, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, glucose and side-effects were recorded at every visit. Results: The follow-up period was 24 months with a continuation rate of 100% (13/13) for the first 6 months, 92.5% (12/13) for 12 months and 53.8% (7/13) for the whole period. No pregnancies were observed. No infections at the implant site or expulsions were observed. Menorrhagia was observed in 4/13 (30.76%) adolescents in the third month. Thereafter all adolescents were treated with tenoxicam (prostaglandin synthetase inhibitor), so that by the end of the sixth month of treatment menorrhagia was not present in any of the 13 adolescents. No increase of blood pressure was observed. A statistically significant increase (p < 0.01) of triglycerides at 6 months after implantation was found; however, no difference was observed in the values of serum glucose, total cholesterol, HDL and LDL. Conclusions: This preliminary study has shown that Norplant is acceptable as a contraceptive method among adolescents in Greece and can be prescribed safely.

Treatment of Recurrent Genital Herpes with Interferon Alpha-2α

The purpose of the present study was to evaluate the efficacy and safety of parenteral administration of interferon alpha-2α in the treatment of recurrent herpes genitalis. A total of 97 patients (66 males, 31 females, mean age 34.86 ± 16.74 years), who had at least five recurrences of genital herpes during the previous 12 months, participated in a prospective open study on the effects of treatment with interferon alpha-2α (Roferon-A; Roche). The patients were treated with interferon alpha-2α (3 × 106 IU) by subcutaneous injection, three times weekly for 4 weeks, and the same schedule was repeated after 3 and 6 months. All patients were asymptomatic at the start of the study. After initiation of treatment, all patients reported to the clinic every 3 months for 2 years (the males were submitted to peoscopy and the females to Pap test and colposcopy) at the time of their recurrences. Comparison was made of the number of recurrences, duration of lesions, duration and severity of pain, and itching and burning. Prophylactic administration of interferon alpha-2α prevented recurrences of genital herpes virus infection in 51 patients (20 males and 31 females). Interferon administration shortened the healing time from 8.5 days before treatment to 2.5 days after treatment (p < 0.001). There was a significant reduction in the number of recurrences during the study period, from 7.46 before treatment to 2.64 after treatment (p < 0.001). On the basis of the overall efficacy and adverse effects, this regimen may be of value in the routine treatment of recurrent herpes.

Subcutaneous hormone replacement therapy

It is estimated that 75% of women are in an acute estrogen deficiency state within a few years after the onset of the menopause. Every woman inevitably reaches this phase except for a fortunate few who have some source of endogenous estrogens available to them. We believe it would be prudent to offer hormone replacement therapy to every woman with symptoms of the menopause, and to those in whom symptoms are not patently manifest, if an estrogen deficit is present as indicated by vaginal cytology. Certainly even in the absence of symptoms, the presence of osteoporosis is sufficient reason to initiate small doses of estrogens (along with increased calcium and protein uptake, and exercise) for the remainder of the womans lifetime. Crystalline pellets of 17 beta-estradiol offer excellent relief of symptoms for those postmenopausal women who fare poorly on oral estrogens or intramuscular injections. Although somewhat more expensive than other modes of therapy, pellet use is convenient, highly effective and associated with few side effects.

The effects of recombinant human erythropoietin given immediately after delivery to women with anaemia

SUMMARY Objective: Anaemia is a common problem during pregnancy and the puerperium. This study was designed to determine the efficacy and safety of giving recombinant human erythropoietin (EPO) to anaemic women during the puerperium. Method: Thirty-seven women received a single dose of EPO (20,000 IU intravenously) immediately after delivery. A control population (n = 37) matched according to age and haemoglobin concentration was evaluated. All women received oral iron supplementation for 40 days after delivery. Haemoglobin concentrations were measured 4 and 40 days after delivery. Blood transfusions were given depending on clinical condition and haemoglobin level. Results: Patients treated with EPO had a significantly higher mean haemoglobin concentration than control patients at days 4 and 40. No women in the EPO group required a transfusion, compared with six in the control group. No side-effects and fewer anaemia-related symptoms were observed during EPO treatment. Conclusion: EPO given at delivery is effective in decreasing the need for blood transfusion and the incidence of problems associated with anaemia during the puerperium.

Clinical Experience with Levonorgestrel Subdermal Implants (Norplant®)1 for Long-Term Contraception

ObjectiveThe study was undertaken to assess the efficacy, acceptability and tolerability profile of levonorgestrel 6-capsule subdermal implants (Norplant®) for long-term contraception, in Greek women.DesignOver a 6-year period, 72 women voluntarily seeking contraceptive advice from our clinic opted for long-term contraception with the levonorgestrel subdermal implant method after receiving counselling. In order to study the long-term effects of the implants, all women were advised to present for follow-up visits at 3 days after implantation, and at 1, 3, 6 and 12 months and every year for the remaining 4 years. Blood pressure, menstrual disorders and adverse effects were recorded at every visit, as were plasma glucose levels and serum levels of total cholesterol, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein-cholesterol and triglycerides.ResultsThe mean follow-up period was 34.9 months (range 6 to 60 months), with a continuation rate of 95.5% for the first year and 94.9% for the second year. Neither normal nor ectopic pregnancies were observed. No significant change in blood pressure was observed, which ranged within normal values (≤140/90mm Hg). Significant increases (p < 0.01) in total cholesterol levels at 12 months (from 156.8 ± 34 mg/dl to 174.2 ± 32 mg/dl) and HDL-cholesterol levels at 6 months (from 58.5 ± 11.1 mg/dl to 60.5 ± 10.8 mg/dl) were observed. These levels returned to baseline values after 29 to 36 months. Adverse effects were reported in a minority of patients and included headache, decreased libido, bodyweight gain and nervousness.ConclusionThe present study has shown that levonorgestrel subdermal implants are well accepted by Greek women and can be provided safely.

Combination therapy with mitoxantrone fluorouracil, leucovorin, and granulocyte colony-stimulating factor in patients with advanced breast cancer: a phase II study

Abstract The purpose of this study was to assess the efficacy of combination therapy with mitoxantrone, fluorouracil, and high-dose leucovorin (MFL) and granulocyte colony-stimulating factor (G-CSF) in patients with metastatic breast cancer. From May 1994 to June 1997, 46 patients with stage IV breast cancer were treated with MFl chemotherapy plus G-CSF, as needed. World Health Organization criteria were used to define objective responses and toxicity. Thirty-eight (82.6%) of 46 patients were assessable for response to therapy and toxicity. Median follow-up was 15.2 months (range, 4 to 34 months). Twelve (31.6%) of these patients demonstrated a complete response and 16 (42.1%) a partial response, giving an overall response rate of 73.7%. A small number of patients had grade 3 and 4 neutropenia and/or anemia. The results of this study using combination therapy with MFL plus G-CSF are encouraging. The overall response rate of 73.7% in the 38 assessable patients is noteworthy, because all had stage IV breast cancer and 24 (63.2%) of 38 patients had visceral-dominant disease. We conclude that the combination of MFL and G-CSF is a well-tolerated, active regimen for use as first-line therapy in patients with metastatic breast cancer.

Reduced cortisol concentrations in the cord blood of newborns whose mothers smoked during pregnancy. † 1089

Reduced cortisol concentrations in the cord blood of newborns whose mothers smoked during pregnancy. † 1089