Soluble intercellular adhesion molecule-1 in newborn infants.

UNLABELLED: The aim of this study was to evaluate the effect of increasing postnatal age on soluble intercellular adhesion molecule-1 (sICAM-1), a very early and sensitive marker of immune activation and response in the serum of newborn infants. Serum sICAM-1 was measured by EIA (T Cell Diagnostics) in 20 healthy adults (controls) and in 43 (24 females/19 males) healthy neonates, of whom 28 were full term, and 15 were born at a gestational age between 35 and 38 weeks of pregnancy, on the 1st, 5th and 30th day of life. Neonatal serum sICAM-1 values showed a very significant increase (P < 0.01) from the 1st day (137.3+/-62.0 ng/ml) to the 5th day (259.3+/-124.0 ng/ml) and then to the 30th day of life (415.0+/-114.0 ng/ml), being significantly lower on the 1st day (P < 0.01), whereas significantly higher on the 30th day of life (P < 0.05), than those in healthy adults (305+/-195 ng/ml). Serum sICAM-1 values on the 1st day of life depended on both the mode of delivery (significantly higher in neonates born vaginally) and the gestational age at birth (significantly lower in those born at a gestational age over 38 weeks). A significant strong correlation was found in sICAM-1 values between the 1st and the 5th day following delivery (rp = 0.77, P < 0.009). CONCLUSION: The results of this study demonstrate a significant rise of serum sICAM-1 during the 1st month of life in healthy neonates suggesting a progressively increased activation of the neonatal immune system.

A comparative study of an estradiol-releasing vaginal ring versus tibolone in postmenopausal women: a transvaginal color Doppler study.

OBJECTIVE: To evaluate endometrial blood flow characteristics in response to estrogen replacement therapy (ERT) and tibolone in postmenopausal women and to correlate the resistance index (RI) with plasma estradiol levels. MATERIALS AND METHODS: Transvaginal color Doppler ultrasound examinations were performed in 72 asymptomatic, postmenopausal women who demonstrated endometrial thickness < or = 5 mm. Thirty-six women receiving tibolone and 36 patients receiving ERT by a vaginal ring comprised the study groups. RESULTS: All postmenopausal women treated with tibolone or ERT showed continuous forward end-diastolic flow. The lowest RI was obtained in women with the vaginal ring inserted. The plasma concentrations of estradiol were found to be significantly higher in the vaginal ring group than those of tibolone. CONCLUSIONS: The data observed suggest that ERT and tibolone modify normal postmenopausal endometrial perfusion. Tibolone had a weaker estrogenic effect on endometrial blood flow resistance, and vaginal ring treatment enhanced endometrial blood perfusion through vasodilatation.

The effect of early second stage bradycardia on newborn status.

In the present study 45 patients with intrapartum cardiotocograms showing prolonged fetal bradycardia during the early second stage of labor were included. Bradycardia persisted for 180 s or more with either rapid or prolonged return to baseline, without loss of variability and rise of baseline fetal heart rate (FHR). The mean duration of bradycardia was 5.0 +/- 1.3 min. In the group with normal FHR tracings the rate of normal delivery (73.3%) was significantly higher than that of the group with fetal bradycardia (26.7%, P < 0.0001). We also noted a significantly higher rate of cesarean section (44.4%) in patients with abnormal FHR tracings, compared to that (11.1%) of parturients with normal FHR tracings (P < 0.001). In all cases blood samples were obtained from the umbilical cord artery, immediately after delivery. Only in two cases with abnormal FHR tracing umbilical cord artery was the pH less than 7.20. We conclude that in most cases, prolonged fetal bradycardia in the early second stage with the characteristics described above is well tolerated by a mature fetus.

Rupture of an heterotopic pregnancy in the 15th week and normal continuation of the intrauterine gestation. Case report.

A rare case report of heterotopic pregnancy, ruptured in the 15th week of gestation is presented. The intrauterine pregnancy continued after the laparotomy and removal of the extrauterine fetus and ended with a normal delivery in the 39th week.

Smoking and preterm labor.

The aim of the present study was to investigate the role of maternal smoking during pregnancy in the occurrence of the premature rupture of the membranes (PROM) and premature labor . Our study consisted of 1,133 women of which 283 (group A) had premature labor (gestation < or = 37 weeks), while 850 (group B) had term labor (gestation > 37 weeks). The two groups did not differ in their socioeconomic status and did not include women with serious complications during pregnancy. There were no apparent effects of smoking on the length of gestation. However, our results showed that smoking had a marked effect on preterm labor of less than 32 weeks; we also found a statistically significant correlation between PROM in premature deliveries and smoking during pregnancy, but no gradient was observed between the number of cigarettes smoked per day and the risk for PROM, in cases of premature labor. We conclude that smoking during pregnancy raises the risk of delivery before the 32nd week, as well as the PROM in premature deliveries, independently of the number of cigarettes smoked per day.

Hematological parameters of the mother and neonatal status during normal labor.

This study reviews the relationship between hematological parameters of the mother and the newborns status. Our material consisted of 180 pregnant women with singleton pregnancies who had an uncomplicated vaginal delivery. A negative relationship was noted between the pH and the maternal hemoglobin values both in the umbilical artery and vein (r = -0.27, p < 0.001, for the umbilical vein and r = -0.32, p < 0.0001, for the umbilical artery). A negative relationship was also noted between the umbilical vein pH and the maternal hematocrit, which was statistically significant (r = -0.28, p = 0.001). A similar negative correlation was observed between the umbilical artery pH and the maternal hematocrit (r = -0.32, p < 0.0001). In conclusion, maternal hematological parameters (hemoglobin, hematocrit) can affect the fetal acid-base balance.

Serum markers of immune activation in women undergoing in-vitro fertilization and embryo transfer.

We evaluated serum concentrations of two early and sensitive markers of immune activation, interleukin-2 receptor (sIL-2R) and intercellular adhesion molecule-1 (ICAM-1) in two age-matched groups of in-vitro fertilization (IVF)-embryo transfer women, group I (n = 26) without and group II (n = 40) with methylprednisolone (MPD) supplementation of the luteal phase, on the days of oocyte retrieval (sample A) and embryo transfer (B), and second (C) and 13th (D) days post-transfer and in 20 normally cycling women (controls) on the day of luteinizing hormone (LH) peak. No difference in the outcome of the IVF-embryo transfer was observed between groups I and II. In sample A, both immunomarker concentrations showed no significant difference between the two groups of IVF women, while they were significantly higher (P < 0.01) than values in controls. In cycles in which conception occurred, significantly higher immunomarker concentrations were observed in sample A of both groups I and II compared with those in unsuccessful cycles of the same group. A significant decrease of both sIL-2R and ICAM-1 was noticed in sample B only in group II (P < 0.0001 and P < 0.001 respectively; paired t-test) that continued further in the late luteal phase only in the case of conception, independently of MPD supplementation. These data suggest that (i) due to multiple ovulations, IVF-embryo transfer women show elevated concentrations of sIL-2R and ICAM-1 at oocyte retrieval; (ii) since, even at oocyte retrieval stage, high concentrations of immunomarkers are associated with IVF-embryo transfer success, sIL-2R and ICAM-1 could be used as early indicators for conception cycles; (iii) transient suppression of T cell activity by MPD supplementation following IVF-embryo transfer does not improve pregnancy rate.

Evaluation of the hypothalamic-pituitary axis in uremic males using dynamic tests. The possible role of testicular inhibin: a preliminary report.

Two dynamic tests (Gn-RH i.v. and clomiphene citrate-CC p.o.) were used to evaluate the hypothalamic-pituitary axis in hemodialysis patients and renal transplant recipients (recipients). In the Gn-RH test the gonadotropin secretion was maximally decelerated in hemodialysis patients while it was normal in recipients. During the CC test a decrease of gonadotropin secretion, chronically and quantitatively identical for both group, was found; while on the following test days an increase was noted, which was more accelerated in male recipients. In cases with uremia a strong negative feedback dominates at the pituitary level probably owing to testicular inhibin. The estrogenic feedback in uremia was intact, while the antiestrogenic feedback at the level of hypothalamus is partly impaired, owing to altered opioid metabolism.

A comparative study of serum alpha-beta A immunoreactive inhibin and tumor-associated antigens CA125 and CEA in ovarian cancer.

alpha-i.r Inhibin, has been recently proposed as a useful tumor marker for mucinous ovarian carcinomas (Ca), as the widely used tumor marker for ovarian malignancies, CA125 is efficient only in nonmucinous ovarian Ca, and, together with CEA, fails to detect minimal disease and show long half-life in serum after successful surgery. Moreover, conflicting evidence has been reported as to whether inhibin in ovarian malignancies is the biologically active dimer alpha-beta A inhibin or the inactive free alpha-subunits and inhibin precursors. Serum alpha-beta A i.r inhibin. CA125 and CEA were measured preoperatively and 8 days postoperatively in 39 postmenopausal patients with ovarian cancer (13 mucinous, 15 serous and 11 different other ovarian Ca) in comparison with 20 age-matched healthy women (Controls), 18 patients with benign ovarian tumors and 10 patients with nonovarian gynecological malignancies. Serum alpha-beta A i.r inhibin values were very low in controls (0.121 U/ml; 0.060-0.250) while they were greatly elevated in both benign (67% sensitivity) and malignant ovarian tumors (100% sensitivity in mucinous Ca, 80% in serous and 90.9% in other ovarian Ca, taken as cut-off level the maximum value in Controls, 0.250 U/ml). In contrast, in non-ovarian malignancies no increased values of alpha-beta A inhibin were found (0% sensitivity). Our results on the sensitivity of CA125 and CEA are in agreement with previous studies. After successful surgery the very high concentrations of alpha-beta A i.r. inhibin were reduced very rapidly (8 days) to normal postmenopausal values in contrast to those of CA125 and CEA, that remained elevated. Serum alpha-beta A i.r inhibin seems to be very useful in monitoring after treatment the patients with any type of ovarian malignancy and specifically those with mucinous ovarian cancer.

Correlation of serum and follicular fluid concentrations of placental protein 14 and CA-125 in in vitro fertilization-embryo transfer patients.

OBJECTIVE: To study serum and follicular fluid (FF) concentrations of placental protein 14 (PP14) and CA-125 in patients participating in an IVF-ET program. DESIGN: Determination in serum and FF on the day of hCG administration, day of oocyte retrieval, and on ET day of PP14 and CA-125. SETTING: Second Department of Obstetrics and Gynecology of the University of Athens; Euromedica IVF Unit; and Hellenic Pasteur Institute. PATIENTS: Thirty-three patients undergoing IVF-ET divided in three groups: 8 with conception, 18 with fertilized oocytes but no conception, and 7 without fertilized oocytes. INTERVENTIONS: All patients underwent an ovarian stimulation with a short protocol of GnRH analogue-pure-FSH-hMG. Three blood probes were collected from each patient, on the day of hCG administration, on retrieval day, and on ET day, respectively, whereas FF was collected on retrieval day. MAIN OUTCOME MEASURES: Determination in serum and FF of CA-125 and PP14. RESULTS: On the day of oocyte retrieval, both mean values of serum PP14 and CA-125 were significantly higher in conceptional than nonconceptional cycles. On the day of ET, the mean values of serum PP14 increased significantly in conceptional cycles whereas CA-125 showed no difference. The mean concentration of PP14 in FF was significantly higher in conceptional cycles whereas there was no significant change in the mean concentration of FF CA-125. CONCLUSIONS: In conceptional cycles after IVF, PP14 increases in serum significantly from hCG day to ET day compared with nonconceptional cycles, whereas CA-125 increases from hCG day to oocyte retrieval day and decreases on ET day. In FF, PP14 was increased in conceptional cycles, whereas CA-125 in FF showed no change.

Prophylactic oophorectomy in ovarian cancer prevention.

OBJECTIVE: To evaluate prophylactic oophorectomy in the prevention of ovarian cancer. METHOD: Between 1970 and 1990, 5262 hysterectomies were performed at Areteion Hospital, Athens. RESULTS: Ovarian cancer was subsequently diagnosed in 520 women (9.9%). The mean interval from hysterectomy to diagnosis of ovarian cancer was 7.2 years. If prophylactic bilateral oophorectomy had been practiced routinely in women undergoing hysterectomy at age 40 or above, 9.4% of cases would have been prevented. CONCLUSION: We recommend bilateral oophorectomy for all women with a positive family history of ovarian carcinoma and for all women undergoing hysterectomy after the age of 40. The decision for prophylactic oophorectomy as a complementary procedure to other indicated gynecologic surgeries should depend on the individual patient and her ability to comply with lifelong estrogen replacement therapy.

The diagnostic value of laparoscopy in 2365 patients with acute and chronic pelvic pain.

OBJECTIVE: To discriminate the etiology in 2365 patients with acute and chronic pelvic pain (APP, CPP). METHODS: Diagnostic laparoscopy was carried out in 736 patients (31.1%) with APP and in 1629 (68.9%) with CPP. In 315 patients (13.3%) the diagnostic procedure was extended to operative laparoscopy. RESULTS: The most frequent laparoscopic findings in patients with APP were acute salpingitis and pelvic adhesions (22.8%) and ectopic pregnancy (19%), while in patients with CPP the most frequent findings were pelvic adhesions (35.4%) and endometriosis (24.6%). In 7.5% of patients with APP and 24% with CPP, laparoscopy did not reveal any pathological finding in the pelvis. Among the 315 patients in whom operative laparoscopy was carried out, 40% suffered from APP and 60% from CPP. In the 446 patients (18.9%) without laparoscopic findings no treatment was given, while of the remaining 905 patients 40% were subjected to laparotomy and 60% received conservative treatment. The total incidence of side effects reached 4.7% and serious side effects resulting from emergency laparotomy occurred in 0.15% of patients with pelvic pain. CONCLUSION: Our results in a large group of patients with pelvic pain show that there are discrepancies in the incidence of laparoscopic findings between patients with APP and CPP. Discrepancies between the two groups of patients were also found during operative laparoscopy, the treatment administered after laparoscopic diagnosis and the complications encountered.

Intrafetal prostaglandin F2alpha administration for uterine evacuation in a case of intrauterine death.

An original route of prostaglandin F2alpha administration for uterine evacuation in a case of a midtrimester intrauterine death is presented. The ultrasonographic study revealed a hydropic fetus with a massive nuchal cystic hygroma and oligohydramnios. Given our previous experience with intrafetal prostaglandin administration in a similar case but with a living fetus, we injected prostaglandin F2alpha into the nuchal cysts under continuous ultrasonographic guidance in order to induce uterine evacuation. The pregnancy was successfully terminated 16 h later.

Transvaginal sonography in postmenopausal women treated with low-dose estrogens locally administered.

OBJECTIVE: The objective of this study was to determine the efficacy of low-dose estrogens, administered locally, in postmenopausal women with symptoms and signs of atrophic vaginitis. Transvaginal ultrasonography was performed for the evaluation of endometrial or ovarian abnormalities. MATERIALS AND METHODS: Fifty-six healthy postmenopausal women with symptoms of atrophic vaginitis due to estrogen deficiency were examined with transvaginal ultrasound. The endometrial thickness, the uterus and the ovaries were measured before and after 6 months of treatment with low-dose estrogens. RESULTS: The mean endometrial thickness, before and after treatment was 3.1 +/- 0.8 mm and 3.1 +/- 1.2 mm respectively. The mean ovarian volume before treatment was 4.5 ml and there was no difference after treatment. There were no changes in uterine thickness during the treatment period. CONCLUSIONS: Our study, using transvaginal ultrasonography, has shown that low-dose estrogens, administered locally, give no sign of endometrial proliferation, measured as endometrial thickness, and do not alter the ovarian volume in postmenopausal volume.

Effect of smoking on ceruloplasmin and its ferroxidase activity in pregnant women.

This study deals with the effects of smoking on serum ceruloplasmin and its ferroxidase activity in pregnant women. The mean value (+/- SD) of serum ceruloplasmin in women smokers during pregnancy is significantly higher (p < 0.01) in comparison to that of nonsmokers, whereas the ferroxidase activity of ceruloplasmin in smokers is not significantly different from that of nonsmokers. These findings suggest that ceruloplasmin in women smokers loses part of its ferroxidase activity.

Genuine stress incontinence: prospective randomized comparison of two operative methods.

Eighty-one women with clinical and urodynamic findings of genuine stress incontinence and genital prolapse were randomly selected to be surgically treated with either anterior colporrhaphy or Burch colposuspension. Each patient had a complete clinical and urodynamic evaluation before surgery and at 2 months and 3 years after surgery. Differences in cure rates between the two procedures at the 2-month post-operative evaluation were insignificant; however, at the 3-year post-surgical evaluation, the cure rate of women who had undergone Burch colposuspension was significantly higher than that of women who had undergone anterior colporrhaphy (cure rates were 88% and 57%, respectively; P < 0.001). The Burch colposuspension was more effective than the anterior colporrhaphy in the stabilization of the bladder base, neck and proximal urethra as confirmed by transvaginal sonography. Post-operative spontaneous voiding was uneventful in both procedures. Results of this study demonstrate that the Burch colposuspension in our hands was more effective in treating genuine stress incontinence and pelvic relaxation than was anterior colporrhaphy.

Ovarian surface serous papillary carcinomas: a clinicopathologic study.

Between 1982 and 1992, 129 patients with malignant epithelial ovarian tumors were reviewed with identification of 10 patients having surface papillary serous carcinoma of the ovary and one having peritoneal papillary carcinoma. The gross operative specimens, histopathologic condition, and treatment records were reviewed. All patients had disease involving the omentum, and the abdominal and pelvic peritoneum, and they all corresponded to stage III, according to FIGO. The median age at presentation was 58-years (age range, 43 to 73 years). All patients had a total abdominal hysterectomy and bilateral salpingo-oophorectomy, and all received chemotherapy. The median survival time for all patients was 15 months. Three patients are alive 3 to 4 years after the initial diagnosis. In conclusion, surface serous ovarian cancers and peritoneal papillary serous cancers have common histologic appearance and the same responsiveness to surgical therapy and to chemotherapy and should be treated similarly.

Prostaglandin F1a and prostaglandin E2 plasma levels after transvaginal cervical cerclage.

Plasma prostaglandin metabolites, prostaglandin F1a (PGF1a) and prostaglandin E2 (PGE2) were measured in a serial set of maternal serum samples by radioimmunoassay after elective transvaginal cervical cerclage (Shirodkar) in 18 patients early in the 2nd trimester (14-15 weeks of gestation) for a history of cervical incompetence. Eight patients received progesterone preoperatively as a myometrial suppressant. The basal PGF1a and PGE2 were 134.0 +/- 25.9 pg/ml and 14.9 +/- 1.8 pg/ml, respectively. A gradual rise in both metabolites was observed within 1 hour after the operation (206.81 +/- 48.3 pg/ml and 16.7 +/- 1.6 pg/ml, respectively, p > .05), peaking at 6 hours (265.4 +/- 51.8 pg/ml, p < .01 and 25.9 +/- 4.9 pg/ml, p < .05), and falling to basal levels within 24 hours (136.7 +/- 26.5 pg/ml and 14.0 +/- 1.2 pg/ml, respectively, p > .05). The increase in PGF1a was proportionately greater than PGE2 metabolite (r = 0.838, p < .001). No differences were found in prostaglandin levels amongst patients who received progesterone as compared to the non-recipients for all the time intervals studied (p < .05). Our findings, further suggest that a temporary increase in prostaglandin production occurs following cervical cerclage, but its role remains unclear.

Heterotopic pregnancies in an in-vitro fertilization program.

During a four-year period in vitro fertilization (IVF) was carried out in 2,356 cycles. The pregnancy rate per transfer was 24% while the incidence of ectopic pregnancies was 7.5% per pregnancy. There were seven cases of heterotopic pregnancies-simultaneous intra- and extrauterine pregnancies (1.5% among all IVF pregnancies). Two of them were diagnosed after tubal rupture of the ectopic pregnancy and five cases were diagnosed by ultrasound at the 7th or 8th week of gestation. Laparotomy and subsequent salpingectomy was carried out in six cases while in one case the ectopic pregnancy was removed by laparoscopy. Three out of the seven heterotopic pregnancies (43%) were successfully continued with normal intrauterine embryo development and delivery.