Awareness of human papillomavirus infection, testing and vaccination in midwives and midwifery students in Greece.

Midwives play an important role in the implementation of cervical cancer screening. We assessed the knowledge of human papillomavirus (HPV) infection and of its relationship with cervical cancer in 107 midwives and 29 graduating midwifery students. The majority of midwives (78.5%) were aware that a viral infection causes cervical cancer, whereas only 48.3% of the students knew this (p = 0.003). Only one midwife (0.9%) was not aware of HPV infection compared with 10.3% of the students (p = 0.029). Midwives were also more knowledgeable of the relationship between HPV infection and cervical cancer and of the availability of a vaccine against HPV infection (p = 0.005 and p < 0.0001, respectively). In conclusion, Greek midwives have a satisfactory level of knowledge about cervical cancer and HPV infection, in contrast to midwifery students. It is important to better educate midwifery students in order to facilitate the incorporation of HPV testing and vaccination in clinical practice.

Ligation of internal iliac artery for severe obstetric and pelvic haemorrhage: 10 year experience with 11 cases in a university hospital.

Bilateral iliac artery ligation is an effective second-line procedure to control massive obstetric and gynaecological haemorrhage, it is life-saving in certain cases and has the advantage that it preserves fertility, which is particularly important in young women of low parity. Bilateral ligation of internal iliac arteries is a life-saving procedure in cases of massive obstetric haemorrhage. It has the advantage of preserving fertility compared with the commonly performed emergency obstetric hysterectomy. It has also proved effective in cases of secondary pelvic haemorrhage in gynaecological operations. We report here a case series of 11 women who had bilateral internal iliac artery ligation for severe pelvic haemorrhage in a period of 10 years in our department. Ten of them were obstetric cases and one was a case of haemorrhage following vaginal hysterectomy. The outcome was favourable in 10 out of the 11 cases and there was only one case of massive postpartum haemorrhage where the procedure failed and required an emergency hysterectomy.

Simultaneously detected primary malignant tumors of ovary and endometrium with unusual histology.

A case of a mucinous adenocarcinoma of the ovary with a synchronous endometroid tumor of the endometrium with focal features of undifferentiated carcinoma and deep myometrial invasion is reported. A review of the literature revealed that our case is interesting in view of the fact that simultaneous presentation of primary ovarian and endometrial neoplasms is rare and usually related to low-stage ovarian lesions and well-differentiated and superficial endometrial carcinomas in contrast to our case with the focal features of undifferentiated carcinoma and the deep myometrial invasion. These double tumors usually present in premenopausal subfertile women with abnormal uterine bleeding. The prognosis in most of the cases is surprisingly good even after total abdominal hysterectomy and bilateral oophorectomy alone without adjuvant chemotherapy or irradiation.

Effect of depleted uranium weapons used in the Balkan war on the incidence of cervical intraepithelial neoplasia (CIN) and invasive cancer of the cervix in Greece.

OBJECTIVE: To compare the incidence rates of CIN and invasive cancer of the cervix in two district areas near the borders with the former Yugoslavia and an urban area away from these borders three years before and three years after the bombings in this country. MATERIAL: Two peripheral hospitals (in Kilkis and Serres) which are near the border with the former Yugoslavia and one University hospital (Hippocratio hospital of Thessaloniki) in a rural area away from the borders, where routine Papanicolaou smear tests for screening of CIN and invasive cancer of the cervix are performed in the general female population. METHODS: Hospital records were searched for abnormal smear test results. Incidence rates of CIN and invasive cancer of the cervix three years before (1997-1999) and three years after (2000-2002) the bombings were calculated and compared in the three different settings. The relation between the mean age of the first occurrence of an abnormal smear test was also examined. The results were examined using the chi-square test. RESULTS: The incidence of CIN in the three-year period 1997-1999 was 0.68% and 0.9% for the two district hospitals of Kilkis and Serres, respectively. These figures rose to 1.11% and 1.13% in the three-year period 2000-2002 for the two district hospitals. The incidence of CIN in the three-year period 1997-1999 was 1.06% for the Hippokrateion University Hospital of Thessaloniki and 0.88% for the three-year period 2000-2002. There has been a small but not statistically significant increase in the incidence rates of CIN in the two district areas near the borders with the former Yugoslavia over the last few years (p = 0.355 for Kilkis and p = 0.472 for Serres), compared with the small but statistically significant decrease in the incidence of CIN in the urban area of Thessaloniki (p = 0.0275). The rates of invasive cancer of the cervix diagnosed from the routine smear tests were too small to make any conclusions. CONCLUSION: The increase in the incidence of precancerous lesions of the cervix in areas near the borders with the former Yugoslavia during the last three years may be influenced by environmental factors such as exposure to depleted uranium due to the bombings of 1999. To comfirm this bigger epidemiological studies are needed.

Fine needle aspiration cytology of the ovary: is it reliable?

PURPOSE OF INVESTIGATION: The purpose of this study was to evaluate the cytologic findings from the fluid of ovarian cysts in comparison with the histologic diagnosis. METHODS: Over a four-year period all women with single ovarian cysts and no evidence of malignancy from ultrasound examination and tumour marker levels were included in the study. Prior to removal of the cyst, fluid was aspirated from the cyst and prepared for cytologic examination. Subsequently the ovarian cyst wall and biopsy from the ovary were sent for histologic examination. The cytologic findings were compared to the histologic diagnosis. RESULTS: The material of the study was 120 ovarian specimens from 107 women. Twenty-four (20%) of the specimens submitted for cytology were non diagnostic and a comparison between cytologic and histologic findings was possible in 96 cases. The sensitivity and the specificity of fine needle aspiration (FNA) cytology of the ovary was 25% and 97%, respectively. CONCLUSIONS: FNA cytology of the ovary is an accurate method for predicting benign ovarian histologic findings in carefully selected populations.