EFFECT OF ORAL CONTRACEPTIVES ON BONE MINERAL DENSITY.

Contraceptives are widely used in our times and a lot of research has been conducted to clarify their impact on Bone Mineral Density. Combined Oral Contraceptives (COCs) may be detrimental to the BMD of adolescents. However, low-dose are more protective than ultra-low-dose COCs. When it comes to premenopause and perimenopause, COCs have no impact on BMD in women with good ovarian function and no estrogen deficiency. In women with impaired ovarian function, it seems that COCs have a positive influence on BMD. Progestin only-pills may not affect BMD, but further research is needed. Depot medroxyprogesterone acetate injection (DMPA) has a negative impact, especially in adolescents, which is duration related but evidence shows that BMD recovers after discontinuation. Levonorgestrel-releasing intrauterine system (LNG-IUS) has no impact on BMD.

Progestins and the Risk of Breast Cancer.

OBJECTIVES: The present paper aims to investigate the effects of both progesterone and progestin treatment mainly related to the occurrence of breast cancer in women. MATERIALS AND METHODS: Extensive systematic bibliographic review of Greek and International articles was conducted through the electronic databases Pubmed, Cinahl, Uptodate, and Google Scholar for the identification of articles related to progesterone, progestins and breast cancer treatment. RESULTS: Hormone therapy with the use of estrogen alone presents a small increased risk or does not present at all an increased risk of breast cancer. With ORs in some studies below 1.0 in current users for 3 plus years and safe option until 7 years, while in other studies the risk was increased with the ORs 1.29. However, the use of estrogen in combination with progestogens, depending on the type of progestogens, shows an increased risk of breast cancer, with the ORs to vary between 1.14- 2.38 from 3 to 5 years and is inversely proportional to the time of its use. This risk varies depending on the combination of the preparations. Other factors that are associated with breast cancer risk when receiving hormone therapy are the years that hormone therapy is taken, directly proportional to the risk. At higher risk are older women, women with low body mass index in menopause (BMI <25kg/m2) and women with increased mammographic breast density. Continued use of hormone therapy is associated with an increased risk for breast cancer compared to sequential. The risk became visible sooner to women who used in the past hormone therapy and were using it again. Starting hormone therapy in the immediate postmenopausal period also increased the risk for breast cancer. Hormone therapy was associated with tumors with positive estrogen and progesterone receptors, and also the lobular histological type was associated with its use. Tibolone use was associated with an increased risk.

ANTIMÜLLERIAN HORMONE AS INDICATOR OF OVARIAN DYSFUNCTION.

AIM: The purpose of this study was to examine various hormonal, biochemical and environmental factors (i.e., smoking and alcohol intake) and to investigate their possible correlation to the development of polycystic ovary syndrome (PCOS). The main objective was to evaluate the associations between hormonal profile and the antimüllerian hormone (AMH) levels in PCOS patients and their relation to environmental factors. PATIENTS AND METHODS: In two gynecological clinics, 38 women with PCOS (defined according to the Rotterdam criteria) were enrolled and observed in relation to AMH, follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), Δ4-androstendione (Δ4-A), dehydroepiandrosterone sulfate (DHEA-S) and glucose plasma concentrations. Obesity, smoking and alcohol exposure were also studied. RESULTS: AMH, T, Δ4-Α, DHEA-S, LH and FSH were increased in 76.3%, 50%, 31.8%, 23.7%, 21% and 18.4% of the patients, respectively. The LH/FSH ratio and glucose concentrations increased abnormally in 18.4% and 15.8% of the patients, respectively. AMH and T levels were both increased in 47.4% of the patients whereas both AMH and LH levels increased in 21% of the patients. Smoking, alcohol intake, obesity and glucose concentrations were not associated with AMH concentrations. On the contrary, high levels of T and LH were linked to higher levels of AMH. FSH concentrations were not increased in these patients. CONCLUSION: AMH is an important hormonal parameter for the diagnosis of PCOS. Larger clinical controlled studies are necessary in an effort to further investigate the inclusion of AMH measurement in the diagnostic criteria of PCOS.

Efficiency of GnRH analogues in treating large functional ovarian cysts.

AIM: The aim of this study was to determine the potential therapeutic benefit of a single administration of a GnRH analogue in pre- menopausal women presenting large functional ovarian cysts (FOCs) (diameter > five cm). MATERIALS AND METHODS: Fifty-one patients (median age 37.4 years) diagnosed with ovarian cysts, presumed benign based on transvaginal and/or transabdominal ultrasound, were divided in three study groups. Patients of group A received no medication whereas patients of groups B and C were treated with a single administration of a GnRH analogue and combined oral contraceptives, respectively. Patients were re-examined after a three-month period. Three of the 51 patients were lost in follow-up or stopped the treatment. RESULTS: Complete resolution of the ovarian cysts was observed in eight (50%), 14 (70%), and eight (67%) patients of groups A, B, and C, respectively. No side effects were observed in either of the three groups. The positive therapeutic effect in group B did not reach statistical significance compared with the two other groups (p > 0.05). CONCLUSION: Anew option of treating large FOCS through a single-dose of a GnRH analogue is proposed and should be carefully considered. Further research is needed in order to evaluate GnRH analogues as an alternative treatment.

Controversies on Transvaginal Ultrasound Screening for Endometrial Cancer in Asymptomatic Postmenopausal Women.

Endometrial cancer (EC) in postmenopausal women is usually associated with abnormal vaginal bleeding. However, asymptomatic cases of EC have been reported. The incidence of EC has been estimated to 1.3-3.05 per 1,000 screened postmenopausal asymptomatic women, the most significant ultra-sonographic feature being the thickened endometrium. We reviewed the literature on the accuracy of endometrial thickness measurement by transvaginal sonography (TVS) in predicting EC in asymptomatic postmenopausal women. The use of endometrial thickness as a sole screening test was found not to be of high predictive value and it should be combined with the evaluation of EC risk factors and followed by hysteroscopy and biopsy in suspicious cases. The lack of a universal cut-off value for endometrial thickness that could be correlated to EC is pointed out.

A large breast lump causing a diagnostic dilemma.

Lipomas are the most frequent mesenchymal tumors consisting of mature fat cells and are usually benign. They represent approximately 4-5% of all benign tumors that occur in human body. They can sometimes present very large sizes in their localization and are referred to as "giant lipomas". In this article, the authors report an unusual case of a right breast giant lipoma causing diagnostic dilemma. A 62-year-old woman was referred to the present hospital with a complaint of a sudden chest asymmetry of the right breast increasing at the connection of the pectoralis muscle. Ultrasonography revealed breast tissue involution (ACR 1). Specifically, the ultrasound findings were mostly compatible with lipid mass (lipoma) and areas with cystic necrosis. The findings from digital mammogram were not conclusive compared with ultrasound examination. Moreover, the results from the breast MRI were contradictory and other diagnosis was evinced. The patient underwent wide-surgical excision and reconstruction and had an excellent postoperative issue. According to the final histopathological examination, the tumor measured 17 cm and was covered by a thin membranous capsule. Furthermore, it had the appearance and composition of adipose tissue. In conclusion, according to the authors' view, this case is rare due to its challenging size and the difficulty in differential diagnosis.

Breast conserving surgery in multicentric breast cancer, preliminary data of our experience.

INTRODUCTION: It is widely supported that multicentric disease of the breast (MCDB) is a contraindication of breast conservative surgery (BCS). MATERIALS AND METHODS: This is a multicentric study (two breast cancer units from Greece, one from France) involving patients with at least two primary tumors in separate quadrants of the breast and no diffuse suspicious microcalcifications on mammography. Sixty-one patients were included in the study, but 49 were followed up to the end. Patients were randomly assigned in total mastectomy (TM) and BCS groups. End point of the study was disease-free survival rates three and five years after initial operation. RESULTS: Three years after BCS, local recurrence (LR) was observed in two patients (7%) and one after five years (total recurrence rate: 11%). A TM was performed in these patients, and in two there was no LR or distant metastasis (DM) five years after. The third patient was disease free two-years later. Three years after TM, eight patients (36.4%) had DM and 14 (63.6%) did not (p = 0.004). Five years after TM, eight patients (36.4%) had DM and 14 patients (63.6%) di not (p = 0.03). CONCLUSION: The results showed that conservative surgery was an alternative surgical option in multicentric breast cancer with good results regarding disease-free survival and recurrence.

Improving ductoscopy with duct lavage and duct brushing.

AIM: To assess the combined technique of duct lavage (DL) and duct brushing (DB) performed during ductoscopy in pathological nipple discharge (PND). MATERIALS AND METHODS: The study was conducted in two hospitals: Rea (Greece) and in Meet Ghmmr Oncology Center (Egypt), from January 2011 to April 2013. Sixty-four women were enrolled. A sample of cells was collected with the use of DB. Afterwards, DL was performed. For each case, liquid cytology was compared to the final histology. RESULTS: From the 19 histological diagnosis of duct ectasia, cytology by DL plus DB (CDLDB) was correct in 17 cases (89.5%). For 28 papillomas, CDLDB was correct in 19 cases (67.9%). For breast cancer (six cases), CDLDB was correct in five cases (83.3%). Also, CDLDB found 45.5% of miscellaneous benign cases. In total, cytology performed by CDLDB was correct in 46 of 64 patients: 71.9%. Thus, the sensitivity of CDLDB ranged from 67% to 90%, depending on the histological diagnosis. CONCLUSION: This technique showed a high accuracy, in contrast to other studies that used only DL.

Tomosynthesis improves breast cancer detection: our experience.

Breast tomosynthesis (BT) is a novel imaging technology in which an x-ray fan beam sweeps in an arc across the breast, producing tomographic images and it can reduce tissue overlap encountered in conventional two-dimensional (2D) and thus has the potential to improve detection of breast cancer and facilitate accurate differentiation of lesion types. The purpose of this article was to assess the positive predictive value (PPV) of breast cancer with BT versus full-field digital mammography (FFDM) and the assessment of detec- tion of both techniques in the present series.

Clinical features and treatment of lactational mastitis: the experience from a binational study.

The characteristics of 38 patients with mastitis are listed in this study, including nationality, age, parity, history of mastitis, clinical and laboratory findings, and medical treatment. Differential diagnosis was mainly correlated to breast engorgement. Mastitis was primarily related to staphylococcus aureus and it was more common in primiparous patients.

Sentinel lymph node detection by intranipple injection of patent blue dye in breast cancer: a preliminary report of a feasibility study.

Sentinel lymph node (SLN) biopsy is a well established option for assessing axillary lymph node status in breast cancer. Several techniques have been applied so far (superficial or deeper ones). Based on anatomical features of the lymphatic drainage in the breast, we assessed the feasibility of an intranipple approach for SLN mapping. Our data support the feasibility of SLN detection by our technique, with a high rate of SLN identification, which could be used in clinical practice as an alternative to the peri-areolar approach.

Lymphedema of the arm after surgery for breast cancer: new physiotherapy.

Secondary lymphedema of the upper limb is a complication which can be found in patients who have undergone surgical breast cancer treatment with an axillary dissection. Lymphedema following breast cancer treatment remains a long-term disabling complication which cannot be treated in a decisive and radical manner. The objective of the treatment is to limit complications, to try to preserve the remaining lymphatic system and to develop new anastomosis. It consists of a specific decongestive physiotherapy, which may include a specific lymphatic drainage and skin mobilization, reducing bandages including Mobiderm (Thuasne), and sub-bandage muscular exercises. However variations in the therapy have been recorded by different teams. Our experience in treating lymphedema in Tunisia takes into consideration the epidemiological, climatic, cultural and socio-economic conditions of the country. The difference in our treatment compared to what is being advocated elsewhere essentially consists of the no muscular exercise while wearing a bandage. This is compensated for by daily domestic activities, by prolonging the first two phases of treatment (the intensive phase and the stabilization phase), and by the use of the hydro gel dressing Hydrosob (Hartmann) to prevent blisters induced by the pressure imposed by Mobiderm studs of the bandage on the skin, and also by the superimposition of two types of Mobiderm bandages (small and large blocks).

The role of oral contraception use in the occurrence of breast cancer. A retrospective study of 405 patients.

UNLABELLED: The investigation of potential predisposing factors of breast cancer, a disease accounting for almost one-third of malignancies in women, is necessary in order to reduce the incidence. MATERIALS AND METHOD: We interviewed 405 female patients who had been diagnosed with breast cancer and who also reported having used oral contraceptive pills before. They were categorized into two groups (group A < 7 years OC use and group B > 7 years OC use). RESULTS: Statistical analysis revealed a small (p < 0.02) but significant increased risk of the disease to BRCA mutation carriers, as well as to the women with a significant medical or family history of breast, ovarian or colon cancer who had also previously used oral contraceptive pills for more than seven years. DISCUSSION: Breast cancer seems to be positively dependent on prolonged oral contraceptive use. CONCLUSION: More research is needed to establish the hypothesis that the human genome is vulnerable to oral contraceptives.

Quantitative assessment of breast mammographic density with a new objective method.

Women with increased mammographic density (MD) have an increased risk of developing breast cancer. The purpose of our study is to evaluate an experimental method to quantify MD using a program (compatible with Windows XP, Vista and 7) which measures black areas as 0, white areas as 100 and grey scale areas with intermediate values between 0 and 100, depending on the "density" of the area. Digital screening mammograms were directly estimated with this method. Initial idea and steps of the program were based on a Mac utility used by our research team.

What kind of care and support do infertile women undergoing fertility treatment in Greece expect? A questionnaire survey.

The aim of this study was to identify infertile women's expectations and perceived importance of professional psychosocial services and to identify the predictors of their expectations. The study included 404 infertile women. Most women sought more medical information and more emotional support than what was offered, mainly by the hospital staff. Less than half the women rated psychosocial services as important. The main predictors of the importance of ratings were high fertility-related stress, low provision of social support, low social class and male infertility factor. A provision for information regarding the medical and psychosocial aspects of infertility should be included in routine care in fertility clinics. Although it seems possible to meet the emotional and psychosocial needs of less distressed women through information and support, it is necessary to offer professional psychosocial services to more distressed women.

Complementary treatment with oral pidotimod plus vitamin C after laser vaporization for female genital warts: a prospective study.

This is a prospective study to assess a complementary treatment for genital warts after laser vaporization. 62 patients were enrolled in two randomized groups: Al: laser vaporization alone. A2: laser vaporization, followed with Pidotimod plus vitamin C for 2 1/2 months. The latter treatment shortened the time of warts remission and marginally decreased the rate of the warts' recurrence: 81% versus 67% (N.S.). Despite the non-significant difference, this complementary treatment seems to have some efficiency.

Preliminary results of objective assessment of mammographic percent density.

Breast density assessments performed by using the Breast Imaging Reporting and Data System (BI-RADS) have been completely qualitative and the American College of Radiology (ACR) fibroglandular density descriptors are mainly subjective. However, women with increased mammographic density (MD) have an increased risk of developing breast cancer. The purpose of our study was to evaluate an experimental method to quantify MD using a software utility which measures absolutely black areas as zero and absolutely white areas as 100. In grey scale areas, these values range between 0 and 100, depending on the "density" of the area. Digital screening mammograms were directly estimated with this method. We concluded that there is a significant correlation between ACR quartiles and this grey scale percentage method, although several improvements on the original idea are planned.

Maximizing the benefits of screening mammography for women 40-49 years old.

BACKGROUND: While women aged 50 and older are broadly considered to benefit from screening mammograms, the evidence of any similar advantages for younger women are still considered insufficient to form any substantial conclusions on the matter. The primary goal of this study was to examine whether or not the mortality rate of younger women is benefited by mammography, and if so, how can this beneficial effect be maximized. METHODS: The authors have taken into account all available randomized control trials (RCTs) and have conducted a meta-analysis based on those RCTs to study the effect of mammography on the mortality rate of women younger than age 50. Further interpretation on various aspects of the results has also led to separate meta-analyses, with the RCTs included grouped in accordance to the mean time interval between screening mammograms employed by each study. The findings and conclusions of the comparison were used to calculate the number of mammograms necessary to reduce the absolute death risk, depending on the time interval between screening mammograms. RESULTS: The meta-analysis indicated a reduction in breast-cancer mortality in the intervention group, which reached statistical significance (relative risk (RR) 0.81 [95% CI 0.71-0.93] p < 0.01). Furthermore, when the RCTs included were grouped according to their mean time interval between mammograms, there was a definite increase of statistical significance in favor of those RCTs with shorter interval times (RR 0.76 [95% CI 0.64-0.89] p < 0.01). CONCLUSIONS: The significant mortality rate reduction demonstrated by the meta-analytical results is a key indicator of the beneficial effect of mammography on the age group of women younger than 50. Additionally, the increase in the aforesaid significance when combining RCTs with short time intervals between mammograms, as opposed to those RCTs with longer intervals, suggests that the optimal use of mammographic screening lies with the former. This is better demonstrated when taking in account our approach to answering the practical question of "how many screening mammograms will take to save one life?" in correlation with the mean time interval involved.

Tibolone vaginal versus per os administration in the management of post-menopausal symptoms.

UNLABELLED: Tibolone is a selective tissue estrogenic activity regulator effective in the management of climacteric symptoms, without stimulating endometrial and breast tissue proliferation. It is a well-tolerated treatment regimen with minor adverse effects. The purpose of the current trial was to investigate the efficacy of tibolone administration per os versus per vaginal, concerning the treatment of climacteric symptoms. MATERIAL AND METHOD: A total of 64 post-menopausal healthy women aged 44-55 years (mean 52,5) were enrolled in the study. The patients were divided into three groups: Group A with 24 patients receiving per os Tibolone 2.5 mg x 1 daily for 6 months, Group B with 21 patients receiving vaginally Tibolone 2.5 mg x 1 for 6 months and Group C--with 19 patients receiving only hygienodietetics advices and psychological support for 6 months. All subjects underwent a physical examination, including a transvaginal ultrasonography for the measurement of endometrial thickness and a mammography for the assessment of breast density. RESULTS: In Group A and B, climacteric symptoms were similarly reduced with non significant differences between groups: 79% (19 patients) vs 76% (16 patients) reduction for hot flushes and 83% (20 patients) vs 76% (16 patients) for sweating episodes respectively (p > 0.05). Reduction of hot flushes and sweating episodes was observed in only 2 of 19 patients (10.5%) in group C (p < 0.01). Vaginal route had better results on vaginal dryness-dyspareunia in group B (in 14 patients taken tibolone orally-58% vs 16 patients taken tibolone vaginally-76%). No statistically significant difference was found related to urine symptoms between A and B groups. Tibolone by vaginal route did not cause any severe side effects (apart of a slight discharge) and it was equally (or better) tolerated than oral route. No significant alterations in breast density and BIRADS and no increase in endometrial thickness were observed in all study groups. CONCLUSION: Tibolone is effective in relieving climacteric symptoms indifferent from applications-modus: orally or vaginally. However, further and larger studies are required to confirm results.

Knowledge and general consideration about Pap test screening among women from Finland and Greece.

It seems that lack of regular Pap smear screening is a risk factor for cervical cancer. Since women started having Pap smears the number of deaths from cervical cancer has dropped dramatically. The purpose of this study was to investigate the knowledge of women about the essential and basic parameters related to the Pap test in the general population of two European countries: Finland and Greece. The same percentages (> 50%) of women in Athens and Helsinki had good knowledge of the Pap test. Comparing country populations, greater numbers of Finnish women had a better level of Pap test knowledge. Additionally, older women in Finland were more educated and informed about the usage of Pap testing due to the good health service information in this country.