Correlation of age at natural menopause with occupational status and other epidemiologic factors in women from Prefecture of Kavala, Greece.

AIM: Aim of this study was to explore possible associations between the timing of natural menopause and occupational status and other determinant epidemiologic factors among women living in the Prefecture of Kavala, a region of North-East Greece. METHODS: The sample of the study comprised of 827 naturally menopausal women, who consented to participate in this questionnaire-based interview study between 2011 and 2016. The study population was recruited from women who were hospitalized or visited the outpatient clinics of the General Hospital of Kavala and women working in the public sector services and private companies in the Prefecture of Kavala. RESULTS: The mean age of the sample at natural menopause was 49.1 years; 12.2 % had early menopause, and 4.5 % were diagnosed with premature ovarian failure. For the majority of enrolled women (80.5 %) menopause occurred between 45-54 years, and for the rest (2.8 %) after 54 years of age. In univariate analysis, a statistically significant correlation was found between age at menopause and occupational status, year of birth, mother's age at menopause, age at menarche, and high levels of chronic stress. Multiple regression analysis revealed that occupational status, year of birth and mother's natural menopausal age could predict age at menopause. CONCLUSION: Socioeconomic, demographic and familial variables appear to be associated with age at natural menopause in a representative sample of women in the Prefecture of Kavala, Greece. HIPPOKRATIA 2017, 21(1): 32-37.

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.

The riddle of Ballantyne's syndrome in the aspect of hydrops fetalis.

Ballantyne's syndrome, the combination of maternal generalized edema and fetal ascites, is rare and alarming in gestation. Early diagnosis might be useful in providing proper management of the fetus and aiming at an improved clinical result. The syndrome is an indication that HF is there, it has already started expanding the fetal torso and endangering the child-bearer's life. Despite the detailed investigation, no apparent cause for the emergence of the hydrops was identified.

The relationship between Anti-Müllerian hormone and other reproductive parameters in normal women and in women with polycystic ovary syndrome.

OBJECTIVE: To correlate Anti-Müllerian hormone (AMH) levels with years since menarche as well as to investigate the AMH relationship with ovarian morphology and levels of androgens in healthy normo- ovulatory women and in women with polycystic ovary syndrome (PCOS). DESIGN: Prospective clinical study. SETTING: University Hospital of Alexandroupolis, Lito Maternity Hospital. PATIENTS: Forty two healthy normo-ovulatory women and sixty one women with PCOS, recruited on the basis of the classic PCOS criteria (Rotterdam consensus meeting definition of PCOS (ESHRE/ASRM, 2004). INTERVENTIONS: Fasting blood was obtained from all subjects in the early follicular phase (days 5-6) after spontaneous or induced menses (in PCOS), and transvaginal ultrasound examination was performed. MAIN OUTCOME MEASURES: Assessment of values for follicular stimulating hormone (FSH), testosterone (T), AMH, as well as assessments of years since menarche and ovarian volume. RESULTS: AMH had a statistically significant positive correlation with the ovarian volume (r =0,623, r =0,579 P<0.01) and negative correlation with years since menarche (r =-0,766, r =-0,796 (P<0.01). In women with PCOS, AMH and years since menarche had a significant correlation with testosterone (r =0,477, r = -0,527, P<0.01) CONCLUSIONS: This study underlines the relation between AMH and years since menarche as well as the AMH differences in relation with certain clinical or endocrine characteristics between normal and PCOS women.

The role of cytokines IL-6 and IL-8 in the pathogenesis of spontaneous abortions.

OBJECTIVE: The aim of this study was to investigate the role of interleukin-6 and interleukin-8 in the spontaneous abortion of the first and second trimester of pregnancy and the possibility of IL-6 and IL-8 being used as markers for the pregnancy outcome. METHOD: The patients were divided into three groups: group 1, women at the time of first trimester miscarriage (n = 35); group 2, women at the time of second trimester miscarriage (n = 35); group 3 included the women without previous history of abortions submitted to hysterectomy (n = 10). Plasma levels of interleukin-6 and interleukin-8 were measured by bioassays method (ELISA). Mann-Whitney U test and Kruskal-Wallis test were used to assess differences between two or more groups of patients, respectively. Post hoc analysis was performed using Mann-Whitney U test with Bonferroni's correction. RESULTS: Interleukin 6 levels in women who had a second trimester abortion were statistically higher compared to those who had a first trimester abortion. Interleukin-8 levels in patients with second trimester abortion were also statistically higher compared to the control group. No significant differences between women with first trimester abortions and those without previous history of abortions were found. CONCLUSIONS: Our data suggest that IL-6 and IL-8 might be crucial factors which take part in the defensive reaction of maternal organization during the 2nd trimester of pregnancy.

Conservative surgery for borderline ovarian tumors--emphasis on fertility preservation. A review.

BACKGROUND: Borderline ovarian tumors account for 15-20% of all ovarian epithelial tumors. Since their original description in 1929, our knowledge of their natural history and molecular pathology has advanced most dramatically over the last two decades. This improved knowledge of BOT has permitted to drastically decrease the therapeutics of these tumors, which remains mostly surgical. METHOD: We studied the available literature on surgical management of BOT accentuating the most important aspects on this topic: radical vs. conservative treatment, fertility preservation. RESULTS: Although there are conflicting reports about some of the aspects of surgical management of these tumors, since BOTs commonly affect women of reproductive age, who have not completed childbearing, have an excellent overall prognosis and the majority of them (approximately 50% to 85%) are stage I at diagnosis, conservative surgery (unilateral salpingo-oophorectomy or cystectomy) can be safely performed after comprehensive surgical staging, in order to preserve fertility. CONCLUSION: Conservative surgery could be safely performed in young patients treated for BOT, provided that they are carefully followed-up.

Differential expression of tenascin-C in the developing human lung: an immunohistochemical study.

Much of the specification for the basic embryonic body plan is the result of a hierarchy of developmental decisions at different developmental times. The extracellular matrix (ECM) appears to be a very dynamic structure during embryogenesis. One of the mesenchymal ECM proteins, tenascin, is reported to be transiently expressed during embryonic tissue development, and is absent or much reduced in most fully developed organs. The respiratory system is an outgrowth of the ventral wall of the foregut, and the epithelium of the larynx, trachea, bronchi and alveoli is of endodermal origin. The cartilaginous and muscular components are of mesodermal origin. The aim of this study was to investigate the role of tenascin-C (TNC) in the developing human lung, during the pseudoglandular, canalicular and saccular stage of lung maturation. Formalin-fixed, paraffin-embedded tissue from the lungs of 30 embryos (10 corresponding to the 10th to the 16th gestational week (pseudoglandular stage), 10 to the 17th to the 23rd gestational week (canalicular stage), and 10 to the 24th to the 27th gestational week (saccular stage), were investigated by conventional histology and immunohistology for the expression levels of TNC. The changes observed in the distribution patterns suggest that during embryogenesis, the rate of tenascin synthesis changes significantly. During the pseudoglandular stage, the density of cells expressing TNC was higher in the condensing mesenchyme surrounding the epithelial glands than in the epithelial cells, whereas the inverse result was observed during the canalicular stage. During the saccular stage the pattern of immunoreactivity with TNC was lower than those of the pseudoglandular and canalicular stage, either in epithelial or mesenchymal cells, but it was highly expressed in the basement membranes. This restricted spatiotemporal distribution suggests that tenascin has a key role (1) in mesenchymal tissue remodeling during the pseudoglandular stage, a period that describes the development of the complete bronchial tree and (2) on the epithelial cell shape and function during the canalicular stage, a period that describes the formation of pneumocytes type I and pneumocytes type II. The later, will produce the surfactant, a phospholipid-rich fluid capable of lowering surface tension at the air-alveolar interface. During the saccular stage, tenascin was present mainly in the basement membranes surrounding the acinar and vascular structures, indicating a supporting and mechanical role.

Irregular dental structures in a benign ovarian cystic teratoma (dermoid cyst): case report.

Mature cystic teratomas, often referred to as dermoid cysts, are the most common germ cell tumors of the ovary in women of reproductive age. The gross pathologic appearance of a dermoid cysts is characteristic. Hair follicles, skin glands, muscle, and other tissues lie within the cyst wall. We present a case of a dermoid cyst ovarian tumor in a 24-your-old patient with a tooth lying on each wall. The mass was laparoscopically removed by ovarian cystectomy.

Attitudes towards contraception in three different populations.

OBJECTIVE: To investigate contraceptive behavior of women belonging to three different ethnic and/or socioeconomic populations as well as to evaluate the main sources of information concerning contraception in each population. METHODS: 150 Muslim women living in Germany (group A), 120 Muslim women living in Thrace, Greece (group B) and 140 Christian Orthodox women living in Thrace, Greece were enrolled in the study. Attitudes concerning contraceptive practices were assessed by means of a questionnaire. Demographic and socioeconomic characteristics of each group were compared with the method of contraception used. Statistical analysis was performed using one-way analysis of variance (ANOVA), followed by Turkey's test, chi-square test and multiple logistic regression analysis. RESULTS: The contraceptive pill (41.7%), the condom (35.1%), periodic abstinence (24.4%) and interrupted coitus were the most common methods of contraception. The gynecologist (23.4%), the family consultant (12.0%) and the sexual partner (10.2%) were the most usual sources of information. The use of contraceptive pills was more frequent among Muslims from Germany and Christians from Greece (p < 0.001), while the use of condoms was more frequent among Christians from Greece (p = 0.019). The use of IUDs was more frequent among Muslims from Germany and Greece (p = 0.039). CONCLUSIONS: Our study results reveal that there are behavioral differences between race/ethnic groups and minorities regarding contraceptive practices, probably due to different cultural, socioeconomic and educational factors.

Hypertensive disorders in pregnancy: risk factors and epidemiologic analysis.

OBJECTIVE: To measure the incidence of preeclampsia-eclampsia and its perinatal mortality as they appear in the two major ethnic groups in Thrace: Christian Orthodox and Muslims. STUDY DESIGN: Incidence and perinatal mortality of preeclampsia-eclampsia were studied retrospectively on all women managed in our clinic for hypertensive disorders in pregnancy who were delivered of a stillborn or healthy neonate between 1986 and 1999. We also compared the prevalence of certain risk factors of the disease as they appear in the above-mentioned distinct ethnic groups. RESULTS: The total incidence of preeclampsia-eclampsia in Thrace was 2.3% and the total perinatal mortality 6.4%. Both variables presented higher values and severe preeclampsia-eclampsia had greater prevalence in the Muslim population. Most risk factors presented statistically significant differences between Christians and Muslims (chi2 test, p < 0.05). CONCLUSIONS: There was an ethnic variation in most epidemiologic variables of hypertensive disorders in Thrace between Christians and Muslims.

Biomagnetism in perinatal medicine. Our experience in Greece.

This is a report on our experience in the application of biomagnetism in perinatal medicine. We provide a brief description of our research work in fetal magnetoencephalography and fetal magnetocardiography in normal, preeclamptic and IUGR pregnancies, together with hemodynamics of the umbilical cord and uterine arteries, providing a new approach to biomagnetism as a non invasive imaging modality in the investigation of perinatal complications.

Magnetic field profiles in normal human breast during the menstrual cycle.

OBJECTIVE: To investigate the subtle magnetic fields produced by living normal breast tissue during the menstrual cycle. METHODS: The magnetic activity of the breast was recorded in four young women, 26-28 years old; two had regular and two irregular menstrual cycles. The recordings were accomplished with a biomagnetometer and covered two complete menstrual cycles. The results were correlated with estrogen and progesterone levels on days 7, 14 and 21 of the menstrual cycle. RESULTS: The magnetic breast recordings in the two young women with the regular cycling endometrium showed a biphasic magnetic curve, apparently corresponding to the proliferative and secretory phase of the menstrual cycle. By contrast, the two young women with irregular menstrual cycles showed a monophasic magnetic curve. CONCLUSION: It is suggested that a biphasic, but not a monophasic, pattern of magnetic activity in the breast is indicative of an ovulatory endometrial cycle.

DNA damage of human spermatozoa in assisted reproduction: origins, diagnosis, impacts and safety.

Sperm DNA contributes half the offspring's genomic material and abnormal DNA can lead to derangements in the reproductive process. Normal sperm genetic material is required for successful fertilization, as well as for further embryo and fetal development that will result in a healthy child. Thus, the damage to sperm DNA is critical in assisted reproductive techniques which are increasingly used to treat infertile couples. There has been improving data about the effects of human sperm DNA damage or fragmentation. As well, increasing knowledge concerning the effects of DNA damage on embryo and fetal development has been attained. This review aims to summarize the present knowledge on the impact of human sperm cell DNA damage on male infertility and outcome in the context of safety.

Human oocyte cryopreservation: past, present and future.

Despite inferior results in the past compared with embryo freezing, oocyte cryopreservation has made great strides in recent years. In fact, it has become a necessity in assisted reproduction technology, providing alternatives to legal, moral and religious problems originating from embryo freezing. Recent advances in freezing technology, modifications of conventional protocols used and continuing optimization of vitrification have efficiently improved the method. A historical description of the method's progression over time, and a comparison of principles, procedures and results as reported in the literature are presented in this review.

Biomagnetism in gynaecologic oncology. Our experience in Greece.

Our experience in the application of biomagnetism in gynaecologic oncology is presented. We provide a brief description of our research work in the investigation of biomagnetic activity in benign and malignant ovarian and breast diseases, and an evaluation of uterine myomas, providing a new approach of biomagnetism as a non invasive imaging modality for assessing gynaecologic tumours.

Magnetoencephalography and magnetocardiography in neonates. Our experience in Greece.

This study reports our experience in the application of magnetoencephalography (MEG) and magnetocardiography (MCG) in neonates. Results gained from our studies, lead us to believe that MEG and MCG could provide clinical practice with non-invasive, rapid and easy to perform methods, which could be adjuncts to conventional methods for the evaluation of neonatal brain and heart function.

Epidemiology of congenital anomalies in different ethnicities.

PURPOSE OF INVESTIGATION: To study the prevalence and the epidemiologic characteristics of major congenital anomalies (MCAs) in two different populations in Thrace-Greece. METHODS: The ethnic origin of all mothers who delivered in our department and the types of MCAs were determined. We compared the frequencies of MCAs between Christians and Muslims. The chi-square test, t-test, binary and multinomial logistic regression analysis were performed. RESULTS: The prevalence of MCAs was significantly higher in Muslims as compared to Christians (51/4,028 (12.78%) vs 49/5,994 (8.17%), p = 0.035). However, the frequencies of each type of MCA in the total number of deliveries between the two groups did not differ significantly. The central nervous system malformations were most frequently associated with perinatal mortality. CONCLUSION: This is the first study in Greece showing that there is probably a higher prevalence of MCAs in Muslims as compared to Christians, although it can not be elucidated whether this increased risk is related to specific differences between them.

Correlation between biomagnetic and Doppler findings of the uterine artery in normal and preeclamptic pregnancies.

OBJECTIVES: To elucidate the hemodynamics of the uterine artery in normal and abnormal pregnancies by use of Doppler ultrasound and SQUID biomagnetometry. METHOD: Two hundred and three women (gestational age 28-42 weeks) were included in the study. Forty-three of them had preeclampsia and/or intrauterine growth restriction and 160 were normal. Uterine artery waveform measurements were evaluated by use of pulsatility index (PI) (normal value PI<1.45). Biomagnetic signals of uterine arteries were recorded and analyzed with Fourier analysis. The biomagnetic signals were distributed according to spectral amplitudes as high (140-300 fT/ radicalHz), low (50-110 fT/ radicalHz) and borderline (111-139 fT/ radicalHz). RESULTS: There was a statistically significant difference between normal and abnormal pregnancies concerning the waveform amplitudes (p < 0.001) and the PI index (p < 0.001). Specifically, we noticed high biomagnetic amplitudes in most normal pregnancies (92.5%) and low biomagnetic amplitudes in most preeclamptic cases (90.7%). CONCLUSIONS: Our study results indicated that biomagnetic measurements of uterine artery might prove to be useful in the evaluation of the fetal well being, especially in cases of preeclampsia and intrauterine growth restriction.