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 effectiveness of misoprostol or dinoprostone in neonatal outcome after labour induction in post-term nulliparas.

OBJECTIVE: The object of this study was to investigate the efficacy of vaginal administration of misoprostol versus dinoprostone in neonatal outcome. MATERIALS AND METHODS: The first Group A included 77 pregnant women, who requested pregnancy termination one week after labour term and received vaginally misoprostol 50 µg, while the other 69 pregnant women in Group B were vaginally administrated three mg dinoprostone. According to the authors' protocol this procedure was repeated after six hours for a maximum of two times. RESULTS: The labour duration was longer in Group B (p = 0.000), while the APGAR score was better in Group A (p = 0.015). In Group A the labour modus was as follows: 86.9% normal vaginal labour, 3.8% vacuum extraction, and 9.3% cesarean section, while in Group B it was 82.83% normal vaginal labour, 3.07% vacuum extraction, and 14.1% cesarean section. CONCLUSION: Misoprostol has advantages according to neonatal outcome compared to administration of dinoprostone.

Syndrome of hypoplastic left heart: a case report.

A 36-year-old woman, gravida 5, para 3, was referred to this outpatient clinic in the 18th week of gestation for monitoring of her pregnancy. A 22-week anomaly scan confirmed hypoplastic left heart syndrome (HLHS) but the parents declined any medical intervention. Here the authors present the management of a pregnancy and the expected quality of neonatal life.

Diagnostic approach and therapeutic management in early-stage endometrial cancer.

OBJECTIVE: The effectiveness of pelvic and para-aortic lymphadenectomy in the morbidity of patients affected by early-stage endometrial carcinoma (EC) is the subject of this study. STUDY DESIGN: Ninety-two cases with endometrial cancer that underwent para-aortic and pelvic lymphadenectomy, from June 1995 to June 2006, were studied and compared with 30 cases of patients with endometrial cancer without lymphadenectomy. RESULTS: According to the results, systematic pelvic and para-aortic lymphadenectomies improved disease-free and overall survival rates among the patients with endometrial cancer. The mean number of removed para-aortic lymph nodes was 19.01 +/- 5.88, whereas the mean number of removed iliac lymph nodes was 32.94 +/- 6.69. Forty-two and 31 metastatic iliac and para-aortic nodes were found, respectively. No surgery-related deaths and major intraoperative injuries occurred. The frequency and the type of postoperative complications were not affected by the performance of lymphadenectomy. The morbidity rate was 6.2%, similar to the group without lymphadenectomy (5.79%). No recurrence occurred in the group with lymphadenectomy, while in the other group the recurrence rate was 23.3%. CONCLUSIONS: Lymph nodes metastases can be observed in early stages of EC. Pelvic and para-aortic lymphadenectomies seems to provide profound information about the Stage of the disease and the patient's survival, identifying which patients are suitable for supplementary treatment, without significant clinical increase of morbidity.

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.

The contribution of laparoscopy to the diagnosis of adnexal masses in young and premenopausal women.

The purpose of this retrospective study was to investigate the contribution of laparoscopy to the diagnosis of adnexal masses in young and premenopausal women, in whom surgery was deemed necessary, between the years 2002-2008. A total of 130 young and premenopausal women scheduled for surgery for an adnexal mass with a diameter of 5-10 cm underwent transvaginal ultrasound (US) examination prior to surgery. Laparoscopic management was successfully completed for 118 of the 130 patients in this study; however, 12 required conversion of laparoscopy to laparotomy due to endometriosis with extensive bowel adhesions, or suspected ovarian malignancy and peritoneal implants. One hundred and twenty-four patients (95.38%) had benign lesions, four (3.07%) had borderline tumors and two patients had malignant lesions (1.53%). We found a statistically significant association between laparoscopic and histological findings. Laparoscopic diagnosis of adnexal masses suspicious at US may help avoid many laparotomies for the treatment of benign ovarian disorders.

The contribution of anaesthesia modus on reducing blood loss during caesarean section.

The purpose of this study was to compare the effects of general anaesthesia (GA) and regional anaesthesia (RA) on the blood loss during caesarean section. We report on 161 patients undergoing both elective and emergency caesarean section at the Obstetrical Department of Democritus University of Thrace. In the majority (113 women, 70.2%) GA was used, while in 48 women (29.8%) RA was used. No significant differences were found in the demographic characteristics of the study women in the two groups. Although the preoperative Hgb and Hct levels did not differ significantly in the two groups RA vs GA, the postoperative Hgb and Hct levels were significantly lower in women who were subjected to GA compared to those who were subjected to RA (p < 0.05). The study showed that there is greater reduction in blood loss with RA compared to GA during caesarean section.

A retrospective analysis of twenty-eight borderline ovarian tumours in adolescent girls.

The aim of this retrospective study was to evaluate the clinical reproductive outcome and the rate of recurrence of low malignant ovarian tumors in adolescent girls after conservative surgical treatment by laparoscopy or laparotomy. We report 28 cases of borderline ovarian tumors (BOTs), that were surgically treated from 1990 to 2006 at the Obstetrical and Gynecological Department of Democritus University in Greece and the Aschaffenburg Teaching Hospital in Germany. All patient information was obtained by reviewing hospital records. BOT lesions in teenagers were associated with variable non-specific presenting symptoms. Ultrasonographic investigations can be helpful in the early diagnosis of BOTs in teenage girls. Most of the patients were diagnosed at an early stage. Available data of our study indicate that in these patients, fertility, pregnancy outcome and survival remain excellent.

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.

Laparoscopic treatment of ovarian dermoid cysts.

Dermoid cysts are the most common germ cell tumors of the ovary in women of reproductive age. We report 67 cases of patients with dermoid cysts (mean age, 31.31 years) originating from the ovary treated from 1994 to 2006 at the Obstetrics and Gynecology Department of Aschaffenburg Hospital-Clinic in Germany. Most patients (60) underwent cyst removal. In two patients salpingo-oophorectomy was performed and in five partial oophorectomy was performed. Additional surgery ensuing laparotomy was never necessary. None of the patients had long-term postoperative complications. Two patients were at nine and 15 weeks of gestation and postoperatively were well following termination of pregnancy. In a group of 43 women, who desired pregnancy, 37 pregnancies resulted. The overall intrauterine pregnancy rate was 83.7%; one patient had an ectopic pregnancy (2.32%). To receive more information on this disease, treatment should be performed according to international protocols.

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.

Uterine sarcoma: a report of 57 cases over a 16-year period analysis.

Uterine sarcomas comprese approximately 4-9% of all uterine malignant tumors with a poor prognosis. We report 57 cases of sarcoma originating in the uterus treated from 1990 to 2006 at the Department of Obstetrics and Gynecology of Democritus University of Thrace, Greece and the Department of Obstetrics and Gynecology of Aschaffenburg Hospital, Germany. The median age of occurrence was 49 years with the commonest symptom being abnormal uterine bleeding. Forty-nine patients underwent a total hysterectomy and bilateral salpingo-oophorectomy whereas 17 cases underwent radical lymphadenectomy. During the last followup (December 2006), six patients were alive and well with no evidence of disease, 23 patients had died of undercurrent disease, and 28 were alive with recurrence of disease. These rare cancers can be aggressive, and account for a greatly disproportionate number of deaths from uterine cancers. Treatment for this rare disease should be performed according to international protocols in order to have the most updated information.

TV sonographic assessment in postmenopausal women with bleeding.

The aim of this study was to evaluate retrospectively the usefulness of transvaginal sonography for the detection of endometrial disease in postmenopausal women with bleeding. This study involved 275 postmenopausal women aged 47-81 years (median 62). None of them were on hormone replacement therapy and all had had amenorrhea for more than one year. Concerning the age of the study patients, we confirm that endometrial cancer occurs at any age, but more commonly in ages above 58 years. Transvaginal sonography was performed in all women. About 89.2% of malignant diseases were discovered in the study women whose endometrial thickness was above 4 mm, but we also found endometrial cancer in 10.2% of the cases in women whose endometrial thickness was below 4 mm. In postmenopausal symptomatic women premalignant or malignant causes of bleeding can not be excluded with just transvaginal ultrasound.

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.

Misoprostol and first trimester pregnancy termination.

OBJECTIVE: To investigate the efficacy of vaginal administration of 800 microg misoprostol as a single dose without performing post expulsion systematic curettage in first trimester pregnancy termination. METHOD: 113 women, aged 16-44, who requested first trimester pregnancy termination, received 800 microg of vaginal misoprostol. All examined women were divided into two groups depending on gestation age. The first group included of 67 women with up to nine weeks and the second of 46 with up to 12 weeks of pregnancy. RESULTS: Abortion occurred within 24 hours and was completed in 74.3% of the cases. The mean induction-abortion interval was 5.9 +/- 1.7 hours (median 5.5 hours). Side-effects were experienced by 24 women (21.2%). There was no significant difference between groups in the success rate, induction-abortion interval, number of previous deliveries and side-effects. CONCLUSION: Misoprostol is an effective agent for first trimester medical termination.

A 15-year report of pathological and benign ovarian tumors in teenagers.

The purpose of this retrospective study was to determine the frequency, clinical aspects and surgical management of ovarian masses in 52 adolescent patients, in whom surgery was deemed necessary, from 1991-2006. We considered age, symptoms, ultrasound investigations, CA 125 levels, family history, operative treatment, surgical complications tumor size, histopathological examinations, pregnancy rate and follow-up. Ovarian lesions in teenagers include a broad array of pathologic diagnoses that have variable and non-specific presenting symptoms. The most common presenting complaint was abdominal pain in 34 (65.4%). Forty-seven patients (90.4%) had benign lesions, two (3.8%) had borderline tumors and three patients had malignant lesions (5.8%). Most of the patients who wanted to conceive subsequently did so. For benign ovarian disorders the operation should be designed to optimize future fertility while in patients with malignancy, complete staging and resection of the lesion should be the first concern.