Integrating MAES implementation into protected area management under climate change: A fine-scale application in Greece.

Increasing anthropogenic pressures often jeopardize ecosystem integrity and policy-relevant conservation management in protected areas. To harmonize nature conservation with human well-being, EU Biodiversity Strategy to 2020 suggests Mapping and Assessment of Ecosystems and their Services (MAES) as the key concept for environmental planning and management in EU Member States. Applying this procedure is challenging due to its data-demanding and multidisciplinary nature, resulting in the ecoystem services (ES) approach being scarcely used in protected areas management. Increased data availability under EU biodiversity-related inventories and monitoring projects, as well as theoretical and empirical research advances developed during the last decade, should be put into practice to guide Member States towards local management frameworks and scenario building under the ongoing changes in the EU socio-economic environment. This study aims at filling this gap by embodying into the MAES operational framework a scenario-based approach and demonstrates this in a challenging case study of a Natura 2000 site, Lake Stymfalia, in Greece. The present management strategy, an ecological-friendly management practice, a water-efficient management practice and a non-environmentally friendly option (e.g. ecosystem destruction) are examined for current and future water demand under current and future climatic scenarios. The proposed methodological framework for ES operationalization is based on the available data (derived by EU Directives and/or modelling), expert judgment and stakeholder involvement. Therefore, this work applies and tests the importance of the MAES approach as a management and coordination platform.

Pregnancies and their obstetric outcome in two selected age groups of teenage women in Greece.

AIM: The aim of this study was to evaluate the outcome of pregnancies in adolescents in the Department of Obstetrics and Gynaecology of Democritus University of Thrace, North-Eastern Greece. MATERIAL AND METHODS: We retrospectively reviewed 194 cases of adolescent pregnancies, with an average maternal age of 16.5 years, from 1st January 2006 to December 30th 2008. Socioeconomic characteristics, type of delivery and complications, such as preterm labor, preeclampsia, intra- and post-partum complications, were evaluated. RESULTS: The median age at first intercourse was 14.2 years and the average period between first intercourse and pregnancy was 1.2 years. Most teen mothers (86.6%) did not use any contraceptive method. Among the teen mothers recruited for the study, 89.7% were married. Adolescent pregnancies accounted for 9.02% of all deliveries (2150) in our Department. In 49 (25.3%) of the pregnant adolescents, no previous pregnancy was reported. The rates of preterm birth of teen mothers were 11.3%, 41.3% and 47.4% in correlation to <32 weeks, 32-34 weeks and >34 weeks, respectively. In 95.4% of the cases, deliveries were not complicated. According to our results, the main complications, especially in very young girls, are preterm labor, anaemia, hypertensive disease, obstructed labor after premature rupture of the membranes and increased neonatal mortality and morbidity. Antenatal care is often inadequate. CONCLUSION: Early teenage pregnancies have always been considered of increased risk for obstetric complications. Prevention of adolescent pregnancy, by wide use of effective contraception programs, would decrease its frequency and intensive care of pregnant adolescents may reduce the pregnancy complications.

Should lymphadenectomy be performed in early stage I and II sarcomas of the corpus uteri.

AIM: The aim of this study was to investigate the impact of radical lymphadenectomy as a prognostic factor in the management of uterine sarcomas. METHODS: Sixty patients with histologically-proven uterine sarcomas were recruited for this study. The patients were evaluated retrospectively, during the time period from September 1990 to June 2008, in the Department of Obstetrics and Gynecology of Aschaffenburg Clinic in Germany. The normality of the quantitative variables was tested using the Kolmogorov-Smirnov test. RESULTS: Of 60 patients, 35 (58.3%) underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic or para-aortic lymphadenectomy. The excision of iliac nodes was the strongest and most independent factor (ß = 0.64, P = 0.000) associated with survival. Recurrence of disease developed in 14 out of 25 patients (56%) who did not receive lymphadenectomy, but in only 10 out of 35 patients (29%) who underwent lymphadenectomy. The mean survival in years after surgery plus lymphadenectomy was 5.28 years, while in patients who did not undergo lymphadenectomy it was 1.56 years. CONCLUSIONS: Removal of lymphatic tissue in patients with early-stage uterine sarcoma significantly decreases the recurrence rate of the disease and improves the postoperative survival. However, there is a need for further prospective randomized controlled trials to investigate the adequate surgical management of uterine sarcomas and to clarify the prognostic value of lymphadenectomy at the initial surgery.

Clinical evaluation of women with PMB. Is it always necessary an endometrial biopsy to be performed? A review of the literature.

BACKGROUND: Endometrial carcinoma is the most distressing cause of abnormal vaginal bleeding. The intention of clinical management in the case of postmenopausal bleeding is to achieve an accurate diagnosis without overinvestigation. METHOD: We studied the available literature on the diagnostic evaluation of postmenopausal women with vaginal bleeding, accentuating the most important aspects on this topic: the accuracy of sonography and endometrial biopsy in predicting endometrial hyperplasia and endometrial carcinoma. RESULTS: The accuracy of the above tests in predicting endometrial hyperplasia and endometrial carcinoma is a subject of continuing debate. Μοreover, in the last decades, there has been an explosion of publications indicating that ultrasound may be useful in predicting endometrial pathology. CONCLUSION: Since advanced endometrial carcinoma has been known to occur in cases without noticeable endometrial thickness on ultrasound, the clinician should beware of the diagnostic evaluation of postmenopausal women with vaginal bleeding.

The role of lymphadenectomy in uterine leiomyosarcoma: review of the literature and recommendations for the standard surgical procedure.

Uterine sarcomas are rare and aggressive gynaecologic malignancies with poor prognosis, arising from myometrial or endometrial tissue. These rare cancers can be aggressive, and account for a greatly disproportionate amount of deaths from uterine cancers. The histological uterine sarcomas classification includes carcinosarcomas (malignant mesodermal mixed tumors), accounting for 40% of cases, leiomyosarcomas (40%) and endometrial stromal sarcomas (10-15%). Each group of these tumors presents differences in diagnosis, prognostic factors, treatment, and outcome. Uterine leiomyosarcomas typically affects women in their sixth decade of life, presenting with atypical symptoms such as abnormal uterine bleeding and abdominal pain. The optimal treatment of uterine leiomyosarcomas is surgery, including total abdominal hysterectomy and bilateral salpingooophorectomy. The aim of this study was to conduct a systematic review of the literature regarding the standard surgical procedure of uterine leiomyosarcomas and investigate whether lymphadenectomy affects the 5-year DSS, as well as other relevant clinical outcomes, in women with uterine leiomyosarcomas. For this purpose, MEDLINE, EMBASE, and the Cochrane Library databases were reviewed, and a critical account of the management strategies of these tumors is presented.

Diagnosis and laparoscopic management of a rudimentary uterine horn in a teenage girl, presenting with haematometra and severe endometriosis: our experience and review of literature.

A unicornuate uterus is a rare congenital malformation of the female genital tract, which appears in about 1/1000 women and is characterized by significant anatomic variability. In the most common type, a noncommunicating rudimentary horn coexists with the unicornuate uterus. The diagnosis of this anomaly is usually delayed, as it remains asymptomatic until adolescence and its initial symptoms are atypical. As a result, it is often diagnosed after the appearance of severe complications, such as haematometra, endometriosis, infertility and ectopic pregnancy. We report a case of a teenage girl presenting with dysmenorrhoea, endometriosis and haematometra secondary to a noncommunicating rudimentary horn. The diagnosis of the anomaly was based on magnetic resonance imaging (MRI) and laparoscopy. The excision of the symptomatic rudimentary horn and the ipsilateral fallopian tube was also performed laparoscopically. A review of the literature follows, focusing mainly on the diagnosis and laparoscopic management of a unicornuate uterus and its complications in adolescence. Laparoscopy is an accurate diagnostic tool, which also carries significant advantages in effective surgical management of congenital uterine anomalies, especially in young women.

Assessment of the feasibility of bipolar coagulation use to reduce hemorrhage in myomectomy performed by minilaparotomy.

The major problem with myomectomy is excessive bleeding from increased uterine blood supply, and this can be a life-threatening condition and prolong postoperative stay. The aim of our study was to evaluate our experience in symptomatic myoma excision with bipolar electrode by mini-laparotomy; we compared 67 procedures with bipolar electrode, in normal saline as distension fluid, to 42 cases performed with unipolar electrode. All participants were pre-menopausal women who had symptomatic myomas

Smoking and AMH levels in women with normal reproductive history.

PURPOSE: To investigate the effect of age and smoking on the AMH levels in normal cycling healthy women with normal reproductive history. MATERIALS AND METHODS: In 137 women, blood samples were taken on day 3 of a spontaneous cycle. Serum FSH, LH, E2, progesterone and AMH were measured in all blood samples. For the statistical analysis of the data, t test, Pearson's correlation and linear regression analysis were performed. RESULTS: Of 137 women (43%), 59 were smokers. Age was positively correlated with serum FSH and LH levels (r = 0.584, P < 0.001 and r = 0.330, P < 0.001, respectively) and negatively correlated with serum AMH levels (r = -0.882, P < 0.001). There were no significant differences in FSH, LH, E2, progesterone and AMH levels between smokers and non-smokers. Multiple stepwise linear regression analysis showed that in both smokers and non-smokers, age was the most significant determinant of AMH levels (r = -0.889, P < 0.001 and r = -0.944, P < 0.001, respectively), while smoking was not related to AMH levels. CONCLUSIONS: Aging significantly decreases AMH levels in women with normal cycles and normal reproductive history, while smoking does not seem to have significant effects on AMH levels.

The contribution of hysteroscopy to the detection malignancy in symptomatic postmenopausal women.

Hysteroscopic evaluation of endometrial cavity is widely used in cases of abnormal uterine bleeding. The aim of the present study is to compare the hysteroscopic and histological findings in women suffering from postmenopausal bleeding. Between 1990 and 2009, 425 women aged 47-83 years were included in the study. None of the women had received hormonal therapy or had any malignancy in the past. All women underwent diagnostic hysteroscopy and histologic sampling of the endometrial cavity. Hysteroscopy was successfully completed in 423 women and was suggestive of malignant lesions in 23 cases, which were confirmed histologically. The hysteroscopic findings in three cases were suggestive of atrophic endometrium, atypical hyperplasia and endometrial carcinoma, and the histologic diagnosis confirmed endometrial carcinoma (two cases) and one uterine sarcoma. Hysteroscopy proves to be a safe and effective technique in the diagnosis and management of abnormal uterine bleeding.

Vascular endothelial growth factor gene polymorphisms and idiopathic recurrent pregnancy loss.

OBJECTIVE: To investigate whether four common polymorphisms (-2578C/A, -1154G/A, -634G/C, and 936C/T) of the gene encoding for vascular endothelial growth factor (VEGF) are associated with idiopathic recurrent miscarriage. DESIGN: Prospective case-control study. SETTING: University teaching hospital. PATIENT(S): Fifty-two patients with a history of three or more unexplained consecutive pregnancy losses and 82 healthy, postmenopausal controls with at least two live births and no history of pregnancy loss. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Polymerase chain reaction and restriction fragment length polymorphism analysis were performed to identify the different VEGF alleles. RESULT(S): There was a significant difference in the -1154G/A genotype and allele frequency between women with recurrent pregnancy loss and controls. The risk of recurrent pregnancy loss was lower in the carriers of the G allele than in women carrying the A allele (odds ratio = 1.91, 95% confidence interval, 0.12-3.28). No significant association between recurrent spontaneous abortions and -2578C/A, -634G/C, and 936C/T genotypes was found. Between women with primary and secondary idiopathic recurrent miscarriage, no statistically significant differences with respect to allele frequencies were observed. CONCLUSION(S): This is the first report on VEGF gene polymorphisms in women with recurrent miscarriage, demonstrating that the -1154G/A VEGF gene polymorphism is associated with idiopathic recurrent abortions.