Bioethical issues on the role of contemporary gynecologists concerning HPV vaccination.

UNLABELLED: Debate is heating up whether or not to require girls to be vaccinated against the human papillomavirus (HPV), a leading cause of cervical cancer (CC). Prolepsis against this plague is mainly focused on early detection with Pap test (screening) and recently with administrating HPV vaccines in youths. OBJECTIVE: To discuss the increased bioethical role of contemporary gynecologist in the young population, with the aim to contribute to the decrease of this malignancy. MATERIALS AND METHODS: The authors searched the web (data-warehouse: articles, forums, etc., and data-mining: sequence analysis and classification) for HPV vaccination and related bioethical issues. RESULTS: HPV vaccines have already caused debates on whether they must be mandatory and on whether they cause a pseudo-safeness mental state, making youths "forget" necessary annual Pap tests or even worse, urging them in promiscuity, resulting in an increased occurrence of CC. CONCLUSIONS: Greece, in order to appropriately apply the Constitutional Law 5 Section 5 (All persons have the right to the protection of their health...), needs to train contemporary gynecologists in adequate youth consultation and proper family approaches regarding HPV vaccination issues. Enhancing the gynecologist's role, vaccination's effectiveness (sensitivity and specificity) will be increased and on the other hand, a rule of social law will be established in the country.

The impact of HPV diagnosis on women's sexual and mental health: preliminary findings.

PURPOSE OF INVESTIGATION: The objective of the present study was to demonstrate the impact of HPV diagnosis on sexual function and mental health of Greek women. METHODS: The study population included 51 patients who proceeded to the gynecological outpatient clinic of "Aretaieion" Hospital, Athens, during 2008-2009. The participants were asked to complete a questionnaire regarding demographic characteristics, knowledge on HPV, gynecological and sexual history, as well as questions regarding their mental and sexual health after the diagnosis. RESULTS: Mean age of the participants was 36 years and mean age of their first Pap smear test was 24.4 years. Mean age of HPV diagnosis was 34 years and mean number of sexual partners was four. Regarding mental health, the majority experienced anxiety after the HPV diagnosis as well as fear regarding their health in the future. Nearly half of the women experienced guilt and anger and some of them distress, shame, diminution of self-esteem and stigmatization. Diminution in the level of sexual interest and desire and decrease in sexual intercourse frequency were quite often reported. CONCLUSION: Except for the important physical impact of HPV infection, its diagnosis seems to trigger several negative feelings and reduce sexual desire.

The slow levonorgestrel-releasing intrauterine system (LNG-IUS) 20 mcg/day: a literature review.

The aim of the study is to present the mechanisms of action, indications, complications, contraindications and the necessary tests before the insertion of a levonorgestrel-releasing intrauterine system (Mirena). After a literature search in Pubmed, a narrative review in the field is presented.

Management of obesity in menopause: diet, exercise, pharmacotherapy and bariatric surgery.

Menopause is characterized by the progressive reduction of estrogens resulting to cessation of menses. It is associated with an increase of cardiovascular risk factors such as hyperglycemia, hypertension, dyslipidemia and of abdominal and/or selective visceral fat mass deposition. Obesity, a modern day epidemic, is promoted by an obesogenic environment that interacts with the genetic background. The result is a positive energy balance materialized by the accumulation of the adipose tissue. This process is marked by great individual variation. Obesity is also associated with the presence of cardiovascular risk factors. In this review, the main pathophysiologic processes for the increase of obesity in menopause and the possible effects of pre-menopausal obesity regarding the cessation of ovarian function are described. The interactions among the hypothalamic-pituitary-gonadal and -adrenal (stress system) axes and the environment are explored. Furthermore, the therapeutic means that a clinician can employ to help menopausal women to overcome the menopause-associated increase of their weight are developed.

Unwanted pregnancy and induced abortion among young women 16-22 years old in Greece: a retrospective study of the risk factors.

UNLABELLED: Unwanted pregnancies and the subsequent induced abortions are common problems of our youths in modern Greece. The aim of this study was to recognize the risk factors of the problem in an effort to find the best possible solution out of this social dead end. MATERIALS AND METHOD: We interviewed 1,320 young female individuals and analyzed their answers using statistical analysis. RESULTS: Several useful conclusions were reached concerning the forces that are involved in unwanted pregnancy/induced abortions. DISCUSSION: We have tried to underline the strategy to combat the problem. CONCLUSION: Sexual education and the proper use of contraception remain the essential tools in this effort.

Ectopic pelvic spleen. Presentation of two cases.

We present two cases of nulliparous women with ectopic pelvic spleens who were hospitalized in our department during the last decade. The clinical and laboratory characteristics and the management of such a rare entity are discussed.

Adolescent pregnancy in a Greek public hospital during a six-year period (2000-2005)--a retrospective study.

STUDY OBJECTIVE: Adolescent pregnancy constitutes a multidimensional social problem in modern Greece. The purpose of this study was to investigate the trends of teenage childbearing and to determine the relationship between the incidence of teenage pregnancy and immigrant status of the mother. DESIGN: This is a retrospective correlational study. The birth registry of the hospital was examined for a 6-year period, from January 2000 to December 2005. Information about the age and nationality of the mothers was collected. SETTING: The hospital under investigation is Tzaneio Hospital, a public general hospital that provides health services to the residents of Piraeus, a large municipality next to Athens. RESULTS: During the study period 4628 women gave birth at Tzaneio Hospital, among which 349 (7.54%) were under the age of 19. The study hypothesis, that adolescent childbearing prevails among immigrant population, was confirmed (P < 0.01). CONCLUSION: Teenage pregnancy rate remains high among some subsamples of the population, such as immigrants. The Greek government, health professionals, and sexuality educators should all work together in order to confront this problem.

Paget's disease of the vulva. A ten-year experience.

BACKGROUND: Paget's disease of the vulva is a rare neoplasmatic lesion which mainly affects postmenopausal women. RESULTS: We conducted a retrospective study during the period January 1996 till December 2005 in which 11 cases of Paget's disease were detected. The clinical manifestations, management, specific pathological features, treatment and prognosis of each patient are presented. CONCLUSION: Surgical treatment is the current standard and long-term follow-up is required.

A retrospective analysis of borderline ovarian tumors in a Greek university hospital.

PURPOSE: The aim of this retrospective study was to analyze the pathologic and clinical characteristics of borderline ovarian tumors. METHODS/RESULTS: During the period from January 1993 up to December 2002 we found 93 cases of borderline ovarian tumors. The mean age of patients was 44.3 years (range 28.9-59.7 years); 77.4%, 10.8% and 11.8% of patients had Stage I, II and III, respectively. The histological outcomes revealed 52.7% of serous and 41.9% of mucinous origin; 44.1% underwent radical surgery, whereas 55.9% had unilateral salpingo-oophorectomy or cystectomy. The mean follow-up was 84 +/- 22 months. The overall five-year survival was 97.4% and 98% for mucinous and serous tumors, respectively. The survival rate was 100%, 90% and 81.8% in Stages I, II and III, respectively. CONCLUSION: From our results it can be concluded that borderline ovarian tumors have a favorable prognosis even after conservative management.

The role of ovarian transposition in patients with early stage cervical cancer--two case reports.

The aim of the study is to present two cases of premenopausal women with early stage cervical carcinoma who underwent ovarian transposition. The role and the advantages of this technique are discussed.

A case of endometrial carcinoma arising in a 36-year-old woman with uterine atypical polypoid adenomyoma (APA).

Atypical polypoid adenomyomas are tumors of low malignant potential. We present a case of endometrial carcinoma arising in a 36-year-old woman with atypical polypoid adenomyoma. The diagnosis and treatment of such a tumor is discussed through an English literature review.

Misoprostol use as a method of medical abortion.

AIM: The aim of our study was to verify with the use of ultrasound (US) scanning the effectiveness of misoprostol in medical abortion. MATERIALS AND METHODS: The study population included women with a medical miscarriage attending the 2nd Department of Obstetrics and Gynecology, University of Athens in Aretaieion Hospital, Athens, Greece. All women < 49 days since their last menstruation received 800 microg vaginal misoprostol. The diagnosis of complete abortion was possible by the US measurements as endometrial thickness of 15 mm by transvaginal US was used as a cutoff level for successful abortion. RESULTS: The mean age of the study population was 27 years (ranging from 19 up to 37 years). Complete evacuation with misoprostol was performed in 149 women. The success rate was 85.2% (127/149). Twenty-two women experienced intrauterine echogenic structures with a diameter > 15 mm and all of them underwent surgical evacuation (14.8%). Vaginal bleeding was present in 17 patients after the procedure (11.4%). Less usual reported side-effects included nausea, vomiting, pain, or diarrhea. CONCLUSION: Misoprostol use is an effective, safe and acceptable method of medical abortion for women.

Leiomyomatosis with multiple extrauterine pulmonary sites: an unusual case report.

The objective of the present study is to present a case of a 48-year-old woman with leiomyomatosis and multiple pulmonary metastases. The classification, pathophysiology, clinical signs, treatment and prognosis of this rare case are discussed. Leiomyomatosis is potentially life-threatening while patients with pulmonary metastases are usually asymptomatic and the condition is incidentally discovered. The treatment of leiomyomatosis is not standardized and many possible variations are under investigation. Still the prognosis is usually excellent.

Abortion rates and the role of family planning: a presentation of the Greek reality.

OBJECTIVE: Due to lack of consistent evidence, it is widely believed that Greece holds one of the highest abortion rates in Europe. The aim of this study is to clarify these rates. STUDY DESIGN: The Greek Society of Obstetrics and Gynecology collected data demonstrating that abortion rates seem to be declining which coincides with the rise of the use of more effective methods of contraception. Data were collected both from public and private hospitals, and an attempt was made to correlate the data with the current trends of family planning and birth control. RESULTS: A decline in abortion rates in Greece was found, which may be due to the better organization of counseling programmes in the field. CONCLUSION: The programmes organized by the Greek Family Planning Association under the guidance of the University of Athens has led to a decline in abortion rates in Greece.