Predictive value of biochemical marker ADAM-12 at first trimester of pregnancy for hypertension and intrauterine growth restriction.

PURPOSE: Delineate whereas ADAM-12 levels at first trimester of pregnancy may be used as a marker for hypertension-preeclampsia (PE) and intrauterine growth restriction (IUGR). MATERIALS AND METHODS: The present is a case control study. Serum ADAM-12 of women presenting for routine assessment of risk for chromosomal abnormalities at 11+0 to 13+6 weeks of gestation was measured. The study group comprised of 98 pregnancies that subsequently developed pregnancy-induced hypertension (PIH) or PE or small for gestational age fetuses (SGA), and were compared to 100 uncomplicated pregnancies. RESULTS: There was no statistically significant difference of mean log multiple of the expected median (MoM) of ADAM12 between control group and the group that consisted of all women with complicated pregnancy (PE, PIH, and SGA). ADAM-12 levels in women who developed PE during pregnancy were significantly lower than in womien of control group (mean log MoM: 0.109 vs 0.008, p = 0.010). Similarly, ADAM-12 levels in women who developed PE and/or PIH were significantly lower than in women of control group (mean log MoM: 0.066 vs 0.008, p = 0.015). There was no significant difference of ADAM12 levels between controls and pregnancies with SGA fetuses. CONCLUSION: Maternal serum levels of ADAM-12 at the first trimester are significantly lower in women who later develop PE when compared with women with uncomplicated pregnancies.

Laparoscopic treatment of 1522 adnexal masses: an 8-year experience.

Objective. To reevaluate the long-term effectiveness and safety of laparoscopy in benign ovarian pathology. Materials and Methods. 1522 women with benign adnexal cysts, laparoscopically treated in the 3rd Department of Ob/Gyn, General University hospital "Attikon" and "Lito" Maternity Hospital between July 1998 and December 2006, were included. Results. The diagnosis in 1222 (80,6%) cases was endometriosis of the ovary, 60 (4%) hydrosalpinx, 51 (3,3%) serous cystadenomas, 44 (2,9%) dermoid ovarian cyst, 38 (2,5%) borderline tumors, 35 (2,3%) unruptured follicles, and 33 (2,2%) paraovarian cysts. In 174 cases (11,5%) laparoscopy was converted to laparotomy due to technical difficulties or suspicion of cancer. In particular, laparotomy was performed in 119 (8%) women due to severe adhesions and 18 (1,2%) women due to bleeding that could not be controlled safely by laparoscopy. In 36 (2,4%) women frozen section during operation revealed malignancy and laparoscopy was converted to laparotomy. A few operative complications were recorded like post-op fever, small hematomas at the trocar entries. Conclusions. Laparoscopic surgery seems to offer significant advantages such as reduced hospital stay, less adverse effects, better quality of life, and superior vision especially on surgical treatment of cases like endometriosis.

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.

Successful pregnancy after radiotherapy with 131I for differentiated thyroid cancer. A case report and review of the literature.

BACKGROUND: Radioactive iodine has been used effectively in the diagnosis and treatment of thyroid diseases. Since radiation is delivered to the whole body, including the ovaries, there is reasonable concern as to whether there is a possibility of mutagenic effect on germ cells. CASE REPORT: A 33-year-old woman with a differentiated papillary carcinoma. (T2N0M0), underwent radiotherapy three weeks after surgery and one year afterwards she became pregnant. At the 38th week of gestation she delivered vaginally a healthy female neonate weighing 3100 g. The child at the age of five years is healthy with no signs of malignancy or other disease. DISCUSSION: Washout of 131I of the whole body takes place in a few days. Nevertheless, most guidelines recommend avoiding pregnancy for four to six or even 12 months after RAI treatment or scanning. As reported in our case a normal uncomplicated pregnancy can follow an operative and complementary treatment of thyroid cancer.

Prevalence of severe pelvic inflammatory disease and endometriotic ovarian cysts: a 7-year retrospective study.

INTRODUCTION: The purpose of this study was to delineate the association between endometriosis and pelvic inflammatory disease (PID) and the prevalence of this coexistence. MATERIALS & METHODS: The records of all patients with endometriotic ovarian cysts treated at the 3rd Department of Obstetrics and Gynecology of the University of Athens and in "Lito" Maternity Hospital of Athens from 2000 through 2007 were reviewed. RESULTS: During this 7-year period 720 women underwent surgery due to endometriotic ovarian cysts. The average age was 40.9 years (range: 17-70). Median diameter of the cysts was 4.495 cm and 59% were located in the right ovary. PID was identified in 21 (2.9%) cases. The average age of these women was 31 years (range: 21-39). Half of the women presented with fever (10/21; 47.6%). Ultrasound examination was performed in all women, followed by laparoscopy. In 47.6% (10/21) the PID abscess was located in the right ovary and the rest (52.38%) in the left. The mean diameter of the endometriotic cysts in these women was 3.52 cm. Laparoscopy was the treatment of choice in all the women with the exception of five cases, where due to technical difficulties during laparoscopy, a laparotomy was performed. In all the cases with PID, abscesses were evacuated laparoscopically. No operative complications were observed. CONCLUSIONS: Endometriosis and PID are two conditions that can easily confuse the physician in setting the diagnosis, especially in the situation where they co-exist. In our study we report that the prevalence of PID in women with endometriosis is sufficiently higher than the prevalence in the general population.

Prevalence of acute hemoperitoneum in patients with endometriotic ovarian cysts: a 7-year retrospective study.

INTRODUCTION: Endometriosis is a quite common condition in women of reproductive age. The purpose of this study is to delineate the association between hemoperitoneum and endometriosis. MATERIALS & METHODS: The records of all patients with endometriotic ovarian cysts treated at the 3rd Department of Obstetrics and Gynecology of the University of Athens and at "Lito" Maternity Hospital of Athens from 2000 through 2007 were reviewed. RESULTS: During this 7-year period 720 women underwent surgery due to endometriotic ovarian cysts. The average age was 40.9 years (range: 17-70). The median diameter of the cysts was 4.49 cm and 59% were located in the right ovary. Hemoperitoneum was identified in 16 (2.22%) of them. The average age of these women was 28.5 years (range: 22-44). Ten (62.5%) of these women presented with acute and strong abdominal pain and moderate signs of cardiovascular shock. The rest presented with abdominal pain and distension worsening at the onset of menses, nausea and/or vomiting and hemorrhagic fluid in the pelvis. Ultrasound examination was performed in all women and afterwards they underwent laparoscopy to identify the source of bleeding. In all cases a ruptured endometriotic cyst was found. In 68.8% (11/16) the ruptured cyst was located in the left ovary and the rest (31.2%) in the right. A thorough examination did not reveal any other sources of bleeding. No operative complications were observed. DISCUSSION: The simultaneous occurrence of ascites and endometriosis is rare. A physician, though, must always take into consideration endometriosis in the differential diagnosis of ascites and acute abdominal pain or pelvic mass.

[Incidence of synchronous primary neoplasms of the female reproductive tract in women with ovarian endometriosis: a retrospective analysis of 811 cases].

PURPOSE: Although endometriosis is a benign disorder recent studies suggest endometriosis could be viewed as a neoplastic process. Objective of this study is to explore the epidemiology of synchronous neoplasms (SPN) in women with severe endometriosis. PATIENTS & METHODS: The prevalence of SPN in cases with endometriotic ovarian cysts that underwent surgery at "Lito" Maternity hospital of Athens and at Anticancer Institute of Sophia was investigated. The review period was 2000 through 2009. The medical records and pathology were reviewed to confirm the diagnosis and stage of tumors. RESULTS: 5 women with synchronous cancers of the genital tract were identified. All of our patients had a grade-I endometrioid carcinoma of the uterus (Ia in 3, Ib in 2). Myometrium was invaded less than 1/3 in 4 cases and less than 1/2 in one. Similarly, 4 out of 5 ovarian cancers were endometrioid, while one was serum cystadenosarcoma. All of the ovarian malignancies were grade I (Ib in 3 and Ia in 2). Median diameter of the ovarian neoplasias was 4.3 cm, in contradiction to 4.5 cm that was the median diameter of all endometrioid cysts. When only the larger ovarian malignant cyst in each patient was accounted, then median diameter was calculated as 5.8 cm. CONCLUSIONS: Women with synchronous primary cancers of the endometrium and ovary have distinct clinical characteristics including younger age, premenopausal status, and nulliparity. This suggests that a hormonal "field effect" may account for the development of these simultaneous endometrioid cancers, supporting the theory of estrogen receptors.