The effect of physical exercise on postpartum fitness, hormone and lipid levels: a randomized controlled trial in primiparous, lactating women.

PURPOSE: To evaluate the effect of an exercise training program combining low-impact dance aerobic, resistance and stretching exercise on physical fitness, hormone and lipid levels of postpartum, primiparous, lactating women. METHODS: Thirty seven primiparous, lactating women were randomly assigned at 4-6 weeks postpartum to either follow an exercise training program of 50-60 min aerobic, strengthening and stretching exercise, 3 days a week, for 12 weeks (interventional group; n = 20) or no training program at all (control group; n = 17). The following parameters were measured at baseline and 12 weeks later: (1) for evaluation of physical fitness: VO2max, muscular endurance, joint mobility and body fat; (2) for evaluation of the lipidemic profile: triglyceride, total cholesterol, HDL and LDL levels, and (3) levels of hormones associated with lactation: prolactin, estradiol, cortisol, TSH, fT3 and fT4. RESULTS: After completion of the exercise training program, comparisons between the interventional and the control group showed statistically significant mean changes in VO2max (p = 0.003), muscular endurance of the upper extremities (p < 0.001), and the abdomen (p < 0.001), flexibility (p = 0.042), and body fat (p = 0.007). There were no significant differences between the two groups in mean changes of lipid and hormone levels. CONCLUSION: Implementation of a low-impact exercise training program appears to improve physical fitness of postpartum women, while it does not seem to affect lipid levels and lactation-associated hormone levels. Hence, implementation of an exercise training program combining low-impact dance aerobic, resistance and stretching exercise is feasible in postpartum, primiparous, lactating women.

Operative treatment of gynaecologic diseases in puberty: seven years of experience.

PURPOSE OF INVESTIGATION: The aim of this study is to present the incidence and surgical management of gynaecologic pathology in adolescence in the 1st Obstetrics and Gynecology Department of Aristotle University of Thessaloniki. METHODS: After a retrospective review of the medical records of over a seven year period (2004-2011), 32 adolescent patients with reported surgical gynaecologic procedures were identified and analysed. RESULTS: Fourteen out of the 16 adolescents with ovarian masses (eight neoplastic and eight non-neoplastic) were treated by laparoscopy. Congenital anomalies were diagnosed in seven patients and only one of them was treated by laparotomy. The rest were surgically treated for uterine leiomyoma (1), ectopic pregnancy (2), pelvic abscess (1), mesosalpingeal cysts (2), mesenterian cyst (1) and investigation of chronic pelvic pain. DISCUSSION: Although benign ovarian cysts and congenital anomalies represent the major indication for operative treatment of gynaecologic diseases in puberty, laparoscopy and/or hysteroscopy should be the gold standard procedure after careful preoperative investigation.

Obstetric outcome in adolescence: a single centre experience over seven years.

PURPOSE OF INVESTIGATION: The aim of this study was to compare the obstetric outcome of adolescent pregnant women (aged < or = 18) with the outcome of adult pregnant women who delivered in a tertiary university hospital. MATERIALS AND METHODS: Delivery files from 2004 to 2011 were reviewed concerning age of the pregnant women, parity, gestational age, mode of delivery and birth weight of the neonates. RESULTS: During the study period 119 (0.94%) out of 10,483 deliveries were performed in adolescent women. Caesarean section was the mode of delivery in 41 adolescent patients (34.45%), while the corresponding rate was 53.6% (5,556 cases) in adult pregnant women. The preterm labour rate in the adolescent group was 13.44% (16 cases) while in the adult group it was 21% (2,201 cases). The most frequent indication of caesarean section in the adults was previous caesarean section (21%). DISCUSSION: In adolescent pregnancies the caesarean section rate was lower than in adult pregnancies. As far as the prevalent cause of caesarean section is concerned, it was repeat caesarean section for adults while in adolescents it was failure of labour to progress.

Effect of short-term tibolone treatment on risk markers for cardiovascular disease in healthy postmenopausal women: a randomized controlled study.

OBJECTIVE: The aim of this prospective randomized controlled cross sectional study was to evaluate the effect of a six month tibolone treatment in healthy postmenopausal women on biochemical CVD markers by calculating the changes of the blood serum levels of total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (Tg), high-sensitivity C-reactive protein (hsCRP), homocysteine (Hcy), and endothelin-1 (ET-1) at the beginning of the treatment and after six months. MATERIALS AND METHODS: Fifty-two healthy postmenopausal women were enrolled in a prospective, randomized, case-controlled outpatient trial. Group 1 (n = 26) received 2,5 mg/d tibolone for six months, while Group 2 (n = 26) received no treatment. Serum levels ofTC, LDL, HDL, Tg, hsCRP, Hcy, and ET-1 were evaluated at baseline and after six months. RESULTS: The two groups did not statistically differ at baseline characteristics. In Group 1 tibolone treatment decreased significantly TC (p = 0.01), HDL (p < 0.001), and Tg (p < 0.001) serum levels while a significant increase ofhsCRP (p < 0.001) was observed. Finally no changes were noticed on LDL, Hcy, and ET-1 serum levels. Regarding Group 2, no changes were observed. CONCLUSION: Short-term tibolone treatment in healthy postmenopausal women exerts a mixed action, acting beneficially in some markers (TC, LDL, Tg, Hcy, and ET-1) where as detrimentally in others (HDL, hsCRP).

Vulvodynia: a case series of a poorly recognized entity.

Vulvodynia remains a poorly recognized entity with unclear pathogenesis. In a case series of six patients with vulvodynia over a five-year period in a tertiary university hospital, we describe the clinical features, the diagnostic procedures, the impact on each patient's emotional status and discuss the necessity and efficacy of the chosen treatment options in accordance with the current therapeutic guidelines.

The impact of six-month tibolone postmenopausal treatment on cell adhesion molecules levels.

PURPOSE: The aim of the present study was to evaluate the effects of tibolone on inter-cellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), inter-cellular adhesion molecule-2 (ICAM-2) and P-selectin levels in healthy postmenopausal women. METHODS: This prospective study included 25 postmenopausal women, complaining of hot flashes, assigned in two groups. Fifteen women received tibolone (dosage of 2.5 mg per day for six months) and ten women did not receive any therapy, according to their personal preference. Basal control included complete medical history, anthropometrics, clinical examination, and blood sampling to perform hormonal, biochemical, hematological testing and ICAM-1, ICAM-2, VCAM-1 and P-selectin measurements. Evaluation was repeated in three and six months. RESULTS: There was no significant difference in ICAM-1, VCAM-1, ICAM-2, P-selectin, homocysteine, total cholesterol, HDL, LDL, and triglyceride concentrations between the women of the two groups after either three or six months of treatment. However, a significant reduction in the frequency and intensity of hot flashes was noted in both groups. CONCLUSIONS: Tibolone does not have any adverse effects on cell adhesion molecule levels which primarily affect atherosclerotic processes or on triglyceride and homocysteine concentrations. These results may support the view that tibolone could be considered a safe treatment, regarding its impact on the endothelium, in healthy postmenopausal women.

Visfatin serum levels are increased in women with preeclampsia: a case-control study.

OBJECTIVE: Visfatin has been implicated in the pathogenesis of preeclampsia with limited and contradictory, however, results. The aim of this study was to investigate the potential association between visfatin serum concentration and preeclampsia. METHODS: Visfatin was determined in the serum of 38 women with preeclampsia and 38 women with uncomplicated pregnancies, matched for age and gestational age. RESULTS: Similar baseline characteristics were present between the two groups in terms of age, body mass index, parity and gravidity. Serum visfatin was significantly increased in the preeclamptic women (median=10.3 ng/mL; interquartile range [IQR] =20) as opposed to their matched controls (median=2.6 ng/mL; IQR=1.4) (p<0.001). Univariate analysis revealed a strong linear correlation of visfatin levels with systolic (r=0.505, p<0.001), diastolic (r=0.467, p<0.001) and mean arterial blood pressure (r=0.497, p<0.001), as well as with uric acid concentrations in the serum (r=0.463, p<0.001). A receiver operating characteristics curve analysis illustrated that serum visfatin concentration is helpful in discriminating between preeclamptic or nonpreeclamptic women with an area under the curve of 0.887 (95% confidence interval [CI]: 0.794-0.948; p<0.001). CONCLUSION: Visfatin serum concentration seems to be increased in preeclampsia as compared with uncomplicated pregnancy.

Hormonal replacement therapy in ovarian cancer survivors: a survey among Greek gynecologists.

PURPOSE OF INVESTIGATION: In this survey we evaluated the prescription attitude of Greek gynecologists towards hormone replacement therapy (HRT) for ovarian cancer survivors. METHODS: An anonymous questionnaire was sent to 900 members of the Hellenic Society of Obstetrics and Gynecology presenting a hypothetical case of an ovarian cancer survivor with indications for HRT followed by a series of relevant questions. RESULTS: Two hundred and ninety-eight responses were analyzed with regards to age, gender and practice setting. HRT would be prescribed by 48% of Greek gynecologists; regarding type of regimen, 60% would prescribe tibolone, 19% estrogen alone and 21% estrogen plus progestagen. In contrast, 52% of Greek gynecologists would not prescribe HRT due to the fear of ovarian cancer relapse (83%), or the development of breast cancer (6%), or both cancers (9%); among them, 21% would alternatively prescribe CNS medications, 9% SERMs, phyto-estrogens or bisphosphonates, while the remaining 70% would not prescribe anything. CONCLUSIONS: One out of two Greek gynecologists would prescribe HRT in ovarian cancer survivors. An alternative therapy, mainly CNS medications, would be suggested by 21% of the opposers.

Comparison of single versus multiple courses of antenatal betamethasone in patients with threatened preterm labor.

PURPOSE OF INVESTIGATION: To compare single versus multiple courses of antenatal betamethasone administration with regards to the morbidity and mortality of preterm neonates. METHODS: One-hundred and twenty-two women with threatened preterm labor were allocated to three different betamethasone schedules: 1) two doses of betamethasone 12 mg, intramuscularly, 24 hours apart (standard treatment) (n = 41); 2) standard treatment plus a third dose of 12 mg after seven days (n = 41); and, 3) standard treatment plus one dose of 12 mg every seven days until delivery (n = 40). Neonatal morbidity and mortality as well as maternal morbidity were evaluated. RESULTS: Neonatal parameters, such as frequency of respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, sepsis and neonatal mortality were not significantly different among the three groups for both singleton and multiple pregnancies. Similarly, maternal parameters were not significantly different among the three groups. CONCLUSION: The administration of multiple betamethasone courses in threatened preterm labor is not superior to single courses with regards to neonatal morbidity and mortality, as well as to maternal morbidity.

A prospective randomized study for evaluation of wound retractors in the prevention of incision site infections after cesarean section.

Surgical site infections (SSIs) after cesarean section appear to be more common than generally believed. We prospectively evaluated 231 consecutive pregnant women who underwent elective or emergency cesarean section, and were assigned to have either the Alexis wound retractor (study group) or a conventional Doyen retractor (control group) during the operation. There was no evidence of SSI, defined as wound dehiscence, pain or tenderness in the lower abdomen, localized swelling, redness, heat or purulent discharge from the wound in any woman in the study group. Moreover, no endometritis occurred in this patient collective. There were three SSI in the control group, but no endometritis. Our preliminary data show excellent protection of wound infections with an additive protective effect to that given by antibiotic cover. After a short learning curve, the handling of the Alexis device became easier and the median insertion time was 18 sec.

Hormone therapy for postmenopausal endometrial cancer survivors: a survey among Greek obstetricians-gynaecologists.

PURPOSE OF INVESTIGATION: In this study we evaluated the prescription attitude of Greek obstetricians-gynaecologists towards hormone replacement therapy (HRT) for endometrial cancer survivors. METHODS: An anonymous questionnaire was sent to 900 members of the Hellenic Society of Obstetrics and Gynaecology, presenting a hypothetical case of an endometrial cancer survivor with indications for HRT, followed by a series of relevant questions. RESULTS: Three hundred and three valid responses were received and analysed according to age, gender and practice setting. HRT would be prescribed by 30.4% of gynaecologists; as far as type of regimen is concerned, 67.4% would prescribe tibolone, 22.8% estrogen-only and 9.8% estrogen plus progestagen. In contrast, 69.6% would not prescribe HRT due to the fear of endometrial cancer recurrence (88.2%), development of breast cancer (2.8%) or both (4.7%); among them, 28.4% would prescribe central nervous system (CNS) medications, selective estrogen receptor modulators (SERMs), phyto-oestrogens or biphosphonates, as alternates. CONCLUSIONS: One out of three Greek gynaecologists would prescribe HRT to endometrial cancer survivors. Alternative therapies, mainly CNS medications, would be suggested by the opposers.

Mucocele of the appendix mimicking an adnexal mass: a case report.

Mucocele of the appendix is a rare entity usually mimicking an adnexal tumour. There is no specific imaging or screening method to determine the diagnosis with certainty preoperatively. Appendiceal malignancy can be the underlying cause, although it is not common. We present a case of an appendiceal mucocele mimicking an ovarian tumour by both clinical and imaging (TVS and MRI) methods. This pathological condition should be considered by all the gynaecologists in the differential diagnosis of a right-sided pelvic mass.

Hormone therapy for postmenopausal breast cancer survivors: a survey among obstetrician-gynaecologists.

PURPOSE OF INVESTIGATION: To investigate the attitude of Greek obstetrician-gynaecologists towards prescription of hormone therapy to postmenopausal breast cancer survivors. METHODS: An anonymous questionnaire was sent to members of the Hellenic Society of Obstetrics and Gynaecology with a hypothetical case and a series of relevant questions. RESULTS: Three hundred valid answers were received. Hormone therapy would be prescribed to a breast cancer survivor by only 8%; 80% of these would prefer tibolone. In contrast, 92% would not prescribe hormone therapy; 97% would do so due to the risk of disease recurrence; 70% would not prescribe any alternative therapy, 21% would prescribe CNS-active compounds and 7% SERMs. CONCLUSIONS: The vast majority of Greek obstetrician-gynaecologists would not prescribe hormone therapy for menopausal symptoms in breast cancer survivors due to the theoretical risk of disease recurrence. Among those who would not prescribe hormone therapy, 21% would opt to CNS-active compounds.

Primary ovarian angiosarcoma--review of the literature and report of a case with coexisting chylothorax.

BACKGROUND: Primary ovarian angiosarcoma is a very rare gynaecologic malignancy with poor prognosis and uncertain, up-to-date, treatment options. Its exact diagnosis is challenging for surgeons and difficult for pathologists. There are only a few cases reported in the international literature. CASE: We report a case of primary pure ovarian angiosarcoma with coexisting chylothorax which is, to the best of our knowledge, the first reported case. An extensive review of the literature analyzing all clinical and pathological parameters related to this condition is presented. RESULT: In spite of all therapeutic efforts, surgical and medical, prognosis of ovarian angiosarcoma remains very poor in most cases. CONCLUSION: Primary ovarian angiosarcoma is a rare and aggressive malignancy. The report of such cases is interesting in order to exchange knowledge and experience, and possibly to further improve our diagnostic and therapeutic capabilities.

Factor V Leiden and prothrombin G20210A mutations in pregnancies with adverse outcome.

BACKGROUND: Inherited thrombophilia has been associated with obstetric complications through mechanisms that are not yet fully elucidated. The aim of this study was to investigate the relationship between specific obstetric adverse outcomes and factor V Leiden and prothrombin G20210A mutations. METHODS: Forty-five women with adverse pregnancy outcome defined as severe pre-eclampsia, abruptio placentae, intrauterine growth restriction and stillbirth, were tested for factor V Leiden and prothrombin G20210A mutations. The control group comprised 100 women with at least one normal pregnancy and no history of thrombosis. RESULTS: Overall, 13 women with one or more of the above-mentioned pregnancy complications (28%) had either thrombophilic mutation, as compared with six in the control group (6%) (p < 0.001, odds ratio (OR) 6.1; 95% confidence interval (CI) 1.9-20). The factor V Leiden mutation was detected in ten of the women with complicated pregnancies (22%) and in four of the controls (4%) (p < 0.001, OR 6.6; 95% CI 1.7-27.2). The prothrombin G20210A mutation was detected in three women in the group with complications (6%) and in two of the controls (2%) (p = 0.17, OR 3.4; 95% CI 0.4-30.5). Compared to controls, the prevalence of the factor V Leiden mutation was significantly higher in the subgroups of severe pre-eclampsia, abruptio placentae and fetal growth restriction. The prevalence of the prothrombin G20210A mutation does not appear to be significantly different from that in the controls in any of the groups studied. CONCLUSIONS: Our data suggest that inherited thrombophilia, and specifically the factor V Leiden mutation, may be associated with adverse pregnancy outcome. The role of the prothrombin G20210A mutation remains to be elucidated.

Ovarian remnant syndrome: a case report and review of the literature.

The ovarian remnant syndrome in an unusual complication of bilateral oophorectomy, usually presenting with pelvic mass and pain. A case of the syndrome is described in a 35-year-old woman with a history of abdominal hysterectomy and bilateral oophorectomy. We suggest that ovarian remnant syndrome should be considered in the differential diagnosis of chronic pelvic pain after recorded oophorectomy.

Growth hormone response to oral glucose tolerance and insulin tolerance tests in patients with PCOS.

Polycystic ovary syndrome (PCOS) is characterized by its heterogeneity. This is the reason for the diversity in the clinical manifestations and laboratory findings. In this study we examined the serum levels of growth hormone (GH) in 15 women with PCOS and 5 healthy volunteers following oral administration of 75 gr glucose (OGTT) and intravenous administration of insulin (ITT). The OGTT produced no significant difference between the two groups of women, in the ITT there was a difference between the GH response of the women with PCOS and that of the healthy women. The group with PCOS showed a later, more prolonged, higher response, indicating that the hypothalamus is probably involved in PCOS.

Etiopathology of endometriosis.

Although endometriosis is one of the most frequent problems in gynecology, its pathogenesis remains controversial and poorly understood. Many theories relating to the etiopathology of this disorder have been proposed. The celomic metaplasia hypothesis states that peritoneal mesothelium undergoes metaplasia, forming typical endometrial-like glands and stroma. The transplantation theory suggests implantation and subsequent growth of retrogradely shed, viable endometrial cells. The induction theory states that unknown substances released from shed endometrium induce undifferentiated mesenchyma to form endometriotic tissue. Regardless of which theory is correct, additional factors may be responsible for the expression of the disease. The possibility that the development and progression of endometriosis is associated with abnormal immune function and an inadequate response of the peritoneal defense system is currently the most recent hypothesis for the etiopathology of this disease.