Transvaginal ultrasound-guided aspiration of benign ovarian cysts.

In our study, we evaluate the diagnostic and therapeutic efficacy of transvaginal ultrasound-guided aspiration of benign ovarian cysts in selected patients. A total of 46 women with benign ovarian cysts were referred to our outpatient clinic. The aspirated fluid was collected and sent for cytological analysis. All women were re-evaluated at 1, 3 and 6 months after the procedure. The cytological analysis was negative for malignancy in all cases. Our study showed an overall recurrence rate for ovarian cysts of 39.1%. Women with endometriotic ovarian cysts have an increased incidence of recurrence, 62.5% (n = 5), in comparison with serous cysts, 35.2% (n = 12) and serous-haemorrhagic cysts, 15% (n = 1), χ(2) = 9.913, df = 2, p = 0.007. The results of our study reveal that transvaginal ultrasound-guided aspiration of benign ovarian cysts is a simple, safe and effective procedure.

Coexistence of three benign and a borderline tumor in the ovaries of a 52-year-old woman.

PURPOSE OF INVESTIGATION: In this paper, the authors describe a rare case of four simultaneous ovarian tumors. MATERIALS AND METHODS: A 52-year-old postmenopausal woman underwent total hysterectomy and bilateral salpingo-ophorectomy. Multiple slides from the ovaries were examined. RESULTS: Histological examination revealed the presence of three ovarian tumors on the right ovary, of the following types: cystadenoma, mucinous borderline ovarian tumor and mature teratoma, and also a benign Brenner tumor on the left ovary. CONCLUSION: Pathologists must examine multiple sections of both ovaries, regardless of the macroscopic or clinical specimen's appearance, in order to exclude the presence of malignancy, which could alter the surgical approach. Particular attention should also be paid to the frozen section of the contralateral ovary, as depending on the result, it could change the surgical approach. From the surgeon's perspective, bilateral salpingo-ophorectomy with total hysterectomy should be the treatment of choice in postmenopausal women with multiple ovarian tumors. The diagnosis of a malignant or borderline tumor on a normal-appearing ovary changes the radicality of the surgical approach. In such a case, staging surgery, including omentectomy, multiple peritoneal biopsies, and washes are required.

Mid-trimester maternal serum markers in predicting adverse pregnancy outcome.

OBJECTIVE: In a prospective study, we investigated the association between mid-trimester maternal serum AFP (ms-AFP), maternal serum hCG (ms-hCG) levels and adverse pregnancy outcome in a South-Western Greek population. MATERIALS AND METHODS: 126 healthy Greek women with spontaneous pregnancies were investigated for ms-AFP and ms-hCG levels between the 13th and 24th weeks of gestation and followed for adverse pregnancy outcome. Abnormal outcomes were considered as ms-AFP levels or ms-hCG levels > 2.0 multiples of the median value for gestation (MoM). Statistical analysis was performed by Pearson's chi-square test. RESULTS: Elevated ms-AFP levels were detected in a total of 25 out of the 126 women studied (19.84%). Elevated ms-hCG levels were detected in a total of ten of the 126 women studied (7.93%). Elevated ms-AFP and ms-hCG levels were detected in a total of four of the 126 women studied (3.17%). CONCLUSION: Multiparameter testing of placental function in the mid-trimester (uterine artery Doppler, placental morphology, ms-AFP and ms-hCG screening) may allow us to identify women with increased risk of developing severe placental insufficiency and pregnancy complications.

Fetal ovarian cysts: report of two cases and literature review.

In the present study we report two cases of fetal ovarian cysts. In the first case the cyst was initially discovered during prenatal ultrasound examination, while in the second case the cyst was identified during autopsy examination of a stillborn fetus. Pathologic examination of both specimens revealed similar histology, which was mainly characterized by the presence of an ovarian cortex comprising several maturing and primordial follicles which were occasionally biovular, and a focal lining of luteinized theca cells. Another prominent feature was the presence of multiple deposits of dystrophic calcifications within the cyst wall. Both cysts were diagnosed as follicular in origin.

Amniotic fluid endothelin levels and the incidence of premature rupture of membranes.

Objective. The purpose of this prospective study was to record Endothelin 1 (ET1) concentrations in the second trimester amniotic fluid and in women who develop premature rupture of membranes (PROM), preterm premature rupture of the membranes (PPROM) and in women with uneventful pregnancies. Method. Amniotic fluid was retrieved by amniocentesis from 125 women in the second trimester of pregnancy. The levels of Endothelin were measured by a sensitive and specific radioimmunoassay. Results. From the 125 women included in the study 20 developed PROM and preterm PROM (13 PPROM and 7 PROM). The ET1 concentration was significantly higher (P<0.001) in PROM and PPROM than in normal pregnancy (96.4 vs. 43 pg/ml). The sub-analysis of the two rupture of membranes groups found that the concentration of ET1 was higher in the PPROM than in PROM (118 vs. 72 pg/ml). Conclusion. The amniotic fluid concentration of ET1 is elevated by the second trimester in women who later develop preterm PROM or term PROM.

Leiomyosarcoma of the vulva: a case report.

Primary sarcoma of the vulva is a rare tumor. Leiomyosarcoma is the most common histologic variant of vulvar sarcoma. The patient, a 55-year-old, gravida 4, para 2 postmenopausal Greek woman, presented with a 5-year history of progressive enlargement of the right labia majora. On vaginal examination there was a 8 x 9 cm raised, ulcerated and irregular mass of the right labia majora. Despite surgery, the patient died six months later because of multiple metastases.

Second trimester amniotic fluid endothelin concentration. A possible predictor for pre-eclampsia.

The mechanism of pre-eclampsia is still an enigma. There is now some evidence that amniotic concentrations of endothelin is elevated in pregnancies associated with pre-eclampsia. The aim of this prospective observational study was to record the concentration of amniotic fluid endothelin and compare this in women who develop pre-eclampsia and women who do not develop pre-eclampsia. Amniotic fluid concentration of endothelin is elevated by the second trimester in women who later develop pre-eclampsia.

Effect of body position on PaO2 and PaCO2 during pregnancy.

BACKGROUND: The body position may have an effect on gas exchange though the magnitude of this effect has not been studied thoroughly during the three trimesters of pregnancy. OBJECTIVES: This study analyzes the effect of body position change on arterial oxygen tension (PaO2) and arterial carbon dioxide tension (PaCO2) in healthy pregnant women. METHODS: We examined 21 lung healthy pregnant women at the end of the first, second and third trimester of pregnancy. Blood was drawn from the radial artery first in the sitting and subsequently in the supine position. Peak expiratory flow rate was determined as well. RESULTS: No statistically significant difference was detected between the mean values of PaO2 in the supine and in the sitting position at the end of the first trimester. On the contrary, at the end of the second trimester the mean value of PaO2 in the supine position was 92.39 +/- 1.95 mm Hg, while in the sitting position the mean PaO2 was 96.56 +/- 1.83 mm Hg (p < 0.001). At the end of the third trimester the mean PaO2 in the supine position was 90.48 +/- 2.91 mm Hg while in the sitting position the mean PaO2 was 97.48 +/- 1.46 mm Hg (p < 0.001). CONCLUSIONS: According to our data we conclude that the statistically significant difference in PaO2 in the sitting and supine positions clearly shows that the position needs to be considered both when attempting to establish reference values and when evaluating gas tensions at the end of pregnancy.

Arterial oxygen tension during sleep in the third trimester of pregnancy.

BACKGROUND: Changes during pregnancy include reduced functional residual capacity (FRC) and residual volume (RV), increased alveolar difference for oxygen and, in the supine position, reduced cardiac output. In conjunction with sleep-related disturbances, these changes could lead to maternal oxygen desaturation during sleep. OBJECTIVES: Because of conflicting data from respiratory sleep studies in pregnancy, we performed complete polysomnography on 21 pregnant women at the 36th week of gestation and again postpartum. We also measured the partial pressure of oxygen in the arterial blood (PaO2) in the supine and sitting positions. METHODS: We tested 21 healthy pregnant women at the 36th week of gestation. Arterial samples were taken in the sitting position. Complete polysomnography was performed in all of the pregnant women. Before the polysomnography arterial samples were taken in the supine and sitting positions and then every 2 h until termination of the study. RESULTS: We did not find any correlation between SaO2/PaO2 levels and apnea, hypopnea or percent of rapid eye movement (REM) sleep. The frequency of apnea and hypopnea was significantly lower during pregnancy (5.81 +/- 2.1 apneas or hypopneas per hour of sleep) than postpartum (12.1 +/- 2.7 apneas or hypopneas per hour of sleep) (p < 0.001), which may be due to the raised level of progesterone. The PaO2 levels in the supine position were significantly lower than in the sitting position at 36 weeks of gestation (p < 0.001). No differences were found between PaO2 levels in the sitting and supine positions postpartum (p < 0.5). CONCLUSIONS: According to our results we conclude that 1) the frequency of apnea and hypopnea in pregnancy was significantly lower than postpartum, and 2) a significant difference in PaO2 levels in the sitting and supine positions was observed at 36 weeks of gestation.

Normal pregnancy and oxygenation during sleep.

Pregnancy is associated with significant alterations in respiratory function. Changes during pregnancy include reduced functional residual capacity (FRC) and residual volume (RV), increased alveolar-arterial difference for oxygen (A-alphaPO2) and in the supine position, reduced cardiac output. In conjunction with sleep-related apneas or hypopneas, these could lead to maternal oxygen desaturation during sleep. Because of the conflicting data from sleep studies in late pregnancy, we performed complete polysomnography on 11 pregnant women at 36 weeks of gestation and again postpartum. We also measured the PaO2, every 2h. The frequency of apneas and hypopneas was significantly lower during pregnancy compared with that on the postpartum control night. PaO2 levels in the supine position, during sleep, were also significantly lower during pregnancy compared to the postpartum period. No correlation was observed between PaO2 levels and apneas or hypopneas or percent of REM sleep.

The effects of recombinant human erythropoietin given immediately after delivery to women with anaemia.

OBJECTIVE: Anaemia is a common problem during pregnancy and the puerperium. This study was designed to determine the efficacy and safety of giving recombinant human erythropoietin (EPO) to anaemic women during the puerperium. METHOD: Thirty-seven women received a single dose of EPO (20 000 IU intravenously) immediately after delivery. A control population (n = 37) matched according to age and haemoglobin concentration was evaluated. All women received oral iron supplementation for 40 days after delivery. Haemoglobin concentrations were measured 4 and 40 days after delivery. Blood transfusions were given depending on clinical condition and haemoglobin level. RESULTS: Patients treated with EPO had a significantly higher mean haemoglobin concentration than control patients at days 4 and 40. No women in the EPO group required a transfusion, compared with six in the control group. No side-effects and fewer anaemia-related symptoms were observed during EPO treatment. CONCLUSION: EPO given at delivery is effective in decreasing the need for blood transfusion and the incidence of problems associated with anaemia during the puerperium.

Organochlorine pesticide residues in human breast milk from southwest Greece: associations with weekly food consumption patterns of mothers.

Breast milk samples were collected from 112 mothers who resided in southwest Greece during the years 1995-1997. The following chemicals, which were present in some of the milk samples, were quantified by gas chromatography: residues of lindane (i.e., alpha-hexachlorocyclohexane [BHC], beta-BHC, gamma-BHC), delta-BHC, 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (p,p-DDE), 1,1-dichloro-2,2-bis(p-chlorophenyl)ethane (p,p'-DDD, and 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (p,p'-DDT). With the assistance of a qualified dietitian, the mothers also completed a 7-d food-frequency questionnaire and provided additional personal information (e.g., educational level, profession, previous or present residence, use of pesticides, treatment of dermal scabies). Concentrations of gamma-BHC (i.e., lindane) were present in 57.1% of the samples (mean concentration = 0.58 microg/l [whole milk], range = nondetectable to 10.86 microg/l). Concentrations of alpha-BHC, beta-BHC, delta-BHC, p,p'-DDD, and p,p'-DDT were detected in 16%, 39.3%, 11.6%, 41%, and 55.3% of the samples, respectively. Moreover, p,p'-DDE, which was detected in all samples, ranged from 0.33 to 278 microg/l. Typically, the amounts of gamma-BHC and sigma-DDTs in breast milk were below the established acceptable daily intake value. Nonetheless, 3 of the 112 samples contained concentrations of sigma-DDT derivatives that exceeded the acceptable daily intake value established by the World Health Organisation in 1987. Concentrations of insecticides in breast milk were affected by dietary habits. Some women who consumed 7 (or more) portions of fresh vegetables per week had gamma-BHC concentrations in whole milk that exceeded 0.15 microg/l (odds ratio = 1.23 [95% confidence interval = 1.05, 1.44]; p = .006). The concentrations of DDT derivatives were associated with the portions of fish, chicken, fruits, milk, and potatoes consumed each week.

Anticardiolipin antibodies levels in healthy pregnant and non-pregnant woman.

To determine the prevalence of anticardiolipin antibodies in healthy non pregnant women and during normal pregnancy, 110 healthy women of mean age 25 years old and 53 healthy pregnant females of mean age 24.5 years old, who no one suffered from any autoimmune disease, were studied. In all women the anticardiolipin antibodies were measured in duplicate by the Enzyme Linked Immunosorbent Assay (ELISA). There was no difference in the percentage of the positive anticardiolipin antibodies between non pregnant and pregnant healthy women (9.1% and 5.6% respectively). Also, there was no difference in the antibodies levels during normal pregnancy, as well as, during an equal time of observation in non pregnant women. The positive anticardiolipin antibodies levels were low.

Cord blood alpha-fetoprotein concentrations in term newborns of smoking mothers.

UNLABELLED: To investigate the toxic effect of tobacco smoke on the fetus, we measured in cord blood the concentrations of alpha-fetoprotein (AFP), the principal serum protein in early ontogenic development, and erythropoietin (EPO), as an index of chronic fetal hypoxia. A total of 103 consecutively enrolled term newborns of smoking mothers and 103 term infants of nonsmoking parents were studied. The mean +/- SD AFP concentrations in the newborns of the mothers who smoked 1-50, 5-50, and 10-50 cigarettes/day were 86.4 +/- 88.9, 96.3 +/- 91.9 and 118.7 +/- 103.7 ng/ml, respectively. The difference of all three groups from the control neonates (57.7 +/- 37.2) was significant. The EPO concentrations in the newborns of the mothers who smoked 1-50 (53.9 +/- 64.6 mU/ml) and 5-50 (56.3 +/- 68.5) cigarettes/day were significantly greater than in the control neonates (29.5 +/- 16.1). In the newborns of the smoking mothers there was a significant positive correlation between AFP concentrations and number of cigarettes smoked per day, and a negative correlation between AFP and birth weight or length. There was no correlation between AFP and EPO concentrations, as well as between EPO and birth weight, length or number of cigarettes smoked per day. CONCLUSION: The absence of a correlation between erythropoietin and birth weight or length and the negative correlations between alpha-fetoprotein and these anthropometric parameters suggest that the intra-uterine growth retardation caused by maternal smoking is not due to tissue hypoxia, but that both growth retardation and elevated alpha-fetoprotein result from the direct or indirect toxic effect of a factor(s) present in tobacco smoke.

Placental pathology in discordant twins.

OBJECTIVE: The aim of this study was to evaluate placental abnormalities in relation to birth weight discordance in dichorionic and monochorionic twins. STUDY DESIGN: The maternal charts and placental abnormalities of 147 structurally normal twin pairs with cords labeled at delivery were reviewed. The placental weight belonging to each twin was determined by measuring the length, width, and thickness in each of the two placental disks. Placental weight, chorionicity, infarction, abruptio placentae, decidual vascular abnormality, villous fibrosis and hypovascularity, chronic villitis, and intraplacental thrombi were also assessed. Birth weight was discordant if > or = 20%. The data were analyzed with chi 2 and analysis of variance after log transformation of skewed discordancy values. RESULTS: Of the 147 twin pairs, 99 were dichorionic and 48 monochorionic. Placental weights were known for 91 dichorionic and 40 monochorionic twins. Of the lighter cotwins in dichorionic twin pairs 36.3% (33/91) belonged to the heavier placenta, 49.5% (45/91) belonged to the lighter placenta, and 14.3% (13/91) had an equal share of the placental weight with the heavier sibling (p < 0.05). In 42.4% (42/99) the lighter dichorionic twin had more placental lesions than the heavier twin, in 38.4% (38/99) the same number of lesions were present in both placentas, and in 19.2% (19/99) the heavier twin had more placental lesions. There was linear correlation between percent discordance and number of placental lesions in the lighter twin. In dichorionic twins 18 of the 99 (18.1%) were discordant. In 77.8% (14/18) the lighter twin had more placental lesions than the heavier twin, in 16.7% (3/18) the number of lesions was the same in both, and in 5.6% (1/18) the heavier twin had one more lesion than the lighter twin (p < 0.05). In monochorionic twins, regardless of birth weight discordance, no differences in placental abnormalities were observed. CONCLUSIONS: In dichorionic twins significant birth weight discordance was attributable not to differences in placental weight but to a greater number of placental lesions in the lighter twin than in the heavier twin (p < 0.05). This did not hold true for monochorionic twins.