Hormonal reproductive status of women at menopausal transition compared to that observed in a group of midreproductive-aged women.

OBJECTIVE: To compare the serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), estradiol (E2), testosterone (T) and dehydroepiandrosterone sulfate (DHEA-S) in perimenopausal women to the levels of the same reproductive hormones in younger women. METHODS: This was a case control study which compared the hormonal status (circulating levels of FSH, LH, PRL, T, E2, DHEA-S) between women at menopausal transition and younger mid-reproductive-aged controls. The t-test for independent samples was used. RESULTS: FSH, LH and E2 were higher, and T and DHEA-S were lower in perimenopausal women. CONCLUSION: The reproductive hormonal patterns in perimenopausal women favor a relatively hypergonadotropic hyper-estrogenic milieu.

Genetic amniocentesis in women 20-34 years old: associated risks.

The aim of this retrospective controlled study is to evaluate the impact of predisposing factors on amniocentesis-related fetal loss. It comprises 3910 consecutive cases of women, aged 20-34 years, who had genetic amniocentesis during the years 1992-97 (study group). The control group comprised 5324 women under 35, at low risk for Down syndrome, during the same period. The fetal losses in both groups were analysed, in respect of: (a) maternal historical conditions; and/or (b) bleeding during current pregnancy. The leading indication for amniocentesis in women 20-34 years was maternal anxiety, mainly for marginal age (33-34 years), which accounted for a remarkable 34.4% of the study group. Total fetal loss rate up to the 28th week was 2.1% in the study group versus 1. 5% in controls. A history of previous spontaneous or induced abortions, as well as bleeding during the current pregnancy, was associated with a substantial rise of fetal loss in both groups. In cases with no predisposing factors, the added fetal loss rate was 0.03%. Previous abortions and bleeding during the current pregnancy are associated with the most fetal losses after amniocentesis. In the absence of these, the added fetal loss rate (0.03%) is non-significant.

Anogenital intraepithelial lesions in HIV positive patients. Report of 3 cases with 3-year follow-up.

Three cases of HIV-positive immunocompromised women, complicated by anogenital intraepithelial lesions are presented in the present paper. Two patients, aged 42 and 33, had a combination of cervical intraepithelial neoplasia grade 3 (CIN 3) and anal intraepithelial neoplasia grade 2 (AIN 2). The other one, aged 26, presented an association of CIN 2 and AIN 1. All lesions were HPV-associated and proved by colposcopically-guided biopsies.

Day clinic diagnostic hysteroscopy in a state hospital.

Within 6 years (1991-97), a total of 680 diagnostic hysteroscopies were performed at the Day Clinic of the 1st Department of Obstetrics and Gynecology of the University of Athens ("Alexandra" Hospital). The procedure was done without general or other forms of anesthesia, using the Siegler method of approach. However in 12 cases with cervical stenosis (1.7%) and 21 patients with marked nervousness (3.1%) general anesthesia proved inevitable. The leading indication was repeated failure of IVF (54.7%), while other indications included abnormal bleeding, amenorrhea and oligomenorrhea, a history of abortions, and infertility. Abnormal hysteroscopic findings were observed in 276 cases (40.5%) among which intrauterine adhesions, endometrial hyperplasia and polyps were the most common. We had no major complications or fatalities in our series and hysteroscopy proved to be a very useful, accurate and safe method of assessing uterine and endometrial functional status.

The management of breech presentation in the last three decades.

In order to evaluate the changes in management of breech presentation during the last three decades, a retrospective analysis of the "Alexandra" Hospital records was undertaken. The years, 1965, 1975, 1985, 1995 and finally 1997 were used as pilot years for this purpose. The cesarean section, breech presentation and breech cesarean section rates were calculated for each year. Specific breech cesarean section rates in respect to birth weight and parity as well as perinatal mortality rates were also recorded for each pilot year. The overall cesarean section rate rose from 8.0% in 1965 to 25.2% in 1995 and 25.1% in 1997 while the breech cesarean rate climbed from 16.9% in 1965 to 74.1% in 1995 and 72.3% in 1997, irrespective of birth weight. A trend towards vaginal delivery of breeches in multiparous women till 1985 became less apparent in later years. During the same period, a marked decrease of the perinatal mortality rate was observed from 70.1/1000 in 1965 to 36.6/1000 in 1997. In conclusion, a more than four-fold increase of the breech cesarean section rate was apparently rewarded by a two-fold decrease in perinatal mortality.

Comparative study of RIS with the 131I-OC 125 F(ab')2 Mab and CT scan prior to second look operation for ovarian cancer.

A tumour-associated radiolabelled monoclonal antibody (Mab) 131I-OC 125 F(ab')2 was used to investigate 27 patients 2 weeks after their last chemotherapy regimen and prior to second-look surgery for ovarian cancer. We did compare the radioimmunoscintigraphy (RIS) findings with the CT scan results and the second-look operation data. In 23 out of 27 cases the RIS results correlated with the operation findings, while there were four false-negative results. Computed tomography (CT) scans correlated in 17 out of 23 cases with the operative findings, while there were six false-negative results. We concluded that RIS is more specific in detecting the tumour site within the pelvis, while CT scan is superior in detecting liver metastases.

Second-look laparoscopy in ovarian cancer.

Forty-six patients with epithelial ovarian cancer previously treated with surgery, chemotherapy or external radiation underwent second-look laparoscopy to evaluate management. Twenty of the patients had positive laparoscopic findings and were not subjected to further laparotomy. The frequency of positive findings was related to the stage of the disease. Laparoscopic examination revealed no evidence of cancer in the remaining 26 patients. Three of the patients in this group were found to have additional disease at subsequent laparotomy. The laparoscopic procedures were not associated with major complications. Although second-look laparoscopy cannot replace repeat laparotomy, it does have a role in the follow-up of patients with ovarian cancer.

E. coli growth inhibition by amniotic fluid.

Amniotic fluid samples were collected aseptically from 29 normal pregnancies, between the 38th and 41st week of gestation and checked for sterility in the laboratory, in order to investigate in vitro the effect of the liquor on the growth of E. coli. Brain Heart Infusion (B.H.I.) and Ringer solution were used as controls. E. coli cultures were inoculated in amniotic fluid, B.H.I., Ringer solution and amniotic fluid plus B.H.I. and incubated at 37degreesC for 48 hours. At 0, 1, 3, 6, 12, 24, 36 and 48 hours of incubation, surface viable counts were performed to estimate the number of E. coli viable cells. The growth of E. coli in B.H.I. started furing the 1st hours after inoculation and continued over 48 hours; in Ringer solution the mean growth curve and almost identical to that of B.H.I. In amniotic fluid the growth of E. coli began from the 1st hour of inoculation but the growth curve was much lower, became static in 24 hours and a permanent inhibition was observed thereafter. The addition of a small amount of B.H.I. in amniotic fluid enhanced the growth of E. coli, but the growth curve was lower in comparison to the curves of the two controls studied. In conclusion, after 48 hours of inoculation in amniotic fluid, 26 of the 29 cases showed bacteriostatic or bactericidal activity of the liquor upon the growth of E. coli.