Chaotic and periodic analysis of fetal magnetocardiogram recordings in growth restriction.

OBJECTIVE: We studied how chaotic and periodic heart rate dynamics differ between normal fetuses (n = 19) and intrauterine growth restricted fetuses (n = 11) at 34 to 37 weeks of gestation. We quantified the chaotic dynamics of each heart rate time series obtained by fetal magnetocardiography (FMCG) using correlation dimension. METHODS: The FMCG was recorded digitally by a single-channel biomagnetometer in an electrically shielded room of low magnetic noise. The position of the fetal heart was determined using ultrasonography. RESULTS: The correlation dimension was significantly lower in IUGR than in normal fetuses (p < 0.001, t-test). The periodic dynamics were also obtained by FMCG and measured by power spectrum. The low-frequency components and therefore the periodicity of the low-frequency range were significantly higher in IUGR than in normal fetuses (p < 0.001, t-test). CONCLUSIONS: The analysis of FMCG recordings may offer important perspectives to understand significant features of the heart function of the fetuses. This technique improves the recognition of IUGR fetuses over healthy ones and may help improve perinatal morbidity and mortality.

The contribution of rapid intraoperative cytology to the improvement of ovarian cancer staging.

OBJECTIVE: The goal of this work was to evaluate the use of intraoperative cytology in the improvement of ovarian cancer staging. METHODS: Fifty-two patients with clinical stage IA-IIB ovarian cancer underwent peritoneal washing (PW) cytology and imprint cytology performed on retroperitoneal lymph node samples, during primary surgical treatment. Cytologic specimens were stained by the May-Grünwald-Giemsa (MGG) and hematoxylin-eosin (HE) techniques. Pertinent histologic sections of the ovarian lesions, cell blocks prepared from PW sediments, and lymph node samples were studied and compared with the cytologic findings. RESULTS: Our study reveals that, when malignant cells are present in the peritoneal cavity, PW cytology has 84.6% sensitivity and 94.7% specificity in detecting them. Imprint cytology performed on lymph node samples presented 94.1% sensitivity and 94.1% specificity in the diagnosis of retroperitoneal metastasis of ovarian cancer. Only 7 patients (13.4%) were upstaged with either cytologic method. PW cytology alone upstaged 6 more patients, while imprint cytology alone upstaged 11 more patients. This corresponds to a total of 17 patients (32.6%) who benefit from the combined performance of both cytologic methods. HE stain presents lower values of sensitivity and specificity compared with MGG. CONCLUSION: Cytologic evaluation of intraperitoneal and retroperitoneal spread of ovarian cancer by use of PW cytology and imprint cytology performed on lymph node samples contributes to the improvement of ovarian cancer staging.

Fetal heart rate patterns in normal and ritodrine-treated pregnancies, detected by magnetocardiography.

OBJECTIVE: The aim of the present study was to test the validity of magnetocardiography in the diagnosis of fetal heart rate arrhythmias in normal pregnancies, as compared to the number of arrhythmias reported in other series, which were detected by use of other diagnostic techniques. We also evaluated the influence of ritodrine on the fetal heart rhythm in pregnancies treated for the risk of preterm labor by means of magnetocardiography, in order to provide preliminary results that could be utilized in the future establishment of magnetocardiography as a screening procedure in the diagnosis and management of fetal arrhythmias. METHODS: We performed a prospective study on two subgroups of pregnant women: one of 84 women with normal healthy singleton pregnancies and one of 68 pregnant women treated with ritodrine for the risk of preterm labor. RESULTS: The prevalence of fetal arrhythmias in the first subgroup was 3.5% (3/84), while in the second subgroup the prevalence was 16% (11/68). CONCLUSIONS: The incidence of fetal arrhythmias detected in our population of normal pregnancies was comparable to that reported in previous studies by use of other techniques. Results gained from the second subgroup, although not comparable to others, owing to lack of similar reports, led us to believe that magnetocardiography's advantages over conventional methods of fetal cardiac surveillance could highlight the technique as a useful screening procedure for the detection of preterm fetuses, which should be submitted to closer investigation, because of the arrhythmias caused by ritodrine infusion.

Neonatal magnetocardiography and Fourier spectral analysis.

OBJECTIVE: In this study we investigated the relationship between heart rate variability (HRV) and respiration in healthy and probably asphyxiated infants using magnetocardiographic (MCG) recordings. METHODS: Ten healthy and eight infants from pregnancies complicated by preeclampsia with indications of mild perinatal asphyxia were included in the study. All were near term. Maternal age ranged from 16 to 39 years (mean = 29.05, SD = 6.13). Spectral analysis was used to find out any association between respiration and HRV. RESULTS: Respiratory sinus arrhythmia (RSA) was reduced in preeclamptic infants with indications of mild perinatal asphyxia. This difference was statistically significant (p < 0.0002, t-test), whereas the heart rate of the two groups was not statistically significant (p = 0.1, t-test). CONCLUSION: The results suggest that infants with indications of mild preeclampsia differ from controls in respiratory activity and this difference is independent of basal heart rate. Thus, spectral analysis could be useful for the estimation of influence of mild perinatal asphyxia in the RSA rhythm of newborns.

Neonatal magnetocardiography.

PURPOSE: The aim of the present study was to test the validity of magnetocardiography (MCG) in the estimation of neonatal cardiac rhythm using a single channel superconductive quantum interference device (SQUID). MATERIALS AND METHODS: Our study population consisted of 50 neonates who were delivered normally between 37-41 weeks of gestation from clinically uncomplicated pregnancies. There was also a neonate included in the study in which the diagnosis of "hypoplastic left heart syndrome" was demonstrated by U/S Doppler examination. Maternal age ranged from 18 to 39 years (mean=29.15, SD=6.13). RESULTS: Our study results revealed 44 neonates with normal cardiac rhythm, four with ventricular tachycardia (VT), one with ventricular tachycardia (VT) and extrasystolic beats and one with bradycardia. The neonate with the hypoplastic left heart syndrome presented frequent episodes of ventricular bigeminy in the magnetocardiographic trace. M-mode echocardiography confirmed the diagnosis of the seven cases of arrhythmia in our study group. CONCLUSION: Results gained from the study lead us to believe that MCG could provide clinical practice with a non-invasive, rapid and easy to perform method, which could be used as an adjunct to conventional methods for the evaluation of neonatal cardiac rhythm.

Descriptive epidemiology of endometrial hyperplasia in patients with abnormal uterine bleeding.

PURPOSE OF INVESTIGATION: To evaluate the prevalence and epidemiologic characteristics of endometrial hyperplasias in women with abnormal uterine bleeding. METHODS: We performed a retrospective analysis on data gained from 294 patients with histologically documented endometrial hyperplasia (with or without atypia), detected among 1,469 women who underwent fractional dilatation and curettage in our department due to abnormal uterine bleeding from 1986 to 1998. Epidemiologic characteristics were abstracted from the patients' medical charts. RESULTS: 294/1469 women were found with endometrial hyperplasia (258 without atypia and 36 atypical hyperplasias). Thirty-six of them were under 40 years of age. Four of the detected endometrial hyperplasias progressed to endometrial carcinoma (one with simple hyperplasia, two with complex and one with atypical hyperplasia). Obesity and hypertension were justified as risk factors in our study population. CONCLUSIONS: The prevalence of endometrial hyperplasia according to our data was 20%. There were statistically significant differences in most epidemiologic parameters between the two types of hyperplasia. The progression of four endometrial hyperplasias to endometrial adenocarcinoma indicates the need for intense follow-up even in cases where patients undergo conservative therapy.

Endometrial polyps: prevalence, detection, and malignant potential in women with abnormal uterine bleeding.

PURPOSE OF INVESTIGATION: To report our evaluation of the prevalence and malignant potentiality of endometrial polyps in women with abnormal uterine bleeding, as well as the efficacy of transvaginal ultrasonography and sonohysterography as diagnostic techniques. METHODS: Fractional dilatation and curettage (D&C) was performed in 1,415 patients aged 23-85 years treated in our clinic for abnormal uterine bleeding from 1986 to 1998. Transvaginal ultrasonography was performed prior to D&C on all patients. Sonohysterography was performed only on 157 patients. Diagnostic efficacy for both techniques was evaluated for the detection of endometrial polyps combined with hyperplasia due to sonographic and histologic difficulties in distinguishing them. RESULTS: The prevalence of endometrial polyps was 8.9% (126/1,415). From all 126 endometrial polyps found, 94 were benign, 30 (23.8%) were found with premalignant changes (complex and atypical hyperplasias) and two (1.5%) had undergone malignant degeneration. Transvaginal ultrasonography was of limited diagnostic value for polyps and hyperplasia in premenopausal women, while in postmenopausal women the method provided a greater yield. Sonohysterography was found to be a more effective diagnostic tool. CONCLUSION: Endometrial polyp prevalence rises by age and/or menopause. Malignant degeneration of endometrial polyps was observed only in postmenopausal women. Sonohysterography represents an improvement over conventional ultrasonography and both methods could be used for screening purposes especially when hysteroscopy can not be performed.

Trends in breast cancer incidence in Thrace, Greece: an epidemiological assessment.

PURPOSE: In the present study we describe the epidemiologic characteristics of breast cancer in relation to certain risk factors affecting the two major ethnic groups (Christian Orthodox and Muslims) in the area of Thrace, Greece. METHOD: We performed a cross-sectional study of 196 consecutive patients, aged 28-85 years, with breast cancer, who were referred to our clinic for treatment from January 1986 to June 1998. All patients were submitted to clinical, laboratory and mammographic control. Ultrasound examination and aspiration cytology were performed on cystic-like lesions. Epidemiologic characteristics of the patients were abstracted from medical charts. To evaluate the results, we used the direct standardization method (1995 Eur. Population) and chi2 test. RESULTS: Breast cancer incidence for the two study populations (Christian Orthodox and Muslims) was 20.9 and 2.3/100,000, respectively. We did not notice statistically significant differences in most epidemiologic characteristics between the two subject groups. CONCLUSIONS: Although the cumulative breast cancer incidence in Thrace, Greece is comparatively low, the discrepancy observed in the incidence of Christian Orthodox and Muslims suggests that differences in lifestyle between these two ethnic groups might be determinant factors influencing the prevalence of the disease. The appearance of the disease in a considerable number of young and elderly women, make the extension of modern screening methods in the above-mentioned age groups necessary for the improvement of breast cancer prevention and incidence rates.

Cytologic diagnosis of axillary lymph node metastasis in breast cancer.

OBJECTIVE: To compare imprint cytology with histology as a method for rapid intraoperative diagnosis of axillary lymph node metastasis in breast cancer. STUDY DESIGN: We evaluated imprint cytology, comparing it with histopathology. A sample of 635 axillary lymph nodes was studied by imprint cytology using both Giemsa stain and hematoxylin-eosin. The results were compared with each other and with those of histopathologic examination. RESULTS: The Giemsa stain method, as compared to histopathology, had 94% accuracy, 97% sensitivity, 90% specificity and 94% positive prognostic value. The hematoxylin-eosin stain method was less accurate than the Giemsa stain method as compared to histopathology (accuracy 91%, sensitivity 96%, specificity 83% and positive prognostic value 92%). CONCLUSION: These data confirm the value of imprint cytology as a rapid, reliable method of intraoperative assessment of axillary lymph node metastasis in breast cancer. It results in better staging of the disease. It can be used intraoperatively, as an alternative to frozen section, if a pathology laboratory is not available, to exclude stage I patients from further treatment.

Epidemiologic aspects of endometrial cancer in Thrace, Greece.

To describe the epidemiologic characteristics of endometrial cancer in relation with certain risk factors affecting the two major ethnic groups (Christian Orthodox and Muslims) in the area of Thrace, Greece. We performed a cross-sectional study of 166 consecutive patients, aged between 29 and 87 years, with documented endometrial cancer who were referred to our clinic for treatment from January 1986 to June 1998. Epidemiologic characteristics of the patients were abstracted from medical charts. To evaluate our results we used the direct standardization method (1995 Eur. Population) and chi2 test. The endometrial cancer incidence for the two study populations (Christian Orthodox and Muslims) was 16.96 and 3.16/100,000, respectively. We observed statistically significant differences in most epidemiologic characteristics between the two major ethnic groups in Thrace (Christian Orthodox and Muslims) regarding endometrial cancer. Our results confirm the increasing trend of endometrial cancer incidence as established in previous investigations.

Is postmenopausal osteoporosis related to pineal gland functions?

There is currently considerable interest in the pathogenesis of postmenopausal osteoporosis, which is the most common metabolic bone disease. Osteoporosis affects approximately 20 million persons in the United States, 90% of whom are postmenopausal women. Although there is evidence that estrogen deficiency is an important contributory factor, the pathogenesis of osteoporosis is multifactorial and presently poorly understood. There is evidence that pineal melatonin is an anti-aging hormone and that the menopause is associated with a substantial decline in melatonin secretion and an increased rate of pineal calcification. Animal data indicate that pineal melatonin is involved in the regulation of calcium and phosphorus metabolism by stimulating the activity of the parathyroid glands and by inhibiting calcitonin release and inhibiting prostaglandin synthesis. Hence, the pineal gland may function as a "fine tuner" of calcium homeostasis. In the following communication, we propose that the fall of melatonin plasma levels during the early stage of menopause may be an important contributory factor in the development of postmenopausal osteoporosis. Consequently, plasma melatonin levels taken in the early menopause could be used as an indicator or perhaps as a marker for susceptibility to postmenopausal osteoporosis. Moreover, light therapy, administration of oral melatonin (2.5 mg at night) or agents which induce a sustained release of melatonin secretion such as 5-methoxypsoralen, could be useful agents in the prophylaxis and treatment of postmenopausal osteoporosis. Finally, since application of external artificial magnetic fields has been shown to synchronize melatonin secretion in experimental animals and humans, we propose that treatment with artificial magnetic fields may be beneficial for postmenopausal osteoporosis.

The pineal gland and spontaneous abortions: implications for therapy with melatonin and magnetic field.

Spontaneous abortion, the termination of pregnancy prior to 20 weeks of gestation, is estimated to occur in 40%-50% of all pregnancies and in 12%-15% of identified pregnancies. The causes of spontaneous abortion can be divided into two main categories: those arising from chromosomal anomalies and those arising from abnormalities in the intrauterine environment. In the following communication, we propose that deficient pineal melatonin functions in early pregnancy may be causally related to the development of spontaneous abortions in cases where chromosomal anomalies or structural abnormalities of the uterus have been excluded. This hypothesis is based on the findings that: (a) melatonin plasma levels normally increase by 200%-300% in the first 20 weeks of pregnancy; (b) melatonin decreases uterine contractility in the rat; (c) melatonin stimulates the secretion of progesterone, which decreases uterine contractility and prevents immunological rejection of the trophoblast; (d) melatonin inhibits the synthesis of prostaglandins, which are potent inducers of uterine contractility and labor, and (e) pinealectomy increases the number of spontaneous abortions in pregnant rats. In addition, since melatonin is a hormone with immunosuppressant properties, we propose that the increased melatonin production in early pregnancy may contribute to a state of "transplantation immunity" to the paternal histocompatibility antigens preventing immunological rejection of the trophoblast. If this hypothesis is correct, then plasma melatonin, levels during early pregnancy could be used as an indicator for increased risk of spontaneous abortions.(ABSTRACT TRUNCATED AT 250 WORDS)

Is the pineal gland involved in the pathogenesis of endometrial carcinoma.

The pathogenesis of endometrial carcinoma, which is the most common malignant neoplasm of the female genital tract, is unknown. It is believed that a prolonged period of increased estrogenic exposure unopposed by progesterone may underlie the malignant transformation of the endometrial cells. In the following communication, we propose that deficient melatonin functions may be an additional endocrine factor implicated in the pathogenesis of endometrial carcinoma. This hypothesis is based on the observations that: (a) melatonin has antiestrogenic properties; (b) melatonin stimulates progesterone production which opposes the action of estrogens; (c) an increased rate of endometrial hyperplasia, a premalignant condition, has been noted during the winter, a time of year associated with diminished melatonin secretion; (d) an increased incidence of anovulatory cycles, which is a risk factor for endometrial carcinoma, occurs in the winter; (e) melatonin secretion decreases sharply during the menopause, a period associated with an increased risk of endometrial carcinoma; (f) obesity, which is a major risk factor for endometrial carcinoma, is associated with impaired circadian melatonin secretion; (g) diabetes mellitus, which is an additional risk factor for endometrial carcinoma, is associated with decreased melatonin secretion and an increased rate of pineal calcification; and (h) the prevalence of endometrial carcinoma is lower in the black population compared to the white population. Similarly, the incidence of pineal calcification, which reflects the secretory activity of the gland, is significantly lower in the African and American black populations as compared to the white population.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomagnetic measurements in uterine leiomyomas using a superconducting quantum interference device (SQUID).

Using the biomagnetometer superconducting quantum interference device (SQUID), the magnetic signals relating to spontaneous uterine activity were measured for the first time in 25 women with uterine leiomyomas, and 12 women with normal, non-leiomyomatous, uteri. Magnetic radiation, in the range of low frequency (below 2 Hz), was of low amplitudes in normal uterine tissues and of high amplitudes in benign leiomyomas. The observed differences were confirmed by the corresponding power spectra obtained from the statistical Fourier analysis. It is suggested that biomagnetic measurements may facilitate the detection of uterine leiomyomas in equivocal cases.