Biomedical subjects

E Salamalekis

Publications and source records attributed to E Salamalekis.

At least 19 recordsLinked to original sources

PubMed2006

Computerized analysis of fetal heart rate variability using the matching pursuit technique as an indicator of fetal hypoxia during labor.

OBJECTIVE: To determine whether the computerized analysis of fetal heart rate variability with the new matching pursuit technique can indicate fetal distress during labor. STUDY DESIGN: Eighty women were studied during the intrapartum period with external cardiotocography. In all cases, cord arterial pH and 5-min Apgar Scores were evaluated. Six cases that presented large segments of missing data were excluded from the study. The remaining 74 women were divided into two groups; 32 women with normal (Group A) and 42 women with non-reassuring FHR tracings (group B). Group B was divided in subgroup BI, including 24 women with pH > 7.20, and BII, including 18 women with pH < 7.20. In order to evaluate the FHR fluctuations, in different frequency ranges, we applied an adaptive time-frequency method, called Matching Pursuit. We estimated the power of the FHR signal in four frequency ranges. RESULTS: The 5-min Apgar Scores were significantly lower in both subgroup BI and subgroup BII (p = 0.003 and p = 0.003 respectively). The Low Low Frequency (LLF) parameter appears to recognize better the cases with lower pH (sensitivity 78.5%, specificity 52.3%) than the cases with non-reassuring FHR (66.6%, 56.2). The sensitivity and specificity of the Very Low Frequency (VLF) parameter were 72.2% and 59% respectively in recognizing the cases with lower pH and 64.2% and 53.1% in recognizing non-reassuring FHR. CONCLUSION: Fetal hypoxia during labor can be recognized using the MP technique for the analysis of FHR signal power in the VLF and LLF frequency ranges. Since the analysis is feasible in real-time, it can be a useful tool for the intrapartum evaluation of fetal well-being.

Apgar Score↗

PubMed2005

21-Hydroxylase deficiency: from molecular genetics to clinical presentation.

Congenital adrenal hyperplasia due to deficiency of the enzyme 21-hydroxylase (21-OH), a cytochrome P450 enzyme located in the endoplasmic reticulum and which catalyzes the conversion of 17-hydroxyprogesterone to 11-deoxycortisol and progestene to deoxycorticosterone, is distinguished in its classical and non-classical form and is also one of the most common autosomal recessive inherited diseases in humans. The classical form appears in a rate between 1:5000 and 1:15,000 among the live neonates of North America and Europe, while the non-classical form occurs in approximately 0.2% of the general white population. This rate is especially high between the Ahskenazi Jews and a part (ie Italians, Hispanics) of the Mediterranean populations. Three alleles are associated with the 21-OH locus and can be combined in several ways in individuals who are either unaffected, heterozygote carriers, or affected with classical or non-classical disease. Variable signs and symptoms of hyperandrogenism, such as hirsutism, acne, virilization of the external genitalia and/or the body, short stature, menstrual irregularities, are common to both types of the disorder. Among the genes responsible for the synthesis of the enzyme 21-OH and the antigens of HLA system, exist both a proven genetic linkage and a proven genetic linkage disequilibrium. HLA-Bw47, HLAB5 and HLA-B35 are the most common haplotypes usually met in the classical form, while the haplotype HLA-B14DR1 is the most recurrent in the non-classical form of the disease. The significant advances in molecular biology and gene analysis over the past two decades have led to the development of novel sensitive methods of DNA analysis and study, such as polymerase chain reaction and southern blot analysis. Thus, it has been revealed that the synthesis of enzyme 21-OH is controlled by two genes, the active CYP21B gene and the CYP21A pseudogene. All three forms of the disease have a known sequence of gene changes owing to mutations in isolated proteins or whole series of genes due to translocations or deletions of genetic material.

Adrenal Hyperplasia, Congenital↗

PubMed2005

No association between insulin resistance and preeclampsia.

OBJECTIVE: To investigate the possible link between insulin resistance and preeclampsia. METHODS: The study included 30 primigravidas between 28 and 34 weeks of gestation. The study subjects were divided into two groups: Group A consisted of 15 normotensive women of a mean gestational age of 31.6 weeks and group B consisted of 15 preeclamptic women of a mean gestational age of 29.9 weeks. Glucose and insulin levels were measured at 0, 1 and 2 h of an OGTT (after 75 g oral glucose administration). Insulin resistance and sensitivity were evaluated with the use of IR HOMA, QUICKI and IS OGTT. RESULTS: Glucose and insulin levels at 0, 1 and 2 h of the OGTT as well as IR HOMA, QUICKI and IS OGTT were comparable between preeclamptic and normotensive pregnant women. CONCLUSIONS: Our results indicate that preeclampsia is not associated with hyperinsulinaemia and/or insulin resistance, in either the fasting or the postprandial state.

Adult↗

PubMed2004

Tension-free vaginal tape efficacy in relation to collagen quantity of pubocervical fascia.

OBJECTIVE(S): To investigate whether the quantity of collagen types I and III in the pubocervical fascia of women with genuine stress incontinence (GSI) affects the efficacy of the tension-free vaginal tape (TVT) procedure. METHODS: Sixty-three patients participated in the study and were divided in 2 groups as follows: 37 patients with GSI and pelvic organ prolapse stage I (group 1), and 26 patients with pelvic organ prolapse stage I but not GSI (control group). Urodynamic studies confirmed the diagnosis of GSI. Biopsies were obtained during surgery from the pubocervical fascia. RESULTS: The quantity of collagen types I and III was statistically significantly reduced in patients with GSI compared to the control group. The efficacy of the TVT procedure in patients with a significant reduction in collagen type I was an 82.1% cure. In patients with a significant reduction in collagen type III, the TVT efficacy was an 85.1% cure. The efficacy of the TVT procedure was not statistically significantly different between patients with GSI and a significant reduction in collagen types I and III, and patients with no reduction in collagen types I and III. CONCLUSIONS: The significantly reduced quantity of collagen types I and III in the pubocervical fascia of women with GSI does not affect the efficacy of the TVT procedure at an average of 25 months of follow-up.

Adult↗

PubMed2004

Prevalence of hepatitis B and C in the maternity department of a Greek district hospital.

OBJECTIVE: To define the prevalence of infection with hepatitis B virus (HBV) and hepatitis C virus (HBC), and the modifications observed during the last 8 years, amongst parturients who gave birth in our department. DESIGN: This was a retrospective study. PATIENTS: The 5497 parturients who gave birth in our department between October 1994 and September 2002. RESULTS: On average, 3.87% (213) of the pregnant women tested positive for hepatitis B surface antigen; 2.90% amongst pregnant Greek women and 4.67% amongst pregnant immigrant women. Among all pregnant women, 0.80% (44) tested positive for antibodies against HCV; 0.16% amongst Greek women and 1.33% amongst immigrant women. CONCLUSIONS: HBV prevalence in pregnant women did not seem to be affected by the increase of immigrants in our obstetric population over the course of time. HCV prevalence in the pregnant women, however, did seem to follow the increase of immigrants in our obstetric population. Economic and security issues unfortunately deprive some neonates, born to mothers with HBV infection, from the use of hepatitis B immunoglobulin.

Female↗

PubMed2004

Three cases of diabetes insipidus complicating pregnancy.

Diabetes insipidus (DI) is a rare complication of pregnancy. In cases related to pregnancy, the condition is thought to result from enhanced placental clearance of arginine vasopressin secondary to placental vasopressinase production. In such cases careful monitoring of the patient's fluid balance during and after pregnancy is essential. If treatment is necessary, desmopressin is the drug of choice. In the present article, we present three cases of pregnancy complicated by DI.

Adult↗

PubMed2004

Isolated torsion of the fallopian tube: a case report and review of the literature.

INTRODUCTION: Isolated torsion of the fallopian tube is a very rare condition. It occurs without ipsilateral ovarian involvement associated with pregnancy, haemosalpinx, hydrosalpinx, ovarian or paraovarian cysts and other adnexal alterations or even with an otherwise normal fallopian tube. We document a case of isolated torsion of the right fallopian tube associated with hydrosalpinx. CASE: The patient was a 39-year-old female, para 2, gravida 4, who was presented with acute pelvic pain, nausea and vomiting. Her medical history included an appendectomy and right hydrosalpinx diagnosed five months before admission by hysterosalpingography because of investigation for secondary infertility. The urinary pregnancy test was negative. Pelvic ultrasonography showed a dilated folded right tubular structure measuring 7.8 x 2.7 cm with thickened echogenic walls and mucosal folds protruding into the lumen; the ovaries and uterus were unremarkable. No free fluid in the cul-de-sac was noted. Preoperatively, a diagnosis of twisted right fallopian tube was suspected and an exploratory laparotomy confirmed the diagnosis of isolated torsion of the oviduct. The ipsilateral ovary appeared normal, but the fallopian tube was gangrenous and right salpingectomy was performed. The patient became pregnant three months after surgery. CONCLUSION: Isolated torsion of the fallopian tube should be considered in the differential diagnosis of patients with acute abdomen and previous medical history of hydrosalpinx.

Adult↗

PubMed2004

Primary fallopian tube adenocarcinoma: preoperative diagnosis, treatment and follow-up.

Preoperative diagnosis of fallopian tube carcinoma is difficult due to the rarity and silent course of this neoplasm. We present herein the case of a 58-year-old woman with primary fallopian tube carcinoma that was diagnosed preoperatively on the basis of a positive for adenocarcinoma Papanicolaou vaginal smear, repeated episodes of vaginal bleeding, negative endocervical and endometrial curettage, characteristic features on ultrasonography and elevated CA-125 levels. The patient was treated by total abdominal hysterectomy, bilateral salpigno-oophorectomy and omentectomy. Pathologic confirmation of primary serous papillary adenocarcinoma of the left fallopian tube was made. Peritoneal washings were positive for malignancy. FIGO stage was considered as IIIb and the patient received six courses of combined carboplatin-taxol chemotherapy. At two years from onset of therapy the patient underwent a modified radical mastectomy and lymphadenectomy because of primary carcinoma of the right breast. The patient was started on tamoxifen therapy, which she is still taking. At 60 months after initial surgery, the patient is alive and well. In conclusion, our study suggests an association between fallopian tube carcinoma and breast cancer and a good response of the patient to platinum-based chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2004

Primary ovarian carcinosarcoma: a case report and review of the literature.

Primary ovarian carcinosarcoma is characterized by an admixture of malignant epithelial and stromal elements. This neoplasm is extremely rare with fewer than 400 cases reported in the English literature. Its histogenesis, clinical features and optimal treatment remain unclear because of the rarity of primary ovarian carcinosarcoma. This study focuses on the clinical, pathological, immunohistochemical features and survival of a 73-year-old patient with primary ovarian carcinocarcoma. The patient was treated with surgery followed by combined chemotherapy with carboplatin and taxol and assigned to FIGO Stage IIIc. She died from the disease 17 months after surgery. In conclusion, ovarian carcinosarcoma is a very aggressive tumor, especially when it is diagnosed at advanced stage.

Aged↗

PubMed2004

Outcome of patients with ovarian metastatic tumors. Report of 83 cases and review.

UNLABELLED: The aim of the study was to review patients with metastatic ovarian tumors in relation to their outcome and clinical characteristics. METHODS: It was a retrospective study including 83 patients with histopathological diagnosis of metastatic ovarian tumor. The examined parameters include age of the patients, origin of the tumor, consistency and appearance of the tumor, histological type and 5-year survival. RESULTS: The 5-year survival time of patients with metastatic ovarian tumors originating from the genital tract was 14.8% and for metastatic ovarian tumors originating outside the genital tract 5.4%. CONCLUSION: The presence of metastatic ovarian tumors should always be included in the differential diagnosis of a pelvic mass. Difficulties in identification of the primary tumor site are present mainly in cases of metastatic tumors from the colon, while metastasis to the ovary from the breast tends to form small nodules in the ovary.

Adult↗

PubMed2004

Congenital bronchopulmonary sequestration presenting as a thoracic tumor: a case report.

The accurate diagnosis of fetal thoracic tumors still remains unclear despite the progress in imaging technology. The differential diagnosis between tumors and congenital anomalies of the fetus respiratory system, largely depends on the diagnostic approaches involved. We report a case of a 25-year-old woman, gravida 3 para 0, who was seen at the 23rd gestational week for routine obstetric examination. The ultrasound scan detected a lung mass, occupying the whole left hemithorax with a significant shifting of the mediastinum exhibiting features compatible with cystic adenomatoid malformation (CAM). No other congenital anomalies were noted. Color Doppler ultrasound failed to detect any blood supply to the mass. Amniocentesis disclosed a normal male karyotype. Pregnancy termination was performed according to the parents' request, with the use of misoprostol and a 500 g dead fetus was delivered. The autopsy followed by detailed histological examination, disclosed the diagnosis of pulmonary sequestration. It is important to emphasize that the initial impression concerning the sonographic appearance and the size of the mass is not always in accordance with the diagnosis of the lesion and the outcome of the pregnancy. These data suggest that in cases of fetal pulmonary tumors, a thorough and comprehensive combination of imaging approaches should be employed followed by a pathologic examination of the congenital anomaly in order to establish a definitive diagnosis.

Abortion, Induced↗

PubMed2004

Multiple dermoid cysts within the same ovary: our experience of a rare case with review of the literature.

OBJECTIVE: Ovarian dermoid cysts are relatively frequent ovarian lesions that can be easily diagnosed by transvaginal ultrasonography. However, the recognition of multiple dermoid cysts, separated by normal ovarian tissue, within a single ovary is rare. CASE: We present a case with bilateral dermoid cysts, four dermoid cysts within the right ovary and one in the contralateral ovary. Transvaginal ultrasonography showed hyperechogenic areas in the right ovary with a hypoechogenic area in front of them; the hyperechogenic areas were separated by areas with the echogenicity of normal ovarian tissue and indentation, suggesting the presence of multiple dermoid cysts within the same ovary. CONCLUSION: Preoperative ultrasonographic suspicion of multiple dermoid cysts within the same ovary might contribute to a better decision about the surgical approach.

Adult↗

PubMed2003

Evaluation of non-reassuring fetal heart rate patterns with fetal pulse oximetry combined with vibratory acoustic stimulation.

OBJECTIVE: To determine the value of fetal pulse oximetry and vibratory acoustic stimulation in the presence of non-reassuring fetal heart rate patterns during labor. DESIGN: Prospective study in women monitored by cardiotocography and fetal pulse oximetry during labor. MATERIALS AND METHODS: During a period of 18 months, 907 consecutive parturients in labor were monitored by cardiotocography. Out of these women, 63 were selected on the basis of a non-reassuring fetal heart rate tracing during the first stage of labor. In these cases, fetal pulse oximetry was applied. Vibratory acoustic stimulation was applied in fetuses without spontaneous reactivity in order to evaluate the fetal status. RESULTS: Our cases were classified into three groups, according to the lower fetal oxygen saturation levels, from the time of oximetry application until delivery. Group A consisted of 29 cases where fetal oxygen saturation levels were > or = 41%, group B (20 cases) with fetal oxygen saturation of 31-40% and group C (14 cases) with levels of < 30%. Spontaneous reactivity was observed in 15 fetuses of group A and seven of group B, while no case of reactivity was noted in group C. Vibratory acoustic-induced reactivity was associated with low fetal oxygen saturation levels. The mean umbilical artery pH levels were 7.29 +/- 0.051 in group A, 7.21 +/- 0.057 in group B and 7.04 +/- 0.05 in group C. CONCLUSION: Fetal pulse oximetry should be indicated not only in fetuses without any reactivity but also in those with induced reactivity, after the application of vibratory acoustic stimulation.

Acoustic Stimulation↗

PubMed2003

Spinal and epidural versus general anesthesia for elective cesarean section at term: effect on the acid-base status of the mother and newborn.

OBJECTIVE: To compare general, epidural and combined spinal-epidural anesthesia with respect to short-term outcome of newborns delivered by elective Cesarean section of healthy parturients with normal pregnancies. STUDY DESIGN: A total of 238 eight pregnant women admitted to our institution between January 1998 and July 2002, for whom elective Cesarean section was planned after 38 weeks' gestation, were grouped according to the kind of anesthesia used for the procedure. Maternal characteristics, birth weight, Apgar scores, and maternal and umbilical artery (UA) acid-base parameters were analyzed. RESULTS: Maternal pH was significantly lower and pCO2: and pO2 were significantly higher in the general anesthetic group, compared to the other two groups (7.38 +/- 0.03 vs. 7.43 +/- 0.02 and 7.43 +/- 0.05, respectively; 35.03 +/- 3.88 mmHg vs. 29.25 +/- 5.05 mmHg and 29.64 +/- 4.16 mmHg, respectively; and 224.56 +/- 86.77 mmHg vs. 151.28 +/- 38 mmHg and 157.36 +/- 53.51 mmHg, respectively, p < 0.05). The pH of the UA was higher in the general anesthetic group, compared to the spinal-epidural group (7.29 +/- 0.02 vs. 7.26 +/- 0.06, p < 0.05). The pO2 as well as O2 saturation of the UA were higher when general anesthetic was administered, compared to the two regional modalities (15.60 +/- 5.48 mmHg vs. 9.29 +/- 4.41 mmHg and 9.20 +/- 4.06 mmHg, respectively; and 17.37 +/- 9.79% vs. 7.87 +/- 4.98% and 6.90 +/- 5.22%, respectively, p < 0.05). UA O2 saturation fell to zero in some cases in the combined spinal-epidural group, without an evident effect on fetal well-being. No fetal acidemia was noted in any group. Neonatal outcomes were similar in the three groups studied. CONCLUSIONS: Type of anesthesia does not influence short-term outcomes in infants born via elective Cesarean section, although differences in acid-base status of both the mother and especially the newborn recommend careful use of spinal anesthesia.

Acid-Base Equilibrium↗

PubMed2003

Matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 in plasma/serum and urine of women during term and threatened preterm labor: a clinical approach.

OBJECTIVE: To explore the concentrations of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in plasma, serum and urine of women during term and threatened preterm labor. METHODS: Plasma and urine proMMP-9 as well as serum and urine TIMP-1 were evaluated in 60 healthy pregnant women; 20 of them presented in term labor following an uncomplicated pregnancy, 20 of them presented with threatened preterm labor and intact membranes at 24-36 gestational weeks and 20 of them were at 24-40 gestational weeks with no evidence of uterine contractions or other pregnancy complications. Data were analyzed with non-parametric statistical tests and cut-off values were determined with receiver operator characteristic curves. RESULTS: ProMMP-9 values were significantly higher and TIMP-1 values were significantly lower in cases with uterine term or preterm contractions compared to non-labor status; and in cases with preterm contractions that progressed to true preterm labor compared to those in which contractions were arrested. CONCLUSIONS: Alterations in the concentrations of proMMP-9 and TIMP-1 can be detected in plasma or serum and urine of pregnant women experiencing term or preterm uterine contractions. The altered values of proMMP-9 and TIMP-1 could possibly identify the inevitable progress of preterm contractions to true preterm labor.

Adult↗

PubMed2002

Fetoplacental leptin levels and their relation to birth weight and insulin in gestational diabetic pregnant women.

To investigate the fetoplacental leptin circulation in gestational diabetes, we compared cord leptin and insulin levels in 17 healthy pregnant women and 17 women with gestational-onset diabetes. Leptin levels in the umbilical arteries (mean+/-SD 1.80+/-0.76 ng/ml) were significantly (P<0.006) lower than those in umbilical veins (2.67+/-0.98 ng/ml) in normal pregnancies. Similarly, leptin levels in umbilical veins (mean+/-4.59+/-1.60 ng/ml) were significantly (P<0.001) higher than those in umbilical arteries (mean+/-SD 2.08+/-0.90 ng/ml) in gestational diabetes. However, leptin levels in umbilical veins were significantly higher (P<0.002) in gestational diabetes than those in controls. Additionally, in women with diabetes but not in controls, the birth weight and the cord leptin concentrations were positively related to cord insulin levels. We conclude that there is a hyperleptinaemia in the fetoplacental circulation in pregnant women with carbohydrate intolerance and in these cases insulin and leptin may have antagonist roles regarding fetal development.

Adult↗

PubMed2002

Maternal homocysteine levels and plasma lipids in gestational diabetes: is there any relationship?

The aim of the study was to investigate the possible relationship between maternal homocysteine levels and plasma lipid parameters and whether gestational diabetes can alter the serum maternal concentration of this substance. The study included 36 primigravidas divided into two groups: group A consisted of 21 healthy pregnant women with a mean gestational age of 38.2 weeks, and group B consisted of 15 diabetic women with a mean gestational age of 38.4 weeks. No difference in maternal homocysteine levels was noted between the two groups (6.006 +/- 1.64 vs. 7.004 +/- 1.36 micromol/L). Serum cholesterol levels and serum triglyceride levels in normal pregnant women were not statistically significantly different compared to those seen in diabetic pregnant women. Similarly, no difference was found between the two groups regarding LDL levels and atheromatic index. In women with diabetes there was a weak positive relation between plasma concentrations of homocysteine and LDL levels as well as atheromatic index, but this relation was not statisticially significant. We conclude that serum homocysteine levels are not elevated in women with gestational-onset diabetes. There was also no relation between serum concentrations of homocysteine and lipid parameters in this complication of pregnancy.

Adult↗

PubMed2002

Abnormal fetal heart rate patterns during the active phase of labor: the value of fetal oxygen saturation.

OBJECTIVE: To determine the predictive value of intrapartum fetal oxygen saturation (SO2) for prediction of an umbilical artery pH less than 7.15 at birth in labors complicated by abnormal fetal heart rate traces. STUDY DESIGN: Eighty-five primigravidas in spontaneous labor complicated by abnormal fetal heart rate traces underwent fetal SO2 monitoring using the fetal pulse oximetry technique. Cases with an SO2 of < 30% were delivered by Cesarean section. Umbilical artery pH was measured at birth in all women. RESULTS: With the value set of 30% as the cut-off point of fetal oxygen saturation, the positive predictive value for umbilical artery pH of < 7.15 was 61.5% and the negative predictive value was 95.8%, with a sensitivity of 72% and a specificity of 93%. CONCLUSIONS: Fetal pulse oximetry is a promising technique for assessment of fetal well-being during labor and may decrease the number of unnecessary Cesarean sections.

Female↗