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Biomedical subjects

G Creatsas

Publications and source records attributed to G Creatsas.

At least 73 records · Page 4Linked to original sources
PubMed2001

Evidence for a suppression of apoptosis in early postnatal life.

BACKGROUND: In fetal life the rates of proliferation and apoptosis are high. We studied if the rate of apoptosis decreases after birth, by measuring the soluble (s) forms of Fas-Fas ligand and Tumor necrosis factor receptor 1 (TNFR1)-TNF-alpha which attenuate apoptosis. SUBJECTS AND METHODS: Blood was drawn from the umbilical cord and from a peripheral vein on day 1 and 4 of life in 35 infants and sFas, sFas ligand, sTNFR1 and sTNF-alpha were determined by enzyme immunoassays. Data were analyzed by paired t-test and Pearson's correlation analysis. RESULTS: sFas and sTNF increased significantly from birth to day 4 of life (p=0.033 and p<0.0001 respectively), while sTNFR1 increased significantly from birth to day 1 of life (p<0.0001) followed by a significant decrease on day 4 of life (p<0.0001). The levels of sFas and sTNF-alpha on day 1 correlated with those on day 4 (r=0.677, p<0.0002 and r=0.525, p<0.007 respectively). sFAS ligand was not detectable in any specimen. CONCLUSION: The increasing concentrations of the soluble molecules, sFas, sTNF-alpha and sTNFR1 might indicate that apoptosis may be downregulated in early postnatal life.

Apoptosis↗
PubMed2001

Management of stress urinary incontinence in women with the use of tension-free vaginal tape.

OBJECTIVES: The objective of this study was to assess the effectiveness and the complications associated with the use of tension-free vaginal tape (TVT) and to assess the possibility of using TVT in combination with anterior colporrhaphy for the management of cystocele. METHODS: Sixty-eight patients who were treated with the TVT procedure for the management of stress incontinence were included in the study. All patients were comparable as regards their age, parity, and BMI. RESULTS: A 90% success rate was achieved at 24 months' follow-up for patients with stage I cystocele, while the success rate of the TVT procedure in patients with anterior coloporrhaphy and TVT was 88.8% at 24 months' follow-up. CONCLUSIONS: TVT seems to be a very good alternative procedure for the management of stress incontinence in women and can be combined with anterior colorrhaphy for the management of cystocele.

Colposcopy↗
PubMed2001

Maternal plasma leptin levels and their relationship to insulin and glucose in gestational-onset diabetes.

To investigate the changes in leptin levels and the relationship between this substance and insulin and glucose in pregnant women with gestational-onset diabetes, we measured plasma leptin levels in the maternal peripheral vein of 17 healthy and 17 diabetic women at 29 and 33 weeks of gestation. We also correlated maternal plasma leptin levels in diabetic women with fasting plasma insulin levels and plasma glucose levels obtained 1 h after oral administration of 50 g of glucose. Maternal serum leptin levels in women with gestational diabetes (mean +/- SD 16.52 +/- 5.07 ng/ml, range 10.84-27.4 ng/ml) were significantly higher (p < 0.001) than those found in uncomplicated pregnancies (10.61 +/- 1.47 ng/ml, range 7.28-13.4 ng/ml). A positive correlation was found between maternal serum leptin levels and glycosylated haemoglobin values in diabetic pregnant women (r = 0.94, p < 0.001). A positive correlation was also found between maternal leptin concentrations and fasting serum insulin levels, as well as between leptin concentrations and plasma glucose levels obtained 1 h after the administration of 50 g of glucose in women with gestational diabetes (r = 0.84, p < 0.001, and r = 0.92, p < 0.001, respectively). We conclude that leptin levels are elevated in pregnant women with gestational diabetes, and its metabolism depends on insulin levels and the severity of diabetes.

Adult↗
PubMed2001

Pudendal nerve terminal motor latency in women with genuine stress incontinence and prolapse.

The aim of this study was to investigate changes in pudendal nerve terminal motor latency (PNTML) time in women with genuine stress incontinence (GSI) and with or without prolapse, in conjunction with measurement of maximal urethral closure pressure (MUCP). Eighty-five patients participated in the study and they were allocated to one of four groups, including the control group. A statistically significant difference was found in the PNTML time between patients with GSI and patients of the control group. The conduction time in patients with prolapse but no GSI did not show a statistically significant difference compared to the patients of the control group. The MUCP was reduced in patients with GSI, but no cutoff value of MUCP, which is pathognomonic of GSI, could be identified. We conclude that GSI is associated with a prolongation of PNTML time and a reduction in MUCP.

Adult↗
PubMed2001

A multinational evaluation of the efficacy, safety and acceptability of the Protectaid contraceptive sponge.

OBJECTIVE: The Protectaid sponge (Gefar Pharma, Switzerland) is a new feminine barrier contraceptive method containing three low-dose spermicidal agents. In order to evaluate its efficacy and safety profiles, an international, multicenter study has been conducted in four countries. METHODS: Healthy, presumably fertile and sexually active women were enrolled in this study and were followed at 15 days, 3, 6, 9 and 12 months. Contraceptive efficacy was assessed by a pregnancy test, while safety was evaluated by performing gynecological examinations as well as reporting adverse events. The 'acceptability' of the sponge by the women was assessed through a standard questionnaire. RESULTS: A total of 129 women were enrolled in the study, generating 1182 cycles of use of the sponge. The overall efficacy rate was 77%, with no significant influence of age or parity. Acceptability was high, with 85% of subjects being symptom- or problem-free while using the sponge. Finally, the safety profile was very good, with no clinically significant evidence of local or systemic adverse reactions. CONCLUSION: The new Protectaid sponge is a safe and effective non-hormonal contraceptive method for women.

Administration, Intravaginal↗
PubMed2001

Differential effects of raloxifene and continuous combined hormone replacement therapy on biochemical markers of cardiovascular risk: results from the Euralox 1 study.

OBJECTIVE: To compare the effects of the selective estrogen receptor modulator (SERM) raloxifene (Evista) and a continuous combined hormone replacement therapy (ccHRT) formulation containing estradiol and norethisterone acetate (Kliogest) on lipid and fibrinogen levels of postmenopausal women. METHODS: Euralox 1 was a prospective, randomized, double-blind trial. After a placebo wash-out, healthy postmenopausal women (n = 1008, average age 56.1 +/- 4.9 years) with a health risk profile that suggested a potential benefit from either treatment were randomly assigned to either 60 mg raloxifene or ccHRT consisting of 2 mg estradiol and 1 mg norethisterone acetate (NETA) per day for 6 months. MEASUREMENTS: Total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol with its fractions HDL2 and HDL3, the LDL/HDL ratio, triglycerides and fibrinogen were assessed at baseline and after 6 months or on early drop-out. RESULTS: Baseline values were comparable between the two groups. Blood samples of 841 women (83.4%) were available at baseline and endpoint. Total and LDL cholesterol decreased statistically significantly from baseline to endpoint in both treatment arms (by 7.2% and 3.8% with raloxifene and by 13.0% and 8.9% with ccHRT, respectively). Raloxifene produced a statistically significant increase in HDL cholesterol by 4.2%, while ccHRT induced a decline by 9.5%. Triglycerides were moderately suppressed with raloxifene and ccHRT, by 3.6 and 5.4%, respectively. Fibrinogen fell by 7.0% with raloxifene and rose by 3.6% with ccHRT. CONCLUSIONS: Continuous combined HRT was associated with decreases in total cholesterol and LDL cholesterol about twice as large as with raloxifene, but also with a decrease in HDL cholesterol. The smaller decreases in total cholesterol and LDL cholesterol associated with raloxifene were accompanied by an increase in HDL cholesterol and a decrease in fibrinogen. In conclusion, raloxifene affects fibrinogen concentrations and the overall cholesterol profile more favorably than ccHRT; these differences may have important implications for the reduction of cardiovascular disease.

Cholesterol↗
PubMed2001

[Description of 8 cases with gonadal dysgenesis syndrome type 46XY].

It is described the clinical evaluation of eight cases with gonadal dysgenesis syndrome type 46XY diagnosed and followed in our division of Pediatric-Adolescent Gynecology since 1992 to January 2000. Two out of eight patients presented pure gonadal dysgenesis (Swyers syndrome), one presented 17-beta-hydroxysteroid-deydrogonase deficiency and the rest five presented Testicular Feminization Syndrome. The adolescents visited our department for the first time while being fifteen years old because of primary amenorrhea and growth retardation of secondary sex features. Apart from interview, physical and gynecological examination we performed complimentary haematological, biochemical, hormonal tests and confirmed the diagnosis by chromosomal analysis. Studying the upper and lower abdomen by the means of imaging methods (U/S and CT) we found out the presence of uterus and in few cases the gonadal position. Because of the high risk of malignancy all the patients underwent surgical gonadectomy. Postoperatively hormonal replacement therapy was administered to reinforce the female sex features and prevent the hormonal deficiency consequences like osteoporosis. The follow up included haematological, biochemical and hormonal tests. If uterus existed the endometrium thickness measured by ultrasound. Furthermore bone density, palpative and ultrasonography breast examination and investigation of possible psychological disorders insure the complete screening of the young "female" patients.

17-Hydroxysteroid Dehydrogenases↗
PubMed2000

Changes in the quantity of collagen type I in women with genuine stress incontinence.

The aim of this study, was to examine changes in the quantity of collagen type I in the pubocervical fascia of women with genuine stress incontinence (GSI), with and without pelvic relaxation. Seventy-eight patients participated in the study and they were divided into three groups that were comparable with respect to their age and parity. All the patients underwent filling cystometry and patients with detrusor instability were excluded from the study. Biopsies were obtained from the pubocervical fascia. The presence of collagen type I was determined with an immunohistochemical technique. The X-test was used for statistical analysis and a P < 0.05 was considered statistically significant. Collagen type I was significantly reduced in patients with GSI irrespective of the presence or absence of genital prolapse. Thus we found that women with GSI had a significant reduction of collagen type I in the pubocervical fascia which consequently affects the tensile strength of the pubocervical fascia and the support provided to the bladder neck.

Adult↗
PubMed2000

Serum soluble E- and L-selectin in the very early neonatal period.

Both E- and L-selectin are cell adhesion molecules. E-selectin is expressed by activated endothelial cells, whereas L-selectin by quiescent leukocytes and is rapidly cleaved off after activation. Both selectins take part in the first step of the 'adhesion cascade', the 'rolling of leukocytes', leading to the extravasation of the white cells to the sites of inflammation, infection or damage. For this reason their soluble forms (sE- and sL-selectin, respectively), are considered early and reliable markers of the immune activation and response. Moreover, sE-selectin has been reported to be a potent angiogenic factor and a reliable marker of infection and sepsis in neonates, as well as endothelial activation, while sL-selectin of the leukocyte function and maturity. Following informed maternal consent, we evaluated prospectively by ELISA, sE- and sL-selectin in the serum of 40 (19 females, 21 males), healthy, term, infection-free neonates, on the second and fifth day of life, and compared them with the respective values in 20 healthy adults (10 females, 10 males), with the purpose of examining the pattern of their values in the early postpartum days, and to establish reference values for both selectins. Values (mean+/-S.D.) of sE-selectin both on the second (139+/-48 ng/ml) and fifth day of life (111+/-35 ng/ml) were found to be highly increased, as compared with those in controls (48+/-13 ng/ml; P<4 x 10(-11) and P<4 x 10(-10), respectively), while sL-selectin values on both the second (674+/-223 ng/ml) and the fifth day of life (684+/-221 ng/ml), were significantly lower than those in controls (938+/-181 ng/ml); P<0.0001 and P<0.0003, respectively). A significant decrease was noted in sE-selectin values, from the second to the fifth day of life (P<10(-7)), while sL-selectin values showed no significant change in the same time interval. A strong correlation was found between values on the second and the fifth day of life of both sE- and sL-selectin (r(P)=0.885 and r(P)=0.813, respectively; P<0.00001). Neonatal values of both sE- and sL-selectin on the second or on the fifth day of life, did not depend on the perinatal factors, neonatal sex, or birth weight, mode of delivery, and maternal age or parity. In conclusion, in the very early neonatal period, our findings of highly increased sE-selectin, while low sL-selectin, suggest an immune and more specifically endothelial activation and an immature and decreased leukocyte function.

Adult↗
PubMed2000

Serum leptin concentrations during the perinatal period.

We aimed to study maternal and infant serum leptin concentrations during the perinatal period and their relationship to the body weight of mothers and newborns. Serum leptin values were measured by enzyme-linked immunoadsorbent assay (ELISA) (R&D systems) in 26 healthy, term neonates during the first (N1) and fifth (N5) day after birth and were compared with serum leptin values in maternal blood (MS), amniotic fluid (AF), and umbilical cord (UC) at delivery. Twenty-five healthy, nonpregnant women, age and body weight-matched to the mothers, were used as controls (C). Infant serum leptin concentrations declined significantly after birth from UC to the N5 samples (p<0.003). MS leptin values were significantly higher than UC, N1, N5, and C values (p<0.001), while AF values were significantly lower than in controls (p<0.001). UC, but not MS leptin values correlated significantly with the birth weight of infants (r = 0.6; p<0.03). The elevated values of leptin in maternal serum and the regressing pattern of infant leptin values after birth suggest an additional, probably placental source of this protein during pregnancy, possibly contributing to the regulation of fetal body weight.

Adult↗
PubMed2000

Soluble form of ICAM-1, VCAM-1, E- and L-selectin in human milk.

In breast milk and paired serum from 70 lactating women and 40 of their term, infection-free neonates, on the 2nd and 5th day postpartum slCAM-1, sVCAM-1, sE- and sL-selectin were measured by ELISA and compared with those in 26 healthy adults (controls). Seven infant formulas and fresh milk from five cows were also analyzed. Human colostrum values of slCAM-1, sVCAM-1 (similar to those in maternal and control serum), sE-selectin and sL-selectin (-10 and -100 times lower than in maternal and control serum) were significantly higher than those in milk, while they varied widely. None of the adhesion molecules was detected in fresh cow's milk or infant formulas. Exclusively breast-fed infants showed significantly higher values of slCAM-1 and sL-selectin on the 2nd day of life than those supplemented also with formula. Only slCAM-1 values correlated positively between colostrum and time-matched maternal serum. These findings show in human milk important amounts of slCAM-1 and sVCAM-1 but minimal amounts of sE- and sL-selectin, which could affect the immune system of the neonate.

Adult↗
PubMed2000

Correlation between an early sexual debut, and reproductive health and behavioral factors: a multinational European study.

OBJECTIVE: To investigate whether women who made an early sexual debut differ from those with a later debut regarding genital signs and symptoms. METHODS: The study included women who considered themselves gynecologically healthy and who attended 17 family planning centers in 13 European countries for contraceptive advice. There were 629 women who made their sexual debut at the age of 16 years or earlier (study population) and 927 women who had their first sexual intercourse at the age of 19 years or later (comparison group). Genital symptoms and signs, contraceptive use, smoking, and genital hygiene habits and previous genital infections were recorded on a structured patient record form. Detection of Chlamydia trachomatis was made by means of a polymerase chain reaction on first-void urine. The study was made, on average, 7-10 years after the women's sexual debut. RESULTS: The mean age of first intercourse was 15.3 years for the study group versus 20.7 years for the control group (p < 0.001). The study population had significantly more symptoms, such as vaginal discharge and pruritus, and signs, such as abnormal discharge, erythema of the vaginal mucosa and lower genital tract infections, than the comparison group. Twice as many women in the study group were smokers and there was a ten-fold increase among these subjects of using low-pH solutions for genital hygiene. The prevalence of C. trachomatis infection did not differ between the two groups (p = 0.22). CONCLUSION: Age at first intercourse is not only a predictor of sexual risk behavior, but also a predictor, regarding both signs and symptoms, of future gynecological problems.

Adolescent↗
PubMed2000

Clinical implications of the ovarian/endometrial renin-angiotensin-aldosterone system.

New organ-specific functions of angiotensin II have recently been described: the importance of its role in the regulation of secretory epithelial function in many tissues including components of the reproductive tract has been documented. The source of angiotensin II in these tissues is the reproductive tract itself, and there is considerable evidence to suggest a distinct renin-angiotensin-aldosterone system in the ovary and uterus. Two main subtypes of angiotensin II receptors are recognized as angiotensin-receptor I and II, according to their sensitivity to the angiotensin II antagonists. However, the presence of angiotensin II receptors in the male and female reproductive tract suggests a multiplicity of roles that are unrelated to their primary functions or to each other. The renin-angiotensin-aldosterone system is a major determinant of sodium balance in pregnancy. More recently RT-PCR methods have revealed angiotensinogen transcription in the smooth muscle of spiral anteries of the decidua; a specific allele of this gene may be associated with hypertension in pregnancy as well as in pre-eclampsia. We investigated the evolution of plasma renin activity and aldosterone levels during normal and hypertensive pregnancy. Both were found to increase progressively during all three trimesters of normotensive pregnancy. Plasma renin activity in hypertensive women remained unchanged during all three trimesters of pregnancy. Plasma aldosterone levels in hypertensive women increased progressively during all three trimesters of pregnancy. However, plasma aldosterone levels remained significantly lower than the ones of normotensive pregnant women. These increased aldosterone levels were noticed despite unchanged renin levels. Further clinical studies investigating the renin-angiotensin-aldosterone system in the pathogenesis of pregnancy hypertension are needed. A renin-independent role of aldosterone in this pathological entity is suggested.

Aldosterone↗
PubMed2000

Angiogenic factors in the perinatal period: diversity in biological functions reflected in their serum concentrations soon after birth.

These studies investigated whether serum levels of the angiogenic factors angiogenin, basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF) change soon after birth due to the elimination of the placenta and to diminished angiogenic but increased adaptational demands in extrauterine life. Also investigated was whether serum levels correlate with sex, birth weight, or mode of delivery. Serum from healthy mothers and their healthy full-term infants at birth (umbilical cord, UC), day 1 (N1) and day 4 (N4) postpartum was analyzed by enzyme immunoassays. Angiogenin levels were higher in maternal serum and rose significantly from UC to N1 and N4, possibly because of the elimination of the placenta, which produces an angiogenin inhibitor. bFGF and VEGF maternal levels were lower than fetal and neonatal ones. Although neonatal bFGF levels did not differ from fetal levels, possibly reflecting diminished angiogenesis ex utero, VEGF levels increased in neonatal serum, possibly signifying adaptational demands. Neither factor depended on sex, mode of delivery, or birth weight. Thus, significant differences from normal reference values of the studied factors might reflect ill-defined situations of the placenta and fetus/newborn serving as early diagnostic markers.

Angiogenesis Inducing Agents↗