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Biomedical subjects

S Michalas

Publications and source records attributed to S Michalas.

At least 91 records · Page 5Linked to original sources
PubMed1998

Fetal blood sampling--indication-related losses.

The aim of this study, was to determine the fetal loss rate after fetal blood sampling (FBS) in relation to the indication. In total, 1981 FBS procedures (1878 pregnancies) were included, of which 117 were performed for the detection of congenital infection (group 1), 1437 for the detection of haemoglobinopathy (group 2), 233 for prenatal diagnosis with normal ultrasound findings (group 3), 121 for rapid karyotyping in cases with abnormal sonographic findings (group 4) and 73 for severe growth retardation (group 5). All the procedures were performed with a free-hand technique under continuous ultrasound guidance. Pregnancy losses occurring within two weeks of FBS were considered procedure-related losses. 343 pregnancies were terminated. Of the remaining 1535 continuing pregnancies, 73 (4.8 per cent) were lost, of which 39 (2.5 per cent) were lost within two weeks of the procedure. The procedure-related losses were 3 in 103 (2.9 per cent), 17 in 1090 (1.6 per cent), 2 in 191 (1 per cent), 11 in 84 (13.1 per cent) and 6 in 67 (8.9 per cent) in groups 1, 2, 3, 4 and 5, respectively. The differences in procedural loss between the five groups were highly significant, suggesting that the method entails a much higher risk when the fetus is structurally abnormal, or severely growth retarded. Patients should therefore be counselled before the procedure accordingly.

Adolescent↗
PubMed1998

Favorable outcome of ovarian germ cell malignancies treated with cisplatin or carboplatin-based chemotherapy: a Hellenic Cooperative Oncology Group study.

PURPOSE: To evaluate the outcome and the prognosis of patients with ovarian germ cell malignancies who were treated with platinum-based chemotherapy immediately after initial surgery. METHODS: We conducted a retrospective review of patients with ovarian germ cell tumors who were referred for consideration of treatment to the Departments of Medical Oncology participating in the Hellenic Cooperative Oncology Group. RESULTS: Over a 14-year period 53 patients were included in our study. There were 13 patients with dysgerminoma and 40 patients with nondysgerminomatous tumors. Forty percent of patients underwent complete resection of their tumors. Platinum-based chemotherapy consisted primarily of cisplatin, vinblastine, and bleomycin (PVB) in 9 patients; bleomycin, etoposide, and cisplatin (BEP) in 15 patients; and bleomycin, etoposide, and carboplatin (BEC) in 25 patients. With a median follow-up of 39 months, 5 patients developed progressive disease and died of their tumor and 1 patient died of bleomycin-induced lung toxicity with no evidence of active tumor. The 5-year overall survival was 100% for patients with dysgerminoma and 85% for patients with nondysgerminomatous tumors. Eighty percent of patients with advanced nondysgerminomatous tumors and residual disease after surgery remain disease free. CONCLUSION: With this study we confirm that patients with ovarian germ cell malignancies have a favorable outcome when treated with platinum-based chemotherapy.

Adolescent↗
PubMed1998

Cathepsin D immunoreactivity in ovarian cancer: correlation with prognostic factors.

In view of the somewhat inconclusive nature of the reports of the role of Cathepsin D (Cath D) in ovarian carcinoma and its relationship with various other parameters of malignancy the present study was performed to aid in the further clarification of this role. One hundred freshly resected primary ovarian carcinomas of various histological types were studied for ER, PR and Cath D status and the results examined with respect to menopausal status, histology, size and lymph node invasion. In our series Cath D positivity was more frequent in serous than in other types of ovarian cancer but this Cath D positivity was not related to the frequency of lymph node invasion regardless of the size of the tumor. Nor was any association observed between Cath D positivity and ER or PR status of the tumors or the menopausal state of the patients. The reported prognostic value of Cath D, ER and PR is discussed as well as the distinction between tumor invasion by lymphatic channels and direct interstitial infiltration. It was concluded that Cath D may not play a role in the former mode but, as might be expected from its proteolytic properties, in local spread by means of tissue destruction.

Adenocarcinoma↗
PubMed1998

Factors affecting postoperative pregnancy rate after endoscopic management of large endometriomata.

OBJECTIVE: To identify factors influencing postoperative pregnancy rate in women with extensive endometriosis and large endometriomata as the only identified cause of infertility that were treated by laparoscopy. METHOD: Sixty-four infertile patients with endometriomata (> or = 3 cm) and no other apparent cause of infertility. The latter were removed by operative laparoscopy. Life table calculations, the Student's t-test and the chi2 test were used where appropriate. RESULT: Thirty-four patients (53%) became pregnant during the 2-year follow-up period. A significantly increased pregnancy rate was found for the first year compared to the second (76 vs. 24%). The existence of adhesions affected adversely the outcome of the operation only as far as early achievement of pregnancy is considered. The number and size of endometriomata and the existence of peritoneal implants have not been found to affect pregnancy rates. The severity of the disease did not affect pregnancy rate, but in the cases with moderate disease most of the pregnancies were achieved during the first postoperative year. The duration of infertility was significantly associated only at the 10% level with decreased pregnancy rates. CONCLUSION: Extensive endometriosis with large endometriomata can be safely and effectively treated with laparoscopy using the traditional laparoscopic tools providing the infertile patient with a high chance to conceive in a relatively short period of time postoperatively.

Adult↗
PubMed1998

The effect of the duration of GnRH-agonist down regulation before ovarian stimulation on the biological and clinical outcome after intracytoplasmic sperm injection.

The object of this study was to compare the biological outcome (oocyte maturity, fertilization, cleavage) and the clinical outcome after a 'long' (15-24 days) and a 'long-long' (25-40 days) protocol of GnRH-agonist administration for intracytoplasmic sperm injection. Group A consisted of 51 patients with a 15-24-day down regulation period and Group B consisted of 35 patients with a 25-40-day down regulation period, all of which entered ICSI due to severe male factor infertility. Duration and amount of gonadotropin stimulation, serum E2 on the day of hCG administration, number of oocytes retrieved, oocyte maturity, fertilization rate, cleavage rate and pregnancy outcome were comparable for the two groups of patients. Therefore, a flexible period of pituitary desensitization can be employed, allowing us to simplify planning for patients and for the medical staff without affecting the outcome of the trial.

Adult↗
PubMed1998

Expression of p53, bcl-2 and heat shock protein (hsp72) in malignant and benign ovarian tumours.

The occurrence of p53, bcl-2 and heat shock protein (HSP) expression in ovarian tumours was examined and the correlation was investigated between the expression of these proteins and other disease parameters, including FIGO stage, histological subtype, tumour differentiation and steroid hormone receptor status. We analysed p53, bcl-2 and HSP expression in 100 smears of patients with epithelial ovarian carcinomas, 16 smears of patients with borderline malignancy and 20 smears of patients with benign ovarian neoplasms by using immunocytochemical techniques. There were 29 patients with stage I disease, 24 with stage II disease, 40 with stage III disease and seven with stage IV disease according to the FIGO classification. The sensitivities and specificities of bcl-2, p53 and HSP for malignancy were 53% and 40%, 43% and 80%, and 37% and 90%, respectively. HSP was statistically significantly associated with malignant rather than benign tumours. Significant association was also observed between bcl-2 and p53, and p53 and HSP. The association of HSP with malignant tumours is confined to the premenopausal group of patients and in this group by itself there is also a significant association between p53 and malignancy. HSP and p53 were associated with undifferentiated carcinomas, bcl-2 and p53 expression is reduced as disease stage progresses in serous carcinomas and bcl-2 expression is increased as disease progresses in endometrioid carcinomas. There was no significant association between bcl-2 and ER/PR status. In conclusion, HSP has a high specificity for malignant ovarian tumours, bcl-2 and p53 have only moderate to low sensitivity and specificity. Changes in the frequency of bcl-2 and p53 overexpression between FIGO I and FIGO III stage disease of different ovarian carcinomas indicate a different role of these substances in cellular survival mechanisms in different carcinomas. bcl-2 probably is associated with cell proliferation but not with differentiation.

Adult↗
PubMed1998

Circulating endothelin-3 and prolactin concentrations in healthy lactating women during the early puerperium.

OBJECTIVE: To study the association between the circulating concentrations of endothelin-3 and prolactin in the early puerperium. DESIGN: Prospective clinical study, including twenty-five healthy puerperal women breast-feeding their healthy full-term infants. METHODS: Venous blood was drawn on day 1 and 4 post partum, and plasma endothelin-3 and serum prolactin were determined. RESULTS: Circulating endothelin-3 and prolactin levels on day 4 did not differ significantly from the corresponding levels on day 1. However, a significant negative correlation was found on day 4 between endothelin-3 and prolactin values (r = -0.688, P < 0.001) and an even stronger negative association existed between the net change in endothelin-3 from days 1 to 4 and the corresponding change in prolactin values (r = -0.732, P < 0.001). CONCLUSIONS: On the fourth day post partum, lactating healthy women show negative correlation between circulating endothelin-3 and prolactin levels. Whether this indicates a role for endothelin-3 in the control of prolactin secretion in the post partum period remains to be clarified.

Endothelin-3↗
PubMed1997

A phase II trial of methotrexate, vinblastine, doxorubicin, and cisplatin in the treatment of metastatic carcinoma of the uterine cervix.

BACKGROUND: Patients with metastatic carcinoma of the uterine cervix have limited survival. Thus, new chemotherapeutic agents and combinations are needed to improve patient outcome. METHODS: Twenty-seven patients with Stage IV primary or recurrent carcinoma of the uterine cervix were assigned to chemotherapy treatment at 4-week intervals with methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC). The treatment was comprised of methotrexate, 30 mg/m2 administered intravenously (i.v.) on Days 1, 15, and 22; vinblastine, 3 mg/m2 i.v. on Days 2, 15, and 22; doxorubicin, 30 mg/m2 i.v. on Day 2; and cisplatin, 70 mg/m2 i.v. on Day 2. Granulocyte-colony stimulating factor (G-CSF) was given subcutaneously on Days 6-10 at a dose of 5 micrograms/kg. RESULTS: After a median of 4 cycles (a maximum of 6 in responders), the authors observed objective responses in 14 patients (52%), including 3 complete responses (11%) and 11 partial responses (41%). Median overall survival was 11 months (range, 4-15+ months), and median progression free survival of the responders was 8 months (range, 6-15+ months). Toxicity was acceptable and included neutropenia, alopecia, vomiting, and stomatitis. CONCLUSIONS: MVAC is an active regimen in the treatment of patients with advanced or recurrent carcinoma of the uterine cervix. It produced responses in one-half of the patients in this study, and it can be administered on an outpatient basis. The addition of G-CSF appears to reduce hematologic toxicity.

Adult↗
PubMed1997

Reconstruction of urethrovaginal fistula and vaginal atresia in an adolescent girl after an abdominoperineal-vaginal pull-through procedure.

OBJECTIVE: To report a rare case of urethrovaginal communication and vaginal atresia. DESIGN: To reconstruct the communication and the vaginal route. SETTING: Division of Pediatric and Adolescent Gynecology and Corrective Gynecological Surgery, University of Athens, and "Alexandra" Hospital. PATIENT(S): A 16-year-old girl with cyclic hematuria, periodic pelvic pain, and primary amenorrhea. INTERVENTION(S): Diagnostic studies, followed by an abdominoperineal-vaginal pull-through procedure. MAIN OUTCOME MEASURE(S): Reconstruction of the urethrovaginal fistula and vaginal route. RESULT(S): Normal menstruation through the vaginal route. CONCLUSION(S): A careful examination of every infant's external genitalia should be performed immediately after delivery. A urethrovaginal fistula should be corrected in time to facilitate menstrual flow and improve future reproductive potential.

Adolescent↗
PubMed1997

Immunocytochemical localization of Cathepsin D and CA 125 in ovarian cancer.

OBJECTIVE: To study the expression of Cathepsin D (Cath D) and CA 125 antigens and ER and PR receptors on freshly obtained surgical specimens of ovarian carcinomas and their relationship with menopausal status, tumor histology, primary tumor size and lymph node invasion. METHODS: The tumors obtained from 100 women were measured and cut in half. The cut surface of one half was pressed against glass slides which were air dried and stained using the Avidin-Biotin peroxidase method for Cath D and CA 125 antigens. The slides were viewed under the light microscope for the characteristic brown granules in the cytoplasm or membrane of the malignant cells. The other half of the tumor was subjected to routine histological examination and part used for the demonstration of ER and PR receptors. The results were analyzed using chi 2 analysis. RESULTS: Cath D positivity was as common as CA 125 positivity. Cath D positivity is more frequently associated with serous carcinomas than with others. No relationship was observed between ER/PR positivity and Cath D or CA 125 positivity. CONCLUSION: The high incidence of Cath D positivity makes it a possible complementary method for following up ovarian carcinoma patients especially those who are CA 125 negative.

CA-125 Antigen↗
PubMed1997

Thrombosis prophylaxis after treatment during pregnancy.

Deep vein thrombosis (DVT) is not a rare occurrence during pregnancy and puerperium due to changes in the coagulation mechanism. Eighteen cases with DVT during pregnancy are presented here. All of them received subcutaneous heparin for two weeks at a dose adjusted so as to prolong the activated partial thromboplastin time, or plasma recalcification time, to twice that of normal controls. Treatment continued with low molecular weight heparin (LMWH), once daily subcutaneously, for the duration of pregnancy and for one month postpartum. All women went into labor uneventfully, except for one who had a missed abortion during the 10th week. No side-effects were observed. LMWH has some advantages compared with standard heparin, which make it the treatment of choice for the prevention of thromboembolic events in pregnant women.

Adult↗
PubMed1997

Percutaneous management of lymphocoeles following pelvic lymphadenectomy for cervical carcinoma.

Eighteen patients with 26 pelvic lymphocoeles following radical hysterectomy underwent percutaneous therapeutic intervention with either needle aspiration, or catheter drainage. In eight patients a percutaneous needle aspiration under sonographic control was performed. Five out of eight patients were successfully managed with needle aspiration, three of them requiring repetitive aspirations. Thirteen patients, with a total of 21 lymphocoeles underwent catheter drainage. Seventeen of the 21 lymphocoeles completely resolved. Redrainage was performed in four cases and it was successful in two of them. The duration of the catheter drainage was 8 to 34 days. Nine of the lymphocoeles were infected at initial drainage. Two patients underwent surgery because of increased volume of output. Percutaneous drainage is a safe and effective method and should be considered as the initial treatment for all patients with postoperative lymphocoeles.

Journal Article↗
PubMed1997

Effects of two combined monophasic and triphasic ethinylestradiol/gestodene oral contraceptives on natural inhibitors and other hemostatic variables.

OBJECTIVE: To evaluate the effects of two preparations of combined oral contraceptives (COCs), the monophasic COC containing 30 micrograms ethinylestradiol and 75 micrograms gestodene and the triphasic COC containing 30/40/30 ethinylestradiol and 50/70/100 micrograms gestodene on seven natural inhibitors and hemostatic variables. METHOD: Forty-four healthy young women, randomly allocated into two groups (A and B) received the two preparations of COCs, respectively. The following variables were tested in a basic examination and at 1-, 3- and 6-month intervals to evaluate the role of the above preparations on the hemostatic balance of prothrombin time, fibrinogen, antithrombin III activity, protein C activity, total protein S antigen, plasminogen activity and lupus anticoagulant. RESULTS: Group A women presented shorter prothrombin time at 6 months, an increased fibrinogen level at 3 months, no influence on the anticoagulant factors, antithrombin III, protein C and total protein S and an increased plasminogen activity at the 1st and 3rd months of treatment. On the other hand, group B women presented shorter prothrombin time at 3 months, no increase in fibrinogen, a decrease in antithrombin III activity and total protein S activity at the 6th month, whereas protein C and plasminogen activities were found to be increased at the 3rd and 1st, 3rd and 6th month, respectively. CONCLUSIONS: The study did not find differences between the two treatment groups, for the evaluated parameters. This finding is clearly important in the light of the recent epidemiological reports on third-generation COCs. However, differences were found among the various periods of administration of both COCs.

Adolescent↗
PubMed1997

Expression of cathepsin-D, CA125 and epidermal growth factor receptor in imprint smears of ovarian carcinoma.

One hundred primary ovarian cancers were studied for the expression of cathepsin-D, CA125 and epidermal growth factor receptor (EGF-R) by staining of imprint smears from freshly obtained surgical specimens. Estrogen and progesterone receptors of the primary tumor, lymph node invasion, menopausal status of the patients and primary tumor size were also noted. The polymorphism of the antigenic characteristics of ovarian carcinomas was noted and significant associations of EGF-R positivity and lymph node negativity, EGF-R positivity and serous carcinomas, EGF-R positivity and cathepsin-D positivity, cathepsin-D positivity and CA125 positivity, and CA125 positivity and serous carcinomas were observed. The high incidence of cathepsin-D positivity makes it a possible complementary method to CA125 for following up patients. It is suggested that complete antigenic profiles of individual tumors are more likely to provide accurate prognostic information in individual cases.

Biomarkers, Tumor↗
PubMed1996

Prevalence study of different hepatitis markers among pregnant Albanian refugees in Greece.

Aim of the study was to record the prevalence of the various types of viral hepatitis, especially hepatitis B, in pregnant Albanian refugees in Greece. The study comprised 500 pregnant refugees of mean age 25.1 +/- 4.6 years. In Albania, all women had lived in overcrowded houses and had been exposed to non throw-away needles and syringes. Various indices for all hepatitis types were determined. The prevalence of HBsAg was 13.4%, of anti-HBs 53%, of total anti-HBc 70.8%, of anti-HBc IgM 0.4%, of HBeAg 1.2%, of anti-HBe 58.6%, of anti-HAV 96.2%, of anti-HAV IgM 1%, of anti-HDV 0.4%, of anti-HCV 0.6% and of anti-HEV 2%. HBeAg was found positive in 7.5% of HBsAg carriers. Prevalence of hepatitis B markers, as determined by HBsAg and/or anti-HBs and/or total anti-HBc was significantly higher in those with a history of previous hospitalization in Albania (p = 0.01) and those with previous history of hepatitis (p = 0.02). The high prevalence of hepatitis B markers in pregnant Albanian refugees proves that HBV infection is highly endemic in Albania and the possibility of perinatal transmission to the offsprings urges for HBV vaccination programmes. On the other hand improvements in the socioeconomic conditions and the sanitation system in Albania is anticipated to reduce the incidence of HAV and HBV infections.

Adolescent↗