Aretaieion Hospital Research Articles

Oxaliplatin-induced Acute Neurotoxicity Recovers Between Repeat Infusion Cycles: An Axonal Excitability Repeated Multiple Measurements Study.

Oxaliplatin, a platinum-based chemotherapy used in the treatment of colorectal cancer, induces acute neurotoxicity following infusion. The aim of this study was to establish whether alterations in axonal excitability develop progressively with higher cumulative doses and whether there is a recovery in motor axons after each cycle of treatment. Twenty consecutive patients with a colorectal cancer diagnosis, referred from the Oncology Department of Aretaieion Hospital of Athens, were enrolled in this study between October 2018 and May 2019. None of the participants had diabetes, alcohol abuse, known neuropathy or were previously treated with another neo-adjuvant therapy. Threshold Tracking techniques and Qtrac software were used for assessing axonal excitability in motor axons. Excitability recordings were undertaken before and immediately after the end of oxaliplatin infusion. Statistically significant changes were found (p<0.01) in axonal excitability (relative refractory period, refractoriness at 2 ms and 2.5 ms, sub-excitability and super-excitability) before and after oxaliplatin infusion. No statistically significant changes (p>0.05) were found in threshold electrotonus and strength-duration parameters before and after oxaliplatin infusion. We also did not find statistically significant differences (p>0.05) between means of excitability parameters before infusion at each cycle. Our study confirms oxaliplatin-induced acute neurotoxicity following infusion and suggests that motor axons recover between repeat infusion cycles.

Climacteric symptoms, age, and sense of coherence are associated with sexual function scores in women after menopause.

Postmenopausal sexual function presupposes the integration of hormonal, neural, and vascular interactions and is subject to optimal crosstalk among psychological, interpersonal, cultural, and environmental factors. Sense of coherence (SOC) reflects a person's ability to cope with stressors and may influence the occurrence of menopausal symptoms and sexual dysfunction. To investigate the association of severity of climacteric symptoms, cardiometabolic risk factors, and SOC with sexual function in postmenopausal women. Overall 281 sexually active postmenopausal women without significant psychopathology or cardiovascular disease attending the Menopause Unit of Aretaieion Hospital were evaluated by the Female Sexual Function Index (FSFI), Greene Climacteric Scale, Beck Depression Scale, and Sense of Coherence Scale. Hormonal and biochemical parameters and cardiometabolic risk factors were evaluated. FSFI scores <26.5 were considered pathologic. Total and subdomain scores of sexual response were determined. Pathologic FSFI scores were found in 79.7% of the sample. Linear models of multivariable regression analysis showed that FSFI scores were associated with (1) Beck scores (b = -0.200; 95% CI, -0.472 to -0.073, P = .001), vasomotor symptom severity (b = -0.324; 95% CI, -0.985 to 0.051; P < .001), and age and (2) SOC (b = 0.150, 95% CI, 0.036-0.331; P = .008), vasomotor symptom severity (b = -0.361; 95% CI, -0.743 to 0.245; P < .001), and age. Both models were adjusted for menopausal age, diabetes mellitus, hypertension, type of menopause, and menopausal hormone therapy intake. SOC was associated with Beck depression scores (β = -0.487, P < .001; Greene Climacteric Scale total scores, β= -0.199, P < .001). FSFI score <26.5 vs >26.5 was associated with SOC (odds ratio,0.982; 95% CI, 0.563 to 1.947; P = .006) and moderate to severe vasomotor symptom severity (odds ratio,2.476; 95% CI, 1.478 to 3.120; P = .009) independent of age, diabetes mellitus, hypertension, menopausal hormone therapy intake, type of menopause, or Beck depression classification. The results indicate the importance of psychometric assessment of postmenopausal women when presenting with scores of low sexual function. The severity of vasomotor symptoms should also be addressed in any case. This is the first study investigating the relationship between SOC and sexuality in menopause in a carefully selected homogenous population. Limitations included the cross-sectional design and the fact that sexual distress was not assessed. Pathologic FSFI scores were highly prevalent in this sample of postmenopausal women. FSFI is associated positively with age and severity of vasomotor symptoms and negatively with SOC.

The Severity of Menopausal Symptoms Is Associated With Diabetes and Cardiometabolic Risk Factors in Middle-Aged Women

Background: Ovarian senescence is associated with increased cardiovascular disease risk. We aimed to evaluate the association between menopausal symptoms, and cardiometabolic risk factors, in a cohort of apparently healthy middle-aged women. Methods: The cohort included 2,793 peri- and postmenopausal women (menopausal age≤15 years), not on menopausal hormone therapy. Participants were classified into perimenopausal (-3 to +2 years), early- (EM, 2 to 7 years) or late-menopausal (LM, >7 years) after the last menstrual period. Demographic/anthropometric and biochemical/hormonal data were assessed. The severity of menopausal symptoms was evaluated by the Greene Climacteric scale (GCS). Findings: Fitting mixed-effects models, GCS-total score associated with BMI (b=0.12, 95%CI: 0.04 to 0.20), T2DM (b=2.10, 95%CI: 0.06 to 4.15), LM (b=-1.24, 95%CI: -2.17 to -0.33). GCS-psychological score associated with BMI (b=0.06, 95%CI: 0.00 to 0.11). GCS-Physical score associated with BMI (b=0.06, 95%CI: 0.03 to 0.09), central obesity (b=0.18, 95%CI: 0.02 to 0.34), menopausal status (EM and LM vs. perimenopause, b=-0.36, 95%CI: -0.59 to -0.13 and b=-0.65, 95%CI: -0.97 to -0.34, respectively). All previous GCS-scores associated negatively with age. GCS-vasomotor score associated negatively with LM. Fitting poisson mixed models, GCS-sexual score associated positively with EM (incidence rate ratio (IRR)=1.53, 95%CI: 1.21 to 1.94), central obesity (IRR=1.18, 95%CI: 1.00 to 1.39), smoking, diastolic blood pressure, age. Interpretation: The severity of menopausal symptoms is associated with T2DM, obesity and smoking, in a cohort of peri- and postmenopausal women. These associations must be considered on the implementations of primary and secondary prevention strategies. Funding Information: This study did not receive any funding. Declaration of Interests: None to declare. Ethics Approval Statement: All participants signed an informed consent; institutional review board approval was obtained by the Ethics Committee of the Aretaieion Hospital.

Integrative medicine models

Patients with chronic pain and chronic diseases are looking for ways to combat the health implications, to alleviate the side effects of treatments and to improve their quality of life. The medical community is constantly looking for ways to provide the comprehensive health care that patients need. In this context, more pluralistic healthcare systems began to develop, combining conventional and complementary approaches in a coordinated way and to varying degrees. These systems are referred to as Integrative (UK) or Integrated (USA) Medicine. Two dominant models of Integrative Medicine have been developed. The first is a selective combination of Complementary Therapies used as add-on to the treatment proposed by conventional medicine, based on evidence from Research and Practice (Supplementary Model). The second includes only Evidence-Based Complementary Treatments that are integrated in the usual care (Collaborative Model). These two models have different levels of autonomy, control and responsibility among the participating health professionals. Despite their differences, both models focus on the patient and offer a holistic approach. In Greece, a Supplementary Model of Integrated Medicine is offered at the Pain Clinic of Aretaieion Hospital. This model selectively combines various Complementary Treatments such as Reflexology, Shiatsu, Acupuncture, Psychological support, etc., as add-on to the conventional treatments thereby maximizing the beneficial results and can serve as a pioneering example for the development of Integrated Medicine systems in Greece. A well-designed model of Integrated Medicine, combining every possible means and every available treatment and that includes all the necessary safety checks can be particularly effective in achieving the goal of any medical system. The goal of a comprehensive treatment of the disease and its side effects across all aspects of the patient’s life.

Theodoros Aretaios (1829-1893) the Most Eminent Surgeon of His Era and the First Pediatric Tracheotomy Due to Laryngeal Diphtheria in Modern Greece

During 1829 in the city of Nauplion, Theodoros Konstantinidis was born. He had studied medicine in Athens, Wien, Paris and Berlin, where he had supported his doctoral thesis. In 1856 he had returned in Greece to work in Astyclinici and Elpis Hospitals. He had soon become professor of Artistic Anatomy and Epidesmologia, professor of Surgery, elected as Dean and eventually Rector of the University. Dedicated to his love for the ancient Greek medicine, font of Aretaeus of Cappadocia, he had changed his name to Theodoros Aretaios. He was the writer of a substantial number of medical treatises, member of the Athenian Medical Society, editor in medical journals of the era, and a pioneering surgeon with a worldwide fame, who firstly performed a pediatric tracheotomy due to laryngeal diphtheria in modern Greece. He had been operating all his life common people from all over Greece. He left a bequest for the first Surgical and Obstetrical Clinic of the University to be built, bearing his name, Aretaieion Hospital. In March 1893, he died and all Greece felt in heavy mourning for its benefactor.

Right-Shoulder Pain: An Unusual Sign of Hepatic Endometriosis

Background: Endometriosis is a common, benign, estrogen-dependent, chronic gynecologic disorder associated with pelvic pain and infertility. Endometriotic lesions have also been found in several remote sites—including the omentum, gastrointestinal tract, peritoneum, operative scars, lymph nodes, umbilicus, skin, lungs, pleura, urinary bladder, kidneys, and pancreas. Only 19 cases of hepatic endometriosis have been found in English-language publications. Case: A 38-year-old female, with a 5-year history of pelvic endometriosis, was referred to the Aretaieion Hospital, University of Athens, in Athens, Greece. A detailed history of this patient revealed that her shoulder pain was associated with menstruation. A chest computed tomography scan showed a mass in the liver and, subsequently, liver magnetic resonance imaging was performed. The latter revealed a 4.4×3.8 cystic mass in segments 7 and 8 of the liver infiltrating the right diaphragm. At exploratory laparotomy, a tumor at the diaphragmatic portion of the liver infiltrating the diaphragm was found. A wedge excision of the tumor was performed with clear margins en bloc with part of the right diaphragm. A histology report confirmed a mixed cystic and solid mass, with endometrial-type epithelium, positive to estrogen receptors and progesterone receptors, and with cholangian differentiation in some sites. The diaphragm excised was infiltrated by endometrial tissue, while the liver margins were free of pathology. Results: The patient was discharged on the second postoperative day and remains free of symptoms 6 months later, as of this writing. Conclusions: Intrahepatic endometriosis is a rare condition. The diagnosis may only be reached preoperatively by high clinical suspicion of the condition, when symptoms are associated with menstruation. (J GYNECOL SURG 30:383)

Dying with Dignity: Is This a Universal Concept?

As a doctor, I had many times to break bad news to terminally ill patients and their families in terms of the diagnosis, prognosis, and palliative care options. However, I was never a relative myself in such a situation. I had dealt with bereavement in the past following the death of my father, but this was a sudden and unexpected event. In the case of my mother, the circumstances were very different and for the first time I found myself struggling with the fragility of the human body and the uncertainty that exists when caring for a terminally ill cancer relative. However, what surprised me in my home country was the lack of organized interdisciplinary palliative care in state-funded hospitals, the restricted range of opioid medications available for pain control, and even the acceptance of death as the natural course of severe illness. It seems that in Greek urban places, death and the dying process has become a taboo subject that is best to be avoided. Disclosing the truth about the diagnosis and prognosis, especially to terminally ill patients, is a topic that relatives tend to avoid and the health care professionals do not object to the family’s wishes out of respect. In the presence of the patient, carers tend to focus away from the negative impact of the disease, the possible consequences, and the prospect of death; instead they try to adopt a more positive attitude. This avoidant behaviour may have cultural roots, but with limited scientific research published on this area, it is extremely difficult to provide a plausible explanation or even a justification. Palliative care also seems to be an unfamiliar concept in Greece and in my opinion not well understood among relatives and even health care professionals. Although palliative care was recognized in Greek law, in 2005, there are still very limited governmental palliative care and bereavement services. It is very surprising that there are no officially established inpatient palliative medicine units in state-funded hospitals, no governmental hospices for adults or children, and there are only a small number of home care teams available. Overall, support is provided mainly by charities and volunteers. When compared to the rest of the European Union, Greece is among the least developed countries in terms of palliative care services. This general lack of governmental support for both patients and carers makes the process of dying even more difficult in terms of physical and psychological coping. While I was writing this article, I was very pleased to find out that the availability of palliative medicine services in Greece is improving. There is a Pain Relief and Palliative Care Centre in Aretaieion Hospital of Athens that provides care to outpatients and a small number of inpatients. Although this is the only specialist unit in Greece that is still evolving, it is encouraging to see that steps are being taken towards improving accessibility to palliative and end-of-life medicine. Recently, the country also joined the Access to Opioid Medication in Europe (ATOME) project that aims to identify legal/regulatory barriers and therefore make appropriate recommendations for improvement. In addition, the Hellenic Association for Pain Control and Palliative Care and the Hellenic Society of Palliative and Symptomatic Care for Cancer and non-Cancer Patients are continuing to increase awareness in Greece and their efforts are to be commended. In the case of my mother, we were very privileged as a family to be able to afford inpatient private medical care with comprehensive ongoing symptom control, and during the course of her illness up until the last days before her death she was very comfortable. However, I do wonder from time to time what happens to the many other patients and relatives that are faced with a similar situation in a country where palliative care is a new or even alien concept altogether and therefore it might not be readily available apart from private medical providers. Do these people attend for their loved ones on their own unsupported at home? Do they struggle in state-funded hospitals? I am not sure how these families cope, but for me this was an eye-opening experience in terms of appreciating the importance of palliative care services. Dying with dignity is a fundamental human right that should not be denied or withheld. Hopefully in the future more countries will embrace and actively support the delivery of organized interdisciplinary palliative care within specialist units.

In vivo dose verification of 3D conformal treatments with the use of an a-Si EPID

In vivo dose verification of 3D conformal treatments with the use of an a-Si EPID

National patient dose survey in dental CBCT and elaboration of national DRLs

National patient dose survey in dental CBCT and elaboration of national DRLs

A comparison of patient specific dosimetric calculations obtained by planar images and Monte Carlo simulation in 111In octreotide therapy

s / Physica Medica 30 (2014) e16ee44 e29 phase, as a function of the mean value of administered activity per patient treated each week was also acquired. Results: 675 patients were treated through 2011-2013. Mean administered activity 113,5±31.8mCi. Tank’s filling phase:42±4days.Rest decay duration:63±3days. I-131 activity,T, at the end of tank’s filling phase is given by the formula: T1⁄45.6*Aavg,[mCi] whereas Aavg[mCi] is the average amount of administered activity during tank’s filling time period. Tvalues:560-835 mCi and average monthly concentration 0.13mCi/lt. In accordance with Greek legislation, maximum limit of discharge is 110MBq /day. Liquid samples collected at releasing time documented radioactive releases of I-131, equal to those derived from estimations, much below recommended levels of once release. During the above time period a tank’s operation was interrupted twice as a consequence of clogging. Graphs that depict the measurements beyond are also provided. Conclusions: Above real practice data may be useful for further studies of environmental radiation protection from liquid waste of patients undergoing I-131 therapy for thyroid cancer. Physicists, taking into consideration ALARA principle, economic and social factors, must design in advance, emergency plan assuring that, any individual’s exposure is kept to the minimum practicable, in case of system’s mulfunction. A COMPARISON OF PATIENT SPECIFIC DOSIMETRIC CALCULATIONS OBTAINED BY PLANAR IMAGES AND MONTE CARLO SIMULATION IN 111IN OCTREOTIDE THERAPY Maria Argyrou , Maria Andreou , Nefeli Lagopati , Irini Baka , Ioannis Vamvakas , Maria Lyra . Radiation Physics Unit, A’ Radiology Department, Kapodistrian University of Athens, Aretaieion Hospital, 76 Vas. Sophias Ave, Athens, Greece; Medical Physics Department, Iaso Hospital,

English

Introduction The issue of violence against women within the family, or as it is widely known domestic violence, is appearing now firmly as much in European policies as in Greek legislation in order to tackle and prevent this phenomenon. Unfortunately, European and Greek laws do not fully cover this important subject and as the respective studies show, domestic violence rates are increased. In the present review we are going to refer, briefly, to the historical background of the actions and the Greek legislation on this topic. Materials and Methods We investigated in libraries as well as on the web for “domestic violence”related articles and Greek court decisions on the matter in question for the last two decades. Access to sensitive data was obtained by every governmental body involved in our study. Results Before of the implementation of the proper legislation, no clear conceptual framework existed. We have to mention that the Greek law has become more specialized and sociallyorientated, aiming mostly at the cure of the revealed cases, rather than the punishment itself. Conclusion The issue of violence against women is very important and requires the participation of both the State, as well as the non-governmental non-profit organizations. Introduction The term of domestic violence is defined as violence in any form, whether it regards physical abuse, sexual abuse, neglect, gendered violence, emotional abuse (verbal), economic exploitation and trafficking. The complex nature of domestic violence, the various different interpretations of the phenomenon, the lack of sufficient recognition of the severity and several other factors led to the formation of stereotypes and the perpetuation of them, and as a result confusion about the nature and characteristics of the abuse within or outside the family1,2. The aim of this review was to discuss the history of actions as well as the evolution of legislation in Greece for domestic violence. Historical background Domestic violence is a very old phenomenon regarding its origins, while on the contrary, very recent as far as its social identification concerns. Social recognition of the phenomenon, its accession into the European agenda, the role of nongovernmental organizations as parts of the mechanism of influence and pressure and the feminist movement led to adoption of practices towards integration of the principle of equality in all EU policies. In particular, within the United Nations, one may identify International Research and Training Institute for the Advancement of Women (INSTRAW), United Nations Entity for Gender Equality and the Empowerment of Women (UNIFEM), Convention on the Elimination of all forms of Discrimination against Women (CEDAW), which in collaboration with the Division for the Advancement of Women (DAW) of the United Nations focus both on an effort to minimize the phenomenon and also to empower position of women in society3,4. The first draft of the Declaration of Violence against Women was constructed in 1992 and ratified in 1993. According to the United Nations any form of violence and circumvention of human rights, especially against women is condemned. Specifically in the article 1, the term violence against women means any act of violence based on gender and the article 2 includes physical or sexual violence within the family, rape within marriage as well as physical, sexual or emotional violence perpetrated or overlooked by the State in general5. At the same year, the United Nations Committee on the Elimination of Discrimination against Women (CEDAW) in accordance with the recommendation 19, condemned violence against women as the General Assembly of the United Nations in Vienna adopted the Declaration regarding the Elimination of Violence against Women6. In 1994, by decision of the Commission on Human Rights, specific measures to eliminate violence at national and international level were adopted through the causes and the consequences thereof, as well as the collection and analysis of data regarding to violence. The signalling that violence is no longer a private matter was established by the institution of the Special Rapporteur of the Commission on Human Rights on Violence against Women. According to article 4 of the UN Convention, the submission of national reports on government actions regarding the implementation of gender equality is *Corresponding author Email: kumusidi@doctors.org.uk 1 Family Planning Unit, 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Greece.

Clinicopathological characteristics of ovarian carcinomas associated with endometriosis

Substantial histopathology data provide evidence that endometriosis might be viewed as a precursor lesion of endometrioid and clear cell carcinoma of the ovary, via intermediary atypical borderline lesions. Also, genes involved in both endometriosis and epithelial ovarian cancer have been shown to play a role in the pathogenesis of endometriosis-associated ovarian carcinoma. A retrospective study of 17 cases of ovarian carcinomas associated with endometriosis, diagnosed between 2000 and 2009, at Aretaieion Hospital of University of Athens, is presented. 10/17 cases in this study (58.8%) were clear cell carcinomas (CCC), 6/17 cases (35.3%) were endometrioid adenocarcinomas (EAC) and 1/17 cases (5.9%) was a serous carcinoma associated with ovarian endometriosis. Patients's age was 27-76 years (mean age 58 years). Typical ovarian endometriosis was documented in 8/17 (47%) of the tumors. In 9/17 cases, areas of fibrosis or cystic lesions infiltrated by iron-laden macrophages and endometrial-like stroma, consistent with endometriosis, were observed. In comparison with common epithelial ovarian cancers, CCC and EACs of the ovary were presented at earlier stages. Cytoreductive surgical treatment is critical in order to plan appropriate post-operative management.

443 PREGABALIN FOR THE MANAGEMENT OF NEUROPATHIC CANCER PAIN: PRELIMINARY RESULTS

European Journal of Pain SupplementsVolume 4, Issue S1 p. 125-126 443 PREGABALIN FOR THE MANAGEMENT OF NEUROPATHIC CANCER PAIN: PRELIMINARY RESULTS A. Vadalouca, A. Vadalouca A Anaesthesiology Department, Pain Relief & Palliative Care Center, Aretaieion Hospital, Medical School, University of AthensSearch for more papers by this authorE. Raptis, E. Raptis Pfizer Hellas, Athens, GreeceSearch for more papers by this authorA. Moutzouri, A. Moutzouri A Anaesthesiology Department, Pain Relief & Palliative Care Center, Aretaieion Hospital, Medical School, University of AthensSearch for more papers by this authorE. Stavropoulou, E. Stavropoulou A Anaesthesiology Department, Pain Relief & Palliative Care Center, Aretaieion Hospital, Medical School, University of AthensSearch for more papers by this authorI. Siafaka, I. Siafaka A Anaesthesiology Department, Pain Relief & Palliative Care Center, Aretaieion Hospital, Medical School, University of AthensSearch for more papers by this authorE. Argyra, E. Argyra A Anaesthesiology Department, Pain Relief & Palliative Care Center, Aretaieion Hospital, Medical School, University of AthensSearch for more papers by this author A. Vadalouca, A. Vadalouca A Anaesthesiology Department, Pain Relief & Palliative Care Center, Aretaieion Hospital, Medical School, University of AthensSearch for more papers by this authorE. Raptis, E. Raptis Pfizer Hellas, Athens, GreeceSearch for more papers by this authorA. Moutzouri, A. Moutzouri A Anaesthesiology Department, Pain Relief & Palliative Care Center, Aretaieion Hospital, Medical School, University of AthensSearch for more papers by this authorE. Stavropoulou, E. Stavropoulou A Anaesthesiology Department, Pain Relief & Palliative Care Center, Aretaieion Hospital, Medical School, University of AthensSearch for more papers by this authorI. Siafaka, I. Siafaka A Anaesthesiology Department, Pain Relief & Palliative Care Center, Aretaieion Hospital, Medical School, University of AthensSearch for more papers by this authorE. Argyra, E. Argyra A Anaesthesiology Department, Pain Relief & Palliative Care Center, Aretaieion Hospital, Medical School, University of AthensSearch for more papers by this author First published: 06 January 2012 https://doi.org/10.1016/S1754-3207(10)70448-XCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume4, IssueS1April 2010Pages 125-126 RelatedInformation

Creation of a neovagina after Creatsas modification of Williams vaginoplasty for the treatment of 200 patients with Mayer-Rokitansky-Kuster-Hauser syndrome

To present and evaluate the results of the Creatsas modification of Williams vaginoplasty for the creation of a neovagina in young women with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. Retrospective study. Division of Pediatric-Adolescent Gynecology and Reconstructive Surgery, Second Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece. Two hundred patients with the MRKH syndrome. Clinical examination, pelvic ultrasound, intravenous urography and/or renal ultrasound, laparoscopy, karyotyping, orthopedics and ears, nose, and throat examination, magnetic resonance imaging, and Creatsas modification of Williams vaginoplasty. Neovaginal functional dimentions, neovaginal axis deviation, and quality of sexual life. A functioning vagina of 10-12 cm in depth and 5 cm in width was created in 191 cases (95.5%). A vagina between 7 and 9 cm in depth and 2 and 3 cm in width was created for the remaining nine patients (4.5%). In addition, 94.5% declared themselves to have a satisfactory quality of sexual life, while only 5% of the cases reported an adequate one. Creatsas modification of Williams vaginoplasty is a simple, quick, and effective method for the treatment of vaginal agenesis.

Treatment of Sperm With Platelet-activating Factor Does Not Improve Intrauterine Insemination Outcome in Unselected Cases of Mild Male Factor Infertility: A Prospective Double-blind Randomized Crossover Study

To evaluate the effect of sperm treatment with exogenous platelet-activating factor (PAF) on intrauterine insemination (IUI) clinical pregnancy rate in cases of mild male factor infertility. PAF is a phospholipid mediator, which is present in human sperm. The study was performed in the Assisted Reproduction Unit of the 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece, and included 92 couples who presented with mild male factor infertility-all candidates for IUI. A maximum of 4 IUI cycles per couple with or without exogenous PAF treatment were performed and the main outcome measure was the clinical pregnancy rate (pregnancies confirmed by ultrasonography per 100 cycles). The overall clinical pregnancy rate after a maximum of 4 IUI cycles was comparable in cases with and without sperm treatment with PAF (12.24% vs 11.11%). Addition or exclusion of PAF sperm treatment in the same patients did not significantly alter the outcome. The generalized use of exogenous PAF for the preparation of sperm in unselected cases of mild male infertility does not improve the clinical outcome of IUI.

Thyroid function and postpartum mood disturbances in Greek women

Background Postpartum mood disturbances are very common with postpartum blues being as high as 44.5% among Greek women. This study aimed to investigate whether thyroid function within the normal range affects the incidence of postpartum mood disturbances. Methods In a cross-sectional study in the maternity ward of Aretaieion Hospital, 57 Greek women were evaluated for postpartum mood swings by the Maternity Blues Questionnaire and the Edinburgh Postnatal Depression Scale on the first and sixth week postpartum. Serum Free T4, Free T3 and TSH concentrations as well as thyroglobulin and thyroid peroxidase antibodies were measured on admission for delivery and daily until the fourth postpartum day. We examined the association between hormone and antibody levels, and scores in the two scales evaluating postpartum mood disturbances. Results Prepartum serum FT3 and FT4 correlated negatively with blues scores in the first week postpartum (blues on day 4: with FT3, rho = − 0.44, p ≤ 0.01; with FT4 rho = − 0.36, p ≤ 0.01). Women with lower FT3 and FT4 levels belonged to the high scoring group (high scoring group: FT3 = 1.22 pg/ml, FT4 = 0.66 ng/dl; low scoring group: FT3 = 1.64 pg/ml, FT4 = 0.73 ng/dl). Serum FT3 showed a negative independent correlation with postpartum blues scores in the first postpartum days. No association was found between thyroid antibody levels and mood scores. Conclusion Our findings indicate an association between the occurrence of postpartum mood disorders and antenatal thyroid function. Within normal limits, lower levels of serum FT3 and FT4 are associated with increased incidence of mood disturbances in the first postpartum week.

Visfatin and leptin levels in women with polycystic ovaries undergoing ovarian stimulation

To detect the levels of visfatin and leptin in the serum as well as in the follicular fluid (FF) of polycystic ovary syndrome (PCOS) patients undergoing controlled ovarian stimulation and to compare them with the levels found in age- and weight-matched normally ovulating women under IVF treatment. Prospective study. Assisted Reproduction Unit, Second Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece. Forty patients with diagnosed PCOS and 40 age- and weight-matched non-PCOS control women enrolled in the IVF program. Blood and FF samples were collected from all subjects at oocyte retrieval. Visfatin and leptin levels were measured in serum and FF using ELISA. Serum visfatin levels were significantly increased in women with PCOS, whereas FF visfatin levels, which were lower than serum levels, did not differ between groups. Serum leptin levels did not differ between groups and were lower than FF levels. Women with polycystic ovaries exhibit significantly increased serum visfatin and decreased FF leptin levels compared with control subjects of similar age and body mass index, indicating a probable role for visfatin in the general state of insulin resistance and a local contribution in the follicle for leptin in patients undergoing IVF treatment.

CYP A-204C polymorphism is associated with subclinical atherosclerosis in postmenopausal women

To assess the association of common polymorphisms involved in lipoprotein oxidation, platelet activation, and cholesterol and homocysteine metabolism with subclinical atherosclerosis and indices of endothelial function and arterial elasticity in healthy postmenopausal women. The study investigated 84 healthy postmenopausal women recruited from the Menopause Clinic of the 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital. The following polymorphisms were genotyped: apolipoprotein B 3500, apolipoprotein E (E2/E3/E4), cholesterol 7 alpha-hydroxylase A-204C (CYP A-204C), cholesterol ester transfer protein B1/B2, glycoprotein IIIa leu33pro, integrin beta 3 PLA1/PLA2, plasminogen activator inhibitor 1 4G/5G, paraoxonase 1 gln192 arg, and methylenetetrahydrofolate reductase ala222val. Ultrasound examination aimed to assess the presence of atherosclerotic plaque and to measure intima-media thickness in the carotid and femoral arteries and to estimate the augmentation index, brachial flow-mediated dilatation, and radial and femoral pulse-wave velocity. The cholesterol 7 alpha-hydroxylase A-204C polymorphism was positively associated with the presence of atherosclerotic plaque (P = 0.004) and carotid and femoral intima-media thickness (P = 0.047 and P = 0.025, respectively). The CYP A-204C polymorphism was positively associated with subclinical atherosclerosis in healthy postmenopausal women. It remains to be clarified whether the presence of these polymorphisms may be valuable in assessing the inherent risk among postmenopausal women.

Effects of mannitol in the prevention of lipid peroxidation during liver resection with hepatic vascular exclusion

Study Objective To examine the efficacy of mannitol in the prevention of lipid peroxidation during major liver resections performed during hepatic inflow occlusion. Design Prospective, randomized, open-label study. Setting Aretaieion Hospital, a university-affiliated hospital. Patients 30 ASA physical status II and III patients, less than 75 years of age, scheduled for elective liver resection. Interventions All patients received combined general and epidural anesthesia. Laparotomy was performed through a bilateral subcostal incision, and hepatectomy was performed by inflow vascular exclusion (Pringle's maneuver). Before this maneuver, and if the patients were hemodynamically stable, they were randomized to receive either mannitol 20% 1.5 mL kg −1 (group M) or normal saline 1.5 mL kg −1 (group S) intravenously for 30 minutes. Measurements Venous blood malondialdehyde (MDA) concentration, as an index of lipid peroxidation, was measured spectrophotometrically at selected time points. Main Results Patients in both groups presented with raised MDA values ( P < 0.05) for the period starting before the release of vascular occlusion until 6 days postoperatively. In patients receiving mannitol, lower MDA values were observed ( P < 0.05) compared with group S at the end of operation. Conclusion Mannitol has an antioxidant activity, but we were unable to confirm a positive impact on the postoperative clinical course.

Anesthesia with 1.5 minimum alveolar concentration sevoflurane is not altered by physostigmine as measured by bispectral and clinical indices

Study Objective To evaluate the effect of physostigmine on 1.5% sevoflurane anesthesia and recovery. Design Prospective, randomized, double-blinded study. Setting Operating room of a university-affiliated, metropolitan hospital (Aretaieion Hospital and St Savas Hospital). Patients Forty female American Society of Anesthesiologists physical status I and II patients scheduled for breast biopsy. Interventions Patients were randomly assigned in physostigmine (PHYSO) and normal-saline (NS) group. Anesthesia was induced with sevoflurane 8% using a vital capacity breath technique, and rocuronium 0.6 mg/kg was given to facilitate Laryngeal Mask Airway (LMA) No. 4 insertion. Anesthesia was maintained with end-tidal sevoflurane 1.5 minimum alveolar concentration (MAC; 3% end-tidal concentration) throughout the procedure. Measurements After skin closure and under steady-state sevoflurane anesthesia 1.5 MAC, heart rate, blood pressure, and Bispectral Index (BIS) were recorded. Immediately after, the PHYSO group received intravenous 2 mg of physostigmine, whereas the NS group received equal volume of normal saline. Bispectral Index and hemodynamic measurements were recorded 5, 8, and 10 minutes after treatment. Anesthesia was then discontinued and the LMA was removed. Zero, 15, and 30 minutes after LMA removal, patients were evaluated for orientation, sedation, sitting ability, and the “picking up matches” test, as well as for nausea and vomiting. Main Results No difference was found in BIS (29 ± 4, 32 ± 6, 31 ± 6, 30 ± 7, 84 ± 11 in the PHYSO group vs 29 ± 6, 30 ± 6, 30 ± 5, 31 ± 5, 86 ± 7 in the NS group), hemodynamic parameters, or recovery parameters between the 2 groups at any time. No nausea or vomiting was observed in either group. Conclusions Physostigmine did not influence BIS values or early recovery when administered to patients anesthetized with 1.5 MAC sevoflurane anesthesia.