Aretaieion Hospital Research Articles

The value of cervical length and plasma proMMP-9 levels for the prediction of preterm delivery in pregnant women presenting with threatened preterm labor

Objective To assess the value of plasma proMMP-9 levels in predicting the progress of threatened preterm labor to true preterm labor and delivery within 7 days of presentation, along with the ultrasonographic measurement of cervical length. Study design The study included sixty two pregnant women presented in the 2nd Department of Obstetrics and Gynecology of University of Athens at Aretaieion Hospital with threatened preterm labor. On subjects’ presentation, cervical length was evaluated with transvaginal ultrasonography, plasma proMMP-9 levels were measured with the use of a solid phase enzyme immunoassay, and maternal characteristics (smoking, history of preterm delivery and parity) as well as the use of tocolytics were recorded. Subjects were followed up for premature delivery within 7 days. ROC analysis for plasma proMMP-9 levels was performed and logistic regression analysis was used for the evaluation of the prognostic effect of the parameters. Results The only significant predictors for establishment of true preterm labor and delivery within 7 days of presentation were cervical length (with cutoff value 15 mm: odds ratio = 0.022, 95% CI = 0.002–0.243, p = 0.002) and plasma proMMP-9 (with cutoff value 67.15 ng/ml: odds ratio = 0.035, 95% CI = 0.003–0.388, p = 0.006). The combination of the adopted proMMP-9 and cervical length cutoff values was characterized by a sensitivity of 90.9% and a specificity of 98.3% for predicting the progress to true preterm labor and delivery. Conclusion Plasma proMMP-9 levels could possibly serve as a predictive factor for the progress of threatened preterm labor to true preterm labor and delivery within 7 days of presentation, along with the ultrasonographic evaluation of cervical length.

A unique case of descending salpingitis and functioning endometrium in a müllerian remnant in a woman with Mayer-Rokitansky-Küster-Hauser syndrome

To describe a unique case of descending salpingitis and functioning endometrium in a noncavitated mullerian remnant in a patient with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. Case report. Second Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece. A 25-year-old patient with MRKH syndrome who presented with lower abdominal pain. Clinical examination, transabdominal ultrasonography, laparoscopy, laparotomy. Clinical symptoms of salpingitis and hematometra; laparoscopic and laboratory confirmation. Laparoscopy revealed an infection of the right salpinx, and surgical excision by laparotomy revealed a noncanalized mullerian remnant with functioning endometrium. Salpingitis can present in patients with MRKH syndrome. Probable presence of functioning endometrium must be taken under consideration.

Effect of sperm treatment with exogenous platelet-activating factor on the outcome of intrauterine insemination

To evaluate the effect of sperm treatment with exogenous platelet-activating factor (PAF) on IUI clinical pregnancy rate. Prospective randomized study. Assisted Reproduction Unit, 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece. Fifty-two couples with unexplained infertility, candidates for IUI. Sperm treatment with an exogenous mixture of PAF (final concentration, 10(-7) mol/L) in sperm-washing medium, direct swim-up technique of sperm preparation, a maximum of six IUI cycles per couple with or without PAF treatment. Clinical pregnancy rate (pregnancies confirmed by ultrasonography per hundred cycles). The overall clinical pregnancy rate after a maximum of six IUI cycles was significantly higher when sperm was treated with PAF compared with the rate after the direct swim-up technique (23.07% vs. 7.92%). Treatment of sperm with exogenous PAF might improve the clinical outcome of IUI in cases of unexplained infertility.

Evaluation of the participation of Aretaieion Hospital, Greece in the WHO Pilot Project of Health Promoting Hospitals

Aretaieion University Hospital participated in the World Health Organization (WHO) Pilot Health Promoting Hospitals Project from 1993 until 1997, when the Hellenic Network of Health Promoting Hospitals was established. This study is an overall evaluation of the participation of Aretaieion Hospital at the HPH Pilot Project. The evaluation comprised two questionnaire surveys, one among all the professionals, and the other among the patients involved in the subprojects. At the professional's survey, the response was 88.6% (39), while at the patient's survey the response was 62.2% (84). Differences were identified between the perceptions of the professionals who were external collaborators and those who were members of the hospital staff. Problems of the Project were reported to be lack of funding, lack of time and personnel shortages, lack of health promotion background and lack of incentives. Major successes were reported to be the personnel training, the development of collaboration and teamwork, the improvement of the overall image of the hospital into the community, the improvement of the working conditions of the personnel. Perception of sustainability of the projects by health professionals was found to be related to how interesting they found their subproject and how relevant to the work of their department. The communication strategy was inadequately planned and this resulted in some difficulties in developing rapport with the patients. However, the patients felt that they benefited from the project, a view also held by the hospital staff professionals.

Development of leiomyomas on the uterine remnants of two women with Mayer-Rokitansky-Küster-Hauser syndrome

Objective To describe two cases of leiomyoma development in patients with Mayer-Rokitansky-Küster-Hauser syndrome (MRKH syndrome). Design Case report. Setting Second Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece. Patient(s) A 42-year-old woman with MRKH syndrome presented with lower abdominal pain, and a 38-year-old woman with MRKH syndrome presented with an asymptomatic left adnexal mass. Interventions(s) Clinical examination, transabdominal ultrasonography, IV urography, laparoscopy. Main outcome measure(s) Ultrasound. Result(s) In both cases, laparoscopy revealed a leiomyoma originating from the left uterine remnant. The leiomyomas and the adjacent uterine remnants were laparoscopically excised. Conclusion(s) In rare cases, leiomyomas can originate from the fibromuscular tissue of uterine remnants in patients with MRKH syndrome.

Effects of blood loss and fluid volume replacement on serum and tissue gentamicin concentrations during colorectal surgery

Background: The prophylactic administration of antimicrobial agents to surgical patients has become standard practice to minimize the risk for postsurgical infection. During surgery, factors such as renal clearance, fluid administration, and blood loss contribute to drug concentrations achieved in the blood and tissues. The aminoglycoside gentamicin was chosen to investigate these factors because it is used for standard antimicrobial prophylaxis in colorectal surgery. Objective: The aim of this study was to investigate the effects of surgical blood loss and fluid volume replacement on gentamicin concentrations in serum and in 3 tissue types (subcutaneous fat, epiploic fat, and colonic wall) in patients undergoing colorectal surgery. Methods: This uncontrolled, open-label study was conducted at the Aretaieion Hospital (Athens, Greece) between November 2002 and March 2003. Patients selected for this study were scheduled to undergo elective colorectal surgery of ⪖ 2-hour duration with general and epidural anesthesia and to receive gentamicin as major antimicrobial prophylaxis. Blood and tissue samples were obtained concurrently at specific times throughout each procedure. The effect of intraoperative blood loss on gentamicin concentrations and its pharmacokinetic properties was determined. Results: Sixteen patients completed the study (11 men, 5 women; white race, 16 patients [100%]; mean [SD] age, 61 [3] years [range, 39–80 years]). Mean (SEM) serum gentamicin concentration was found to be insufficient; the maximum plasma drug concentration/minimum inhibitory concentration (MIC) ratio was <8:1 for pathogens commonly isolated in the surgical unit of the hospital (MIC: 1–4 μg/mL). The mean (SEM) concentration at first surgical incision was 7.83 (0.82) μg/mL and decreased to 2.60 (0.28) μg/mL at skin closure, resulting in borderline effectiveness even for susceptible gram-positive microorganisms (MIC ∼1.0). Initially, mean (SEM) tissue gentamicin concentrations in subcutaneous fat, epiploic fat, and colonic wall were low (2.02 [0.34] μg/mL, 2.41 [0.42] μg/mL, and 1.93 [0.38] μg/mL, respectively) and decreased ∼1.0 μg/mL (∼50%) by skin closure. Statistically significant positive correlations were found between gentamicin concentrations in serum and tissues ( P ≤ 0.03). A strong negative correlation was found between the intravenously administered fluids and gentamicin concentrations in serum and tissues ( P ≤ 0.04). Conclusions: In this study, the administration of a 2-mg/kg dose of gentamicin as antimicrobial prophylaxis during colorectal surgery associated with significant intraoperative blood loss and therefore requiring significant fluid replacement did not achieve concentrations of the drug above MICs for gram-negative microorganisms throughout the procedures in either serum or tissue samples.

Serum lipids and apolipoproteins in Greek postmenopausal women: association with estrogen, estrogen-progestin, tibolone and raloxifene therapy.

The aim of this study was to assess lipid and apolipoprotein levels in postmenopausal women taking various regimens of replacement therapy or no therapy. Seven hundred forty-eight postmenopausal women followed in the Menopause Clinic of the 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, were studied in a cross-sectional design. Women were either non-users of replacement therapy (no. = 511) or users of one of the following regimens: conjugated equine estrogen 0.625 mg (CEE, no. = 34), CEE 0.625 mg plus medroxyprogesterone acetate 5 mg (CEE/MPA, no. = 60), 17beta-estradiol 2 mg plus norethisterone acetate 1 mg (E2/NETA, no. = 44), tibolone 2.5 mg (no. = 84), raloxifene HCI 60 mg (no. = 51). Total cholesterol (TC), LDL-cholesterol (LDL-C) and HDL-cholesterol (HDL-C), triglycerides (TG), apolipoprotein A1 (ApoA1) and apolipoprotein B (ApoB) levels were assessed. Women were grouped according to replacement regimen and mean levels of lipid and apolipoproteins were compared between groups. Women in the raloxifene group were older and longer menopaused. After adjustment for age and duration of menopause, TG levels were significantly lower in the tibolone and E2/NETA groups (75 and 89.9 mg/dl, respectively) compared to non-users. TC was lower in all therapy groups, but the difference acquired significance only in the E2/NETA (207.8 mg/dl), compared to non-users (231.5 mg/dl). LDL-C levels were significantly lower in the CEE (133.8 mg/dl), CEE/MPA (130.4 mg/dl) and raloxifene group (129.9 mg/dl) compared to non-users (151.9 mg/dl). There was no difference in HDL-C levels between users and non-users (58.9 mg/dl) except for the tibolone group where HDL-C was significantly lower (48.6 mg/dl). ApoA1 levels were significantly higher in the CEE/MPA group (194.4 mg/dl) and significantly lower in the tibolone group (141.6 mg/dl) compared to non-users (170.4 mg/dl). No difference was detected between groups concerning ApoB levels. In conclusion, tibolone therapy is associated with lower TG levels as well as lower HDL and ApoA1 levels. ERT, continuous combined estrogen-progestin therapy (HRT) and raloxifene are associated with lower LDL-C levels. Among continuous combined HRT users, CEE/MPA is associated with higher ApoA1 levels, while E2/NETA with lower TG levels. Large prospective randomized studies are required to validate these results.

Intrapartum Surveillance of IUGR Fetuses with Cardiotocography and Fetal Pulse Oximetry

Objective: To investigate the efficacy and safety of intrapartum fetal pulse oximetry, as a predictor of metabolic acidosis at birth of fetuses with intrauterine growth retardation (IUGR). Study Design: We studied 18 IUGR fetuses (group I) and a control group of 30 appropriate for gestational age (AGA) fetuses (group II) during labor. Both groups had abnormal fetal heart rate tracings and were monitored simultaneously throughout labor with cardiotocography and fetal pulse oximetry. Apgar scores, pH and base excess of fetal blood obtained from the umbilical artery after delivery were compared in both groups. Setting: The Fetal Surveillance Unit of the 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, Athens University. Results: In IUGR fetuses, when their oxygen saturation value (FSPO₂) was less than 34%, cord artery pH was 7.10 ± 0.04, base excess –13 ± –1 mmol/l and Apgar scores ≤5 at the 5th min, and when FSPO₂ was over 35%, artery pH was 7.29 ± 0.08, base excess –8 ± –2 mmol/l and Apgar scores ≧7 at the 5th minute. In cases of drops of FSPO₂below 30% for more than 2 min, labor was completed operatively and cord pH was 7.00 ± 0.04, base excess –15 ± –2 mmol/l and Apgar scores ≤5 at the 5th minute. In AGA fetuses, when FSPO₂ was over 30%, artery pH was over 7.20, base excess <–11 mmol/l and Apgar scores ≧9 at the 5th minute; in contrast, when FSPO₂ was <30% for 2 min, a cesarean section was performed and cord pH was ≤7.02, base excess ≧–13 mmol/l and Apgar scores ≤4 at the 5th minute. Conclusions: In IUGR fetuses, FSPO₂ values less than 34% represent an acidotic status, while values of ≧35% are well tolerated. Fetal pulse oximetry proved reliable, according to umbilical cord blood measurements and Apgar scores, reducing cesarean deliveries in cases of nonreassuring cardiotocographic patterns in IUGR fetuses.

Computerised intrapartum diagnosis of fetal hypoxia based on fetal heart rate monitoring and fetal pulse oximetry recordings utilising wavelet analysis and neural networks.

To develop a computerised system that will assist the early diagnosis of fetal hypoxia and to investigate the relationship between the fetal heart rate variability and the fetal pulse oximetry recordings. Retrospective off-line analysis of cardiotocogram and FSpO2 recordings. The Maternity Unit of the 2nd Department of Obstetrics and Gynaecology, Aretaieion Hospital, University of Athens. Sixty-one women of more than 37 weeks of gestation were monitored throughout labour. Multiresolution wavelet analysis was applied in each 10-minute period of second stage of labour focussing on long term variability changes in different frequency ranges and statistical analysis was performed in the associated 10-minute FSpO2 recordings. Self-organising map neural network was used to categorise the different 10-minute fetal heart rate patterns and the associated 10-minute FSpO2 recordings. Umbilical artery pH of < or = 7.20 and Apgar score at 5 minutes of < or = 7 formed the inclusion criteria of the risk group. After using k-means clustering algorithm, the two-dimensional output layer of the self-organising map neural network was divided into three distinct clusters. All the cases that mapped in cluster 3 belonged in the risk group except one. The sensitivity of the system was 83.3% and the specificity 97.9% for the detection of risk group cases. A relationship between the fetal heart rate variability in different frequency ranges and the time in which FSpO2 is less than 30% was noticed. Fetal pulse oximetry seems to be an important additional source of information. Computerised analysis of the fetal heart rate monitoring and pulse oximetry recordings is a promising technique in objective intrapartum diagnosis of fetal hypoxia. Further evaluation of this technique is mandatory to evaluate its efficacy and reliability in interpreting fetal heart rate recordings.

Computerised intrapartum diagnosis of fetal hypoxia based on fetal heart rate monitoring and fetal pulse oximetry recordings utilising wavelet analysis and neural networks

Objective To develop a computerised system that will assist the early diagnosis of fetal hypoxia and to investigate the relationship between the fetal heart rate variability and the fetal pulse oximetry recordings. Design Retrospective off-line analysis of cardiotocogram and FSpO 2 recordings. Setting The Maternity Unit of the 2nd Department of Obstetrics and Gynaecology, Aretaieion Hospital, University of Athens. Population Sixty-one women of more than 37 weeks of gestation were monitored throughout labour. Methods Multiresolution wavelet analysis was applied in each 10-minute period of second stage of labour focussing on long term variability changes in different frequency ranges and statistical analysis was performed in the associated 10-minute FSpO 2 recordings. Self-organising map neural network was used to categorise the different 10-minute fetal heart rate patterns and the associated 10-minute FSpO 2 recordings. Main outcome measures Umbilical artery pH of ≤7.20 and Apgar score at 5 minutes of ≤7 formed the inclusion criteria of the risk group. Results After using k-means clustering algorithm, the two-dimensional output layer of the self-organising map neural network was divided into three distinct clusters. All the cases that mapped in cluster 3 belonged in the risk group except one. The sensitivity of the system was 83.3% and the specificity 97.9% for the detection of risk group cases. Conclusions A relationship between the fetal heart rate variability in different frequency ranges and the time in which FSpO 2 is less than 30% was noticed. Fetal pulse oximetry seems to be an important additional source of information. Computerised analysis of the fetal heart rate monitoring and pulse oximetry recordings is a promising technique in objective intrapartum diagnosis of fetal hypoxia. Further evaluation of this technique is mandatory to evaluate its efficacy and reliability in interpreting fetal heart rate recordings.

Obstruction of the Female Genital Tract Because of Vaginal Septum in Adolescence

The purpose of the study was to present a case series reporting the clinical presentation, evaluation, and management of seven adolescent girls with symptomatic vaginal septa who were treated in the Division of Pediatric-Adolescent Gynecology and Reconstructive Surgery of the 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, from September 1997 to June 2000. The patients were divided in two groups depending on the type of vaginal septum. Group A consisted of three patients with transverse vaginal septum, all with hematometra, endometriosis, and congenital abnormalities of the urinary tract. One patient had a bicornuate uterus. Group B consisted of four patients with oblique vaginal septum, three with hematometra and congenital abnormalities of the urinary tract, all with endometriosis, two with didelphys uterus, and one with a bicornuate uterus. The patients of both groups underwent total excision of the septum followed by the administration of GnRH analogues for 6 mo...

Anasthesia using a laryngeal mask airway in a patient with osteogenesis imperfecta

AnaesthesiaVolume 55, Issue 5 p. 489-518 Free Access Anasthesia using a laryngeal mask airway in a patient with osteogenesis imperfecta G. Kostopanagiotou, G. Kostopanagiotou Aretaieion Hospital Medical School, Athens, GreeceSearch for more papers by this authorT. Coussi, T. Coussi Aretaieion Hospital Medical School, Athens, GreeceSearch for more papers by this authorN. Tsaroucha, N. Tsaroucha Aretaieion Hospital Medical School, Athens, GreeceSearch for more papers by this authorD. Voros, D. Voros Aretaieion Hospital Medical School, Athens, GreeceSearch for more papers by this author G. Kostopanagiotou, G. Kostopanagiotou Aretaieion Hospital Medical School, Athens, GreeceSearch for more papers by this authorT. Coussi, T. Coussi Aretaieion Hospital Medical School, Athens, GreeceSearch for more papers by this authorN. Tsaroucha, N. Tsaroucha Aretaieion Hospital Medical School, Athens, GreeceSearch for more papers by this authorD. Voros, D. Voros Aretaieion Hospital Medical School, Athens, GreeceSearch for more papers by this author First published: 24 December 2001 https://doi.org/10.1046/j.1365-2044.2000.01425-28.xCitations: 15AboutPDF 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 onFacebookTwitterLinkedInRedditWechat Citing Literature Volume55, Issue5May 2000Pages 489-518 RelatedInformation