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Biomedical subjects

D Kassanos

Publications and source records attributed to D Kassanos.

At least 19 recordsLinked to original sources
PubMed2004

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

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

Adult↗
PubMed2003

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

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

Acoustic Stimulation↗
PubMed2002

Transvaginal sonographic monitoring of the uterine effects of raloxifene and a continuous combined replacement therapy in postmenopausal women.

OBJECTIVE: To study the effect of 17beta-estradiol+norethisterone acetate and raloxifene on the endometrium and uterine volume in postmenopausal women. METHODS: Patients were randomly assigned to 17beta-estradiol 2 mg+norethisterone acetate 1mg (E2+NETA) daily (n=90) or raloxifene HCl 60 mg (Evista) daily (n=43). Transvaginal sonography was done at baseline and at 6, 12 and 18 months, and at 6 and 12 months in-patients treated with E2+NETA and EVISTA respectively. Patients were asked to record bleeding-spotting episodes. Whenever required patients were referred for hysteroscopy+/-biopsy of the endometrium. RESULTS: Patients under E2+NETA had a higher bleeding-spotting incidence (48.6%) compared with EVISTA (7.7%). Endometrial thickness increased significantly under E2+NETA as compared with baseline; however, at end point thickness reverted to baseline values. Evista had a non-stimulatory effect on the endometrium. Changes in uterine volume were not statistically significant. CONCLUSIONS: Both treatment regimens provided comparable uterine safety. However, raloxifene exhibited a more favorable safety profile on the uterus as expressed in the bleeding-spotting incidence and the effect on endometrial thickness and uterine volume. Transvaginal sonography appears to be a dependable method for monitoring the effect of treatment on the uterus.

Administration, Oral↗
PubMed2002

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

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

Adult↗
PubMed2002

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

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

Adult↗
PubMed2002

The role of the mode of delivery in the alteration of intrapartum pathological cervical cytologic findings during the postpartum period.

OBJECTIVE: The aim of the study was to determine whether abnormal antepartum cervical cytologic findings change in the postpartum period and the relation of this alteration to the mode of delivery. STUDY DESIGN: Between 1991 and 2000, 192 pregnant women with antepartum abnormal cervical cytology were identified; complete demographic, clinical and cytologic reports were available for 90 of them. Papanicolaou smear tests were collected and separated in three groups using the Bethesda classification system (ASCUS, L-SIL and H-SIL). RESULTS: Of the 90 women, 52 (61.1%) were delivered vaginally and 38 (38.9%) by cesarean section. No difference was found between women delivered vaginally and those delivered by cesarean section, regardin age, parity and smoking history. The overall postpartum regression rate for the 20 women with antepartum H-SIL cells was 45%. Of the 12 women with H-SIL cells who were delivered vaginally, eight (66.6%) showed regression in the postpartum period while this regression was achieved only in one (12.5%) woman, who was delivered by cesarean section (p < 0.002). CONCLUSION: Postpartum spontaneous regression of suspicious Papanicolaou smears consistent with H-SIL occurs with increased frequency among women who are delivered vaginally compared to those delivered by cesarean section.

Adult↗
PubMed2001

Mucin-like carcinoma-associated antigen (MCA) during normal pregnancy.

OBJECTIVE: To assess the usefulness of Mucin-like carcinoma-associated antigen (MCA) in monitoring pregnant patients with breast cancer. STUDY DESIGN: Maternal serum (MS) and amniotic fluid (AF) antigen values were measured by an enzyme immunoassay in 30 pregnant women during the second trimester, in 28 during the third and in 26 at parturition. Sera only from 26 women in the first trimester and from 26 healthy, non-pregnant women (controls) were also analyzed. RESULTS: Maternal serum MCA concentrations increased significantly with gestational age (p<0.0001). The frequency of elevated serum values was 5% in the first, 35% in the second and 100% in the third trimester and at parturition. Antigen values in AF were markedly higher than those in MS (p<0.0001) and increased also significantly with advancing gestation (p<0.0001). A strong correlation was observed between MS and AF antigen values (r=0.77, p<0.0001). Maternal serum values at parturition were dependent on the mode of delivery, being higher in the cases who delivered vaginally, compared to those delivered by elective caesarean section (p<0.006). CONCLUSION: Our data suggest that pregnancy affects significantly maternal serum MCA. Consequently, MCA seems to be a non-reliable marker in monitoring pregnant patients.

Amniotic Fluid↗
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

The value of transvaginal ultrasonography in diagnosis and management of cervical incompetence.

To determine the value of transvaginal sonography in women with a previous history of second trimester miscarriage due to cervical incompetence, 55 patients were subjected to either elective cervical cerclage or follow-up (every second patient) with weekly evaluations of the cervix by transvaginal ultrasonography. Emergency cerclage was applied when significant cervical changes were noted. All patients were evaluated with cervical cultures and ultrasound. Women with infection, fibroids, uterine malformations and multiple pregnancies were excluded from the study. The study population was divided in two groups. In group I (n=27) elective cerclage was applied during the 14th week. Women in group II (n=28) were subjected to serial weekly evaluations of the cervix by transvaginal ultrasonograms. In 18 cases emergency cerclage was applied due to significant cervical changes. In group I, labor started before the 33rd week in two cases (7.4%), between 33 and 37 weeks in nine (33.3%) and after the 37th week in 16 cases (59.2%). Out of the 18 patients in group II who had cervical cerclage after ultrasonographic evaluation, four (22.2%) delivered before the 33rd week, three (16.6%) between 33 and 37 weeks and 11 (61.1%) after the 37th week. No statistical difference was noted between the two groups referring to pregnancy outcome (p<0.1). We concluded that ultrasound-guided management despite cervical shortening, does not result in unfavorable pregnancy outcome. A significant number of patients can avoid the operation.

Adult↗
PubMed2000

Sweeping of the membranes versus uterine stimulation by oxytocin in nulliparous women. A randomized controlled trial.

The aim of this study was to evaluate whether sweeping of the membranes at term could shorten the length of pregnancy and reduce the incidence of postterm pregnancies. We randomly selected 104 nulliparas with uncomplicated pregnancy and gestational age between 281 and 287 days. Our patients were divided into three groups. Group A consisted of 34 women who were subjected to sweeping of the membranes. Uterine stimulation with oxytocin was applied in 35 women (group B), and 35 women (group C) were used as a control group. We had no significant reduction of the time interval from sweeping of the membranes until delivery (1.9 +/- 1.2 days), compared to that of group B (2.1 +/- 0.8 days) as well as that of the control group (2.5 +/- 0.9 days). The incidence of spontaneous labor in patients after sweeping of the membranes was greater (67.6%) when compared with oxytocin-stimulated patients and the control group (p < 0.05). Furthermore, a better Bishop score was noted in patients of group A. No statistically significant difference was noted in the mode of delivery between the groups, but sweeping of the membranes significantly decreased the incidence of postterm pregnancies (p < 0. 05). We concluded that sweeping of the membranes is an effective method for initiating labor in women with a gestational age between 40 and 41 weeks, thus reducing the need for induction.

Adult↗
PubMed2000

A randomized trial of pulsatile vs continuous oxytocin infusion for labor induction.

In a prospective randomized study, 560 pregnant women were subjected to labor induction with continuous or pulsed intravenous oxytocin infusion. There were no significant differences with respect to maternal history, Bishop score and perinatal morbidity. The mean induction to delivery interval was shorter in the pulsed infusion group than in the continuous infusion group (325 +/- 63 vs 433 +/- 67 min in primiparous, p < 0.001 and 204 +/- 52 vs 236 +/- 87 min in multiparous women, p < 0.01). The mean amount of oxytocin administered in the pulsed infusion group was also significantly lower than in the continuous infusion group (4.7 +/- 0.6 mU/min versus 9.6 +/- 3.4 mU/min in primiparous, p < 0.001 and 2.1 +/- 0.4 mU/min versus 5.2 +/- 2.3 mU/min in multiparous women, p < 0.001). Our study demonstrates that pulsatile administration of oxytocin is as safe as continuous intravenous infusion, requires less oxytocin and is more effective as it reduces labor duration.

Female↗
PubMed2000

Changes of glucose tolerance after delivery in women with gestational diabetes.

We investigated glucose tolerance after cesarean section in 24 women with gestational-onset diabetes (group A), in 18 women with an adverse pregnancy outcome (group B), and in 19 healthy pregnant women (group C). Glucose tolerance was performed within six days as well as six weeks after delivery. Eleven (45.8%) women in group A, five (27.8%) in group B and one (5.2%) in group C showed glucose intolerance immediately after delivery. Six weeks after delivery, 18 (75%) women in group. A showed normal glucose tolerance (NGT), four (16.6%) impaired glucose tolerance (IGT) and two (8.3%) diabetes according to WHO criteria. NGT showed 16 (88.8%) women in group B, and 19 (100%) in group C, while two (11.1%) women in group B presented with IGT. We conclude that a glucose tolerance test both immediately and six weeks after delivery is useful not only in women who have gestational diabetes but also in women with an adverse pregnancy outcome.

Adult↗
PubMed1999

Defective antioxidant mechanisms via changes in serum ceruloplasmin and total iron binding capacity of serum in women with pre-eclampsia.

OBJECTIVES: The aim of this study was to investigate the role of serum ceruloplasmin, its ferroxidase activity and total iron binding capacity in women with pre-eclampsia. METHODS: Thirty primigravidas between 32 and 36 weeks of gestation were studied. The subjects were divided into two groups: group A consisted of 15 normal pregnancies with a mean gestational age of 33.9 weeks, and group B consisted of 15 pre-eclamptics with a mean gestational age of 32.8 weeks. RESULTS: The pre-eclamptics presented significantly higher serum ceruloplasmin levels compared to those with normal pregnancies (P<0.01), while the mean ferroxidase activity levels of ceruloplasmin did not differ significantly between the two groups (450.13+/-110.88 and 467.26+/-135.35 micromol/l/min in groups A and B, respectively). The mean+/-S.D. serum iron level (104.48+/-39.81 microg/dl) was greater whereas the total iron binding capacity (55.59+/-8.47 micromol/l) was lower in women with preeclampsia when compared to normal pregnancies (P<0.01 and P<0.0001 respectively). CONCLUSIONS: Our results indicate that the plasma of pre-eclamptic women shows a loss of ferroxidase activity of ceruloplasmin as well as a reduction of total iron binding capacity. Thus, it seems that the plasma of pre-eclamptic women lacks the protective anti-oxidative action of these substances.

Adult↗
PubMed1999

Umbilical cord blood gas analysis in augmented labour.

Labour augmentation with oxytocin may produce an excessive increase in frequency, duration or strength in uterine contractions which may result in fetal stress. Umbilical cord acid-base assessment provides an objective parameter in evaluating the neonatal condition immediately after delivery. We evaluated the neonatal condition in 235 deliveries where oxytocin was used for labour augmentation. The umbilical cord blood acid-base status was correlated with intrapartum cardiotocographic findings and Apgar scores. In two cases we noted umbilical artery pH <7.05 but the BDecF was not higher than 11 mmol/l and the 5-minute Apgar score was 8 in all cases. Our results indicate that the use of oxytocin for labour augmentation had no adverse effects on neonatal condition.

Journal Article↗
PubMed1999

Evaluation of fetal heart rate patterns during the second stage of labor through fetal oximetry.

The purpose of this study was to assess the feasibility and accuracy of fetal pulse oximetry during the second stage of labor in cases with abnormal fetal heart rate (FHR) patterns with reference to postpartum acid-base status and Apgar scores. Forty-eight parturients with normal and 20 parturients with abnormal FHR tracings during the second stage of labor were monitored by fetal pulse oximetry and postpartum umbilical artery pH, pO(2), pCO(2) values and 1- and 5-min Apgar scores. The mean SpO(2) value was 55. 47 +/- 9.95% in cases with normal and 52.55 +/- 16.42% in cases with abnormal FHR patterns. A significant correlation was noted between fetal SpO(2) and umbilical artery pH in cases with normal (r = 0.76, p < 0.05) as well as in cases with abnormal FHR patterns (r = 0.78, p < 0.05). No significant correlation was found between fetal SpO(2) and Apgar scores at 1 and 5 min in cases with normal FHR patterns. On the contrary a significant correlation was noted in cases with abnormal FHR patterns. A normal FHR pattern alone is reassuring. In cases with abnormal FHR, fetal pulse oximetry is an objective method for distinguishing a hypoxic fetus.

Apgar Score↗
PubMed1998

Adenomyoma and leiomyoma: differential diagnosis with transvaginal sonography.

PURPOSE: The purpose of this study was to evaluate the capability of transvaginal sonography to differentiate adenomyomas from leiomyomas. METHODS: Two hundred six patients scheduled for surgery for symptomatic uterine masses underwent preoperative transvaginal sonography. Sonographic findings were compared with pathologic findings. Pathologic findings showed that 111 patients had leiomyomas, 48 had diffuse adenomyosis, 31 had adenomyomas, and 4 had leiomyosarcomas. RESULTS: For the diagnosis of adenomyoma, transvaginal sonography demonstrated a sensitivity of 82.0%, specificity of 88.3%, positive predictive value of 84.6%, and negative predictive value of 87.5% compared with a sensitivity of 95.1%, specificity of 82.0%, positive predictive value of 90.7%, and negative predictive value of 85.7% for the diagnosis of leiomyoma. Two sonographic characteristics, lesion margin (p = 0.0001) and lacunae (p = 0.0001), allowed the differentiation of adenomyoma from leiomyoma. CONCLUSIONS: Transvaginal sonography is an effective procedure for the preoperative differentiation of adenomyoma from leiomyoma. If the status of the lesion's margins and the presence or absence of hypoechoic lacunae were selected for analysis, leiomyomas could be correctly diagnosed with transvaginal sonography in 95% of cases.

Adenomyoma↗
PubMed1998

Intrapartum vibratory acoustic stimulation after maternal meperidine administration.

OBJECTIVE: To examine the effectiveness of the acoustic stimulation test in the interpretation of suspicious cardiotocograms obtained after meperidine administration to the mother during the first stage of labor. SUBJECTS AND METHODS: We studied 45 unselected parturients who received 50 mg meperidine i.m. when cervical dilatation was 5 cm. In all cases a decreased beat-to-beat variability of the fetal heart rate and fetal movements was noted after the injection of meperidine. A vibratory acoustic stimulation was performed in 25 patients (group A) while the remaining 20 (group B) had no stimulation. RESULTS: After the meperidine injection, the acoustic-induced reactivity returned immediately in group A, while the spontaneous reactivity returned 30 minutes later. The mean number of fetal movements in all parturients was 8.71 +/- 2.18 before meperidine administration. Sixty minutes after the meperidine injection the mean number was 8.52 +/- 2.48 in group A and 1.65 +/- 1.81 in group B (p < 0.0001). CONCLUSION: The acoustic stimulation test is an effective method of interpreting suspicions CTG's obtained after meperidine administration to the mother during the first stage of labour.

Acoustic Stimulation↗