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Biomedical subjects

G Creatsas

Publications and source records attributed to G Creatsas.

At least 19 recordsLinked to original sources
PubMed2006

Hospital visiting in obstetrics and gynecology: a tool for the advancement of training.

OBJECTIVE: To assess the improvement of obstetric and gynecologic training brought about by peer influence in Europe. METHODS: In 1996, the European Board and College of Obstetrics and Gynecology (EBCOG) initiated a visiting process by international and local peers to improve training and decrease differences in health care standards. RESULTS: A large number of visits of obstetrics and gynecology departments have been conducted across Europe at teaching hospitals by the Hospital Visiting Committee. Compliance with the structured approach of the visiting policy and problems met during these visits are reported. CONCLUSION: The program focuses on the continuous improvement of the competencies of all persons trained in the obstetrics and gynecology departments of teaching hospitals throughout Europe. It also increases the understanding of diversity in training methods and can gradually lead to the convergence of training and health care standards in Europe.

Clinical Competence↗
PubMed2006

Computerized analysis of fetal heart rate variability using the matching pursuit technique as an indicator of fetal hypoxia during labor.

OBJECTIVE: To determine whether the computerized analysis of fetal heart rate variability with the new matching pursuit technique can indicate fetal distress during labor. STUDY DESIGN: Eighty women were studied during the intrapartum period with external cardiotocography. In all cases, cord arterial pH and 5-min Apgar Scores were evaluated. Six cases that presented large segments of missing data were excluded from the study. The remaining 74 women were divided into two groups; 32 women with normal (Group A) and 42 women with non-reassuring FHR tracings (group B). Group B was divided in subgroup BI, including 24 women with pH > 7.20, and BII, including 18 women with pH < 7.20. In order to evaluate the FHR fluctuations, in different frequency ranges, we applied an adaptive time-frequency method, called Matching Pursuit. We estimated the power of the FHR signal in four frequency ranges. RESULTS: The 5-min Apgar Scores were significantly lower in both subgroup BI and subgroup BII (p = 0.003 and p = 0.003 respectively). The Low Low Frequency (LLF) parameter appears to recognize better the cases with lower pH (sensitivity 78.5%, specificity 52.3%) than the cases with non-reassuring FHR (66.6%, 56.2). The sensitivity and specificity of the Very Low Frequency (VLF) parameter were 72.2% and 59% respectively in recognizing the cases with lower pH and 64.2% and 53.1% in recognizing non-reassuring FHR. CONCLUSION: Fetal hypoxia during labor can be recognized using the MP technique for the analysis of FHR signal power in the VLF and LLF frequency ranges. Since the analysis is feasible in real-time, it can be a useful tool for the intrapartum evaluation of fetal well-being.

Apgar Score↗
PubMed2006

Menstrual disorders during adolescence.

During the post-menarcheal years several kinds of menstrual disorders can be observed, such as abnormal uterine bleeding, primary and secondary dysmenorrhea, premenstrual syndrome, primary and secondary amenorrhea and oligomenorrhea. Abnormal uterine bleeding and especially the subtype of dysfunctional uterine bleeding is the most urgent gynecological problem during adolescence, while dysmenorrhea is the most frequent one for which adolescents and their parents refer to a physician. Normal menstrual cycle physiology as well as definitions of all the above menstrual disorders is briefly mentioned before going on with dysfunctional uterine bleeding and dysmenorrhea.

Adolescent↗
PubMed2005

Tension-free vaginal tape for elderly women with stress urinary incontinence.

OBJECTIVE: To investigate the efficacy of the tension-free vaginal tape (TVT) procedure for the management of stress urinary incontinence (SUI) in elderly women. METHOD: A total of 55 women aged between 65 and 86 years underwent a TVT procedure for urodynamic SUI. Of these, 15 (27%) had undergone previous surgery for treatment of SUI. Before the TVT procedure, a complete medical history was taken and a gynecologic examination performed. RESULTS: Operating time ranged between 11 and 35 min (excluding the time of concomitant surgery, if any); hospitalization time ranged between 1 and 5 days; and no severe intraoperative or postoperative complications occurred. Cure occurred in 39 (76%) of 51 evaluable patients and its rate was positively associated with bladder neck mobility. Among patients in whom the angle of displacement on the Q-tip test was less than 30 degrees , 42% became continent whereas among those in whom it was 30 degrees or higher, 90% became continent (P<.001). Among those in whom the angle was between 20 degrees and 30 degrees, 57% became continent, and among those in whom it was less than 10 degrees, 80% remained incontinent. CONCLUSION: The TVT procedure in elderly women with SUI offers a satisfactory cure rate; however, in patients with significantly decreased bladder neck mobility (an angle <20 degrees on the Q-tip test), the results are not encouraging.

Aged↗
PubMed2005

Cardiovascular disease: screening and management of the a-symptomatic high-risk post-menopausal woman.

Menopause-related oestrogen deficiency increases the risk of cardiovascular disease (CVD). The presence of abdominal obesity, dyslipidemia, hypertension, fasting hyperglycaemia or impaired glucose tolerance further aggravates the CVD risk imposed by menopause. A detailed personal history should be recorded, covering PCOS, gestational diabetes mellitus, alcohol intake and smoking, as well as a family history of cardiovascular disease. Screening of the a-symptomatic post-menopausal woman should include fasting lipid profile, plasma glucose and liver, renal and thyroid function tests. Serum low-density lipoprotein cholesterol (LDL-c)>130 mg/dL is associated with an increased risk of CVD. Levels of triglycerides (TG)>or=150 mg/dL and high-density lipoprotein cholesterol (HDL-c)<or=50 mg/dL coupled with an increase in small dense LDL and very low-density lipoprotein (VLDL) particles constitute the atherogenic dyslipidemia, which characterizes the metabolic syndrome. In women with previous VTE episodes, screening for thrombophilia is advisable, as well as an estimation of baseline homocysteine and C-reactive protein (CRP). Non-pharmacological intervention should be targeted towards smoking cessation, a low-salt, low-fat, high-fibre diet and increased physical activity.

Cardiovascular Diseases↗
PubMed2005

Serum androgen levels and insulin resistance in postmenopausal women: association with hormone therapy, tibolone and raloxifene.

OBJECTIVE: To assess endogenous androgen and insulin resistance status in postmenopausal women receiving continuous combined hormone therapy (HT), tibolone, raloxifene or no therapy. METHODS: A total of 427 postmenopausal women aged 42-71 years were studied in a cross-sectional design. Among them 84 were taking HT (46 women conjugated equine estrogens 0.625 mg; medroxyprogesterone acetate, 5 mg, CEE/MPA; and 38 women 17beta-estradiol 2 mg; norethisterone acetate 1 mg, E2/NETA); 83 were taking tibolone 2.5 mg; 50 were taking raloxifene HCl 60 mg; and 210 women were not receiving any therapy. Main outcome measures were FSH, LH, estradiol, total testosterone, SHBG, free androgen index (FAI), Delta4-Androstendione (Delta4-A), Dehydroepiandrosterone sulphate (DHEAS) and HOMA insulin resistance index (HOMA-IR). RESULTS: In women not on hormone therapy smoking and older age was associated with lower DHEAS levels. FAI values increased linearly with increasing BMI. Age and BMI were positive determinants of HOMA-IR, while no association was identified between endogenous sex steroids and insulin resistance. CEE/MPA therapy was associated with higher SHBG, lower FAI and lower HOMA-IR values compared to women not on therapy (age and BMI-adjusted SHBG: CEE/MPA 148.8 nmol/l, controls 58.7 nmol/l, p < 0.01; age-adjusted FAI: CEE/MPA 0.8, controls 3.2, p < 0.05; age-adjusted HOMA-IR: CEE/MPA 1.3, controls 2.6, p < 0.05). On the contrary, E2/NETA treatment had no effect on these parameters. Women on tibolone had lower SHBG, higher FAI and similar HOMA-IR values compared to controls (age and BMI-adjusted SHBG: 24.1 nmol/l, p < 0.01; FAI: 6.0, p < 0.05; HOMA-IR: 2.3, p = NS). Raloxifene users did not exhibit any difference with respect to sex steroids and HOMA-IR levels. CONCLUSIONS: CEE/MPA users had lower free testosterone and improved insulin sensitivity. Tibolone on the other hand associated with higher free testosterone, while raloxifene did not relate to any of these parameters.

Adult↗
PubMed2005

Prediction of preterm delivery by sonographic estimation of cervical length.

BACKGROUND: Identification of pregnant women presenting with threatened preterm labor who are destined to deliver prematurely would greatly assist planning their management. OBJECTIVES: The purpose of the study was to evaluate the ultrasonographic measurement of cervical length as a prognostic factor for predicting preterm birth in cases of threatened preterm labor. METHODS: The study included 104 women with singleton pregnancies who presented with threatened preterm labor at 24-36 weeks of gestation. Cervical length at presentation was evaluated by transvaginal ultrasonography. Other potential prognostic factors, such as previous history of preterm labor, smoking, parity and administration of tocolytics were assessed. All women were observed for preterm delivery within 7 days of presentation. RESULTS: The only significant predictor of preterm delivery was cervical length assessed by ultrasound (p<0.000001, odds ratio 93.3, 95% Cl 10.4-837.1). CONCLUSIONS: Cervical length assessed by transvaginal ultrasonography in women presenting with threatened preterm labor is a powerful predictive tool for progression to preterm delivery.

Adult↗
PubMed2005

21-Hydroxylase deficiency: from molecular genetics to clinical presentation.

Congenital adrenal hyperplasia due to deficiency of the enzyme 21-hydroxylase (21-OH), a cytochrome P450 enzyme located in the endoplasmic reticulum and which catalyzes the conversion of 17-hydroxyprogesterone to 11-deoxycortisol and progestene to deoxycorticosterone, is distinguished in its classical and non-classical form and is also one of the most common autosomal recessive inherited diseases in humans. The classical form appears in a rate between 1:5000 and 1:15,000 among the live neonates of North America and Europe, while the non-classical form occurs in approximately 0.2% of the general white population. This rate is especially high between the Ahskenazi Jews and a part (ie Italians, Hispanics) of the Mediterranean populations. Three alleles are associated with the 21-OH locus and can be combined in several ways in individuals who are either unaffected, heterozygote carriers, or affected with classical or non-classical disease. Variable signs and symptoms of hyperandrogenism, such as hirsutism, acne, virilization of the external genitalia and/or the body, short stature, menstrual irregularities, are common to both types of the disorder. Among the genes responsible for the synthesis of the enzyme 21-OH and the antigens of HLA system, exist both a proven genetic linkage and a proven genetic linkage disequilibrium. HLA-Bw47, HLAB5 and HLA-B35 are the most common haplotypes usually met in the classical form, while the haplotype HLA-B14DR1 is the most recurrent in the non-classical form of the disease. The significant advances in molecular biology and gene analysis over the past two decades have led to the development of novel sensitive methods of DNA analysis and study, such as polymerase chain reaction and southern blot analysis. Thus, it has been revealed that the synthesis of enzyme 21-OH is controlled by two genes, the active CYP21B gene and the CYP21A pseudogene. All three forms of the disease have a known sequence of gene changes owing to mutations in isolated proteins or whole series of genes due to translocations or deletions of genetic material.

Adrenal Hyperplasia, Congenital↗
PubMed2005

Effect of hormone therapy on the elastic properties of the arteries in healthy postmenopausal women.

The aim of the study was to assess the effect of continuous hormone therapy (HT) for 1 yr on pulse wave analysis and central aortic pressure in healthy postmenopausal women. Sixty-five healthy postmenopausal women were randomly allocated to receive either conjugated equine estrogens 0.625 mg plus medroxyprogesterone acetate 5 mg (CEE/MPA, Premelle 5, Wyeth-Ayerst Lab, Philadelphia, PA, no.=32) or no therapy (no.=33). Treatment was continuous, and the study period lasted 12 months. Central aortic pressure, augmentation and augmentation index (AI) were determined non-invasively using applanation tonometry. All measurements were performed at baseline and at the end of the study by the same person. Ns differences were found between baseline values and values at the end of the study in either the control or the CEE/MPA group in central systolic aortic pressure (107.0 +/- 13.1 vs 107.6 +/- 11.3 mmHg, p=0.80, and 110.8 +/- 10.8 vs 112.3 +/- 11.4 mmHg, p=0.23, respectively), augmentation (12.6 +/- 4.2 vs 11.9 +/- 4.8 mmHg, p=0.45 and 11.7 +/- 3.7 vs 12.6 +/- 4.2 mmHg, p=0.34, respectively), and percentage of AI (36.8 +/- 9.3 vs 36.3 +/- 10.3, p=0.81 and 34.1 +/- 8.9 vs 34.9 +/- 9.8, p=0.72, respectively). The results of this preliminary report suggest that HT for 1 yr does not have any significant effect on central aortic pressure and wave reflection in healthy postmenopausal women.

Aorta↗
PubMed2005

HLA-G in murine peripheral blood after interruption of pregnancy.

HLA-G antigens are highly expressed in maternal peripheral blood during early pregnancy in transgenic mice. In this study, we determined the levels of HLA-G in white blood cells during early pregnancy and after interruption of pregnancy in triple transgenic mice (H-2K(b)/HLA-G, hbeta2m, and hCD2/hCD8-TRI). The pregnancies were interrupted on day 7 using the anti-progesterone agent mifepristone (RU486). Blood samples of 20 pregnant TRI mice were taken and the HLA-G levels were determined on days 2, 4 and 6 of pregnancy and on days 9, 11 and 13 after fertilization. The monoclonal antibody W6/32, specific for monomorphic determinant HLA class I molecules, was used in combination with an immunolocalization method using a photonic microscope. The HLA-G levels increased gradually on days 2, 4 and 6 of pregnancy, and the interruption of pregnancy on day 7 was followed by a decrease of HLA-G levels. The data indicate that pregnancy is characterized by the early presence of HLA-G in maternal peripheral blood in TRI transgenic mice and suggest that HLA-G may serve as a useful indicator for pregnancy maintenance and well-being.

Animals↗
PubMed2005

Ultrasound imaging to evaluate Creatsas vaginoplasty.

OBJECTIVE: To present a new imaging technique for the evaluation of the functional effectiveness of Creatsas vaginoplasty. METHOD: Eighteen women with Mayer-Rokitansky-Kuster-Hauser syndrome underwent a transabdominal and transperineal ultrasound examination 4 weeks and 6 months after the surgical creation of a neovagina, and then yearly, with a condom filled with water as a distending and imaging medium. The functional length and width of the neovagina and its axis deviation were assessed, as well as the postoperative quality of the women's sexual life. RESULTS: A functional vagina 10 to 12 cm in length and 4 to 5 cm in width was observed; its axis deviation, which was similar to the anatomic deviation, was easily determined; and 94.5% of the women reported a satisfactory while 5.5% reported an adequate sexual life. CONCLUSION: This new imaging technique is a simple and effective alternative for the evaluation of the postoperative effectiveness of colpopoiesis.

Adolescent↗
PubMed2005

First-trimester pregnancy termination with 800 microg of vaginal misoprostol every 12 h.

The objective of the study was to evaluate the efficacy and safety of 800 microg of misoprostol every 12 h, for a period of 36 h for pharmacological abortion. A group of 162 volunteer women with gestations between 50 and 63 days received misoprostol every 12 h up to a maximum of three doses for abortion. Outcome measures assessed included: successful abortion (complete abortion without requiring surgery), side effects, and a decrease in hemoglobin, mean time of vaginal bleeding, mean expulsion time and mean time of returning of menses. Complete abortion occurred in 148 of 162 (91%, 95% confidence interval 87.95) patients. The mean decrease in hemoglobin was statistically significant (p = 0.001). Vaginal bleeding lasted 8.0 +/- 3.2 days, spotting 8.0 +/- 3.5 days, and total bleeding 16 +/- 4.0 days. The mean expulsion time was 8.5 +/- 4.0 h. According to the observed outcomes, 800 microg of misoprostol vaginally could be a valid method to terminate pregnancies up to 9 weeks of gestation.

Abortifacient Agents, Nonsteroidal↗
PubMed2005

No association between insulin resistance and preeclampsia.

OBJECTIVE: To investigate the possible link between insulin resistance and preeclampsia. METHODS: The study included 30 primigravidas between 28 and 34 weeks of gestation. The study subjects were divided into two groups: Group A consisted of 15 normotensive women of a mean gestational age of 31.6 weeks and group B consisted of 15 preeclamptic women of a mean gestational age of 29.9 weeks. Glucose and insulin levels were measured at 0, 1 and 2 h of an OGTT (after 75 g oral glucose administration). Insulin resistance and sensitivity were evaluated with the use of IR HOMA, QUICKI and IS OGTT. RESULTS: Glucose and insulin levels at 0, 1 and 2 h of the OGTT as well as IR HOMA, QUICKI and IS OGTT were comparable between preeclamptic and normotensive pregnant women. CONCLUSIONS: Our results indicate that preeclampsia is not associated with hyperinsulinaemia and/or insulin resistance, in either the fasting or the postprandial state.

Adult↗
PubMed2005

Factors influencing the initiation and progress of breastfeeding in Greece.

OBJECTIVE: The aim of this study was to investigate and assess the factors associated with the initiation, progress, and duration of breastfeeding in Greece. METHODS: We studied 1,010 infants born from 862 women from 1996 to 2000 in 17 hospitals. We followed the mothers for the period January-October 2001, while they were at the maternity hospitals to give birth to their next child. RESULTS: Statistical analysis of the data showed that factors positively associated with the duration of breast-feeding were the application of rooming-in (p = 0.0001), the initiation time of breast-feeding--mainly one to six hours after delivery (p = 0.0004), natural delivery (p = 0), pleasant delivery (p = 0.0142), the time the decision about breastfeeding was taken (p = 0), the fact that it was mainly a maternal decision and the mothers were not influenced by a specific person (p = 0.0272) and the fact that no mixed diet was administered (p = 0). Smoking was negatively associated with the duration of breastfeeding (p = 0.0036). Factors not associated with the duration of breastfeeding were: number of the mother's family members (p = 0.1231), whether the women themselves were breastfed as babies (p = 0.03924), some elements of their personality (p = 0.3871) as well as their beliefs concerning maternal milk (p = 0.1922). CONCLUSIONS: From our results we have indications as to which factors are related or unrelated to the initiation and progress of breastfeeding in Greece.

Breast Feeding↗
PubMed2004

Cervical pregnancy treated with transvaginal ultrasound-guided intra-amniotic instillation of methotrexate.

AIM: Aim of the study was to investigate the efficacy of single transvaginal ultrasound-guided intraamniotic installation of methotrexate in the management of cervical pregnancy with concurrent review of the literature. MATERIALS AND METHODS: Six patients with cervical pregnancy are included in the study. All patients were treated with single transvaginal ultrasound-guided intraamniotic installation of 70 mg of methotrexate plus folic acid p.o. The main presenting symptoms were mild to moderate vaginal bleeding and lower abdominal cramp-like pain, resembling the clinical presentation of a threatened abortion. The typical ultrasound findings were the absence of intrauterine gestational sac and the detection of a gestational sac within the cervical canal, invading the anterior or the posterior wall of the cervix and normal appearance of the adnexa, bilaterally. The hourglass-shaped cervix was not characteristic at 5 weeks of gestation but it was at 8 weeks of gestation. DISCUSSION: Ultrasound-guided intraamniotic installation of methotrexate in the management of cervical pregnancy appears to be an effective and safe method but the choice of the method should be depended on the gestational age of cervical pregnancy, the presence of active bleeding or not and its severity, the desire for preservation of future fertility, the presence of coexisting valuable intrauterine pregnancy and the experience of the physician in charge.

Abortifacient Agents, Nonsteroidal↗
PubMed2004

Tension-free vaginal tape efficacy in relation to collagen quantity of pubocervical fascia.

OBJECTIVE(S): To investigate whether the quantity of collagen types I and III in the pubocervical fascia of women with genuine stress incontinence (GSI) affects the efficacy of the tension-free vaginal tape (TVT) procedure. METHODS: Sixty-three patients participated in the study and were divided in 2 groups as follows: 37 patients with GSI and pelvic organ prolapse stage I (group 1), and 26 patients with pelvic organ prolapse stage I but not GSI (control group). Urodynamic studies confirmed the diagnosis of GSI. Biopsies were obtained during surgery from the pubocervical fascia. RESULTS: The quantity of collagen types I and III was statistically significantly reduced in patients with GSI compared to the control group. The efficacy of the TVT procedure in patients with a significant reduction in collagen type I was an 82.1% cure. In patients with a significant reduction in collagen type III, the TVT efficacy was an 85.1% cure. The efficacy of the TVT procedure was not statistically significantly different between patients with GSI and a significant reduction in collagen types I and III, and patients with no reduction in collagen types I and III. CONCLUSIONS: The significantly reduced quantity of collagen types I and III in the pubocervical fascia of women with GSI does not affect the efficacy of the TVT procedure at an average of 25 months of follow-up.

Adult↗
PubMed2004

Ovarian masses during adolescence: clinical, ultrasonographic and pathologic findings, serum tumor markers and endocrinological profile.

This retrospective study was undertaken to assess the epidemiological and clinical features, laboratory findings, preoperative work-up, surgical treatment and pathologic findings in adolescents with ovarian cysts. All adolescents who were referred to our institution and had been operated on because of a diagnosed ovarian mass, from January 1997 to June 2003, were included in this study. Forty-four cases of women with an ovarian mass were retrospectively analyzed. These patients, aged between 12 and 21 years, had 47 ovarian masses (three patients had bilateral lesions), of which 49% were non-neoplastic and 51% were neoplastic. Of the neoplastic lesions, 62.5% were germ cell tumors, 20.8% were epithelial and 16.7% were sex cord-stromal tumors. Of the neoplastic tumors, 95.8% were benign while 4.2% were malignant. Procedures included 30 operative laparoscopies (68.20%) and 14 exploratory laparotomies (31.8%). Simple excision of the ovarian cyst was performed in 39 cases (88.6%). According to our study, most of the adolescents with an ovarian cyst underwent an operation because of a neoplastic lesion. The majority of ovarian tumors occurring in adolescents are non-epithelial in origin, and germ cell tumors are the most common histological type. Ultrasound examination is one of the most important diagnostic tools. Preoperative diagnostic approach of these patients should always include careful history taking, physical examination, imaging and evaluation of serum assays. Gynecologists who care for young girls must be familiar with the differential diagnosis of ovarian masses whose surgical treatment should be conservative when appropriate, so that hormonal status and future fertility are not compromised in this group of patients.

Adolescent↗