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Biomedical subjects

G Creatsas

Publications and source records attributed to G Creatsas.

At least 19 recordsLinked to original sources

Adolescent gynecology and obstetrics.

Adolescent gynecology is a subspeciality of obstetrics and gynecology and not broadly known. It deals with many gynecological and obstetrical problems which may be seen during adolescence. The International Federation of Pediatric and Adolescent Gynecology is a branch of FIGO and promotes research and teaching programs on pediatric and adolescent gynecology. Health care professionals should address sex education programs providing accurate information to young people on sexual matters. Prevention of gynecological diseases, undesired pregnancies and sexually transmitted diseases are the goals of physicians working in adolescent gynecology.

Adolescent

Spermicidal and antiviral properties of cholic acid: contraceptive efficacy of a new vaginal sponge (Protectaid) containing sodium cholate.

Cholic acid (sodium cholate) exhibits a strong spermicidal and antiviral [anti-human immunodeficiency virus (HIV)-1] activity. The same effects are observed for F-5 Gel, the active mixture of a new contraceptive sponge (Protectaid), which contains sodium cholate in association with low concentrations (0.5%) of nonoxynol-9 and benzalkonium chloride. Both cholic acid and the F-5 Gel exert a dose-dependent, in-vitro inhibitory effect (i) on the activity of HIV-1 associated reverse transcriptase in an acellular system and (ii) on the potential of HIV-1 efficiently to infect human lymphocytes. During 12 months use, the contraceptive efficacy of the 'Protectaid' sponge was 100% in 20 young women who had chosen this method for reasons of both contraception and anti-sexually transmitted disease. No side-effects were recorded throughout this period. Cervical cultures at 6-month intervals showed the presence of Mycoplasma hominis and Candida albicans in one or two cases. The combined spermicidal and anti-HIV properties of cholic acid reported in this paper and used in the 'Protectaid' sponge offer a new and modern protective method of contraception.

Adult

Endocrinological profile of oligomenorrheic strenuously exercising adolescents.

The endocrinological profile of 20 strenuously exercising oligomenorrheic adolescents divided into 2 groups (groups A and B), was correlated with that of 10 athletes (group C) with normal menstrual cycles and without strenuous exercise. Group A LH serum baseline values were found to be statistically significantly lower than those of group C (P less than 0.001). FSH/LH basic values were 1.9- and 2.9-times higher in group A athletes than those of group B or C (P less than 0.05 and P less than 0.001, respectively). 17 beta-estradiol (E2) and prolactin serum levels were found lower in group A and B athletes than those of group C (P less than 0.01-0.05). Dehydroepiandrosterone sulfate and delta 4 androstenedione serum levels were found lower in group A athletes than those of group C (P less than 0.001). The low LH and E2 values indicate the anovulatory status of group A and B cases which were also confirmed by ultrasound. It is concluded that no severe endocrinological changes exist in strenuously exercising oligomenorrheic athletes in relation to menarche.

Adolescent

Combined GnRH-agonist and HMG therapy in patients with stimulation failure.

This study deals with the combined therapy of GnRH-agonist (GnRH-a) and HMG for stimulation in 15 patients who failed two prior in vitro fertilization attempts. Fifty-three patients who received HMG without GnRH-agonist suppression served as controls. Comparing the HMG group with GnRH-a/HMG cycles, the cancellation rate dropped from 35.5% to 13.2%. Oocyte recovery was similar in both groups, as were the fertilization rates, 88.4% in GnRH-a and 82% in HMG cycles, respectively. The number of embryos available for transfer was virtually identical in both groups (3.7 vs. 3.6). Embryo cleavage speed was higher in GnRH-a than in HMG regimens. The E2 rise was smooth in the GnRH-a group compared to the sharp rise observed in the HMG group. The pregnancy rate per transfer was 30.5% in the GnRH-a group versus 20.5% in the HMG group. GnRH-a seems to offer a clear improvement to a number of stimulation failures.

Adult

Teenage pregnancy: comparison with two groups of older pregnant women.

To evaluate the risk of adolescent pregnancies, we examined three groups of primigravidae in a prospective study from 1987 to 1988. A special protocol for the evaluation and follow-up of adolescent pregnancies was made. The rate of adolescent pregnancies was found to be two times higher between the years 1985 and 1987-1988. The pregnancy complications seen in the adolescent patients were equal to or lower than those found in older women. The cesarean section rate was also found to be lower in adolescent pregnancies. We conclude that sexual education programs are necessary for the reduction of teenage pregnancies and adequate medical prenatal care, as well as psychologic and social support, must be given to avoid both medical and psychologic problems for the sensitive young mother.

Adolescent

Outcome of ovarian response after suppression with a gonadotropin releasing hormone agonist in different chronological periods prior to gonadotropin stimulation for in vitro fertilization.

Gonadotropin-releasing hormone analogues (GnRH-a) are currently used in combination with gonadotropins in ovarian stimulation for in vitro fertilization programs (IVF). The present study aims at evaluating the treatment cycles for IVF for which human menopausal gonadotropin (HMG) was initiated only when pituitary desensitization was confirmed regardless of the time of GnRH-a administration. Two groups of patients were examined. Patients in group A (n = 46) were commenced with HMG treatment on day 15 when E2 level was less than 40 pg/ml. Group B patients (n = 27) comprised the cycle treatments in which E2 levels were greater than 40 pg/ml on day 15. In these cases HMG was first given when E2 levels declined to less than 40 pg/ml. The fertilization rate was similar in both A and B groups, 71.6 and 67.7% respectively. The pregnancy rate per transfer was 27.5 and 34.6% in group A and B respectively. Multiple pregnancies were found at 18.1% in group A versus 44.4% in group B. It is concluded that postponement of HMG administration in patients with high levels of E2 on day 15 after GnRH-a administration seems to offer an improvement in embryo cleavage speed, pregnancy rate and multiple pregnancies.

Adult

Prostaglandins: PGF2 alpha, PGE2, 6-keto-PGF1 alpha and TXB2 serum levels in dysmenorrheic adolescents before, during and after treatment with oral contraceptives.

Ten adolescents with primary dysmenorrhea (PD) were treated with the oral contraceptive (OC) Lyndiol 2.5 mg (R) for one cycle. The levels of PGF2 alpha, PGE2 and the metabolites of PGI2 and TXA2: 6-keto-PGF1 alpha and TXB2 were tested by a radioimmunoassay method during the 1st and 23rd day of the pre-treatment cycle (PrTC), the 23rd day of treatment (TC) and the 1st day of the post-treatment cycle (PoTC). The ratios PGF2 alpha/PGE2 and TXB2/6-keto-PGF1 alpha were also tested and compared during the above-mentioned days. Analytical comparison was made, for each Prostaglandin (PG) separately, between the 1st day of the PrTC and PoTC as well as the 23rd day of the PrTC and TC, respectively. All PG levels during TC and PoTC were found significantly lower, compared to those of the PrTC respectively. With regard to the ratios mentioned above, no statistically significant differences were found on the same days and cycles as previously stated. The reduction of the PG levels in PD patients after treatment with oral contraceptives, together with an improvement of the clinical findings of the disease, support the theory that oral contraceptives can be used for the treatment of PD cases, especially for those adolescents who also desire a contraceptive method.

6-Ketoprostaglandin F1 alpha

The validity of gynecological ultrasonography.

The present study was undertaken to examine the reliability of the sonographic diagnosis in 705 gynecological patients. The determination of the lesions was defined according to the operative diagnosis. The sensitivity, specificity and positive predictive value of the ultrasound technique were evaluated using the surgical findings as 'gold standard'. In 631 patients (89.5%) the ultrasound examination established a correct diagnosis. The sensitivity and specificity of the ultrasound examination varied between 75-95.3% and 93.3-100%, respectively. The positive predictive value was found between 89.7 and 100%, while the false sonographic results were 10.4%, which included those of ectopic pregnancies. It is thus concluded that ultrasonography as compared to the surgical findings has proved to be of great value in establishing a gynecological diagnosis.

Adnexal Diseases

Treatment of anaerobic female genital tract infections with metronidazole.

Intravenous metronidazole was given to 12 patients with severe genital tract infections. Nine of them suffered from acute salpingitis or pelvic inflammatory disease and the remaining three from acute endomyometritis following cesarean section. Metronidazole was the only antimicrobial agent given to 4 patients. In the remaining eight, treatment had been started with other drugs such as gentamicin and/or penicillin, and metronidazole was added two to five days later. Blood cultures and cultures taken from the cervical os or pus of abscesses had previously shown either anaerobic or mixed pathogens. All patients recovered well. No severe side effects were observed during metronidazole therapy. To study the pharmacokinetics of metronidazole the drug was administered intravenously or orally. The levels of the drug in the menses and cervical mucus of 25 healthy women were tested using the agar diffusion method. The concentration of the medication in the menses and mucus was found to adequately inhibit in vitro the most commonly anaerobic pathogens found in female genital tract infections.

Bacteria, Anaerobic

Treatment of chronic prostatitis by consecutive per os administration of doxycycline, sulfamethoxazole/trimethoprim, and cephalexin.

Fifty men with cytologically confirmed chronic prostatitis were treated for 3 months by consecutive p.o. administration of doxycycline, sulfamethoxazole/trimethoprim, and cephalexin. The subjective symptoms, palpatory findings, secretory capacity of the accessory genital glands (values of acid phosphatase and fructose in the seminal plasma) were evaluated. The cytologic findings from the expressed prostatic fluid and semen analysis before and after the treatment were also studied. Approximately 60% of the patients were cured of the subjective symptoms. The palpatory findings disappeared in 50% of the cases. The cytologic findings became normal in 70% of the patients (inflammatory cells less than 25/HPF). The secretory function of the prostate and the seminal vesicles was improved in 50% and 25%, respectively, of the patients, and the quantitative and qualitative motility and viability of the spermatozoa after treatment were significantly enhanced.

Administration, Oral

Colposcopic patterns and their histopathologic correlation.

White epithelium, mosaicism, punctation, and atypical vessels are internationally used colposcopic terms describing an atypical transformation zone. Other morphologic findings are surface contour, clarity of demarcation, and tone of whiteness with or without atypical vessels. In the State University of New York at Buffalo affiliated hospitals, 665 cervical and vaginal atypical colposcopic patterns of 552 patients were matched with their histologic findings. Mosaicism, punctation, and white epithelium correlated with the histologic diagnosis of vaginal intraepithelial neoplasia and cervical intraepithelial neoplasia in 43%, 55%, and 42% of the cases, respectively. When white epithelium accompanied the mosaicism or punctation, the incidence of histologically confirmed vaginal and cervical intraepithelial neoplasia raised to 66% and 68%, respectively. In patients with prenatal DES exposure, mosaicism rarely (17%) correlated with the histologic findings of vaginal and cervical intraepithelial neoplasia. Overall, there was a great variability in the correlation depending on the specific colposcopic abnormalities.

Cervix Uteri

Bacterial contamination of the cervix and premature rupture of membranes.

The endocervical flora was examined in 32 women with premature rupture of membranes (PROM). Sixty-six pregnant women served as controls. Ten patients with PROM who later developed chorioamnionitis were also included in the study. Samples for culturing were obtained from the endocervix on admission and at delivery and later from the fetal surface of the placenta. Blood for culturing was also taken in cases of chorioamnionitis. The total number of bacteria in the endocervix and placenta was higher in patients with PROM. Anaerobes were the most common, except for the fetal surface of the placenta, where aerobes were found in greater numbers. Cultures of blood from women with chorioamnionitis were positive in seven cases. These findings suggest that the high incidence of pathogenic or potentially pathogenic cervical bacteria in pregnancy is related to chorioamnionitis and PROM.

Amniotic Fluid

Cytologic, colposcopic, and histologic correlation in young females.

The purpose of the reported study was to correlate the cytologic and colposcopic patterns with the histopathologic diagnosis. This was accomplished in 81 young females who underwent direct colposcopic biopsy because of suspicious appearance of the cervix and abnormal or suspicious cytology. Among them 17 were intrauterine DES-exposed females. The results of our study showed that the white epithelium plus punctuation, punctation alone, white gland openings, mosaism, white epithelium plus mosaism, white epithelium, and atypical vessels were the mot common findings compatible with cervical intraepithelial neoplasia (CIN). Cytology and colposcopy together as diagnostic procedures were the most suitable and successful combination for the diagnosis of CIN in young patients with suspicious appearance of the cervix.

Adolescent

Clindamycin phosphate in the treatment of endometritis due to anaerobic bacteria.

Treatment of endometritis due to anaerobic pathogens demands early isolation and identification of the offending pathogen by the appropriate culture and optimum use of antibiotics according to the sensitivity test. Clindamycin phosphate has been used as a highly active antibiotic against both gram-positive and gram-negative anaerobic pathogens, including bacteroides fragilis. The concentration of clindamycin phosphate in blood from the uterus was tested in 30 women after administration of one single dose (600 mg) intramuscularly. The levels of clindamycin in the above-mentioned tests state how samples were compared with the minimal inhibitory concentration of the offending anaerobic pathogens in cases of endometritis.

Anaerobiosis