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Biomedical subjects

G Daskalakis

Publications and source records attributed to G Daskalakis.

At least 19 recordsLinked to original sources
PubMed2007

Screening for pre-eclampsia and fetal growth restriction by uterine artery Doppler and PAPP-A at 11-14 weeks' gestation.

OBJECTIVE: To assess the role of maternal demographic characteristics, uterine artery Doppler velocimetry, maternal serum pregnancy-associated plasma protein-A (PAPP-A) and their combination in screening for pre-eclampsia and small-for-gestational age (SGA) fetuses at 11-14 weeks. METHODS: This was a prospective study of 878 consecutive women presenting for a routine prenatal ultrasound examination at 11-14 weeks. Pulsed wave Doppler was then used to obtain uterine artery flow velocity waveforms and the mean pulsatility index (PI) of the uterine arteries was calculated. Maternal serum samples for PAPP-A were assayed. Along with maternal history, these measurements were compared in their ability to predict adverse outcome, defined as pre-eclampsia and/or SGA and/or placental abruption. RESULTS: Mean uterine artery PI > or = 95(th) centile and PAPP-A < or = 10(th) centile each predicted 23% of the women that developed pre-eclampsia and 43% of cases of placental abruption. For SGA < or = 5(th) centile, mean uterine artery PI > or = 95(th) centile predicted 23% of cases and PAPP-A < or = 10(th) centile predicted 34%. Independent predictors for subsequent development of pre-eclampsia were increased mean uterine artery PI > or = 95(th) centile (OR, 2.76; 95% CI, 1.11-6.81) and maternal history of pre-eclampsia/hypertension (OR, 50.54; 95% CI, 10.52-242.73). The predicting factors for SGA < or = 5(th) centile were increased mean uterine artery PI > or = 95(th) centile (OR, 2.0; 95% CI, 1.07-3.74) and low PAPP-A (OR, 0.43; 95% CI, 0.20-0.93). Increased uterine artery PI was the only independent factor in the prediction of placental abruption (OR, 8.49; 95% CI, 2.78-25.94). The combination of uterine artery PI and maternal history of pre-eclampsia/hypertension was better than was using uterine artery Doppler alone in predicting pre-eclampsia. Similarly, for the prediction of SGA < or = 5(th) centile, combining uterine artery Doppler and maternal serum PAPP-A was better than was uterine artery Doppler alone. In both cases, the difference approached statistical significance. CONCLUSIONS: The combination of maternal history with abnormal uterine artery Doppler and low PAPP-A level at 11-14 weeks achieves better results than does either test alone in the prediction of pre-eclampsia and SGA.

Abruptio Placentae↗
PubMed2006

Pharmacokinetics of oral cefatrizine in pregnant and non-pregnant women with reference to fetal distribution.

OBJECTIVE: To investigate the effect of gestation on the pharmacokinetics of orally administered beta-lactams, choosing cefatrizine as the model antibiotic. SETTING: A tertiary teaching hospital. DESIGN: Prospective study. METHODS: In 20 women with affected fetuses, 17 by beta-thalassemia major and 3 with congenital malformations, termination of gestation between 19 and 24 weeks was induced by intra-amniotic administration of prostaglandin F(2)(alpha). Pharmacokinetics of cefatrizine in maternal and fetal blood were studied after the administration of three 1 g doses of oral cefatrizine, every 12 h. Twenty female non-pregnant volunteers consisted the control group. RESULTS: Gestation was found to decrease substantially both cefatrizine oral bioavailability and maximum serum plasma concentration (42.8 and 44.5%, respectively) but increased elimination half-life. This effect can be attributed to a substantial increase of the apparent volume of distribution of cefatrizine in relation to a moderate increase of clearance that occurs during pregnancy. Fetal serum cefatrizine levels were lower for the first few hours after administration and then exceeded the corresponding maternal ones. CONCLUSIONS: Our results indicate that gestation decreases the oral bioavailability of cefatrizine. A delay in the maternal drug elimination compared to non-pregnant controls was more pronounced in the fetus.

Administration, Oral↗
PubMed2006

Short-rib-polydactyly syndrome presenting with increased nuchal translucency in a high-risk family.

Short-rib-polydactyly syndrome represents a group of rare, autosomal recessive, lethal skeletal dysplasias characterized by hypoplastic thorax, short ribs, short limbs, polydactyly, and visceral abnormalities. We describe an affected fetus from a high-risk family presenting with increased nuchal translucency at 13 weeks of pregnancy. The diagnosis was established in the 2nd trimester.

Adult↗
PubMed2006

Serum S-100B protein as a biochemical marker of brain injury: a review of current concepts.

S-100 protein, described initially by Moore, constitutes a large family of at least 20 proteins with calcium binding ability. It is found as homo- or hetero-dimers of two different subunits (A and B). Types S-100AB and S-100BB are described as S-100B protein and are shown to be highly specific for nervous tissue. It is present in the cytosol of glial and Schwann cells, and also in adipocytes and chondrocytes, although in very low concentrations in the latter two. The role of protein S-100B is not yet fully understood. It is suggested that it has intracellular and extracellular neurotropic as well as neurotoxic function. At nanomolar levels, S-100B stimulates neurite outgrowth and enhances survival of neurons. However, at micromolar levels it stimulates the expression of inflammatory cytokines and induces apoptosis. Recently, serum S-100B protein has been proved to be an attractive surrogate marker of primary severe brain injury and secondary insults. It can be measured in the arterial and venous serum; it is not affected by haemolysis and remains stable for several hours without the need for immediate analysis. Its short half-life makes measurements crucial in the emergency and intensive care settings. This review summarises published findings on S-100B regarding its role as a serum biochemical marker of brain injury, i.e., after severe, moderate or mild neuro-trauma, subarachnoid haemorrhage, thrombo-embolic stroke, cerebral ischaemia and brain tumours, as well as extracranial trauma, neurodegenerative and psychiatric disorders.

Brain Injuries↗
PubMed2006

Evaluation of primary and secondary treated and disinfected wastewater irrigation of tomato and cucumber plants under greenhouse conditions, regarding growth and safety considerations.

Tomato and cucumber seedlings were distributed into 10 groups (five for each plant) of 15 plants each. The plants were irrigated for 10 weeks with primary treated wastewater (group A), secondary treated wastewater (group B), chlorinated secondary treated wastewater (group C), a fertilizer dilution (group F), and tap water (group M). All precautions were taken to secure that there was no direct contact between the wastewater and the edible portions of the crops. During this period and on a weekly basis, the height and number of leaves was monitored, while, at the end, the dry weight of leaves, stems, and roots for each plant of each group was measured. Based on these growth parameters, both types of plant in groups A and F recorded the most significant development compared to the other three groups. The plants irrigated with tap water recorded the smallest development, in every case. Plants in groups B and C were similar, with a slight (but not significant) superiority for the plants irrigated with secondary treated wastewater, probably as a result of some phytotoxic effects of residual chloride in the chlorinated wastewater. The presence of nutrients and specifically nitrogen in the various solutions explains the differences satisfactorily. The vegetables grown on the plants of each group were harvested, and their surface tissue analyzed for total coliforms (TC) and enterococci (EC). Tomatoes grown on the plants of groups A and B recorded the highest values for TC, with 505 and 490 cfu/g, respectively, whereas, for cucumbers, those values were 342 and 450 cfu/g, respectively. Enterococci were detected on the surface of harvested vegetables from groups A and B, but the small number of cases and their random character cannot support any strong relations between the used wastewater and their presence. The TC values in group C were very low, far lower than those if group F. No EC were found in either group C or group F. These primary results suggested that irrigation with appropriate disinfected wastewater, even of such high-risk cultivations of vegetables eaten raw, should not be discarded completely as unsafe, but be reconsidered and studied further. However, the use of undisinfected wastewater in such greenhouse cultivations, where all safety precautions have been taken to prevent any contact of the fruits with the soil or the wastewater, does not prove to be 100% safe.

Consumer Product Safety↗
PubMed2005

Contribution of combined colposcopy and cytology in cervical pathology.

AIM: The regular Papanicolaou (Pap) smear is the cornerstone of women's preventive healthcare. The introduction of the regular Pap smear as a screening tool for cervical cancer has markedly decreased the number of deaths from cervical cancer. During the past decade, however, the rate of death from cervical cancer has remained relatively static. This screening method is known to have a high percentage of false negative results. To improve the detection of cervical lesions using the Pap smear in screening, a number of adjunct procedures have been developed. The purpose of this study is to evaluate the utility of a magnified chemoluminescent screening examination (Colposcopy) combined with the Pap smear in detecting cervical abnormalities. METHODS: We investigated a cohort of 58 subjects who have been forwarded for colposcopic evaluation due to referral cytology suggestive of persistent inflammatory process not otherwise specified, and cervical intraepithelial or invasive neoplasia, in Chania Colposcopic clinic. RESULTS: The higher the lesion detected by cytology, the more severe the corresponding colposcopic impression viewed. CONCLUSION: The data presented here are in harmony with previous reports and share our experience in a Regional Community Hospital Colposcopy Clinic. An integrated cytology-colposcopy program facilitates the assessment and identification of women harboring cervical pathological conditions.

Adult↗
PubMed2004

Embryo reduction versus expectant management in triplet pregnancies.

OBJECTIVE: In triplet pregnancies, to compare pregnancy outcome of expectant management with that after embryo reduction to twins. METHODS: Retrospective study of 255 trichorionic triplet pregnancies, of which 185 had embryo reduction to twins (reduced group) and 70 were managed expectantly (non-reduced group). RESULTS: Median birth weight was higher by about 500 g and gestation prolonged by about 3 weeks in the reduced pregnancies compared with the expectantly managed pregnancies (2300 vs. 1760 g; 36 vs. 33 weeks). The rates of preterm delivery were significantly lower in the reduced group (11.17 vs. 36.76% for delivery at < or = 32 weeks and 40.58 vs. 83.82% for delivery at < or = 35 weeks, reduced vs. non-reduced group). The percentage of infants born with low birth weight was significantly higher in the expectantly managed triplets (10.98 vs. 28.44% for birth weight < or = 1500 g and 68.55 vs. 92.89% for birth weight < or = 2500 g, reduced vs. non-reduced group). Total fetal loss was significantly higher in the reduced group than in the non-reduced group (15.41 and 4.76%, respectively) and the difference was mainly due to the higher miscarriage rate in the reduced group (8.11 vs. 2.86% in the non-reduced group). With the expected rates of handicap in preterm infants, we would anticipate 0.63% of severely handicapped children due to extreme prematurity in the reduced group and 1.64% in the non-reduced group. CONCLUSION: In triplet pregnancies, embryo reduction to twins significantly reduces the risk of severe preterm delivery and very low birth weight by about one-third, at the expense of a significant increase in total fetal loss, by about one-quarter. The procedure is likely to reduce the risk of having a severely handicapped child due to extreme prematurity.

Abortion, Spontaneous↗
PubMed2004

Pregnancy outcome after multifetal pregnancy reduction.

OBJECTIVE: To study the effects of multifetal pregnancy reduction (MFPR) as a means to reduce the adverse outcome of multiple gestations. METHODS: This was a retrospective study evaluating the outcome of 334 multiple pregnancies after embryo reduction. RESULTS: In 313 multiple pregnancies in which MFPR was performed before 15 weeks, the rates of miscarriage, preterm delivery <33 weeks, preterm delivery <36 weeks and total fetal loss were 9.12%, 13.33%, 38.60% and 16.25%, respectively, and median gestational age at delivery was 35 weeks. There was a significant correlation between miscarriage and the finishing number of fetuses. In 185 triplets reduced to twins, miscarriage, preterm delivery <33 weeks, preterm delivery <36 weeks and total fetal loss occurred in 8.25%, 11.18%, 40.59% and 15.41% of cases, respectively, and median gestational age at delivery was 36 weeks. In the subgroup of 32 reduced triplet pregnancies that also had second-trimester amniocentesis, the risk of miscarriage (3.13%) was not significantly different from that in the rest of the group. Among 21 twin pregnancies that had selective termination at or after 15 weeks, the risk of preterm delivery <33 weeks was three times higher than in the group of 22 twin pregnancies with first-trimester procedures. CONCLUSION: MFPR resulted in at least one live neonate in 83.75% of cases and was effective in reducing the risks of pregnancy loss and severe prematurity in quadruplets and higher-order pregnancies. The risk of miscarriage increased with increasing finishing number of fetuses. In reduced triplets gestation was prolonged in comparison with average figures reported in the literature. In twin pregnancies selective termination in the first trimester carries a lower risk of severe preterm delivery and this emphasizes the need for first-trimester diagnosis.

Abortion, Spontaneous↗
PubMed2004

Successful vaccine immunotherapy. An exciting novel approach to cancer treatment.

Global cancer spread to pandemic proportions, has reinforced the importance of disease surveillance and prevention programs, and has provided the stimulus for greater resources in vaccine development. Many reports from phase I or II trials indicate that both partial and complete responses have been observed, with little or no toxicity, in a small proportion of vaccine recipients. Future prospects will be to increase basic knowledge of immunogenic tumor antigens to vaccine administration, which will make the cancer patient develop an immune response able to induce tumor regression. Clinical trials already under way in patients with malignant diseases may yield more definitive conclusions.

Cancer Vaccines↗
PubMed2004

Assessment of ovarian tumors using transvaginal color Doppler ultrasonography.

In our study we used transvaginal color Doppler ultrasonography in a token of 127 women presenting with unilateral ovarian tumor. The characteristics of the tumors were analyzed, the presence of vascularization was checked and the resistance index (RI) was calculated. Consequently, based on a concrete scoring system, we attempted to discriminate these tumors as benign or malignant. It was proven that 24 of 127 ovarian tumors were malignant. Transvaginal color Doppler correctly identified 21 of the 24 malignant tumors, as well as 94 of the 103 benign tumors. In nine other cases we had false-positive results. The sensitivity and the specificity of the method was 87.5% and 91.2%, while the positive and negative predictive values were 70% and 96.9%, respectively.

Adolescent↗
PubMed2003

Fetal blood sampling in twin pregnancies.

OBJECTIVE: To evaluate the role of fetal blood sampling for prenatal diagnosis in twin pregnancies. METHODS: This was a retrospective study of 84 twin pregnancies that had undergone fetal blood sampling between the years 1977 and 2000. These results were compared with those from a similar study on amniocentesis and chorionic villus sampling. RESULTS: Miscarriage occurred in 3.6% of cases after fetal blood sampling. The total fetal loss rate was 13.6% and the fetal loss that could be attributed to the procedure was 8.2%. The procedure-related fetal loss rate was dependent on the indication for fetal blood sampling. The rates of preterm delivery at </= 32 weeks, preterm delivery at </= 35 weeks, perinatal mortality at </= 28 weeks, perinatal mortality at > 28 weeks and neonatal mortality were 16.9%, 28.3%, 10.9%, 3.1% and 7.7%, respectively. CONCLUSION: Fetal blood sampling in twin pregnancies carries higher risks for the fetus than do amniocentesis and chorionic villus sampling. However, it remains useful in evaluating the fetal condition in special circumstances such as hydrops and infection.

Adult↗
PubMed2002

Second-trimester amniocentesis vs. chorionic villus sampling for prenatal diagnosis in multiple gestations.

OBJECTIVE: To study the impact of invasive procedures for prenatal diagnosis on multiple pregnancies and compare first-trimester chorionic villus sampling with second-trimester amniocentesis. DESIGN: Retrospective study of 347 second-trimester amniocenteses and 69 chorionic villus sampling procedures. RESULTS: Miscarriage occurred in 4.18% of women after amniocentesis and 4.54% of women after chorionic villus sampling. In the amniocentesis group the risk of miscarriage was higher in the cases with transplacental entry (4.54%) than in those with transamniotic entry (2.08%). The rates of preterm delivery < or = 32 weeks and preterm delivery < or = 35 weeks in the amniocentesis group were 11.8% and 32.4% and in the chorionic villus sampling group 16.66% and 23.8%, respectively. Total fetal loss rate was similar in the amniocentesis group (8.8%) and the chorionic villus sampling group (10.22%). In the 21 cases where selective feticide was carried out the total fetal loss rate was lower in the chorionic villus sampling group (8.3%) than in the amniocentesis group (11.1%), although the difference did not reach statistical significance. CONCLUSION: Chorionic villus sampling appears to be a safe alternative to amniocentesis and should be considered as the method of choice particularly when there is a high risk of an affected fetus necessitating selective feticide.

Abortion, Induced↗
PubMed2001

First trimester transabdominal embryo fetoscopy.

The aim of this study was the visualization of the embryo and blood sampling through transabdominal embryoscopy during the first 12 week of pregnancy. Twenty women attending Alexandra Maternity Hospital, Athens for pregnancy termination were invited to participate in this study. Informed consent was obtained before participation. The gestational age ranged between 9 and 12 weeks from LMP. We used a Karl Storz semirigid fiberoptic endoscope 20 cm in length, with a diameter of 1 mm and an angle of view of 70 degrees. Under local anesthesia the endoscope was introduced transabdominally into the amniotic sac, using continuous ultrasound guidance. Complete examination of the embryo including head, face, limbs ventral and dorsal walls, genitalia, placenta, umbilical cord and yolk sac were performed. A 0,6 mm diameter puncture needle was inserted into the blood vessels of the chorionic plate or umbilical cord through the side arm of the canulla to obtain a small amount of blood. The complete anatomical survey was possible in all cases (100%). Access to the embryonic circulation was attempted in 14 cases. A small quantity of blood was obtained in 10 cases (71,4%). The average length of the procedure was 15 min. No maternal complications were recorded. D & C were performed 24 hours after the embryoscopy. Embryoscopy represent a diagnostic tool to confirm a diagnosis suspected through noninvasive means. Gaining access to the embryonic circulation when embryos are immunologically naïve will allow perhaps gene or cell therapy. Finally embryoscopy may be helpful to study the biology of embryonic development.

Embryo, Mammalian↗
PubMed2000

The effect of gestational age and placental location on the prediction of pre-eclampsia by uterine artery Doppler velocimetry in low-risk nulliparous women.

OBJECTIVE: To assess how placental position and gestational age can influence the value of a diastolic notch of the uterine arteries as a screening test for pre-eclampsia, in a low-risk population of healthy nulliparous women. METHODS: Color Doppler ultrasound was used to examine both uterine arteries in 654 healthy nulliparas at 4-week intervals between 20 and 32 weeks. The only criterion for an abnormal result was the presence of an early diastolic notch. In each subject the placental position was also recorded. The major end points were pre-eclampsia and pre-eclampsia requiring delivery before the 34th week. RESULTS: Ninety-eight women (15%) had abnormal flow velocity waveforms at their first visit. Twenty-one out of 654 women developed pre-eclampsia (3.2%). The sensitivity of the test became lower as gestational age advanced and ranged from 81% at 20 weeks, to 71.4% at 32 weeks. In contrast, the specificity and positive predictive value increased significantly. Eleven out of 12 women who delivered before 34 weeks had abnormal waveforms at the 24th week. In women with a full lateral placenta, the predictive value of the test was extremely low, especially in cases with unilateral notches. CONCLUSION: Pre-eclampsia can be more accurately predicted if, along with the presence of a notch, both gestational age and placental position are taken into account. At week 24 the test maintains a high sensitivity (76.1%), but also has an improved specificity (95.1%) and positive predictive value (34%), which allow the clinician to intervene with a potential preventive treatment.

Arteries↗