Biomedical subjects

T Stefos

Publications and source records attributed to T Stefos.

At least 19 recordsLinked to original sources

PubMed2006

Reproductive outcome in patients treated by oral methotrexate or laparoscopic salpingotomy for the management of tubal ectopic pregnancy.

OBJECTIVE: To determine the reproductive outcome of women who have received methotrexate or been treated by laparoscopic salpingotomy (LS) for ectopic tubal pregnancy. STUDY DESIGN: The study consisted of 123 participants, all women with tubal pregnancies, who had been treated either by methotrexate per os or by laparoscopic salpingotomy. The reproductive outcome of these women was estimated after a follow-up time-period of ten years. RESULTS: In the methotrexate group, consisting of 34 women, the fertility rate was 82% with a mean interval time to conceive of 9.4 months after the treatment. In the group treated by LS, consisting of 89 women, the fertility rate was 82.6% and the mean interval time to conceive was 11.7 months. CONCLUSION: The reproductive outcome of the women who received either per os treatment of methotrexate or LS for tubal pregnancy, remains high. Both therapeutic methods constitute reliable solutions for managing ectopic pregnancy.

Abortifacient Agents, Nonsteroidal↗

PubMed2005

Ectopic missed abortion after laparoscopic sterilization with the harmonic scalpel.

A case of a patient who presented with ectopic pregnancy and subsequent missed abortion one year after laparoscopic sterilization with the harmonic scalpel is reported. According to our knowledge of the relevant literature, this is the first time that a case of ectopic pregnancy after sterilization with a harmonic scalpel has been reported.

Abortion, Missed↗

PubMed2005

Administration of recombinant human erythropoietin in patients with gynecological cancer before radical surgery.

UNLABELLED: The purpose of this prospective study was to investigate the efficacy of preoperative administration of recombinant human erythropoietin in patients with gynecological cancer. METHODS: The study included 38 women with gynecological cancer who were divided randomly in two groups. Study group A included 20 women with gynecological cancer who received recombinant human erythropoietin (rHuEPO) plus iron supplementation for ten days before surgery and five days postoperatively. Group B (controls) included 18 patients who received only iron supplementation for the same time period. Blood samples were obtained on days -10, -3, 0, +3, +5, +10. RESULTS: The mean hemoglobin level was significantly higher in group A than in group B on the day of the operation and remained significantly higher postoperatively while an inverse relationship was observed for mean ferritin values in the two groups. CONCLUSION: Preoperative administration of rHuEPO in patients with gynecological cancer seems to be effective in the blood management of these patients.

Adult↗

PubMed2003

Unicornuate uterus and uterus didelphys indications and techniques for surgical reconstruction: a review.

Unicornuate uterus and uterus didelphys consist of miscellaneous congenital malformations of the female genital system. These anomalies can cause many gynecological and obstetrical complications including infertility, ectopic pregnancy, recurrent abortions and preterm deliveries. Laparoscopy and hysteroscopy are two helpful operative procedures in establishing an accurate diagnosis and treating effectively. A case of a patient with unicornuate uterus and longitudinal vaginal septum, who presented at our hospital suffering from infertility, is reported.

Adult↗

PubMed2002

A case of partial mole and atypical type I triploidy associated with severe HELLP syndrome at 18 weeks' gestation.

Partial mole is a rare complication of pregnancy and 90% of cases are associated with triploidy. HELLP syndrome is also a rare and life-threatening condition that occurs after 20 weeks' gestation. We report a case presenting with a combination of severe HELLP syndrome, partial mole, triploidy type I and fetal growth restriction at 18 weeks' gestation. Partial mole and any type of triploidy must be considered in cases of hydrocephalus and severe growth restriction in the second trimester of pregnancy. Our case highlights the fact that growth restriction can be associated with type I triploidy and that severe HELLP syndrome can develop in such cases even before 20 weeks' gestation.

Chromosome Aberrations↗

PubMed2001

Maternal prolactin secretion during labor. The role of dopamine.

BACKGROUND: To investigate the role of dopamine on the mechanisms of maternal prolactin secretion during labor and in the first six hours following delivery. METHODS: The study included 30 pregnant women with normal pregnancies, who were meeting the same criteria. They were divided into three subgroups of 10 patients each and they delivered healthy newborns. Group A was the control group. Metoclopramide 10 mg/h intravenously was given in Group B, while bromocryptine 5 mg per os was given in Group C. Maternal blood samples were obtained every hour during labor and in the six hours postpartum. Prolactin values were determined by using a radioimmunoassay method. RESULTS: Metoclopramide infusion caused an initial significant (p<0.01) rise in PRL level in Group B. Prolactin levels showed the same multiphasic pattern during labor and first h postpartum in both Groups A and B. PRL levels decreased until 1-2 h antepartum, then increased for about 3 h and they finally decreased, starting at 2 h postpartum and reaching values lower than the basic at 6 h postpartum. However, absolute PRL values were higher in Group B (where metoclopramide was given) than in Group A, in every time point. Bromocryptine (Group C) markedly lowered PRL levels, but PRL fluctuation still followed the same trends as in the other two groups. CONCLUSIONS: The different PRL values between the three groups show that maternal PRL is still under dopaminergic influence during labor. However, the fact that PRL levels exhibit the same multiphasic pattern, suggests that there are factors other than dopamine, which strongly influence this pattern.

Administration, Oral↗

PubMed2001

Perinatal morbidity and mortality rates in severe twin-twin transfusion syndrome: results of the International Amnioreduction Registry.

OBJECTIVE: Serial aggressive amnioreduction is the most widely used therapy for pregnancies that are complicated by twin-twin transfusion syndrome. Survival rates reported with this therapy are 33% to 83%, the wide range attributable to the small number of patients in these case series. Similarly, data on morbidity in survivors are imprecise. We instituted the international twin-twin transfusion syndrome registry to determine the perinatal survival and morbidity rates and the factors that influence perinatal outcome in patients with twin-twin transfusion syndrome who were treated with serial aggressive amnioreduction from 1990 to 1998. STUDY DESIGN: A total of 223 sets of twins who were diagnosed with twin-twin transfusion syndrome before 28 weeks' gestation from 20 fetal medicine referral centers were analyzed, with follow-up data until 4 weeks after birth. RESULTS: Three hundred forty-six twins (78%; 182 recipients and 164 donors) were born alive. Two hundred sixty-six twins (60%; 144 recipients and 122 donors) were alive 4 weeks after birth. Both fetuses survived to 4 weeks in 108 pregnancies (48.4%), whereas, at least 1 fetus survived in 158 pregnancies (70.8%). The interval between the last amnioreduction and delivery ranged from zero to 138 days (median, 17.5 days). In the infants who survived to 4 weeks after birth, abnormalities on neonatal cranial scan were diagnosed in 24% of recipients and in 25% of donors. Logistic regression analysis indicated that the survival rate was significantly related to gestational age at diagnosis, presence of end-diastolic blood flow in the umbilical artery velocity waveforms, presence of hydrops, mean volume of amniotic fluid removed per week, larger birth weight, and gestational age at delivery. The hemoglobin level difference at birth was the only significant parameter to predict abnormal cranial ultrasonography in newborns. CONCLUSION: These data document perinatal survival and neonatal morbidity rates in severe twin-twin transfusion syndrome that were treated by serial aggressive amnioreduction. Outcome was influenced by several perinatal risk factors, which may be used to counsel patients before and during therapy.

Amnion↗

PubMed2001

Evaluation of fetal heart monitoring in the first stage of labor.

OBJECTIVE: To evaluate the usefulness of continuous electronic fetal heart rate (FHR) monitoring in the first stage of labor. METHODS: A total of 814 pregnant women in labor without identifiable risk factors was divided into two groups. In group A (468 cases), continuous FHR monitoring began in the earliest phase of the first stage of labor (cervical dilatation < or = 4 cm), while in group B (346 cases) it began when the cervical dilatation was > 4 cm. Initial FHR tracings were normal in all 814 cases. The fetal monitoring findings were analyzed at 10-min intervals, and comparisons were made between the two groups concerning FHR findings and their correlation with the state of the newborns. RESULTS: No significant difference was found between the two groups in the incidence of repetitive variable decelerations (1.9% and 1.7%, respectively); sporadic variable decelerations (9.2% and 8.7%, respectively); persistent repetitive late decelerations that resulted in Cesarean section (1.1% and 1.4%, respectively); or sporadic late decelerations (8.3% and 8.1%, respectively). One newborn from each group required intensive neonatal care. CONCLUSIONS: The same tracing sufficiency of fetal stress was observed in the two groups. However, the manner of labor supervision in group B seemed to be more beneficial, because of greater maternal comfort, a lower necessity for personnel, lower consumption of cardiotocographic materials and the possibility of labor induction for more women. Since fetal monitoring is widely used, it is preferable to start continuous FHR monitoring when the dilatation of the cervix approximates 4-5 cm (second phase of the first stage of labor) without risk of fetal loss.

Adolescent↗

PubMed2000

Use of prostaglandin E2 for cervical ripening in pregnancies with oligohydramnios.

The effectiveness of intracervical prostaglandin E2 (PGE2) was studied in 96 primigravidas with unfavorable cervix and need for induction of labor. Group A consisted of 49 oligohydramnios and group B of 47 cases with normal amniotic fluid volume (controls). A single dose of 0.5 mg PGE2 gel was applied intracervically and several parameters were recorded during the next hours. The mean number of uterine contractions increased during the first 2 h in both groups, decreased during the next one and did not change significantly afterwards. The mean fetal heart rate (FHR) in group A decreased during the first 2 h and then increased, staying always within normal limits. The mean FHR in group B increased for 2 h, decreased during the next hour and did not change significantly afterwards. No significant differences were found between the two groups regarding mode of delivery, Apgar score and neonatal acidosis. Intracervical PGE2 appeared to effectively stimulate cervical ripening and labor induction in oligohydramnios, without causing side effects to the uterus and fetus.

Cervical Ripening↗

PubMed1998

The role of deoxyribonuclease I in amniotic fluid during pregnancy and labour.

The purpose of this study was to detect the presence, and determine the normal values and the significance of DNase I in the amniotic fluid and in human placentas. Fifty-one pregnant women at 16-22 weeks of gestation and 89 women in spontaneous labour at term were recruited to the study. DNase I activity was measured in amniotic fluid and cytoplasmic extracts from the fetal portion of placentas by using a spectrophotometric technique (DNA precipitation assay) and nucleic acid electrophoresis, following degradation of the DNA by the enzyme. DNase I activity was undetectable in the placental cytoplasmic extracts. In the second trimester of pregnancy DNase I activity was detectable in amniotic fluid (2.3+/-0.64x10(5) U/l). During labour DNase I activity was also detectable, but reduced levels were observed in the presence of clear amniotic fluid, compared to second trimester levels, (1.9+/-0.44x10(5) U/l, P<0.001), whereas higher levels were found in the presence of meconium-stained amniotic fluid compared to both second trimester and clear amniotic fluid at labour (11.4+/-4.1x10(5) U/l, P<0.001 and P<0.001, respectively). Three out of 17 fetuses with meconium-stained amniotic fluid (18%) developed perinatal infection. In conclusion, the detection of DNase I activity in the amniotic fluid of second and third trimester indicates a physiological role in human pregnancy. DNase I activity normally decreases at term, compared to second trimester levels, but increases significantly in the presence of meconium.

Amniotic Fluid↗

PubMed1998

Comparison of somatomedin-C (SMC/IGF-I), human placental lactogen and Doppler velocimetry between appropriate and small-for-gestational-age pregnancies.

Thirty-two pregnant women with small-for-gestational-age (SGA) fetuses and 45 pregnant women with appropriate-for-gestional-age (AGA) fetuses (controls) were recruited after the 32nd week of gestation. Blood samples were collected for estimation of somatomedin-C (SMC/IGF-I) and hPL in the maternal serum and in the umbilical cord serum. The systolic/diastolic (S/D) ratio of the umbilical artery was also recorded. The results showed somatomedin-C and hPL levels in the maternal serum and in the umbilical cord to be significantly decreased and the Doppler S/D ratio to be significantly increased in the SGA group. In this group, using the multivariable regression analysis, we found significant correlations between maternal hPL, somatomedin-C, Doppler S/D ratio and birth weight.

Birth Weight↗

PubMed1997

Lead concentrations in maternal and umbilical cord blood in areas with high and low air pollution.

The lead concentrations in maternal and umbilical cord blood were determined in 50 parturient women at delivery. Twenty-five lived in agricultural areas with low air pollution and 25 lived in urban areas with high air pollution. The mean lead concentrations (mean +/- SD) in maternal and umbilical cord blood and the correlation coefficient of mothers from urban areas with high air pollution were 37.2 +/- 4.7 ng/ml, 20 +/- 3.4 ng/ml and r = 57, respectively. The mean lead concentrations in maternal and umbilical cord blood and the correlation coefficient of mothers from agricultural areas with low air pollution were 20.5 +/- 5.6 ng/ml, 12.9 +/- 3.6 ng/ml and r = 0.70, respectively. Our results show that the difference in mean lead concentration between the blood of mothers both from urban and agricultural areas and the blood from the umbilical cords of their newborns was statistically significant (p < 0.001). The factors that control the transfer of lead from the mother's blood to the fetus are the quantity of the element in the mother's blood and the placenta itself which has a dynamic protective function that is amplified when maternal blood lead levels are raised.

Adolescent↗

PubMed1996

Data and information requirements for the Department of Veterans Affairs resource allocation systems.

The department of Veterans Affairs (VA) uses a global budgeting process to allocate congressionally appropriated resources to provide medical care to veterans. The Department of Veterans Affairs has developed this process to accommodate the effects of changes in pure inflation, workload, and cost per unit of work in forecasting operating dollars required for facility global budgets. In 1990, VA began shifting to a new method of allocating its global budget called Resource Planning and Management (RPM), based on a capitated system. Facilities receive resources according to their unit costs and the number and type of patients they are expected to serve. A key characteristic of any global budgeting information system is flexibility. The VA information system accesses the portion of each patients's care that is provided at every facility and aggregates this information across all facilities to create a single prorated patient record; the system reconstructs prior years of data into the new patient-centered format to forecast workload. No other health care system in the United States pays for and directly provides such a diverse set of services for such a large population as does VA. Nevertheless, many of the problems VA faces are similar to those of other providers and insurers.

Budgets↗

PubMed1995

Hospital staffing adjustments under global budgeting.

The U.S. Department of Veterans Affairs operates a hospital system that distributes a national global budget to 159 hospital units. Over recent years, cost containment and downward budgetary pressures have affected hospital performance and the quality of care delivered in unknown ways. This article examines hospital staffing levels as potential performance measures. We first develop a regression model to estimate the number and types of clinical staff required to meet current inpatient workloads at VA medical centers. We are able to improve on previous analyses by employing better data on physicians and by evaluating the behavior of hospitals in consecutive years. Our findings provide managers of hospital systems with promising new approaches for comparing hospital production processes and more information on the effects of global budgeting on individual hospital staffing within systems.

Budgets↗

PubMed1994

Prediction of neonatal crown-heel length in normal singletons, twins, and triplets using individualized growth assessment.

In groups of normally growing singletons (20), twins (20), and triplets (13), predicted femur diaphysis length (FDL) values at birth were obtained using Rossavik growth models specified from second-trimester ultrasound studies of fetal growth. Six previously published functions were utilized to obtain predicted crown-heel length (CHL) values from predicted FDL values. These values were compared to the actual CHL values and the percent differences calculated. Based on their systematic (mean percent difference) and random (standard deviation of percent difference) prediction errors, the functions of Vintzileos (singletons), Hadlock (twins), and Brown (triplets) were found to give optimal results (no systematic error; random error: +/- 6%). Using predicted CHL values obtained with these optimal functions, growth potential realization index values for CHL (GPRICHL) were determined for singletons, twins, and triplets. In all three groups, the mean GPRICHL value was 100% with a range of approximately 95% to 105%. These results indicate that the CHL can be predicted from second-trimester growth patterns and evaluated using individualized growth assessment methods.

Embryonic and Fetal Development↗

PubMed1992

Measuring inpatient and outpatient costs: a cost-function approach.

In this article, the authors estimate a multiple-output cost function for a sample of 2,235 hospitals during the period 1984-88 to disaggregate total costs into inpatient and outpatient components. The results suggest that outpatient cost growth is roughly proportional to that of inpatient cost, despite much higher relative growth in revenues and utilization on the outpatient side. The stability in the outpatient/inpatient cost ratio implies that the increase in the outpatient-to-inpatient utilization ratio was offset by a decline in their relative unit costs.

Cost Allocation↗

PubMed1992

Fairness in prospective payment: a clustering approach.

Problems of fairness in prospective payment have existed since the inception of this regulatory method in the early 1980s. While prospective payment ostensibly has sought to reward efficient producers and provide disincentives for inefficient producers of health care, many hospitals have been penalized financially as a consequence of facing systematic factors beyond their control. This article defines homogenous peer groups of Department of Veterans Affairs providers for the purpose of establishing competitive prospective reimbursement rates. An econometric analysis classifies hospitals into six categories: small affiliated, small general, midsize affiliated/tertiary, large affiliated/tertiary, midsize general, and psychiatric. The Department of Veterans Affairs adopted this classification to alter its prospective payment system in 1988.

Cluster Analysis↗

PubMed1991

Federal provision of health care: creating access for the underinsured.

Access to health care for the underinsured in America is a major current policy issue. Federal provision of health care has not been evaluated seriously as part of the solution to the problem despite the presence of federal health care provided to veterans, the class of Americans most completely guaranteed universal access. We first explore the arguments for and against universal access, clarifying issues but yielding no definitive solution. Then the federal health care system for veterans is used as a model for exploring problems that must be solved in a universal access plan. The discussion focuses on the effects of competition for patients and health care resources on costs, innovation, regulation, and quality.

Evaluation Studies as Topic↗