Maternal--neonatal serum selenium and copper levels in Greeks and Albanians

AIM

To evaluate selenium (Se) and copper (Cu) concentrations in Greek and Albanian immigrant mothers and in the cord blood of their newborns.

SUBJECTS AND METHODS

From 1118 Greek and 820 Albanian mothers and from the cord blood of their neonates blood was obtained for Se and Cu measurement. Se and Cu concentrations were determined in sera with graphite furnace atomic absorption spectroscopy (GFAAAS) and atomic absorption spectrometry, respectively. In all, 30 days' nutrient intakes were evaluated in both groups.

RESULTS

Animal protein, Se and Cu intakes were poor in the Albanians vs the Greeks (P < 0.001). Se concentrations in the Greek mothers (68.3 +/- 8.5 microg/l) and in their newborns (37.02 +/- 8.9 microg/l) were found higher as compared with those in Albanian mothers (37.4 +/- 9.9 microg/l) and in their newborns (34.3 +/- 9.1 microg/l) (P < 0.001). Cu levels were also found higher (P < 0.001) in the Greek mothers (1687 +/- 353 microg/l) and in their neonates (449 +/- 87 microg/l) compared with those in the Albanian mothers (959 +/- 318 microg/l) and in their newborns (229 +/- 67 microg/l). Additionally, 31.5% of neonates born to Albanian women with Se concentrations less than 28 microg/l had higher Se levels (P < 0.01) than their mothers.

CONCLUSIONS

The low Se and Cu levels evaluated in the Albanian mothers and their newborns could be related to their poor animal protein intake which could be the consequence of their low socioeconomic status. As an effective preventive measure, accurate dietetic strategies to assess the requirements of pregnant immigrant women for trace elements may be planned in Greece.

Maternal - neonatal folate and vitamin B12 serum concentrations in Greeks and in Albanian immigrants

BACKGROUND

Low folate and vitamin B(12) concentrations during pregnancy are implicated with neural tube defects (NTD) and neurological manifestations in the neonates.

AIM

To compare serum concentrations of folate and vitamin B(12) in 1025 Greek mothers, 908 immigrant Albanian mothers at delivery and in the cord blood of their neonates.

METHODS

A 30 days food diary was kept from each mother. Folate and vitamin B(12) sera concentrations were measured with Bayer ADVIA Centaur System.

RESULTS

Energy, carbohydrates and total fat intake were significantly higher in Albanian mothers when compared with those of Greek origin. On the contrary, total protein, and especially animal protein intake were higher in the Greek mothers. Folate intake was similar between the two ethnic groups whereas vitamin B(12) intake in Albanians was evaluated lower (1.8 +/- 0.13 microg day(-1)) when compared with that of Greeks (2.8 +/- 0.12 microg day(-1); P < 0.001). Folate serum concentrations in mothers and newborns were similar (17.7 +/- 9.1 and 26.5 +/- 15.2 nm versus 18.1 +/- 8.6 and 24.6 +/- 14.7 nm, respectively P > 0.05) in the two ethnic groups. In contrast, vitamin B(12) serum concentration was significantly lower (135.0 +/- 19.6 pm) in the Albanian mothers compared with that of Greeks (164.5 +/- 17.7 pm, P < 0.0001). Consequently, the vitamin concentrations was found lower in the newborns of Albanian origin (133.6 +/- 11.8 pm) compared with that of Greek neonates (213.3 +/- 11.4 pm, P < 0.0001).

CONCLUSIONS

(a) Folate serum concentrations in Greek and Albanian mothers and in their neonates were similar, (b) vitamin B(12) serum concentrations, evaluated for first time in these ethnic groups, were significantly low in Albanians, both in mothers and newborns, (c) the low protein and especially the reduced animal protein intake from the Albanian mothers, possibly due to their low socio-economic status, may be responsible for their decreased vitamin B(12) serum concentrations and (d) vitamin B(12) supplementation along with an increase of animal protein intake might improve the vitamin serum status in the Albanians.

Maternal-neonatal retinol and alpha-tocopherol serum concentrations in Greeks and Albanians

BACKGROUND

Vitamin A and E are required in physiological processes such as pregnancy and growth.

AIM

To evaluate retinol and alpha-tocopherol serum levels in Greek and Albanian mothers and in their newborns.

METHODS

Data concerned 1125 Greek and 898 Albanian mothers along with their newborns. Immediately after delivery, blood from the umbilical cord and from the mothers was collected into light-protected tubes. Retinol and alpha-tocopherol serum levels were measured with a reversed-phase HPLC method. A 60-d dietetic diary was kept by each woman during the last 2 mo of pregnancy.

RESULTS

Retinol (1.3 +/- 0.1 micromol/l) and alpha-tocopherol (32.9 +/- 9.5 micromol/l) levels were estimated to be normal in Greek mothers and in most of their offspring (0.9 +/- 0.1 and 18.5 +/- 3.4 micromol/l, respectively). In contrast, in Albanian mothers, retinol concentration was found to be low (0.6 +/- 0.1 micromol/l), and in 1/3 significantly low (<0.45 micromol/l). Consequently, the vitamin was evaluated to be very low in their newborns (0.4 +/- 0.1 micromol/l), and in 1/2 extremely low. However, in 12% of the Albanian cord blood samples, retinol level was determined to be higher as compared with that of their mothers. alpha-Tocopherol was evaluated to be normal in most of the immigrant mothers (20.0 +/- 8.8 micromol/l) and low (<7.5 micromol/l) in 15% of their newborns. Vitamin A intake was found to be extremely low and vitamin E low (p < 0.05) in the Albanians.

CONCLUSIONS

(a) The decreased vitamin A and vitamin E intake, and their low blood status in the Albanian mothers and in their newborns, could be due to their low socio-economic and nutritional status. (b) Immigrant Albanians, during their pregnancy, and their newborns should be "followed up", being at risk of developing symptoms from the very low levels of these lipid-soluble vitamins.

Hormonal therapy with letrozole for relapsed epithelial ovarian cancer. Long-term results of a phase II study

OBJECTIVE

We conducted a phase II trial to evaluate the activity of oral letrozole in women with relapsed or recurrent epithelial ovarian cancer.

METHODS

Twenty-seven patients were treated with letrozole at a dose of 2.5 mg once a day. Patients with measurable or evaluable disease (n = 21) and those with only increasing CA 125 serum levels (n = 6) were eligible. Paraffin-fixed histological sections from tumor specimens resected at the initial laparotomy were assessed for the presence of estrogen, and progesterone receptors.

RESULTS

Among the 21 patients with measurable or evaluable disease who were evaluated for response by WHO criteria, we observed one complete and two partial responses for an objective response rate of 15%. Using criteria for CA 125 response we obtained a marker response in 4 of 27 patients (15%), and the marker remained stable in 5 additional patients (18%). Letrozole treatment was generally well tolerated. No correlation was observed between tumor marker response or stabilization and either estrogen or progesterone receptor expression.

CONCLUSION

The results of our study suggest that the aromatase inhibitor letrozole is an agent with some activity and limited toxicity for relapsed ovarian cancer. As we could not find any association between response and hormonal receptor expression, the underlying mechanisms of letrozole action have to be elucidated.

Vulvar intraepithelial neoplasia (VIN)--diagnostic and therapeutic challenges

PURPOSE

Vulvar intraepithelial neoplasia (VIN) represents a current diagnostic and therapeutic challenge. The present retrospective study is an institutional experience on the diagnosis and management of VIN.

METHODS

One hundred and thirteen women with VIN were reviewed and analyzed. Diagnosis was established by colposcopically directed biopsies whereas treatment was performed by either a surgical or a laser CO2 approach.

RESULTS

The mean age of all VIN patients was 47.4 years. The most common symptom was pruritus (60.1%). The majority of the lesions were multifocal (N = 64, 56.6%) and located in the non-hairy part of the vulva (87.6%). VIN management consisted of laser CO2 treatment in 51 patients (45.1%), surgical treatment in 37 (32.7%) whereas 25 VIN, cases were managed by conventional medical treatment. The risk of disease relapse was not associated with VIN grade (p = 0.35) nor with the treatment modality used (p = 0.42). The risk of disease relapse was significantly higher for multifocal lesions (p < 0.001). Long-term follow-up of our patients showed that four patients (3.5%) developed an invasive vulvar carcinoma.

CONCLUSION

Our study confirms other reports concerning the diagnostic and treatment difficulties of the management of VIN. Although the benefits of treatment are obvious there seems to be no guarantee that invasion will not occur.

Intravenous leiomyomatosis

INTRODUCTION

Intravenous leiomyomatosis (IVL) is rare and it is characterized by intravascular nodular masses of histologically benign smooth muscle that may extend variable distances. Although histologically benign, IVL might be malignant in its mode of behavior.

CASE REPORT AND DISCUSSION

A case of IVL is reported with emphasis on immunohistochemical analysis and recent literature.

Management of ureteric injuries during gynecological operations: 10 years experience

OBJECTIVE(S)

To present our 10 years experience in the management of ureteric injuries occurring during gynecological surgery.

STUDY DESIGN

Seventy-six patients had a variety of injuries. In 29 cases, the ureteric damage was diagnosed intraoperatively. Management of early-diagnosed injuries included suturing, ligature removal, end-to-end anastomosis, and reimplantation of the ureter. In 47 cases, the injury was diagnosed postoperatively. Ureteric catheterization was attempted in all cases presenting with obstruction. Catheterization failures were managed with ureterolysis, and reimplantation. Small ureteric fistula were managed with catheterization, and large communications with reimplantation. Two cases with urinomas were treated with surgical evacuation and anastomoses.

RESULTS

Management of early-diagnosed injuries was relatively easy in most cases. Postoperatively-diagnosed injuries were more difficult to treat. Catheterization failed in 28/44 (65.9%) ureters and surgical re-exploration was necessary. Long-term morbidity was minimal and no relapses occurred.

CONCLUSION(S)

Early recognition of a ureteric injury is the key to a complications-free repair. Unrecognized injuries cause prolonged morbidity, and their management can be difficult. Treatment of these injuries by experienced teams may minimize long-term consequences.

Cervical intraepithelial neoplasia in the young female. Diagnosis and management

The prevalence of HPV and CIN in young women has increased in recent years. During a 5-year period (1996-2000), 78 sexually active young females, aged 15-20 years, were referred to the Colposcopic Unit of the 1st Department of Obstetrics and Gynecology of the University of Athens in the major University-appointed hospital in Greece, because of an abnormal cytology or a suspicious cervical abnormality in the presence of negative cytology. Colposcopic examinations were found to be within normal limits in 12/78 (15.4%) of cases. Cervical pathology was related in 22 cases (28.2%) to HPV infection, 23 (29.5%) cases to CIN 1, 18 (23.1%) cases to CIN II and 3 (3.8%) to CIN III. No relation between oral contraceptive use and cigarette smoking with HPV infection was found. Our findings strongly confirm the necessity of obtaining cervicovaginal smears on all sexually active gynecologic and obstetric teenage patients.

Ovarian tumors in young females. A laparoscopic approach

Ovarian tumors are one of the major preoccupations in the everyday practice of gynecology. During the period January 1997 through December 2000, 54 cases of ovarian tumors in young females aged 14-20 years were diagnosed and managed laparoscopically in our institution. Twenty-two cases of mature cystic teratoma, 12 cases of endometriosis, eight cases of serous cystadenoma, five cases of mucinous cystadenoma, three cases of fibroma-thecoma, two cases of serous low-malignant tumors and one case of mucinous low-malignant tumor were found. The management of ovarian tumors during this age by laparoscopic techniques represents an efficient and safe procedure.

Gene analysis of the N-terminal region of the estrogen receptor alpha in preeclampsia

Alterations in the NH(2)-terminal region of the estrogen receptor alpha (ERalpha) gene expressed in placental bed tissue may be implicated in the development of preeclampsia, the pathogenesis of which involves the spiral arteries. Therefore, mutations and polymorphisms on exons 1 and 2 of the gene encoding ERalpha were studied. Placental bed biopsies were taken from 20 healthy, normotensive pregnant women and 16 preeclamptic patients. DNA was extracted from the tissue and exon 1 and exon 2 were amplified by PCR prior to denaturing gradient gel electrophoresis analysis or to single stranded conformational polymorphism analysis. In exon 1, a codon 10 polymorphism, either homozygous for the wild type gene, homozygous for the mutant type gene, or heterozygous, was revealed in both patients and healthy individuals. A codon 87 polymorphism, homozygous for the wild type gene, was detected in both groups. No mutations or polymorphisms were found in exon 2. The allele distribution for either codon 10 or 87 between patients and healthy individuals showed no significant differences. In conclusion, genetic alterations in the NH(2)-terminal region of the ERalpha molecule are not correlated with preeclampsia.

A novel HLA allele, B*4104, identified in a cord blood donor

Results from a number of HLA typing methods prompted the DNA sequencing (SBT) of a cord blood sample at the HLA-B locus. A novel HLA-B allele, B*4104, was identified. This was confirmed by sequencing the mother of the cord blood unit for HLA-B.

Squamous vulvar cancer: a clinically based individualization of treatment

OBJECTIVE

The aim of the study was to evaluate treatment results in 211 patients with previously untreated squamous cell vulvar cancer who were primary managed by surgery at the Gynecologic Oncology Unit of Alexandra Hospital, in terms of en bloc radical vulvectomy (N = 105), modified radical vulvectomy with three different incisions technique (N = 60), and radical hemivulvectomy (N = 46) with inguinofemoral lymphadenectomy.

METHODS

The surgical stage of disease, nodal status, lesion location and focality, marginal status, tumor size, physical and performance status, surgical modality used, and finally complications and recurrence rates were the analyzed factors for both survival and disease remission.

RESULTS

The overall 5-year survival was 70.1%. The 5-year survival for node-positive patients was 53.8% versus 79.7% for node-negative patients. Unifocal lesions had a 5-year survival of 76% compared with 50% of multifocal lesions. Posterolateral lesions had a better 5-year survival than that of anterior central lesions (79.5% vs 54. 4%). The marginal status of the surgical specimen was a significant predictor of both survival and recurrence. There was a significant difference in complications related to the en bloc radical vulvectomy in terms of wound breakdown, infection, and wound cellulitis.

CONCLUSIONS

Modified radical procedures are equally effective with the en bloc radical vulvectomy for the management of early (stage I/II) vulvar cancer. In advanced disease concervative surgery in an individualized approach could also effectively be applied.

Nanoscopic-confinement effects on local dynamics

The segmental dynamics of 1.5-2.0 nm polymer films confined between parallel solid surfaces is investigated with dielectric spectroscopy in polymer/silicate intercalated nanocomposites. The confinement effect is evident by the observation of a mode, much faster than the bulk-polymer alpha relaxation and exhibiting much weaker temperature dependence. This is discussed in relation to either the interlayer spacing restricting the cooperative volume of the alpha relaxation or to the dominance of the more mobile interphase regions as predicted by simulations; the data qualitatively support the former.

Predictive values of CA 125 antigen levels and CT scan in second-look procedures for ovarian cancer

23 patients with ovarian cancer were investigated 10 days after their last regimen of chemotherapy by CT scan and CA 125 in comparison with 'second-look' findings. In 17 out of 23 cases the CT scan results correlated with the operative ones. There were 6 false-negative findings but no false-positives. In all cases serum CA 125 levels correlated with the second-look operation. Our data suggest that the upper limit of CA 125, especially for patients, with negative findings, is less than or equal to 20 U/ml which is much lower than that of 35 U/ml, which is generally accepted. They also indicate the value of CA 125 in the detection of persistent ovarian cancer and the value of the CT scan in the detection of liver metastases. According to the above findings we question the value of the second-look operation in certain cases of ovarian cancer.

The treatment of gynaecological and intra-abdominal infections: a comparative study of cefotetan versus netilmicin plus clindamycin

In a prospective randomised study 60 patients with gynaecological or intra-abdominal infections were given either 2g iv every 12 hours of cefotetan or a combination of netilmicin (150mg iv every 12 hours) and clindamycin (600mg iv every 8 hours). The clinical condition of nearly half the patients (26 of 60) was characterized as serious and surgical manipulation and drainage were performed in 57 of the 60 patients. The clinical response was similar in both groups with 21 of 29 patients in the cefotetan group and 29 of 33 patients in the netilmicin plus clindamycin group. Side effects were few and mild in nature with no significant differences between the two groups. This work is continuing but the results to date suggest that cefotetan monotherapy is a safe and effective alternative to a combination of netilmicin and clindamycin in the treatment of gynaecological and intra-abdominal infections.