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Zisi M, Zygouris D, Tsonis O, Papadimitriou S, George M, Kalantaridou S, Paschopoulos M. Uterine sparing management in patients with endometrial cancer: a narrative literature review. J OBSTET GYNAECOL 2022; 42:823-829. [PMID: 34989284 DOI: 10.1080/01443615.2021.2006164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Endometrial cancer is the most common malignancy of the female genital tract. Approximately 25% of cases occur in premenopausal women, and up to 5% of cases occur in women who are younger than 40 years old. The survival rate in these cases is 99%; therefore, uterine-sparing management could be considered under strict criteria selection and the strong desire of the woman to preserve uterus and fertility. Diagnosis should be performed after a hysteroscopic biopsy instead of dilatation and curettage. The highest remission rate was achieved after combining a hysteroscopic resection with hormonal therapy compared to single hormonal treatment. The most common regiments are the following progestins: megestrol acetate (MA) and medroxyprogesterone acetate (MPA) taken orally with a daily dosage of 160 mg-320 mg for MA and 250 mg-600 mg for MP. Evaluations at three and six months could be performed by office endometrial biopsy and/or hysteroscopic directed biopsy especially in the presence of levonorgestrel intrauterine system, and in cases of remission, either a pregnancy attempt or maintenance therapy should be considered. After childbearing, hysterectomy with bilateral salpingo-oophorectomy is recommended, whereas ovarian preservation could be considered depending on the patient's age and whether they fulfil the strict criteria selection.
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Affiliation(s)
- Maria Zisi
- Department of Obstetrics and Gynecology, Medical School, University of Ioannina, Ioannina, Greece
| | - Dimitrios Zygouris
- Department of Obstetrics and Gynecology, Medical School, University of Ioannina, Ioannina, Greece
| | - Orestis Tsonis
- Department of Obstetrics and Gynecology, Medical School, University of Ioannina, Ioannina, Greece
| | | | - Mastorakos George
- Endocrinology Unit, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens Medical School, Aretaieio Hospital, Athens, Greece
| | - Sophia Kalantaridou
- 3rd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens Medical School, Attikon Hospital, Athens, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynecology, Medical School, University of Ioannina, Ioannina, Greece
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2
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Vrachnis N, Argyridis S, Vrachnis D, Antonakopoulos N, Valsamakis G, Iavazzo C, Zygouris D, Salakos N, Rodolakis A, Vlahos N, Mastorakos G, Drakakis P, Iliodromiti Z. Increased Fibroblast Growth Factor 21 (FGF21) Concentration in Early Second Trimester Amniotic Fluid and Its Association with Fetal Growth. Metabolites 2021; 11:metabo11090581. [PMID: 34564397 PMCID: PMC8470231 DOI: 10.3390/metabo11090581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Abstract
Altered fetal growth, either reduced or exacerbated, is associated with adverse perinatal outcomes. The underlying pathogenetic mechanisms of altered growth remain unclear. Fibroblast growth factor 21 (FGF21) and insulin are both considered to be major regulators of tissue growth and metabolism. The aim of our study was to investigate the association of second trimester amniotic fluid FGF21 and insulin concentrations with fetal growth. The amniotic fluid concentrations of FGF21 and insulin were determined in 80 cases of different fetal growth patterns (SGA—small for gestational age, LGA—large for gestational age, and AGA—appropriate for gestational age fetuses). Both peptides were found to be increased in cases of abnormal fetal growth, reduced growth velocity (SGA), or macrosomia (LGA). Specifically, FGF21 was significantly increased, as higher FGF21 levels were observed in the amniotic fluid of SGA and LGA fetuses compared with AGA fetuses (p < 0.05). Furthermore, the more severe the fetal smallness, the higher the FGF21 levels (p < 0.05). Similarly, higher insulin levels were noted in the amniotic fluid of SGA and LGA fetuses compared with those in AGA fetuses, though this was not statistically significant (p > 0.05). Again, the more severe the reduced fetal growth, the higher the insulin levels.
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Affiliation(s)
- Nikolaos Vrachnis
- Third Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Attikon Hospital, 12462 Athens, Greece; (N.A.); (D.Z.); (P.D.)
- Vascular Biology, Molecular and Clinical Sciences Research Institute, St George’s University of London, London SW17 0RE, UK
- Correspondence: ; Tel.: +30-697-4441-144
| | - Savvas Argyridis
- Department of Obstetrics and Gynecology, Archbishop Makarios III Hospital, Nicosia 2029, Cyprus;
| | - Dionysios Vrachnis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Alexandra Hospital, 11526 Athens, Greece;
| | - Nikolaos Antonakopoulos
- Third Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Attikon Hospital, 12462 Athens, Greece; (N.A.); (D.Z.); (P.D.)
| | - Georgios Valsamakis
- Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (G.V.); (N.S.); (N.V.)
| | - Christos Iavazzo
- Department of Gynecological Oncology, Metaxa Cancer Hospital, 18537 Piraeus, Greece;
| | - Dimitrios Zygouris
- Third Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Attikon Hospital, 12462 Athens, Greece; (N.A.); (D.Z.); (P.D.)
| | - Nikolaos Salakos
- Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (G.V.); (N.S.); (N.V.)
| | - Alexandros Rodolakis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens Medical School, Alexandra Hospital, 11526 Athens, Greece;
| | - Nikolaos Vlahos
- Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (G.V.); (N.S.); (N.V.)
| | - George Mastorakos
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens Medical School, Aretaieio Hospital, 11526 Athens, Greece;
| | - Peter Drakakis
- Third Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Attikon Hospital, 12462 Athens, Greece; (N.A.); (D.Z.); (P.D.)
| | - Zoi Iliodromiti
- Neonatal Department, National and Kapodistrian University of Athens Medical School, Aretaieio Hospital, 11526 Athens, Greece;
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Vrachnis N, Papoulidis I, Vrachnis D, Siomou E, Antonakopoulos N, Oikonomou S, Zygouris D, Loukas N, Iliodromiti Z, Pavlidou E, Thomaidis L, Manolakos E. Partial deletion of chromosome 6p causing developmental delay and mild dysmorphisms in a child: molecular and developmental investigation and literature search. Mol Cytogenet 2021; 14:39. [PMID: 34303382 PMCID: PMC8310580 DOI: 10.1186/s13039-021-00557-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 07/06/2021] [Indexed: 11/28/2022] Open
Abstract
Background The interstitial 6p22.3 deletions concern rare chromosomal events affecting numerous aspects of both physical and mental development. The syndrome is characterized by partial deletion of chromosome 6, which may arise in a number of ways. Case presentation We report a 2.8-year old boy presenting with developmental delay and mild dysmorphisms. High-resolution oligonucleotide microarray analysis revealed with high precision a 2.5 Mb interstitial 6p deletion in the 6p22.3 region which encompasses 13 genes. Conclusions Identification and in-depth analysis of cases presenting with mild features of the syndrome will sharpen our understanding of the genetic spectrum of the 6p22.3 deletion.
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Affiliation(s)
- Nikolaos Vrachnis
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Medical School, Attikon Hospital, Athens, GR, Greece. .,Research Centre in Obstetrics and Gynecology, HSOGE, Athens, Greece. .,Vascular Biology, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
| | - Ioannis Papoulidis
- Access To Genome P.C., Clinical Laboratory Genetics, Athens-Thessaloniki, Greece
| | - Dionysios Vrachnis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School, Alexandra Hospital, Athens, Greece
| | - Elisavet Siomou
- Access To Genome P.C., Clinical Laboratory Genetics, Athens-Thessaloniki, Greece
| | - Nikolaos Antonakopoulos
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Medical School, Attikon Hospital, Athens, GR, Greece.,Research Centre in Obstetrics and Gynecology, HSOGE, Athens, Greece
| | - Stavroula Oikonomou
- Second Department of Pediatrics, Aglaia Kyriakou Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | | | - Nikolaos Loukas
- Department of Gynecology, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, National and Kapodistrian University of Athens Medical School, Aretaieio Hospital, Athens, Greece
| | - Efterpi Pavlidou
- Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki, Greece
| | - Loretta Thomaidis
- Second Department of Pediatrics, Aglaia Kyriakou Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil Manolakos
- Access To Genome P.C., Clinical Laboratory Genetics, Athens-Thessaloniki, Greece
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Vrachnis N, Zygouris D, Vrachnis D, Roussos N, Loukas N, Antonakopoulos N, Paltoglou G, Barbounaki S, Valsamakis G, Iliodromiti Z. Perinatal Inflammation: Could Partial Blocking of Cell Adhesion Molecule Function Be a Solution? Children (Basel) 2021; 8:children8050380. [PMID: 34065912 PMCID: PMC8150343 DOI: 10.3390/children8050380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 11/16/2022]
Abstract
In spite of the great advances made in recent years in prenatal and perinatal medicine, inflammation can still frequently result in injury to vital organs and often constitutes a major cause of morbidity. It is today well established that in neonates—though vulnerability to infection among neonates is triggered by functional impairments in leukocyte adhesion—the decreased expression of cell adhesion molecules also decreases the inflammatory response. It is also clear that the cell adhesion molecules, namely, the integrins, selectins, and the immunoglobulin (Ig) gene super family, all play a crucial role in the inflammatory cascade. Thus, by consolidating our knowledge concerning the actions of these vital cell adhesion molecules during the prenatal period as well as regarding the genetic deficiencies of these molecules, notably leukocyte adhesion deficiency (LAD) I, II, and III, which can provoke severe clinical symptoms throughout the first year of life, it is anticipated that intervention involving blocking the function of cell adhesion molecules in neonatal leukocytes has the potential to constitute an effective therapeutic approach for inflammation. A promising perspective is the potential use of antibody therapy in preterm and term infants with perinatal inflammation and infection focusing on cases in which LAD is involved, while a further important scientific advance related to this issue could be the combination of small peptides aimed at the inhibition of cellular adhesion.
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Affiliation(s)
- Nikolaos Vrachnis
- Third Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Attikon Hospital, 11526 Athens, Greece;
- Vascular Biology, Molecular and Clinical Sciences Research Institute, St George’s University of London, London SW17 0RE, UK
- Research Centre in Obstetrics and Gynecology, Hellenic Society of Obstetric and Gynecologic Emergency, 11526 Athens, Greece; (D.Z.); (N.R.)
- Correspondence: ; Tel.: +30-2107777442
| | - Dimitrios Zygouris
- Research Centre in Obstetrics and Gynecology, Hellenic Society of Obstetric and Gynecologic Emergency, 11526 Athens, Greece; (D.Z.); (N.R.)
| | - Dionysios Vrachnis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, 11526 Athens, Greece;
| | - Nikolaos Roussos
- Research Centre in Obstetrics and Gynecology, Hellenic Society of Obstetric and Gynecologic Emergency, 11526 Athens, Greece; (D.Z.); (N.R.)
| | - Nikolaos Loukas
- Department of Gynecology, General Hospital of Athens “G. Gennimatas”, 11527 Athens, Greece;
| | - Nikolaos Antonakopoulos
- Third Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Attikon Hospital, 11526 Athens, Greece;
| | - Georgios Paltoglou
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 11526 Athens, Greece; (G.P.); (G.V.)
| | | | - Georgios Valsamakis
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 11526 Athens, Greece; (G.P.); (G.V.)
| | - Zoi Iliodromiti
- Department of Neonatology, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece;
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Kavallaris A, Gkoutzioulis A, Zygouris D. Laparoscopic emergency cervicoisthmic cerclage in second trimester of pregnancy: A case series report. Eur J Obstet Gynecol Reprod Biol 2020; 256:184-188. [PMID: 33246203 DOI: 10.1016/j.ejogrb.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/24/2020] [Accepted: 11/05/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to evaluate the feasibility and safety of Laparoscopic emergency cervicoisthmic cerclage in second trimester of pregnancy. METHODS Between November 2015 and March 2019 5 patients underwent Laparoscopic emergency cervicoisthmic cerclage. All women had showed cervical insufficiency with dilation in the second trimester due to extensive conisation (3 patients) or re-conisation (2 patients) and failed transvaginal cerclage (5 patients) due to a short vaginal cervix. Patients' characteristics were obtained from hospital's medical record and we evaluated surgical data, intra, postoperative complications, and perinatal outcome. All operations were performed by the same surgeon. RESULTS The average operation time was 88 min (ranging from 80 to 95 minutes), the average estimated blood loss during the procedure was less than 100 mL and there were no perioperative or postoperative complications. The mean gestational age at surgery was 14.4 (ranging from 14.2 to 16) weeks. All women underwent an elective CS after 38 weeks of gestation. The overall pregnancy survival rate was 100 %, the mean gestational age at delivery was 38.1 weeks (ranging from 38.0 to 38.5 weeks) and the mean birth weight was 3190 g (g) (ranging from 2980 g to 3350 g). CONCLUSION Laparoscopic cervicoisthmic cerclage might be an alternative approach even in the early second trimester of pregnancy. Our study's success rates compare favourably to the laparotomy approach and the laparoscopic cervicoisthmic cerclage showed a relatively high success rate in women who are at risk of poor obstetric outcomes. Of course, the surgeon's experience and competence plays a key role and this approach should only be attempted in well-organized units.
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Affiliation(s)
- Andreas Kavallaris
- Department of Minimally Invasive Gynecology, St Luke's Hospital, Thessaloniki, Greece
| | - Antonios Gkoutzioulis
- Department of Minimally Invasive Gynecology, St Luke's Hospital, Thessaloniki, Greece
| | - Dimitrios Zygouris
- Department of Minimally Invasive Gynecology, St Luke's Hospital, Thessaloniki, Greece.
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Kavallaris A, Zygouris D. Laparoscopic sacrocolpopexy comparing polypropylene mesh with polyvinylidene fluoride mesh for pelvic organ prolapse: Technique description and long term outcomes. Neurourol Urodyn 2020; 39:2264-2271. [PMID: 32776608 DOI: 10.1002/nau.24480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 11/08/2022]
Abstract
AIM Our aim was to evaluate the feasibility and safety of laparoscopic sacrocolpopexy (LSCP) and compare the long-term outcomes and complication rates of polypropelene (PP) and polyvinylidene fluoride (PVDF), following up within a minimum of 12 months. METHODS This was a retrospective cohort study using patients who underwent LSCP for POP involving either PP or PVDF mesh between January 2011 and January 2018. RESULTS Our study focused on 172 women who underwent LSCP with mesh between January 2011 and January 2018. All procedures were successfully completed laparoscopically, and patients' baseline characteristics were not statistically different in the two groups. Between January 2011 and December 2014, we performed 82 cases of LSC, mainly using PP mesh. Over the last 5 years, since January 2015, we have used PVDF mesh for POP. CONCLUSIONS LSCP using PVDF mesh was found to provide excellent anatomical and functional outcomes after a median follow-up duration of 41 months, compared with the PP group, which had a median follow-up duration of 54 months. Mesh infection and erosion rates in the PP group were significantly higher than those in the PVDF group. Additionally, rates of vaginal pain and discomfort were significantly lower in the PVDF group when compared with the PP group.
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Affiliation(s)
- Andreas Kavallaris
- Department of Minimally Invasive Gynecology, St. Luke's Hospital, Thessaloniki, Greece.,Department of Gynecology and Obstetrics, Mother and Child Medical Center, Nikosia, Cyprus
| | - Dimitrios Zygouris
- Department of Minimally Invasive Gynecology, St. Luke's Hospital, Thessaloniki, Greece
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Vrachnis N, Dalakli E, Zygouris D, Vlachadis N, Salakos N, Botsis D, Kalantaridou S, Drakoulis N, Mastorakos G, Creatsas G, Deligeoroglou E, Iliodromiti Z. Altered Resistin Concentrations in Mid-trimester Amniotic Fluid of Fetuses With Trisomies 18 and 13: A Window onto the Pathophysiology of Trisomies 18 and 13. In Vivo 2019; 33:433-439. [PMID: 30804122 DOI: 10.21873/invivo.11491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIM The study aimed to examine whether resistin is present in second trimester amniotic fluid from pregnancies with trisomy 18 and 13 and evaluate its concentration in comparison with euploid pregnancies. PATIENTS AND METHODS The study included 37 women who underwent amniocentesis. Eleven fetuses had trisomy 18, 3 had trisomy 13, while 23 had a normal karyotype. RESULTS Resistin was detected in all cases. The mean level of resistin in trisomy 18 was statistically significantly lower compared to euploid controls. Resistin levels in all abnormal cases were below its median concentration in euploid controls. ROC analysis showed very good prognostic value for both trisomies. CONCLUSION Resistin is a constituent of mid-trimester amniotic fluid of pregnancies with trisomies 13 and 18, exhibiting lower levels than those in euploid fetuses. The reduced levels of resistin in amniotic fluid may be associated with early changes in metabolic pathways and immunoinflammatory responses.
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Affiliation(s)
- Nikolaos Vrachnis
- Third Department of Obstetrics and Gynecology, School of Medicine, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Erminia Dalakli
- Third Department of Obstetrics and Gynecology, School of Medicine, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Zygouris
- Third Department of Obstetrics and Gynecology, School of Medicine, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Vlachadis
- Second Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Nikolaos Salakos
- Second Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Dimitrios Botsis
- Second Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Sophia Kalantaridou
- Third Department of Obstetrics and Gynecology, School of Medicine, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Drakoulis
- Department of Pharmaceutical Technology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - George Mastorakos
- Unit of Endocrinology, Diabetes mellitus and Metabolism, Second Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - George Creatsas
- Second Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Efthymios Deligeoroglou
- Second Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Zoe Iliodromiti
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
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Vrachnis N, Vlachadis N, Dalakli E, Zygouris D, Papageorghiou A, Kalantaridou S, Deligeoroglou E, Iliodromiti Z. OC04: Alterations in mid-trimester amniotic fluid levels of resistin, leptin and tumor necrosis factor-a in pregnancies with trisomy 18 or 13 and euploid embryos. Ultrasound Obstet Gynecol 2018; 52:556. [PMID: 30284363 DOI: 10.1002/uog.19204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- N Vrachnis
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, School of Medicine, Aretaieio Hospital, Athens, Greece
- Unit of Gynecology, Obstetrics and Perinatal Medicine, Evgenideio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - N Vlachadis
- Unit of Gynecology, Obstetrics and Perinatal Medicine, Evgenideio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - E Dalakli
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, School of Medicine, Aretaieio Hospital, Athens, Greece
| | - D Zygouris
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, School of Medicine, Aretaieio Hospital, Athens, Greece
| | - A Papageorghiou
- Nuffield Department of Obstetrics and Gynecology, University of Oxford, Oxford, UK
| | - S Kalantaridou
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, School of Medicine, Aretaieio Hospital, Athens, Greece
| | - E Deligeoroglou
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, School of Medicine, Aretaieio Hospital, Athens, Greece
| | - Z Iliodromiti
- Neonatal Department, Aretaieio Hospital, National and Kapodistrian University of Athens, School of Medicine, Aretaieio Hospital, Athens, Greece
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Kavallaris A, Zygouris D, Dafopoulos A, Kalogiannidis I, Terzakis E. Nerve sparing radical hysterectomy in early stage cervical cancer. Latest developments and review of the literature. EUR J GYNAECOL ONCOL 2015; 36:5-9. [PMID: 25872326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Cervical cancer is the second most common malignancy of the female genital tract worldwide. Radical hysterectomy with pelvic lymphadenectomy exemplifies the treatment of choice for early stage disease, whereas even if it is performed by gynaecologist-oncologist, still has the drawback of significant postoperative morbidity, especially for urinary bladder function. Nerve-sparing radical hysterectomy (NSRH) is a technique in which the neural part of the cardinal ligament which encloses the inferior hypogastric plexus, as well as the bladder branch (distal part of the plexus), remains intact. By this way, the bladder's innervation is safe and its functional recovery is more rapid. There is sufficient data to support the feasibility of the technique via laparotomy and laparoscopy, as well as the effectiveness related to the postoperative bladder dysfunction compared to conventional radical hysterectomy. On the other hand, the evidence related to survival outcomes is weak and derives from non-randomized trials. However, the low rate of local relapses after NSRH in early stage disease (IA2-IB1) with tumor diameter less than two cm makes the procedure suitable for this group of patients. CONCLUSION According to the current evidence NSRH seems to be a suitable technique for gynaecologist-oncologist familiar with the method in early stage cervical cancer. It is a technique which improves significantly postoperative bladder recovery and the patients' quality of life (QoL), without compromising the oncological standard.
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Zygouris D, Pouliakis A, Margari N, Chrelias C, Terzakis E, Koureas N, Panayiotides I, Karakitsos P. Classification of endometrial lesions by nuclear morphometry features extracted from liquid-based cytology samples: a system based on logistic regression model. Anal Quant Cytopathol Histpathol 2014; 36:189-198. [PMID: 25291856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate the potential of a computerized system for the discrimination of benign from malignant endometrial nuclei and lesions. STUDY DESIGN A total of 228 histologically confirmed liquid-based cytological smears were collected: 117 within normal limits cases, 66 malignant cases, 37 hyperplasias without atypia, and 8 cases of hyperplasia with atypia. From each case we extracted nuclear morphometric features from about 100 nuclei using a custom image analysis system. Initially we performed feature selection, and subsequently we applied a logistic regression model that classified each nucleus as benign or malignant. Based on the results of the nucleus classification process, we constructed an algorithm to discriminate endometrium cases as benign or malignant. RESULTS The proposed system had an overall accuracy for the classification of endometrial nuclei equal to 83.02%, specificity of 85.09%, and sensitivity of 77.01%. For the case classification the overall accuracy was 92.98%, specificity was 92.86%, and sensitivity was 93.24%. CONCLUSION The proposed computerized system can be applied for the classification of endometrial nuclei and lesions as it outperformed the standard cytological diagnosis. This study highlights interesting diagnostic features of endometrial nuclear morphology, and the proposed method can be a useful tool in the everyday practice of the cytological laboratory.
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Vrachnis N, Zygouris D, Iliodromiti Z, Daniilidis A, Valsamakis G, Kalantaridou S. Probing the impact of sex steroids and menopause-related sex steroid deprivation on modulation of immune senescence. Maturitas 2014; 78:174-8. [PMID: 24852404 DOI: 10.1016/j.maturitas.2014.04.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 04/17/2014] [Accepted: 04/18/2014] [Indexed: 12/22/2022]
Abstract
Immune senescence denotes the general decline in immune system function, characterized by a reduced immune response and an increased inflammatory state. Menopause is a natural change in a women's life, the menopause-related low estrogen levels affecting many body functions, among them the immune system. Numerous human studies with menopausal women and animal models with surgically induced menopause show a clear impact of sex steroids in immune responses. Female superiority in vaccination response and predisposition to infections are eliminated after menopause, while during menopause inflammatory cytokines such as Tumor Necrosis Factor-α (TNF-α), Interleukins-1β, 6, 8 and 13 (IL-1β, IL-6, IL-8, IL-13) and Monocyte Chemoattractant Protein-1 (MCP-1) are increased, implying a molecular connection of sex steroid loss with immune senescence. Moreover, immune cells modify their number and function after the menopausal transition, this offering another explanation for immune senescence. Until now most of the existing studies have concluded that menopause plays an additional role to aging in immune senescence. While it is clear that we are as yet far from thoroughly understanding the molecular pathways connecting sex steroids and menopause with immune senescence, such knowledge is highly likely to enable future targeted interventions in treatment and prevention of age-related diseases in women.
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Affiliation(s)
- Nikolaos Vrachnis
- 2nd Department of Obstetrics and Gynecology, University of Athens Medical School, Aretaieio Hospital, Athens, Greece.
| | | | - Zoe Iliodromiti
- Department of Neonatology, University of Athens Medical School, Aretaieio Hospital, Athens, Greece
| | - Angelos Daniilidis
- Department of Obstetrics and Gynecology, University of Thessaloniki Medical School, Ippokrateio Hospital, Thessaloniki, Greece
| | - Georgios Valsamakis
- 2nd Department of Obstetrics and Gynecology, University of Athens Medical School, Aretaieio Hospital, Athens, Greece
| | - Sophia Kalantaridou
- Department of Obstetrics and Gynecology, University of Ioannina Medical School, Ioannina University Hospital, Ioannina, Greece
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Vrachnis N, Zygouris D, Kalantaridou S, Iliodromiti Z. Metabolism in pregnancy: a field for novel therapies. Nat Rev Endocrinol 2014; 10:310. [PMID: 24614260 DOI: 10.1038/nrendo.2013.234-c1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nikolaos Vrachnis
- 2nd Department of Obstetrics and Gynecology, University of Athens Medical School, 124B Vasilissis Sophias Avenue, Athens 11526, Greece
| | - Dimitrios Zygouris
- Hellenic Society of Obstetrics and Gynecology, 10 Alkaiou Street, Athens 11528, Greece
| | - Sophia Kalantaridou
- Department of Obstetrics and Gynecology, Room 220C, University of Ioannina Medical School, Panepistimiou Avenue, 45100 Ioannina, Greece
| | - Zoe Iliodromiti
- Department of Neonatology, University of Athens Medical School, Aretaieio Hospital, 2 Anninou Street, Zografou 15771, Athens, Greece
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Stathopoulou V, Koliopoulos G, Zygouris D, Pappas A, Spathis A, Karakitsos P, Kassanos D, Chrelias C. The diagnostic accuracy of E6 & 7 mRNA detection as a primary screening test for the detection of severe cervical lesions. J BUON 2014; 19:490-496. [PMID: 24965411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE This prospective accuracy study aimed to assess the diagnostic accuracy of nucleic acid sequence amplification (NASBA) and flow cytometry for E6/7 human papillomavirus (HPV) mRNA detection as a primary screening test compared to cytology in the triage of severe cervical intraepithelial neoplasia (CIN) lesions. METHODS 1083 women referred to our outpatient gynecology clinics for a routine Pap test were recruited. Residual material of the Pap smears was tested by NASBA and by flow cytometry for E6/7 mRNA expression. Biopsy results were used as reference standards. The accuracy indices of both techniques and of NASBA type-16 HPV were assessed for the detection of CIN2+ lesions and were compared to cytology. RESULTS An increased lesion severity was associated with increased positivity rates of both NASBA and flow cytometry tests (x(2), p<0.001). A positive correlation between NASBA and flow cytometry was identified when these methods were examined with the Phi coefficient (value 0.369, 95% confidence interval [95%CI] : 0.307-0.426). Furthermore, NASBA (89.7 vs 57.7%, p<0.0005) and flow cytometry (77.3 vs 57.7%, p<0.0005) exhibited higher specificity rates than cytology. However, their sensitivity rates did not exceed those of cytology (NASBA:69.8 vs 84.6%, p=0.051; flow cytometry: 69.12 vs 84.6%, p=0.043). CONCLUSIONS Both NASBA and flow cytometry exhibited increased specificity for the triage of CIN2+ lesions. However, their relatively lower sensitivity and higher positivity rates when compared to cytology do not make them ideal for a primary screening test. Hence, the role of mRNA detection in the screening for severe cervical lesions remains to be clarified.
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Affiliation(s)
- Vasiliki Stathopoulou
- 3rd Department of Obstetrics and Gynecology, University of Athens Medical School, "Attikon" University Hospital, Chaidari, Athens, Greece
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Affiliation(s)
- Nikolaos Vrachnis
- Second Department of Obstetrics and Gynecology, University of Athens Medical School, Athens, Greece
| | - Dimitrios Zygouris
- Third Department of Obstetrics and Gynecology, University of Athens Medical School, Athens, Greece
| | - Zoe Iliodromiti
- Second Department of Obstetrics and Gynecology, University of Athens Medical School, Athens, Greece
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Grigoriadis C, Androutsopoulos G, Zygouris D, Arnogiannaki N, Terzakis E. Uterine angioleiomyoma causing severe abnormal uterine bleeding. CLIN EXP OBSTET GYN 2014. [DOI: 10.12891/ceog16122014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Grigoriadis C, Androutsopoulos G, Zygouris D, Arnogiannaki N, Terzakis E. Uterine angioleiomyoma causing severe abnormal uterine bleeding. CLIN EXP OBSTET GYN 2014; 41:102-104. [PMID: 24707699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Angioleiomyoma or angiomyoma or vascular leiomyoma is an unusual benign mesenchymal neoplasm. The authors present a rare case of large uterine angioleiomyoma causing severe abnormal uterine bleeding. CASE The patient, a 53-year-old, gravida 2, para 2, premenopausal Greek woman presented with a complaint of severe abnormal uterine bleeding. On gynecologic examination there was a palpable pelvic mass. Preoperative computer tomography (CT) of the abdomen and pelvis revealed an intra-abdominal mass 25 x 15 cm with abnormally increased vascularization. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, total omentectomy and elective pelvic lymph node dissection. Histopathology revealed uterine angioleiomyoma. Follow up 84 months after initial surgery showed no evidence of recurrence. CONCLUSION Despite the type of surgery, patients with uterine angioleiomyoma have very low risk of recurrence and excellent prognosis.
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Pouliakis A, Margari C, Margari N, Chrelias C, Zygouris D, Meristoudis C, Panayiotides I, Karakitsos P. Using classification and regression trees, liquid-based cytology and nuclear morphometry for the discrimination of endometrial lesions. Diagn Cytopathol 2013; 42:582-91. [DOI: 10.1002/dc.23077] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 10/29/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Abraham Pouliakis
- Department of Cytopathology; University of Athens; “ATTIKON” University Hospital; Athens Greece
| | | | - Niki Margari
- Department of Cytopathology; University of Athens; “ATTIKON” University Hospital; Athens Greece
| | - Charalampos Chrelias
- 3rd Department of Obstetrics and Gynecology; University of Athens; “ATTIKON” University Hospital; Athens Greece
| | - Dimitrios Zygouris
- 3rd Department of Obstetrics and Gynecology; University of Athens; “ATTIKON” University Hospital; Athens Greece
| | - Christos Meristoudis
- Department of Cytopathology; University of Athens; “ATTIKON” University Hospital; Athens Greece
| | - Ioannis Panayiotides
- 2nd Department of Pathology; University of Athens; “ATTIKON” University Hospital; Athens Greece
| | - Petros Karakitsos
- Department of Cytopathology; University of Athens; “ATTIKON” University Hospital; Athens Greece
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Iliodromiti Z, Zygouris D, Sifakis S, Pappa KI, Tsikouras P, Salakos N, Daniilidis A, Siristatidis C, Vrachnis N. Acute lung injury in preterm fetuses and neonates: mechanisms and molecular pathways. J Matern Fetal Neonatal Med 2013; 26:1696-704. [PMID: 23611524 DOI: 10.3109/14767058.2013.798284] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Acute lung injury (ALI) results in high morbidity and mortality among preterm neonates and efforts have therefore been devoted to both antenatal and postnatal prevention of the disease. ALI is the result of an inflammatory response which is triggered by a variety of different mechanisms. It mostly affects the fetal lung and, in particular, causes damage to the integrity of the lung's alveolar-capillary unit while weakening its cellular linings. Chemotactic activity and inflammatory products, such as proinflammatory cytokines TNF-α, IL-1, IL-6, IL-11, VEGF,TGF-α and TGF-β, provoke serious damage to the capillary endothelium and the alveolar epithelium, resulting in hyaline membrane formation and leakage of protein-rich edema fluid into the alveoli. Chorioamnionitis plays a major part in triggering fetal lung inflammation, while mechanical ventilation, the application of which is frequently necessary in preterm neonates, also causes ALI by inducing proinflammatory cytokines. Many different ventilation-strategies have been developed in order to reduce potential lung injury. Furthermore, tissue injury may occur as a result of injurious oxygen by-products (Reactive Oxygen Species, ROS), secondary to hyperoxia. Knowledge of the inflammatory pathways that connect intra-amniotic inflammation and ALI can lead to the formulation of novel interventional procedures. Future research should concentrate on the pathophysiology of ALI in preterm neonates and οn possible pharmaceutical interventions targeting prevention and/or resolution of ALI.
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Affiliation(s)
- Zoe Iliodromiti
- 2nd Department of Obstetrics and Gynecology, University of Athens Medical School, Aretaieio Hospital , Athens , Greece
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Kavallaris A, Zygouris D, Chalvatzas N, Terzakis E. Laparoscopic myomectomy of a giant myoma. CLIN EXP OBSTET GYN 2013; 40:178-180. [PMID: 23724541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We present the case of an infertile woman with a giant myoma which was laparoscopically removed. A 34-year-old patient was referred to our department with a large abdominal mass. Ultrasound revealed an 18 cm uterine myoma. Diagnostic laparoscopy showed a giant uterine myoma and with the help of a bent angle camera we started myoma enucleation. The myoma was totally enucleated and removed without disturbing the endometrial cavity. The uterine defect was closed with an absorbable suture in two layers. The myoma was removed using a PK (Gyrus) morcelator, without tissue or blood spillage in the abdomen. The operation time was 165 minutes and the myoma's weight was 1,200 g. The patient recovered uneventfully. Laparoscopic myomectomy can be an option even for giant myomas, with the condition of an expert surgeon and appropriate surgical instruments.
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Affiliation(s)
- A Kavallaris
- 4th Department of Gynecology and Obstetrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Zygouris D, Androutsopoulos G, Grigoriadis C, Terzakis E. The role of mini laparotomy in patients with uterine myomas. CLIN EXP OBSTET GYN 2013; 40:137-140. [PMID: 23724528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM The aim of this study was to evaluate the therapeutic effectiveness of myomectomy by mini laparotomy in patients with subserosal and/or intramural uterine myomas. MATERIALS AND METHODS Between January 2002 and December 2008, 83 women with symptomatic uterine myomas were referred to the Second Department of Gynecology of St. Savvas Anticancer--Oncologic Hospital of Athens. The study included women with subserosal and/or intramural uterine myomas with a maximum diameter of ten cm. All patients underwent myomectomy by mini laparotomy. RESULTS The median age of the patients was 36.8 years (range 19-43). The median number of the removed uterine myomas was 3.1 (range 1-12) and the median operative time was 98 minutes (range 47-170). All patients were mobilized within the first 24 hours and the median time of postoperative ileus was 1.6 days (range 1-3). The median hospital stay was 44 hours (range 30-120). There were no serious intraoperative or early postoperative complications. Conversion to laparotomy was performed only in four cases (4.82%), but none of the patients underwent emergency hysterectomy. During a mean follow up of 38 months, no recurrences of uterine myomas in the study population were observed. CONCLUSION Mini laparotomic myomectomy is a safe and effective minimally invasive method alternative to laparoscopic myomectomy for patients with subserosal and/or intramural uterine myomas.
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Affiliation(s)
- D Zygouris
- 2nd Department of Gynecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Grigoriadis C, Androutsopoulos G, Zygouris D, Arnogiannaki N, Terzakis E. Uterine malignant mixed Müllerian tumor after adjuvant tamoxifen treatment for breast cancer. EUR J GYNAECOL ONCOL 2013; 34:94-98. [PMID: 23590011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Uterine malignant mixed Müllerian tumor (MMMT), also known as carcinosarcoma, is a biphasic tumor of the female genital tract and demonstrates both malignant epithelial (carcinoma) and mesenchymal (sarcoma) components. The authors present two cases of uterine MMMT after adjuvant tamoxifen (TAM) treatment for breast cancer and a review of the current literature. CASES The patients presented with a complaint of abnormal uterine bleeding. They both had a history of breast cancer Stage IIB previously treated with modified radical mastectomy, at 51 and 78 months, respectively. They also had history of tamoxifen treatment 20 mg daily for seven and 73 months respectively. They underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and total omentectomy. Histopathology revealed a uterine MMMT. Postoperatively, they received adjuvant chemotherapy and radiotherapy. One of the patients died 26 months after initial surgery due to uterine MMMT. CONCLUSION Uterine MMMT is a rare, highly-aggressive, and rapidly-progressing tumor associated with a poor prognosis. Postmenopausal patients, with prolonged adjuvant TAM treatment for breast cancer, are at increased risk for the development of uterine MMMT.
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Affiliation(s)
- C Grigoriadis
- 2nd Department of Gynecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Zygouris D, Kotsopoulos IC, Chalvatzas N, Maltaris T, Kartsiounis V, Kavallaris A. Laparoscopic para-aortic and pelvic lymphadenectomy and radical hysterectomy in a patient with cervical cancer, six months after primary chemoradiation. EUR J GYNAECOL ONCOL 2013; 34:484-486. [PMID: 24475590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Treatment of Stage IB-IIA cervical carcinoma is controversial. The choice to perform surgery or chemoradiation depends on the FIGO Stage, which does not include evaluation of lymph node involvement, although the prognosis of the patients depends on this evaluation. There is no method however, to safely evaluate preoperative lymph nodes metastasis, as both magnetic resonance imaging (MRI) and computed tomography (CT) have poor sensitivity and high specificity. As a result, inaccurate preoperative lymph node assessment can lead to suboptimal treatment. The authors report the case of a 42-year-old patient with cervical cancer Stage IB2, who was primary treated with chemoradiation. Although at the time of diagnosis no lymph node metastasis was detected, six months after treatment, an enlarged five-cm lymph node was found in the area of left iliac vein. The patient underwent laparoscopic pelvic and para-aortic lymphadenectomy and nerve sparing radical hysterectomy. Pathologic examination revealed one positive lymph node out of the 41 removed and no cancer cells in the uteral structures. There are cases of cervical cancer in which chemoradiation seems to be insufficient. Laparoscopic nerve-sparing radical hysterectomy can be the treatment in patients with lymph node metastasis after primary chemoradiation. It offers oncological safety combining the advantages of laparoscopy and the nerve-sparing technique. Furthermore, adjuvant chemotherapy or radiation can be initiated immediately, offering the best therapeutical choice in the authors' opinion.
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Affiliation(s)
- D Zygouris
- Second Department of Gynecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece.
| | - I C Kotsopoulos
- Department of Obstetrics and Gynecology, University of Patras, Medical School, Rion, Greece
| | - N Chalvatzas
- Department of Gynecologic Oncology, St. Loukas Hospital, Thessaloniki, Greece
| | - T Maltaris
- Department of Gynecologic Oncology, St. Loukas Hospital, Thessaloniki, Greece
| | - V Kartsiounis
- Department of Gynecologic Oncology, St. Loukas Hospital, Thessaloniki, Greece
| | - A Kavallaris
- Department of Gynecologic Oncology, St. Loukas Hospital, Thessaloniki, Greece
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Zygouris D, Androutsopoulos G, Grigoriadis C, Terzakis E. M281 LEEP EFFECTIVENESS IN GREEK PATIENTS WITH VAGINAL INTRAEPITHELIAL NEOPLASIA AND HISTORY OF CERVICAL CANCER. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61472-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Zygouris D, Grigoriadis C, Androutsopoulos G, Arnogiannaki N, Terzakis E. 202 SURGICAL TREATMENT OF POST MENOPAUSAL WOMEN DIAGNOSED WITH PELVIC ORGAN PROLAPSE AND STRESS URINARY INCONTINENCE: A 5 YEAR REVIEW. Maturitas 2012. [DOI: 10.1016/s0378-5122(12)70313-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zygouris D, Leontara V, Makris GM, Chrelias C, Trakakis E, Christodoulaki C, Panagopoulos P. Endometrioid ovarian cancer arising from an endometriotic cyst in a young patient. EUR J GYNAECOL ONCOL 2012; 33:324-325. [PMID: 22873112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To present a case of a young woman with ovarian endometrioid adenocarcinoma arising from an endometriotic cyst and review of the literature. CASE REPORT A 33-year-old woman, gravid 2, para 2 was admitted to our department with a 5 cm adnexal mass. Diagnostic laparoscopy was performed and pathological examination demonstrated an endometriotic cyst with an area of an ovarian endometrioid adenocarcinoma well differentiated, with no capsular invasion. One month after the operation the patient underwent MRI which revealed a 6 cm mass in the Douglas pouch. The multidisciplinary oncology council decided on exploratory laparotomy, which revealed no pathology. After that the multidisciplinary oncology council decided on adjuvant chemotherapy and the patient received four cycles of carboplatin/taxol. CONCLUSION It should always be considered that even when there are no risk factors for malignancy occurrence, a high index of suspicion is necessary and will help to prevent delay in the diagnosis of this rare neoplasm.
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Affiliation(s)
- D Zygouris
- 3rd Deptartment of Obstetrics & Gynaecology University of Athens, Greece
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Zygouris D, Androutsopoulos G, Grigoriadis C, Arnogiannaki N, Terzakis E. Primary ovarian leiomyosarcoma. EUR J GYNAECOL ONCOL 2012; 33:331-333. [PMID: 22873115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Primary ovarian leiomyosarcoma is an extremely rare subtype of ovarian sarcomas. It most commonly occurs in postmenopausal women and has unfavorable prognosis. CASE The patient, a 58-year-old postmenopausal woman, presented with a complaint of abdominal pain. Preoperative examination revealed an intraabdominal mass 25 x 17 x 14 cm in the right adnexa. She underwent bilateral salpingo-oophorectomy, total omentectomy, appendectomy and bilateral pelvic lymphadenectomy. The histopathology revealed leiomyosarcoma of the right ovary Stage Ia. She did not receive any postoperative adjuvant therapy. Follow-up 21 months after initial surgery, showed no evidence of recurrence. CONCLUSION Additional studies are needed to understand more about the nature, clinical behavior and treatment of this very rare tumor.
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Affiliation(s)
- D Zygouris
- 2nd Department of Gynaecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Grigoriadis C, Androutsopoulos G, Zygouris D, Arnogiannaki N, Terzakis E. Synchronous squamous cell carcinoma of the endometrium and endometrioid adenocarcinoma of the ovary. EUR J GYNAECOL ONCOL 2012; 33:666-668. [PMID: 23327069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Synchronous primary endometrial and ovarian cancers are relatively uncommon in general population. The etiology and pathogenesis of this phenomenon remains unclear. The authors' aim was to present a case of synchronous squamous cell carcinoma of the endometrium and endometrioid adenocarcinoma of the ovary and review current literature. CASE The patient, a 64-year-old, nulliparous postmenopausal Greek woman presented with a complaint of abdominal pain and abnormal uterine bleeding. Preoperative computer tomography (CT) of the abdomen and pelvis, and abdominal ultrasound (U/S) revealed an intra-abdominal three cm mass with solid components between the left ovary and small bowel. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH+BS), total omentectomy, pelvic and para-aortic lymph node dissection, and removal of the implant at the serosa of small bowel. Histopathology revealed Stage IA endometrial cancer squamous type and Stage IIIC ovarian cancer of endometrioid-type. Postoperatively the patient underwent adjuvant chemotherapy and radiotherapy. Follow-up of 22 months after initial surgery revealed no evidence of recurrence. CONCLUSION The reason for better median overall survival of patients with synchronous primary endometrial and ovarian cancers is not intuitively obvious. Perhaps favourable clinical outcome may be related with the detection of patients at early stage and low-grade disease with an indolent growth rate.
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Affiliation(s)
- C Grigoriadis
- Second Department of Gynaecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Derdelis G, Zygouris D, Grigoriadis C, Terzakis E. Conservative Management of Vulvar Cancer Stages I–II: Past and Future. J Gynecol Surg 2011. [DOI: 10.1089/gyn.2010.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Grigorios Derdelis
- Second Department of Gynecology, Anticancer Hospital of Athens “Agios Savvas”, Athens, Greece
| | - Dimitrios Zygouris
- Second Department of Gynecology, Anticancer Hospital of Athens “Agios Savvas”, Athens, Greece
| | - Charalampos Grigoriadis
- Second Department of Gynecology, Anticancer Hospital of Athens “Agios Savvas”, Athens, Greece
| | - Emmanouil Terzakis
- Second Department of Gynecology, Anticancer Hospital of Athens “Agios Savvas”, Athens, Greece
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Terzakis E, Androutsopoulos G, Zygouris D, Grigoriadis C, Arnogiannaki N. Loop electrosurgical excision procedure in Greek patients with vaginal intraepithelial neoplasia and history of cervical cancer. EUR J GYNAECOL ONCOL 2011; 32:530-533. [PMID: 22053668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The aim of our study was to evaluate the therapeutic effectiveness of loop electrosurgical excision procedure (LEEP) in Greek patients with vaginal intraepithelial neoplasia (VAIN) and history of cervical cancer. MATERIALS AND METHODS Between January 2002 and January 2009, eight women with histologically confirmed VAIN and history of cervical cancer were included in our study. For the LEEP procedure we used a high frequency Electrosurgery Unit with at least 80 W output. RESULTS Complete response rate, at 12 months of follow-up, was 75%. Recurrence rate, at 12 months of follow-up, was 25%. Complete response rate, at 24 months of follow up, was 62.5%. Recurrence rate, at 24 months of follow up, was 37.5%. CONCLUSION LEEP may constitute a valuable excisional method for the treatment of VAIN in cases with a history of cervical cancer. It provides an interpretable specimen of the whole lesion within a few minutes. It needs a short period of training and has low cost.
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Affiliation(s)
- E Terzakis
- 2nd Department of Gynaecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Arnogiannaki N, Grigoriadis C, Zygouris D, Terzakis E, Sebastiadou M, Tserkezoglou A. Proliferative Brenner tumor of the ovary. clinicopathological study of two cases and review of the literature. EUR J GYNAECOL ONCOL 2011; 32:576-578. [PMID: 22053680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Ovarian Brenner tumors are rare epithelial tumors that account for 1%-2% of all ovarian neoplasms. They can be subdivided into benign, borderline or proliferative, and malignant neoplasms. In the vast majority of cases, these lesions are benign. Tumors of borderline malignancy are less frequent and only about 1% of Brenner tumors are malignant. We present two cases of Brenner tumors with borderline malignancy which were treated in our Department together with a review of the literature. CASES A 50-year-old, gravida 1, para 1, patient was admitted for abnormal vaginal bleeding. Clinical examination, abdominal ultrasound (US), and computed tomography (CT) revealed a cystic multilobulated tumor of the right ovary with solid elements measuring 20 x 19 x 15 cm in diameter. In the other case a 70-year-old, gravida 2, para 2, patient presented with severe urinary difficulties. Palpation revealed a mobile abdominopelvic tumor 10 x 15 in diameter. US and CT exhibited a cystic tumor with multiple solid elements and calcifications of the left ovary. Both patients underwent exploratory laparotomy. Total abdominal hysterectomy with bilateral salpingo-oophorectomy and total omentectomy were performed in both cases, while pelvic lymphadenectomy was decided only in the second case. Histologically, in both cases the diagnosis confirmed borderline Brenner tumor. CONCLUSION Although Brenner tumors are rare and the majority of them are benign, the correct histological diagnosis at frozen section with identification of the small proportion of malignant tumors, allows the extent of the operation to be adapted if needed.
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Affiliation(s)
- N Arnogiannaki
- Department of Pathology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Terzakis E, Androutsopoulos G, Adonakis G, Zygouris D, Grigoriadis C, Decavalas G. Fallopian tube primary cancer: report of five cases and review of the literature. EUR J GYNAECOL ONCOL 2011; 32:95-98. [PMID: 21446336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The aim of this retrospective study was to analyze the clinical characteristics, management and prognosis of five patients with fallopian tube primary cancer (FTPC) who were diagnosed and treated in our departments. A review of the current literature is also presented. MATERIALS AND METHODS Between January 2000 and August 2009, five cases with histologically confirmed FTPC were diagnosed in our departments and were then evaluated retrospectively. All patients underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and total omentectomy. RESULTS We had two patients in Stage IA (40%), two patients in Stage IC (40%) and one patient in Stage IIIA (20%). All patients received adjuvant chemotherapy with platinum-based combinations and two of them received additional radiotherapy. CONCLUSION FTPC, compared with ovarian primary cancer (OPC), is more likely to present at an early stage and have an overall more favourable outcome. More extensive clinical research must be performed to have definite aetiologic, diagnostic and management modalities.
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Affiliation(s)
- E Terzakis
- Department of Gynaecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Arnogiannaki N, Grigoriadis C, Zygouris D, Androutsopoulos G, Derdelis G, Terzakis E. Primary ovarian non-Hodgkin's lymphoma. EUR J GYNAECOL ONCOL 2011; 32:441-442. [PMID: 21941973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Primary ovarian non Hodgkin's lymphoma (PONHL) is a very rare disease. We present a case of PONHL and review the literature. CASE The patient, a 24-year-old nulliparous Greek woman, presented with the complaint of abdominal pain. She underwent left salpingo-oophorectomy, multiple biopsies from the right ovary, total omentectomy, pelvic and paraortic lymphadenectomy, appendectomy and curettage. The histopathology revealed diffuse large B-cell non-Hodgkin's lymphoma of the left ovary. She underwent postoperative chemotherapy. She remains well without evidence of disease, 15 months after initial surgery. CONCLUSION The use of chemotherapy is based on the principle that PONHL must be considered a localized manifestation of systemic disease. Patients with PONHL have a similar outcome compared to patients with other NHL.
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Affiliation(s)
- N Arnogiannaki
- Department of Pathology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Terzakis E, Androutsopoulos G, Adonakis G, Zygouris D, Grigoriadis C, Decavalas G. Vaginal primary malignant melanoma: report of four cases and review of the literature. EUR J GYNAECOL ONCOL 2011; 32:122-124. [PMID: 21446344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The aim of this retrospective study was to analyse the clinical characteristics, management and prognosis of four patients with vaginal primary malignant melanoma (VPMM) who were diagnosed and treated in our departments together with a review of the current literature. MATERIALS AND METHODS Between January 1997 and September 2009, four cases with histologically confirmed VPMM were evaluated retrospectively. All patients underwent wide local excision. RESULTS One patient was in Stage I (25%), two patients in Stage II (50%) and one patient in Stage IV (25%). Among them, one patient received additional radiotherapy and three patients received additional immunotherapy with interferon. CONCLUSION The prognosis of VPMM is very poor, despite the treatment modality, because most cases are diagnosed at late stage.
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Affiliation(s)
- E Terzakis
- 2nd Department of Gynaecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Terzakis E, Androutsopoulos G, Zygouris D, Grigoriadis C, Derdelis G, Arnogiannaki N. Angiokeratoma of the vulva. EUR J GYNAECOL ONCOL 2011; 32:597-598. [PMID: 22053688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Angiokeratoma of the vulva is relatively uncommon in the general population. We present two cases of angiokeratoma of the vulva and review the literature. The two patients presented with the complaint of vulvar pruritus. They underwent wide local excision of the lesions. Histopathology revealed angiokeratoma of the vulva. The women remain well with no evidence of recurrence 48 and 32 months after initial surgery. Although it is a rare disease, angiokeratoma of the vulva should be included in the differential diagnosis of a vulvar tumor.
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Affiliation(s)
- E Terzakis
- 2nd Department of Gynaecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Terzakis E, Androutsopoulos G, Derdelis G, Zygouris D, Grigoriadis C, Apostolikas N. Loop electrosurgical excision procedure in Greek patients with vulvar intraepithelial neoplasia. EUR J GYNAECOL ONCOL 2010; 31:191-193. [PMID: 20527238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The aim of our study was to evaluate the therapeutic effectiveness of loop electrosurgical excision procedure (LEEP) in Greek patients with vulvar intraepithelial neoplasia (VIN). MATERIALS AND METHODS Between January 2002 and January 2009, 55 women with histologically confirmed VIN usual type were included in our study. For the LEEP procedure we used a high frequency electrosurgical unit with at least 80 W output. The tissue was removed to the second surgical plane. Statistical analyses were performed using the SPSS-13 for Windows. RESULTS Complete response rate at 12-month follow-up was 100%. Complete response rate at 48 months of follow-up was 80%. Recurrence rate at 48 months of follow-up was 20%. CONCLUSION LEEP may constitute a valuable excisional method for the treatment of VIN. It provides an interpretable specimen of the whole lesion within a few minutes. It needs a short period of training and has low cost.
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Affiliation(s)
- E Terzakis
- 2nd Department of Gynaecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Terzakis E, Androutsopoulos G, Zygouris D, Grigoriadis C, Derdelis G, Arnogiannaki N. Loop electrosurgical excision procedure in Greek patients with vaginal intraepithelial neoplasia. EUR J GYNAECOL ONCOL 2010; 31:392-394. [PMID: 20882879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The aim of our study was to evaluate the therapeutic effectiveness of the loop electrosurgical excision procedure (LEEP) in Greek patients with vaginal intraepithelial neoplasia (VAIN). MATERIALS AND METHODS Between January 2002 and January 2009, 23 women with histologically confirmed VAIN were included in our study. For the LEEP procedure we used a high frequency electrosurgery unit with at least 80 W output. RESULTS Complete response rate at 12 months of follow-up was 86.96%. Recurrence rate at 12 months of follow-up was 13.04%. Complete response rate at 24 months of follow-up was 75%. Recurrence rate at 24 months of follow-up was 25%. CONCLUSION LEEP may constitute a valuable excisional method for the treatment of VAIN. It provides an interpretable specimen of the whole lesion within a few minutes. It needs a short period of training and has low cost.
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Affiliation(s)
- E Terzakis
- 2nd Department of Gynaecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Terzakis E, Androutsopoulos G, Grigoriadis C, Zygouris D, Derdelis G, Arnogiannaki N, Fragkakis G. Synchronous primary endometrial and fallopian tube cancers. EUR J GYNAECOL ONCOL 2010; 31:467-468. [PMID: 20882898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Synchronous primary cancers are relatively uncommon in the general population. We present a case of synchronous primary endometrial and fallopian tube cancers and review the literature. CASE The patient, a 54-year-old, gravida 2, para 2 postmenopausal Greek woman presented with a complaint of abnormal vaginal bleeding. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and total omentectomy. The histopathology revealed synchronous primary cancers of the endometrium and right fallopian tube. The patient underwent postoperative chemotherapy and postoperative radiotherapy. She remains well without evidence of disease, 65 months after initial surgery. CONCLUSION The reason for the better median overall survival of patients with synchronous primary endometrial and fallopian tube cancers is not intuitively obvious. Perhaps it is due to the detection of patients at earlier clinical stage and lower grade disease state.
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Affiliation(s)
- E Terzakis
- 2nd Department of Gynecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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